A vet friend just told a story (and she might blog about it at some point) that reminded me of an experience I had several years ago. I was working as an emergency vet at some tiny EC and a couple brought in a tiny doggie with some sort of very fixable issue. I don't even remember the issue, just that it was a no-brainer and would be a happy end for the family.
Now, this couple was engaged and they were kind of planning to start attempting to have a baby soon after getting married. As with all smart couples, they discussed how this addition would change their lives. The happy, wriggling canine on the table, all 5 lbs of him, was friendly and openly interested in making new friends. But not everyone in the house was like that.
The woman had a cat, one that she loved dearly, that was....honestly, nuts. The cat was fine with her, but would attack the fiancee, even charging the WINDOWS and tearing up blinds if she saw him coming up the stairs, before he had even entered the house. She had attacked him, unprovoked, on multiple occasions, but was mostly fine for the female. It sounded like there might be some displaced aggression issues, along with over stimulation issues, plus some other psycho babble that I will not bore you with.
It was obvious from the stricken look on the woman's face, that she loved this cat. And the husband to be loved his wife to be. They had talked to multiple vets and veterinary technicians about this cat and how to help her adjust. They had done metabolic testing, tried drugs, and behavioral modification....and all had failed so far. I mentioned referral to a veterinary behaviorist, and might have been more enthusiastic about it, save one issue: the possible future baby.
Now, if a cat sized animal is dangerous to an adult, it usually ends up with some biting/scratching wounds for the adult and perhaps a punting injury to the animal. If something is attacking my leg, the first thing that snaps to mind is to get that thing OFF OF ME. I do admit to throwing a lizard into a bathtub wall as a kid when I slung my hand in an effort to GET IT OFF OF ME as it chomped down between my thumb and finger. Around Easter, a chihuahua tried to attack my 6 year old (who loves most animals BTW), and that dog almost got punted across the yard...a well placed kick/shove and my daughter would have been safe (soccer, those skilz are useful when being attacked). It is pretty much instinct and, while I do not agree with kicking animals, I would have to qualms about it in that situation.
Well, a cat hopped up on pure crazy could do some serious damage to a baby. Even just infected scratches, lacerated eye balls, scaring the child so that the mere mention of "meow" sends it running and hiding under at desk at the tender age of 26....that is trauma. And I felt like it warranted, "the talk." Now, keep in mind, the happy dog was technically my patient, but the owners were really torn up about this cat thing. They wanted to help her, but they also didn't want to put the future groom and risk, much less a theoretical baby.
Every vet and vet tech they had talked to made them feel guilty. As a new mother with a timid, possible biting dog on my personal hands, I could easily place myself in their shoes. I told them that if they were looking for permission to euthanize the cat, I gave it to them, that I would do it for them. I said that the cat was mentally ill and perhaps years of drugs and therapy might help, but in that time, they and future fruit 'o the loins could be hurt. If they wanted to euthanize, I would pre-medicate the cat and allow her to fall asleep before really putting a hand on her to minimize stress. I would not make them feel guilty about it because I knew I was facing something similar at home with my dog and daughter.
I was not going to shame them into a position of attempting to "help" the cat, only to get a call in a couple of years about how it attacked their baby or a guest. There are so few times that I will literally say, "If this was my animal, I would euthanize," but this was one of those times. It was agonizing for the woman who loved her cat and I could see the pain in the man's eyes as he watched his future bride think about it. I told them that they needed to go home and discuss it. If they wanted me to euthanize, they just had to call back to the EC to make sure I was working that night and I would do it for them.
When they did come back in with the kitty, it was rough on everyone. I sedated her until she was pretty much asleep, allowing "mom" to let the kitty fall asleep while she was petting her. The couple chose to leave the room once the kitty was asleep, but before I actually euthanized her. It was tough on me, on them, and on my staff, even though we all knew that it was the best decision for everyone.
The next time I saw the couple was a happy day visit at a regular clinic where I did relief. The happy puppy had grown to 7 lbs doggie and was still as happy and wriggly. The couple was married and the wife was pregnant. And the relief was palpable. The family unit was intact, and though any pet, even a well adjusted little dog, can hurt someone (especially a baby), the risk was so much lower.
Not a fun rainy day topic, but my friend's case made me think about this one. Yes, I euthanized the cat: one that could not be re-homed due to aggression, one that might have hurt someone in the family. But perhaps I took away that cat's mental pain and saved a child from a scar or a scare or worse. It sounds like an unhappy thing at first: euthanizing a "healthy" animal, but I would do it if I felt like I could save a little kid in the process. Most vets have had to face this issue on multiple occasions. Some owners will have to face this decision.
