Mistake

I've thought about whether I wanted to post this or not for a few days. In the interest of representing what it is truly like to be an animal doctor, I think I would be heavily remiss in not sharing one of the the hardest parts of being a veterinarian (or any sort of doctor).

I made a mistake.

It's arguable whether or not it cost my patient her life.

On Sunday morning, a nice woman brought in her Golden Retriever. She had been hit by a car. Her respirations were rapid and shallow. I suspected a pneumothorax. Her gum color was not good, and her blood pressure wouldn't read.

We started stabilization: IV fluids, pain medication, and a chest tap. I removed over 3 liters of free air from her chest. At that point, I made the decision to put in a chest tube. She responded rapidly to this treatment. I discussed her condition with the owner, she left a hefty deposit and left her dog in my care.

Over the course of the day, we were slammed. I didn't eat, drink, or use the bathroom until 4:30 that afternoon. I was rushing around managing the patients pouring through the front door, as well as the 11 hospitalized patients in the back. See, we'd been open since Christmas Eve. I'd worked 14 hours on Friday, 14 hours on Saturday, and (as it turned out) 14 hours on Sunday. Further, I'd been sleeping terribly (Friday and Saturday night, I got a cumulative 6 hours of sleep). I was tired, emotional, and overwhelmed. I wasn't on my A game, or I can assure you, this never would have happened.

At any rate, over the course of the day, my patient's breathing became more and more shallow (despite the chest tube evacuating the air in her chest). Her gum color wasn't good (pale pink), and her blood pressure dropped repeatedly despite fluids.

ANY OTHER time - ANY OTHER day - I would have immediately suspected internal bleeding. The dog practically had a flashing neon light the size of a Mack truck above her head screaming HEMOABDOMEN HEMOABDOMEN HEMOABDOMEN!!!! It actually occurred to me that I should wheel the ultrasound over and check, but then something always intervened - another dying animal through the door, or something in the hospital needing my attention RIGHT THAT SECOND. I never did put the u/s on her.

As I transferred her over to the doctor on shift after me, my technician turned and said, "her blood pressure is 39 (normal systolic BP should be around 100!)." After I left, my colleague checked her belly, and sure enough: horrible internal hemorrhaging.

Surgery revealed a liver that was in multiple pieces and more than 3 liters of blood in the abdomen. My patient arrested under anesthesia.

My colleague has tried to make me feel better by telling me it wouldn't mattered had I caught it early or not, the liver was shattered. Somehow, that doesn't help. You see - somewhere in the back of my mind, I KNEW that my patient had internal bleeding, and I didn't look for it.

Why? Perhaps because I was exhausted and couldn't deal with the idea of an intensive surgery. Perhaps because I'd annoyed the techs enough that day and just couldn't stand seeing them roll their eyes when I asked that the ultrasound be wheeled over to the cage. Perhaps because my last hit by car hemoabdomen died on the table.

I'll never know the answer. I only know that I missed something that was blatantly obvious and now my patient is dead.

Christmas Eve dinner

Since I have to work tomorrow, we had Christmas early with my family (Tuesday) and Jim's family (Monday). Both were lovely, lovely days. Other than getting stranded on the interstate during the snowstorm on Friday night and having to shack up in a scary Days Inn in the wilderness of North Carolina, my break away from work was lovely.

I worked last night and have tonight off. I start days tomorrow (Fri/Sat/Sun). Jim's sister is also working tomorrow, so we had them over for dinner. It was my first real holiday meal for other people. In the past, we've always been somewhere for these types of dinners, so it was delightful for me to be able to prepare a holiday feast (how much do I love my amply sized kitchen??).


It was fairly traditional: honey glazed ham, garlic mashed potatoes, green bean casserole, corn, and yeast rolls. I made a fresh, homemade apple pie, too - using my mother in law's recipe. It was delightful. I am full and fat and happy...but I must away to bed. Work in the morning! (PS: I love having a job I look forward to going to!)

Here's a Christmas gift (begrudgingly given)

At 3am, the phone rang. A woman described her female dog's behavior: panting excessively, rigid, unable to stand, and frantic. The dog had bitten her tongue and was bleeding because she was shaking so hard. She'd given to birth to puppies 2 weeks previously. My technician explained eclampsia (low blood calcium - which is not exactly the same as eclampsia in human women, and thus, is rather confusing). At any rate, he explained that the mother dog was suffering from low blood calcium in all likelihood and should be seen. He carefully explained the cost of being seen at our clinic - $88 for the initial exam by me, followed by additional costs for diagnostics and treatment. The woman called twice, asking for other ways to treat the dog (which there are none, treatment needs to be IV calcium).

