On Tuesday, my pickup was a beautiful, sweet German Shepherd who came
into Emergency with a hemoabdomen and also had a chronic history of severe DJD
and could barely walk on her right hind leg. She was scheduled for
surgery that afternoon to remove her spleen (the most likely source of
the bleed) but her parents didn't want to proceed if she had metastatic
cancer, so when she was transferred to Medicine we did chest rads and an
abdominal ultrasound. We could have stopped after the chest rads -- she
had an obvious miliary pattern indicative of lung mets everywhere. But
when the intern called with the news, her parents wanted to know where
the primary mass was* -- which I totally agreed with, given that we were
going to either make a decision not to treat, or euthanize her, based
on the conclusion of metastatic cancer. So even if it was incredibly
unlikely that she did NOT have mets, it was worth doing the U/S for
peace of mind.
On ultrasound, she had mets everywhere -- the primary mass looked like
it was in her liver, and there were nodules in her spleen, kidneys, and
peritoneal wall. She was extremely sweet and cooperative the entire
time, and when I took her back up to Fluids after her U/S, she gobbled
up a can of mixed food (I mixed 3 canned types together to see if any of
them would interest her, and she ate the whole thing). I ran out to
grab the intern before he called her parents, so that he could let them
know she ate well, since we were planning to discharge her on steroids
and warn the parents that she could rupture another mass and bleed out,
but that she seemed to be feeling okay (HR and RR were WNL, she was
calm, alert, eating -- she didn't seem to feel too bad) so we wanted her
to have at least another few days at home with her family. She might
have lived another couple of months**! If we could control her pain
adequately, they could have been good months full of attention and
cuddling and fabulous food, and her parents could have had some time to
adjust to the fact that they were going to lose her. I mean, they
brought her into ES because she'd had a decreased appetite, not
expecting to find a hemoabdomen and mets everywhere. I assume they
thought she had some GI bug or something. They certainly didn't think
that was going to be the end of their life with her!!!!!
So, the intern was happy that she ate and went off to call the parents. I
went back to hang out with her and finish my physical exam, since we
were in such a rush to get to Radiology that morning that I hadn't done
one when we picked up her case (the intern did, of course). After that I
went to pump, and on my way into the bathroom, I heard the intern
calling my name. I came back out into the hallway, and he told me they
were euthanizing her. They were too afraid to have her bleed out at
home, and wanted to euthanize her today.
I was surprised by that, on one hand, although I completely understand
it on another. I want every last minute I can possibly get with Mr.
Bear. If he had a terminal illness and I could keep him happy and
comfortable and buy myself another week or two with him, that's what I
would do. I would pet him, brush him, feed him steak and eggs and all
the pretzels he could eat, cuddle with him, take him for rides in the
car, teach him a new word or two, tell him what a wonderful dog he is,
and make sure he knew how much I love him. And then when I either
couldn't control his pain anymore or he just got too tired or depressed
to enjoy his life anymore, I would euthanize him. But not UNTIL then. On
the other hand, when anything is wrong with him, I'm so upset and
stressed and afraid, that I can't function. I can't sleep, I can't eat, I
cry at the drop of a hat, I can't work productively, I'm a complete
mess. So I can understand where my patient's parents were coming from,
not wanting to go through that. I do think it's a little sad that the
dog didn't get at least one more good weekend at home with her family,
since her last 24 hours were spent at the vet hospital and that kind of
sucks for her, but rationally I know that dogs don't really understand
about lifespans and don't really look toward the future, so SHE probably
wasn't worried about that.
So, anyway, she was euthanized. I had to stay with her body after her
parents left, while the intern found a gurney to take her body down to
the necropsy room. I petted her and very quickly blotted away tears each
time they sprang up so that the intern wouldn't come back and find me
crying over this cancer-riddled dog I'd known for 3 hours. I think
really I just wanted one more good weekend for her. She might not have
gotten it, but I think she probably would have lived that long. And it
makes me really sad that her last 24 hours were spent in our hospital
with strangers, instead of at home with her family. Even if it's hard
for me to take one of my dogs home, knowing that I'm going to have to
euthanize soon, I hope that I can give him or her a wonderful end.
