Diva Las Vegas

[Author's note: I hereby apologize for the gap in posting. I'm fine, just catching up from the trip, my cold, and some extra scheduling. For two weeks in a row my usual writing days were consumed by non-standard scheduling events. With any luck, that's over for a while. Meanwhile, my sincere thanks to all who have inquired after my welfare and offered help should my stock dog (in the air as we speak, on her way home to me) become stranded. That's generous, and much appreciated. It only confirms that "animal people" - whether they currently own animals or not - are the best, warmest, most generous and good-hearted people around. In my Very Humble Opinion, of course - but feel free to join me in this opinion! And now, back to your regularly scheduled programming....]

Sometimes, in my more frustrated moments, I wonder about things. For instance, hardly a week goes by that I don't run smack up against some logical inconsistency that brings me up short, stopping me dead in my tracks and making me wonder: Is it me? Am I expecting too much? Am I the one who's off-step here, while everyone else is on the same page, but one different than the one I'm on?

Sometimes, mind you, it becomes obvious that I AM out of step, and that the clients ARE on the same page, which happens to be one I have not yet turned to.

Meanwhile.... I get it that not everyone processes information the same way, and that some people can't process factual information until their emotional state has been addressed. I get that. I also get it that for such people, pointing out their logical inconsistencies (no matter how gently, diplomatically and carefully it is done) quite often makes them feel picked-on, defensive, insulted. This is a difficult position to be in, as a doctor; not only is logic my personal default position, it is also my job to impart factual information and arrange it in a logical fashion, accessible to the client. It is in addition my job to disabuse them of harmful notions. This is difficult to do, sometimes; it is impossible to overestimate the passion with which an emotional client will cling to a wrong idea if they fall into this group, assuming you have not first disarmed them by addressing their emotional state. Sometimes I have the distinct feeling that the client KNOWS they are clinging to a wrong, mistaken, irrelevant or downright idiotic idea, but they cannot stop: they will cleave to it more and more tightly until someone soothes the emotional child within. Assuming this is even possible, which sometimes it appears not to be.

This is not, strictly speaking, my job, but at times it's the only way to get the job done. I admit I find this kind of poutiness and contrariness tedious, and in some cases both petulant and self-absorbed, although I assume it is largely involuntary and may result from things beyond the client's control. So, in general, I suck it up and do what I have to do. Unfortunately, I don't always recognize that the client is veering that direction until after they've gone all the way to their internal limits and have reached a point where they can't be moved off the position they've staked out, with any amount of coaxing, reason, logic or dynamite.

A case in point: One day a woman comes in to the clinic with a puppy and a poop sample. I am up in the reception area handing over a file and some medication for a dog, while the dog's owner waits patiently for his meds and his bill. The woman is at the reception desk looking antsy; she has in her hand a fecal sample, hermetically sealed (the stool wrapped in a paper towel, inserted into a sealed Ziploc, and then contained in a tightly-closed Tupperware-style container). The receptionists are all tied up with other clients - it being a busy time of day - and my own client and his dog's meds are next, but the woman with the poop says, gesturing with her carefully-sealed stool sample, "Who do I give this to so I can stop holding it?"

Well, okay. There is no chance that the tiniest poop molecule can possibly escape its confinement in the multi-layered bomb-proof arrangement she has created, but some clients are squeamish. Mucus and diarrhea may be MY life, but they certainly aren't EVERYONE'S, so I understand that not everyone has my level of comfort with what might be termed "biological samples". This particular client is extremely pretty, with a beautiful manicure, and an air of someone who has more than the usual degree of fastidiousness. Well, nothing wrong with that, exactly; poop isn't everyone's gig.

"I'll take it," I say, relieving her of the stool sample; she is getting edgy and impatient, so I ask TN, who has taken the meds and chart for my previous client, to quickly look up the antsy woman's number so I can record it on the sample and get it started. My previous client - who, I will point out, was there first - waits patiently and with all evidence of good humor while I slip this small task in ahead of him, and makes no protest.

