I’m currently covering my coworker’s maternity leave which means i’m seeing her patients and my boss is seeing his and my patients. We are one man down so i cant exactly call in and say i need a day off to go handle a dog thing. I usually order my flea and heart-worm meds from a company that takes a good amount of time shipping them but due to recent policy changes has now doubled the price. It has forced me to look for a more in person solution to the problem of how to obtain flea and heart-worm meds for my dogs for the coming year. I had two remaining doses of each chew. Now, if i just needed a medication refill i could pay via phone and the vet tech would leave the meds in her mailbox and i’d just grab them on the way home as she lived in a town i passed through to get from the one where i worked to the town where i live. However, in this country a heartworm test is required every year in order to obtain heartworm meds, which i think is stupid and i’ll explain why, but regardless it doesnt change the fact that it is needed. Now, if your dogs have been on a heartworm preventative that you faithfully gave them 12 times in the last year, each time making sure they had a full meal first and were in for the night so there’s no chance they could go throw it up somewhere and thus not get the benefit of the medicine….do you think that test is going to be negative or positive? Its never in their lives been positive, because its actually impossible for it to be positive if the meds do in fact work, which is why we’re buying them, right? Lets play devil’s advocate here and say i was somehow overnight turned into a non-ocd person that just haphazardly breezes through life without checking or chronicling things and i forgot to give them their heart-worm chews one month. Well, the medicated chews kill juvenile heart-worms. They cant kill adult heart-worms but they do kill juvenile heart-worms. If the infestation is new…the worms would still be young. You would literally have to forget several months in a row to land them heart-worm positive on a test. Most people i know who adopted heart-worm positive dogs actually chose just to give them a couch potato style life until the infestation was clear and put them on preventative because the drugs to treat a full blown heart-worm infestation can actually be taxing on the dog’s heart. Most decide they’d rather have what time they can with them than maybe kill them now. At that point you’re basically waiting out the lifespan of the adult worms which are doing damage and putting stress on the dog’s heart until the end of their life cycle and you hope that they die before too much damage is done. The treatment for a heart-worm infestation is also expensive which is another reason people out here opt out of treating and just stick to preventative to kill additional spawning generations of worms. But, it doesnt matter how much i point out the flawed logic in the gate keeping of vital preventative dog meds in the name of useless tests that change nothing about the behavior outcome…it is still the law. So, we had to play ball and go get a blood draw before we could be a responsible pet owner this year. The problem was, the vet was only open monday through friday and they were neither in the town where i lived nor in the town where i worked. They were half way between. So, i would only have time to work a half day if i had to run the dogs all the way back home and then come all the way back the other direction to make it to work. I decided there was nothing to do but hope my coworker returned from her maternity leave before january because december 1 would be the dogs’ last dose in the house. That was cutting it close for the usually over-prepared me that orders six months in advance before running out… but, financial reasons and gate keeping drove the situation as the price for meds had increased double since i bought them last from my regular source.

Long story short, the country vet came to my rescue. He said he was making a grocery run to the lowes market in the nearest town on saturday and he could bring his pickup which he called the “vet truck” with a little mat in the bed of the truck and some boxes full of vet supplies and he’d park it in his vet tech’s yard who lived in the town where the lowes market was and i could just shuttle the dogs to this town (the closest one to me) and he’d put each one in the truck bed temporarily for a quick blood draw and he could do the test and sell me a year’s worth of flea and heart-worm meds right there in the vet tech’s yard. The question was, did i think my dogs would do it. What they were asking was, if we didnt have the table with the collar hold to keep them in a specific position, would they hold still and not bite the vet or the vet tech holding them on the mat on the open truck bed? I was pretty sure they could both be coaxed into a state of “i’m a good girl.” So i said yes they’d be able to do it and we’d just have to give them the command “load up.” Since that was what they’d been trained with.

At 10:00 i said to both dogs, “load up” and gestured towards the open car door. Sili jumped into the back seat of the car. Cashew ran right past the open car door and around the back of the car. She then took a running leap straight into the trunk door and window. It was not open. She bent the rear wiper slightly as she perched momentarily on it and pushed off of the window with her claws, quickly improvising some sort of parkour move as if she had meant to run smack into a closed trunk window. I just stood there stunned, pulling at my jaw thinking, “wtf dog?” As she frantically searched for where her sister went i pointed towards the continuously open back door of the car. Sili stuck her head out to see if Cashew was okay. Cashew then spotted her and it was like a lightbulb went off in her head and she scurried over and jumped into the back seat. I closed the door behind them and inspected the rear wiper on the car. It was a bit bent but it was still making contact with the glass and i bet it will still run. I shook my head. My crazy wild child. They were polar opposites but i loved them both equally for different reasons.

