Triage, Night Shifts & The Reality of ER | Dr. Brooke Schampers (@doctor_brooke)

In this episode, Dr. Lottie chats with Dr. Brooke Schampers to discuss emergency veterinary medicine! This has become increasingly popular over the last few years and is something that many new grads are choosing to go into so it’s definitely a topic to cover. They talk about what types of cases a common in ER; if some personalities are better fitted to this work; how to triage patients; and whether ER vets should be performing surgery.

Brooke is based in Australia and went straight into emergency after finding a love for it while on vet school placements. Over a decade later, she received her membership qualification with the Australian and New Zealand College of Veterinary Scientists (MANZCVS) and has found a love for teaching the new generation of vets.

Where to find Brooke:
Instagram: @doctor_brooke

Find us on TikTok & Instagram: @veterinaryvista

Timeline:
00:00 Intro
01:51 Brooke Getting into Vet Med
09:53 What Actually Happens in the ER?
25:44 Juggling Multiple Cases
31:34 Emergency Surgeries
46:46 Triage
58:20 Emotions in Emergency
01:17:06 Who Should Be in ER & How to Get There
01:28:28 Final Qus
01:33:20 Outro


Current Vet is an educational podcast intended for veterinary students, veterinary professionals, and individuals with an interest in veterinary medicine.
All content provided in this podcast and its associated materials is for educational and informational purposes only. It is not intended as, and must not be considered a substitute for, professional veterinary advice, diagnosis, or treatment.

Any clinical cases discussed in this podcast are fictional, and are designed to reflect typical or likely clinical scenarios for educational purposes. They do not represent specific real-life cases, clients, or animals.

While every effort is made to ensure accuracy and alignment with current evidence at the time of publication, veterinary medicine is a rapidly evolving field, and recommendations may change over time.

Creators and Guests

Host

Dr. Lottie Wilkinson

Creator and host of the Current Vet podcast

What is Current Vet?

The podcast that makes veterinary medicine simple.

In each episode, Dr. Lottie breaks down clinical conditions, cases, and concepts across species, focusing on pathophysiology, decision-making, diagnostics, and what actually matters in practice. It’s the kind of context that makes your knowledge finally click.

Every month, we’ll also have honest conversations with guests about the incredible variety of veterinary medicine, what you can do with a vet degree and how to think bigger about your career.

Whether you’re cramming for exams or looking for a soundtrack for your dog walk, Current Vet will make vet med simple

Hello, hello, and welcome back to Current vet This is the podcast that makes veterinary medicine simple. I'm your host, Dr. Lottie, and today we're talking about emergency and critical care. It's a very intense, fast-paced, and emotionally demanding area of vet med. It's also quite popular at the moment. I think it's got quite trendy and maybe a bit romanticized in some areas, despite the fact that it's, it's a lot of pressure, it's a lot of emotional fatigue, it's a lot of responsibility,

but to be fair, having said that, I am hoping to start an emergency job in the next couple of months. So this is actually gonna be me milking our guest for as much information that might help me survive in my new job, and obviously anyone interested in emergency. So today's episode is gonna be all about what ECC is actually like in real life.

We're gonna talk about, you know, triage, stabilization, burnout, building confidence in your job, and then whether emergency is a good fit for everyone. What should we actually know before applying for that position? So to get into all of that, I'm joined by Dr. Brooke Champers, who is an emergency vet from Australia.

You're also incredibly passionate about teaching and supporting younger vets entering the profession. So Brooke, thank you so much for being here.

Thank you so much for having me, Lottie. It's so great to come on and have a chat to you today

Yeah. I'm really excited to get into this. Like I said, I'm, I'm gonna be absolutely, like, hanging on every word, like, trying to get as much advice as possible. But let's start by talking about how you got into vet meds, and then how that, , led you to emergency

Brooke Getting into Vet Med

I mean, I was one of those like classic kids of I wanted to be a vet for as long as I can remember. I grew up reading, you know, Beauty and all of those like animal books. That's what I really gravitated towards. And I think that just set me up with, you know, that's what I was gonna do. And I can't really remember having a second thought about, you know, another career. So my whole schooling of like high school was the goal of, "I'm gonna get into vet school." and I never really deviated from that path. I I was just obsessed with animals

Yeah

And it is the really that classic like obsession that led me into the role. When I reached level 10, grade 10 in Australia, I applied for a vet clinic for a kennel hand job. , And I was essentially like a kennel hand or a junior nurse through, of high school into, you know, when I was in vet school I would do some kennel hand duties and junior nursing duties. You know, prepping kits and scrubbing cages and restraining animals and all of that sort of thing, just to get idea about what this job really entailed. And I don't think I really in those moments- Sat with the owner interactions. I don't think I absorbed a lot of that in those early years because I still wasn't seeing a lot of consultations. I was still very much behind the

Yeah

had a very good idea of what was required to run a GP clinic and what was the, you know, nursing side of things day to day in a GP clinic and what that looked like and what were the cases that were coming through. So by the time I was in vet school, I had already kind of crossed GP off the list. I was like, I loved my experience and, and I loved my time there. But I was like, I just don't think... I had such a fire to get into vet school, and being in GP just didn't light that fire for me. And I was

Really?

going to work and working in GP after I graduate.

For me, that just, it sit right. then I spent most of my vet school trying to figure out what kind of vet I wanted to be and, you know, through the university I went to up in Townsville. We got to do lots and lots of like placements. , And we had to as part of our schooling. So you know, I think we did the most amount of placements across Australia in terms of requirements, and we would do weeks and weeks and weeks in our school holidays So I did everything from like cattle, horses. I did a lot of mixed practice work, I was face down in the mud at 5:00 AM in the morning doing a fetotomy. I was like, "I don't think mixed practice is for me"

This isn't it. Not the one

I don't think I'm, I don't think I'm cut out

Uh

So I crossed mixed practice off the list pretty quick after that. I was like, "Oh God, what else is there?" I, I was like, "I don't know. What else am I gonna do?" 'Cause at that stage I only really had exposure to like mixed practice or GP, and that was it. And I was

I didn't, I was completely unaware of like other areas of vet med that weren't large animal, GP, equine, that's it, Like especially those early placements, specialty was not on my radar
Mm. Absolutely. And I was like, "Oh my goodness." So then one of the nurses that I used to work with back in GP, she had transitioned into working in emergency and I was very, very lucky that this incredible, you know, technically her title is vet technician, but in Australia we use vet nursing as our overarching description.

Right

and she is this absolutely incredible person. and I was telling her about this dilemma that I was having that, you know, I didn't feel like I belonged in mixed practice. I didn't feel like I belonged in

GP. she was like, "Well, let me

chat to my boss and see if I can get you to come do placement at the animal emergency service." and little did I know that her boss was Dr. Gerardo Poli and Dr. Alex Hynes
who the--

Oh my God

who are the,

the GOATs

Yeah

and here in Queensland. And

I was in my

third year of vet school at this point, so

pretty early. I mean, our vet schooling is five

years, so third year in is pretty early to start to do clinical placements. So I walked into emergency and I think from spending 20 minutes in emergency, I was like, "This is, this is what I've been looking for.

This is what I am meant to

do for the

Yeah

and I just had this feeling that I had found... I'd found it. And I didn't really look
back after that. Every single time that I had the opportunity to do any sort of discretionary placement, I would always pick emergency. And I ended up doing essentially
from the time I reached like my third year of vet school through to graduation, I ended
up

totaling six months of extra

work in by the

time I graduated. , I was so obsessed that like I went to the University of Philadelphia to
go work with in their ICU department because I was like, "This is, this is what I'm meant
to do. So I went all the

Yeah

I did some placement at Verge in Brooklyn with, Dr.

DeFazio who she's written, you know, the textbook chapters on neurological
So I just got to meet some absolutely incredible people during that time. , And it's amazing now to look back on the people who I did placement with over in the States and one of the vets is now, she's now a criticalist, which is just absolutely insane

that we were together

and, you know, now she's a big amazing criticalist.

I

think I've been very fortunate in

that it has been a very smooth pathway for me from high

school to vet school through to, you know, finding out what I wanna do. I've been very, very fortunate in that everything, the stars have just for me and there's absolutely lots of hard

work, behind the

Ja

as well.

But, I do think, you know, there's been a little bit of luck on my

side

Yeah. But I was gonna say, it sounds like you put yourself out there a lot, and, like, you went for those opportunities. You, you knew what you wanted to do. so

You went for it and got it. So, there's obviously a lot of, motivation and direction on your part as well.

what was it about GP that you just didn't like?

