Tuesday, July 20, 2010

Boiling point

Sorry I've been such a slacker about posting lately. Work has gotten on my nerves to the point that when I'm off (as I have been for the past 8 days), I don't really want to talk about it. This anecdote, however, is too good to not tell. I found my boiling point...

A couple of Saturdays ago, I was presented with a 13 year old German shepherd. She had suddenly begun urinating blood. Not just blood but blood clots. That's usually not good. My top differentials would be urinary tract infection, bladder stones, bladder cancer (usually transitional cell carcinoma), maybe renal failure, or less likely, a clotting problem or heartworm disease (caval syndrome). I went over these with the elderly, male owner and recommended diagnostics. He couldn't answer my questions well, and he kept stammering over things - such as - "is Fluffy on monthly heartworm prevention?" Finally, tired of my questions, he summoned his wife - who, as it turns out - was sitting in the car.

She comes in, sits down. I start with my spiel again - differentials, recommended diagnostics, treatment options (hospitalization versus outpatient and follow-up with regular veterinarian). When I say "regular veterinarian" she pins me with a steely gaze.

"I don't speak to my vet anymore." She said.
Uh-oh, I thought. I deliberately DID NOT ask what her beef was and continued. She interrupted me and said, "They did not acknowledge that I administered my own vaccines. I am a NURSE. I KNOW how to give a subcutaneous injection."

I shrugged and said, "I'm sorry, ma'am, but I cannot help you with that. So back to Fluffy's bloody uri--", and here, she interrupted me.

"They wanted to charge me $200 for vaccines. That's rape. She was RAPING me. YOU ALL-" and here, I got a pointed, nasty look, "are raping us."

My temperature started to elevate. I could feel my face growing hot and flushed.

"Ma'am, I am not here to discuss your previous veterinarian and your complaints. I am concerned about Fluffy's bloody urine."

She glares at me. "I am a NURSE. What you said about kidney failure was contradictory."

I am speechless momentarily. Finally, I say, "what exactly was contradictory??"

She says, "She just started having bloody urine, how could she be in renal failure already? That's contradictory."

So then, I explain my concerns again and tell her that renal failure is LOW on my list, but that it needs to be ruled out. I explain that we will check her kidney enzymes on bloodwork and this, combined with her urine specific gravity, will give us an idea of the status of her kidneys. She interrupts and says, "Do the renal failure test. If it's positive, what then?" I then have to explain that it's not positive/negative test - it's measuring enzymes and comparing them to her urinalysis. This goes in one ear and out the other.

Then she REALLY throws me for a loop.

"Why are you recommending treatment for a terminal condition?"

I am speechless AGAIN.

"Ma'am, I do not know WHAT is wrong with your dog yet. I have given you a list of POSSIBLE causes, but I cannot rule them in or out without TESTING."

She continues to glare at me.

"I want her placed on APPROPRIATEpain medication, do you understand?"

At this point, I can barely control my rage. I take the file, the dog's leash, and leave the room before my head explodes, thus spraying her with gore.

Diagnostics found no bladder stone, no urinary tract infection, no giant tumor. Something was amiss here.

The owner, of course declined hospitalization, taking the dog home on cephalexin and tramadol. I managed to mostly hold my tongue, although I found myself explaining to her, in no uncertain terms, how very many pets we see in our ER that have been vaccinated by their owners and now have the disease which they were supposedly vaccinated against. She didn't care.

The absolute ICING ON THE CAKE?? Today, I spoke with our office manager, who did a callback to check on the dog. Three days after I saw it, the dog started dragging both its rear legs. The owner called because she thought it was the CEPHALEXIN that caused it. Our OM carefully explained that it was not the antibiotic and that a dog dragging both rear legs should be seen for emergency care immediately.

The dog did not show up at work. The owner called 2 days later, saying that the dog was now completely paralyzed in the rear limbs. She refused to bring it back in because she did not want it "poked and prodded" and "stressed by the car ride." She would let her die PEACEFULLYat home. I wasn't there for this, or there would have been words. The woman was a grade A bitch. Sorry, no other way to say it.

