Wednesday, March 23, 2016

Fish Of Death

Or at least "Fish Of Extreme Pain".
Soon after I graduated I decided to try to develop a sideline in fish medicine as way to  make myself more useful to the practice. Or at least less useless. The sensible among you will immediately see the logical flaws in trying to get people to bring their pet fish into the clinic. There are several such flaws. But my employers, bless them, were indulgent and patient with me. To give myself some credit, I was nothing if not enthusiastic. I made sure I had the best text books and I set to work writing brochures on a variety of fish health subjects. And then I waited for patients... and waited...

Until one day the owner of a nearby pet shop came in carrying a large ice cream pail. I'll call her Carla because that's her name and because even on the very off chance that she'll read this I don't think she'd be at all fazed by an implicit accusation of attempted murder.
"What have you got in the bucket Carla?"
"A fish! Actually two of them."
Imagine my excitement. Just imagine it.
I strode over to Carla and her bucket. Not walked, but strode. I peered into the bucket. Two fish indeed: a large, roughly eggplant sized, colourful fish with bold orange and white stripes and long feather-like things sticking out all over it, and a small, roughly walnut sized, dull brown coloured fish. There were two really interesting things about this scene. The first was that the big fish was a lionfish. (More on why that's really interesting in a moment.) The second was that the little fish was head-first halfway into the lionfish's mouth.

"Carla, that's a lionfish!"
"Yes, it's really expensive and it's choking on that stupid catfish!"
Which fish was more stupid struck me as a debatable point.
"I see..."
"Can you get the catfish out?"

So this is where I should explain what's really interesting about lionfish. Those cool looking feathery things are actually sharp spines (easily sharp enough to slice exam gloves) and are covered in venom. The venom has an entertaining array of potential effects including, and I quote, "extreme pain, nausea, vomiting, fever, breathing difficulties, convulsions, dizziness, redness on the affected area, headache, numbness, paresthesia (pins and needles), heartburn, diarrhea, and sweating. Rarely, such stings can cause temporary paralysis of the limbs, heart failure, and even death". Well, only "rarely" death, so that's ok.

"Well, can you?"
The lionfish actually looked distressed. The catfish was presumably even more distressed, but it was hard to tell.
There was no way to grasp the lionfish without touching the venomous spines and the standard aquarium wrangler's net wouldn't help, so, after a bit of pondering I came up with an idea. I found two long pieces of wood - this was a while ago, so I don't remember exactly, but they might have been leftover molding from a reno - and a large pair of surgical forceps. I wielded the wood pieces with my left hand like giant chopsticks to restrain the lionfish while carefully submerging my right hand with the forceps to firmly grasp the tail of the catfish.
Deep breath.
Then I yanked.
The catfish was free! However, I am sad to report that it did not live to enjoy its freedom. The catfish immediately succumbed to its injuries, or to the shock of the whole unpleasant event.  But the lionfish survived. And I survived. A mortality rate of only 33%. Not bad for a novice fish vet.

But that was pretty much the end of my short-lived fish vet career.

Years later we were in the Cayman Islands and met a local with a boat full of lionfish. It turns out that they are an invasive and aggressive species that is decimating native fish populations. The government there was paying a bounty on them. And they are steadily spreading northwards...

Monday, March 14, 2016

Please Repeat That In English

Every veterinarian gets this from time to time. We have just finished painstakingly explaining a complex medical condition to a client and then, after a brief silence, the client says, "Please repeat that in English!".
We have failed to communicate clearly. We have used jargon or at least we have used words that didn't seem like jargon to us, but clearly seemed that way to the client.

Why does this happen? Three reasons:

1) When we are first starting in practice we sometimes use big words and convoluted explanations to demonstrate our knowledge and win the client's trust in our competence. I looked very young when I graduated in 1990. I got called Doogie Howser a lot (the reference itself tells you how long ago that was...). Consequently I tried to impress with Latin. Look, I really am a doctor! I don't do that anymore. I don't need to. Now I get called "the old guy". I'm undecided which is better...

2) We don't want to insult clients by "dumbing it down". In reality only crazy people are insulted and there is no pleasing them anyway. Most clients who prefer that you use more technical language will politely tell you so, and often be pleased that they have the opportunity to tell you so.

3) We have "The Curse of Knowledge". This is the big one and the hardest one to overcome. A Stanford University researcher conducted an experiment whereby she asked people to tap out the rhythm of a well known song, like Happy Birthday or Mary Had A Little Lamb, and then asked other people to guess what the song was based on the tapping. The tappers predicted that 50% of the time the listeners would guess correctly. In reality only 3% of the listeners did! The tappers had "The Curse of Knowledge". It was impossible for them not to hear the tune in their minds while tapping and it was almost as impossible for them to be able to imagine someone not hearing it. Once you know something it is very difficult to recreate the state of mind that exists when you do not know it.

So, veterinarians can no longer put themselves in the minds of people who don't know the difference between a colon and a duodenum, or between an antibiotic and an anti-inflammatory or, my favorite, between the abdomen and the stomach. We're not alone though. All professionals do this. Actually, all people with specialized knowledge do. Car mechanics and accountants are the worst in my experience.

What can we do about this? If we have certain regular spiels we should try them out on our unsuspecting family members or friends. And we should try to put ourselves in that unknowing frame of mind as often as possible. For my part, I am trying to learn to play the mountain dulcimer (yeah, yeah, whatever) and whenever my musical friends start talking about "the key of..." and "quarter tones" and whatnot they have The Curse of Knowledge and I feel like the drooling guy in the wool cap who delivers the fliers. This make me humble. This gives me empathy, and empathy is a key ingredient in effective communication.

I'll close with an illustrative anecdote. A few years ago an elderly lady came in with a little white fluffy dog. We'll call her Mrs. Winterbottom and the dog Priscilla. Mrs. Winterbottom was a very elegantly dressed woman with a lovely summer dress, matching shoes, matching handbag and even a matching hat. She spoke very properly and politely.
"Mrs. Winterbottom, we're going to need to run a fecal on Priscilla."
Blank look.
"I'd like to do a stool test."
Still blank.
"Um, so, do you think you can collect one of her... um... bowel movements?"
Dawning comprehension and a big smile.
"You mean bring her shit!"
I think I'll stick with "bowel movement".