Grief

Unfortunately, in my line of work, I see a lot of grieving people from all different causes; unexpected tragic losses to expected but not quite ready long term cancer patients.  I am extremely sympathetic, as I love my own pets dearly and know what it feels like to be on the other side of the exam table.

I am no psychologist, but from experience, I can tell you that there are many variations of normal grief.  Some people hide their tears and break down once they walk out of the room, others cry openly and accept my condolences and even a hug after their pet has passed. Others do not talk, and some are even slightly rude with the reception staff at the counter.  99% of my clients grieving, even given the most extreme circumstances, thank me for helping their pet at their final minutes, and are courteous and kind.

Yesterday, I had the misfortune of dealing with someone who could not control herself, and took it out on me and my staff.

"Sissy" was her cat, a 14 year old domestic longhaired cat with extreme difficulty breathing.  At triage, my technicians immediately recognized the urgency and placed Sissy on oxygen.  The client had stated that an asthma attack was the cat's presenting complaint, that she had had this before, and she had been trying to wait for her veterinarian to open (in another 24 hours).   Sissy was cyanotic (blue gums), and very pale.  She was open mouth breathing and fluid was coming from her nose, and she had a low body temperature.  When I listened to her chest,  I heart a high heart rate and moist lung sounds, or "crackles" that often occur when fluid builds up.  The most likely causes of these findings is congestive heart failure, however other possible diagnoses (or 'differential diagnoses' in medical terminology) include pneumonia, neoplasia, or asthma.  These differentials were much less likely given the picture as a whole, but none of the possibilities can be completely ruled out without testing, like chest radiographs (x-rays) or an echocardiogram (ultrasound of the heart).

I went into the exam room.  I inquired further about the history; it turns out that Sissy had never had any testing to confirm asthma, furthermore she had not had any treatment or flare-ups in 4 years.  This is not consistent with asthma, and certainly my physical exam findings were not consistent with asthma as the  most likely diagnosis.  I recommended oxygen, chest radiographs, and hospitalization with medications to be determined based on imaging.  The client refused any testing and screamed at me.  "JUST GIVE HER A STEROID SHOT! ALL SHE NEEDS IS A STEROID SHOT!!"

Steroids are a prime treatment for asthma, however can worsen heart failure.  I explained this to the client, as well as the findings that did not go along with asthma.  I discussed that we could try medications alone, but that Sissy might decline.  I also discussed that given her critical condition, even with all diagnostics and no limitations, she was at risk for sudden death or respiratory failure.  I have pulled cats back from this condition before, but there are no guarantees in medicine.  Further complicating the issue was that the client did not want to spend any of her own money on her cat.

The client screamed at me again.   She then put her hand up in my face, dialed her phone, and called someone.  I excused myself to go check on her cat, as well as to give her time to make her call, despite her rude behavior.

Five minutes later, I came back into the room.  Her sister had joined her and was also hysterical. "CAN'T YOU JUST FIX HER? FIX HER! WHY CAN'T YOU JUST FIX HER?!"  Calmly, I explained the medical situation again, and that I could definitely try to fix their cat, but ultimately, the clients decided upon euthanasia.

"NOW what's going to happen!?" She screamed.  "I want my cat right now!"

Sissy had been resting in our oxygen-enriched incubator, where she was still struggling to breathe, but had more comfort than the room air environment.   I explained this to the client.  I offered for her to come sit with Sissy while we provided oxygen via a face mask to help her stay comfortable.

I brought the client to the treatment area, and an assistant placed Sissy in her arms with a blanket.  I brought over an oxygen mask, and told the client "This oxygen will help Sissy to breathe easier while you spend time with her."  I slowly moved the mask into place, and the client screamed at the top of her lungs in a tone that could have fightened a demon;

"WHAT IS THAT!!!!!!!!!!!!!!!!!! WHAT ARE YOU GIVING HER?!?!?!??!!!!!!"

Somewhat dumbfounded, I replied "Ma'am, this is OXYGEN to help Sissy breathe while you hold her." (What did she think it was? Poisonous gas we were going to make her and her cat breathe?)

When the clients were ready, and amongst screaming, yelling, and swearing, I administered the euthanasia solution.  Sissy stopped struggling to breathe, and passed peacefully.  I knew we had done the right thing, despite the drama associated with the decision.

As sad as the loss of a pet is, there's no reason to treat the veterinarian like an enemy!