From Clock in to Clock out: What 12 Hours as an ER Veterinarian Looks Like

What does a 12-hour shift as an emergency veterinarian actually look like?

In this episode of Behind the Stethoscope, I take you behind the scenes of a typical day working in a busy veterinary emergency room.

From the perspective of the night shift. From nightly rounds and patient transfers to critical emergencies, client conversations, medical records, and everything in between, I'm sharing what life is really like as an ER veterinarian. While every shift is different, this episode gives you an honest look at the fast-paced, unpredictable, and incredibly rewarding world of veterinary emergency medicine.

Whether you're a pre-vet student, current veterinary student, fellow veterinarian, or simply an animal lover curious about what happens inside an emergency animal hospital, I hope this episode gives you a new appreciation for the people working behind the scenes to care for pets when they need it most.

In this episode, we discuss:

• What happens before a shift even begins
• How ER cases are triaged and prioritized
• The balance between patient care and client communication
• The behind-the-scenes work people never see
• What makes ER medicine so rewarding—and so challenging

If you enjoyed this episode, be sure to like, subscribe, and leave a review. New episodes of Behind the Stethoscope are released every week, where we have honest conversations about veterinary medicine, career growth, mental health, and life beyond the clinic.

Follow along for more behind-the-scenes content:
📸 Instagram: @dr.elizabeth.brann
🎵 TikTok: @dr.elizabeth.brann

