Thursday, March 19, 2015

On St. Gertrude's Day

For the record, I would like to say that I'm tired of the late-night vet trips.

Because yes, we had to do another one, this time for Smokey, on Tuesday night.

And this time, it didn't go well.  It went well in the sense that Smokey is now doing much better and he's clearly on the mend, but it didn't go well in the sense that we had to go to an emergency vet, not one of our regular vets, because it was (of course) after hours.

And it didn't go well because, in the end, I ultimately left the ER vet's office with Smokey, entirely untreated, and simply went home and called our regular vet in the morning.

Now, I'm not knocking emergency vets at all.  I wish there were more of them.  But I am going to give this particular place a few knocks, and here's why.

They specifically state that you should call ahead if you're not sure if your pet-situation is an emergency.  That way, they can assess the situation and let you know if they're already booked solid with emergencies.  They can tell you how much of a wait there will be, if your pet's situation is not life-threatening.

So I did this.  And even though Smokey's condition was clearly not life-threatening, they advised me to bring him in. (Of course.  Cha-ching $$$$$$$$$$$.)

There was no mention of a wait, and no mention of anything, really, except that they told me to leave him in the car until I filled out the required paperwork so they could put us in a room.

They said that if what he had was contagious, they didn't want him infecting other animals.

Hm.  Okay.  I can see their point, but I must admit, it surprised me a bit.  I've been to quite a few vets in quite a few places over the years, and I've never before been told "leave him in the car, we don't want him infecting the others."

Because really, that's the whole point of going to a doctor's office and sitting in the waiting room, isn't it?  You officially find out that what you had wasn't a problem at all, and you walk to your car knowing that you've now needlessly exposed yourself and your loved ones to all kinds of bugs and bacteria.  That's the modern health-care system at its finest.

Anyway, we were admitted, we got our little room (which Smokey promptly sneezed all over), and we met the tech.  He was nice enough, but he was, in my opinion, oddly uninterested in animals.  At least, that was my impression.  In my experience, most vet techs will chat with you about your pet.  This one didn't really seem to want to hear it, and his compliments about what a "good cat" Smokey was seemed perfunctory at best.  That struck me as odd: I don't need you to gush, I just need to sense that you give a crap.

So there we were.  We were checked in, told "a vet will see you shortly," and that was that.

For the next 2 hours.

No, I'm not kidding.  We sat in that little room for over 2 hours.  In the end, I just took my adorable grey kitty and left.

The next morning, I called our regular vet.  Smokey was given an immediate appointment.  The vet arrived right on time and it was clear that she had been contacted in advance about our situation, because she walked in the door said, "Ohhh... Smokey!  What's going on?  He's having a little trouble breathing?  Poor guy.  We'll take care of that."

Less than a half hour later, Smokey had a dose of antibiotics in his system, and we were back home.

Let me make something clear: I knew going in that, in the scheme of veterinary concerns, what Smokey had was by no means high-risk, top-priority, or "critical."  I knew that.

I may be a Crazy Cat Lady, but I do get it.  Really, I do.

And I do understand the concept of "triage."  I knew going in that we were going to be at the bottom of the list, and I knew that was actually a good thing, really, given the situation.     

But there is no excuse for leaving a pet-parent and his/her pet shut in a little room for over an hour with no word from anyone about anything.

We arrived at 9:00 p.m..  At 10:30 p.m., I went out to the front desk with a couple of questions.  We had seen absolutely no one since the vet tech disappeared at 9:15, so I was wondering, basically, "WTF?".  But I didn't say that, of course.

I think I handled it well.  I went to the receptionist and said, "Hi!  We're in exam room 11, and we haven't seen anyone for a while... I know my kitty isn't critical, but I just wanted to make sure you hadn't forgotten about us."  (Smile, laugh, be friendly.)

No, they hadn't forgotten.  They were just very busy, and "catching up" after "a slew of critical cases" from earlier in the evening.  But they'd check for me, and see if they could give me a ballpark figure of when we might be seen by the vet.

Turned out, there was one more person waiting ahead of me and then, we would be "next."

But no, they couldn't possibly tell me or give me even the slightest hint as to what that might translate into in terms of, you know, minutes (or hours) because "you never know" and "it just depends."

This is odd.   I have students drop by my office on a pretty regular basis, and sometimes, there's a backlog and a little line of people waiting to see me.  When that happens, students will often tap on the door and say, "Sorry to interrupt, Professor, but I have class at 4:00.  Do you think you'll be able to meet with me before then?  Because if not, I can come back--I just don't want to wait and then have to leave anyway."