At 11 we arrived in the vet tech’s yard. She and her husband were standing in the yard next to the vet truck. They came and greeted me. I left the car running for the a/c and greeted them and the vet…thanked them for letting us meet in her yard on a saturday and bringing the tests with him. I got each dog out one at a time. The vet tech’s held the dog on the truck bed mat while i smooshed their face and ears in my exaggerated petting and showered them with kisses and “you’re a good girl, yes you are” praise so they wouldnt squirm or nip the vet. Each one behaved perfectly. Cashew was a bit squirmy but thats more because she’s an australian shepherd than because she was scared. She never stops moving. She’s like a ball of energy. Both of them did well and didnt nip at all. We lifted each down and the vet tech offered a treat each time. Cashew is always so overstimulated in new situations she could care less about food. She wants an “at a girl” more than anything in the world. On the other end of the spectrum was sili who will gage whether you are pleased with her or not by how many treats you shower her with. Cashew predictably took and dropped her treat and paid the second one the same amount of attention. She ignored all attempts at food reward. I gave her some big thumps on her side and told her “what a good girl! What a good good girl you are!” Her stubby tail went into hyper drive and you could see the words wash over her as she seemed to say “yeah i am, im a really good girl! Mom said i was a good girl!” She was loving it. Cashew never needs a treat. Your approval is worth 1000 treats to her. Sili however needed only one suggestion to enjoy a nice chewy treat for her efforts and she would go ahead and take care of cashew’s treats too just so there wouldnt be a mess in the grass you know. She was very dainty about it but she scarfed down the little red and brown discs with purpose once she had each one picked up. I put both dogs in the back seat and then the vet held up the little rectangular discs and said “well, nobody’s pregnant.” I laughed. They did look like little mini pregnancy tests. The vet tech said, “they’re both heart-worm negative. Then they asked if i wanted to pay by check or phone. I paid by phone and they handed me a bag containing a year’s worth of flea and heart-worm meds for both dogs. I thanked them for making an exception and meeting me on a saturday so they could get their preventatives before my coworker came back from maternity leave. The vet thanked me for what i do. He said, “i hope i never need your services but thank you for what you do.” It meant the world to me. It was so kind. Working in healthcare is more complicated than working elsewhere when it comes to taking a day off. Yes you have vacation days. Technically you accrue them, but the patients have to be seen, so you have to find someone to cover your hours if you are going to take a day off, and finding ethical help is harder to do than it sounds. Just because a person has a license does not mean they are going to be kind and responsible with your patients and you dont want to put them in a situation where they are getting neglected or abused by agency workers because you needed a day off. Why agency workers are usually disgruntled and checked out has to do with the fact that the agency who provided them is taking a cut of their wages and there was something wrong to begin with that forced them into a circumstance where they had to take a contract job in a city other than the one where they live with their families. Its not always this way, but it is usually. Since the agency worker also doesnt belong to the facility but to the agency, the facility management cant fire them either, which does little to motivate them to abide by facility rules or have good interdisciplinary verbal collaboration. For example, at one point in my career a patient appeared to be in crisis and going downhill fast. I identified immediately that he was in crisis and needed to go to the hospital. The agency worker told me and the patient’s wife that i had made a rookie mistake and not warmed the hand before using the device to measure the vitals and thus got an inaccurate reading. After years in the medical field i know that an electronic device is not the only way to tell if a patient’s vitals are off. You can use your eyeballs because there will be signs of the patient’s distress. The agency nurse put me in a regrettable position because i knew after examining the patient with my eyeballs that i wasnt wrong about his vitals and she had to be flat out delusional to think he was within functional limits and there was no possible way that she got the reading that she said she got because i was looking at a patient whose respirations, skin color, and sweating situation were not correct. Also their cognitive function was still compromised and they could barely keep enough air to make a sentence. I spelled it out for the wife as best i could without flat-out calling the agency nurse a liar…which probably would have resulted in a write up or termination. There’s ways to go about things, but i was trying to communicate to her that her husband was in danger without making it so i could never help another patient again. I told the wife that i knew what the nurse said but that i had to base my conclusions on observation and what years of experience had taught me, and regardless of what the monitor did or did not say, he was still presenting as a person, he was showing physical signs of a person who was having difficulty breathing, having a low oxygen sat. I turned to her and said, “theres no way we can do therapy today. He’s struggling to breathe and if i make him exercise while he’s doing that he’s just going to get worse.” I looked at her, hoping i could communicate the seriousness of the situation without saying outright “she’s a lying ass and i dont trust her.” I said, “if his symptoms get any worse, get the nurse immediately.” For all i know, she could’ve gotten the nurse and the nurse could have told her it was nothing again. For four hours i went through the chain of command as policy dictated it was all i could do if i wanted to keep my career. I told my direct supervisors. I told the directors of both buildings. I told the physical therapy assistant, the speech therapist. I told anyone who would listen in my department, what i had seen and what the nurse said and what i believed and why. Why i believed she was wrong. I knew i was right. After years in the field, you dont f***ing miss what impending death looks like. Finally the speech therapist was the one who risked her career to go over the nurse’s head. Upper management was involved when his o2 sat was beyond critical. They were notified that this was the situation going on and she wanted to make them aware of it because several employees disagreed with the nurse’s assessment of the situation and if he died, the consequences of the negligent decision would not only be on her but on everyone above her who allowed her to make said decision. Upper management responded immediately, took one look at the patient, and ordered him sent one city over to the big hospital immediately. He was intubated.

