When I was a senior in veterinary school, my 3-year-old mostly indoor cat stopped eating, became very lethargic and developed a pretty good fever. I took him to the hospital where I was doing my senior rotations. The resident examined Hal (short for “hop-a-long,” as he had only three legs) and determined that we needed to do some tests, starting with complete lab work, including FeLV/FIV, and full-body X-rays, all of which returned normal. Next up was an abdominal ultrasound to look for the ever-sneaky feline pancreatitis. Sure enough, his pancreas looked “a little suspicious.” Hal was admitted to critical care and was started on fluids and antibiotics. When he didn’t improve within 24 hours, the veterinary team added heparin because, apparently, DIC (disseminated intravascular coagulation) was imminent.
EDITOR’S NOTE
Dr. Stacee Santi, Today’s Veterinary Business’s newest columnist, aims to share everything from career tips to life advice and to remind readers that the best lessons in veterinary medicine live off the record.
At the time, my only income came from waiting tables at Olive Garden on weekend nights, and I remember feeling embarrassed having to tell Hal’s clinician that I couldn’t afford more. I decided to take Hal home and do my best.
The next day, while dragging Hal out from under the bed to give his heparin shot, I felt a large lump about the size of a lemon on his lower back. It burst. And just like that, I knew that Hal didn’t have cryptic pancreatitis or imminent DIC. He had a good old-fashioned cat bite abscess, the most common fever-causing condition in cats, something that neither the resident nor ER clinician had seen.
Once I graduated and got into general practice, the story became a crowd-pleaser with my colleagues. They would shake their heads and say, “You gotta love the ol’ ivory tower.”
Where Idealism Lives
During my veterinary training, most of the teachers were specialists. Few had been on the frontlines for a lengthy time, which is why my cat’s abscess got missed. Additionally, the cases that wind up in university teaching hospitals are filtered, financially and medically, by general practitioners. This approach creates a warped view of veterinary practice, where you think your day-to-day will be scouting for zebras, like atypical Addisons and sneaky liver shunts. In the real world, however, you find yourself knee-deep in otitis, arthritis, dental disease and abscesses. These conditions don’t make it to the ivory tower. They get handled at the GP level, quietly and competently, every single day.
Most of the new grads I’ve worked with (or students on externships) fall into the same trap I did in the real world. You take what you learned in veterinary school and try to apply it in the trenches, only to realize it doesn’t quite work as well. You aren’t taught to think like a general practitioner.
Here is one of the best lessons my GP mentor taught me. I now pass it down to every young veterinarian.
A 9-year-old golden retriever walks in with pale gums, a distended belly and collapse onset since yesterday — classic hemoabdomen symptoms. The standard first-wave workup you learn in school is CBC/chem, X-rays and ultrasound, with a price tag circling the $1,000 mark. Technically, this is the “correct” approach. But in real life, the IRL approach is to grab a syringe and stick the belly. When it comes back full of blood, you have a meaningful conversation with the pet owner about spending the first $1,000 to get started and the next few thousand to try to save the dog’s life. Real-life medicine doesn’t always look like what you were taught in veterinary school.
5 Steps to Proficiency
You don’t need a residency to reach a specialist level. With enough cases, curiosity and repetition, you can become an expert in general practice. Here’s the five-step roadmap:
1. Pick a Focus and Master It
For me, it was ultrasound. I became so obsessed with ultrasound that I pitched my boss to invest in a machine for the veterinary practice. I took extra courses in both abdominal and echocardiogram procedures.
The vet school professors had told us, “Look at enough normal ultrasounds and the abnormal will jump out at you.” So, that’s what I did. I scanned every sedated patient I could — spays, lacerations, anything. The techs were annoyed, but I was putting in the reps. After you scan a couple of hundred normal animals, hypertrophic cardiomyopathy in a cat or a liver mass in a dog stands out like a bladder stone on X-rays.
