from the archives: The Night a Piece of My Heart Died
I have worked as a registered veterinary technologist in an large animal referral hospital for fifteen-going-on-sixteen years. My longevity is an outlier, made all that more impressive that national statistics report credentialed technicians leaving the field after approximately five years of work. The rate of us leaving is greater than those of us who stay, for reasons related to pay, benefits, underutilization and burnout. This has been happening long before the pandemic of 2020 broke the veterinary industry, long before the Great Resignation of 2021. In fact, credentialed veterinary technicians leave the industry faster than their veterinarian colleagues.
Once upon a time, not so long ago, in a land that was still chilled from a passing winter, where the river meets the wetlands, a full moon rose over a misty valley, and I walked into the hospital almost an hour before shift change to prepare for what I knew to be a long, long night.
My co-worker met me in the NICU, where I was introduced to my foal watch assistants, who would watch over our patient - a dysmature foal with traumatic leg injury from a difficult birth, with hypoxic ischemic encephalopathy and therefore on a ventilator - while I was taking care of everyone else in the barn*. She updated me on all of the particulars: where to find the milk, where the milking equipment was, what kind of fluids he was getting, antibiotics, opiods, rotating hips, cleaning the nasotracheal tube... and something about the Butorphanol CRI being discontinued, which I realized was not written on the ICU sheet. She watched me cross it off and we tagged out for the night.
From that point, the night became darker, the air full of mounting tension, an impending sense of doom, so oppressive was it that I don't remember much else about that night, other than walking swiftly back and forth between the NICU and a post-op colic with ileus, who required frequent refluxing of his stomach. I entered a state of automaton: going through the motions, ignoring the body's demands, relying on instinct and habit to endure what was becoming easily too much for me to handle. Like the robot I was, we began to prepare to assist the foal to stand and rotate his hips. The foal watch assistant in the hind end had to grasp the foal's flank folds so they would not damage the bladder by heaving around the abdomen. The foal watch assistant in the front of the foal had to carefully grasp the shoulders and actually tip and lean the foal, rather than lift, due to many broken ribs that marched up and down his thorax. This foal, a whopping one hundred and forty pounds, and I - both with and without help - had been doing this dance for the past week and half. I opted to stabilize the nasotracheal tube and assist the foal watch assistant on the front, to give myself a break. We heaved our own bodies to breaking so that we would not further traumatize our patient. The foal had been noticeably more painful as the night ticked on, and he had little interest in standing on his own. We slowly started to lower him back onto the mat, when the foal watch assistant in the front lost her balance or strength or grip.
The national shortage of veterinary technicians walks hand in hand with increasing reports of suicide in our veterinary colleagues. The National Institute of Health reports that both veterinary technicians and veterinarians commit suicide at two to three times the rate of the general public. In part, this is how the culture of vet med negatively impacts the emotional and mental health of its members. Another part is the disparate low-pay-to-educational-debt ratio. The worst is the compounding effects of witnessing, participating in or managing the trauma of working within veterinary medicine, often amplified by chronic sleep deprivation and/or client interactions.
But, here we still are.
In thundering towards the end of 2023, I have seen great beauty in how my little team has bonded and grown. We've ordered weekly Panera, sent memes and Tik Toks, help fill in shifts, given elbow bumps, we chip in with treatments, laugh about some Bull Shit, know where to find all of the snacks, share in our joys and our sorrows. What I love about the young-ness of this little team is their consistent, relentless pursuit of understanding. Why do the surgeons prefer this instrument? What is the disease process of pleuropnemonia? How can I advance my learning? Can I do more teaching? I want to feed it all, to give them something bright and shiney to hope for after all of this goes away.
Sometimes that thirst for understanding presents itself as a challenge in the face of heartbreaking cases: I don't understand why we continue to treat this patient despite its obvious suffering. I didn't sign up to watch patients suffer. This is cruel.
I say to them, "I know. I understand how you feel. I've been there. What you are feeling is absolutely valid. I don't have an easy answer for you." I then remark on the nature of medicine: healing requires the patient to suffer, to an extent. An injury yields inflammation, inflammation is the harbinger of the healing scaffold. Sometimes. Sometimes the patient just need time and nursing care.
In my career, I have Seen Some Shit. I don't talk about it too much - I just try to let my work do the talking. But, I've decided to republish a piece early in my time at my job. I was no more than twenty-five, working third shift treatments during foaling season, and this night is one of my worst, one of a bucketful that I will remember until I am on my death bed. I often tell my mentees and trainees, "I have made medical errors. We all will. I won't talk about it unless I'm drunk, though." And it's true, for the most part. But I dug this one out for '23 National Veterinary Technician Appreciation Week, because transparency might spurn action. It might vindicate me from my mistakes, I don't know...
