Saturday, December 31, 2011

Family pets

It's funny. There's that saying, "Physician, heal thyself," yet, I'm sure most physicians agree that if there is anything seriously wrong, it's not a good idea to try to treat yourself. Similarly, it's generally considered unethical and inappropriate for physicians to treat family members for serious conditions. Percival's Medical Ethics (pub 1803) addresses the matter, proposing separation of personal and professional identities with respect to caring for family members. There are many reasons for this, loss of professional objectivity probably being the most important. So, anyway, what does this mean to me as a veterinarian? Well, there are no formal rules regarding treatment of one's own pets. It's not frowned upon by any professional societies that I know of. In the absence of a third-party payer system, in fact, most veterinarians I know do choose to either treat their own pets, or simply have an arrangement with a close colleague in their own practice in which they treat each other's pets. For me personally, it's a problem not so much with my own pets (whom I do have a colleague treat, because I find that my own loss of objectivity is so great as to interfere with providing quality care - my own pet once went apneic under my care, and while I did successfully resuscitate her, I will NEVER AGAIN put myself in that position!), as it is with family pets.

Ahhh, family. Gotta love'em, right? I am lucky enough to be surrounded by lots of loving family members, and honestly in the grand scheme of things, I have very few complaints about them. I would love to provide them all with free veterinary care, but - well - first of all, I'm not a practice-owner. There are limits to what I can give away. Information, sure. After all, information wants to be free. Medications, diagnostic tests, other sorts of things, well - those I can sometimes get at cost or cost plus something, sometimes I can't. And while some family members are really understanding about that, others I know think I'm just being mean. Sorry about that, guys. It's especially hard when I know certain family members simply don't have the money to provide the gold standard of care, as much as we would all love them to. On occasion, I've been lucky enough to have a local specialist colleague offer a family member of mine a professional discount. My profession is full of caring individuals like that, who will offer highest quality care at a deep discount, when THEY feel it is appropriate (not when Jane Random Client wants it, which is a whole separate issue). I hope that they can karmically balance out the scummy, corner-cutting Dr. Pols of the world. [And let me just take a moment here to go off on a tangent and add: Dr. Pol does NOT practice high-quality medicine. In one episode, he left a severely dehydrated puppy with hemorrhagic gastroenteritis alone in a cage dying, without even giving it any fluids. Seriously? he also doesn't seem to gown/glove up for surgery, or do any other 'standard of care' type things. OK, moving on...]

So anyway, all of this is really a lead-in to a story I wanted to tell. Details have been changed but the heart of the matter is completely true.

One day at 5 AM, my spouse's cell phone rings. It's a close relative on my spouse's side of the family. She found one of their cats on the floor near a "pool of dark liquid." The cat was "gasping" and when she touched it, "nothing happened." "What should we do?" she wanted to know.

It was one of those moments for me. I have them all the time. Moments when I feel like the person I'm talking to is going to be grossly unsatisfied with my response, no matter what my response is. Moments when I feel like no matter what I say, the person I'm talking to is going to come away with the idea that I'm an imposter, because surely a "real doctor" could do better than THAT.

I was in bed. It was 5 AM. The baby was nursing and I was just noticing that she was in fact running a fever again (the fever had not been present at bedtime). What was I supposed to do, get up and go over there and see that the cat was in fact agonal? Is this what they expected of me? I'd have no access to any diagnostic tools save my eyes, ears, and fingers; nor would I have what was probably the most important thing - Euthasol. Better to send them to a hospital. But which one? They won't go to the local university teaching hospital. They claim the vets there killed one of their cats. We always disagree on that, but it was a long time ago and besides, the cat is dead (ha ha)(sorry) so I can't suggest that. But the local ER sucks. The one my boss refers to - I wouldn't direct them to if they paid me. That leaves the one I almost went to work for, the one with the unreasonable non-compete clause in the contract. So I tell them:

It doesn't sound good. I can't tell what's going on, but you can't do anything at home to help him and you can't do anything at home to end his suffering. He needs to go to the hospital.

Later, I call my spouse to find out what happened. The vet said that the cat was agonal (duh) and she didn't know why. She offered supportive care and diagnostics, with the caveat that whatever they found was probably incurable, or humane euthanasia. The owner elected euthanasia, which is what I would have hoped for. But they declined a post-mortem exam, which was a total let-down for me.

We got together with this part of the family about a week after this event. They told me the whole story, in their own words. I'm sure they didn't mean to make me feel guilty, but when they said "since you couldn't come over, we went to that place you suggested," I heard "since you didn't love us enough to get out of bed, we went to that inconvenient and expensive place you suggested, which couldn't even help us anyway."

It's hard to be a veterinarian in an extended family of pet-owners, is the bottom line. Just wanted to put that out there. Thanks for listening.


  1. Been there, and have received the scathing looks. Bummer.

    Re: Dr. Pol - Hate, hate, hate, hate, hate that show. Write a letter to National Geographic explaining the (many) atrocities and why they'll be on the hook, liability-wise, if any layperson tries any of this, including the many instances when Pol allows clients to restrain their own animals for procedures. That's what my friends and I are doing.

    Happy New Year.

  2. Happy New Year to you too, Jenna. Good for you for writing to Nat Geo. I'm not sure I can think about it long enough to compose a coherent letter without suffering a catastrophic brain bleed, though.

  3. I've had to add an in-law's contact information to my cell phone so I don't accidentally answer it, and I don't even practice any more. You're not alone.

  4. I am so glad I do not get NatGeo or I probably would have popped off a heart valve by now.

  5. Wonder if he's any relation to Pol Pot...