If I handled this the way the ER vet did, I would say, "Well, I'm sorry, but there's just no knowing.  I'm in the middle of a deep intellectual conversation here, and I really can't tell where it might lead--at any minute, it might get even more complex.  So no, I can't tell you if I can get to you by 4:00.  I can't tell you anything really, except that there are 2 people ahead of you, and then you're next."

Or, similarly, if a student asks, "When do you think you'll have the papers graded?"  I will typically say, "I have [X number] to go, so my plan is to have them done by [X date]." 

A less satisfactory (and really rather bizarre) answer would be, "Well, I don't know, and I really can't say.  It pretty much depends on what happens when I read them.  I can't tell you any more than that."

And so, at 11:10 p.m., after spending another 40 minutes alone in the little room that Smokey and I had begun to call "home," I went out to the front desk again and spoke to a different receptionist.  This time, the greeting I got was far less friendly.

She said, "Well, you know, we're busy.  Like any emergency facility generally is, you know...".  This was followed by an exasperated sigh, expelled as she deliberately looked away from me to stare at her computer screen.

Bear in mind that she said (and did) this in the setting of a large, nearly empty waiting room.  There was only one other person waiting, and she didn't have a pet with her.  She was just sitting there, watching TV, so I don't know what her story was--perhaps her pet was currently being treated.   

All I know is, as I glanced around, I began to feel like I was taking part in that bar scene in The Shining.

Only in this case, I kind of knew, you know, that there's really... no one... here.  (That said, God only knows how many of us had been quarantined in little rooms all our own.  In all honesty, I had no way of knowing that exact figure.)

Given that there was only one other car in the parking lot besides mine, though,  I'm going to go out on a limb and say that I suspect that there were only two actual clients (including myself) left at that point.  Even though they still had 3 receptionists working the front desk.

So, I took a deep breath and thought what I always think in such moments: "Do not engage with this personality.  Focus on the situation."

And so I responded: "Yes, I understand that you're busy and I know that you've had a lot of critical cases.  I know that you've been scrambling to catch up from a slew of critical cases earlier in the evening.  But people have, you know, lives, and some of us have to get up early in the morning and do things like... go to work.  I know that Smokey's case isn't critical.  But if you could give me some kind of ballpark figure as to how much longer we're going to have to wait, that's all I'm asking.  At this point, we've been waiting for over 2 hours and it's getting quite late.  Sooner or later, I'm going to have to go home.  That's simply how it is."

[This is classic Rogerian argument-strategy, by the way.  You summarize the "opponent's" point of view, in simple, neutral language, before you offer your own claims.  That way, the person can't say that you "don't understand" or "aren't listening"-- basically, you deprive them of the right to get defensive.  Over the years, I've used it to render many a snarky receptionist more or less helpless.]

Case in point: after I said this, this particular receptionist responded, "Okay, I'll check."  The verb "check" was said in that tone of voice that someone uses when they know they're not supposed to roll their eyes at you, but basically, they're rolling their eyes at you.

So, she "checked" (implicit eye roll).  And for the record, she could give me no indication of how much longer it would be.  15 minutes?  Half hour?  Hour?  Nothing doing.  Can't say, don't know, that's just how it is. 

She said she had "talked to the vets."  These invisible vet-spirits remained completely unseen the entire time I was there.  That also freaked me out--you never saw any  of them, anywhere.  Like, not even in a hallway for a few seconds.   The place was silent and seemingly empty.

As far as the question of time, the vets "couldn't possibly say."  She said that they had been "doing procedures non-stop" all evening.  She said that they said, "Just tell her she's next."  And that was all they could say.

The receptionist, however, had a bit more to say to me.  She said, "You know, I know it looks like there's no one here, but really, it's very busy, and all of these rooms are full."

Okay, that line is straight out of The Shining, I'm pretty sure.

So I stared at her in silence and simply nodded.  When she left, I began bracing myself for the fact that any minute now an axe might begin hacking its way through the closed door and I would have to figure out how to save Smokey and I when someone yelled, "HEEEERRE's JOHNNY!!!"

As I contemplated this, I quietly began putting the top back on Smokey's carrier and bolting it into place.  At 11:30 p.m., I said, "Okay, Smokey, hang tough, little man.  It's go-time.  We're outta here."