And as someone who has been on both sides of that table, I can tell you it is hard. But once my dog finally bit my daughter (by the time she was 3, I could no longer control all of their interactions), I knew that it was time. He snapped at her when she bumped into him because he was afraid...but an inch to the center and she might have lost an eye as his tooth scraped her face. I could not deal with that. And though I still look at my pictures of him and keep his urn on my shelf, it took about a week before I realized I was no longer worried about a bomb going off in my house and taking out my daughter.
Showing posts with label death. Show all posts
Showing posts with label death. Show all posts
Tuesday, July 31, 2012
Thursday, May 10, 2012
PTSD and the vet- true, but not funny
This past month has been a trial of various medications in order to allow me to overcome being anxious about dealing with clients. I have a therapist, a couples counselor (because this kind of thing makes your spouse crazy), a primary care internist, and the psychiatrist. The actual diagnosis is being worked out, but this is a marathon and not a sprint. So, cost THIS week of therapy: $205 for the combined therapists and @$290 for the psychiatrist. I get a small break next week: one therapist is out of town. Oh, insurance covers NONE of this so it is out of pocket.
My PCP, therapist, and psychiatrist all agreed that I have PTSD. The psychiatrist mentioned that there are two main types: several small instances (non-combative) vs single/multiple combative PTSD. She thinks I have both. I had a boyfriend in junior high that abused and threatened to kill me and my whole family. He held me hostage with threats against his own life, attempting suicide when I broke up with him. Less than a year later, my father died when I was 16 and in a new school. Two big traumas. Then all of the little money grubbing digs, all of the rich doctor heartless jokes, all of the animal abuse, euthanizing 10-30 patients a weekend on emergency. The fear of never knowing if when I told an owner "I have a 90% chance of saving your dog, but it will cost at last $2000 and might go up from there," what they were going to say. Some would hug me and tell me to go ahead, then send thank you cupcakes. Some could not afford it and I euthanized their dog, but still got a nice card and sometimes bakes goods...no recriminations. And some called me a thief. And some just yelled at me. And when you have PTSD, all your limbic system processes is that all of things that stand out are the traumas. And you have constant cortisol release. And then your hippocampus shrinks. And you become angry and at its most base form, anger is fear. I was paralyzed when picking up the phone. I was paralyzed going into exam rooms.
Given my previous history, I would have been better off going into pathology or anatomy or research. But I am an adrenaline junky...jumping horses goes along with that, diving competitively goes along with that. I despite what my doctors think, I believe that I am high functioning ADD. My psychiatrist says that my brain just works differently and that I have a busy brain. It makes me good at solving problems, but does not help with the mundane things. I can diagnose and manage several severe medical cases, remove a spleen in 10 minutes, and start treatment on an animal my techs show me through the surgery window and I am closing the splenectomy. However, I cannot clean the house. I can cook a fabulous meal without a recipe but I cannot repeat it. I can create pictures that make people cry. I can give lectures and create inventions, but I cannot work through the mundane task of patenting them. Talking to a single client picking up the phone is trauma inducing. Giving a grand rounds lecture to an entire human hospital staff makes me high for at least a day. Instead of a wall that only lets a few things in, my mind is a colander, letting all sorts of things in and out. The box that all the exec want people to think outside of does not exist in my world. And even though my doctors all agree that this a 4 D way of thinking makes me a wonderful doctor, it makes me a shitty wife, and a less than mundane mother. At this point, I am agreeing that polygamy is a good choice...if I could have a wife that did all of that day to day stuff...how perfect would that be?
I am finding my way in this new world of purely capitalistic veterinary hospitals, where so many hospitals are competitors and not colleagues. And so many hospitals are being bought by corporations. I am navigating the land mines of the big box companies forcing pharmacist, with no veterinary training, to sell veterinary drugs that they *MIGHT* learn about through the hazy filter than is their rep (and do they know what they can trust, do they know about the interaction of Comfortis and Ivermectin products??.) I am trying for education rather than anger. I have already given one pharmacology CME, might as well charge Wally World for more.
And I am fighting this battle with suicide. Veterinarians have one of the highest suicide rates in the world...next to dentists. Money problems, easy access to drugs that kill, a feeling of helplessness, of being devalued....those all come into play. PTSD and the unending anxiety also
So you vets and human health care workers...you might have some PTSD too. ED medics, nurses, and doctors are at risk. Be safe. Get your help. I am mortgaging my future to do so, because without this help, my future will be in the state run loony bin or in the ground.
