Monday, 28 May 2012

Visiting Hours

Boil a vet's job down into it's very basic components and you're left with three parts; the elementary particles of veterinary life, if you like (incidentally, please don't boil a vet down into their basic components; you'll just end up with a nasty-smelling soup and an unhappy vet). These three fundamentals of the job are 'consults', 'ops' and 'visits'. I've talked about consulting and operating a few times before (here and here, for instance) but it's the last of the three that I'm going to talk about today. The dreaded visits.

(While I think about it, you could argue that there is a mysterious fourth particle, the OOH particle, representing out of hours (emergency) work - but I would suggest that instead all OOH is merely a dark mirror of the basic work; the veterinary equivalent of anti-matter - for every consult, there is an OOH consult. I'm getting a bit carried away with metaphor, aren't I? Must be the coffee).

So, visits are the part of the job where you leave the practice and visit your patient at their home. So...dreaded? Why dreaded? Why when a visit pops up on the board does that procedure you've been trying to avoid all day suddenly look a lot more attractive? (A visit? Oh, I'd love to, but, erm... well, I've got that constipated cat that I really need to clean out. Shame.)

Well, as with anything in life, there's pros and cons to visits. Let's do the cons first - I'm that type of person, you see.

(And I should point out at this stage that this blog is written from the perspective of a small animal vet; it can't help but be, because that's what I am. I'll just mention here that for a large animal vet (or the increasingly endangered 'mixed' vet) much of this doesn't apply, as their whole job consists of travelling from visit to visit, with brief trips back to the practice to scrape the worst of the cow shit off. Their visits are a little different though, as they are often to people that they already know and have visited many times before, and are often combined with some kind of surgical procedure (usually on the patient) and

First up - finding the place. People live in the craziest places - on top of hills, beside rivers, squeezed into the tiniest possible gaps on housing estates. Couple this with many people's complete inability to give directions to their own home, and you have a problem before you've even pressed the doorbell (I don't exclude myself from this group - never ask me directions to my house. I seem to notice landmarks that mean nothing to normal people. 'Go left after the tree that looks a bit like a pirate, and you'll come to a scary wood that would be a great setting for a ghost story...')

This isn't so bad if you're just heading out to clip a puppy's claws, but I have uncovered a hitherto unknown physical law, which states that the later the hour and the more urgent the call, the harder the clients house will be to find. Writing this, I can think of many stressful middle-of-the-night calls attempting to drive with an A-Z on my lap, swearing at the car, the map, my legs and life in general. Of course, now everybody has SatNavs, so complaining about this makes me sound as bad as someone moaning that there has been no good music made since 1994 (but seriously, have you heard what they're listening to nowadays?), but SatNavs are neither infallible nor particularly good at calming you down when you're stressed, so the problem still periodically raises it's head.

Secondly, people. I suspect that it won't be news to my readers if I suggest that people, although many of them can be caring, compassionate, big-hearted, generous, grateful and charitable, are, more often than not, just plain weird; and if they're weird when they're in the bank or doing their shopping, then that weirdness is likely to dramatically increase when they are safely back in their houses, away from the judging eyes of the rest of humanity (and if, incidentally, you don't understand what I'm getting at, then I'm afraid there's a fair chance that you're one of the people I'm talking about).

Partly this is a problem because you're out of your comfort zone on a visit, away from your safe consulting room where you know where the thermometer and hand wash is, and in a place where you don't know what the sticky patch on the floor is, or what that peculiar smell is, or just who that person is at the back who isn't saying anything, but just staring it you wearing only a towel. If I say that the village closest to my first practice had 'twinned with Royston Vasey' scrawled across it's welcoming road sign in black spray paint, you may understand why I've become slightly nervous of visits.

As well a people who are a little...well, different, there's people who are just plain unpleasant. I've been personally threatened with violence a couple of times on visits. Both times I had been called out to put an animal to sleep, and arrived to discover that some members of the family disagreed with that decision. Sadly, in both cases it was the members of the family with the largest fists and the shortest tempers.