I think that there

just wasn't enough, you know... And there is variety in GP, I will say that. But for me in vet school, my thought around it was there's just not enough variety and there's not enough and adrenaline going on. And I didn't like that, you know, you could almost...

I didn't like that there were booked

appointments, I think was the biggest thing.

I don't like knowing what's going to come next. I like, I

like the unknown and I like?

the fear in

that and the excitement in that.

So I

think that was the biggest thing,

you know? just don't

Yeah

And the more I learnt about skin, I was like I just don't think this is it for
me

Oh, a dermatologist.

away, as

hated, hated

Really?

in vet school. I was like, "This is, this is not
it."

that did not

Doesn't touch teeth. Yeah.

What Actually Happens in the ER?

So what is the normal kind of day like for
you in ER then?

I think first there's always this big misconception that emergency is like go, go, go,
death everywhere, you know, critical patients. And I think after working in ECC for nine years, you see all of the same cases, and it does get a bit repetitive, and it does get a bit boring. Um, but

it has taken nine

years for me to

probably get

to I think as you would in GP, you see the same... You know, what is normal in GP, you then have

what is normal in ECC. So you'll get a heap of gastro. So much gastro, so
much HGE.

diarrhea

Like, if you can do gastro, you can do fifty percent
of the consults that come through the
door.

And then, you know,

you might sprinkle in a sick HGE every now and again that tries to go septic and tries to die, but that's like in a hundred cases. You know, a lot of foreign body obstructions, a lot of fluted cats, a lot of, you know, obstructed and non-obstructed
FIC cases. A lot of seizures, intoxications, distress and congestive heart
failure is pretty
common.

And a lot of like different types of traumas, so wounds, lacerations, hit by cars,

yeah

They're kind of the other subset, but that's probably ninety percent of the
cases

Yeah

sprinkle in a GDV every now and again, a splenectomy every now and again. I mean, we see a lot of heme abdomens, but they don't always go to surgery.

Sure

so, you know, what is normal in

GP, you flip that and you've got those really normal run-of-the-mill cases in emergency and as long as you get used to that normal. I don't think it's necessarily any more difficult or any more challenging than, you know, what you would find in GP.

a

It's just-- And like a lot of, you know, for obvious reasons being that most people go into GP, a lot of what you're taught at uni is kind of the GP way, and then going into emergency is just a different learning curve. But

It's not that people can't do it, it's just not necessarily what you've been taught straight away at university, so you don't have as much of that, that basis there

Yeah, I think so. And I think that the flip side, you know, from

talking to GP friends, they're like, "Oh, it's, trying to convince people to do workups blood tests and things like that is it might be a process over a couple of consults to eventually get them to see the point of, you know, doing that dental or doing that yearly blood work."

It's like cumulative effort and repetition. Whereas in

emergency, people don't come in because they want to. They

come into emergency because they have to. So their mindset around what needs to be done is already really different, and they're coming into

emergency because they have a feeling it's gonna be expensive. So mentally, they're already prepped to spend money. They're here because they know that their pet is unwell most of the time. And when

your pet is unwell, they kind of assume some
sort of testing might

need to

they're already mentally primed for those things. So when you deliver an estimate and you go, "Oh, I wanna do blood work, and that's gonna be four hundred dollars," yes is so much
easier compared to how it would be in GP.

So

I that that is something

Ja

as emergency vets we don't necessarily appreciate as much because we might look at a history and go, "Oh, why didn't they do bloods?" But chances are the owner said no because they weren't mentally primed already that diagnostics

so I think that that makes it a lot easier in emergency.

The biggest shift, I think, in emergency between GP you know, an emergency consultation really does hinge on owner communication again, owners don't want to be in emergency. They're there because it's a time pressure and their pet is really unwell, and they know it's gonna be expensive. So already they're stressed, worried, and they're bracing themselves for a big bill, which again puts a little bit more pressure on

your owner communication.

So the biggest difference, I would say, is the fact that you have to learn to build trust rapidly within, you know, a half an hour consult. You have to be good at delivering estimates in a calm, clear way that you know you're advocating for the pet, but you're also finding that financial balance, and you're being that support person during that very difficult time.

So if you're a person who struggles with owner communication and struggles with, know, dealing with moments and then conveying that to owners, that is the one thing to get good at before you go into emergency, is why, you know, a lot of vet students will ask me, "Oh, should I,

you know, spend a year in GP first or should I go straight into emergency?" I would always advocate for a year in GP unless you find an emergency clinic that you absolutely adore and you know will give you really good support and really good consult training.

Do a year in

GP first

that owner

Okay

and that practice that you get in s- discussing stable cases is invaluable. And being able to talk to owners is the number one skill that you need to have if you come into emergency
medicine

Have you got any tips or things that you learned that really helped you for the communication learning that you can share?

I think the biggest thing that I found, and I mean I was very lucky in my internship in that we were so supported and we had very specific, you know, consultation training around how to talk to owners. I spent the first three months going into consults and listening to the vets talk before I would, before I was even kind of allowed to do my own consults. So I would absorb the way other emergency vets spoke,

and then molded the way I talk off, you know, what I would hear in consultations with them. So I would say be a sponge. If you can listen to other

vets consult in your first, you know, week or month that you're in an emergency practice, do it,

because there

is such an art of the consultation in emergency to make owners feel supported, but also, directing the conversation in whatever direction it might need to go

in, owner's finances

as well. And you, do have the time or the, capacity to do some training around how to talk to owners, I think putting ego aside and, you know, learning more, is really important. So, know, my colleague Talita and I, we talk a lot about owner communication in our monthly mentoring sessions, and we've got some resources up online about how to like run a consultation and do it well. So seeking out that sort of thing. The Vet Vault Podcast has some great free resources on, you know, with owners and things like that. So, I think putting ego aside and learning more, just because you might have been in GP for a couple of years and you're like, "Oh, I know how to talk to owners," that you can always do more, you can

always

Yeah

within that, I think if you ever have an owner communication experience that doesn't necessarily go your way, again, putting ego aside and reflecting back on that conversation and going, "Could I have communicated that better?" I once had a lady take her respiratory distress, cat home AMA, and instead of...

I mean, I was very upset at that after I had five minutes to kind of decompress, I sat and reflected back on that conversation to go,

"Should I have communicated that in a different way? Did I communicate the concerns and the gravity in an optimal fashion? Did I miss picking up on what her biggest concerns was?"

You know, did, how did our wires get so crossed there that she elected to take
her I think, again, reflecting back on those conversations, and a lot of the time, you know, a lot of owner Anger and frustration, we c- we have almost complete control over that, and I think that would make a lot of vets upset to hear that. how we communicate, I think maybe 10 to 20% is the owner. The other 70 to 80% is how we deliver that information and how we communicate. what expectations have we set? information have we given them? Have we given them informed consent so that they can decline diagnostics appropriately? All of that comes down to us, and I think it's so important that we reflect back on those owner conversations that we have without

ego and with a lot of empathy and a lot of compassion. Because I'll often hear interns go, "Oh, they're just-- they're so stupid. They're not listening to me. I don't understand what they don't get about, you know, their, their dog.

It can't breed, so it has to stay here. How do they not get that?" I'm like, "I get that you're frustrated, but this is the hardest day of someone's life. If they're not understanding what you're saying, that's a you problem. You need to find another way to communicate appropriately with those owners." Because obviously, you know, you can deliver the same speech 100 times and, 100 of those owners will get it.

But in that one time that that owner doesn't understand the way that you're communicating it, you need to pivot and find a different way. and I think consultations with curiosity and asking why, you know, vocalizing their emotions that they're feeling makes such a difference to getting owners on the same page. And I think that that is the number one consultation tip that I would have

for any veterinarian is if you feel that the owner is getting stressed or upset, point that out. "Hey, I can tell that this is really hard for you. Do you wanna just give
me a bit of an idea about, you know, where you're at or what's the

problem I

Yeah

And that phrase is enough to sometimes get owners back on the same page because they understand that you understand how they're feeling,

And a lot of the time there's,

maybe a stress that

you completely don't know about until you ask. Like I've, I've had some cases where
the owner had a

previous pet die under anesthesia

and they're now really panicked about you mentioning sedation and you have no idea that that's gonna be a kind of trigger

Yeah
because
don't know them.