I am not sharing it to make light of anything, or to incriminate myself. I'm absolutely not sharing to cast blame at my employer or my past teams. Let its resurfacing be a strongly worded warning: take note of what your actions, as a pet owner or as a veterinary team member or leader, will have on the mental and physical toll that the veterinary team.
In thundering towards the end of 2023, I have seen great beauty in how my little team has bonded and grown. We've ordered weekly Panera, sent memes and Tik Toks, help fill in shifts, given elbow bumps, we chip in with treatments, laugh about some Bull Shit, know where to find all of the snacks, share in our joys and our sorrows. What I love about the young-ness of this little team is their consistent, relentless pursuit of understanding. Why do the surgeons prefer this instrument? What is the disease process of pleuropnemonia? How can I advance my learning? Can I do more teaching? I want to feed it all, to give them something bright and shiney to hope for after all of this goes away.
Sometimes that thirst for understanding presents itself as a challenge in the face of heartbreaking cases: I don't understand why we continue to treat this patient despite its obvious suffering. I didn't sign up to watch patients suffer. This is cruel.
I say to them, "I know. I understand how you feel. I've been there. What you are feeling is absolutely valid. I don't have an easy answer for you." I then remark on the nature of medicine: healing requires the patient to suffer, to an extent. An injury yields inflammation, inflammation is the harbinger of the healing scaffold. Sometimes. Sometimes the patient just need time and nursing care.
In my career, I have Seen Some Shit. I don't talk about it too much - I just try to let my work do the talking. But, I've decided to republish a piece early in my time at my job. I was no more than twenty-five, working third shift treatments during foaling season, and this night is one of my worst, one of a bucketful that I will remember until I am on my death bed. I often tell my mentees and trainees, "I have made medical errors. We all will. I won't talk about it unless I'm drunk, though." And it's true, for the most part. But I dug this one out for '23 National Veterinary Technician Appreciation Week, because transparency might spurn action. It might vindicate me from my mistakes, I don't know...
I am not sharing it to make light of anything, or to incriminate myself. I'm absolutely not sharing to cast blame at my employer or my past teams. Let its resurfacing be a strongly worded warning: take note of what your actions, as a pet owner or as a veterinary team member or leader, will have on the mental and physical toll that the veterinary team.
The Night a Piece of My Heart Died:
published 2/3/13, but happened in 2010Once upon a time, not so long ago, in a land that was still chilled from a passing winter, where the river meets the wetlands, a full moon rose over a misty valley, and I walked into the hospital almost an hour before shift change to prepare for what I knew to be a long, long night.
My co-worker met me in the NICU, where I was introduced to my foal watch assistants, who would watch over our patient - a dysmature foal with traumatic leg injury from a difficult birth, with hypoxic ischemic encephalopathy and therefore on a ventilator - while I was taking care of everyone else in the barn*. She updated me on all of the particulars: where to find the milk, where the milking equipment was, what kind of fluids he was getting, antibiotics, opiods, rotating hips, cleaning the nasotracheal tube... and something about the Butorphanol CRI being discontinued, which I realized was not written on the ICU sheet. She watched me cross it off and we tagged out for the night.
From that point, the night became darker, the air full of mounting tension, an impending sense of doom, so oppressive was it that I don't remember much else about that night, other than walking swiftly back and forth between the NICU and a post-op colic with ileus, who required frequent refluxing of his stomach. I entered a state of automaton: going through the motions, ignoring the body's demands, relying on instinct and habit to endure what was becoming easily too much for me to handle. Like the robot I was, we began to prepare to assist the foal to stand and rotate his hips. The foal watch assistant in the hind end had to grasp the foal's flank folds so they would not damage the bladder by heaving around the abdomen. The foal watch assistant in the front of the foal had to carefully grasp the shoulders and actually tip and lean the foal, rather than lift, due to many broken ribs that marched up and down his thorax. This foal, a whopping one hundred and forty pounds, and I - both with and without help - had been doing this dance for the past week and half. I opted to stabilize the nasotracheal tube and assist the foal watch assistant on the front, to give myself a break. We heaved our own bodies to breaking so that we would not further traumatize our patient. The foal had been noticeably more painful as the night ticked on, and he had little interest in standing on his own. We slowly started to lower him back onto the mat, when the foal watch assistant in the front lost her balance or strength or grip.
