Saturday, May 28, 2005

Dolor

I've had 2 cases in the past 2 weeks that have really taken it out of me. Most of the time veterinary medicine is a great, rewarding job. Sometimes it is devastating.

Last week I managed the case of a young standard poodle. He had been purchased by a family with a 10 year old girl. They had done their research, selecting a breed that was appropriate for their family, then found a breeder, and waited for their perfect puppy. 3 days after they brought him home, he became violently ill with parvovirus and campylobacter (a severe intestinal bacteria, causing food poisoning-type symptoms in humans as well as dogs). The dog was previously treated at another hospital, had been sent home, then had just begun vomiting again when I got him. Unfortunately, under my care he rapidly deteriorated. We tried everything, IV fluids, powerful antiemetics, even a plasma transfusion from one of my nurse's dog who recently survived parvo. But, the double whammy of 2 severe infections took their toll. After 3 days he was moribund, laying in his cage unresponsive, vomit and diarrhea coming from both ends. At my recommendation, we euthanized him. I felt so bad that this puppy's short life ended so horribly - being removed from his family, then spending a week hospitalized, poked by needles, vomiting and pooping his guts out. We pulled out all the stops, and I don't think we could've given him better medical care. He died anyway.

This week I got a case of an old Golden Retriever with Immune Mediated Hemolytic Anemia (body's own immune system attacking its red blood cells). This dog had been put on an appropriate immunosuppresive drug that had an averse side effect on her - liver failure. And, she was getting anemic again. I called a human chemotherapy pharmacy and gave her an infusion of a powerful immunosuppressive drug, started aggressive hospitalization care, and got an ultrasound done on her -- but 2 days later, she was weaker, getting more anemic, and developed a GI bleed. Her owner was committed to spend whatever was necessary, but didn't want her sweet dog to continue to suffer. With the owner present, I euthanized her.

It is such a strange thing, after doing so much medically, to give an injection that actually kills my patient and undoes all of my previous hard work. Although both patients' treatments were clearly justified by their initial presentation, I can't help but feel guilty for "spending" so much of the clients' money. In the end, though, I feel my job is always to advocate for what is best for the patient, and alleviate suffering. Sometime that means aggressive treatment. Sometimes it means euthanasia.

Sometimes it really sucks.

10 comments:

Grandad said...

Jenn, I know how hard it is for you in the winless situation from the Christmas Day shot-dog emergency of several years ago when I watched you try to save that dog. All the time having to explain to the owner the processes and costs while trying to save a dying animal. Tough stuff. But, I know you have a better bedside manner than my latest Cardiologist. But that's not hard to beat!

K. Restoule said...

Ok I'm crying now.

Emily said...

I, too, have watched you in some tough situations with your patients and clients. You do have a wonderful manner with them. And the fact that you do care so much about all of it (from the illness and patient's suffering to the cost to the client) is what makes you such a great doctor. I'm sorry you had a tough week! Love you.

Anonymous said...

Sorry you had a bummer of a week at work...Keep doing what you do...your a great doctor!!! Love ya- Bev-

EdamameMommy said...
This comment has been removed by a blog administrator.
EdamameMommy said...

Not everyone has the nerve to express anal glands, cauterize testicles, diagnose and treat malignancies, amputate, vaccinate, and perform thousands of other procedures everyday. But those that do get to practice medicine on every species on the planet excluding homo sapiens.

My sister. My hero.

The Veterinarian Oath is below:
Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.
I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics.
I accept as a lifelong obligation the continual improvement of my professional knowledge and competence

Jennifer said...

Wow, you guys, thanks for the awesome comments. It means a lot to me that you appreciate what I write, and what I do (even if you don't have a cool anime thumbnail)!

Stacie said...

Awww, I'm so sorry for your tough week. I'm a paramedic so I definitely know what tough cases are like,,, only I think animals would be harder,, they are so helpless. Keep up the good work. BTW I love your blog, I'll be back!

Stacie

thicket dweller said...

Wow. You're amazing. I have often wondered how my vet feels about our animals' care, and if she feels anything like you do, I'll consider myself blessed.

Laura IA said...

I can only imagine how difficult it must be to do your job.

As the "mommy" of a 6 year old Toy American Eskimo that is now a 2 year survivor of IMHA, I truly realize how lucky I am. When he was diagnosed, his PCV was 8. He really should not have made it, but we have an awesome vet, and we were very lucky.

I knew going in that the treatment would be extremely expensive and the odds were against us. Please don't feel guilty for "wasting" our $$. We love these little guys and they are worth more than any amount of money.