And especially in emergency

where basically every client's a new client, you don't really get repeat clients in emergency and you, you're just not gonna know that. Or like,

you know, they also had another pet with cancer and it's the same type and it's bringing up all of these memories and

you don't know until you ask.

And like you say, it's probably one of the worst days of their life and
emotions are high. And even if you're saying all the right things, they may not be hearing you at all because you're just so in a- another world when you're in that head space that sometimes it doesn't matter what you say or how you say it, it's never gonna go through
Yeah, 100%. And I mean, I think about when my dog's unwell, if he so much as has a vomit, I am a puddle. So I don't know sometimes how owners are so calm in emergencies, because if it was my dog, I would be an absolute wreck. So I sometimes, if I'm
struggling to put myself in a pet owner's

mindset, I think about

if it was my own dog and how I would be feeling. and

I would be horrified. So I don't know I think sometimes remembering that, you know, as pet owners, we would probably be in the exact same situation

Yeah. No, definitely. Are there cases that you've particularly learned from where you're like, "Okay, this was absolutely

something that people did not respond well to, or like some real learning cases for you in that, communication area?

I mean, I think the cases that are always really challenging and really hard for people to wrap their head around is gonna be the cases that things happen really suddenly. And for some reason, I find that respiratory distress cats that are usually... I mean, I used to think respiratory distress cats were hard, but turns out 99% of the time it's heart failure. Um, so that makes things a lot easier. But,

respiratory
distressed cats and heart failure in cats for some reason is really hard for
owners to wrap their heads around. And out of the cases that will go home out of the very few handful that
I've had, they've always been respiratory
distressed heart failure

right

think it's because it happens so it's so

silent, there are no warning signs. And sometimes the cats will be very young, you know, two to five years old. So owners just can't seem to wrap their heads around
that, you know, their cat's in heart failure. And because we're the people giving them that news, they react in anger or frustration, or they just simply don't believe us.

Ja

Sometimes you can talk them around and you can show them, you know, the ultrasound that you're seeing and things like that. But sometimes owners will just, you know, completely go, "I don't believe what you're saying," because ultimately you're giving them the decision of... And the hard thing

is there's only two options.

If the cat is oxygen dependent, your two options are you hospitalize and you spend $1,500 to $2,000 in the next 12 hours, or you euthanize. And such a binary option, again, gives them a lot of anger and a lot of stress and a lot of fear. and I think that distrust because you haven't had time to build up that trust, the fact that they might not believe you, combine that with the huge bill,

all of that just leads to, you know, a very unfortunate outcome for the pet. So yeah, I find those cases always very

challenging. And again, those owners, the reason why they don't wanna go ahead with treatment, 9 times out of 10, it comes down to cost, because they don't have the money to admit, they don't believe you enough to put the pet down

then ultimately

they decide the best case scenario is to take their pet home. So those cases I find can be really challenging.

And then that is the 10% where, you know, no matter how well you communicate, they've already made up their mind

they

Yeah

put their pet to sleep. And you, you can't change their mind around that. So I would say they're probably the really, really challenging cases

Juggling Multiple Cases

And when you have, multiple cases coming in And you, have big emotional ones, or you have ones that need lots of workups, how are you balancing all of these different cases at the same time and making sure that you're giving that. attention, giving good communication to all of your clients all at the same time?

Oh, I mean, it's-- I think that

this is a balance that you're probably never ever gonna perfect, because sometimes cases will just, you know, change, change direction while you're in the middle of them. But in my mind, I try to keep a big case and a small

case going at the same time if we're really that busy. So a big case might be, you know, a vomiting diarrhea patient that needs to be admitted to hospital, but then

there might be an emesis case waiting. So I'll pick up a big case and a small case. I'll go in, I'll go get the emesis case, bring it out the back, give them the, apomorphine injection, ask a nurse to monitor, and then I'll go out and I'll start the consult on

the vomiting and diarrhea case. Tell them their pet, their pet needs to be admitted to hospital or they can take it home after some outpatient imaging. Give them five, ten minutes to have a think about it, then I'll go back, see how my emesis case is doing, type it, bill it, go update the owner that, yes, your pet's, you know, we've successfully removed the sock. We're just gonna keep an eye on it for another five, ten minutes and then, you know, I'll bring it-- I'll bring them out so that you can go home. In the meantime, I'll go back in and check, you know, are we admitting to hospital? Great, we are. And then I'll flip between the two. I really try not to be in two big consults at once.

So, you know, a collapsed dog plus a respiratory distressed cat. I'll really try to, give that to another vet if possible. Otherwise, just tag teaming two consults and I guess not getting stuck in the room is a big one. You don't need to be in the room while they need to, discuss it over with their partner or while they're arguing about money.

And not saying, "Oh look, I'm gonna... I have to go." Being like, "Oh, I'm just gonna go check on their progress. I've just got another unwell

patient, so I just need to check in on how they're doing, but I'll be back in five minutes." So making

sure that we are using our time wisely and we're not just sitting in the room for ten
minutes up

Yeah.

decision. But I think keeping in mind one big case, one small case is probably the easiest
way

be as efficient as possible without overloading yourself
and doing records as you go rather than like,
I'll remember this for later," and then
five hours later when you've had ten emergencies come in and you've forgotten everything, then

yeah

I think the biggest thing is even if you just spend one to two minutes typing the history, everything else you can come back and do later. But even the aspect of like typing the history between consults will make the world of difference because physical exam, know, your assessment problem list in your plan pretty quick. So the
history and the owner communication side of things is the hardest part. And, you know, if you want to use AI note typing, apps and
things like that, do it. I'm still a little bit of a dinosaur in that, you know, sometimes I will use
them, but I just have templates that I copy
and and

I edit, which for me

works.

But yeah, I think as long as you get the history typed mentally, that's so much nicer to open that, you know, record after you, you've done hours of

consulting "Oh my God, at least I've

Yeah. And you've got something to refer back to at least even if you haven't got notes for everything,

you've got something to jog your memory on what that, case was. Do you still take notes? I feel like this is such a,

People either think it's fine or they think it's really rude, but do you like type notes in the consult?

'Cause I always do that, and I've had some people be like, "You're not giving 100%
yeah, it

depends. If it's, oh, I've already examined the patient out in the treatment area and they have a very long, complicated history and they've been seen by internal
medicine a million times, I will type notes in those consults. If I've already examined the animal, then I'll bring up its history And I'll be typing as I'm going,
referring back to its old history and things like
that. But nine times out of 10,

the way I consult, and again, this

comes down to like my really early consultation training that I had, is that I will always, sit, I will

pull my chair out

away from behind the desk. I will sit '90 degrees to the owner. I will sit down. I will have a clipboard and a piece of paper and I will write what they're saying.

Right

that simple act of sitting

down from the desk makes owners perceive that it's, you know, you don't have that physical barrier,

build

Yeah

Sitting down gives the owner the illusion that you're taking the
time because they've

Yeah

comparisons in people where, you've stood up and spoken to them versus you've sat down. And although you spent the exact same amount of time with them, the people who sat down felt , that the vet was there with them

longer or the exact,

um, data, but sitting down gives that illusion.

And then I find writing allows me to listen to the owners a little bit better. yeah,
that's what I do.

And I mean, sure, if that's gonna cost me an extra half an hour typing notes later, then kind of so be it. It's such a habit for me now that, I I don't think I can break it anytime
soon.

Emergency Surgeries

you mentioned about,

you know, like having GDVs and those kind of surgical cases and splenectomies and stuff.
Are you

performing surgeries as an emergency vet, and
how much of your kind of caseload is surgical,

I mean, in Australia and in the practices that I've worked at, nine times out of 10 it's the emergency vets performing the emergency surgeries. That being said, over my working in ECC, going from a hospital that does not have access to specialist surgeons overnight to working at a hospital that does, I know what my preference is now.

And turns out that there are very few emergency surgeries. If you diagnose a foreign body, chances are

you do not have to take that foreign body to surgery overnight. I've definitely sat on
hundreds of foreign bodies, you know, diagnosed it at 7:00 PM, and we wait for the surgical team to come in the next day and cut it, and nine times out of 10 it is absolutely fine. So my preference now is that I do not cut things that can

wait, it can

Fine

a specialist surgeon because we're in a practice where cost-wise it's not that much different at the moment. So the price of cutting overnight versus cutting with a specialist, cutting it with a specialist that's gonna do a better,

quicker I know

Yeah

want as a pet owner.

