Monday night was my first night back at work. It was fairly busy for a Monday - rather against my wishes, as I had hoped for a quiet night so that I could recuperate from our trip to Florida. No such luck. I plan on sleeping very, very late tomorrow to make up for my lack of good rest lately.
Unfortunately, Monday brought a bad case that I would handle completely differently, if I had a time machine. A woman presented her 15 year old Chihuahua for "worsening since yesterday." She was seen by our relief veterinarian for back pain. At that time, no other abnormalities were noted. The dog (Daisy) was discharged on pain medications. Her owner reported that she wasn't doing any better.
Daisy was brought straight to the back, and it became apparent that she was having very labored breathing. When I listened to her heart, she had a severe heart murmur that wasn't present the day before. She was also cyanotic and having serious difficulty breathing. We placed her in oxygen and I went to talk to her owner.
Unfortunately, her owner was very mentally handicapped. She could not drive, and she had been dropped off by a friend. She could not give me any information on her dog. She failed to grasp the severity of Daisy's condition. I tried to explain, but all she wanted to do was hold Daisy. No matter what I said, I could not make her understand how ill her dog was. Further, she was severely financially limited. She was on disability and had about $395 in Care Credit.
Daisy would need at least 2-3 days hospitalization, maybe more - depending on her underlying disease condition. She would likely need lifetime medications and diligent care. I tried to convey this and kept failing. I asked her who her regular veterinarian was, and it turned out to be one of our shareholders. In this particular case, the shareholder has a history of helping out with difficult financial cases (for established clients). I crossed my fingers that she was an established client and proceeded to treat the dog with the limited money she had.
Daisy's xrays were puzzling. I expected to find heart failure, but I was not convinced of this on the xrays. She had a severe interstitial pattern in her lungs, but it wasn't the typical heart failure appearance. It could've been pneumonia too, but she wasn't coughing, and she didn't have a fever. I really wasn't sure what I was dealing with, so I treated what I could and kept my fingers crossed.
Shortly after Daisy's owner left, she called back sobbing hysterically. Her father, who cares for her, refused to drive her back in the morning to pick up her dog. Instead, he had told her that she needed to bring the dog home and "let it die." She was beside herself. Feeling terrible, I volunteered to drive the dog to the clinic myself (nearby, thankfully). The morning rolls around, and we run her Care Credit to pay for the night's care. It was declined. Stellar. I call the shareholder clinic to get information on the client. Turns out that she is NOT established and is considered an inactive client. Daisy was unvaccinated, not on heartworm preventative, and had only been seen a handful of time in 10 years for nail trims and the like.
In other words, not a client that the shareholder will work with financially. Great. What the hell was I going to do with the dog now? I called the owner, and we had a very frank discussion. I again explained that her dog was seriously ill, needed ongoing, expensive care, and more diagnostics. It finally seemed to get through to her. After much crying and discussion, she elected to euthanize Daisy.
An hour past closing time, she showed up (neighbor drove her), and we did the inevitable. Daisy went quietly. We fixed her Care Credit and were able to run it through for a part of the amount she owed us. In the end, I felt terrible about the situation. I spent $400 of this woman's money on a dog that needed more treatment without knowing for sure that more treatment was even feasible. As it turned out, it wasn't. If I could go back now, I would have put euthanasia on the table with that first discussion. Hindsight and all of that.
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