Do you know where Newfoundland is? Do you have a general idea of it at least? A lot of people don’t have a clue, it turns out. This is never more apparent to me as when I have to send a client to a specialist.
In veterinary medicine we can do pretty much anything they do in human medicine – MRIs, angiograms, complicated orthopaedic surgery, intricate cardiology procedures. . . etc. There are veterinary cardiologists, dermatologists, ophthalmologists, oncologists, dental surgeons. . . etc. These are available for your pets needs at referral centres, such as Veterinary Colleges and Specialty Centres. Neither of which exist in Newfoundland.
We have some vets who are comfortable with some orthopaedic procedures, and we have a couple options if we’d like an ultrasound done, but anything beyond that we need to send our clients out of province. The nearest referral centre is the Atlantic Veterinary College in PEI, and they are generally very familiar with receiving pets from Newfoundland. Some clients may choose to drive (not a simple drive – you have to drive to the west coast, take a ferry to Nova Scotia, and then drive up to PEI. Easily a two day journey depending on weather and how you like to drive. . .), some will fly their pets. Often if the animal is being flown it is flown by itself and arrangements are made for someone from the college to meet the animal at the airport.
AVC is a small college, however, and not all specialities are available there, and not all diagnostic options either. When we have to deal with other options, this is when we really start to feel like we’re on an island in the middle of nowhere that nobody is aware of.
Last summer I had a patient with a congenital heart defect. We were able to diagnose it with cardiac ultrasound: pulmonic stenosis. Unfortunately, that was as far as we could go. This little puppy had a narrowing near his pulmonic valve that could cause sudden death, and the procedure to correct that is definitely not something that could be done in Newfoundland. Unfortunately, he was also a Bulldog, so there was a chance he had cardiac arteries that wrapped around the area that needed to be expanded (which would rupture and lead to death if the pulmonic stenosis was corrected) and the only way to check for those is with an angiogram. This can’t be done in Newfoundland.
So I called AVC. Usual cardiologist is on a sabbatical and I speak to the new guy. He lets me know they can do a procedure to try to correct the stenosis, but they can’t do the angiogram. He’s not sure where Newfoundland is, but they usually send their clients to Boston or Guelph. Someone gets him a map, and he decides Boston is closest. Yes, that’s right; he was not sure where Newfoundland was. But at least he looked at a map!
So it’s about 3pm in the afternoon, Newfoundland time, when I call the speciality centre in Boston and speak to their cardiology department. I start the phone call with “I’m calling from Newfoundland” and let her know what I’m looking for. Her reply? “We have an appointment available this evening at 5pm.”
. . .
“I’m calling from NEWFOUNDLAND. We will not be able to get there this evening.”
“Oh, right. . . we can do an angiogram tomorrow afternoon, 2pm.”
“Okay, so, this dog will need to be flown to Boston, we need a little more time to make arrangements. Also, the owner may not be able to fly with him.”
“Ooooooo… well, I’ll have to talk to the cardiologists about this. Leave me your name and number and I’ll get back to you.”
Very helpful. Only not. So I called the Ontario Veterinary College in Guelph as well, because AVC is a fairly young college and before they opened Newfoundland cases were often sent to OVC. Also, OVC has a lot more specialists than AVC so they still receive a good number of cases from the Atlantic provinces. There’s a car service that goes to the Toronto airport that will take unescorted animals from the airport to Guelph, so if the owner can’t be there that is not a problem. And the technician I spoke to at OVC has been around for awhile and was very experienced in bringing in animals from far away. So at the end of the day this little puppy went to Ontario (Boston ultimately said they wouldn’t take the dog without the owner escorting him, anyway.)
Now, so this doesn’t seem like I’m only picking on Americans, another tale of referral:
One Friday afternoon I saw a young large breed dog who had been hit by a car and had a badly fractured tibia. Two of the veterinarians in the area who are comfortable with orthopaedics were on vacation, leaving only one I could consult. She wasn’t comfortable tackling this fracture by herself, especially given the size of the dog, so suggested I refer to AVC. Not a problem. Or so I thought.
This was unfortunately the week the new batch of interns had started at the college. So I call the emergency line and get someone who has zero experience with accepting cases from Newfoundland. Again, I start my conversation with “I’m calling from Newfoundland.” I explain the situation and she tells me that it is not an emergency and I should call back Monday to schedule the surgery as an elective. Nevermind the fact that I am not about to tell my client their broken dog is not an emergency, this dog is going to be flow down and arrangements need to be made. I tried to explain this to her, and she didn’t understand. She did admit she didn’t know where Newfoundland is. AWESOME. I think she thought it was a town in PEI. Eventually she said she’d consult with her supervisor. While I waited for her to call back, I told the owners to make arrangements and when AVC called back we’d just say “The dog is arriving at the airport at such and such a time, deal with it.” It all worked out in the end, and hopefully that intern learned where Newfoundland is.
So, for future reference… Newfoundland is an island in the Atlantic. There are no bridges attaching us to the mainland. Our options to escape are by air or by sea. And our options are hugely weather dependent. If you’re working in Canada, you might want to familiarize yourself with the country you’re living in. If you’re Canadian, you have no excuse. Seriously.