Tuesday, May 7, 2013

Unsupervised and furious

On a spring Saturday shift at the ER, I met a lovely family and their 7 year old German Shepard named Reggie.  Reggie had been diagnosed as an epileptic at the young age of 2 years old, but had done incredibly well over his lifetime with proper medications and monitoring.  Unfortunately, in the few hours before his arrival to my emergency room, he had experienced 20-30 seizures in rapid succession.

Reggie was admitted to the hospital for medications, monitoring and testing.  Additional anti-seizure medications were added to his therapy, and gradually, his seizures abated.  

When Monday morning arrived, Reggie's family decided it was time to head back to their primary care veterinarian -  a very common occurrence in our world.  We stabilize pets in the emergency, and then send them back to their veterinarian for ongoing care.

Later that day, after the general practice had closed, lab testing returned for Reggie.  I called his owner to give the results and check on him.

"Reggie didn't have any seizures today," the client reported. "He's there right now."

"Okay," I said. "I hope he feels better soon."

The client seemed nervous, and concerned.  "There's someone in their clinic all night, right?" she asked. "They have overnight staff, don't they?"

Our emergency room serves a large part of our community - so primary / daytime veterinarians don't have to be on call at night.  It's hard enough to work all night (just ask me!) but it'd be impossible to work all night and the next day, too.  For this reason, almost no other clinics in town have overnight techs, and none of the clinics have doctors scheduled on duty overnight.  Sometimes they make exceptions, but the vast majority of clinics transfer any unstable patient to us for monitoring overnight.

"I don't know what their staffing schedule is," I replied. "You should ask them about that tomorrow. Sometimes clinics will have a tech stay late,  but there's no way for me to know."

"WHAT THE $*#*!" The client replied. "You're saying he's there, by himself, all night?"

"I don't know."

The client thanked me for my help, and hung up.  I thought that'd be the last I heard from her - but about 45 minutes later we received another panicked phone call.   She had just driven past the clinic, looked in the windows and noticed there was no cars in the parking lot, nobody in the building and she knew her dog was in there, unobserved.  Reggie could be having any number of seizures, or stuck in constant seizure that won't end, and eventually will lead to death (called status epilepticus) and nobody would be able to help him.  The client was in tears, hysterical and upset that nobody had told her he would be alone all night - otherwise she would have just brought him back to our ER or taken him home, where at least someone would know if he was having a seizure.

I couldn't blame her for being upset.  Of course, I have no idea if she was told there was nobody in the clinic and chose to ignore it - it wouldn't be the first time a client has twisted their doctor's words - but her reaction seemed genuine.

At her request, I called her doctor at home.  He was noticeably intoxicated on the phone, but since he was at home -- there's obviously nothing wrong with a few adult beverages.  I offered to return the call for him after I noticed his state, but he unfortunately requested to do so himself.  Oh, to listen to that conversation - I can't imagine any positive outcome. 

I just hope Reggie is okay.

The lesson here:  Before you leave your pet anywhere overnight, make sure to ask if a doctor and / or technician is in the hospital all night.  Some states now require written disclosure of hours of operation and if the pet will be left unattended.  If nobody is in the clinic overnight, you should be advised of a 24 hour option and or discuss the risks of leaving your pet unattended. Some stable patients (such as orthopedic surgery, declaws, etc) are truly fine left on their own.  Although ER stays can be expensive, it's the cost of having doctors and staff up all night long to monitor and care for your pet. Many ill patients, such as those with seizure disorders, should NEVER be left in a clinic unattended.