I was livid. Several lower employees toyed with the idea of ending our careers to override her anyway but were reminded that if we did so, we’d be taken from the other patients who needed our longterm care. No, things had to be done a certain way. The information had to be handed to the higher ups above her and they had to make their own decision. Fortunately, management agreed with me, not her, and they sent him, but look at all the time that was wasted because of f***ing agency. I said, “i mean i dont care…i literally dont care if you’re gonna be typical agency and be super mean and bitchy to me every time i have to communicate with you. I dont care. But if you’re not gonna f***ing help the patients, f*ck you.” She said, “ no, now stop that. Don’t get fired.” She said, “i try and give her the benefit of the doubt. Maybe she was going through something. Maybe she’s having a really bad day and cant cope.” I said, “then you drop the ball on literally everything else. If you’re nursing, you dont drop the ball on medication, and you dont drop the ball on people who are dying. Drop the ball on literally everything else if you dont have the bandwidth. We all work here, and we all have bad days. We’ve had days where we dropped the ball on paperwork, coworker interdisciplinary verbal relations, meetings, inservices, freaking parking the car or remembering to put the scrubs on right side out or even packing a lunch. Drop the ball on f***ing everything else, but you dont mess up with dying people, you dont mess up when someone has fallen and split their skull, you dont mess up a beeping blood sugar monitor. You put your stressors from home and your coworker differences aside and you f***ing find the peel-back foil orange juice cups, apply pressure to the head wound, start cpr, hold the door and direct the emts while another nurse gets the packet ready to go with the patient to the hospital and another employee clears the area of healthy patients who need to be occupied with something else and another nurse calls the family and notifies them of which hospital to meet the emts at. You f***ing get your shit together and serve the f***ing patients and you can continue sucking and falling apart when you get off shift.” Its at this point that two of my coworkers remind me of my rank and tell me to calm the f*ck down and stop saying the f word. I dont have a right rank wise to be this livid about the matter. But i am, because im familiar with agency. Its just a f***ing paycheck to them and they dont care what they ruin because they’re not in it because its their calling. They’re in it for the money. If their work was good, a company in their hometown would hire them and they wouldnt have to work agency. I was sick of these people having access to MY patients and not being able to tell the patient their nurse was an incompetent idiot. He was MY patient, the same as he was speech’s patient, physical therapy’s patient, and the family’s patient, because we cared, and had it been a regular nurse, they would have cared too. I said quietly but in a stern voice, “if he dies, his death is on her hands.” My coworker looked stunned that i’d said it but without protest, agreed. As i told my coworkers that day, “nursing is a calling. You have to be wired for it. Some are, some arent. If you cant check all your shit at the door to the developing crisis and f***ing show up to the situation, you shouldnt be in charge of human beings. Go work at the grocery where the worst that can happen is smashed or spoiled food or unidentified bob (items at the bottom of the basket that cant be seen from behind the conveyor).” So, even though i look like a glorified babysitter teaching elders to dress and toilet themselves and guiding them in arm exercises, i cant take a day off because id create a situation in which people who should not have access to my patients now have access to my patients. If my coworker needs a day off, i’ll cover her. If i need a day off, she’ll cover me, because they’re “our” patients and we’d both tend to them as if their lives were precious and advocate for them loudly in a crisis but on maternity leave…everyone stay healthy and stay put so agency isnt needed. So the vet looking me in the eye and thanking me for what i do, being willing to see me and my dogs in his pickup bed on a saturday so i can still do what i do…it meant the world to me, because i knew he meant it. And i in turn thanked him for what he does, which i find equally important. I take care of of elders. He takes care of animals…livestock and pets. The world would be a very different place without both professions. And he is one for whom this is a calling. I am grateful for the truck bed examination and a year’s worth of dog meds. I am grateful that this country vet gave a country solution to a healthcare problem because you know no city vet would be driving to a nearby town to see my dogs on the way to a weekend supply run at the nearest grocery.