And the moment that the foal fell solidly onto the mat, what had become a comfortable fog around my brain burned up within a half of a second, and I watched what was probably only five seconds of this patient's life play out into a terrible, slow action film.
The foal rolled off of the mat, onto his back. It was a wonder that the nasotracheal tube did not pull out; the tube to the ventilator disconnected, however, and the pressure alarms began sounding, lending the mechanical voice to the scream in my own head: Something's not right! This isn't right! The foal was on his back, mouth open, legs thrashing. And as the foal watch assistants scrambled to help, I let out out my anger and fear: "Get him sternal! Get him up! Get him up! Sternal!"
And they couldn't, and, as the foal's eyes had this glazed over, far distant stare as if he were dreaming of a life that he had not been born into, and once pale pink mucous membranes in his mouth literally washed out to a blanched, white color, I swear to God above that my heart stopped beating.
I reached over and hauled him back into a sternal recumbancy, groaning aloud with the pain and fear. His head flopped between his outstretched knees, and his hind legs were stiff. I jammed the ventilator tube back into the nasotracheal tube, the alarms stopped and the machine began breathing for him again. The foal watch team flailed, and he began to roll back off of the mat.
As I grabbed my stethoscope from around my neck, I bellowed, "I said UP. Keep him UP, God dammit! Do not let him fall!" Pressing the bell into the heart girth, my breath choked as I realized how bradycardic he was. I stared at the whorl of red hairs on his withers as I counted again and again, as slowly, slowly, the heart beat rose from 12 to 28 to 32...
"Oh my fucking God," I breathed. "Oh shit, fuck me!" I pressed my finger into his white mucus membranes - lengthened capillary refill time - fumbled for a pulse, but I couldn't feel it for the shaking of my hands or his bottomless pit blood pressure. Heart rate again: 36, 36, 40, 40... "Dammit! Dammit!" I was frozen, absolutely grounded, with the electric shock of not knowing what the hell to do.
The foal watch team, in all of their ignorance, sat absolutely still, propping the slowly recovering foal with their own hips. I looked at his mucus membranes again, and was thrilled to see some color slowly returning to the tacky gum line. 48... 58... 60... I released a choked breath with a shuddering sob. "Fucking foal! Oh, my God." The foal watch team stared at me. I unconsciously wiped my forehead with trembling hands. I apologized for my language, and swallowed a lump in my throat. Slowly, ever so slowly, stabilizing. I then rechecked his vitals and parameters on the ventilator, working up the nerve to call the poor, exhausted medicine resident in charge of his case. I wanted to cry, but I didn't, because I had things to do.
The next couple of hours were a blur. Eventually the pain and status of the foal was so great that the resident and attending came in. The resident, staring at the ICU sheet, barked, "Why has the butorphanol CRI been discontinued?!" and I stuttered something misunderstanding relayed information - I was so confused and angry with myself. No wonder the poor foal was painful! But what the fuck am I doing on this case!? I don't know what I'm doing anymore! Jesus, God, I don't even know... The care of the foal was quickly whisked out of my care as it was decided to take the foal for an exploratory abdominal surgery. The on-call surgical team showed up, and I continued providing what care I could for the patients still in the hospital.
I poked my head in the surgical suite periodically. There, I discovered the that foal had a diaphragmatic hernia, where the diaphragm was torn or ruptured, allowing not only the stomach but part of the small intestine to slide into the thorax. Well, no wonder he was painful, I thought. No wonder he about died in my arms, what with his viscera sitting on his lungs...
And that was all of the briefing I had, concerning that case. I didn't receive a follow up about the mistake that was made concerning the CRI. There was no talk about what I could have done to improve in my management of a ventilator case. Nothing. No guide towards better resources. I didn't expect a hug at the end of the day - this wasn't my first case gone awry, not the first patient I had lost - just some form of closure other than a corpse and necropsy report. For, five hours post-operatively, the foal crashed due to a unresolvable pneumothorax as a result of the surgery.
And, on my way out, one employee was kvetching at another about one small task I had not completed to their standard. One, very small task. When her displeasure was turned onto my fried body, I wanted to grab the clipboard from her well-manicured hands and break it over the counter top.
Instead, I stared at her with a vacant look in my eyes and said, "Well. I will have to try harder tomorrow." But I didn't know how I could give anymore of myself without literally snapping in half. Because, that morning, I felt as though a piece of my heart, however small, had died watching the color disappear from the mucus membranes in that small, young mouth. And there was nothing, absolutely nothing, more that I could have given at that point in my career to have changed the course of events that night. I couldn't win.
