Monday, February 14, 2011

Slander (Actually, Libel)

Working in the ER means that I'm often required to provide people with bad news.  Most of the time, it doesn't go this badly.

Sarah presents at 2am during one overnight shift with a wretchedly thin boxer-cross, Tank.  Tank is extremely painful, Sarah says, and not able to use his leg.  She's driven a long way to get help from the doctors at my hospital.
"How long has this been a problem?" I inquired.

"At least a month." Sarah replied.  She told me the long story; she'd spoken to 'doctors' at 'universities' across the country who'd recommended multiple diagnostic tests that she hadn't yet been able to perform.    Tank, an adult boxer cross, was emaciated, in excruciating pain, and not able to bear any weight on his front left leg.  A hard, bony swelling was present near the shoulder.  His nearby lymph nodes were severely enlarged. Immediately I suspected osteosarcoma, an aggressive bone tumor, and the most common cause of these symptoms.  Our geographic location did not make fungal infection likely, although certainly tests would be performed to rule out other causes before any treatment would be started.

I recommended the tests needed to definitively diagnose his symptoms; starting with limb radiographs and likely including chest radiographs, to start the search for spread of suspected cancer. I also recommended pain relief medications, as his posture and inability to use his limb appeared excruciating. I explained treatment for that likely diagnosis; although we wouldn't be able to start treatment until the diagnosis was confirmed. (The most common course of treatment includes amputation of the limb for pain control, followed by chemotherapy.  Other therapies include limb-spare surgeries or radiation).

"It can't be cancer.  My dog's dam is still alive, and she doesn't have cancer.  They eat an organic diet.  There's no way it's cancer. You're wrong."  Sarah refused to believe my medical opinion, and started to become angry, aggressive, and argumentative.

Her response was a common feeling among many who receive a devastating diagnosis; denial.  However, for this client, it was different.  She refused to accept pain control medication for her dog, and she could not afford the thousands of dollars needed for diagnostics, surgery and chemotherapy.   She expected that our facility could provide her with over $4000 of free services, and demanded that we do so immediately, at 2 in the morning.  While I wish that this was the case, unfortunately veterinary hospitals, like the one where I was employed, are privately owned businesses and have to make a profit to stay open and serve clients.  Fortunately, our hospital did have grants for patients who had a good chance of a full recovery, however bone cancer did not fit the requirements for a good prognosis.

I again asked if I could give her dog something for pain, but she refused.  Sarah did not believe that her dog was in pain.  My supervisor that evening also examined the dog, and came to the same conclusion; he again tried to reason with her to let us provide pain relief for her dog, but she refused.  Furious, she stayed in our lobby all night in order to speak with administration when the offices opened at 8am.

During the next several weeks, despite their better judgement, the hospital ended up providing Sarah and her dog Tank with grant funds to see two groups of specialists, who did confirm definitively my suspected diagnosis based on radiographs and fine needle aspirate.  A pathologist evaluated cells from the tumor under a microscope, and an unequivocal diagnosis of osteosarcoma was given.  Tank was prescribed three types of pain medications, and Sarah refused to give any of them based on her own uneducated, misguided attempt at 'holistic' medicine.  The tumor had already spread to the chest and lymph nodes; eliminating any chance for a cure.  We never heard directly from Sarah again, and I only hope that Tank did not suffer too much in the last months of his life.

Several months later, on a public review website, Sarah accused me of not offering pain relief, of making the wrong diagnosis, and of malpractice.  She used my full name and stated that I should be removed from the profession.  The posting was vicious and one of the most difficult things I've ever had to read.  Fortunately, not only was her post completely false, it was also against the terms of use of the web host, and was removed almost immediately.

1 comment:

  1. That is so sad. I'm really sorry that Tank and you had to go through that.