Tuesday, June 1, 2010

Ya want fries with that?

I love my job, I really do. I feel lucky to have a job that stimulates me constantly - that allows me to stretch my thinking while helping animals and their people. Sometimes though - just sometimes - I wish the worst part of my day was screwing up someone's fry order.

On Saturday night, as I rounded with my colleague, we came to the incubator. A small dog lie within, fighting for survival. A week prior, the dog had developed nasty, horrible diarrhea. He had been to his vet, and the dog was not doing well. When it presented to us, he was septic - with a white blood cell count of 930 (normal 5000-16,000). We could not keep the dog's blood pressure up (it wouldn't read for the first 8 hours of hospitalization, despite every possible measure), and his blood glucose hovered in the 30s - despite every effort to bring it up. On top of that, the dog was excruciatingly painful in its abdomen. We suspected a foreign body or some other severe GI problem.

The owner, of course, had financial constraints. We told her quite clearly - that the dog had <1% chance of survival. We told her it would be expensive. She wanted to try. We tried, but we all agreed that the dog needed exploratory abdominal surgery. She wasn't strong enough to survive it, likely. We told the owner that too.

I took over. The dog continued to deteriorate, and then suddenly, she began to do better. She was still very ill, and she was still suffering terribly, and I (and another doctor) told the owner so. We reiterated that she needed exploratory surgery - which increased her chances (completely subjectively) from <1% to maybe 5%. The owner elected euthanasia. She came to be with the dog. After about 5 minutes, she came out of the room and asked if surgery would give her dog a chance at all. I said that the dog DID have a chance, but it was still very, very slim. I explained again that the dog might not survive surgery. She decided to try.

I gave my technician explicit instructions to have her sign a surgery estimate and acquire a surgical deposit. He didn't. I didn't find that out until halfway into surgery. Oh, and of course, I didn't find a good explanation for her illness. Her intestines were hemorrhagic and not moving at all - but there was nothing stuck. It looked for all the world like parvovirus. Two tests 24 hours apart were negative. I'm still not convinced it wasn't, though.

At that point, her bill was already $1700. With surgery, it came to just under $3000. I called her back and asked for a further deposit before I left (5 hours beyond the end of a 16 hour shift). She demured and said she would call back. Four hours later, and a helluva lot of phone tag with the owner (who, as it turns out, had to hide in the bathroom away from her husband to talk to us) - we figured out she was a nutbar.

Long story - shorter - we didn't get paid, the dog had to be euthanized, and the woman spent 15 minutes screaming at my colleague last night around 3:00 am about how I only care about money and we forced her to do surgery - just for the money. Oh, and her son called this AM - threatening to show up at the clinic and "straighten us out." The police are currently on standby, in case he actually decides to make good on that threat.

And somehow - on some level - I feel like this is my fault. Like I AM money-grubbing and evil. Why? I can't answer that, but the feeling lingers on.


HP said...

I realize that they are grieving over their pet, but why don't people understand that we need to get paid just like everything else? Veterinarians aren't money grubbing selfish people and if we did things for free day in and day out how would we pay our mortgage? Feed our families? If this woman gets sick and needs to see her doctor, I'm fairly certain it won't be a free visit. Whether she or insurance is paying for it - somebody is footing the bill. Why can't all clients understand that vets are doctors and need money to survive just like they do?
I apologize for ranting - I still have 2 years left of school before I'm faced with this issue, but I've seen it all too often already!

Tammy said...

Wow - that's a really horrible situation all the way around! It is really hard to understand how someone can do something like this! You did everything you could for this pup and for the woman, sounds like! I'm glad to hear that you've alerted police just in case things do escalate!

KansasBrendan said...

Have you improved your technician training?

The Homeless Parrot said...

No, but I've improved my technician scolding :) He's a great tech...it was a misunderstanding. They happen. We addressed it. No developments as of now. Her son did not show up to "straighten us out."

Mary said...

Sorry you had to go through this. As I've said before, I don't know how you do what you do, but I'm so happy that you (and others) are willing to do it.

I know you know you're not money grubbing or evil, but felt like I had to say it anyway.

Medicine is not an exact science and, rereading your story, I can't see one thing that would indicate you should have done anything differently.

I'm so glad I don't work with the public -- I wouldn't be able to keep my cool!

Elizabeth said...

You don't deserve to feel that way... there are always going to be people like her.. sadly.

LittleVet said...

I think that owners sometimes have no understanding of the amount of stress and pressure that we feel as veterinarians to heal their sick animals particularly when there are financial constraints. That we lie awake at night worrying about the patient's lack of improvement and the size of their bill. If they did then maybe they would be more understanding.
Big bill + no pet = I want my money back and that is a real shame.

The Homeless Parrot said...

Thanks for the support guys. I'm mostly over it today. I had some fresh vegetables for dinner last night along with my homemade wheat bread for dinner - an impromptu dinner party with friends - and I feel much better.