Monday, September 26, 2016

Cat Goes Mad

While hiking in England a headline in a small town paper caught my eye: "COW BRUTALLY ATTACKS OAP". Yes, it was all caps. In fact, those four words were the only thing on the front page. (By the way, "OAP" means "old age pensioner". I had to look it up.) In any case it brought to mind a story my wife told me about a similarly startling headline in the Winnipeg Sun when she was growing up. Apparently the front page screamed, "CAT GOES MAD", accompanied by a picture of a suitably concerned looking elderly woman sitting on a couch festooned with doilies. And this got me thinking about rabies in cats. That's how that funky old train of thought sometimes goes. One minute you're thinking about oaps and the next you're thinking about feline rabies.

Rabid cats came so readily to mind because just prior to leaving for England I had a telephone conversation with a client about the subject. As I outlined in the last post I don't always have a minute-by-minute overview of my telephone messages. In fact an hour or more can easily go by before I see them. On this particular morning I opened the message center on my computer to find a series of increasingly frantic sounding messages from Mr. Stirling:
-Please call. Thinks Buttons has rabies.
-Urgent: Very concerned about his rabid cat.
-Called again!!
Intrigued, I called Mr. Stirling back.
"Hello, I understand you are worried that Buttons might have rabies?"
"Yes! She's not acting like herself at all!"
"How so? Can you describe what she is doing please?"
"Usually I keep the bedroom door closed at night, but two nights ago I left it open and she came into my room in the middle of the night."
"And then she jumped on me and sat there for a while. I woke up but I didn't move. Then she bit me!"
"Oh dear. Did she break the skin?"
"No. I guess it was more of a nibble than a bite."
"Hmm. Anything else?"
"Yes! Then last night she did the same thing, except without the bite. That time she just purred loudly."
This was beginning to shape up like a Monty Python sketch.

I have a great deal of faith in the shrewdness of my readership, so I'm confident you can more or less reconstruct my response and the rest of the conversation. No, Buttons did not have rabies. Buttons was bored and lonely and wanted to play. Mr. Stirling was relieved. He called back the next day to apologize for overreacting. There was no need to apologize. I would much rather people took rabies "too seriously" than not seriously enough, because that side of the coin is all too prevalent.

I am sometimes asked how many cases of rabies I have seen in my patients. The answer is zero. Shallow thinkers will take that as evidence that vaccination is not necessary. This is of course the wrong conclusion. The right conclusion is that it is evidence for the effectiveness of the vaccination program. Otherwise it's a bit like saying, "See my house has never burnt down so I can start letting the kids play with blowtorches." Countries without comprehensive rabies vaccination programs have shockingly high rates of the disease. 20,000 people die of rabies every year in India. Twenty thousand people die.
It is one of the ugliest deaths imaginable. And the number of animals dying of it must be an order of magnitude higher.

So please, if you are at all concerned that your cat or dog (or cow) has gone mad, please do not hesitate to call. We won't laugh. (Unless you use a Michael Palin voice.)

Wednesday, September 7, 2016

Why Hasn't The Doctor Called Me Back Yet!?!?

My father was dying of brain cancer. He had a glioblastoma removed from his left prefrontal cortex and was given months to live. He was a physicist and his intellectual capabilities were unimpaired but his judgment and social graces, such as they were, had been annihilated. Told by the surgeon that they removed the tumour using suction my father delighted in pointing to the large scar on his forehead and loudly telling strangers that his brain had been removed by a vacuum cleaner. There were other surprising moments of levity, but otherwise this was a bleak time. He was too young for this and we were not ready to lose him. Not nearly.

A few weeks after the surgery an issue arose regarding one of his medications. I don't recall which or why, but I do recall being quite anxious about it. It was not an emergency by any stretch, but the problem was beginning to spiral in our minds, so I phoned his oncologist to ask about it. He was unable to come to the phone, so his receptionist took a message. Ten minutes went by, then twenty, thirty, forty, fifty... By the time a full hour rolled around I had checked twice to make sure the phone was working (dial tone? yes) and my pacing had become obsessive. I couldn't read. I couldn't listen to music. I couldn't concentrate on chores. I couldn't think about anything except a recursive loop of 'Why hasn't he called me back yet!?!?'
'It would only take a minute!'
At the two hour mark my tone had darkened . I was much quicker to anger in those days.
'I can't effing believe this! He can't find a minute to help a dying man?'
'The arrogant prick!!'
I was beside myself. I left another message, trying to make my voice sound like cold steel, gleaming with sarcastic fury.
But at least another hour passed before he called. When he did his tone was disarmingly pleasant and empathetic. He took the time needed to properly answer my questions and the problem was sorted.

All these many years later I still cringe when I think of how I reacted that day. I cringe in part in recognition of the different person I was then and I cringe in part in imagining how my own clients must sometimes feel when I am slow returning their calls. I know that most people are reasonable and understanding, but I know that some must be just like I was - in a vulnerable and slightly irrational emotional state or perhaps even just unaware of the workflow in a busy clinical setting.

So for the latter group, it is probably worthwhile explaining the "type of busy" that we often are. In some jobs you can be very busy doing one thing. You have a single important task in front of you that is fully occupying your time, but you can take regular breaks from it to quickly address other matters as they arise. Veterinary (and presumably human medical) practice is not like that. We generally have numerous simultaneous demands on our attention throughout our entire shift. We are constantly in triage mode, figuring out in what order to do things so that the least number of people with urgent problems are left waiting the least amount of time. Moreover, for telephone messages specifically, in some cases it may be a few hours before we even see the message, let alone try to fit it into our triage. Another factor is that estimating the length of a phone call is notoriously difficult, for either the client or the doctor, so we are sometimes unwilling to take the risk and will leave it until a gap opens in our schedule or to the end of our shift. This is almost certainly what happened with my father's oncologist. It was closer to ten minutes than one and he was wise enough to leave it for the end of his day.

So, "How To Contact Your Veterinarian":
- By all means please phone if you have any questions.
- If you feel the question is urgent, tell the receptionist so.
- Ask for a realistic guesstimate on when you are likely to hear back.
- Please make sure the receptionist knows which phone number you can be reached at. Many files list multiple work and cell numbers for multiple family members in addition to the home landline.
- Please make sure you specify if there are times you will not be available to be called back.
- Please use email sparingly and only if you are ok with waiting for a day or two for a response. Sometimes we're quick with email, but sometimes we're not. For a variety of practical reasons it is not given a high priority.

(my dad and my brother, ~1970)