Sunday, July 29, 2012

What would you do?

Pretty much on a daily basis, a client asks me "What would you do?!" in their given situation.

While this may seem like a simple question, it's impossible to answer and loaded with problems.

One busy evening, a 2 year old beautiful pit bull mix arrived after being accidentally hit by a car on a busy highway.  "Toby" had been playing outside on the client's rural property when he unfortunately chased a squirrel into the road, and was hit by a car who had no chance to slow down.

Toby's owner was a kind young man who rushed his dog in to our ER immediately.

I assessed Toby, and at my direction, the staff started emergency triage and care; providing oxygen, placing an IV catheter, start fluid therapy, and providing pain medications.

Toby's injuries were severe.  He had two obviously broken hind legs, a possibly broken pelvis, and even more substatially, his tail was torn from it's attachment at the base, his rectum was torn and he had no sphincter remaining.  Besides attempt at trauma resussitation, Toby's wound was very dirty and required immediate surgery, attempt at reconstruction, and possibly a tail amputation. With the injury to his rectum, Toby may never be able to control defecation and may develop permenant incontinence.  Furthermore, after stabilization and initial wound management were complete, Toby had two broken legs that would likely require additional surgery.  Needless to say, Toby's wounds were extensive, severe and would require a long hospital stay, likely several surgeries and a massive financial investment.

Could Toby be saved? Yes. 

Should Toby be saved?   That's the part I can't answer.  Every individual person that walks through our doors has a different set of beliefs, values, religious affiliations, attachment to their pet, life experiences and financial abilities.  As I'm sure the reader is aware, some people choose not to have blood transfusions or transplants for their own healthcare based upon their religious beliefs; others decline to have CPR or life saving care based upon their moral / ethical concerns.  Some clients have been through chemotherapy themselves and would never want that thrust upon their pet.  Some people have been through a trauma with their pet by their side, and would give anything to save their companion.  The experience of each human being that I meet is drastically different, and there's no way for me, meeting them in a a time of extreme need, to determine what's right for them. I've met all types of clients; quite literally, from those who refused to even have their pet evaluated by a vet because it's "just a dog," to those who elect to try treatment despite an extremely low chance of a positive outcome.

Financially, Toby's care could easily cost over $5000, based upon the extreme nature of his injuires.  Finances aside, he may need a week or longer of intensive care, several surgeries, and would have to endure excruciating pain in the interim.  Some people feel that this duration of pain and suffering is not in Toby's best interest.  The nature of his injuries also may make him unable to control his feces; resulting in a problem for any pet owner who wants to keep a clean and sanitary household, or relegating Toby to be an outside dog. Unlike human healthcare, euthanasia IS an option for our pets - and when it is appropriate to do so is dependent upon all the above factors. 

So what would I do?  You and I are very different people, and that's why I can't actually answer that question when you come into my ER.  It's not fair if I tell you that I would treat, and make it seem like you're heartless for not doing so. On the other side of the coin, it's not fair if I tell you I would euthanize, making it seem like there's no hope for survival.   My task is to assess your pet and provide objective medical information, to help you to understand your pet's condition, to understand the possible outcomes and prognosis, the chance for success, and the possible time to recovery and cost.  (Obviously, if the pet has zero chance of recovery, I tell the clients that as well).  As the pet owner, it's your job to do what you think is right for your pet and your family.  I'm just here to help you along the way.

Afer a lot of discussion and thought, Toby's family decided that due to his extensive injuries, euthanasia was the kind decision.  We tearfully said good-bye, and I gave them my heartfelt sympathies for their tragic and unexpected loss.



  1. I think it is natural for people to ask. Especially in these situations. I don't want to put that responsibility on on anyone else including petsitter's so when I go away I leave signed letters on file at my Vet clinic which also has ER care 24/7. It gives my Vets the power to make all medical decisions if I cannot be reached. The clinic knows me well and know that all I ask is they they make the decisions in the "best interest" of my dogs/cats at the time. That is all I can ask. Now the chances I can't be reached are slim but just in case... I would rather be prepared.

  2. I hate when people ask this. Most of the time I don't have a good answer for them-often for the reasons you mention but also because many of the clients I see have let their pet get into a condition that I would never allow my pet to be in. As in they waited too long, didn't provide preventive care, have a pet they can't afford, or didn't provide a safe environment for the pet.

  3. Elizabeth, I agree it's natural to ask -and I'm of course kind when I tell them why it's a question that just can't be answered. It's not that I don't want to, I can't. Your regular vet might know you better and especially if they've known you for years, know what you'd want to do for your pet, but as an ER doc who just met you 5 minutes ago - there's no possible way I could even begin to guess. You think that it would be a simple answer to do what's best for the pet, but that's not always straightforward, and it does involve money, which is different for every person. Thanks for the comments. ~ERdoc