The customer is NOT always right

One evening, at about 2 am, an older gentleman arrived with his geriatric cat, "Nutty" who was having open mouth breathing.  His request, however was not for treatment, and his complaint was not to address the respiratory difficulty; he wanted us to bathe his cat.  He refused to let my staff get vital signs on his cat, refused to let them take the cat to be seen immediately by me, and refused to let us provide the cat with oxygen.  I let my staff know that we would not be bathing his cat under any circumstance; any stress in a dyspneic patient can result in death, in addition to the fact that we are not a grooming service and do not provide outpatient baths.  The client became very angry and started yelling at my assistants to bathe his cat, and continued to refuse an exam by a doctor (me), or any treatments.  The client was nearly asked to leave due to his inappropriate behavior and aggression.


He had been a previous client of our hospital and I quickly read through his chart.  The more I read, the more incredulous I became; his cat had 1) a brain tumor, diagnosed with a CT scan, 2) nasal cancer 3) a liver tumor 4) mammary cancer, 5)spread of cancer to the lungs, and 6) kidney failure.  Nutty had not eaten in weeks, and had been failing multiple chemotherapy protocols.  Nutty was clearly suffering, and unfortunately due to grief or mental dysfunction, the client could not recognize this.

I went in to speak with the client; and was even more appalled at what I saw; Nutty was gasping for air,  too weak to even lift her head, was critically dehydrated, had crusted food on her face (her owner had been trying to syringe feed her but she would not swallow the food), she was emaciated, and had a low body temperature. She had no teeth, and a nasal tumor was occluding the left nostril. Due to her severe weakness and lethargy, she had been urinating and defecating on herself, and was covered in urine and feces. I begged with the client to allow me to provide her some relief with oxygen, and he finally gave in.  I offered to clean the urine and feces from her coat with a waterless shampoo, and the client refused, stating that he did not want any sort of chemicals placed on her.  We removed as much as possible with a wet washcloth; feces and urine on the skin for extended periods can result in fecal or urine scald and a skin infection.

Mr. client and I spoke for about 15 minutes; I tried to explain to him that she was suffering, starving herself, and at risk of dying, with or without any therapy.  I tried to convey my empathy for his situation, and I could see how much he loved her, but at this point, there was literally nothing that could be done to fix her.  I talked to him about her prognosis (grave), that even one type of cancer is a difficult prognosis, and his kitty had at least 5 types of cancer.  She had already tried chemotherapy and failed to improve.  She had been sick for weeks; declining each and every day. When I mentioned humane euthanasia, the client became IRATE.  How dare I even bring up this subject?  He would absolutely NOT consider euthanasia, under any circumstances.

The client did not allow any testing or treatments that night except for providing Nutty with oxygen.  He came in the morning and picked her up; she had really little improvement in her status.  He refused pain medications.  She died sometime that week, at home, after struggling to breathe and starving for an untold amount of time.  I can't imagine a worse way to feel.

Even more unbelievable -- after the ER visit, the client called the clinic every day for a week to complain about me.  He told anyone who would listen that I was "hostile" and each time, went on and on about how angry he was that I had mentioned euthanasia.

I still remember how sad I felt just looking at Nutty that evening.  Her image is burned in my memory forever.   Most of my patients never have to suffer through the bitter end like Nutty, because in veterinary medicine, unlike human medicine, euthanasia is a viable option.   I'd prefer to fix every pet forever, but obviously, death is a fact of life.