Being ‘on call’ or ‘on duty’ can take a challenging and often tiring job to another level. Our working day is a long one and our skills of decision-making, diagnosis and communication are frequently tested. Within a ten-minute consultation, for example, we greet the owner, acquaint ourselves with the patient, take a history of the condition, carry out an examination (sometimes needing to employ all our powers of calming and soothing to avoid being scratched or bitten by an anxious or just plain angry patient), decide whether further tests are needed, make a diagnosis, decide upon a treatment plan, discuss this with the owner, prescribe the appropriate medication, arrange a checkup, and then cheerfully bid them both farewell. Repeat this twenty or thirty times, add a handful of operations, a list of calls and maybe a calving or lambing and that makes up a standard day in mixed practice.
When the day comes to an end, the phones are put through to a message handling service. They answer the calls that come in during the evening and through the night. One lucky person gets to put bleep one in his pocket. Another, slightly luckier, gets to have bleep number two. Being on call is a necessary evil for a veterinary surgeon, and puts considerable constraints upon our home lives. The first-on-call vet, with bleep number one, is paged by the message handling service as calls come in. These can be absolutely anything, from life-threatening emergencies like calvings, horses with colic, bloated cows or cats that have been run over, to people wanting to book an appointment for the following day, a guinea pig with a piece of carrot stuck in its mouth, or a dog that hasn’t eaten its tea. The vet who is second-on-call is there to help out if two emergencies arise at the same time (this often happens at lambing time) or if the first-on-call vet needs assistance with an operation, such as a caesarean. It is usually much quieter on second call than it is on first, although there are exceptions.
One Easter weekend, Tim was called to rescue a dog from the fast lane of the A19. The dog, subsequently christened Mac (short for Tarmac), had been hit on the road more than once, and had broken all four of his legs. So severe were his injuries that on this occasion three vets had to be called in, all to operate at the same time to repair his broken limbs. Mac went on to make a full recovery and was adopted by our practice cleaner, Julie, who owns a smallholding in Thirsk. I would see Mac lolloping around with the hens whenever I called at Julie’s to help lamb her sheep or vaccinate her horses. A couple of his broken legs were left a bit wonky, but his recovery was spectacular, considering the terrible injuries he had sustained.
The rota is equally shared, and we all work two nights on call during the week (one on first, one on second) and approximately one in two weekends. A weekend on duty can sometimes feel equivalent to a full week of work if it is busy, and we are straight back into the breach on Monday morning. One summer, I remember working four weekends in a row, a first, then a second, then another first followed by another second. It was thirty-three days of work without a day off.
Friday night marks the beginning of a weekend on call. I love coming down Sutton Bank on the way back from the first visits of the evening. If the weather is clear the view stretches from Swaledale in the north, through Wensleydale and Nidderdale with Wharfedale behind, and on into the far distance, where you can see Emley Moor mast in the heart of the West Yorkshire Pennines. Looking down the Vale of York, it is sometimes even possible to see the tower of York Minster. Our patch, at least for farm animal and equine work, is spread over a radius of about 15 miles, and it always feels a privilege to be looking after all the animals in this beautiful landscape. It tempers the anxiety one feels when wondering what the rest of the weekend might have in store. If an evening call takes me in the opposite direction, towards the Vale of York, my return journey brings me back through the middle of town, where there is the bustle and excitement of busy pubs and restaurants, full of folks relaxing after their week of work. There is no relaxation for the vet on call though.
Sometimes, as a young assistant on call on a Friday night, I would stop on my way through town for fish and chips. There are some excellent fish and chip shops in Thirsk, perfect for a quick and filling tea for a hungry young vet. On one occasion I was returning, tired and hungry, from a calving. The shop was fairly full, but the queue seemed to evaporate when I walked in, and I could not understand why the waiting customers had fallen silent. It was only when I got back home to tuck in that I realized I had blood all over my forehead and cheeks. I looked like some kind of mass murderer. It was apparently a good way of jumping the queue. I should try the same trick in Tesco.
It is often the case that difficult jobs are the most rewarding, and some of the most memorable times while working as a veterinary surgeon have been associated with being on call. Nowadays, many practices, particularly those dealing only with small animals, especially in urban areas, do not undertake their own out-of-hours work, but instead employ the services of an emergency clinic. I can’t help feeling that, while the vets undoubtedly have an easier and more balanced life, they are missing out on a lot of the excitement, and the biggest challenges. Many young veterinary surgeons now choose jobs where there is no out-of-hours work. This means they are less likely to be exposed to some of the most rewarding cases that veterinary medicine has to throw at us.
Two of my favourite patients – Fred and Poppy Martin, both Great Danes – came to our practice directly as a result of their previous vets handing their out-of-hours provision over to an emergency centre. The Martins were adamant that they wanted the same vets to treat their dogs at midnight as at 9.30 in the morning, so, based on a personal recommendation, they decided to come to our practice. They travel from a great distance to see us. Being Great Danes, both dogs are prone to the most serious, challenging and life-threatening emergency that we see in our job: gastric dilatation and volvulus (GDV). This is a dramatic and rapidly developing condition, whereby the stomach blows up with gas and then twists, causing catastrophic effects on the body. If it is not treated within about an hour, death follows quickly.
