Life in the (Animal) ER

JoVE mentioned a childrens' book about what I do in her post today. I don't know anything about the book, particularly, but I would suspect it's edited heavily for the child audience. I've been reading this book lately, and although its focus is human medicine, the intellectual and professional challenges it describes are very much my own.

My work certainly does have its interesting moments. Last week I saw both John Kerry and Jessica Lynch in the same night. Not the celebrities, just regular people with those names, but it still struck me as funny. And I see dogs and cats with porcupine quills, and skin infections, and broken toenails, and all sorts of other straightforward, routine sorts of cases that are an emergency clinic's bread and butter much the way vaccine appointments are for a day practice.

But a lot of what I do also makes people cry. We do an inordinate number of euthanasias. Sometimes people bring their pets in specifically for this reason. They've been watching their pet decline for some time and they have made the decision that the time has come to say goodbye. Many, however, don't realize that they are going to have to make this decision. They know that their pet is sick, but they don't realize just how sick. And I have to be the one to tell them. Or their pet dies in the hospital and I get to be the one to make that phone call.

After 13 years of doing this, I'd like to think that I'm actually pretty good at that part of the job. It is, for most of my clients, the loss of a family member - a major life event - and I try to be ever mindful of that fact and do what I can to make it just a little bit easier for them, as do all of our staff. Most people recognize that effort and appreciate it.

Sometimes, though, I have to deal with people who just don't get it.

I mentioned yesterday that I had one sort of frustrating case to deal with near the end of my shift. My senior tech triaged back a little toy poodle who was recumbent and too weak even to lift her head, her gums pale and dry from septic shock and dehydration and just the slightest bit jaundiced. When I put my hand on her, I realized that she had large areas of skin that were necrotizing - literally rotting on her body - with pockets of what I was pretty sure was pus underneath. I stuck a needle into one of the fluid pockets and got out a brown-grey fluid that looked and smelled like raw sewage. When I stained some of the fluid later to look at it under the microscope, I could identify at least three distinct populations of bacteria. This was a dog that was highly unlikely to survive.

As it happened, the dog had not received any veterinary care for several years, but it's questionable as to whether or not this had anything to do with the problem in the first place. It is possible that if they'd been more of a mindset to have the dog checked when she'd first acted sick two days previously that things might have gone differently. It is also possible that she had some underlying chronic disorder that had not been caught and had negatively impacted her immune function. At a fundamental level, though, what was going on with the dog was likely not directly due to any fault of the owners.

When I went into the exam room to talk to the owners, they turned out to be a leather couple who lived in town. The half of the couple who was the actual owner of the dog seemed quite nice and, I think, more or less grasped the situation. His boyfriend, however, needed to have the shit slapped out of him. Unfortunately, he was the one who was doing most of the talking for the pair.

I explained, as clearly as I could, what was going on with the dog and told them in no uncertain terms that the dog's only hope was aggressive treatment, and even then she only had the slimmest chance of survival. And even if, by some miracle, she managed to survive the immediate problem of infection, she was going to lose a lot of her skin, which would require skin grafts ideally or at the very least very long-term open wound management. The only viable options, I explained, were aggressive treatment for septic shock or euthanasia. The boyfriend responded in a thick Southern drawl, "We don't believe in that. That's murder. That Dr. Kevorkian should be in HAY-ull."

Say what? Usually, whenever I hear Southern, I have to ask where the person hails from. Earlier that day I had a client from Charlotte whose dog had come from South Carolina, about an hour from my hometown. With this particular guy, though, I just didn't want to know.

At first they wanted just to take the dog home on pain meds, where I told them that she would certainly die. That is, until I made them sign an AMA* form. The boyfriend balked at that, and then they wanted to know about admitting the dog. The initial estimate I had given them was simply not a financially viable option, so I had to rework the estimate, knowing as I did so and making it explicitly clear that it was a suboptimal approach. Still, we admitted the dog and I set about doing what little I could for her, knowing that it was an exercise in futility.

She died about a half hour after I'd left. I'm told the boyfriend complained that we were too expensive.

*Against Medical Advice