Tuesday, July 5, 2011

When caring hurts.

I apologize for my long absence - the last two weeks at work have been insane.  I'll try to re-cap the interesting details over the next few days. 

Several days ago, I was presented a 14 year old, laterally recumbent akita mix who had been in a state of seizure for over an hour.  Her owner, Lila, was hysterical. She called us about 2 hours prior to arriving, and we urged her to come in as soon as possible. When she arrived 2 hours later, her dog was in critical condition.  "Pep" was unable to rise, or even lift his head; his gums were gray and his blood pressure was dismal. His pupils barely responded to light.  It was clear to all of us who were there that Pep was dying, and his chances of survival, even with optimum care, were very poor.

Lila was an emotional wreck.  I explained to her the physical exam findings, the possible causes, and the consequences on the body of having prolonged seizures, as well as sustained hypotension.  I offered to her a treatment plan, but explained my concerns that it was unlikely to be successful, and that I was worried his chances of returning to a normal life were very poor. 

So far, a normal story.  This is where a sad story and a loss of a beloved family member becomes an enraging, nightmarish case that makes us all want to run screaming from the building.

After the first 30 minutes, we had gone over the history, my findings, and my recommendations two or three times - pretty standard for someone who is upset over their very ill pet. I'm used to explaining things several times, in different ways, and I definitely realize that the general public does not understand how the body works - that's my job.  This case, however, was not a normal one.  It went something like this:

Client: "If I could just get him home, I only have to wait 5 more hours to get him to the vet."

Me: "I understand and respect that you trust your general practitioner very much, and I'm sorry that they're not available right now.  I'm a licensed veterinarian, and we're capable of providing treatments here, right away, until your doctor is open.  Pep is critically ill, and he will die if we do nothing.  We need to help him now, or we need to end his suffering.  Without treatment, he'll die."

Client: "Can't you just give him some medicine? Like a shot of antibiotics or something?"

Me: "There's not one drug that is going to fix Pep; we need to start with testing, IV fluids, and getting his blood pressure back up, and monitor his progress.  He's in critical condition, a shot of antibiotics is not going to fix him."

Remember, the dog is comatose, and doesn't even respond to light in his eyes.  He's this way for about 2 hours, and we go over the recommendations literally 20 times.  The client does not authorize any treatments- she allows an IV catheter to be placed, but does not allow bloodwork or IV fluids.  At the 2nd hour, her level of emotion raises to hysteria.  She wails and cries, and screams that she will die without her dog, and that she has no reason to live.  Her friend tries to console her, but nothing he says provides comfort.

At the third hour, watching Pep gasp for breath, agonal, and dying in front of our eyes while we stand by and do nothing, Lila finally signs the consent forms for euthanasia, but it doesn't end there.  She calls me in to the room, and then screams and sends me back out 3 times; her friend had given up on her and went outside the building (he couldn't take it any more).

I find it difficult to quite explain the details of this situation without sounding callous, uncaring, and unsympathetic.  I've been through a lot of very sad, emotional euthanasia with families and their pets, and I can guarantee that this one is the outlier.  Most clients are understandably very sad, and I always take the time to give my deepest sympathies, to let them greive as long as the need, and to make them comfortable with every step of the process, including ensuring that they feel 100% comfortable with their decision.   I've lost pets in my lifetime, and I love my furry family members like family.  I've shed tears over particularly sad cases, and always feel empathy for the loss of love and life that accompanies every single euthanasia, regardless of the circumstances.

The type of situation above is a client with severe emotional disturbences or personality problems.  I'm (obviously) not a trained psychologist, and veterinary school does not begin to teach us how to handle these types of people.  Dealing with this case for 3+ hours, while watching the patient suffer is one of the most awful parts of my job in the ER. There's nothing more emotionally draining than a hysterical, screaming, emotionally unstable person.  Cases like this are the fast track to compassion fatigue, which is rampant in the medical community.

A concurrent problem with a case like this is the client's pathologic attachment to a pet (which, in general, means an excessive, harmful dependency on the pet).  The human-animal bond is an extremely important part of society, and in the veterinary profession, the key ingredient that allows people to care for their pets.  A serious problem arises, however, when the attachment to the pet is above and beyond a healthy bond; for example, when the client threatens to harm themselves if the pet dies, claims that they cannot go on in life without their pet, or similar.  Obviously, no cat or dog can live the lifespan of a human, and unfortunately even with every advance in medicine (veterinary AND human), death is a part of life.  Clients like the one above need a trained psychological professional to guide them through understanding and healing - a position which I am clearly not qualified to fill.

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