Ja

so the things that I do cut are those GDVs, splenectomies that fail to stabilize with blood and plasma, because nine times out of 10, again, we'd like to try to get a CT before going to splenectomy. So you know,

that's, I'm only cutting it if I really have to. Septic are another one, and it depends on how sick the septic abdomen is

because again, I'm at a practice at the moment where if it's during the week we do not have an on-call surgeon.

and

you know, potentially there is a surgeon that we could if we really need to, and we could beg them to come in, but it also has massive flow-on effects to their day the
next

day 'cause have to work.

Yeah

so if it's a stable septic abdomen and I'm diagnosing it at 4:00 AM, that will wait till the next day.

You know, that'll wait six hours until a surgeon is in the building that is ultimately, I think, better for the patient than me going in and finding something that maybe I can't fix
then what? I have

Yeah

back up and then wait for the next day.

That's not in the patient's best interest. So I think that it's a very fine line.

And I mean, the- that means that

the cases that I do cut are really sick and really unstable, and it's really high pressure, and I don't enjoy

it. be the first

person

Yeah

like, I really don't

like going to surgery. Splenectomies and cesareans are probably the only two that I genuinely enjoy.

And it's weird because I came from a very heavy surgery background in the first emergency hospital that I worked at. and at

AES we used to cut everything. And I cut almost 50 ex laps in my like first year of practice. huge surgical

load. Huge. But again, that reflected, I think the caseload that we
were seeing too.

Like we had so many intra-abdominal dog attacks. We would cut thoracotomies because they were dog attacks, like huge surgical cases. again, we had incredible surgical support as well. So it's not just vets going rogue and

cutting

Going in blind and yeah

We were going in with, know, vets who had 20 plus years of surgical experience who we could call and then they would come in and help us cut those cases. Or you would have-- you would always have a senior emergency vet on with you no matter what shift. And those vets would

always be very well versed in

surgery. So

now working in the practice I'm at, we don't have that surgical support. So I think I'm
reluctant. I, I have a rule where I won't cut things that I can't fix, because I just have a very healthy respect for what's

going on
in abdomen.

Yeah.

and I know my

Yeah.

I'm always happy to try, but that
will be a conversation with the owner at
the end So I

don't know. I think it's, uh, it's hard. It's very easy to,
easy to be brave and cut things when you have support.
if you have that

Yeah

such a huge advocate for going in and, you know, doing what you need to
do. don't have that

Yeah

I think the worst thing that you can do is open that abdomen. unless it's like a GDV or a spleen or they're gonna die if you don't go in like a mesenteric torsion, or an intussusception, like if time genuinely changes prognosis, then have to open that abdomen. But if time doesn't necessarily impact prognosis

or it's only gonna be six hours until

there's a surgeon in the

building, then I think we really need to weigh up our options, put our ego aside and
wait for senior support. And that doesn't necessarily have to be a specialist.
There are brilliant vets out there who are not

specialist

Ja. Ja, ja

at what they do. but I think having a very healthy respect for the abdomen and questioning whether we're the best person to cut as emergency vets is an important responsibility that
The biggest job as emergency vets is getting good at identifying

what surgery.

And I think that that takes time and experience, but I think being aware of, you know, what a mesenteric torsion looks

like and how to differentiate that from a foreign body and having enough belief in yourself that you are making the right decision

and knowing what a surgical emergency looks like is probably the most valuable skill to start to gain. Rather than being aware of, how to do a GDV surgery, I think the decisions that lead you to decide to take that patient to surgery is potentially even more important
What are your thoughts on,

Say

you've got a surgical case that can wait till the next morning, but you don't have the surgeons there

coming in

to come and cut it,

but they could be a couple of hours car drive, for example, like if you're more rurally located,

would you then advocate for,

, ER vets to be doing those surgeries and to be going in those kind of situations?

Or do you think like

basically s- surgical specialists or experienced surgeons need to be doing

most of these cases?

I think first and

foremost, I think it comes down to the time of day., Because what we know from studies is that surgeries done, and I... essentially done after midnight have a worse prognosis than surgeries done during the day.

And that's 'cause people are tired and

because people are tired. , And I think about the amount of foreign bodies that I would cut at four AM in the morning.

And I cringe at the thought of doing that now. I would never open a stable foreign body at four AM, in the morning now, because I just don't need to. They can be stabilized for the next emergency vet. You know, particularly during the weekends, we wouldn't call in a surgeon to cut a foreign body on the weekend. So if I'm cutting a foreign body at
four AM, I'm not doing my job very well, I don't think. And you know, I think emergency vets and GP vets are very good at what they do, and if you're comfortable doing those surgeries, great, cut it. But just don't

do it at four AM in the morning if you don't have

to. and

Yeah

surgical emergencies where We just don't have a choice. We have to open the abdomen. mean, I cut a splenectomy at thirty the other day because it just wouldn't stabilize, and I was like, "This dog is gonna be dead before nine

AM this

Yeah

So I cut it because I had to, and you know, and a live dog is better
of the day.

Yeah

I think that we get very... And I think particularly now, we get so stuck in this lane of like, oh, you know, you have to be a specialist in order to cut those surgeries, and I think that's really dangerous for pets. And it's dangerous for owners because if they just don't have the money or they can't

do that drive and that sort of thing? So I think as long

as you have surgical support or you've spoken to the owners and they are willing to give it a go and you're willing to give it a go everybody is on the same page, cut the abdomen,
Sure.

I think everyone has to be on the same

page. if you've never

yeah

you know... And if you've never done a GDV before and owners can't afford to drive, two hours to a specialist hospital and that dog won't be stable enough to drive to a specialist hospital, your job to open the abdomen. I think it's just finding that balance and having that discussion with the owners. I mean, you think back to like 10, 20 years ago where we didn't really have the same amount of specialist surgeons that we did. Even my best friend when she was in GP you know, reasonably rural in a small town, her first GDV was she had a textbook next to her at 2:00 AM in the morning. She didn't have anyone else to call. The dog went fine. She was a new grad, but that's what we did. And I feel like it's only recently that there's just been this huge shift of new grads who will not cut. And I also don't know if though that's our fault in this profession for shaming vets who give it a go.

I feel like there's a lot of, because of the push in specialty, and I know this is kind of the case in the UK obviously, I'm not sure

exactly how it is in the rest of the world, but there has absolutely been a lot of corporate acquiring specialist practices and GP practices. And then, there are more and more specialists popping up as well.

A lot of people are going down that, internship, residency route, which is great, but they're a lot more expensive. But then I think a lot of what's happening in the UK is the GP practices then have an easier route into the specialty because it's owned by the same overarching corporate, that those cases get pushed into referral.

So then they're not dealing with a lot of those cases, so then they're not as confident. And then obviously students and new grads coming into these roles are then like, "Oh, well, you know, this is above basics. It's above what we do, refer it." So then no one coming into the practice is learning these skills and learning those surgeries, and it's just,

we just refer those cases.

That's what we do.

And I think that has become a lot more common, especially with the, increase of corporate-owned practices and corporate-owned hospitals.

'Cause also for the corporate,
you can get more money for the same surgery

like,

it's the same to them. Like, the surgery happens or it doesn't happen.

They get more money if a specialist does it.

They don't get as much if it's done at GP, which you know, might be controversial to say, but I think there is a little bit of that element as well.

Yeah

I think so. And I think the, the other thing is like vet med is starting to model human medicine, which is not necessarily a bad thing. But I think the biggest difference is that Pets are not small humans, and

there's a limit financially for pets. Whereas, I mean, in Australia and the UK, there's NHS, there's Medicare here. So having a lack of funds isn't necessarily a to healthcare in human medicine. So sure, you can still go see a specialist and it might not cost you as much. So I mean, and I think about this vet that I was watching on social media, and she managed a colonic torsion, and she's an emergency vet, and she was sharing this case and sharing how well it went,

and she got so much flack from people saying, "Why did you do that surgery?" And she was like, "Well, the owner didn't have money for specialists. I'd read up on it. I was comfortable... Not comfortable doing the procedure, but I felt confident enough to do the procedure. Why wouldn't I cut that surgery?" And I think that that's exactly right. I think that if the owners are on board, they've declined specialist referral or specialist referral isn't available, and you have done your due diligence and you've appropriately
researched that procedure and you've made the decision to go into surgery, I think all of that is completely and absolutely fine, and I think that's what we should be
doing. ,

Yeah

and even if your support is a textbook, like, I don't know, we all have to learn somewhere.
question, like, with that access to, you know, specialists, aren't we leveraging that educational system more? Why aren't corporates building into the fact that, great, you have access to a specialist

surgeon, go spend a week with a specialist shadowing their procedures.

