‘Controversies; fingers or probe?’ is on Friday, November 5 at 5 pm. ‘Controversies: Pyothorax – medicine vs surgery’ is on Saturday, November 6 at 3:15 pm. Kate will also take part in a clinical discussion forum on critical cases on Saturday at 5:45 pm.
In this Q&A, Kate discusses her early years as a clinician, her transition into ECC, the importance of mentorship, plus what we can expect from each of the sessions she’s involved in at this year’s ECC Virtual Congress.
What’s your veterinary background?
I’m Australian and I went to vet school there, graduating from the University of Melbourne. I went out into small animal practice after that before going back to university in Melbourne to do an ECC residency. That’s where I got the ECC bug and I went to some conferences in America to expand that before coming to the University of California, Davis to do another ECC residency. I then became boarded in ECC, did a PhD and stayed on as faculty in ECC at the vet school.
Was this always the career path you envisaged?
I grew up on a farm and being a large animal veterinarian was pretty much what I always wanted. That was my focus at first at vet school and I didn’t have much good to say about small animal veterinary practice – until there was a job shortage when I graduated. I took a small animal job and that took me down a very different path than I expected.
And how did the ECC interest come about?
When I thought about days that were exciting, it was typically a day when we had an emergency, even if we didn’t do ECC. Many years later, I found one of my application letters in my final year of vet school and I actually said I had a passion for emergency medicine. So, I guess I always enjoyed that excitement and the adrenaline most of us get from it. There’s that potential of having an animal that could die and totally change that outcome. I still love emergency, but my bigger passion is the critical care side.
"Being in the intensive care unit working on patients is my favourite thing. I still love being a vet more than anything else."
How has your ECC expertise expanded?
I have been exceptionally lucky in having amazing mentors all the way through. I aspire to be half as good as any of them. Their exposure to high-level medicine and the opportunities to do things I never thought I’d get to do really made a huge difference. They fuelled the desire to do better and to share knowledge. In ECC we do a lot of support of other clinicians and that’s really important.
What is your working life like?
I spend 50% of the time on the hospital floor in the small animal intensive care unit. I start my day in ICU by 7 am, going through cases with the residents and students, stabilising any that need intervention and working with the surgical and anaesthesia teams on the cases going through to them. We’re adjacent to the emergency room so we help with ER cases that need stabilisation as well. It’s an enormous hospital and there are always lots of animals coming in, so it’s very hands-on and 6 pm is the earliest we think about leaving. Being in the intensive care unit working on patients is my favourite thing. I still love being a vet more than anything else.
And the other 50%?
That’s the teaching, research and admin. I’m currently the small animal hospital director and I also do a lot of clinical research, especially in my interests of acid base and electrolyte abnormalities as well as respiratory disease and mechanical ventilation. And in the last 10 years, I’ve developed a research interest in cardiopulmonary resuscitation.
Tell us about the ‘Pythorax: medicine vs surgery’ session?
That’s a pro/con debate. That will be with Ana Marques, who is a surgeon, while I’m obviously coming at it from the critical care side. We have this conversation in veterinary medicine about cats and dogs which have Pythorax. Should they just be managed medically or should they go to surgery? In California, we probably see more of Pythorax than anywhere else in the United States because of the grass seeds here and it’s often a surgical disease. But elsewhere in the world that wouldn’t necessarily be required, so I think it’s a really interesting conversation to have. What are the factors that might influence your decision? We’ll go through cases and have a debate about how we might manage them. I think at the end of the day there isn’t going to be a one-size-fits-all answer.
And what about the ‘Controversies: fingers or probe’ talk?
It’s another pro/con debate, with Kris Gommeren, and we’ll be discussing the hands-on physical examination of an animal – which is what I’m a proponent of – versus using ultrasound at the bedside. Should we all just be performing point of care ultrasound and skipping the physical examination or is that not necessarily the best approach? Ultrasound provides amazing diagnostic options but in this session, we will be trying to better clarify what its role is, so we use it appropriately.
And your third session?
That’s a case conference with a group of the speakers putting together some cases that highlight many of the important aspects of the talks we’re covering. Hopefully it will help demonstrate the integration of some of the concepts we’ve been discussing. It is common that individual specialists have a different approach, so even for a very similar clinical situation, there will be a variety of options. It’s always interesting to see that there’s more than one way to do something and hear of things we hadn’t considered before.
Who do you think will benefit from taking part in your sessions?
Really anyone who is involved in emergency medicine. Even if you are in a practice where you don’t have a high frequency of sick animals, hearing the Pythorax conversations will be useful as it’s a pretty common disease. And assessment of volume status is important for every sick patient. That’s a core concept even for veterinary students, although even those with lots of experience don’t have all the answers. And with the case conference, I think it’s reassuring to see that even the experts are having conversations about the best approach.
Finally, you mentioned support and mentorship earlier. Surely looking after yourself is more important than ever with the wellbeing issues so many have faced in the past couple of years.
I spend a lot of time at work because it’s what I love but I do look after myself. Mentorship is so important as young vets need to understand how to draw the line. This job never ends; there are always sick animals and owners that need you. I see that younger vets coming through aren’t as good at being able to say it’s time to go home as they can only do so much. Our roles as mentors is to help them learn to take that time for themselves. I am happy to say we are spending more time thinking and talking about wellbeing than ever before. We are prioritising work-life balance and recognising the benefit of just asking if people are okay.