Monday, March 14, 2011

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.


  1. oh. my. gosh.

    that is incredibly sad. how can someone be so ignorant? i get that some people believe "love is blind" and all that... but that is borderline abuse on the part of the client! euthanasia isn't the "murder" that this client was irate about. it truly is the last gift that an owner can give to their sick animal - to end their suffering forever.

    what a difficult situation - it sounds like you handled it as best as it possibly could be handled!

  2. I definitely agree with you on the borderline abuse comment -- I struggled with the question of reporting this client to animal control for that exact problem. Ultimately, I elected not to do so because some belief systems/religions don't allow for euthanasia, and this guy really did love his cat -- so I didn't think that anything positive would have come of it. I was even worried the client may hurt himself or someone else if we had tried to report him for abuse. It was an awful, awful situation.

  3. You never forget these, do you?

    About ten years ago, I was called out for a fourth opinion. When I arrived I discovered the owners were contesting a legal euthanasia order. If you've ever dealt with your local animal law enforcement authorities, you know how long it takes and how difficult it is to convince a judge to sign a court order allowing an animal to be seized and euthanized. Anyhow, the owners hoped I'd be a witness for them, so they could keep their horse alive.

    Well, among other things, the horse was emaciated and recumbent 23 hours a day. He had at least three untreated chronic conditions I could diagnose without need of any testing or examination beyond simply looking. I discussed all of this with the owners ("money is no object" - yeah, right), and we came up with a plan, in writing. The plan involved consultation with a specialist. Law enforcement was temporarily satisfied... until I spoke to the specialist (oh yes, we do communicate) and discovered the owners had been dishonest with him about the terms of my agreement with them and also dishonest with me about what they were planning to allow the specialist to accomplish (not much). I contacted the owners and informed them I'd be submitting my final status report to law enforcement then withdrawing from the case. Then I did.

    The horse was euthanized shortly thereafter, not by me, but I'm sure I'm still the devil in the eyes of those owners.

    Sometimes, what people do and don't do for their animals is NOT about the animal, it's about them. If they can, dysfunctional owners will manipulate the veterinarian into giving them whatever they want: sympathy, attention, admiration, control, etc. I see these people all the time on the pet owner boards, complaining they're misunderstood.

    Who knows why that owner wanted you to give his cat a bath? It wasn't about concern for the cat, that's for sure, but as you keep saying: we don't diagnose or treat humans. It's more than sad to look at an animal like Nutty; it's infuriating and heartbreaking.

    Chin up. Hang in there.

  4. Thanks for sharing that story, Outrider. Despite dealing with these cases first-hand, It still blows my mind when I meet people in this category. I really, really don't think I could be a psychiatrist/psychologist and have to deal with that kind of pathology on a daily basis.

  5. Many psychistrists don't do talk therapy anymore; it's a meds adjustment then street 'em. That's not too different from what you do now as an ER doc, minus the prescription for the client's happy pills. Or electroshock. (Hmmm... I'm sure I can adapt a cattle prod...)

    I'm with you, though, I couldn't be a psychologist, either. Listening to crayzee 40+ hours a week? No way. ;-)

    You gave Nutty the cat a little comfort during one of his final days. Good for you. He's probably rolling in a giant bed of catnip up in sunny kitty heaven, purring and thinking of you.