Trying to get through

(Extra points for readers who immediately grok the musical allusion in the post title!)

We are busy here in VBB central with our new puppy, so here is another guest post for you this morning:

So after mumbletymumble years in the field of veterinary medicine, I thought I was getting pretty good at client communication. Whenever I start to think I'm getting good at something, I'm proven wrong. This time, my own husband played a role in snapping me back to reality. Here's the story...

A couple of years ago, I rescued a very nice boxer who had been hit by a car. He had horrible comminuted fractures of his right hind leg and needed an external fixator that remained for about 3 months. Not long after that, he pilfered a corn cob off my 2 year old son's plate and needed surgery. He also had heartworms when we adopted him, but we never seemed to get around to treating them (you know the saying about vets' pets!). [FYI for readers who do not know the saying about vets' pets - it's the same idea as "the cobbler's children go barefoot" or, I suppose "the teacher's children flunk out".... :) -VBB] Fast forward to this week.

I decided that I would finally treat him for the heartworms. Bloodwork was good and his lungs were stable. I knew it would be a pain to restrict his activity, but decided now was as good as any other time. So I gave him the first injection of immiticide and took him home to start the long confinement. I thought I explained to my husband that letting him run around the back yard could KILLhim. But I don't think the point sunk in. So the next day, not 6 weeks from now, but the VERY next day, I come home to see guess who running around the back yard! At first, I was very angry and offended that my husband had so little respect for my medical recommendations. But the more I thought about it, I realized it was my own fault.

Normally, before starting heartworm treatment, I bring a client in to the clinic and sit down with them to explain heartworms, the treatment, and the seriousness of following the exercise restrictions. I did not do this for my husband, but I am fixing that mistake now. This morning, I took the dog back to the clinic and I plan to let him come home after my husband comes in for a proper heartworm consultation. Incidentally, I live about an hour away from my office. Hehe.

Thanks for sharing, Gentle Reader! 

My mother represents my clientele

And it's driving me nuts.

I work ER in a small town. Many of my clients can't afford preventative care, let alone the big bills associated with emergency veterinary care. I see many, many "home fixes." It drives me crazy, because by the time I see these patients, they're in far, far worse condition and require far, far more treatment (that's expensive). I can't stand seeing this scenario.

So, on that note, my mom called me the other day. Her dog was attacked by a pit bull. He suffered pretty nasty wounds from her description. Concurrently, my father was in the hospital for emergency surgery. So, instead of taking the dog to the vet, she just let him sit at home with his wounds.

Wait, no. That's not true. She started him on pain medications and antibiotics under her own direction. She didn't even ask me if or what she should use. And for the record, despite my dad being in the hospital, one of my brothers could have taken the dog to the vet. It wasn't as if there was NO ONE to  help with the scenario.

She called me a couple of days later and relayed that the dog wouldn't get up at all, and the wounds were worse than she thought. I tried to hide my irritation when heavily recommending that he should see a veterinarian.

Thankfully, 3 days after the injury, she took him to the vet. He stayed overnight to have his wounds debrided and sutured, and he required drains, as well. Luckily, they don't appear to have become infected yet.

*Gack* Why is it my own family who doesn't take my advice on pet care? I have to see it every single day at work. It'd be nice to not have to watch my own mother do it!

*yawn*

Well, it's 2012. My son remarked to me that he was surprised the world didn't end last night - he apparently believed that the Mayans predicted the world would end at midnight as 2012 began. I had thought the world was supposed to end NEXT New Year's. I guess we'll find out in about a year.

I started the new year of eating off pretty well, with chicken & waffles & a flight of mimosas. No complaints about my first meal of 2012! But, the new year of everything else? Yeah, no. Not so great. I was awakened this morning at about  6 AM by a panicked phone call. I'm not going to say who made the call, but suffice it to say it was not someone on the list of people ALLOWED to call me at 6 AM on New Year's Day. The caller was freaking out because apparently someone had knocked over their fishbowl during the evening's revelry, and the fish was missing, and they wanted to know what to do.

I'll just wait while you let that sink in.

Yes.

You read that right.

Now, maybe our blog audience isn't the right group of people to ask, but I'mma ask anyway - Really? When you knock over your goldfish bowl and you can't find your goldfish, the first thing that comes to mind is "I better call my cousin's friend's old neighbor's ex-girlfriend's brother's co-worker's former roommate, the veterinarian, and see what to do?" Even "gosh, I'm going to call my veterinarian with whom I have a warm and mutually respectful relationship to find out what to do" is a stretch, IMO. What was I supposed to do other than say "Hmm. I guess you should continue to LOOK FOR IT until you FIND IT, or else wait til it starts to smell and follow your nose!" ? Right?

So. That happened.

I also had the subject of a relative's newly-acquired dog come up in conversation. Changing the details - the dog had some outpatient surgery, and was acting weird when it went home, and cried all night. I suggested to the relative telling me the story that perhaps the dog had a) been discharged before it was fully recovered, and b) not had adequate pain medicine. The storyteller advised me that was impossible because a) the vet called the owner to say the dog was ready to go, and b) the vet told the owner that that particular surgical procedure was nonpainful. I didn't have the energy to argue. I just calmly said "oh, well, without knowing more details, I couldn't say what happened. Hey, who's watching the game today? What game? Um, I don't know. Isn't there a game today?" and then the kids and men started talking about game schedules. Phew. But in my secret heart of hearts I have to wonder: who doesn't just automatically KNOW that surgical procedures are by definition going to be painful, and that a dog who is up crying all night the night after a surgical procedure IS IN PAIN?

Sigh.

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.