Yes, it is a downer post. But it is true to my life. Off to watch more TED talks and work on my next lecture. If I get my grant, it should gain some national attention.
My PCP, therapist, and psychiatrist all agreed that I have PTSD. The psychiatrist mentioned that there are two main types: several small instances (non-combative) vs single/multiple combative PTSD. She thinks I have both. I had a boyfriend in junior high that abused and threatened to kill me and my whole family. He held me hostage with threats against his own life, attempting suicide when I broke up with him. Less than a year later, my father died when I was 16 and in a new school. Two big traumas. Then all of the little money grubbing digs, all of the rich doctor heartless jokes, all of the animal abuse, euthanizing 10-30 patients a weekend on emergency. The fear of never knowing if when I told an owner "I have a 90% chance of saving your dog, but it will cost at last $2000 and might go up from there," what they were going to say. Some would hug me and tell me to go ahead, then send thank you cupcakes. Some could not afford it and I euthanized their dog, but still got a nice card and sometimes bakes goods...no recriminations. And some called me a thief. And some just yelled at me. And when you have PTSD, all your limbic system processes is that all of things that stand out are the traumas. And you have constant cortisol release. And then your hippocampus shrinks. And you become angry and at its most base form, anger is fear. I was paralyzed when picking up the phone. I was paralyzed going into exam rooms.
Given my previous history, I would have been better off going into pathology or anatomy or research. But I am an adrenaline junky...jumping horses goes along with that, diving competitively goes along with that. I despite what my doctors think, I believe that I am high functioning ADD. My psychiatrist says that my brain just works differently and that I have a busy brain. It makes me good at solving problems, but does not help with the mundane things. I can diagnose and manage several severe medical cases, remove a spleen in 10 minutes, and start treatment on an animal my techs show me through the surgery window and I am closing the splenectomy. However, I cannot clean the house. I can cook a fabulous meal without a recipe but I cannot repeat it. I can create pictures that make people cry. I can give lectures and create inventions, but I cannot work through the mundane task of patenting them. Talking to a single client picking up the phone is trauma inducing. Giving a grand rounds lecture to an entire human hospital staff makes me high for at least a day. Instead of a wall that only lets a few things in, my mind is a colander, letting all sorts of things in and out. The box that all the exec want people to think outside of does not exist in my world. And even though my doctors all agree that this a 4 D way of thinking makes me a wonderful doctor, it makes me a shitty wife, and a less than mundane mother. At this point, I am agreeing that polygamy is a good choice...if I could have a wife that did all of that day to day stuff...how perfect would that be?
I am finding my way in this new world of purely capitalistic veterinary hospitals, where so many hospitals are competitors and not colleagues. And so many hospitals are being bought by corporations. I am navigating the land mines of the big box companies forcing pharmacist, with no veterinary training, to sell veterinary drugs that they *MIGHT* learn about through the hazy filter than is their rep (and do they know what they can trust, do they know about the interaction of Comfortis and Ivermectin products??.) I am trying for education rather than anger. I have already given one pharmacology CME, might as well charge Wally World for more.
And I am fighting this battle with suicide. Veterinarians have one of the highest suicide rates in the world...next to dentists. Money problems, easy access to drugs that kill, a feeling of helplessness, of being devalued....those all come into play. PTSD and the unending anxiety also
So you vets and human health care workers...you might have some PTSD too. ED medics, nurses, and doctors are at risk. Be safe. Get your help. I am mortgaging my future to do so, because without this help, my future will be in the state run loony bin or in the ground.
Yes, it is a downer post. But it is true to my life. Off to watch more TED talks and work on my next lecture. If I get my grant, it should gain some national attention.
Thursday, April 26, 2012
Spring, death, and no vet med
Every time of year, I find myself in an incredible depression. Spring should be a happy time, full of parvo puppies, unwanted litters of kittens dumped on your door step, and equine dystocias. The night before last, I had a dream about a spring festival that my high school has every year. Since 1904, my school has had a May Day festival. The sophomores pray for fertility by dancing around a may pole (why the FUCK does the school want the sophomores to be fertile anyway???) and the seniors wear ball gowns and are presented to society. Yes, it was a girls' school, though the thought of 18 year old boys in ball gowns makes me laugh.
