Niche Market

I practice in a rapidly developing niche market believe it or not: rural mixed animal practice providing emergency services.
I'm not trying to pat myself on the back or anything (okay, I am) but of my immediate friends, there's very few that do this. Last year at this time, when I was seeking out another job such as the one I was leaving (because they were leaving this type of practice) and the one I have (and hopefully am staying at), I discussed this sort of job with my friends in mixed practice. They said they could leave large animal medicine behind and be okay. That's the part I find hard to give up. I'm not looking to become a solely large animal vet anytime soon but as of now, this is what I like to do.
Now I've been blessed that neither practice has offered emergency services for small animals after 11pm. I'm not sure that clients really understand that this is the best for them, their pets and their vets. Think about it this way. Take your typical Tuesday (this is the day I tend to be the most versatile), I get to the office about 8:30, talk to the techs, look at some bloodwork, return a few calls, look at a day patient or two, draw some blood  and cruise through the cat ward. Then I do morning appointments which can range from the benign vaccine visits to emergencies. Lunch. Then maybe I sedate a dog for a procedure, finish what I started before appointments, do a quick surgery for my boss and then go see a sick cow or horse. Maybe two sick large animals. I normally get home between 5 and 6. I make my husband dinner and then relax. A pretty full day. If  I'm on call there's a good chance that I'll be back into the office before 7 or shortly thereafter. There's really no predicting how busy I will be on emergencies or what sort of emergencies I will have. Sometimes its a mix. Sometimes its heavy in small animals, sometimes large animals. With only a few exceptions, its normally pretty quiet at night. But what if I was called in at 3am to do a surgery on a dog? Would you want the vet that just worked 8, 10, 12 hours doing a surgery in the middle of the night with little sleep? How about when 45 minutes away there is a well rested vet working their normal night shift? (I couldn't do what they're doing!) Then what if you were the person that was having surgery on their dog the next day after the vet worked a full day the day before and then worked for several hours that night? I wouldn't want that to be my dog. So its actually a benefit for me not to see emergencies after 11. Now, I still see large animals but they don't have an alternative. I've seen colics at midnight in the cold and blowing wind by the light of headlights. Its not cool but I've done it. I had a 20 hour day once. It sucked.
Anyway, what was my point? Oh, mixed animal practice providing emergencies services is a rare thing. And going back to that one of the sucky things about this practice is that we see emergencies for other vets. Most of the time its not a big deal. A dog needing a c-section is a dog needing a c-section. A dog with a gun shot wound is a dog with a gun shot wound. Though I wonder about vets that wouldn't see it during the day. I had one last week which was a trainwreck and ended with death on the surgery table. It was sad. The dog presented in lateral recumbancy with pale mucous membranes. Apparently, they had been to/talked to another vet that said they couldn't do anything for it and to go elsewhere-because they didn't have an x ray machine. I hope, hope, hope, pray that the vet just talked to them on the phone and told them that the dog was shocky (because of the pale gums) and didn't actually see the dog. Because if the other vet saw the dog and didn't do anything, its unethical, illegal and frankly a malpractice case for failure to meet standard of care.  Because 1) the owners ended up calling us so it wasn't like the vet referred them to us (or at least didn't want to do the dirty work of calling us) and 2) even if I didn't have an x-ray, a gunshot wound to the abdomen is an exploratory surgery. I don't need an x-ray to tell me that. Anyway, I x-ray the dog (because I can and to see if I could tell how much blood was in the belly-not much) and put it on fluids for an hour or so before taking it to surgery. The dog was still pale but got up and walked to get weighed. TC asks if I was still going to surgery and I respond yes. I figure that the dog may not be hemodynamically stable now but the next day could be septic and not hemodynamically stable. If there's bleeding in the belly, I need to get in there and stop it. The dog is literally on the table when the tech is like 'I can't hear the heart'. I figure its the stethoscope. The dog is now gasping and I figure its because she's getting light because the anesthesia machine ran out of gas and we were in the process of changing it. We give the dog some injectable anesthesia. The tech is serious though about not hearing the heart so we give some atropine and TC is like there's a heartbeat but all sorts of crazy VPCs. We roll the dog to her side and her heart stabilizes. Well, I still want to push ahead with surgery because the dog is not likely to make it though the night if this is happening. Maybe there's something in her belly that I can fix. Back to her back and she's gone. And not coming back no matter how much atropine or epi  I push. It was sad.
I'm sort of lonely and rambly today. Anyway, emergencies for other vets. Emergencies that are for ongoing problems are an issue though. Every vet has a different treatment philosophy and knowing what was done to a pet for the ongoing problem is an issue after hours because I can't call to talk to that vet or get the records faxed to me. Plus people get things wrong, don't understand it or lie. This weekend, a man calls me because his dog is seizing and now wandering around the house. Its had seizures before and was on phenobarbital but the vet told him he could stop it if the dog didn't have seizures. I hope that the vet did a gradual taper. The vet however also told him that if the dog had a seizure that he could give a phenobarbital no matter when the last one was. I tried to patiently tell him that phenobarbital didn't work like that. That it has a long halflife and takes several weeks to get to full effect. Essentially giving the dog an extra pill probably sedated it which helped prevent seizures or the administration and ceasing of seizures is probably a coincidence. The owner decided to come see me but after I get to the office calls me back and tells me the dog had another seizure, they gave another pill and now the dog was laying down but breathing heavily. He didn't want to be seen anymore. I advise that the dog be seen on Monday by the regular vet. He would call me back about half an hour later-the dog died. Sad but probably not a lot that I could have done. Its also very difficult to express appropriate grief over the phone.

Now that I've patted myself on the back for the variety of veterinary medicine I practice, I want to also proclaim that there is no way in hell that I could be an emergency vet. I don't like being up at night. (What am I a vampire?) I don't get a thrill for emergencies. Give me a good vaccine appointment any day. I don't get excited when my cell phone rings at night or on the weekend. My gut can't take that sort of thing. I just grin and bear it.
In that vein, I could never be an equine vet. The variety of my practice allows me to forget about horses. This weekend was a testament to my versatility but also to the courage of equine vets. Friday night, I get home and was just getting ready to feed the dogs when my phone rings. Its one of the techs and a friend of hers has a mini mare that has prolasped her uterus. I tell her to get her on a trailer for referral. That's not an option so out I go. Luckily, when I get there, its not a prolasped uterus. Its the placenta. Where's the foal? Still in the mare? Oh. So I break the amniotic sac and expect that the foal's front feet and head are there ready for delivery. Not so much. In I reach, the front legs are bent at the knee and the head is flopped over to the side. I do manage to get the legs up and into position rather quickly but the head gave me lots of trouble. Had this been a cow and I had everything that I had in this mare, it would have been a pretty quick ordeal but because mares are considerably more fragile, I didn't go quickly for my krey hook or head snare. And there was no way in hell that I was going to get the gigli wire out. Eventually, I do get the krey hook in and with some pulling and manipulation I get the head up and we get the foal out. It was a beautiful bay blanket appaloosa of course. It was dead and probably had been for a while (at least that day). I treated the mare and honestly, didn't expect it to make it through the night. As of now, its doing fine. Fingers crossed for continued good health.

In conclusion:
1) I do a rapidly rare thing of providing emergency services for large and small animal clients.
2) I could never be an emergency vet.
3) I really could never be an equine vet.