Sunday, March 13, 2011

I feel repetitive

I think that if I post about how bad today was, ya'll will start to think I'm making all this up. I wish I were. Today, if possible, was worse than yesterday. I'm tired of whining about it. Really. Still, I feel that this day, this special, special day, should be shared.

First and foremost, waking up at 7am to a DARK room is not acceptable. Springing forward has always been my nemesis. It's just wrong. I was so poorly rested this morning that I was actually use a made up word. My thoughts were fuzzy, my eyes burned, and my tongue felt like a lump of lead.

Work started out slow and quiet. The first 2 cases of the day were manageable stuff. Then the proverbial sh*t hit the fan. And I mean HIT THE FAN. All at once, there were 4 groups of people in the lobby with 4 different animals. A woman wandered in off the street with a kitten crying in her hands. It went like this.

The kitten was brought back to me. Now, we all know what a sucker I am for a kitten. This little girl was about 3 weeks old. She weighed about a 1/2 pound. She was struggling mightily to breathe. The woman who brought her in "found" her in the parking lot. All Good Sams are required to fill out a brief bit of paperwork telling us where they found their animal, their personal information (so we can contact them if we have questions), and a signature. It's also a way for us to keep up with people who take to dumping animals on us. Well, this lady who "found" the kitten had been in our clinic a year earlier, also with a kitten that was in dire condition. She'd had no money at the time, so we'd euthanized it for free. The kitten she "found" that day reeked in a particular way that is only associated with catteries. So did the woman. Further, the kitten had milk around its mouth and chin, so someone had been bottle feeding it. I knew it was her kitten, and she was dumping it on us. I made a note in the computer and turned to examine the little grey kitten. She was so cute and sweet, rolling over to expose her soft belly when you stroked her with a finger.

She couldn't breathe and was struggling desperately. I decided to take the kitten on as a personal Good Sam, but I was super concerned about the breathing and suspected something very malignant. I xrayed her chest and my suspicion was confirmed - a megaesophagus was present. She had severe aspiration pneumonia. Her xrays were consistent with a condition called persistent right aortic arch. I've seen this once before in a kitten. Short of surgery, there is no cure - and the pet ultimately starves to death (or chokes to death). For whatever reason, I didn't accept it immediately, fed her some liquified baby food (which she frantically ate out of my hand), then put her in the oxygen cage while I turned to other matters. She slept peacefully.

Meanwhile, our exam rooms filled up. I stepped into room 1 and was confronted with a dog I had seen 5 days ago for a "pregnancy check." The owners knew nothing about normal dog whelping, had bred her accidentally, and were concerned. When they brought her in, she was doing fine, was not in labor, and had 6 healthy, live puppies on ultrasound. I told them to take her home and wait till she gave birth in a couple of days. Friday, she'd had 5 puppies fairly painlessly. Then she stopped. It was now 36 hours later, and the final puppy had not been born. Now, she was feverish (104), her heart rate was high, her abdomen was distended with gas, and she was vomiting. Her owners had $100 to fix her. Sighing, I left them with a CareCredit application and moved to Room 2.

Room 2 contained a Labrador retriever that had escaped from his kennel. He'd been gone for 3 days. When he came back, his front paw was devastatingly mangled. From the wrist down, the paw dangled, five times the normal size. It appeared to have been caught in a trap of some kind and completely, utterly destroyed. Now, it was rotting. Worse, the dog was lying on the floor - licking it and pulling strips of skin off with his TEETH. I nearly vomited at the sight. They had $150 to spend on his care. Leaving them with a CareCredit application, I moved to Room 3.

There I faced a nice Boxer dog with a fluid distended abdomen. He'd been diagnosed with a "heart problem" 1 year ago. The owner knew nothing about it. No treatment had ever been done. Today, he'd been lethargic, exhausted, and could not get up. His abdomen had also become tight and distended. I explained to the owner he was in right heart failure and discussed his options. The owner requested euthanasia. As we discussed, I was summoned urgently back to the ICU by my technician.

There I was confronted with a Shih-Tzu whose eye was dangling partway out of his head - the victim of a dog bite to the head. His owners had brought no cash or other way to pay for his care - but they wanted his eye removed (as it needed to be).

There I stood in the ICU dealing with a 1) septic dog with a dead puppy inside her 2) a dog in right-sided heart failure 3) a dog with a rotting paw that needed an amputation 4) a Shih-Tzu with a bloody, tramautized eye hanging out of its head and 5) tiny kitten depending on my decision whether to end or continue her life. Between all the owners, there was probably $300 to spend on these problems.

