Monday, November 28, 2011

Trauma drama

5am, Thanksgiving morning.

A phone call comes through from a client.  "Two of my dogs were shot!  We're on the way!" She's too upset to give us any more details about their condition.

Immediately, I wonder -- how in the heck do not one but TWO of your pets get shot?

My technician and I start preparing for arrival of two potentially serious, potentially life-threatening injuries.  Gunshots can result in any bad trauma you can think of; bleeding, penetrated bowels, ruptured bladder, spinal paralysis, pneumothorax, instant death, infection....

The first pet arrives and walks into the clinic under his own power, which is a surprise. My tech receives permission for initial treatment and diagnostics.  He has two entry wounds on one side of his chest, but no exit wounds.  He is experiencing mild shock, and is exceptionally painful, but for a gunshot wound, appears moderately stable.

We start pain medications, IV fluids, oxygen, and antibiotics.  I walk up to the lobby to speak with the client who is understandably hysterical.  Hysterical, however, slows down my ability to do my job.

"Hi, I'm ERdoc.  Your pet is in fair condition, and is already receiving pain medicine, oxygen and IV fluids."


"Ma'am, I understand you're upset, this is a very scary situation.  You have to realize that we're working as fast as we can, and if you just take a deep breath and calm down a bit, we'll be able to help you more quickly.  Now is there any major medical history I should know about ?  How did this happen?"

The client calms a bit, and I get a history.  The pets had escaped out the front door, and it was suspected that a neighbor shot them for being on their property.  Cruel, but actually not illegal since the dogs were at large.

The second dog arrives and actually looks better than the first.  He has a thru and thru gunshot wound so close to his spine that it's frightening.

Amazingly, both patients recovered well and were sent home with their (very) thankful families the next day.

Despite the high stress, extreme potential for disaster, and emotionally charged situation, we were able to provide happy outcomes for both of these patients!

Thankful for the boys in blue.

What a crazy weekend.

One of my most extreme situations ever occurred this weekend, and I'm very proud of my determination in preventing animal suffering.

I arrived at work in the morning and received patient rounds from the overnight doctor.  One of the patients was a young, large beautiful cat who had arrived at 1am.   The client found this cat tragically injured after being caught in a bear trap. As the cat entered the clinic, my colleague described that he was absolutely howling in pain.  She quickly administered pain medication, despite the client's lack of ability to pay. The cat was injured nearly beyond repair.   Both hind limbs were broken, in several locations, including the feet, ankles, and tibias bilaterally.  Both hind limbs had severe degloving injuries; meaning that the skin was pulled away from the muscles, bone and tendons underneath.  Both hind legs had the pads removed, and the tissue appeared very unhealthy due to lack of blood flow and overwhelming infection setting in.   In order to try fixing this kitty's injuries, it would require far more than most veterinarians or clients are capable of - the repair would take months and months of dedicated treatment, daily bandage changes for much of that time, multiple surgeries, as well as thousands and thousands of dollars.  My heart bled for this poor, poor cat.

If the cat was a human, amputation would probably be performed, however, a human has the ability to use a wheelchair, have assistance, and understands what is happening to them.  A cat without hind limbs would be bordering on inhumane.

Unfortunately, the client was out of her mind crazy.  She also had not a penny to contribute towards any sort of care.  Let me reiterate that this was not a "give him some medicine and he'll be okay" situation.  If this cat had been my own, I don't think that even I would have chosen to try to treat him.  His injuries were massive.

The client had spent 5-6 hours trying to obtain any sort of financial assistance. By the time I arrived, the cat had been suffering for far too long.

I stepped in to her exam room.  Immediately, I knew that something was off.  The client could not sit still, could not make eye contact, and was agitated.  She did not answer any questions or respond to my comments, she instead spoke to herself and rocked back and forth.  In my experience with 'crazy' clients, she looked like a typical methamphetamine addict.

Then the unthinkable happened.  The client demanded to take her cat home, without treatment.

I was stunned.  Nobody in their right mind would think of doing that to a poor, innocent cat.  Of course, this woman was definitely NOT in her right mind.

I stated plainly - "I will not allow you to take this cat home without treatment.  This is cruel, and definitely classifies as animal neglect.  I will report you to animal control and the authorities if you try to leave the building with your cat.  I know that it is a very sad situation, but your cat is suffering and it is my job to make sure that all my patients are relieved of suffering.  Even if you had a million dollars, I honestly can't guarantee that this could be fixed. "

She didn't get it. She tried to walk out of the building with her cat, and could not listen to reason.  I had had enough and could not stand to watch the cat writhing in pain for one second more.

I contacted our local police department and asked them to assist in enforcing animal cruelty laws, as I do not have the authority to confiscate a pet.

The police arrived and dealt with the crazy woman for about an hour and a half.  She screamed, yelled, and threw things.  She lied to the police and made up a story about another clinic doing thousands of dollars of treatment "for free."  She made up crazy stories and eventually, the police told her that she could either agree to treat her cat (and present the funds necessary to do so), could agree to euthanize her cat, or she would be thrown in jail for animal cruelty.  The cops prepared for a battle as the woman kicked, screamed, spit and was a all-around psycho as they escorted her from the building.

We couldn't thank the police officers enough for helping us to prevent this poor, sweet cat from suffering for one minute more.  We pet him, told him what a good kitty he was, and teared up as I euthanized him.

For readers who have never experienced this sort of situation, I realize that it may sound odd that I fought for the ability to euthanize this cat.  If left untreated, this cat would have died after days or weeks of suffering incredible pain, being unable to move, and having massive infection take over his wounds.  The veterinary oath demands that I will use my skills for the "prevention and relief of animal suffering".  There was truly no chance for healing and I couldn't allow this crazy person to torture an innocent pet.

Tough day.  More stories to come.

Monday, November 21, 2011

Triage is the name of the game!

Last weekend was extremely busy at the ER.  Multiple critical cases,  mostly with positive outcomes, but of course some sad ones came through, too.

Out of all the chaos, the one call that I just can't understand  -

The phone rings.  My technician answers -

Caller: "Hi, I have a dog who's acting wierd.  I need you to guarantee me that if I come in right now, I will be seen immediately."

Tech: "Well, sir, we'd be happy to take a look.  We are an emergency room, and we're experiencing very high case loads right now, so a wait time does exist.  When you arrive, a technician will triage your pet, obtain vitals, and if your pet is deemed stable, they will have to wait in line.  The most critical cases have to be seen first, just like the human ER."

Caller: "NO!!!  I demand that if I come in to see you, I WILL BE SEEN RIGHT AWAY!"

Tech: "Sir, what symptoms is your dog experiencing?"

Caller: "He's just acting weird, and I... I can't explain it.  He's still eating and drinking normally."

Tech: "Has there been any vomiting or diarrhea?"

Caller: "No. But I WILL NOT WAIT!  If I come, you have to promise me I'll be seen without waiting!"

Tech: "I'm sorry sir, but there's no way I can tell you that.  Your dog sounds stable, but we are happy to take a look.  If your pet is stable, you'll have to wait your turn to see the doctor.  There are several people here waiting right now."


**Hangs up.