Transcript

SPEAKER_00 0:00

Hi everyone and welcome back to Behind Us at the Scope. My name is Dr. Elizabeth Brand. I am just a new ER Gred veterinarian, just trying to figure everything out like the rest of us. I want to thank you guys so much for such a great positive response for my last episode. If you guys haven't watched it, I definitely recommend going watching it. It's we're talking about resetting. I really love when I get a positive response for things that are going on in my life and to know how relevant it is in y'all's life and also going on in my life. I feel like it really connects us all together and shows that you're not alone in the things that you're going through. So thank you guys so much. On this episode, we truly are gonna go behind the stethoscope. I was talking to someone and they were asking about my job and what that entails and what my everyday looks like. And so I thought on this podcast, we should go through that. So on this podcast, we are gonna talk about a day in the life of what my 12-hour shift looks like. So let's get into it. Okay, so I imagine this episode being like the pit. If you guys haven't seen the pit, each episode is like an hour of the 12-hour shift that they go through during the day. This is just gonna be one episode, but I'm gonna try to go hour by hour, see what everything looks like. It might be a little bit chaotic, it might be a little bit all over the place, but unfortunately, that's my job. Hour one, we're gonna talk about what I mostly do, and that's overnight shift. So hour one, I get there at around 7 p.m. Promptly, I am rounded by the daytime doctor who is getting off at 7 p.m. We have hospitalized patients, so dogs or cats that are in the hospital for whatever reason. The most common ones would be like a foreign body. If we ate something we weren't supposed to and had to go to surgery. So they stay in hospital on pain medications, fluids, everything like that until they're ready to go. So blocked cats is another one, toxin ingestion. So that could be chocolate, that could be lilies, that could be grapes, that could be human medications, congestive heart failure, kidney disease, liver disease. There's a slew of things that we recommend hospitalization for. And so they get rounded on those. Every day it varies on how many patients that are in hospital. So sometimes it can be eight or nine, sometimes it can be one or two, sometimes it can be 15. So really varies on the day versus it varies on the day, the time, honestly, what time of year it is. So I get rounded on that. That takes about 30, sometimes 45 minutes, again, depending on how many are in there. My job in the first couple of hours is to go examine those patients, do a full good physical exam on them, check the treatment sheets, make sure everything is up to date of what I want, if I want to change anything, if I want to add medications or discontinue medications or anything like that. So I'm doing a lot of those things, but unfortunately, at, I guess fortunately or unfortunately, 7 p.m. between 6 p.m. and 8 p.m. is our craziest time of the day. And so we call it outpatients. So clients and their animals come in, dogs, cats, lizards, bunnies come in for anything they're experiencing during that time. It's an ER hospital, so they come in, no appointment needed, they can just show up for again, whatever reason it may be. My dog's throwing up, my dog's having diarrhea, my cat is straining to urinate. My dog got into blank. Again, a whole slew of issues that it could be. And so here at the hospital that I work at, we go and we triage, make sure they're stable, vitals are stable, all of this stuff. So come in, get rounded, and then immediately start my day. So 7:45, 8. Hopefully by that time, I'm on the back on the floor. Again, I need to go examine all of my hospitalized patients, check their treatment sheets while also taking the outpatients that come in. I do have, we call them swing doctors. We have day and night, and then we have those doctors in between to help with that. So their job is to only see the outpatients. So anything that walks in the door, that's their job is to see them. They don't have to deal with any hospitalized patients or anything like that. They're helping me along with the things that are coming in. So they're seeing things as well, and I'm seeing things as well. Most of the time, I would say 90% of the time, things are very manageable where I can go see my inpatients, do my physical exam, and then start seeing outpatients. There are some times that maybe I only can do one physical exam and then I see an outpatient, one physical exam and then I see an outpatient. Sometimes it gets a little crazy. And so, what an outpatient looks like. I see a dog comes in, they say, Hey, so and so is here for a chocolate ingestion. I go talk to the owner, get the history, do a physical exam on the dog, then I talk about my recommendations of do we need to induce vomiting? Do I need to run blood work? Do I need to take x-rays? Whatever cases, again, based on the history and the physical exam of that dog. So, for example, the chocolate toxicity comes in. Hey, my dog ate a whole bag of MMs 30 minutes ago. Great. I think we should induce vomiting. Let's get all that up. I'll go back to my computer, check and see the chocolate toxicity dose based on the weight of the dog and that going through that. And we induce vomiting, we see that. Okay, another one comes in. Hey, we are in respiratory distress. I gotta go see that dog immediately talking to the owner. Hey, what's going on? My