A few minutes later I am in the room with the antsy client, her husband, her son, and her three small dogs. First we vaccinate her two adult Poms, dogs she informs me are "her babies", and that she cries every time they get shots. She warns me the dogs will scream and struggle when vaccinated, although neither of them do; only one appears to feel the vaccine, and does not protest. The client is shocked and amazed and admiringly asks me if I can give her HER next shot, as I appear able to do it without hurting her sensitive Poms. Then we are on to her puppy, a new acquisition. Amongst other things, this dog has an ear infection. The ear hurts - is in fact quite tender, crusty and raw and swollen inside - and despite the dog's good nature and generally friendly and willing attitude, she ducks away from my hand every time I try, gently, to examine the affected ear. Finally, with patience, I manage to get an ear swab and thence a diagnosis.

I go back into the room and explain that we have to put medication in the ear twice daily. Because the infection has proceeded up the pinna - the "flap" part of the ear, which in this case has small red bumps and some pinpoint scabs on it - I advise her and her husband that in addition to dripping the meds into the cup of the ear, they'll need to smear a little medication over the pinna: anywhere the lesions are. The wife - on the far side of the table from the infected ear, so not getting anything like a up-close view - none the less turns away immediately, her mouth dragged down in a grimace disgust, her eyes squinty with distaste.

"Oh, GOD!" she exclaims loudly, in complete disgust, shuddering. "URGH! That's disgusting!" She can't even watch while I do this extremely minor - and much-appreciated - service for the dog. I can't decide what is so completely ghastly about this; after all, I'm just touching the flap of the ear, not inserting my finger into the the canal, and the lesions on the pinna are in fact pretty dry and non-disgusting, as skin lesions go. The husband looks on, nodding intelligently, closely observing my actions.

"It's not really so bad," I reassure the client. "She's pretty cooperative, and this kind of feels good to her." I go on to detail ear-cleaning instructions.

"Don't tell ME," she says, shuddering again. "Tell THEM. THEY'RE going to have to do that," she says, grimacing at her husband and son.

Looking at her acrylic nails - which are not only meticulously manicured, but long and filed to sharp square tips - I say, "Well, that might be best, actually; as pretty as your nails are, they aren't the best shape for cleaning little bitty ears like this. Her ear really hurts, and we want to make this as easy on her as we can." I think I'm agreeing with the client, but evidently I'm insulting her.

"I'd wear gloves!" she tells me, waspishly, completely missing the point.

"It's not that," I tell her patiently. "These are small ears, and it's hard to get a finger in there when you have long nails, without scratching the ear. If it were a big dog you might have no problem, but with these little ones it's a lot harder." I glance at the husband's hands, which are large and capable, but not the best size for inserting into the canal of a small dog's ear to wipe away debris. "It might be best, based on the size of your hands, to use a Q-tip moistened with the ear cleaner, rather than trying to clean the ear the normal way," I smile at him. "I don't think your finger would fit in there." He smiles back, looking down at his big fingers and the dog's tiny head and evidently seeing my point.

"I'd better clean them before I go back to the Slope," says the husband, musingly.

"I'm not incompetent!" the wife snaps at him. "I do things with my other dogs! I kill animals! I can do stuff!"

Hmm. Maybe it's just me, but are you not the self-same person who could not hold a heavily-sealed packet of poop for five minutes because it grossed you out? Did you not just gag and turn away with extreme grimaces of disgust rather than watch me medicate your dog's ear - a minor and decidedly un-gross event, lasting no more than ten seconds, but still too much for you to bear? Did you or did you not just tell everyone here that you weren't going to treat the dog's ear because it was disgusting and that everyone else in the room was going to be responsible for it, but you refused to be? And maybe I'm missing something here, but what does killing animals (yikes!) have to do with your ability to clean and medicate an ear without hurting the dog?

Urk.

Probably what the client needed me to do was to say that I could see that she was deeply caring and tender hearted and sensitive and so of course we wouldn't expect her to do this and it would be no problem; we'd let her husband do that part and she could handle the cuddling and praise, a team effort with everyone playing to their strengths. Unfortunately, I did not recognize where the owner was going until it was too late, at which time I find it is generally a waste of time to try to jolly them out of it: no matter what you do by then, they will become more and more insulted and self-righteously furious, which solves nothing. At that point the best result is usually to be calm, cheerful and matter-of-fact, because nothing you do will break the owner's tantrum, and most things will just make it worse. As this client is now in full-blown pout mode, I give it up as a bad job, convey the information as factually and unemotionally as possible, and bail out.

Sigh.

Is it me....?