Dear Diary — What is Diversion?
How did we get here?
Diverting was something seldom done in emergency veterinary medicine.
If the doctor is in surgery — tell the next client the expected wait time and keep on truckin’.
If that client doesn’t wanna wait and wants to seek assistance elsewhere — go for it.
Otherwise we’ll be with you in X amount of time.
Only on days or nights where the power went out and the backup generator failed, when the doctor had to goto the human hospital because they were bitten in the face, when the building was evacuated because of a gas leak, or when there are multiple back to back to back to back surgical procedures — only then in those rare freakish circumstances, would the word DIVERT be uttered.
I’ve gone deep into wormholes thinking about the impact of the pandemic and the aftereffects the pandemic has and will continue to have.
The terror and stress of the unknown.
The loss of friends/family, the isolation, the grief, the hypervigilance and hacks that people (and animals) developed.
Cumulative and ever so slight changes in traditions and cultural norms that will be carried into the future years, decades, centuries — like rings in a tree — present forever.
The planet y’all. Jesus — it’s already a non-eco friendly struggle-bus up on this Earth.
Other things that come up repeatedly:
- massive waste from the entire world producing and discarding PPE,
- our limited understanding of immunology, science, and medicine
- all the ways we have embraced the revival of the urban homesteader lifestyle, resurgence of crafts, resourcefulness and survivalist strategies
Everything everywhere has been and will forever be impacted by Covid19 pandemic.
I could go in and have a full exploration of a new worm hole everyday, about this pandemic situation and still never scratch the surface of all that I would like to know.
I can’t know most of it, not now anyway.
But what I can break down for you — at least only as much as I understand it myself at this moment — is what in the fuck just happened?
Veterinary Hospital — Heels of Pandemic Edition:
Let’s just say — being an emergency vet on any given day is usually an unpredictable, drama filled, variably wild ride lasting 10–16 hours.
It’s already a really hard job.
There are very few career ER vets in this world.
Why? Because it’s a brutal job.
Most energetic ER vets burn out within a few years and immediately transition to a less stressful area of veterinary medicine.
I had already outlasted so many colleagues who came into ER vet med and then sashayed right the fuck out again. With the pandemic afoot, it became untenable.
The number of urgent cases needing to be seen like, yesterday, coupled with the molasses like pace we initially adopted as the world (and veterinarians everywhere) transitioned to curbside service in order to minimize contact between humans from within and humans from outside of the hospital, made everything sloooooooow down.
Under ordinary life circumstances — this sounds great.
Slow down, right?
Have more time with patients, clients, more time for thinking about science and medicine and health and how to best assist the animal in front of you, right?
Slowing down, when there is a bottle neck not just at our practice, but at every vet hospital everywhere while everyone is suddenly at home staring at their pet and projecting all of their anxiety about everything onto their pet and then deciding that they must head straight to the ER.
LOL. As if.
Clients hated it and hated us for it, sometimes.
Others loved it.
Permission to sit in a car and rock out on your phone with coffee, snacks, and vapes? Fuck yes.
We did it because:
a) those were the rules and
b) we didn’t wanna die.
Remember early days- when the death count rose exponentially daily? I remember. I had covid stat trackers and would look at them many times a day. As in, more times a day than most people check social media — which is to say — I was uh, anxious.
We muddled through the things that are now commonplace protocols and have standard operating procedures for all things pandemic related. Similar to literally everyone else, everywhere.
Only essential businesses were open.
Veterinarians, ER hospitals especially — were classified as essential.
So: we worked.
Normally, but slower — because of new COVID protocols which did not allow clients into the hospital unless they were there to put their pet to sleep (euthanize). When we did allow folks inside to be with a dying pet — there was a two person maximum. If we had larger families — we’d go outside and put an animal to sleep atop a bed of soft blankets on the grass.
It was sweet, some of the things that we did to make the sad dark days less horrible for the pets and people. It was also logical — huge family? OUTSIDE with the huge blankets — set up an array of enticing snacks under a tree for our special friend (cat/dog) who is about to be beamed up to …. wherever.