nurses are placing catheters, starting fluids, or whatever that dog needs. I'm doing an ultrasound and a physical exam and talking to the owner all at the same time while my dog's vomiting chocolate over there. Then, hey, another one's here, a dog's vomiting and having some diarrhea. Okay, great. Talk to the owner, stabilize the respiratory distress because in a triage world, we worry about the most important, most deadly patient in the sense of which one is most critical. So that respiratory stress dog is the most critical at that time. So we give a sedative, it's actually in heart failure. We give a sedative, we place us into oxygen, we let us chill out, I come up with a plan, I go triage the next dog of vomiting and diarrhea. Talk to them about the history. It's a two-year-old golden who came in for vomiting, diarrhea over the last couple of days. My major concern, a young dog, golden retriever lab, is ingesting something we're not supposed to. Unfortunately, vomiting and diarrhea can be a million things. And so we have to use age, breed, history to narrow down our differential list of what's going on. A two-year-old, young golden. I have a golden myself. And my major concern is did we eat something that we're not supposed to? So talk to them about x-rays and blood work and seeing what comes of that, prioritizing x-rays to make sure we rule out that obstruction. And so coming up with an estimate, talking to the chocolate toxicity dog, circling back to them, talking about, hey, here's the toxicity dose, here's my recommendations, hey, you're good to monitor at home, or hey, we need to hospitalize because this is really bad. We got into a lot kind of that. Then I got to circle back to the respiratory dog, talking about, hey, this is this is what's going on, talking about medical terms in layman's terms. So I have a twin sister, and she knows nothing about medical terms. She knows absolutely nothing. So I try to talk to owners like I'm talking to my sister, like breaking it down to the bare minimum of heart don't be good, fluid in the lungs, secondary to heart don't be good, breaking it down. Everybody is all variance levels of medical knowledge. Some people are like, oh, congestive heart failure. Yep, I already know what that is. And some people were like, what's a heart? So different levels, gauging the level that they're at, trying to meet them at that level. So talking to them about that, made the estimate for the golden, talking to the chocolate dog. Oh, by the way, hey, one of my inpatients also needs something, or their owner's here to come. I gotta run over there and talk to the owner, talk to them about their patient, my recommendations on that front. Oh, hey, another cat, a cat came in for vomiting. It is a two-month-old cat that's vomiting and having diarrhea. It's in isolation. We go into isolation, we talk to them about my concern for panleukopenia, which is a disease. It's like parvo, but for cats, it's a virus that they get. We can get vaccinated for it, but our young animals are really prone to getting them because they are not fully vaccinated. So talking about that, hey, we shall run a snap test. Hey, circling back to the vomiting and diarrhea dog saying, Hey, we took x-rays, we're gonna send that out to a radiologist. Here's my first impressions. Circling back to the so I'm basically I'm making this as an example of what my day looks like, right? I'm talking to technicians, I'm talking to my swing doctors, hey, what do you need? Hey, how can I help you? And vice versa. Talking to owners, I'm talking trying to figure out what's best for the pet at that time. And so you keep running in these circles basically, pretty much all night. But realistically, again, varies on the day, realistically goes between again, when I get there at seven, it gets start getting pretty crazy. I would say it goes until 12 or 1 a.m. That's when it starts slowing down a little bit. So usually during that time when things start slowing down a little bit, it gives us time to do procedures, right? So hypothetically, that golden comes in and needs surgery because we ate a squeaker. Then usually around that time where we start slowing down a little bit, that's when I'm able to go in and do surgery on the two-year-old golden who ate a squeaker. So luckily at my hospital, I'm able to cut anything that I want. So foreign bodies, spillonectomies, sestotomies, so removing bladder stones if I want. So really anything, pyometras, infection of the uterus, I can do a spay, I can cut into the stomach or small intestines for a foreign body. I if I need to remove some of that small intestines, I can do that as well. So I'm super lucky at my hospital to be able to do really any surgery I want while that swing doctor is on the floor, right? So she is there until a certain time of the night. And so the goal is if I do have a surgery, if that golden retriever has to go to surgery, then I can do that before that swing doctor leaves. Again, this is all in a perfect gold standard world. Emergency never is gold standard. Emergency never goes as planned. Ideally, we have things set up into place to where we can do all of these things. But unfortunately, sometimes we're busy until 3 a.m. and my swing doctor leaves at 2 and I'm going to surgery and I'm the only doctor on the floor. So triaging, I'm in surgery as things are coming in. My nurses have to triage and we can go from there. Kind of so with all of that being said, yes, it can be very crazy. Yes, sometimes I am busy. Literally, it is nonstop till 7 a.m. the next morning. But