You know,
Yeah

we can leverage that system so much better. And I mean, even in the practice that I work at, if the surgeons are cutting a foreign body and I don't have anything on, I'm in there like, "What's going on? What are you doing?"

Don't mind me

"Don't mind me, just watching in the background." Because, yeah, I wanna stay up to date.
I watched a pyo the other day, because one of the junior vets was cutting a pyo, and I hate pyos. Hate them

with a passion. So I stood there and I just watched her, and I kind of brushed up on my skills doing that. The Vet Success Academy, which is one of Jurado's, websites,
incredible videos of him actually doing the surgeries, and

I brush up on them if I'm going into like, that I've ever had to, thank God, but a resection and anastomosis.

I'll re-watch that

every six months just to kind of-

fresh in
my mind in case I might
need and

Yeah

done two in my career, but God, I'm sure

one

There's so much out there that

Is, is picking the case.

Yeah.

Picking the case, picking the owner.

informed consent

yeah, I think

And

Yeah

the educational, you know, support that you have around you, and because it's not there written out on paper, get a bit creative and find it and seek it.

Triage

I wanna talk a bit about

your kind of case approach,

so say you've got

a case walked in the door, you don't have any history, you have nothing. What is your initial triage approach, and how do you approach that case

when it comes in?

this is probably the biggest thing that I will tell people going into emergency, is that
it's not rocket science what

we do. You go back to your physical exam, you go back to your ABCs. A, airway. Does it have a patent airway? B, breathing. How is it breathing? It's breathing like shit, give it oxygen. Easy peasy.

C, listen to the heart. Do you

hear a massive heart murmur, and it's breathing
like shit? Great. It's probably congestive heart failure.

or is it tachycardic?

Then you go back to

your, profusion parameters in your physical exam.

Is this patient in shock, yes or no? is it in shock? Well, it's either
gonna be, chances are something in

its abdomen is causing it to be in shock. Check its heart, and, has it had ongoing losses through vomiting and diarrhea? So then the next tool that you're using beyond your physical exam is the ultrasound. And again, ultrasound doesn't have to be hard and scary, but think everyone should be able to use an ultrasound probe and look for fluid around the lungs, fluid around the heart, and fluid in the abdomen. Because if you can find fluid, that will solve ninety-nine percent of cases, I think. and then after that, even if you don't have a blood gas, using at least glucose and electrolytes, ideally lactate as well, and I wouldn't be able to function as an emergency vet without lactate. Using those markers again to help you figure out what's going on with the patient. And at the end of the day, you're asking the patient questions, and then they're giving you the answer. So is this patient in shock, yes or no? Look at their profusion parameters. If their profusion parameters are normal, they're probably not in shock. Are they dehydrated, though, yes or no? If they are, great, you pick a rehydration rate of fluids. Are they in pain, yes or no? If they are in pain, the safest drug to
use is probably gonna be an opioid Give it a low-dose opioid, and then figure it out from there. And if there's free fluid tap it, and chances are it'll give you an answer.

Yeah

I don't know. I think always just going back to the basics of your physical exam, relying on ultrasound hugely in emergency will solve a lot of the problems for you. And then if you can sprinkle in a blood gas or at least electrolytes

and glucose, get you 95% of the way there. And then you decide which ones you wanna run bloods on or which ones you need to do X-rays for.

But it's only a small

percentage of

patients that I'm, you know, really needing to do those in the
first hour

Yeah. following those strands that you're picking up from a, a physical exam, basically
Yeah, exactly. And then you add the history on top of that, and chances are you've already got a pretty good idea

as to

Yeah.

an old

Yeah

cat,

It's gonna be kidneys until proven otherwise. So

you just,

Yeah

things do happen commonly and yes, there are zebras in clinical practice, but chances are, it's gonna be the common things that you'll see most of the

time

say I'm not an emergency vet, I'm a GP vet on, on call,

or just something has come into the practice as an emergency. What are the top things that we should really be comfortable with?

I think the, best thing that vets can get good at, regardless of you- if you're in GP or emergency, is

knowing what a sick patient looks like. Because I think a lot of the time when I'm getting referrals from GPs, I'm like, "Oh my God, this, this is seriously unwell," and maybe the gravity of that hasn't been identified. it's not GP's fault because they don't look at sick
patients, sick, patients

very often. A really critically

unwell patient to me, yes, they might walk in, but

they might have injected mucus membranes. might have a slightly low temperature, which is weird. They might be borderline tachycardic, and they might have a tense abdomen. That to me is an absolute disaster. I'm like, " that patient's septic Injected gums, mild tachycardia, slightly low temperature that's already showing it's starting to decompensate. That makes me incredibly uncomfortable. And you add in a normal glucose, terrifying a normal glucose in a sick patient is abnormal.

When we're stressed, we should release cortisol. Cortisol should spike our glucose, and you should have a stress hypoglycemia. So if you a really unwell patient in front of you and it's got a normal glucose, that in itself is and then again, just picking up on like profusion parameters and knowing what's a normal profusion parameter is probably the most important thing because if your patient is showing SIRS criteria or is showing abnormal profusion parameters and you have a very unwell patient in front of you, and that patient should not be going home. I think that's the other question that is so important in emergency is job is to identify those patients. And I say this to owners, I'm like, "My job tonight is purely just to figure out if it's safe

for your pet to go home if that's what you want to do." So unless your pet can convince me that they're safe to go home, I'm going to recommend admission to hospital, which is where using the ultrasound comes in and any patient that has free fluid, again, massive red flag that there is something

So

Yeah

whatever tools you need to, to find out how sick this patient is, is absolutely essential. And glucose, lactate, free fluid, and profusion parameters will tell you ninety-nine percent of the time needs to happen. And then if you can sprinkle those skills in on top by trying to, again, you know, nine times out of ten I'm trying to rule in or out, does this dog have a foreign body

and can I safely give it maropitant and send it home or do I need to admit it to hospital? Because amount of foreign bodies that I've seen perf because it's been given maropitant,
I've kind of lost

Yeah

So I am so anti-maropitant as like a test.

it vomits

Yeah

bring it back 'cause it's definitely got a foreign body. I think that's my most hated saying.
and I completely appreciate that, you know, sure, some owners can't afford diagnostics and that in itself is a valuable diagnostic test.

But

shouldn't be the go-to

It shouldn't be the go-to, and if we can use ultrasound help guide us in that decision-making, an AFAST should be cheaper than an X-ray. And all we're looking for on AFAST is, do we have a dilated stomach? not hard to find the stomach. You go where the xiphoid is, and you hold your probe on the midline, and you will find the stomach. is the stomach big is it

small? If the stomach is non-dilated and small, chances are it doesn't have a huge
obstructed foreign body. If the stomach is big, okay, that's already one cross that this patient gets. Then I move my probe down to the umbilicus. Again, we all know where the umbilicus is, and if my intestines are dilated, again, that's an
indicator that there is a

foreign body there.

If my intestines are non-dilated, Small stomach, non-dilated intestines, no free fluid, have a maropitant injection and go home. If I have a large stomach, dilated intestines, and free fluid, oh, you are getting admitted to

or if there's even no

free fluid but we've got dilated stomach, dilated intestines, I'm having, again, informed consent and an informed conversation with the owners of, "Your dog has indicators of a foreign body obstruction.

It's not diagnostic. I am not a specialist. It could just be really bad

gastro,

Hmm.

findings have made me anxious enough that I cannot safely rule it out. would you like maropitant and would you like to go home? Would you like ondansetron because it's not going to cover up a foreign body?"

Because maropitant cover up a foreign body. "Or would you like to be admitted to hospital for

imaging and plus or minus surgery if that's what's indicated?" So again, we just need to figure out is this patient safe to go home or not. And I think being confident in using AFAST skills, is the most valuable thing that you can do as a

Yeah.

and you just think going to a course or doing s- extra training in ultrasound is gonna be the best way to

learn?

or if you have access to an ultrasound, ask your boss, "Can I just do this as an extension of a physical exam? Can we have it included in the consultation price while I'm still learning so that I can get used to what normal looks like?" Because if you ultrasound 100 normal stomachs, the moment you put the probe on and you see an abnormal stomach, that in itself is super valuable. There's some really incredible resources online, like just on YouTube about how

to perform an A-fast and a T-fast, so as long as you get used to what's normal,
you know, you will

Yeah

abnormal and you might not know what to do with abnormal, but at least that tells you you need to admit the patient to

hospital

not recommending they go home if you're like, "Oh, this doesn't look right"? "

like,

Yeah

looks weird," then should admit. I mean, the other morning we ultrasounded a dog's, and its liver looked weird. was like, "It's vomiting and its liver looks odd on ultrasound. I have no idea what's going on. But, you know, I think we should probably admit it because on the off chance that these hyperechoic dots that I can see is actually a liver abscess, doesn't look like a normal liver abscess. But if it is and I send it home and it's about to develop a raging septic abdomen, it's not safe."

