Friday, October 24, 2008

raindrops keep fallin' on my head...

it's a rainy, dreary, cold day here in the south. i'm back at the old stomping grounds, spending the weekend with my best friend and brother-in-law. it's a perfect day for lolling around and doing exactly nothing, and i love it.

tonight, we will play poker and probably eat burritos courtesy of moi.

i am recovering from the riot that was this past weekend, but i'm still a bit too bitter and tired to write about it in its entirety.

suffice to say that i had a patient with terrible vomiting that i couldn't control with conventional anti-emetic therapy, including a drug called zofran. zofran (ondansetron) is an anti-vomiting medication used for human chemo patients. it is usually fantastic. it didn't help my patient. after 2 days, i made the call to take my patient to surgery on the off-chance that he was obstructed in a way that wasn't obvious on the xrays (which were normal) and to obtain GI biopsies. i found exactly nothing - other than a strange thing hanging off the spleen. it didn't look like cancer or a granuloma - so i had no explanation for it. i wound up doing a splenectomy, but the owner was cash-strapped - and i couldn't submit the splenic thing for pathology. afterwards, my patient didn't wake up from anesthesia. his blood pressure plummeted - and he went into respiratory arrest. we aggressively resuscitated him, but the owner elected to stop.

i should feel good. the owner didn' have enough money to keep treating. we were going to euthanize when i offered him a payment plan (which we are typically not allowed to do in emergency medicine - just the nature of our client base). he accepted this tearfully, thanking me. i had a good sense about him, i knew he would pay us and gratefully. we decided that i would do surgery - if i found an obstruction, i could remove it. if i found something else, something terrible, i would euthanize on the table.

i gave the patient a chance. we were going to euthanize him. still, i feel so bad. it was terrible. and i still don't know why. all of my testing was normal - and he still died - despite my care, despite my testing, despite finally making the call to go to surgery.

it left me feeling sad, empty, and confused. of course, his owners were lovely, lovely people with children. and of course, my patient was a lovely, young (2 years old) animal whom i wanted to spend all of my "spare" time petting.

one of the many things that made this weekend a particularly rough one. another case that reminds me that no matter how hard i work, no matter how conscientious i am - i am not god, and i cannot fix them all. it's a bitter pill to swallow, but one i must keep swallowing nonetheless.

1 comment:

Xslf said...

Came here from the discussion and Dolittler.
I originally came came here to let you know that not all pet owners hold it against the vet if the outcome does not come out well.

Then I read what you wrote at this post here- it was all too familiar.

Just over a month ago my dog died at the emergency clinic, after being there for a four days. The vet who took care of her there was also our GP (this emergency clinic is a new one he opened after working for years in a general practice. I'll miss having him as my GP vet).

We only got a diagnosis about what was wrong with her in a CT we did the day before she died. All the other tests came back as normal.

As you wrote, vets are not gods, and they can not fix them all, no matter how hard they try.

Julie died at noon- only an hour or so after the vet went home following a long 14 hour shift (he did a night shift and then stayed the morning for a staff meeting).

I felt sorry for him that he went home to sleep and then was sent an SMS telling him that his patient died.

Later on I learned that he didn't even get that much- one of the techs from the "general" clinic called him with the news and woke him- I'm not sure how much sleep he got that day.

What I'm trying to say is that I know he did the best he could (and then some), and Julie got the best care possible- but some times that just isn't enough.
I don't hold that against him.
On the contrary.

I wish he could continue to take care of my cats and get to meet the new dog that will be coming home in a couple of weeks- but he chose to focus on the emergency clinic.

Well, at least I know that in case of emergency, my animals will be in good, caring, gentle, hands.

Take care- and please try to find the fine line between compassion and despair.
We pet owners need good compassionate vets at emergency clinics, even if you can't always save our beloved animals.