most of the time, I would say, again, like I said, probably 12 or 1, things start to slow down a little bit. If we need to do any procedures or anything like that, that kind of lingers into the like the 2 or 3 a.m. range. And then the hours between, again, maybe two or three until maybe five, things start pretty much slowing down. So I have time to catch up on my records because everything I saw, I have to write a medical record for. And including the hospitalized patients, including the outpatients that I saw, I could see up to 10 or 12 outpatients during that, during my shift, right? And so I have to write a medical record for all of them and hospitalized patients. It's a lot, it can get a lot, especially the records in particular. And so most of the time I usually have maybe a couple of hours to catch up on my medical records. I'm never gonna get fully caught up, especially on shift. I just have too many things going on, adjusting inpatients, circling back. Hey, what does this look like? Or how is the patient? Is it still painful? Can we back off the pain medication? Or hey, is the are we still having diarrhea? What does a diarrhea look like? And again, adjusting those plans as needed. And then around five or six, that's when people wake up. And so most of the time, I would say through the night, if we're seeing anything, most of the time it is a true emergency, right? My dog is in respiratory distress from congestive heart failure. I let my dog out, it got out and got hit by a car. My I let my dog out and it got bit by a snake. We've had a couple coyote attacks. That that can definitely happen in the morning time. When they're out all night and then the dogs are just now getting out, they'll attack them then. Seizures are really common. But funny enough, ear infections are also very common throughout the middle of the night because the owner is just scratched, like again, the owners just get annoyed and they're like, I can't sleep. I need to go in. I just need to get this fixed. And so we'll see those very commonly. But I would say if anything comes in between the hours of, I would say two and five, two and six, most of the time, I would say 99% of the time, it is a true emergency for something that can't wait until the morning. So in between all of this craziness of people coming in and out, following up, talking, following up, hospitalized patients, talking about this, sending out this, reading blood work, making decisions, writing scripts, all of this stuff and trying to give your full attention to the animal that's right in front of you and spreading yourself all over. We have people calling. So at my company, people are able to call and talk to a vet. So not only am I doing all of this stuff, I am answering phone calls too, talking about hey, you should come in, hey, maybe it can wait, advice over the phone, or all of the things. That adds another level of complexity to the whole situation, too. So again, it can be a lot. I love what I do. I think it's so cool. I always say this to literally any doctor, and they're all like, you're crazy, is what job? Naming one job besides probably emergency human medicine that you can be a toxicologist, you can be a surgeon, you can be an internist, you can be an OGBYN, you can be like all of these sayings, you get to see all of those cases. So in a span of a day, I would see a C-section plus a foreign body plus congestive heart failure plus diabetes, plus again, an ulcer on the eye, an ear infection, seizures. So you're like neurologists, toxicology, repro, like all of these things, and you're like, I am all of these things. Am I an expert in any of that? Not even close. I'm not even gonna front with you, not even close. But I love the diversity that it brings. I love the variety that it brings. I never know what day I'm gonna have when I walk in the door. We could have 10 to 15 hospitalized patients. And so I know, wow, the hospital's patients are gonna be really heavy that day, but it could be also a heavy outpatient day. I could see a lot of things that come in the hospital. I could not see anything that walks in the hospital. It could be completely dead, and I see maybe one thing. Very rare that happens, but definitely a possibility. And so again, I love that. I know a lot of people are like, I could absolutely not do that. I need to know what I have planned for the day. I need a schedule, I need meetings, I have a schedule saying what's gonna happen instead of being like, whatever comes my way that day is what's gonna come my way that day. I've always been like that. I've always just gone with the flow, whatever happens. And so I've definitely grown up with that. And so it was a very, I don't know, easier is the right word, but very natural transition for me during that time. Or I guess transitioning into being an ER doctor. Okay, so the technicians. I like always like to shout them out because not only am I running around like a banshee, like I'm doing this, I'm going here, I'm going here, I'm going here. The technicians are like almost 10 times busier than I am because I go to my chocolate ingestion dog and I said, Hey, we need to induce vomiting, X, Y, and Z. And they said, Okay, great. The technicians are coming over, giving the injections, giving the anti-nause sub Q fluids. Okay, I'm going to the golden retriever and I said, Hey, I want this and this. And then so they have to go run blood work and do x-rays. Then I have my congestive heart failure dog. I said, I need this and this. And then they go and do that. And so they're doing that. They're