So we admitted it to hospital for X-rays to look for free gas. Turns out it had all of this weird like mineralization within its liver and I was like, "That's beyond my pay grade. Needs to go. We need specialist

advice on this." again, I'm just trying to answer that question, yes or no, is

this home?

And in that case, the answer was no, something is weird here, so let's do further
diagnostics. So let's admit this

patient to hospital. And the owner was happy to do that, which is great. And if they're not happy to do that, they can absolutely take their pet home.

But again, it's all about informed

Emotions in Emergency

So a lot of cases in emergency as well have

a lot of emotion from, or from, for you as well. You can have sudden euthanasias if the owner wasn't expecting it or that, they come in for vomiting, diarrhea, and
they found out it's a much worse

diagnosis than they were expecting. You know, the financial conversations, stress around those.

I've had some cases where the owner isn't even there and the dog sitter or the dog walker is bringing the pet in, which can be really tricky. They're on the phone, they're trying to get a hold of them.

And then you have

long shifts or night shifts. There's, there's so many ways it can be really

draining.

do you think you've

got quite good at dealing with the emotions in those situations and

knowing how to process them?

yes and no. I think over time affects you lessons for sure. And you know, I wouldn't say I've necessarily become hardened, but I think I just got better at compartmentalizing. You know, that ultimately a lot of the decisions that are made are beyond my control. And just because, would like to continue treating that patient and that owner has elected to say goodbye, it's not my decision. so getting good at letting go of, letting go of the things that help future cases, I think is really important. So on that respiratory distress cat that went home AMA and thinking about it at home and thinking about it dying and thinking about how stressed and sad that pet might be, not helpful. Has absolutely no value to the next patient that I'm gonna see. So I put a very firm line in my brain of, we're not gonna think about that. It has absolutely no benefit to the next patient. Am I gonna reflect on that owner conversation and make sure I did my job there? Absolutely. But I'm absolutely not allowed to dwell on that case, and I tell my interns, I'm like, "Have a filing cabinet in your brain and put that case in your sad box close that box and close that loop and move on."

And I think I've just gotten better at that over time.

And I

mean, there's absolutely cases that will break my heart. A couple of years ago I had three fake cats back to back that all got euthanized,

and that was

Oof.

first half an hour of my shift. And I was like, "Oh," like, "I'm

done. a

This is a bad day.

I'm done.

Oh

bad day." So like, I think there's days like that that you absolutely cannot be prepared for, and I just turned around to my team and said, give me any more euthanasias tonight. Someone else can do them." Again, we're very lucky that there is another vet in the building, so I can defer those cases if I need to, and not everyone has that chance. And I just said to them, I was like, "I can't really take any more heavy conversations tonight because I've... That's my quota.

done."

Yeah

And I don't know, there's those cases that you get really emotionally invested in because we care, we should be getting emotionally invested in those cases
'cause it would be weird if we didn't But I don't know.

I think it's just something that's progressive and you just have
to think about, this benefiting me thinking on these cases, or is this sending me into a spiral? And if it's sending you into a spiral, close the loop, talk rationally through that case, talk to someone, debrief with someone about it, and then tell your brain, " I give myself permission to rest on this.

I'm closing the loop, I'm putting it in the box, and I'm moving on," and you do
something else to distract yourself or change your mind about, you know, to take your mind off those cases. I think the most valuable skill that emergency vets can have in particular is that mental boundary of you leave work at

work.

Hmm

our hospitals run twenty-four seven, so overnight you can log in and you can check your patient's chart and you can see how they're doing, and action is potentially one of the most detrimental things that you can do as a veterinarian, is log in on your days off and check in how your patients are doing.

And yes, we do it because we care and we're invested, but if you do that, you will never switch off. And for some people it can even be a, physical reminder. So I will never forget this story of a policeman who would always wear a pen, his uniform, and every day when he took off his pen and put his pen in his locker, that was him leaving work at work. So for us, whether that is taking our stethoscope off and putting our stethoscope in our bag, whether that is the minute we take our scrubs off. For me, it's the minute I get in the car.
You know, when I close that car door, I'm leaving work at work and I'm making that decision. and I think that in itself is...

it's a very
simple skill to start implementing.

So if you can start implementing that, it gets much easier to emotionally cope with those
because you're giving yourself a physical reminder, and physical reminders are often much easier than, you know, mentally trying to
close the

I know that when I first graduated, I lived and breathed medicine. I would do like 200-hour months, 200-plus hour months.

I
would shifts

My God

was so... I loved being there. And loved the cases and I loved the hospital and the people, and I just

lived and breathed it, but I didn't have that much else going on outside of work. And I got to
a point where I realized that I, I looked around at all of the
other vets that were

there, and some of the vets had been like struggling to find partners because, you know, emergency medicine is not very conducive to, dating. the and the timings

Yeah

difficult and, you know, yes, they did have things going on outside of work, but they were always the people who were free to pick up extra shifts and, I don't know, I
looked at the trajectory that my life was on and I was like, "Okay, I can s- see it here. I'm gonna sit my memberships, then I'll

become a senior vet. I become a senior vet, maybe I'll move into like a clinical lead role. Once I become that, I don't know, hospital director potentially." Like, I could just see the trajectory, and the trajectory was all work.

so

Yeah

had the option, and I met someone incredible, and I had the option to completely uproot my life and completely flip my life on its head, I chose that option because I didn't like
the trajectory that I was on because I could see what the next 30 years of my life
looked and I decided that I didn't want that. So I think everyone has a choice. Maybe they wanna live at work and that's what they wanna do and that's what brings them joy, and if they can do that in a healthy way-

Mm-hmm.

That's a skill that I just don't have. But I think as a new graduate or, you know, if you've just stepped into emergency, everything that we do is a habit. So if that's a habit that you slip into when you "

first start in emergency medicine, then it just becomes a very slippery slope and a very difficult habit to break. You know, you wake up in the morning and you check your emails, and then you p- check your patients' charts. Oh no, that patient deteriorated overnight.
How's that gonna affect the rest of your day?

"Ooh, I might go in early now because I want to help," or, "Ooh, they're really busy today.
Let's go in and help." and then suddenly you're--

yeah, it's your whole life

how much brain space are you willing

to give a job?

Because at the end

Yeah

we are so much more than our job and our title. So how much brain space are you willing to
give to a job where you don't get paid when

you're at home? I don't

know.

Even if you don't go into work or even if you don't call someone or even if you don't get involved, like it can still affect, your rest of your day, your emotions for the day. Like it just knocks you

off and then even if you're not at work,

you're still in the work mindset and it away from your day. But yeah, they-

can't do anything when you're at home. You can not do anything about it. So I don't, I don't know why you would burden

yourself with that information when you literally have no control and you can't act or change something. I think that, I mean, I think that's a real life lesson in general.
You know, why give brain space to things that you have no control over or that you can't act and change?

Yeah. But it is so hard as well now that, you know, in the last,

say even in the last, like, kind of five years, maybe since COVID and, like, everything went
online, work from home, that became a lot more normal.

The boundaries between work and home life became a lot more crossed and blurred.
And, now you don't even have to be at a computer to see your charts and your work login. You can see it on your phone, and everyone's got their phone in their hand all the time. So that boundary between work and home life is almost nonexistent. You can see work wherever you are, whenever.

So it's, it's almost not necessarily people's fault. Like, it's obviously you n- need to take responsibility to set those boundaries of what's right for you and what works for you. But it's also a lot harder to do that, especially if you're getting notifications on your phone because something's been updated at work and you're just like, "Oh, I'll just check that."
Or, like, emails, you don't sit at a computer and log on to your email anymore. It comes up on your phone. Everything's there, so it's a lot-- it takes a lot more, effort, mental effort to set a boundary and go, "No, I'm actually gonna turn notifications off for this." But with the accessibility, it's almost become an expectation that you are

available

24/7, basically,

of you should be able to be contacted in the morning, you should be able to be contacted in the evening.