Because every general practice veterinary hospital (think: your ‘regular vet’ the one you call when your dog has diarrhea in the house, or has worms, or needs more flea preventative) was ALSO was grappling with implementing and troubleshooting initial curbside services and biosecurity measures, every hospital, everywhere was booked.
Remember that folks were out with COVID, on quarantine or out caring for ailing family members or homeschooled kids — and in a profession dominated by women — guess who the burden of homeschooling kids and caring for sick family members falls on?
YOU GUESSED RIGHT?!
Right, so we were all booked, then short staffed, then…. overbooked.
Diverting is what you do when your hospital is too full, your people (doctors, techs, support staff) are too busy or too few due to staffing shortages, and there are too many animals to save/help/see.
So — we do as we normally do and we triage — see the sickest first.
If you’re gonna die NOW — we will see you.
If you’re not actively DYING — then you are diverted.
During the past two years of this covid 19 pandemic — I have seen more veterinary hospitals divert cases than ever before.
I have seen massive University vet school referral institutions be closed — diverting all emergency cases elsewhere.
This was relatively unheard of pre-COVID.
Places advertising 24/7 availability — suddenly became overwhelmed, then inundated. Eventually a point was reached where the show actually could not go on, and cases needed to be diverted.
Counterintuitive , right?
It’s an ER — but don’t come in because we don’t have enough fill-in-the-blank (time, staff, space, help, medicine) to assist you and your pet properly.
Because so many ERs in our area were diverting at any given time, it became a game of challenge, skill, and luck every time we had a patient that needed to be transferred elsewhere for further specialized care.
We’d call other referral hospitals, multispeciality referral hospitals and receive the news: Diverting, diverting, diverting.
We’d expand our search and call all of the states neighboring ours.
Yeah. I wrote that.
Someone (a genius) — A former vet school classmate — made a database for which referral speciality and ER hospitals were diverting and which were accepting transfers or emergencies and what the bandwidth and wait times were like.
I wish I could have thought of something so helpful and tech savvy, but I was probably rocking back and forth weeping while someone with a greater reserve of emotional stability was dreaming up that helpful database.
It’s always communication, right?
Communicating with clients, the owners of the animals I treat — is extremely important. Almost or equally important to actually examining a pet with all of my senses (except taste).
Communicating with clients when you cannot see them face to face, and have to speak to them on a phone with a mask on — adds extra layers of difficulty. All of which are impediments to optimal communication.
I’d go out to their car to speak to clients in rain, heat, cold, snow. I’d stand adjacent to their car window and from 4–6 feet away, scream/LOUD talk through my mask.
And so it would go.
Both parties are missing the benefits and nuance of facial expression, struggling to hear and be heard, trying the best we can despite all of the other things happening.
Communication with your veterinarian and vet techs when your pet is potentially sick and you are stressed out is actually SUPER IMPORTANT.
It’s hard enough to communicate with clients when you’re staring at each other, unmasked, 2 feet away with the sitting between you IRL.
Put the client in their car, with or without a cellphone, put the doctor in the building, the pet somewhere betwixt, then — add in some additional players (techs, front desk reception) add in some technology that is not ubiquitously understood by the masses — and you’ve got a real shit show percolating.
Now do that 10–20 times a day… for 2 years.
I mean — you get better, faster. There’s a learning curve — as with everything. But sometimes it doesn’t matter how steep the curve is, yanno? It still takes a toll. On everyone.
And now that we know how to do all of these things, everything will never return to the way it was before.
We stretched out of our comfort zones and learned some new things that are smarter, faster, more efficient, safer, and don’t expose people to COVID. But damn, all the updated health insurance, HR policies, all the corporate resources that went into protecting us (trying to!), protecting the animals, the clients, and the bottom line — it’s a lot.
It’s also impressive.
If your usual vet hospital or veterinary ER says they are diverting, it’s not because they’re eating pizza and watching The Bachelorette in the breakroom. Ask them: what hospitals are accepting cases today? Ask them which ER is NOT diverting. And be nice. Damn it.