Both dogs have had the misfortune to suffer from a GDV, so their owners are very alert to subtle changes that might indicate the development of the condition. Since they have a journey of about forty-five minutes to get to the surgery, they usually jump into the car and set off at the first sign of any possible problem, phoning the practice en route. On one occasion, in the middle of the night, their speeding Land Rover, with a bloated dog on the back seat, was pulled over by the police, on the A1 somewhere north of Thirsk. After a brief discussion, it transpired that the policeman knew the practice, and indeed me, the vet on call, very well. In his pre-uniform days he used to keep cattle and pigs at a farm near Thirsk. Rather than a reprimand (or worse) for the driver, he gave them a high-speed police escort directly to the surgery! There followed three hours of emergency surgery to decompress and untwist Fred’s stomach, sew it back into place, and to remove his spleen, which had been badly and irreversibly damaged because the torsion had cut off its blood supply. It was a difficult and exhausting night’s work, but incredibly rewarding, and one of those occasions that ultimately makes you a better vet. I still see Fred regularly. He now has a serious heart condition called dilated cardiomyopathy. The textbooks tell me he should have been dead two years ago, but Fred stubbornly refuses to follow the rules. When he comes for his monthly checkups, I always think of his night-time blue light trip, which undoubtedly saved his life.
There is an amazing variation in our on-call work. It will oscillate wildly between a genuinely life-threatening emergency, such as Fred or a horse with colic, to the dog that I saw last night at midnight, who had a sore tail. The yellow Labrador came running into the practice, vigorously wagging the aforementioned tail with great enthusiasm. It was not quite the emergency that had been portrayed down the telephone, and a dose of pain relief was all that was required. I always wonder if the same kind of thing happens in hospital casualty departments. It is amazing how different the perception of an emergency can be from one person to the next.
It is not just the night and weekend duties that get in the way of a ‘normal’ life. Holiday periods like Christmas, New Year and Easter are often disrupted too. Luckily for me, my wife is also a veterinary surgeon, so understands perfectly the pressures of on-call life (although her practice uses an emergency out-of-hours service), and my kids are used to it and accept it as standard. My youngest son, Archie, is perfectly au fait with terminology like ‘on second’, which means a trip to the local skate park is feasible, but a mountain bike ride is not. It means I can take him to swim training but not to a gala. For Jack, who is older, ‘first call’ means I can drop him off at his tennis match in Ripon, but he might need to wait around afterwards, or get a lift home with friends. They accept it as a minor inconvenience but mercifully have never held it against me. It is, after all, what they have grown up with. For the rest of my relatives, it is more difficult. I am frequently unable to attend family Christmas parties or significant birthdays, or I just turn up, say a brief ‘hello’ then make a hasty getaway, because I have asked a colleague to stand in for me for an hour or so.
Over Christmas and New Year we share out the on-call duties so everyone gets some time off. We always try to finish early on Christmas Eve, which feels like a festive treat. We never get away, however, without the traditional Christmas Eve call to attend an animal up in Hawnby, at the farm furthest away from the surgery. Invariably, they find a lame bull, a cow off colour or a couple of calves that are ‘not quite right’. It takes half an hour to get there in good weather, but much longer if there is snow on the ground, so whoever goes up there is late home for their mince pies.
I can remember my first Christmas as a vet. I was working on the day itself, so planned to visit my family in Castleford on Christmas Eve. My mum was going to make Christmas dinner and we were going to exchange presents, as if it was Christmas Day. I managed to avoid the Hawnby call and headed fifty minutes down the A1, for Christmas dinner a day early. It was a lovely evening, and actually a perfect time to eat a big dinner, as I had been working all day. I also remember the Christmas present I was given by my parents – my first-ever mobile phone. Before the widespread use of mobile phones, we had to stop at a telephone box if our beeper went off, so this very heavy device, with a battery life of about thirty minutes, was transforming.
I stayed in Castleford overnight and got up early on Christmas morning to drive back to Thirsk. On days like these, the duty vets usually meet up at the surgery to hand over beepers, check the inpatients and exchange case notes. We would wryly offer each other the season’s greetings, in the knowledge that Christmas might not be quite as festive as it could be. During one Christmas holiday, a local farmer had a complete disaster when he discovered that the bull he had used on all his cows had produced calves too enormous to be delivered on their own. Almost every one required veterinary attention, so when we exchanged our beepers, we would compare the number of calvings or caesareans we had performed at his farm, Vicar’s Moor, over the last twenty-four or forty-eight hours, and how huge the calves had been. Of course, we always tried to describe a more fantastical scenario than our colleagues.
