The struggle in Vet Medicine
Veterinary medicine has its own set of struggles just like any other profession. I think the thing that makes our profession so different is the aspect of life or death. Yes, they are just pets, but these pets are peoples’ family members. My ability to diagnose and make proper decisions about a diagnosis may be the difference between a pet going home and a pet dying. While we trained for this, there are always cases that make you second guess your decision.
I got a phone call Saturday that both irritated me and made me really sad at the same time. A patient of mine came in Thursday for ADR (ain’t doing right). The owners main complaint was diarrhea, but also described an incident that sounded much like a syncopal episode. In dogs, this is usually caused by an underlying heart condition where there is a temporary stop of oxygenated blood to the brain, causing the dog to faint. This particular patient had a history of an irregular heart sound over the past 2 years, but had never been fully worked up. I stated all of my concerns to the owner, foremost being the potential heart disease. I recommended x-rays to check the chest and determine if the heart is indeed the culprit. I also recommended a fecal sample to try to determine the underlying belly issues the dog was experiencing.
Here’s where veterinary medicine can get a little tricky at times. I can explain what diagnostics I want performed until I’m blue in the face, but it’s the owners’ decision to allow me to proceed. We can often persuade an owner one way or another but every diagnostic procedure has a price tag that weighs on the owners decision as well. In this case, x-rays cost a lot more than the fecal and treatment of the diarrhea. The owner also stated she didn’t want to “stress” the dog out by taking x-rays and doing a cardiac work up, but wanted to treat the diarrhea. In her opinion the dogs most pressing issue was the upset stomach.
The phone call on Saturday was to tell me this patient came in on emergency struggling to breath. She received oxygen therapy, blood samples to check internal organ function, and x-rays of the chest. Long story short, the patient suffered a major cardiac episode and was not perfusing the internal organs properly. She started experiencing seizure like episodes while undergoing treatment and the decision was made to humanely euthanize.
My frustration is partly on me and partly with the owner. Every owner has the right to choose what they believe necessary for their cat/dog, but it’s hard to practice best quality medicine when you’re handcuffed by owners. I also feel as though I should have pushed this owner into x-rays a little harder than I did. I explained my reasoning, but maybe I should have tried harder. Maybe I didn’t make myself clear enough as to my concern about her heart. Could I have changed what happened in the next 48 hours? We will never know. If a heart condition is identified and treated properly, it’s possible she would have had several months before getting sick. It’s also possible that this was a sudden change in her heart that would not be seen on X-rays 2 days earlier.
I felt bad for the owner, but I especially felt bad for the dog. Her final hours were probably full of stress, pain, and fear. I don’t like for any of my patients to become fatally ill, but it’s especially hard when they don’t get to die peacefully. I can’t change the past, but I can learn from it. Only being 2 years into this profession, I probably do lack some confidence in really declaring what needs to be done for my patients. I like to discuss options with the owners and guide them through the decision-making process. I don’t usually tell owners they have to do X or their pets life is at stake, unless I’m certain of it. In this particular case, the syncopal episode described by the owner, was the only heart related piece of the puzzle. It sounded fair if the owner wanted to wait, as long as she monitored closely for changes indicating heart disease. This is on me. I feared when she left the clinic, she would be returning within the next 2 weeks for a heart work up. If not sooner. I didn’t expect the rapid decline in her health.
Veterinary medicine is tough. My patients can’t tell me what bothers them the most, and it’s my job to be their voice. It never gets easier to lose a patient, no matter what the cause. I love this profession and I wouldn’t dream of changing it. Sometimes with the good, you are forced to take the bad.
“Our perfect companions never have fewer than four feet.” – Colette.
Saturday night we went to Top Golf with the hubbs’ work. They hit their year sales goal and took everyone out to celebrate.
It even snowed! It’s been a weird winter with less snow than usual, so we took full advantage.
It was a good way to get my mind off work.
“Becoming is better than being.”- Carol Dweck