I love that my job comes with some surprises. Not the least of which involve fluids, and sometimes solids, forcefully erupting, and sometimes, launching like a volatile projectile from some sort of a lumenous or cystic structure. In some cases, the projectile gets Vegas odds. “Two feet,” one of my technicians shouts! “Six inches,” someone else declares. “Green, no grey,” I wager. A needle or simply a poke with a scalpel will determine the winner(s) of this ill-conceived wager.
It’s not just my people who gamble in other’s suffering. Cynicism is what keeps people like us showing up to care for other’s lives. Several years ago I recall an event that had me a bit turned upside down, dysuria and a bit of a burning sensation when I urinated. I thought that I must have a UTI (urinary tract infection). As I drove towards the clinic to self-medicate with some antibiotics my wife urged me to call/see a “real doctor.” You see, to her I’m the same guy she married: an unemployed and overzealous twenty something year old guy who knows nothing about medicine, physiology, or “dysuria,” for that matter. In her mind’s eye, I needed an expert.
Blood is something we just see a lot of– blood in a tube, coming from a wound, in the urine, in vomitus, in stool, on the floor, and sometimes even on the ceiling. My father practiced for three and a half decades as a general surgeon on the human side. My brother and his wife are both kid doctors. I, on the other hand, took my first job in a veterinary practice at the age of 16. I’m akin to the black sheep of my family, in that I have chosen to treat four-legged patients rather than two. Regardless of our chosen paths, my brother and I are capable of doing our jobs, in no small part, because of our desensitization to the sight of blood at an early age. I recall my mother complaining of the blood drenched underwear on the floor after my father was on trauma call. I was much older before I realized that this was not just a complaint about his underwear on the floor.
As of late, our practice has had a bit of a run on anticoagulant rodenticide toxicosis cases. My latest one presented for a simple cough, one with a little blood in it. My client: a teenager of minority ethnicity. Her grasp of the English language was stellar but her mother, the actual owner, could communicate in my native language with less fluency and was not present for today’s visit. As my technician presented the patient to me, a walk-in on an otherwise busy day, I began to process the information and apply the relevant history in a calculated flow-chart style visualization of the potential causes for the clinical presentation. I looked up just briefly enough from my record writing tasks to see a large husky-like dog provide for me an example of this very deep chested guttural cough that he presented for. On the floor in front of his forelimbs, a perfect forty degree spray of frank ruby red blood appeared on the otherwise bright white and grey speckled floor. “CBC, Chem, PT, aPTT, and survey films of the thorax and abdomen,” I asked of my technician. Cursory physical exam accomplished. I worked on completing tasks for my scheduled cases and other emergency walk-ins as I eagerly awaited the results of my requested diagnostics.