And if you don't set that habit, like you said, that becomes the expectation that, "Oh, even on his day off, he'll pick up the phone, she'll pick up the phone," or, "Even though it's 10:00 PM at night,

he'll come in, he'll answer my questions." Like, if you don't set those boundaries,
even if you want to change them later on, it's so much harder because now the team has learnt that it's fine to contact you whenever because you're always happy to help or you're always happy to come in, and then

It's so much harder to tell everyone else in the clinic, like, "I'm no longer available
in my time off."

Yeah. And it's such a

it's such a slippery slope unfortunately, and I think even worse in emergency medicine we function 24/7. So even, you know, the clinic never closes, which makes it just so much
harder

What do you think that we should be doing to make emergency sustainable as a career in the long term?

I, think the trouble with emergency medicine will always be the fact that there's night shifts involved. And night shifts are challenging, and they are technically carcinogenic, which is not ideal.

Such a depressing read reading those papers, isn't it?

depressing. it's so, grim. But I think that rostering is huge when it comes to emergency medicine and finding a sustainable roster that works for you

And being very firm with management about Because ultimately, if they don't roster you appropriately, you will burn out and you will become tired, and then you'll leave the practice. So it's really in their best interest that they do their job appropriately, I mean, bad rostering and bad management are, you know, potentially some of the two big reasons as to why someone would leave a practice.

bad management you can't really do anything about. But bad rostering is something that potentially you have a say over. So trial and error of finding what is going to work for you and your sleep pattern and your lifestyle is really, really important. And for me, for many years, that was just doing night shifts, or afternoon shifts.

I, about five years ago, three years ago now, I stopped swapping from days to nights. Um, I just said, "Look, I can't do it. My body won't let me." I was getting awful, like, sleep anxiety. If I had a 7:00 AM shift, I wouldn't fall asleep until, like, 4:00 or 5:00 AM in the morning, because I was just so anxious about having to be awake and I don't know, I just couldn't do it.

So I put a line in the sand and said, "I'm not gonna do that

anymore." and that was brilliant. Really, really good for my

sleep still, you

Yeah

of the time getting seven to nine hours sleep a day, even if I was, if, even if that was like eight hours of sleep between night shifts, that was brilliant for me because I'd found a pattern that

The other thing

Yeah

that worked really well was only doing two night shifts in a row. night shifts used to work when I was younger, but now I'm old. I can't do more than two night shifts in a row because it just, it takes me way too long to recover otherwise.

Like having a hangover

Yeah, literally, and, you know, I may get a solid like six to eight hours of night, of sleep between night shifts on my first night shift, but the second night shift, ultimately I would pretty much always wake up five hours later, it just kept being this repetitive pattern
and I was like, This is not sustainable.

I cannot, I cannot do this long term." So trial and error of finding a shift structure that works for you.

and I don't think

we necessarily have to be married to the fact that you have to do emergency full-time. I personally don't know how

people work in emergency

full-time. I think the great thing about emergency medicine is that we get paid very well.
So I think because of that we have a little bit more flexibility, and so maybe you only work 140 hours a month, 130, 120. And listen to your body and, you know, go back to your finances and decide how much do you actually need to work.

And is that extra, you know, $500 a month the extra shift? Do you really need that money? So yeah, just looking at it from that perspective, I'd say. But yeah, I think rostering is the number one key to sustainability in

really. Protecting your days off are

incredibly important.

and then

The other

big thing when it comes to sustainability in emergency medicine and veterinary in general is I think we forget what an incredibly joyful job we

have. how

Mm-hmm.

people get to go to work and have fun with the people that they work with every day? because I mean,

especially emergency medicine, the, like, our dark humor is notorious. Our ability to joke in incredibly inappropriate situations

is hug cute patients and get to save lives and make a difference, like,

it's pretty

Yeah

the job that we get to do. And I mean, sure, human medicine's great, but you know, the patients are not nearly as

cute

patients talk back

I know. so I think being very conscious of the joy that we get to experience on a day-to-day basis. If you're feeling, you know, very frustrated at your job or you're finding it a little bit hard, find three things that bring you joy in the job that you do and seek them out and sit in it and don't brush past those moments. So if an owner says, "Thank you so much," don't just brush it off and be like, "Oh yeah, no worries." Move on to the next consult. Sit in that thank you and note it and mentally log it and

say thank you back and, you know, connect in those moments. For
me, like I love oodles, any oodles, like rub them all over me and ung, ung, ung, eat them for breakfast. So the minute I walk into the hospital,

every single shift I will see, I was like, "Who's in hospital

today

and I'll go give them a cuddle the first moment that I have a chance to. And everyone in hospital knows me now that like the minute I walk in the door, one of the nurses will be like, "Oh my God, we have the best cover

oodle for you

Aw.

Like, I don't know, it's just such a joyful experience. So I think that finding the joy in the profession that

really important.

I think the other biggest thing about sustainability in this profession is being so mindful of how we talk to ourselves, and talk to ourselves in those really, really hard moments.
And, you know, when you're tired, your brain will automatically hold onto negative emotions because it's easier. so you can tell yourself, "Oh, I'm no good at this. I must be really
stupid. How could I have not figured this out?" Or you can flip that self-talk and go, "Oh, I'm just tired. I'm a little bit overwhelmed at the moment." a very normal feeling to have. But how you talk

to yourself in that moment will completely change how you feel

how you

progress. So I think being very cognizant of self-talk, burnout, imposter syndrome, being well-versed

on the red flags of that is, again, a really vital skill to have for veterinary medicine in general, not just emergency

Who Should Be in ER & How to Get There

Absolutely. Do you think there's a certain type of
vet or a certain type of personality that is, suited to ER?

I mean, I think we, we're all ER vets the like, you know, a hit by car walks through the door, and that's something that GPs have on a regular basis. But I think to work purely in emergency medicine, you have to have a certain

appreciation for being there for

owners in their hardest moments, and you have to have a certain

of empathy and

resilience for those kind of conversations.

So if dealing with emotional owners is, know, your least favorite thing to do, then,

Maybe be a

surgeon. or do

Yeah

else where you're

not, you know, having to rely so heavily on

owner So

being aware that, yeah, that's gonna be a huge part of your job. and I don't necessarily think wanting order and consistency is, you know, essential.

I am so type A in my life. I have my entire days and weeks structured and planned and blocked out. But I think some of the reasons why I love emergency is I love the unpredictability of it. I love walking in and not knowing

what's gonna happen. So I think if you're okay with that unknown, then that's a really important skill to have. Being able to stay calm during an emergency and I mean, I think you have to find sick patients exciting.

if sick

Mm.

you really anxious and scared, and even if you know what to do and you
don't find that enjoyable, I think again, that

gives you your answer. Because for me, the closer they are to, you know, seeing the light, the more fun I have. it sounds crazy, but I think it's that adrenaline rush of, let's get them
back,

be there for the owners in their worst moments. You know, I think that, that adrenaline rush is

the best feeling.

so I think they're the big things, being calm in chaos, loving the sick patients and, you know, being able to thrive in that environment being okay with working night shifts to some degree, I think is
really

Yeah. so if, say

I love

seeing those sick patients I'm love, a bit of chaos, like, I'm all up for that
What are your recommendations for getting into emergency?

Step number one, find a practice that is going to offer you support, and something that is not sole charge. Especially to begin with. Maybe after, you know, a year or so or six months or so, sure, there might be a little bit of an expectation there.

But making sure that it is well-supported when you first start is really important and that you have another vet on with you the entire shift. That's key. The other thing would be
making sure you know what

resources are

available to you or know

where to go to

get help if you need

it. So there's so many different Instagram pages.

The Vet Vault Podcast is amazing. like, they're

paid streams for like emergency

internal medicine and surgery. That's where I go to stay up to date on like all of the latest information.

having access to the great textbooks that you need. I think they would be the really big
ones, into it with

Yeah

wide open and just excited to start and rely on your

nurses.

Your nurses will save your butt so many times. So if you can listen to your nurses And respect your nurses' opinions and when they're coming to you and they're saying, "You need to reassess this patient," listen to them. I think that's gonna be the biggest thing
Check

it's of trial and error to find an emergency clinic that is going to suit you because there are so many different emergency clinics with or without ICU departments, with or without criticalist

So

doing some casual shifts before you sign on permanently is really, really reasonable, to just get an idea of, you know, what the practice actually looks like, how it functions. Are the promises that they're giving you in the interview, are they empty promises or, you know, do they actually back up those claims? So doing a little bit of trial and error and
seeing which clinic is gonna work with,

work for resonate for you is really

Yeah.

as well

also, like we said

right at the, start, you don't necessarily get

emergency exposure as a student. So even if you do well in that environment, you need to experience it before signing up to a job in a

Non-committal way. So going, doing an externship, going And doing a couple of weeks practice, couple of shifts because some people get into it and go, "Oh no, actually, I thought I'd be fine. I'm really not This is my worst nightmare."