running around like banshees because there's me who has three or four outpatients. I'm asking, hey, I need this and this. Not only is there another doctor, sometimes there's three of us total, sometimes, who are all doing the same thing. And then I have my inpatient nurse who are doing vitals and giving medications. Hey, I see this. Hey, I see this trend in the breathing. I see this trend in the urine output. Hey, this dog's kind of painful. And so one person is having to deal with the whole ICU. So all of the hospitalized patients every hour has treatments. And so they're running around doing that stuff too. So not only am I doing a lot as a technician, I know how hard it is to be a technician in the ER. And it is so difficult. And a shout out to you guys because again, I'm busy, but you guys are so much busier than I am. And I can respect that and the hard work that you guys do as technicians. I could not do my job. We could not do our jobs if it wasn't for the technicians. Like I said, I was a technician, I know how it goes, and I understand the value of a good technician and what you guys do for us as doctors. So I have to shout the technicians out. I cannot talk about a 12-hour span without talking about my technicians. So that is the craziness. Around 6:37, I start calling owners about the hospitalized patients, plan moving forward, rounding off my hospitalized patients around 7, 7:30, sometimes 8, depending on the day. So I usually get out of there hopefully around 8 most of the time. That's usually my goal. But sometimes it does take a little bit longer, sometimes 8:39. Then go home, rinse and repeat, leave by 6, get there by 6:30. Again, round at 7, repeat, repeat for again however many days I'm on. Most of the time I work three or four straight and then I'm off, and then I work three or four straight and then I'm off. I work 12 shifts a month, sometimes 13, sometimes 14, depending on the month. And again, my runs are sometimes different. Sometimes it's a set of two, sometimes set of three, four, et cetera. But during those times, you're working 13, 14 hour shifts. I'm scheduled for 12, work 13, 14 hour shifts, come home for seven hours, maybe, hopefully eight hours, and then rits and repeats. So not doing a ton during my days on, but my days off, most of the time I am off. Sometimes I have medical records to do. I would say most of the time I have medical records to do. Cause like I said, when you're seeing six or seven outpatients, 12 total, 13 total, plus your inpatients. There's no way to get kind of everything done at once. Some people can do it improps to them. I am too dyslexic myself to do all of that all at one time. So there's that. But yeah, that's a little glimpse of what a day in the life of my life looks like. I love my job. I am not complaining, literally in the slightest. It is so fun. It always keeps me on my toes. I love the people I work with, my colleagues, the doctors, the technicians, the receptionists, and they are amazing and they are why I go to work too. They bring so much joy into my life. They make the job fun. Sometimes we're in the trenches together. Like we're drowning. We can't keep up. We have so many things going on, and there's only so many of us. Just like an ER. If you've seen the pit, you kind of understand that waiting room where you have like a bunch of people in the waiting room and you're working as fast as you can to try to get everything seen, get everyone stable, get everything that they need. But sometimes, man, we are in the trenches, and it makes it so freaking fun to know that hey, this girl right here got my back. This girl right here got my back. And I will go to war for my technicians. I will go to war for my colleagues, my fellow doctors. I think they are the best. I would not, again, want to do this with anybody else. But yeah, that's a little day in the life of me and what I do every day. If you guys have any questions, I would love to answer them for you. I am very open about my job. I was meant to be an ER doctor and I, again, love it. But okay, some moments are good, some moments are bad. You kind of take the good with the bad and you try to make some positive out of it. I'm gonna leave you kind of with that. I hope this brings perspective of what my job does. If you ever find yourself in the ER, I hope it brings perspective of what they go through and what's happening behind this stethoscope and what kind of a day in a life of that ER doctor looks like or that technician looks like. And if you're a pre-vet student and you were like, I think I want to do ER, I hope it brings perspective of saying what an average day in the ER looks like. And then if you're an ER vet and you're listening to this, I hope you got a laugh and a chuckle and being like, Yes, me too. Not every ER is the same. I've worked in multiple different ERs. Every ER is different, but I feel like the basis is still the same no matter where you go. So I hope you guys enjoyed, and I will see you guys next week on Behind the Stethoscope. Thank you guys. Okay, I just have to put a disclaimer in here. This content shared behind the stethoscope is for educational and informational purposes only. This podcast does not provide medical advice, establish a veterinary client patient relationship. Any cases that I discuss throughout this episode are generalized and anonymous. Pet owners should always consult their veterinarian for medical decisions regarding their pet. And opinions expressed are my own and does not represent my employer or organization. Thank you guys so much.