Tuesday, March 30, 2010

Why take it personally?

Sunday night, a disheveled woman comes in with her cat that is acting oddly - he's meowing loudly and painfully. She makes it clear on the phone beforehand that she ONLY has the $92 to be seen by the doctor, nothing else.

OF COURSE OF COURSE - her cat was blocked (see sidebar for explanation).$92 ain't gonna cover that, no way, no how.

Here's my dilemma:

In a best case scenario, I run bloodwork to look at kidney values, place an IV catheter, anesthetize, unblock, run a urinalysis, leave the catheter in for 24-72 hours while the patient is hospitalized, continue pain medications and fluids, and eventually discharge the patient to go home. This runs between $800-1500 depending on the length of the hospital stay.

There ARE other possible treatment scenarios. For instance, although I hate to do so, I can eliminate the bloodwork and urinalysis. This isn't a great idea, because I can't tell if the patient has gone into renal failure from the obstruction or not, and thus, I have no barometer for measuring if fluid therapy is effective...but if it's euthanasia or that...I'll cave and give the animal a chance. Or, if I'm feeling particularly bold and money is extremely tight, I will anesthetize the patient, unblock it, and send it home. This is a recipe for disaster - I'm not going to lie. Most cats unblocked this way and not put on fluids, will reblock within 24-48 hours (in my experience). Many cats when treated with the Cadillac plan will reblock at some point in the future anyway.

So, Mom is not happy with our "no billing" policy. It's either pay or we can't help you. I know that sounds heartless, but if we extended credit to everyone who said they couldn't pay, we would quickly be bankrupt and no animal would receive emergency care.

Mom tries to guilt trip me - and that's where I almost got angry. She calls her 15 year old daughter, hands me the phone, and makes me explain what's going on. She's trying to BLAME ME for her lack of funds, her inability to qualify for credit (CareCredit), and her inability to find one single person to loan her $500. If I needed $500, there are at least 10 people I could call off the top of my head that would loan it to me, no questions asked.

Daughter becomes hysterical. I calmly inform her (all the while seething inside at mom's underhanded maneuver) that her mother is deciding to euthanize kitty because of funds. I made it HER decision, NOT mine.

Mom starts ranting about how "if only Obama had gotten health care for animals, too." And yes, I bit my tongue so hard it might have been bleeding.

In the end, Mom came up with $200. I was able to sedate the cat, cysto to empty it's bladder of some very bloody urine, and dispense Buprenex (an opioid pain medication). It was 11pm, and her vet opened the next day at 7:30am. She swore she would be on the doorstep at that time.

She signed an "against medical advice" form saying that she was taking her pet home against medical advice. At the bottom she wrote, "I am not choosing to do this. I didn't have money, so I got no help."

At the end of our interaction, she said "hurry up, so I can get out of here, and you won't have a bad conscience."

I looked at her levely and said, "ma'am, I did a humane thing for your cat, emptying his bladder and getting him pain medications. I did what I could given the limitations you had. My conscience is clear."

She shut up after that.


The Snowboarding Vet Student said...

I'd bet she treats the MDs she deals with the same way. Poor cat.

Justine said...
This comment has been removed by the author.
Shannon said...

Wow. Just wow. It still astounds me when people cry poor when it comes to the care of their companion animals. I have three cats myself and am a full student with my only income being a line of credit and I know broke. I would NEVER deny any of my cats care because of food and I would NEVER beg poor at a vet clinic anymore than I would go into a grocery store, fill up my cart and approach cash claiming to not be able to pay. I'm impressed with the way you handled yourself.

Life in vet school said...

I can't believe she made you talk to her daughter! And didn't have any emergency plan for her cat. What a low-life.

Lioness said...

Oh God, like we don't feel bad enough that an animal cannot be given proper care already! Owners not willing or able to spend money on their pets' health should ever have become owners.

Hi! It's been a long time, hasn't it. Am catching up!

The Homeless Parrot said...

I would not have talked to her daughter when she handed me the phone had I realized she was 15. I thought she had contacted her daughter with the hope that she could borrow some money from her. Once I realized how old she was, I was already talking to her. It made me SO mad, though. It was SUCH an underhanded maneuver.

Anonymous said...

Wow. Charming. And not only was it not fair to you to make you speak to her 15 year old daughter, it was totally unfair to put her daughter through that. A 15 year old shouldn't be forced to deal with adult issues.

Elizabeth said...

I was at my Vet's clinic late one evening because of an emergency and a lady came in with a dog in labour/distress. She was talking so loud you could hear her everywhere.
She barged in the room as I was trying to come out with my dog and asked my vet to do the c-section her dog apparently needed free because she had once donated a puppy to be used as a therapy dog.. Then she started demanding the vet do it for free because of that. Now I was confused as to how that had anything to do with my vet. My vet was patiently explained that she had told her several hrs ago that they could set up a payment plan if she could come up with a $200 deposit. (I was thinking BAD IDEA, you will never see the money).
She then walked over to the counter where I was paying my bill and, commented to me that they were going to just let her dog and the pups die...
Now she chose to talk to the wrong person because I am not one to hold my tongue.
My first comment to her was, do you see what I am doing? I am paying my bill. Then I told her how lucky she was that my vet was willing to do what was needed with only a small deposit. I then told her if her dog died it would be her fault for "letting" it happen.
I wished her dog well and left..

I found out later that she complained some more but then pulled the money out of her purse. Not sure if they ever got all paid or not..

The Homeless Parrot said...

Good for you, Elizabeth! Fighting the good fight!

That's one thing I have found over and over again, it's not always a true lack of money - it's a lack of WILLINGNESS to pay for services. For some reason, the owners just expect us to do it for free...because, you know, we're all softies. We got into veterinary medicine to help animals, and we certainly don't expect to get paid for it, right??

Nicki said...

I think you handled it well. When push comes to shove I've sedated, unblocked, given pain meds and SQ fluids, left cath in overnight and sent kitty home the next day. Not ideal, but better than euthanasia. People like that make me so mad. Like having a pet is a right, not a privelege, and it's ok to let them suffer or expect someone else to pay for their care. Ugh. Oh and nice job Elizabeth!

The Homeless Parrot said...

Nicki: Unfortunately, sedating, unblocking, a night of hospitalization, etc. at our ER runs at minimum $600 - so even that wasn't an option.

Elizabeth said...

You are so right when you say its not always that they don't have the money it's they often don't want to spend it.
It's not just in veterinary medicine that people do this, it's just these people find it so easy to play the "you don't care about my (insert pet here) card". If they have an audience even better. Lets make the vet feel like a heel..
People who do want to do the right thing for their pets and are upfront with their vets about money issues will find things will go a lot better for them then trying to use guilt and insults..
That gets you nowhere but the door.