And even just testing can you do night shifts, you can sign

Hmm.

and, be like, "Oh, I'm sure I'll be able to sleep during the day." But if you cannot sleep during the day, you can't be an emergency vet Because you just can't do the rostering in the job. So you have to have

some capacity to be able to deal with the, like, the shift structure that's required. Because I think that if you go into emergency not expecting to do any night shifts, that's a little bit of a hard ask, unfortunately

Yeah. Yeah. You put, like, the employer in a shitty position before you've even started, like...

And the rest of your vet team, you're making them

do more night shifts because you're not willing to,

to do that part of the job

100%. And I mean, if you're not willing to do night shifts, then that, mm, maybe you need to split your time between two practices and, you know, work casually at both and just pick up the

shifts that suit you or work permanent

part-time you know,

split your time across two practices. That will give you afternoon and day shift availability.
But I think to work full-time in an emergency practice and, not expected to do any night shifts or any late

Yeah

is a little bit of an

unfair unfortunately

And then I've got a, a couple of

quickfire questions before we finish, but I do just wanna,
Chat about doing an internship

versus learning on the job, because especially in America, a lot of
emergency companies are offering, you know, six, 12-month training programs, learn on the job. It's not,

it's not an internship, but

I guess that's

a similar style. What are your thoughts on going down formal internship route versus doing a bit more learning on the job?

I mean, when I reflect back on first year in emergency practice, yes, they called it an internship, but it wasn't really an internship in a formal sense. It was definitely like learning on the job?

But again, very, very privileged to have such a great experience in that. And it was very structured in... And I think that this is what I would c-caution people to keep an eye out for if they are doing like a learn on the job ER experience,

is our first like three months was you would shadow an emergency vet and you would be rostered on as an extra on those shifts. Whereas I get concerned when you are doing that and you're rostered on as a full

the vet

to me is concerning. Because you shouldn't, you shouldn't be a full vet on the floor if it's your first three months

in emergency. should be rostered on as an extra. so we were rostered on as an extra for the first like six months, at least. After three months of shadowing, then we started seeing a lot more consults on our own,

but we were still always partnered with

a through that

Yeah,

Then we were also doing like a monthly like training session, um, and we sat a little exam or a little quiz at the end, and it was so informal. Like we were at our boss's house and we just, you know, did a

little oral

Yeah

but it was just to have some ongoing training and additional knowledge, which again, super important to

have.

So I think looking for, is it really just training on the job or do they do have some time, you know, teaching and training? because I think that's really important. then after that then we were kind of rostered

on at like .75 capacity. So again, we would never be sole charge, but we would be sandwiched between two senior vets and then one of the senior vets would leave, but you always had another senior

vet to rely on. And you always had someone there to like check your work, check your cases, always

be and

Yeah

so I think

As long as you're ticking those boxes in whatever training program you choose, that's important because there can be emergency internships out there and they could be shit. and just because they've titled internship does not mean you're necessarily going to get support. There are plenty of internships in Australia where the interns are sole charge overnight. So just because it's got internship in front of it doesn't mean it's gonna be better supported or more formal in its

So I

think it's just asking those really hard questions during the interviews of will I be sole charge? What are my expectations? Am I

rostered on as a full vet? Am I sandwiched with another vet for support?

and you know, how will I go

about getting

consultation training? What formal training do you

offer outside of the internship?

Or the training program, is it just learning on the
floor? sent

Mm-hmm.

All of that sort of thing. I think all of that makes up so much more than,
you know, a formal internship

Yeah.

I do have an issue with though that they, if, you know, you're being labeled as like an on-the-floor

training and the person

Mm-hmm.

is two years graduated

and

Yeah

that

Yeah.

no business training

you. Sorry, but

don't.

They're still babies themselves. And I think that that is such an unfair expectation to put on person training you as well, because you're still learning and you're still, you know, processing, that sort of thing. And from who now has to

help train interns see my own cases, that's hard and it's stressful, and it takes a whole new
toll on

you for the cases that you're

seeing because you're not just seeing

your own 10 cases, you're seeing 10

of the interns as well.

so I think that that expectation, even putting that expectation on junior vets to train interns is hard and really rough, and I think it's a little bit inappropriate sometimes

Final Qus

Okay, I'm gonna do my, quick fire questions. These are basically just, like,
fun little questions.

and then I've got a final question that I ask all our guests. So,

what is one misconception that you find a lot of vets have before going into ER?

I think the biggest misconception that people have going into ER is that all the patients are unstable. I think nine times out of 10, our patients are really... You know, there's very few true emergencies where you only have seconds minutes to act and think. Most of the
time our patients will give us the decency of at least five to 10

minutes to kind of think of a

plan and, you know, start a fluid bolus and whatnot. There are very few true
emergencies where you have to know what to

do immediately in that moment, in

that second. Most of the time it's, you know, got
minutes

You got some space to think. Yeah,

room

Yeah.

What is your favorite caffeinated drink to get you through shifts?

Just a good old

double shot latte. I have it at the start of my shift on the way to work, full cream milk. I mean, I live in Melbourne, so we

have

Oh, yeah

with my coffee machine. So yeah, mm, heaven

What is your favorite emergency case to handle?

Ooh, my favorite emergency case to handle I mean,

I would say my favorite emergency case to handle, I love a good heme abdomen a really good, like, septic

patient. Give me all of the trees of life. Let me use my brain.

Let me try to get this stable. I love

it. They're, they're the ones.

big dramatic

Hi.

to bring this dog back from the brink of death.
Like, oh, sign me up.

And then what is your least favorite?

My least favorite

case in emergency would be those internal medicine patients that come in and the list of organs that works is shorter than the list

of organs that are broken. And trying to figure out

which problem is their current problem that is

making the pet unwell. No, thank you. you have more than three problems, I just...
If I can't fix it in the first 12 hours, I don't really wanna know

It's not emergency

It's not an emergency

and what do you do to decompress after a crazy shift?

A really long, hot shower and binge watch my comfort shows that I will re-watch over and over and over again. So Bones, Brooklyn Nine-Nine,

re-watch

that

those comfort shows.

Brooklyn Nine-Nine

good.

is so good. I was so sad when that ended.

perfect. and then the one question we ask all the guests is, if you could give one piece of advice to

vet students and new grads, what would it be?

Hmm.

One piece of advice for vet students and new grads

would be how you talk to

yourself in those really hard moments, because will probably be the biggest defining factor of if you will have a sustainable career or not. If you can pull yourself out of
those really hard moments in the way that you

talk to yourself and stop your brain from spiraling,

that is key. But

if you continue to dwell on those really hard

moments and you talk down to yourself and you give into that imposter syndrome and you can't pull yourself out of that, that's gonna be really, really difficult. So it doesn't

necessarily mean, know, I'm the best at what I do, I'm great, I never make mistakes, I'll be fine.

Oh, well, there was a complication. cares? Move on. But I'm talking about like genuine self-reflection that is objective, that you can learn from, and then that you can close the loop of, put that in the box in your brain and then, efficiently move on to the next patient. That is key. That is a key skill to learn and have, along with how to communicate with owners. if you can find a practice that will let you go do formal consultation training or you can absorb, great consultation tips from other vets, learning how to talk to owners
will solve 99% of your problems

Outro

Perfect. Thank you so much. I think that's

everything for today's episode. But Brooke, thank you so much for coming on and
giving all your amazing experience and advice.

Um, I mean, I'm definitely gonna be relistening to this like

10 times before I start, any job. So, and as soon as, like, this finishes, I'm gonna be on training, alt sound sh- alt sound courses, like anything I can get.

You'll be

But yeah, thank you so much. Thank you

It was such a great

chat. I

If you enjoyed this episode, make sure to follow or subscribe where you're listening, and share it with a friend or colleague who's interested in emergency medicine as well. And as always, you can find us on Instagram and TikTok at Veterinary Vista. Let us know any topics, any guests that you wanna hear from next.

We always love hearing your suggestions, and thank you so much for listening. We'll see you next time