That last point touches upon another problem with visits; what you're actually going out there to do. In most situations, people will bring their animals in to the practice, and visits usually only happen when people are housebound with no way of getting in to see us, or if the pet is of such a personality that it gets in far too much of a panic when it gets brought in - this often means that the animals we're off out to see are more skittish and possibly more aggressive than those we normally see in the practice, and we're going to see them with less manpower (usually just one vet, or one vet and a nurse), and we're invading their home territory to boot. Not really a recipe for fun.

The other situation you'll visit an animal at home, of course, is when it is the last visit they will ever receive. Some people choose to have their animals put to sleep at home, in familiar surroundings, so that they don't go through the stress of being taken in to the practice. Who can argue with that? It's what I'll do for my animals, too - but it does mean that a high proportion of home visits are euthanasia visits. The lack of manpower can cause a few problems here, too. I well remember a time, a few years into my career, when I visited an elderly woman who lived in a large house in a seaside village to put her great dane to sleep. It was a Sunday afternoon, and that meant that it was just me, no nurses. The procedure went smoothly (the poor dog was very, very ill) but then we were faced with something of a problem - although I am, of course, incredibly manly and strong, I couldn't lift an eighty kilogram dog by myself. The old woman was almost bent in two with back problems, but she didn't seem worried.

'Just a second,' she said, brightly. She opened the front door and hobbled out to a man who was passing by. 'Excuse me,' she said. 'Could we just have a hand lifting something?' The kind stranger agreed, and it was only when he walked into the living room that he realised exactly' what the 'something' was. Poor guy. He took it in his stride, though, only looking aghast for a few seconds before he helped me carry the dog. I often wonder what he told his family and friends about that day.

It was while I was working at the same practice when I received a call from a man asking me to visit him to put his canary to sleep. It was, of course, a Sunday afternoon again, and I was extremely busy, so I asked if there was any way he might be able to bring it in to the practice.

'I can't get near it,' he said, sounding nervous.

'Er...right. Is it somewhere you can't get to?' I asked, thinking it might have flown up into his loft or something.

'No, no, it's outside the front door, tied up, but he won't let me get past him. I can't even get to the car!'

The mental image of a massive bird, all wide-staring eyes and saliva-dripping from its beak viciously pecking anyone who dared to step near it confused me enough that it took me several minutes to understand that the man was actually talking about a presa canary - an enormous mastiff-type dog several rungs higher than the Hound of the Baskervilles on the 'violent bastard' ladder, and about as far from a gentle yellow bird as it is possible to get without watching a horror film. It turned out he'd bought it from his mate down the pub, and now it wouldn't let him leave the house. In the end we had to enlist the services of a vet with a blowgun, who darted it into unconsciousness so that the deed could be done.

I can also sadly remember the many times I have visited people to put their pets to sleep, and taken them back to the practice with me. There's something awful about taking someone's companion away with you, and leaving them alone in the house. I do always ask if someone is coming round to keep them company after I've gone, but the answer isn't always yes.

So, there's a lot of cons about home visits - but there's a few pros, too. It gets you out of the mania of the practice for a little while, and it's always nice to have a breather. Secondly, and principally, it gives you a chance to be nosey - the same kind of nosey as peeking into people's living rooms as you pass them by (I swear that's half the reason my wife rides horses; she gets a much better view from higher up, you see). I think this interest stems from the nagging feeling a lot of us have that we are the weird ones mentioned above; that there's something not quite normal about our own households, and other people do it differently. Well, we're right. After an extensive study of other households over the years, I can reassure you all that you're right; everyone is a bit strange, and weird is actually the normal state of affairs. It's the normal ones you've got to watch out for.

Well, that covers most things I wanted to say on the topic. In conclusion, I'd just like to add... sorry, just getting a message from the practice... what was that? A visit to do? Clip a canary's claws? Er... well, I'd love to, but I've got some impacted anal glands that really can't wait any longer...

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