Communication: works in real life!

Sounds like one of those headlines where you think "Why on earth did they need to spend 2 years and $10 million to figure that out?"

The remainder of my CCS rotation since my post on Tuesday was fairly uneventful.

Wednesday's 4 hours of class covered topics including expressions of empathy, non-verbal behavior, and handling difficult communication situations (e.g. angry client, tearful client, panicked client, breaking bad news, etc.). They brought in 3 of the clinicians from the hospital and 3 of the students from the class role-played clients in different situations -- a woman who wanted to euthanize her cat because it had a very treatable medical problem but would no longer be a winner in the show ring, a person whose horse died under anesthesia for a routine elective procedure, and a guy who was mad about getting a bill for services rendered when his cow died a couple days after a c-section. It was really interesting to watch how experienced clinicians handle these sorts of things. Throw in some very genuine tears and amazing acting from my classmate playing the women whose horse died, and it was a pretty intense thing to watch.

Thursday was another day in the communication "lab" (aka the Law & Order rooms... choink choink). They had prepared us that Thursday's simulated client scenarios would be more challenging than Tuesday's, and I think we all expected them to throw way more problems at us than we actually ended up having to deal with.

There were angry clients, worried clients, sad clients. I thought I ended up with the easiest of all the scenarios. My client was just a little... let's call it "high maintenance." Other than that, there weren't really any new emotions for me to deal with. Which maybe means I did a good job communicating? And avoided whatever potential there was for things to break down? Who knows.

Friday started with a trip to a pet cemetery and crematory (no better way to start your Friday, right?). I couldn't decide which was less fun: standing outside in the 45 degree 8 am chill looking at the cemetery, or standing inside where it was warm because we were in the room with the crematory ovens... (here's one thing I learned: you can allow owners to observe their pet's cremation if they really want to, but don't let them get too close to the ovens because some of them will try to reach into the 1000-degree heat and get their animal's body back out, a.k.a. "don't change your mind once Fluffy's in the furnace")

But don't worry. The morning didn't really go uphill from there. Once we got back to the VTH, we spent the remain 2.5 hours of our rotation talking all about death and euthanasia and end-of-life decisions. They brought in clinicians again, this time for no apparent purpose other than to share with us their horror stories of "euthanasias gone wrong" -- when the owner has already shot the horse in the head 3 times before you get there and it's still standing, when you give all of the euthanasia drug that you have in your truck and the animal won't stop breathing, when the dog lets out an ear-splitting scream immediately before dying... oh, don't you worry, there are plenty of ways things can go wrong. Fortunately it usually doesn't.

So CCS is over (well, CCS-1 is over; CCS-2 comes in April). And it's not really over -- I still get to write a 4-6 page paper tomorrow reflecting on my communication skills during my two videotaped sessions (assuming of course that I actually get up the nerve to watch my DVDs). Nothing like a fun paper to get to write on the weekend when you have a huge small animal neuro exam open online from Friday through Monday, with the first radiology exam of the semester opening on Monday and a bovine reproduction exam opening on Wednesday...

But who needs free time? Or sleep?

Just to torture myself, I volunteered for another Pet Hospice case yesterday (my third in the last 8 months).

My new hospice patient is a 15.5 year old chihuahua who lives with an adult couple and two other chihuahuas. I know a lot of people consider their animals to be like their children, but this is the first family I've met where I actually believe that to these wonderful people, their dogs are their children. Their level of adoration and devotion to their dogs is really remarkable.

Anyway, the main concern for these folks was administering subcutaneous (SQ) fluids to their dog twice a day. She's a tiny thing -- less than 4 lb -- so it would be a challenge even for those of us who are experienced giving fluids. Our primary goal this morning was to help them find a way that felt comfortable to everyone involved -- the husband restraining, the wife injecting, and of course the dog getting the fluids.

The visit ended up being over two and a half hours. My first visits on other hospice cases have been 1.5-2 hours each, so I was expecting a long morning (we started at 8:30, meaning I left the house at 8) but this one took the cake.

I wouldn't change a minute of it, though. On both of my previous hospice cases, I have been paired with someone much more experienced at hospice than I am. In both cases, my partner really took the lead in directing the conversation and raising difficult topics, and I really just observed.

Today, though, was the first day on a case for my partner (a very nice sophomore student). And while he did a fantastic job of chiming in and asking questions of his own (he really held his own during the whole visit), it was the first time that I had really felt comfortable with the sort of discussions we had, and being in more of the leadership position between the two of us. It felt easy and natural.

I think that is in large part to my experiences with CCS this week. If you remember some of my past posts, you'll know that I haven't been looking forward to CCS (okay, maybe "dreading" is a better term). I was afraid that it would be completely hokey and lame, and that nobody else would want to take it seriously.

But I have transformed from a CCS skeptic to a wholehearted supporter. No longer will I be telling prospective students on tours "It sounds a little bit horrifying to me, being videotaped and everything... but it's probably a good experience in the end."

Although I would have loved to sleep in this morning (I'm typically up between 9 and 11 am on Saturdays, rather than this morning's 7:15), and a multiple-hour nap is definitely on my mind for tomorrow, I can't think of a better way to spend my Saturday morning. I left the clients' home feeling so positive about the visit, and knowing that my partner and I had really been able to help these folks -- not just teaching them how to give the fluids, which they did before the end of our morning visit, with our guidance, and on their own (!) this evening without us there -- but just providing a nonjudgmental ear to listen to everything they wanted to tell us about the stress in their lives.

This is why I want to be a vet. I love feeling like I will actually be there someday.