I started the school as a sophomore, meaning that I was on tap to practice the fertility rite of dancing around the may pole (the obligatory orgy usually associated with this type of festival is frowned upon by the school and the parents). Well, back to the dream. I dreamed about the very sweet girl that was the May Queen in our senior class. She was dressed in a t-shirt and jeans and this year's seniors were insisting that she could not participate without the ball gown. I was arguing that of course she could, she was Mary Smith. Unlike many schools whose elected fall queens, prom queens, etc, our class chose someone that was unfailingly sweet rather than the obligatory cheer leader. Oddly enough, at an all girls' school, there was a distinct lack of the "mean girls" phenomenon.
Well, back to the dream. It turns out that yesterday was indeed the May Day celebration at the school. It also coincided with the 20th anniversary of the sudden death of my father. My father was on his way back from a golf tournament. His plane hit a sudden snow storm in the mountains of North Carolina. It was missing for several days before it was finally found. While some people held out hope that he and the pilot would be found alive, I was pretty sure that it was not going to end happily.
The last time I saw my dad, I was a spoiled 16 year old. I passed him on the road, him in his work truck and me in my car. I honked and waved and sped up because I didn't want him to give me flack about going out with my friends that day. I purposely avoided him.
The next day, while he was playing in the golf tournament, I was very distraught. I told my mother that something huge was about to change. I asked her, "What if I told you that tomorrow, the most important thing in your life would be gone? What would you do? Everything is about to change."
That night, my dad was not back on time. About 4 AM in the morning, I heard my mother scream and start wailing. She had learned that the plane had gone down. For several days, they searched for the plane. During this time, I continued to go to school and practice the may day dance. The plane was found and both my dad and the pilot were dead. A family friend went to ID the bodies so we didn't have to. But after practically predicting the event, my family looked at me differently.
So yesterday was the 20th anniversary and my subconscious knew it. The only good thing that really came out of that situation was that my inheritance allowed me to finally buy a horse. And that horse was a better incentive for good grades than any other possession. That horse got me into a college with a riding scholarship. And that school got me into vet school. My dad always wanted me to be a brain surgeon. And while I have poked on some brains when examining a skull fracture, I am not a neurosurgeon.
Sorry for the downer post. And sorry for the minimal tie in to veterinary medicine. But I am just writing about what is going on in my life.
I started the school as a sophomore, meaning that I was on tap to practice the fertility rite of dancing around the may pole (the obligatory orgy usually associated with this type of festival is frowned upon by the school and the parents). Well, back to the dream. I dreamed about the very sweet girl that was the May Queen in our senior class. She was dressed in a t-shirt and jeans and this year's seniors were insisting that she could not participate without the ball gown. I was arguing that of course she could, she was Mary Smith. Unlike many schools whose elected fall queens, prom queens, etc, our class chose someone that was unfailingly sweet rather than the obligatory cheer leader. Oddly enough, at an all girls' school, there was a distinct lack of the "mean girls" phenomenon.
Well, back to the dream. It turns out that yesterday was indeed the May Day celebration at the school. It also coincided with the 20th anniversary of the sudden death of my father. My father was on his way back from a golf tournament. His plane hit a sudden snow storm in the mountains of North Carolina. It was missing for several days before it was finally found. While some people held out hope that he and the pilot would be found alive, I was pretty sure that it was not going to end happily.
The last time I saw my dad, I was a spoiled 16 year old. I passed him on the road, him in his work truck and me in my car. I honked and waved and sped up because I didn't want him to give me flack about going out with my friends that day. I purposely avoided him.
The next day, while he was playing in the golf tournament, I was very distraught. I told my mother that something huge was about to change. I asked her, "What if I told you that tomorrow, the most important thing in your life would be gone? What would you do? Everything is about to change."
That night, my dad was not back on time. About 4 AM in the morning, I heard my mother scream and start wailing. She had learned that the plane had gone down. For several days, they searched for the plane. During this time, I continued to go to school and practice the may day dance. The plane was found and both my dad and the pilot were dead. A family friend went to ID the bodies so we didn't have to. But after practically predicting the event, my family looked at me differently.
So yesterday was the 20th anniversary and my subconscious knew it. The only good thing that really came out of that situation was that my inheritance allowed me to finally buy a horse. And that horse was a better incentive for good grades than any other possession. That horse got me into a college with a riding scholarship. And that school got me into vet school. My dad always wanted me to be a brain surgeon. And while I have poked on some brains when examining a skull fracture, I am not a neurosurgeon.
