Wednesday, January 27, 2010

End of Day

We spent the weekend at a Bed & Breakfast with old friends.   We were so looking forward to the break, although I think they needed it more than us, since they are dealing with an almost 3 year old and a 10 month old who hasn't been sleeping much since she's been sick the past few months.  Anyway, it should be  called a Bed & Dinner & Breakfast, since it includes a chef prepared 3 course meal at 6 o'clock for all the guests.

My clinic stays open until 6 pm, and my last appointment is scheduled at 5 pm.  But, you know, its medicine, and stuff happens, and I'm not always out of there on time.  However, if I get all my records done as I go and end up with a softball of a last appointment, it is totally feasible that I could get out of there by 5:30 and be toasting the weekend with friends by 6.

My last appointment was "blood in urine" which certainly is straightforward.  The patient, an older cat, had two previous bladder infections in her history.  Piece of cake.

"She's been incontinent for a few days," the owner told me.  "She is constantly making small puddles everywhere."  Of course, the discomfort of infection makes for frequent small urination.  It all fit; I could get a urinalysis, confirm the diagnosis, dispense antibiotics.

Except.  On exam her bladder was enormous, full like she hadn't peed for a day.  She was dehydrated.  And although she was quiet, when I listened to her chest she was grunting with every inhalation.

This didn't add up.  I took her back and confirmed by ultrasound that it was indeed her bladder that was huge, then collected a sample with a needle.  Then I took her out to manually express her bladder, but even when I squeezed as hard as possible, I only got five drops out.  That meant she was obstructed - either with crystals and infection (common in young male cats) or had a tumor obstructing her.

Back into ultrasound, I looked again at the bladder wall.  It was all stretched thin, except going down toward the urethra - there it was thickened and irregular.  Another vet came by, confirmed what I was seeing, and said maybe I could hit the wall and get a little sample with a needle.  The ultrasound helped me guide my needle to the right spot.  I looked at the sample under the microscope -- cancer cells, everywhere.

I explained my findings to the owner.  As she realized how grave my words were, she turned in front of me so that I saw the back of her head but she faced her cat.  I know she was hiding her emotions, but I had to give her the rest of the bad news to her back.  "The tumor is inoperable where it is.  She's suffering, and I likely won't be able to catheterize her.  I really think you should euthanize her."

"Oh no," she said quietly, "I can't do this.  My husband always takes care of this part, and he's out of town, just got a new job out of state.  I can't handle this.  Can it wait until Monday?"

"No, she's much sicker than that, and I'm sure she's vocalizing because of her discomfort.  The best I can do is drain her bladder with a needle and you can take her home overnight, and bring her back in the morning.  But I think it is better to let her go now."

I felt so sorry for the woman, who clearly wasn't expecting to make this heavy decision.  She, too, thought she was bringing her cat in for a simple infection.  I left her alone to make some phone calls.  She couldn't reach her husband, but did reach her adult daughter, who helped her make the right decision.  We took care of the paperwork, and then I gave the cat a sedative.  Usually I leave the pet and owner alone during this time, but she kept asking me questions until I finally realized she did not want to be alone.  Once her cat was unconscious, she said goodbye and left, then I administered the final injection.

Sigh, 6:10 pm.  It was not how I intended the end of my day to go, but I know the owner didn't think her day would end with the loss of her cat, either.  It is not the kind of decision that you can rush, either.  Fortunately for me, I only missed the salad.  


Emily said...

Oh, I have tears in my eyes. How sad for this client. I dread the end of Sabrina's life. I don't think it's ever something you can quite prepare for. At least she was able to say goodbye and know that her cat was no longer suffering.

Anonymous said...

Wow, gosh, Jenn, I had no idea that was how you started your weekend of freedom, fun and laughter with your friends! Sorry it started that way but glad you were able to help your patient and client. Happy also you had a retreat to soothe your soul.
Love you, M

grandad says said...

What a good caring Dr you are. Glad Mommy and I could help.

noni said...

Thank you for telling the owner that her pet needed to be put out of her misery. The local vet here will not do that ... leaves the decision entirely up to the owner, which, in my opinion, instills guilt in the owner, since they never know for sure if they made the right decision. Fortunately, when my own Tinker the kitty got sick, I knew it was time. It still hurts, though. I'm glad you had some good time off after that.

peevish said...

You describe it all so well, I feel like I was there with you.

I hope the rest of your weekend was a piece of cake in comparison.

Sinda said...

Jenn, that was a really great post, even with sad subject matter.