I'm working on getting Animal Control involved, because at this point, I have no idea if the dog is alive, dead, or lying in its own feces somewhere, dying a slow death.

Look, I understand if you don't want to subject your 13 year old, large breed dog to a bunch of diagnostics tests only to euthanize it. I don't have a problem with that. If you're ready, and you think your pet is ready, then I'm ready, too. Bring them to me, and together, we will ease their suffering. BUT AT LEAST GIVE ME THE CHANCE TO DO THAT INSTEAD OF LETTING YOUR DOG DIE A LINGERING DEATH.

Sometimes, I really hate people.


Mary said...

I hope that you are doing something relaxing and enjoyable on your time off.

I hate it when people treat me meanly -- I would have such a hard time not taking it personally.

I feel for you :(

The Homeless Parrot said...

Mary: I hope you read the post AFTER I added the follow-up information. I posted it right before I talked to the office manager. Read the rest of the story - then tell me what you think!

Elizabeth said...

You were being too kind calling her a Bitch...

The Homeless Parrot said...

Elizabeth: I believe I used the c-word when discussing her with my husband.

Outrider said...

I'd include NSAID toxicity on the list of differentials for hematuria in this dog, given this is a "DIY" owner.

Nurses, unfortunately, can be terrible clients... worst of the worst (some nurses are okay, but the majority of my awful clients over the years have been nurses). Many are convinced they are qualified to practice medicine. In contrast, my physician clients generally know when they don't know.

The Homeless Parrot said...

Outrider: I did ask about NSAIDs in this dog. Supposedly - assuming the owner didn't lie to me - the dog had not been on any for many months. HOWEVER - she also told me the dog was current on HW prevention - and she hadn't seen a vet in 2+ years. I don't know where or how she was getting the HW meds. Caval syndrome was one of my concerns, too - since the dog was breathing rapidly/harshly and was febrile. Unfortunately, the owner would not let me work the dog up appropriately. A PCV/TS was normal, though.

Outrider said...

Ick. I am sending you a ton of sympathetic vibes, because I HATE this brand of client.

In addition to pitying the poor dog, I feel bad for her husband, because I'm certain she's just as obnoxious in her dealings with the physicians attempting to care for him.

Mary said...

I do feel absolutely horrible for her dog. I hope that he is now at peace.

Our state is horrible for animal control calls -- food, shelter, water. That's it.

The rescue where I volunteer is dealing with a client right now who is withholding vet treatment and quite possibly killing her bird for selfish reasons, and there is nothing we can do about it, so parts of this post hit very close to home right now.

There are just no words for people like this.

The Homeless Parrot said...

My husband and I got into a big argument over what constitutes animal cruelty and what constitutes different standards of care. I wanted to have AC check on the dog - not confiscate it or anything. He thought that was an invasion of the owner's privacy rights. I can see his point.

What if the owner is feeding the dog by hand, and keeping it clean, and helping it go to the bathroom?

Then again, what if she's not?

I see far too many of the latter at my job. FAR TOO MANY.

On the other hand, the less gov't involvement with our lives, the better. It's a difficult subject.

Elizabeth said...

HP : The C word is closer... but that is still too kind..

I see nothing wrong with AC checking on the dog.. Invasion of Privacy... maybe but better to know the dog is being cared for..

Mary said...

Even if this is happening:

What if the owner is feeding the dog by hand, and keeping it clean, and helping it go to the bathroom?

Wouldn't the dog still be in a lot of pain? Unless she got pain meds from somewhere?

I totally agree that it's a difficult subject, with many gray areas/examples (involving animal control). It just really sucks when the animal is being mistreated and you can't do anything.

I have a very poor science background, but it's my understanding that most likely if it were a person in this situation, the best course of action would be hospice and comfort care.

I see a ton of neglect/abuse (and much gray area neglect) at the rescue where I volunteer. I'm sure you see even more that I do. I just keep telling myself I can't save everyone, but it's still really hard to know about these animals languishing and not be able to do anything about it.

Sorry for rambling on so much.

Nicki said...

Nurses are the worst. Sorry for the rough case.