Thursday, September 1, 2011

Frustrations and bad decisions

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.


Nicki said...

That is pretty crappy but it's not your fault the owner didn't have money, and didn't have an established relationship with her vet for routine care. It's harder because she was handicapped and may not have realized but that still doesn't make it your fault. You did what you could and tried to help the dog.

WeldrBrat said...

I have a half-sister that is mentally retarded to the extent of needing a guardian to oversee her finances and transportation. Through my life I have learned - sanity requires going the opposite direction anytime you are approached by the thought of hindsight. Believe me - you took the right direction. It was not in vain. In time - she will find her own way to appreciating you for being the one that cared enough to help her get her pet to a point of no longer being in pain. That will matter most to her. She'll always be more sad than most of us find ourselves as years go by. But they just seem to have this uncanny way of finding their own plateau for acceptance - and in the most loving ways. You did great. And you might as well know - Mother Nature's work on preparing you for motherhood is showing in this scenario. Just enjoy the ride!!

Anonymous said...

As you said, stellar.

I recently dealt with a mentally handicapped owner. She owned an animal with a serious problem, refused referral, didn't recognize it would have been malpractice for me to just give her some pills and send her on her way, then listened to her know-it-all friend who is an ex-client of mine (for non-payment, and other issues) and ended up stiffing me for the entire bill.

Perhaps WeldrBrat can help me here: what is the etiquette for respecting a developmentally delayed person's autonomy while ensuring he or she is capable of agreeing to treatment and payment? This was an impossible situation, and now I'm faced with the prospect of suing this person in small claims court, along with the handful of other bad pay clients.

This situation occurred over a holiday weekend, and of course I also cut her a break on the bill she didn't pay, before I realized she wasn't going to pay it anyhow. No one really won here, and I'm now unwilling to take on any more special needs clients who do not have a legal guardian present during all interactions. Even then, it's too much work.

Laura Potts said...

Wow! That's a really unfortunate situation. I deeply admire vets like you who make such tough calls every day.