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.