On this, my first Christmas morning as a veterinary surgeon, I had a not-too-festive visit at 8.30 a.m. to see a very poorly calf, suffering from severe pneumonia. The farm was beset by a variety of problems, and we were frequent visitors. I can remember the sharp December air, the damp straw and the poor little calf with a raging temperature of 107 degrees Fahrenheit, as clearly as yesterday. I also remember the farmer making not a single reference to it being Christmas day at all! No ‘Merry Christmas’, no ‘Sorry to have to get you out today’, not a thing.
I returned home for a coffee and was about to sit down with a mince pie when my beeper was in action again. This time it was a cat that was ‘not quite right’.
‘Well, she’s sitting under the piano. Can you come and look at her?’
House visits are generally much more challenging than examinations at the surgery. It is hard to keep the animal in a suitable position to be examined, the light is often poor, the television is invariably blaring, and we have a more limited selection of equipment and medication than is available at the surgery. We prefer, therefore, to see patients at the practice. However, in this case the cat was sitting under the piano and apparently could not be caught. Also (and probably more to the point), since the pre-dinner sherry had been broached in the middle of the morning, the cat’s owners were in no fit state to transport it in a car.
I had an idea what would follow, and I was right. I spent forty-five minutes crawling around on the floor of the Christmassy house, trying to catch the cat that had made a miraculous recovery as soon as this strange man, smelling vaguely of surgical spirit, had appeared. I was unable to examine it in much detail. I managed to administer a precautionary injection and suggested that they bring the cat to the surgery for a checkup after the holiday. Again, there was no ‘Sorry to disturb you’, not even a ‘Merry Christmas’ and certainly no mince pie! I wasn’t particularly bothered by this, just somewhat surprised by the general lack of festive cheer.
Back home again, I put the kettle on and at last considered the possibility of that mince pie. But no, the bleeper went again. This time it was an elderly gentleman, whom I knew to be more poorly than his little dog. The terrier had terrible respiratory disease. We went out regularly to administer extra medication because his owner, Mr Moss, also had severe emphysema and needed to be attached to an oxygen machine for long periods. I knew that Mr Moss would be by himself today, as always. Since I had not yet eaten my mince pies, I decided to take them with me to his house to share, and we sat together, accompanied by the hissing of the oxygen machine, eating mince pies, while I injected his dog with steroids. It was not quite the Christmas day I had expected, but I was glad Mr Moss had not had to spend it alone. It was the most important thing I had done that day, and it had nothing to do with veterinary medicine.
Usually, if we work Christmas, we don’t work New Year and vice versa. It is always a busy time, as winter lambing and calving are both in full swing and people are out and about on their horses, and with their dogs. Interestingly, though, wishes of ‘Happy New Year’ are frequent when we are called out during this part of the festive season.
The first call of the year, I feel, sometimes sets the tone for the rest of the year ahead. Four years ago I got a call at 2 a.m. on 1 January from a local farmer. He was in a terrible tizz; he had a cow with her ‘calf bed out’. This condition is technically called a uterine prolapse. It happens shortly after calving, particularly if the calf was big, or the delivery difficult. The whole uterus is pushed out, and turns completely inside out, just like a sock that has been pulled off a foot in a hurry. These cases are a major emergency, because the inverted uterus quickly gets covered in straw and other debris and can even be trodden on by the cow. Some cows remain lying down, so the uterus is less likely to be trodden on, but gets very dirty, while others wander around with an organ as big and as heavy as a sack of potatoes hanging out of their back end. It is extremely physical work to replace the swollen and often damaged uterus, and is guaranteed to leave the veterinary surgeon hot, sweating and covered in blood and dirt. An old vet called Eddie Straiton, a friend and contemporary of Alf Wight, reputedly recommended that the vet should strip off completely to perform this procedure, to save his clothes from ruin. I had no intention of following Eddie’s advice on this freezing night.
When I arrived, a very worried farmer greeted me. He had clearly been enjoying the New Year celebrations earlier in the evening, and wasn’t handling his cow’s problem well. He was rushing around, without being much help, so I asked for a bucket of warm water, in the hope that this simple job would give him something useful to do and calm his anxiety. When he returned he recounted the horrific sight of this enormous uterus appearing and how, as soon as he saw it emerging from the cow’s vulva, he had rushed inside to phone me. He had not been back to check the cow after he made the phone call, so when we arrived at the yard where she was penned, the situation was not quite as I had expected. In fact, there was a happy, healthy, normal cow licking her lovely newborn calf. Next to this calf was a huge pile of afterbirth. This is the placenta, which is passed five or ten minutes after the birth of the calf (hence its name). The inebriated farmer had seen this appearing and mistaken it for a prolapsing uterus, panicked, and phoned for help. Rather apologetically, he wished me a Happy New Year and we laughed about it. I couldn’t have been more relieved. It made for a very simple first call of the year and I didn’t even have to get my hands (or the rest of me) dirty.