Glad that's over

I have successfully (at least I think) completed Week 2 of the dreaded junior-year Client Communication Skills!

As expected, the spring semester week was less fun and more stressful and depressing than the fall semester. Our discussions focused on how to talk about end-of-life decisions, the euthanasia process, delivering bad news like a terminal diagnosis, talking about medical errors, and addressing financial concerns with clients.

So, yeah, not a lot of fun.

The simulated client scenarios they gave us were, predictably, more of a challenge. Tuesday's cases included:

-- Explaining to a reptile fanatic that the geckos he brought in were not the species he thought they were and as a result he was housing them in a desert habitat instead of a tropical habitat which was making them sick

-- Meeting with the owner of a horse after you've done a pre-purchase exam on the horse for a potential buyer, meaning the results of the pre-purchase exam are part of your confidential veterinarian-client-patient relationship with the potential buyer so you can't discuss your findings with the actual owner (and what you found caused the potential buyer to decide not to buy the horse)

-- Handling a client who brought his dog in once 6 months ago for chronic skin, ear, and eye problems (probably allergies) and now is back with "I just want to get more antibiotics and leave" (this was the case I got)

-- Discussing a physical exam finding of a fractured tooth that needs to be removed under general anesthesia with the owner of an 18 year old, hyperthyroid, chronic renal failure kitty

Tuesday's case (the allergy dog) went well for me. Knowing a little more about what to expect from having the cases in the fall semester helped to decrease the nerves a little, as did having 6 months of practice dealing with real clients on clinics.

Thursday's cases were... pretty terrible. They were:

-- A panicked horse owner who is standing in the breezeway watching her horse thrash around violently from severe colic, which isn't responsive to sedation or pain medications; you have to get the owner to sign an estimate for surgical fees *with* informed consent, meaning she truly understands the risks

-- Explaining to an owner coming to pick up his cat from CCU that the cat's IV line had been switched with another patient so that the cat had received the wrong medications for 8 hours (although thankfully there would be no lasting ill effects)

-- Delivering the news of a rapidly terminal prognosis (splenic hemangiosarcoma in the process of bleeding out) to a distraught owner, and deciding whether to euthanize or pursue treatment

-- Discussing a dog with severe maggot infestation with your technician, who wants to report the owners for animal cruelty/neglect even though there were extenuating circumstances

-- A young, previously healthy dog with serious sepsis and less than a 5% chance of leaving the hospital alive, and owners who can in no way, shape, or form put down any part of the $1000 deposit required to initiate treatment beyond emergency stabilization

I had the splenic hemangiosarcoma dog, and was that ever a doozy. The added problem (besides just giving a terminal diagnosis) was that owners often have no idea their dog has this type of cancer because the dog just grows a blood-filled tumor in its abdomen and doesn't act very sick -- until one day the tumor breaks open and bleeds and bleeds and bleeds into the dog's abdomen -- and usually the dog gets very weak or collapses. So this dog's simulated owner had no idea that the dog was even sick, and now had to get the news that without surgery and other complicated treatments that might not even fix the problem, her dog would probably bleed out and die within the next few hours.

Yep, fun times. I was nervous enough about the complicated cases (and they didn't tell us which case we would get until right before each of us started). It made me feel sick to read some of the case descriptions earlier in the week and imagine myself (a) trying to deliver this news to a client or (b) being the client getting the news.

And the case description I was given implied that the dog's owner had been told what was going on (i.e. the diagnosis) and was given some time to sit with the dog and decide what she wanted to do, and I was supposed to go in and support her through the decision. One of my first questions to the owner was "What has the doctor told you is going on with Penny?" and the answer was "Nothing." Great. Have another obstacle.

Mostly the difficulty for me with this case came from having never delivered this kind of news before and having to do it with an owner that was very in shock and emotionally shut down. I'm not great with allowing spaces and pauses in my conversations with clients, and that was exactly what this owner needed -- time to process what I was saying. And before I had had a chance to explain anything other than "Penny has cancer," she was asking me questions like "What do we do?" and "So I can just take her home now and then in a few days it might be time to put her to sleep?" -- questions that I felt I couldn't answer adequately or fairly without even given her a little bit more of an idea about what was going on with the dog.

In the end, I was the "someone always cries" person among my group of five students. It was so intensely frustrating to feel so sorry for this owner and what she was going through; to want so badly to help her through this process and yet not be able to connect with her; and to struggle to answer her questions directly without deviating off along my own path of "what I think she should know" versus "what she's telling me she wants to know." (And don't forget -- I was being videotaped and watched by my 4 classmates, my coach, and my coach's coach. No pressure, though.)

So I held it together during the actual interaction with the client -- which I was thankful for. There are plenty of stories on VIN posted by vets who've ended up with a client comforting them during a euthanasia or tough conversation, rather than the other way around -- and I didn't want that to happen, at least not on my first try.

But once the "acting" part of it was over and it was time to debrief and discuss the interaction, I did lose it a little bit. Thankfully, there was already Kleenex right there in the room for the actors who were crying! I certainly didn't have a total meltdown or anything, but there were a few tears and shaky voice for the next 15 minutes or so.

In the end, although it was a thoroughly sucky experience, I'm so glad that I had it in a simulated setting. I can't imagine what it would be like to go through that for the first time with a real client -- not able to pause when you lose direction, not able to rewind when you mess up, not able to get direct feedback from the client about how your words and actions made them feel, and not able to get support and suggestions from a great group of classmates and a coach.

And I definitely learned a lot for next time!

(Now, I'm just hoping there won't be a "next time" other than the regular stuff we have to do during senior year... but the decision about who fails their video reflection paper at the end of the rotation seems completely arbitrary this semester, so who knows -- I may 'get' another shot