I wanted to go hide in the back and shriek until I was hoarse. Either that or cry hysterically. In situations like this, I will admit that I'll sometimes have a cigarette to calm me. I'm not a smoker, but occasionally - the stress requires that I do alleviate the stress. Obviously, I'm pregnant - so even that respite wasn't an option.

So, I just sucked it up and we got 'er done. The proptosed eye dog's people came up with $700 (the estimate was $800-1000). I made it work for that amount of money because I couldn't bear not to. I was able to crush the dead puppy's skull in utero and help the Dachshund pass the puppy. She was septic still, and the owners were able to contact some family members and come up with money to hospitalize her. The Boxer's owner chose euthanasia. The rotting paw dog's owner also picked euthanasia.

At the end, I sat with the tiny grey kitten on my lap and fed her a touch of liquefied food again. This time, she choked terribly on it - gagging helplessly, as the food refused to pass down into her stomach. She was starving but unable to eat. This last episode of choking made the decision "easier" - although I still cried the whole time I did it. It was a combination of exhaustion, stress, and sorrow for my inability to help. In the end today, both of my patients in the hospital (the proptosed eye and the septic post-partum dog) are "discount" treatments - meaning I am doing treatment much cheaper than normal and without my usual diagnostic testing. I couldn't bear to euthanize them in the face of the past few days I've had. The pragmatic side of me just has to let that go for now.

By the time I made it home, I was nearly comatose. Thank God for my husband. He fixed me spaghetti, salad, and garlic bread for dinner. Then he sat on the couch and kept me company while I watched Chopped AllStars on the Food Network. I think I'll go to bed now and hope that someday soon, this curse on me will pass and that owners will again be able to care for their pets.


Liz said...

I hope things get better for you soon. Venting is good for people - it helps keep it off your chest.

So glad your husband was there for you. :)

Fi from Four Paws and Whiskers said...

reminds me why I am now a lecturer....

I often think about hospice nurses and emergency trauma staff... they work in an environment where many, or even all, of their patients die. Animal recuse places know they cannot rehome all of the animals.
In general, you are doing the best you can in the face of ill prepared owners. The animals can be saved, but financially it is not going to happen.
You carry a heavy load... I think all you can do is to know you made the end peaceful, ended any suffering, eased the journey. People will always own animals they cannot afford in the hope that nothing bad will ever happen... but it does. And we keep rehoming animals into willing homes where this is likely to happen repeatedly.

You did your best - you helped some, you lost some. You are a good vet with a lot of empathy and you care. You want to save them all if possible - and so you should. Just be kind to yourself.

I wrote about some of this once...

HP said...

People like you are amazing. I'm almost certain that I couldn't do what you do on a daily basis - I'm going into a very busy private practice, and I'll take the emergencies as they come - but those will be the minority, not the majority.

On a side note, speaking of clients with no money, I did have a client come in a few months ago that had been overcharged by $0.18. And she wanted her 18 cents back. And she does not live in town, so she wasted much more in gas than the 18 cents was worth (in my opinion). There are just so many crazy people out there...

God bless you for what you do and for continuing to care and fight for what is right for these animals.

Karen Whiddon said...

You've made me cry. Why don't people understand that having a pet is a responsibility.

Blessings to you and like Liz said, venting helps.

Holly said...

I am so sorry. This is so hard.

I have a top price limit that I can spend on my pets, I know what it is and if I think there is going to be surgery involved, I let the office staff know that when I either call or arrive. I would love it if I could do whatever is necessary with cost being no obstacle, but the fact is...ALL medicine is expensive and I cannot jeopardize myself or my family financially. When the event is something that I have planned for (canine pregnancy comes to mind quickly), I have the funds for emergency set aside before I ever choose the stud or have the bitch tested. If I don't need them, great. If I have to have an unplanned section, or emergency spay, I'm covered.

My personal vet has worked hard to make this limit for me in the past. Probably because he's a compassionate man and outstanding doctor. It probably also does not hurt that I spend freely at his clinic for routine procedures.

Anonymous said...

Wow, I have so much respect for you. I don't think I could work emergencies like you do and go through all of those emotional ups and downs--I have enough of my own! But you're doing a wonderful thing, and I hope for your sake you have a good, long month of happy, rewarding cases!

Lise said...

What a nightmare. At least those poor animals didn't go on suffering for days longer before dying in pain. :-/

Take good care of yourself.

Nicki said...

I'm sorry. That's all I can say. Some days really suck. But for a cool case with a happy ending (so far anyway) check out my blog-my own personal cat, naturally.

Leslie said...

We've had days like this at our clinic. They're the worst. Makes me grateful for Care Credit and client's friends/relatives...