Sunday, March 25, 2012

Bad outcomes can't always be predicted

Every time I look, another week has whizzed by me.

I had a sad, sad case recently. It broke my heart on a great many levels. It was a busy weekend. In the midst of it, I was presented with a young cat that would not get up. She attempted to bite us every time we touched her. Her gums were pale, her temperature was low, and her heart rate was very high. I picked her up and grimaced as a I felt a giant, firm knot protruding from her abdomen. I suspected she'd suffered abdominal trauma based on what I felt and had a hernia of abdominal organs.

Xrays confirmed my suspicion. Part of her intestines were herniated. Given her condition, I suspected the intestines that were out of the body were strangulated and dying. Her bloodwork showed evidence of systemic infection. Her blood pressure was low, her white blood cell count was low, and her blood sugar was dropping. We stabilized her prior to surgery - normalizing her blood pressure, body temperature, and pulses. She looked pretty good prior to surgery. Once in the abdomen, I removed the 4 inches of dead intestine and sewed the ends together. Unfortunately, That wasn't the worst of it.

The hernia was caused by 2 penetrating bite wounds. And they had done more damage than just the hernia. The entire subcutaneous space (between the skin and the muscle) was filled with pus and necrotic, infected fat. Further, the muscles had started to die from trauma and infection. The smell was absolutely horrific. It took me 45 minutes just to clean out all of the nastiness between the body wall and the musculature.

Post-operatively, my patient would not recover from anesthesia. Her blood pressure and heart rate plummeted. Her pupils became fixed and dilated. We aggressively resuscitated her with fluids, giving her crystalloids, colloids, and vasopressors. She rallied briefly, but then began to decline again.

I knew her deterioration was likely due to the surgical agitation of all that necrosis and infection. The strangulated guts had been pinched off from the abdomen. When we opened it and removed them, a mass of inflammatory mediators were released into the blood. Further, opening and removing the necrosed and infected fat also likely released all kinds of nasty cytokines and free radicals into circulation. She was also probably suffering from a coagulopathy, as we'd had to give her large quantities of Hetastarch to help maintain her blood pressure.

It was all stacked against her. She absolutely required surgery to survive, yet surgery tipped her already barely stable septic condition into full on septic shock and DIC. It was a damned if you do, damned if you don't.

I was left having to tell her "owner" - a girl of 7 - that I couldn't help her kitty anymore. She was very brave, but tears rolled down her face. She didn't really understand. She only knew her kitty was terribly terribly sick. It made me so sad. I saw my daughter in her face. Imagined the first time my daughter suffered a loss. It made me so sad that I couldn't save her cat.

In the end, she kissed kitty on the head, and left with her daddy. I was left to give the only solution that I could offer kitty for her terrible injury.

It was bitter.


Jenn said...

Thinking of you - I know how difficult cases like that can be, especially when there are children in the picture - for me, one of my worst days was the afternoon we had to euthanize an older dog that had suddenly collapsed (ruptured hemangiosarc). He belonged to a boy of 9 or 10, who was absolutely hysterical when they came in. Let's just say that I left in tears that night.

I'm glad you were able to provide the care this kitty desperately needed, even with the sad outcome.

katydogcrazy said...

Oh, I am so sorry. As soon as you opened her up there was no REASONABLE hope, but still there WAS hope that she may be able to rally. A young and previously healthy animal . . . all the gods might be with you and she could come through it. But no.

And there would have to be a child involved. Old enough to understand that her pet was terribly ill and suffering, and to know that death means never coming back; hoping and maybe trusting that you could save her kitty. But too young to sort out how to deal with all that transpired. Sad doesn't begin to describe it. I am sending you some heart healing hugs.

Vivien said...

I cried like a baby when my beautiful Rex Bunny caught myxo. Age and understanding doesn't make that decision any easier or less painful.

Holly said...

oh my. That made me tear up. I think we all see our kids in a spot like that and it makes it tough.

foffmom said...

Yes, I am sure it was bitter. But the child-owner could have learned much in this loss. We all face the fact that love is inevitably linked to loss and grief. And most of us decide that it is worth it to love despite the pain. I am sure you were as gentle and kind as possible. And that counts as well, even if no one got the outcome they desired.

Anonymous said...

I'm so sorry you couldn't help this poor kitty. Thank you for trying, and for caring.