2. Remember That Everyone Has a First Time, Even the Specialist
I’ll never forget my first canine extraction. The patient was a 2-year-old pit bull named Rocky, who had a midcrown fracture on a very large canine. I did what I was taught in school: Refer him to the veterinary dentist across town.
The owner, whose name was Tina Turner (I will never forget this part!), was fired up. She asked me, “Who do you think I am that I can afford $1,500 to fix my dog’s tooth?” Then she stared me down and asked what her other options were. I told her we could extract the tooth.
She narrowed her eyes. “How many times have you done this?”
For a second, I thought about lying. Instead, I said, “Once. On a cadaver head in vet school.”
Tina Turner paused, gave me the world’s longest side-eye and said: “All right. You can do it. But if you get in over your head, promise me you’ll ask for help.”
It was rough work. That first extraction in Portland, Oregon, took me over an hour. But after enough reps with other patients, I got it down to less than five minutes. That’s what happens. You do it scared, ask for help when needed, and then one day, it’s second nature.
3. Put Yourself in the Proper Environment
If you want to get your hands dirty and your feet wet, find a job a few hours away from the nearest ER or specialty clinic. I had the good fortune to work in Durango, Colorado, where the closest referral center was four hours away. (In the wintertime, it might as well have been on Mars.)
That kind of setup forces you to stretch. You either figure it out or the patient suffers. There’s no safety net, which means you rise to the occasion and do your best.
That situation opens the door to doing cool things you might not get to try otherwise, like launching a chemotherapeutic service. Once companies like Oncocur came onto the scene, we figured out how to administer high-end IV chemo in our small-town clinic. Lymphoma, transitional cell carcinoma, osteosarcoma — we treated everything. It was a win for the patients and another serious skill under my belt.
4. Say Yes to High-Volume, Low-Income Practice
My first job out of the gate was at SE Portland Animal Hospital, which was known for two things: tons of cases and clients with no money. And honestly, I couldn’t have been happier.
It was real-life practice, full throttle. When you’re seeing that much volume, you gain experience at warp speed and end up handling cases you’d barely believe. I’m talking emergency colectomies, open-abdomen peritonitis, chest tubes for cat bite pyothorax, and yes, even a cat whose head is stuck in a mayonnaise jar.
Picture a high-paced episode of the old TV series “ER.” It was like that, only the animal version, every single day for six years. It was like a fast-track residency in medicine, surgery and people.
5. Surround Yourself With People Who Are Doing What You Want To Do
If you take the time to find the people who love to teach, you can become a Jedi. Teachers are everywhere. They are your colleagues with a few more years under their belt, your boss and especially your technician.
One of the people who taught me the most over my career wasn’t a veterinarian. Mr. Thanh Tran was a veterinary technician, and anyone who worked at SE Portland Animal Hospital in the ’90s or 2000s is probably nodding their head now.
Thanh came to the United States as a teenage refugee from Vietnam. He started out cleaning kennels, and then assisting doctors. Eventually, he became the head surgery tech and was assigned to train every new grad who walked through the door. He taught me and loads of other new grads to spay and neuter like a machine. How to pin fractures. How to apply bone plates. But most of all, he taught me to believe in myself.
Whenever I’d hesitate, Thanh would look at me and say in his unforgettable dialect, “Why you can’t do this? You tell me now.”
Why can’t you do it? Are you not smart enough? Not willing to learn? Not willing to work hard? Once you realize the answer is, “Of course, I can,” you’re officially on your way to one of the most gratifying, chaotic, fulfilling, weirdly wonderful careers out there.
And someday you’ll be the one telling a newbie, “Why you can’t do this? You tell me now.”
DID YOU KNOW?
The U.K.-based International School of Veterinary Postgraduate Studies offers a general practitioner certificate (GPCert). Learn more at isvps.org.
DEEP DIVES
Learn about hypertrophic cardiomyopathy, emergency colectomies and peritonitis — and much more — at vetfolio.com. Much of the educational content is RACE-approved.