I escaped.  The snarky receptionist wasn't at the desk (she was probably upstairs tucking those creepy Identical Twin Girls into bed or running a bath for the Woman in Room 237), so I just cheerfully said, "I'm sorry, but I have to leave.  I just have to."

Which was totally true, at that point.

And so I left.  The next day, at the regular vet's office, I chatted with the receptionist about my experience there, and she said, "Yeah, they're good at what they do, when it comes to handling emergencies, but they're kinda...weird... there, sometimes."

She herself had taken a dog there.  She said that they have a policy that, unless the pet takes a turn for the worse, they will not contact you before 11:00 a.m. if you have to leave a pet overnight.

She said, "And they stick to that, believe you me.  To such an extent that if you call them and ask for a quick update at 9:00 a.m., they will flat-out refuse to give you one.  They will basically scold you for calling."

As I told her, it seems to me like the people who care about their pets shouldn't ever be reprimanded for caring too much about their pets.  Especially by a vet.  Because this is what is really sort of happening there, even though I'm sure that isn't their intention at all.

I suspect all of this is simply the end result of some serious bureaucracy.  "Policies" had to be created at this vet ER because it's a large organization dealing with a lot of crisis-situations and highly emotional animals and people.  So, they came up with a system designed to cope with that and make life easier on the doctors and staff.

I suspect that this self-same bureaucracy has now begun to eat them alive, to such an extent that they're actually behaving in ways that run completely counter to their original purpose.  Receptionists are clearly being trained to respond "by the book" and vets are focused on following triage-protocols, but in the meantime, they're probably losing clients at the rate of about one or more per a day. 

Because I don't think I'm the only one who's ever walked out of there, and I suspect I did it far more calmly and pleasantly than most. 

Because yes, we weren't an emergency-situation.  Very true.  No question.  But what's also true is that it would have taken a vet less than 5 minutes to look at Smokey and send us on our way with an antibiotic.    

This is the downside of triage.  It's a theoretical system designed to function efficiently in crisis situations, but in fact, as an objective system of categorization that is then subjectively interpreted, it is by no means foolproof or fail-safe.    

A triage system is designed to work efficiently and effectively when resources are limited; it's a way of organizing and managing a potentially overwhelming medical demand when available manpower is in short supply.

However, there's been little or no objective scientific research to prove that triage really works as well as it's supposed to (or even that it actually accomplishes what it intends). Critics of current triage protocols charge that, because the system lacks any real scientific or methodological basis, it may end up generating confusion and inefficiency (at best) and actually costing lives (at worst).

One of the main concerns frequently expressed is that standard triage protocols don't incorporate the question of scale.  In a triage system, you adhere to the exact same protocols, regardless of whether you're dealing with 5 people or 5000.

Implementing a triage system when you have an overflowing ER or a major accident or disaster scene might make sense (even though it will still have its drawbacks).

But sticking to a triage protocol when you have only 2 or 3 patients in front of you... well, that's not gonna go so well for anyone involved.

Sooner or later, when faced with questions (or complaints), you're going to be forced to fall back on a kind of medical "authority": I know best, I've assessed your situation, get over it and wait your turn.

That approach probably isn't going to sit all that well with anyone, really, but if I look around and see dozens (or hundreds) of injured, I'm less likely to take offense and more likely to "obey."

But if I look around and see 3 receptionists and only one other client (watching TV), I'm really not going to like being spoken to like that. 

Ultimately, the vet ER created a situation in which I became increasingly nervous and angry and resentful, because I began to feel like, "Okay, I get that we're not critical, but you know, Smokey matters.  Maybe he doesn't really matter to you, because you're all very busy sewing the beak back on a parakeet or something, but he matters to me."

And in this situation, I'm not a helpless "victim." Ironically, because of the triage system, I know that my situation has been tagged "non-critical," so I also know that I may not really need your services at all, actually.

Particularly once I pick up Smokey's chart and read it.  I'm a reader who may very well understand what she's reading and who knows how to look stuff up when she doesn't.  In short,  I got options.

At the end of the day, I'm also someone who is potentially going to help support your practice and recommend you to others, and right now, from what I can see, your waiting room and your parking lot are nearly empty.

So triage-be-damned: you need to think about being a whole lot nicer to me and my kitty.  Because although we may not be "critical," we matter.  

Especially on St. Gertrude's Day.

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Ralph Waldo Emerson once wrote, "Life is short, but there is always time for courtesy."