I had a bit of both this weekend.
Saturday night, I was presented with a small breed dog in full-blown status epilepticus (non-stop seizuring). He had been seizing the entire 20 minute drive to the clinic. Due to the prolonged muscle contraction, his temperature already was too high to read on the thermometer (>108). We were able to get the seizures under control, but he rapidly began showing signs of a heat stroke (petechiae all over his body, low white blood cells, low glucose, and non-responsive hypotension). After NINE hours of pouring my soul into his care, as well as $2000 of his owners' money, fresh frozen plasma, Hetastarch, antibiotics, dopamine, and everything else under the sun, he died. His parents were devastated. I was too. I cried during the euthanasia, which is unusual for me. I'm fairly good at being able to turn that off, if you will. The difficulty of dedicated, crushed owners, an unavoidable illness (the dog was not a known seizure patient, this was his first - and last - seizure), no financial limitations, and then to lose him - it was too much for me.
Saturday mornings usually wrap up for me around 8:30 when I work the night shift. At 7:00am, a dog came in with weakness, a distended abdomen, and restlessness. Xrays showed severe abdominal effusion (fluid in the abdomen). An abdominal ultrasound showed tons of free fluid, which I sampled and found to be frank, acute hemorrhage. I suspected a mass in the spleen, but it wasn't the usual "HEY LOOK AT ME, I WEIGH EIGHT POUNDS!" tumor. This one was rather small (I thought). I'm not a radiologist, and while I am comfortable with the big things on ultrasound, this "small mass" I thought I saw could have been anything but.
I talked to the owner, ran appropriate bloodwork to rule out rat poisoning, etc. and then told her that I suspected a bleeding abdominal tumor, likely splenic in her older (7 year old) dog. I recommended surgery.
By then, it was 8am. My shift was over, and the doctor for the day offered to do the surgery. I wanted to stay though and do it myself. I love surgery, and I wanted to get the bad taste of my last patient out of my mouth - hopefully ending the day on a bright note (although a hemoabdomen probably isn't the best idea for that sort of thing).
Luckily, there was a "small" mass on the spleen (about the size of a half dollar and 3 inches thick). It had ruptured and was hemorrhaging profusely into the abdomen. With the help of my trusty and AWESOME LDS stapler, I had the spleen out in 5 minutes. She was awake from surgery within 10 minutes and looked amazing. The mass looks benign, although you really can't tell looking at them. It was well-demarcated, smooth, not necrotic or ugly. My fingers are heavily, heavily crossed for a hemangioma.
I only got 4 hours of sleep before pulling my 16 hour Sunday night shift, but it was worth ending Saturday on a good note. SO worth it. Especially when my surgery patient's owner asked if she could give me a hug this morning.
(Oh and my tracheostomy patient is home and doing great)
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