juxtaposition

here's a little lesson in the variety of owners i see:

Case 1:
4 year old yorkie recently obtained (about 6 months prior) by the owners. said owners are obviously poor and uneducated. nevertheless, they genuinely care about their pet. unfortunately said yorkie is incredibly malnourished. she presents seizuring. according to the owner, she has been seizuring for 8 hours. all of the trouble began shortly after she ate dinner the night before. i do a quick physical exam on her and find that she is emaciated, has a palpably small liver, and is severely depressed and seizing. she also has some obvious congenital defects. the owner says that he got her from a breeder who didn't want his name mentioned when the dog was brought to us (i bet he was a scrupulous, careful breeder, eh?). he gave the dog away because of its numerous birth defects. after my physical exam, i have several differentials in mind - the most important being a congenital abnormality called a porto-systemic shunt. other things that could cause this include toxins (antifreeze notably), trauma, severe emaciation, sepsis, etc. i talk to the owner, and i explain that his dog is in very poor shape. she requires hospitalization, bloodwork, and intensive care if she is going to survive. the owner tells me that he doesn't have money for all that. i carefully explain that we are looking at spending easily $1000 or more. the owner says he doesn't have it. he explains this cautiously, and it's obvious that it hurts him to tell me this. he explains that he knew the dog was thin, but that the "breeder" recommended a certain amount so that she wouldn't get fat and have trouble walking on her gimpy leg. it is obvious he feels terrible. he calls his wife to relay the news. i can hear her crying. he hands me the phone, and i explain it all again. she thanks me for my kindness and says that we will have to euthanize the dog. no recriminations, no accusations, no insinuating or outright saying that i am a dog murderer because i can't care for their dog for free. just a thank you and an acceptance.

Case 2:
owners bring me a big 'ole dog (80lbs). he is chipper but staggering slightly, as well as vomiting. all signs point to antifreeze. i explain to them the 2 treatment options: antidote to cost $1700 for their very large dog or ethanol alcohol IV. both require hospitalization. ethanol is cheaper in the short-term but requires intensive monitoring due to the massive amount of alcohol infused into the patient (basically you get them knock-down drunk/comatose) and 2-3 days in the ICU. when i explain this to the owners, they tell me that they don't have the money. i sadly offer euthanasia. i am lambasted, told that i am a dog killer. i calmly explain that no, i am not a dog killer but antifreeze is. i explain about the overhead of running our clinic, the cost of keeping the lights on, paying technicians. i am again called heartless - a dog killer. i step out of the room to let the owners discuss their options. i go back in. the ownres tell me how very much they love this dog (i bite my tongue and do not mention the fact that 1) the dog has had heartworms because they loved it too much to give it preventative and 2) the dog has been shot because they let it roam FREELY without regard for his safety - but i WANT to say it. i want to BADLY). in the end, they coughed up enough for alcohol and hospitalization. the dog went into anuric renal failure on sunday (unable to produce ANY urine, despite massive IV fluids). guess who still hasn't finished paying the bill in full?

i try to take a deep breath and remember those that are thankful and friendly and understand that i cannot give away treatment for free. most of the time, i can remember them. sometimes, i really have to bite my tongue, because bitter words spring to my lips all too easily.

in the end, do the 2 types weigh each other out? i hope so.