Tuesday, December 18, 2007

sometimes i wonder...

this externship ends in a couple of days. it has been an exhausting and emotional 2 weeks. i've worked anywhere from 14-24 hour days. i've managed intensive cases - including a diabetic cat with pancreatitis/liver failure/portal triad syndrome and an old dog with vestibular disease - all on my own. it's been terrifying and exhilirating at the same time. i'm so afraid of making mistakes, of missing something, of not saving an animal because i wasn't fast enough or smart enough. but i loved it. LOVED IT.

but...i digress. i came here to talk about the fact that sometimes i wonder if i'll be able to do this. veterinary medicine. why? you might ask - since i so obviously love what i'm doing. i'll tell you a story then - to illustrate what makes this job so hard.

yesterday, a husband and wife came in with a 6 month old miniature pinscher. it was sunday - which = crazy around here. and i mean CRAZY. the pinscher presented for ADR (ain't doin' right) for a couple of days. i was swamped and overwhelmed, but i took the case because the otehr 2 doctors were equally busy. the puppy was obviously ill. i could hear seriously increased lung sounds, wheezes, a heart murmur, the skin would not return to its normal place when i pinched it because the dog was so dehydrated, and the mucus membranes were BLUE. that means its gums - which should be pink - were BLUE. it was obviously extremely ill. it also developed blow-out bloody diarrhea while it waited for me to examine it.

when i finally got to the puppy, i realized how sick it was. and i told the owners - who were belligerent already because they'd had to wait (in an emergency hospital, no less). they also informed me that they had 20 other dogs at home and just couldn't afford to do anything about this puppy. i told them that we needed to do bloodwork and chest radiographs to find out what was causing the sounds in the lungs (fluid, i guessed). i talked to the owners about the murmur, i talked to them about heart failure. i TOLD them that the dog - with blue mucus membranes - would not make it through the night. they declined every test in the book - they even declined fluids. we did a snap parvo test and a fecal exam in the hopes that we would find something. the owners absolutely and totally refused any sort of diagnostics or treatment, despite me practically begging them to allow me to conduct radiographs. they asked me if the dog would make it through the night again - and i said that i doubted it. i even went so far as to call them at home and beg them to come back for a lasix injection to help the supposed pulmonary edema.

they left, and i heard nothing. tonight, when i came on for the night shift, i called the owner to ask how the puppy was doing. the owner proceeded to yell at me - the puppy had died - as predicted by myself and my mentor. he called me a greedy asshole - saying that my recommendations were strictly for me to make money. AS IF. i'm getting paid $500 for this externship. he took the puppy to the vet the next day and allowed bloodwork to be conducted. at which point the vet "diagnosed" rat poisoning. just in case you're wondering - there is no definitive diagnosis for rat poisoning. you can do a clotting profile - which can increase your index of suspicion. but you cannot say for sure that the dog got into rat poison (barring finding it in the stomach on post-mortem). regardless - at least i was right about the lung sounds and heart murmur. hemothorax (blood in the chest) and increased blood turbulence due to the fact that the dog was bleeding out ... (rat poison causes decreased coagulation).

still, it hurts. it hurts that the little dog died because its owners were negligent. it hurts me that i couldn't really do anything about it. i wish i could. i offered, they declined. i couldn't do it for free. and still, i feel like the bad guy. veterinary medicine (and human medicine) is a sticky area. you want to give away health care for free - but you can't. it's a hard fact of life. still...

sometimes i wonder if i can do this the rest of my life and not become embittered...

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