Sure enough, at 5am, they show up. They have "$20." At least, that's what they tell me at first.

I was mad. The dog was severely hyperthermic (temperature 105), laterally recumbent, with such tremoring that she couldn't even lift her head. She needed an IV catheter, IV calcium, and fluids to bring down her body temperature immediately. The owners, of course, had NO financial recourse. They didn't qualify for Care Credit (both were on disability - don't EVEN get me started there, both looked to be perfectly healthy and mobile), they didn't have a single relative that would loan them money, supposedly had no credit cards. In short, they couldn't procure even the $88 required to see me.

I was seething. I have an extremely hard time believing that they couldn't come up with EIGHTY EIGHT DOLLARS SOMEWHERE. ANYWHERE.

In the end, I treated the dog anyway. Eclampsia is extremely easy to treat in dogs. IV calcium over 20-30 minutes, some fluids for the hyperthermia, and they're usually right-as-rain. She recovered just fine, and I sent her out the door.

Her owners signed a payment agreement for the $234 they owe us. They swore they would pay us. And - mysteriously - when they got to the counter, it turned out they only had $10. How strange.

I'm not holding my breath. I'm just counting it as a Christmas good deed, even if I wasn't happy about doing it. They'll screw us, and I know it. It pisses me off, because these people - on disability - expect everything to be given to them for free. I gave in and did it, of course. Mainly because the condition is SO very easy to fix. I just couldn't put the dog down 2 days before Christmas for a problem I could fix easily in 30 minutes.

Yeah, I'm a sucker.

In memoriam

This time of year is a hard one for my family. I'm overly emotional all the time. Yesterday, at the mall, I was looking at the wishes hung on the Angel Tree and started crying. Once, I loved Christmas. Now it's a time of year during which I cry at the drop of a hat. I miss my family and wish we could be together. In 3 days, it will be the 4th anniversary. We still miss you little man.

Holy sick animals Batman!

Last night was nuts. It was a Tuesday night, and we were slammed again. We had 7 patients in the hospital this morning. For a small ER practice with 1 overnight technician and 1 overnight doctor, that's quite a bit of patients. We had 2 extremely emergent patients at once - a Labrador in terrible respiratory distress bordering on ventilatory exhaustion and a mystery case - a young (3 year old) Border collie with severe muscle tremoring. I was running between 2 sets of distraught owners and 2 critical animals. It kept me on my toes.

More to come on the mystery case.

Sunday bloody Sunday

Yesterday was (to use a very crude but very apt phrase) balls to the wall CRAZY. It reminded me of my internship. I think we did greater than $11,000 in business in 15 hours or so.

I saw (in no particular order): a severe diabetic ketoacidotic beagle (weighing in at 50#, should have weighed 25#), a cat with upper respiratory stridor and a possible polyp, a labrador retriever that ate a bag containing a bottle of acepromazine, a bottle of ibuprofen, and a bag of coffee grounds, 3 big dog / little dog attacks, a hemorrhagic gastroenteritis, a febrile, anorexic cat...and the list goes on and on.

It was busy, it was frantic, but the staff handled it well, we kept things moving, no one waited for an excessive length of time, and overall, I think we did a great job. Inpatient care suffered, but this - unfortunately - is the nature of vet ER medicine.

I didn't leave until 10:30 (my shift ended at 6pm), but it was different from my internship. I didn't get home and lie in bed, depressed and moody. Even my husband commented, in an amazed tone of voice, that I didn't have one complaint about the day. And really...I didn't.

Much better

The car situation is worked out, for the most part. We were able to sell it in about 2 hours on Craigslist. We got $1500 for it. Thanks to the generosity of a close family member, we are able to pay off the car in full and start back where we were 3 months ago - car-less. It's ok, though. The husband is working at home on his PhD dissertation anyway, and he doesn't need a car to get around.

It's the end of my 9 day stint away from work, so I'm diving back into the fray tonight. There will be more interesting stories to come, I'm sure. At some point, I'll have to talk about last Sunday and the ordeal...but not just yet.