Sunday, January 8, 2012

Non compos mentis

The VBB, you may have noticed, complain about clients a lot. That is not to say that all clients are terrible. There are many we simply aren't mentioning here, because honestly - would it be any fun to read about my perfectly lovely day with perfectly lovely people bringing perfectly normal pets for perfectly routine visits? No. That's not funny, and it's not fun. So anyway, there's one segment of the frustrating client population that I don't believe we've mentioned yet. We've covered the rude, the abusive, the ignorant, and the stupid, but not the ones who are not of sound mind.


It may not be obvious to all, but the mentally ill/mentally disabled/demented are a group which is present in society, and that includes the population of people who bring their pets to a veterinarian's office. I happen to have a lot of elderly clients, and a good number of them are very sadly in various stages of dementia. This is terrible. I feel terrible for them, and I feel terrible for their pets. I usually start out trying to help by making them large-print schedules of when to give their pet medication, and often I will ask for an additional contact person and then try to get their son or daughter or whomever to help out. But unfortunately, more than once, I've had a client become so incompetent that he or she has actually become confused, and thought I was a physician, and then gotten distraught when he or she realized there was an animal in the room. These were clients who used one of those "elder transport" services, so no one was with them. It's heartbreaking all around when these things happen. Luckily I've never had one of these people decompensate to the point that I had to call 911 or anything. The few times it has been really bad I have led them into my personal office, sat them down with a bottle of water and a cookie, and had a tech babysit them until they pulled it together enough to move forward, or their ride showed up, whichever came first.

Along the lines of mentally ill, I've been keeping a diary of my client/patient encounters since I entered practice, and I was reviewing it recently and found this from many years ago:

Saturday, I'm giving a cat an enema when I hear yelling from the reception area. I go up to the front desk and see a client literally screaming to the receptionist  "You are EVIL. You are an EVIL LIAR. I can NOT BELIEVE you would say that!" The receptionist is sitting mutely and staring at the woman. I interrupted the tirade and asked if I could help. The woman sweetly said that yes, she had Fluffy here for an office call. I brought them into an exam room, did an exam, chatted about Fluffy, and prepared to send her home when she said "and by the way, I will need all of the records for all of my pets because I can't come back here. I can never trust that SHE won't harm my animals." I said I was sorry to hear that and that I was sure my boss would be sorry to lose her as a client, and asked if there was anything I could do to make her happy today. She said all I could do was fire the receptionist, which of course I couldn't do, seeing as how I just work there, so I said ok, I will ask the receptionist to get the charts ready for transfer. So, we did, and the woman freaks out on me "No, no! I must have the ORIGINAL forms. You are SO SNEAKY. No copies!! Just ORIGINALS!" I offered her the phone number of the state board of veterinary medicine and explained that if she called them she'd see I was not lying when I told her that I was legally required to keep the originals. She then jumped down my throat, called me an "EVIL LIAR" and stalked out. Half an hour later, she called and apologized, and has been doing so twice daily since then!

Clearly, that is a mentally ill person, right? I mean, no one mentally sound would do something like that, right? Another one from my archives: I have also had a middle-aged man start taking his clothes off in the exam room. When I exclaimed "stop that right now!" he looked befuddled and said "oh! sorry, I thought I was told to disrobe and wait for the doctor." I said no one had told him that and he meekly apologized. Then he asked me if I knew where the lettuce was. I said I did not have any lettuce, and asked if he wanted me to go ahead and examine his dog now. He said "yes please, but is it ok if I wait out there? There are too many people talking in here." I sent him to the waiting room happily. He and I had been the only people in the room.

Vets do not receive training in how to handle this sort of situation. We muddle through as best as we can. It can be pretty difficult at times.


  1. My most recent serious crazy was a young woman who brought her perfectly normal 8-month-old golden retriever in at 3AM insisting the dog had been bitten by a "stair-climbing recluse spider" that had been trained and put into her dwelling by some nebulous person, possibly a government agent, who was out to get her. As the dog jumped up on me wagging his tail and acting like a normal 8-month-old puppy, she yelled, "See? He's lethargic!" And then proceeded to point out the nonexistent bite wounds to me. She insisted on bloodwork, which was, of course, completely normal. And then had no money to pay her bill, as one might expect.

    Dealing with the mentally ill is always a challenge, but my rule is never to play into the delusion. My experience has also been that people experiencing a psychotic break are prone to try to manipulate others, whether to try to normalize their version of reality or to try to exert a level of control that they don't have with their own mind. Allowing them to pull you into their reality puts you in a weaker position to avoid being manipulated, plus it validates what is ultimately a harmful situation for that person, and potentially for the animal.

  2. I love the "worms crawling out of my arm and my pet" or the "worms crawling out of the TV".

  3. The reception staff at our hospital deserve medals, a bonus and a large alcoholic drink on a daily basis for having to deal with Mr. Shortafewcards. Mr.S (for short) has been a thorn for as long as I can remember while working at this hospital (going on 14 years next month). He has a horrible stutter, barely enough money to live on from So-So Security, several small dogs and must call the hospital on average of 5-10 times a day to ask our poor receptionists if it is okay to feed the dogs an hour later as he needs to go shopping, is it okay to give the homeopathic anxiety medication to his storm-stressed dog as the weatherman says there is a 75% of rain today, etc. etc. etc. He has a special fondness for our office manager and asks for him all the time, often to talk about things not even related to his dogs. If he is put on hold while the staff deals with 3 appointments checking in, 2 checking out, multiple phone calls and OTC sales, he will leave that line busy and call in on another line within seconds of being put on hold. They dread when he actually comes into the office as he has been known to routinely do what it is he needs to do in the office, leave, then come back within minutes, sometimes not even making it out of the parking lot, to verify something small and inconsequential (such as how to spell a word or who gave him the information or the time of day), often repeating this pattern for the next 45 minutes to 2 hours. What is even sadder, we know he does the same thing to every other business he deals with...the bank, stores he frequents (Walmart "loves" him), but I honestly don't think he does this to any of the psychiatrists he has seen over the least none that has continued to see him. I wonder what their secret is as I get the misfortune of picking up the phone in an effort of helping the front staff during a busy time, only to have Mr.S on the other end.