Sorry for the downer post. And sorry for the minimal tie in to veterinary medicine. But I am just writing about what is going on in my life.
Thursday, January 26, 2012
She can't live like this!
Thursday morning:
Ring! Ring!
VBB's Receptionist: Hello, World's Best Veterinary Hospital, how may I help you?
Client: My cat is dying. What should I do with the body if she dies while you're closed?
VBB's R: Hold on. What's going on with your cat? Do you want her to see the doctor?
Client: No, I don't want to pay for a visit. I just want her to die at home but then I don't know what to do with her body when she dies. Is there someone who will come get it?
VBB's R: We can see her today. Do you want to come in today?
Client: No, I just think she's dying. Please tell me what to do with the body.
VBB's R: Well, you can wrap her in trashbags and keep her in the freezer or garage until we open and then bring her to us for cremation if you like. But are you sure you don't want to have her see the doctor, even for euthanasia?
Client: No. I said I want to let her die at home!
VBB's R: Ok, I'm sorry. I'm sorry your cat is sick. Take care.
Friday morning:
Ring! Ring!
VBB's R: Hello, World's Best Veterinary Hospital, how may I help you?
Same Client: It's my cat! she's having trouble breathing. I'm on my way in with her.
VBB's R: Wait. Is this the cat that was supposed to be dying at home?
Client: Yes, but, I didn't think she was going to have trouble breathing! She can't live like this!
VBB's R: Well, no. When an animal dies, it stops breathing, and stops living. So, you're coming in?
Client: Yes, of course, I'll be there soon. [hangs up]
The client and her poor cat did arrive shortly after, and the cat was in fact having trouble breathing. The owner wanted us to fix the breathing so that she could take the cat home to die - but wanted to make sure the cat wouldn't continue to have episodes of trouble breathing. On the one hand - I do understand it is horrible to watch someone you love struggle to breathe. I have watched countless animals as well as a couple of humans do this, and it is just awful. On the other hand, like my receptionist said - when you die, you do stop breathing. Sometimes, when you're in the process of dying, you breathe irregularly for a while, and then do some gasping, because of the way CO2 builds up and triggers a reflex to breathe. Death is not like a Hollywood movie.
We ended up euthanizing the poor kitty because I could not promise that there would be no additional episodes of dyspnea. I hope the client wasn't too disappointed that her kitty didn't get to die at home.
Ring! Ring!
VBB's Receptionist: Hello, World's Best Veterinary Hospital, how may I help you?
Client: My cat is dying. What should I do with the body if she dies while you're closed?
VBB's R: Hold on. What's going on with your cat? Do you want her to see the doctor?
Client: No, I don't want to pay for a visit. I just want her to die at home but then I don't know what to do with her body when she dies. Is there someone who will come get it?
VBB's R: We can see her today. Do you want to come in today?
Client: No, I just think she's dying. Please tell me what to do with the body.
VBB's R: Well, you can wrap her in trashbags and keep her in the freezer or garage until we open and then bring her to us for cremation if you like. But are you sure you don't want to have her see the doctor, even for euthanasia?
Client: No. I said I want to let her die at home!
VBB's R: Ok, I'm sorry. I'm sorry your cat is sick. Take care.
Friday morning:
Ring! Ring!
VBB's R: Hello, World's Best Veterinary Hospital, how may I help you?
Same Client: It's my cat! she's having trouble breathing. I'm on my way in with her.
VBB's R: Wait. Is this the cat that was supposed to be dying at home?
Client: Yes, but, I didn't think she was going to have trouble breathing! She can't live like this!
VBB's R: Well, no. When an animal dies, it stops breathing, and stops living. So, you're coming in?
Client: Yes, of course, I'll be there soon. [hangs up]
The client and her poor cat did arrive shortly after, and the cat was in fact having trouble breathing. The owner wanted us to fix the breathing so that she could take the cat home to die - but wanted to make sure the cat wouldn't continue to have episodes of trouble breathing. On the one hand - I do understand it is horrible to watch someone you love struggle to breathe. I have watched countless animals as well as a couple of humans do this, and it is just awful. On the other hand, like my receptionist said - when you die, you do stop breathing. Sometimes, when you're in the process of dying, you breathe irregularly for a while, and then do some gasping, because of the way CO2 builds up and triggers a reflex to breathe. Death is not like a Hollywood movie.
We ended up euthanizing the poor kitty because I could not promise that there would be no additional episodes of dyspnea. I hope the client wasn't too disappointed that her kitty didn't get to die at home.
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