* Just in case you are joining me halfway through the past five years - that's right, I work alone at night. And I've had as many as 50 patients in a night.
The foal rolled off of the mat, onto his back. It was a wonder that the nasotracheal tube did not pull out; the tube to the ventilator disconnected, however, and the pressure alarms began sounding, lending the mechanical voice to the scream in my own head: Something's not right! This isn't right! The foal was on his back, mouth open, legs thrashing. And as the foal watch assistants scrambled to help, I let out out my anger and fear: "Get him sternal! Get him up! Get him up! Sternal!"
And they couldn't, and, as the foal's eyes had this glazed over, far distant stare as if he were dreaming of a life that he had not been born into, and once pale pink mucous membranes in his mouth literally washed out to a blanched, white color, I swear to God above that my heart stopped beating.
I reached over and hauled him back into a sternal recumbancy, groaning aloud with the pain and fear. His head flopped between his outstretched knees, and his hind legs were stiff. I jammed the ventilator tube back into the nasotracheal tube, the alarms stopped and the machine began breathing for him again. The foal watch team flailed, and he began to roll back off of the mat.
As I grabbed my stethoscope from around my neck, I bellowed, "I said UP. Keep him UP, God dammit! Do not let him fall!" Pressing the bell into the heart girth, my breath choked as I realized how bradycardic he was. I stared at the whorl of red hairs on his withers as I counted again and again, as slowly, slowly, the heart beat rose from 12 to 28 to 32...
"Oh my fucking God," I breathed. "Oh shit, fuck me!" I pressed my finger into his white mucus membranes - lengthened capillary refill time - fumbled for a pulse, but I couldn't feel it for the shaking of my hands or his bottomless pit blood pressure. Heart rate again: 36, 36, 40, 40... "Dammit! Dammit!" I was frozen, absolutely grounded, with the electric shock of not knowing what the hell to do.
The foal watch team, in all of their ignorance, sat absolutely still, propping the slowly recovering foal with their own hips. I looked at his mucus membranes again, and was thrilled to see some color slowly returning to the tacky gum line. 48... 58... 60... I released a choked breath with a shuddering sob. "Fucking foal! Oh, my God." The foal watch team stared at me. I unconsciously wiped my forehead with trembling hands. I apologized for my language, and swallowed a lump in my throat. Slowly, ever so slowly, stabilizing. I then rechecked his vitals and parameters on the ventilator, working up the nerve to call the poor, exhausted medicine resident in charge of his case. I wanted to cry, but I didn't, because I had things to do.
The next couple of hours were a blur. Eventually the pain and status of the foal was so great that the resident and attending came in. The resident, staring at the ICU sheet, barked, "Why has the butorphanol CRI been discontinued?!" and I stuttered something misunderstanding relayed information - I was so confused and angry with myself. No wonder the poor foal was painful! But what the fuck am I doing on this case!? I don't know what I'm doing anymore! Jesus, God, I don't even know... The care of the foal was quickly whisked out of my care as it was decided to take the foal for an exploratory abdominal surgery. The on-call surgical team showed up, and I continued providing what care I could for the patients still in the hospital.
I poked my head in the surgical suite periodically. There, I discovered the that foal had a diaphragmatic hernia, where the diaphragm was torn or ruptured, allowing not only the stomach but part of the small intestine to slide into the thorax. Well, no wonder he was painful, I thought. No wonder he about died in my arms, what with his viscera sitting on his lungs...
And that was all of the briefing I had, concerning that case. I didn't receive a follow up about the mistake that was made concerning the CRI. There was no talk about what I could have done to improve in my management of a ventilator case. Nothing. No guide towards better resources. I didn't expect a hug at the end of the day - this wasn't my first case gone awry, not the first patient I had lost - just some form of closure other than a corpse and necropsy report. For, five hours post-operatively, the foal crashed due to a unresolvable pneumothorax as a result of the surgery.
And, on my way out, one employee was kvetching at another about one small task I had not completed to their standard. One, very small task. When her displeasure was turned onto my fried body, I wanted to grab the clipboard from her well-manicured hands and break it over the counter top.
Instead, I stared at her with a vacant look in my eyes and said, "Well. I will have to try harder tomorrow." But I didn't know how I could give anymore of myself without literally snapping in half. Because, that morning, I felt as though a piece of my heart, however small, had died watching the color disappear from the mucus membranes in that small, young mouth. And there was nothing, absolutely nothing, more that I could have given at that point in my career to have changed the course of events that night. I couldn't win.
* Just in case you are joining me halfway through the past five years - that's right, I work alone at night. And I've had as many as 50 patients in a night.
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