TRIAGE, STAT!

Here's a story from the vault of my life that I'm excited to share.

I was working a typical afternoon in a busy referral hospital. The large facility employs many veterinarians, including general practitioners, specialists, and emergency doctors, plus support staff, receptionists, administration, etc.  Many clients (probably about 20) are waiting in the lobby for their regular appointments, follow up exams, or specialist consultations.

I walked into the lobby to receive my next appointment.  As I call out the pet's name, the overhead speaker announces "ER TRIAGE ROOM 5!"

This announcement means that a critical (usually dying or dead) patient has just arrived and needs to be seen by the ER service NOW.  Etiquette is that all doctors who are able drop their current task and immediately respond.  As I was in the front of the hospital, I was easily the closest.

I ran into the noted exam room to find a hysterical client and her 50 pound, 4 year old pit mix.  "SHE'S CHOKING!" the client screams, "I CAN'T GET THE BALL OUT!"

The dog has her head and neck extended, she's drooling and gagging.  Her gums are purple and she can barely stand.  It's obvious that this dog is in immediate distress.  The client relays to me that they were playing fetch in the park only minutes prior; all was well until the dog swallowed the ball and immediately started choking.

I grabbed the dog, quickly gained permission from the client for sedation, IV catheter access, and to remove the ball.  We needed to act fast -- we only had minutes to intervene before it would be too late. A general rule of thumb is "3 minutes, 3 days, 3 weeks," in general, you can live 3 minutes without oxygen, 3 days without water, and 3 weeks without food.  This dog was already on borrowed time.

I ran to the ICU, carrying the dog and called for assistance.  Technicians placed an IV catheter, administered a sedative and prepared an oxygen mask and endotracheal tubes.  I reached my bare hand into the dogs throat and found the object; a spiky, hard plastic ball made of rubber, similar to "Kong" type material.  The ball was firmly lodged in the back of my patient's throat, and the spikes served as anchors, which in addition to the slippery saliva, prevented my initial attempts at removal with my hands.  Hindsight is 20/20; but this ball was way too small for this size of dog - larger dogs need larger balls so that they can't swallow them.

My patient continued to become purple and was gasping for air.  Thankfully, the ball had a small hole in the center which was providing a small amount of airflow (probably the only reason she wasn't dead upon arrival to the hospital).

Several of my colleagues ran to the OR to grab surgical instruments; it was nearly time for a tracheotomy.  Then, I had a great idea -- I grabbed towel clamps, an instrument used to attach a sterile drape along a surgical field.  Towel clamps have sharp points, meant to pierce the skin, and a very firm grip.  I attached the towel clamps to the rubber ball, which was just the traction I needed.  The ball came out, and my patient's upper airway obstruction was relieved!  An exhilarating, amazing feeling.  We all celebrated, especially me - this was the first case like this I'd ever seen, and I'd been the one to remove the object.  I saved a life. It felt great!

I went up to talk to the client, expecting tears of joy, hugs, and gratitude for saving her dog.  I never would have guessed, in a million years, her reaction.

"We got the ball out!  Your dog is now more stable.  She'll need to stay with us at least for a few hours so we can make sure she recovers; she was hypoxic and may have some complications from her choking episode.  You can come visit with her in just a few minutes."

"HOW MUCH IS THIS GOING TO COST ME!? You're all money grubbing assholes, and you don't care about animals!" The client screamed at me, in front of a full lobby of (stunned) clients.  The onlookers had seen me take the dog from her, and had heard that we'd saved it.  Many of them were just as shocked at her reaction as I was.

 I almost didn't even know how to respond.  "....Ma'am -- I just saved your dog's life, and I didn't even talk about money when time was of the essence -- how can you even say that we don't care about pets?"

"GIVE ME MY DOG!  I WILL NOT PAY ANYTHING FOR HER TO STAY!"

At this point, I was done dealing with her garbage.  "I'm sorry you're upset.  I want you to know that we just saved your dog's life.  I'm not really sure what I could have done differently to make you happy.  All I can do now is make you an estimate for the care we recommend, and the care that was ALREADY provided."

I sent the client to the financial office, where she continued to be the most ungrateful, rude, heinous person I could imagine.  She didn't pay one cent for the care we provided, and as a result, did nothing to support the salaries of the four doctors who were involved in the care, did nothing to help pay the technician's wages (many of whom haven't had raises in 3 years), and paid nothing for the supplies that the hospital has to buy (oxygen, IV catheters, fluids, medications, DEA licensing, surgical instruments....) to be able to provide this level of care, not to even mention electricity, rent, janitorial services... the list goes on and on.

This is one example of why I'm glad I'm not a human physician -- at least we saved her dog.  Her dog was an innocent party to the nonsense that occurred aftewards, and we can still feel great about saving the young, innocent, sweet dog.

On a side note -- if you play fetch with your dog, make sure the ball is wider than the space between their canines (the large teeth in front).  A properly sized ball will help to prevent an emergency like this one.