Yesterday, I went down to the post room to see her necropsy. There were
tumors EVERYWHERE. Pathology saved her organs for teaching purposes,
because they were such excellent examples of metastatic
hemangiosarcoma. There were hundreds of little mets in her lungs, huge
cavitary masses in her liver and spleen, and her right knee had the worst
degenerative changes I've ever seen in a joint. I felt better about her
euthanasia after that.
*One thing I hope I never forget is how it feels to be a client. I
vehemently disagree with some of the decisions that are made about
client management, because I know how it feels to have a sick dog that
you hand over to this hospital and are then kept apart from except for
supervised 10 minute visits every 24 hours, and how much I HATED that.
The radiologists and internists were a little critical of the parents'
desire to have the ultrasound done, after what we saw on the chest
films. They were like, why waste $300 when you KNOW your dog has
metastatic cancer?!? And to a clinician who's seen dozens or hundreds of
HSA cases, the 99% probability that those chest rads mean HSA mets is
the end of the story. There's your diagnosis, let's move on. But to the
parents, if there's even a 1% chance that it's something treatable, you
have to finish the workup!!! WHAT IF it's not HSA?!?!? You'd spend the
rest of your life wondering if maybe there was a tiny chance it was
something treatable and you could have had another 5 years with your
dog. So I agreed with the parents. Of course it ended up being HSA, and I
knew going into the ultrasound that we would almost certainly find more
masses. But I completely understood their desire to be 100% sure. 99%
isn't good enough, when it's YOUR DOG!!!
**Of course, there's absolutely no way to predict when another mass
would rupture. She could have lived another 2 months. She could also
have bled out on the way home that day.
10 comments:
Sad case.
I know you mean well, but it's jarring to read about pet "parents". They're owners, and it's a matter of time before one becomes offended and corrects you. Clients are not nearly as offended if you refer to someone as "owner" and she prefers the term "parent", IME.
Your story is the #1 reason I could never be a vet. Owners who would not cherish every last minute they could with their pets.
Thank you for your poignant post.
@ Anonymous (why hide behind anonymous)
Your comment reiterates my own. I don't get people like you.
Why do you have a dog/cat then? Possession? Control? Status symbol (like mutts that are now called, "Designer dogs" so they can be sold for more money?)
I have often said that how people treat their furred house inhabitants is how they treat their fellow man.
Bentley and Hope are my "kids" as much as my skinned one. I would do whatever I could medically for them as long as they were pain free, the exact same as I would do for my skinned one.
Won't turn this into a battle ... so, I'll bite my tongue now :)
I find it remarkable that someone would find the term "pet parent" to be more offensive than "owner."
On the other hand, there are a lot of things that other people think are totally normal that I find repugnant, so I guess I shouldn't be surprised.
LIVS -- I think you make some really interesting points about attitudes medical staff have towards patients. More than once my vet has lectured me about how frivolously expensive something I want for my dog is (remember the ear tumor from last year), and I kinda want to tell him to mind his own business. If I want to spend the money to have an extra test done, it's my prerogative, especially if it's not harming the animal, and could benefit her. It's not like paying for veterinary care is like buying makeup, for goodness sakes! It's another living being!
Anyway, your post made me all teary. Thinking about the day when we'll have to euthanize Miss Boo (which is hopefully many MANY years off still) makes me very sad.
Anonymous give me a break... My furkids are very important to me and being called a pet parent is an honour. But then again you can say anything when you are anonymous can't you..
@ Old MD Girl, I totally agree it's my money and I will spend it how I like on my pets. If I choose to go to the wall for them no matter what the odds are so be it. It's my money, I earned it..
@Anonymous -- I can see how some people would be offended by that, but they're probably not people I care as much about offending. In my experience, more people are offended by being called owners. Plus they're the people I care more about not offending. Plus *I personally* consider them parents, not owners, so that's what I call them. I wouldn't correct someone for calling them owners, however. To each his own. Occasionally I do get someone who is clearly an "owner" rather than a "parent", and I usually refer to them as such, but that (in my fortunate experience so far) has been the anomaly.
@OMDG -- I'm always SHOCKED when a vet disapproves of the lengths someone wants to go to in order to try to save their dog or cat. (As long as they're not causing harm by doing so). I was in ICU one day while a neurologist was discussing with a nurse how much her patient's mom had spent already, and was making fun of the mom and saying that if she felt like dropping $20K (or whatever it was) then she should have funded another neurology salary! I really wanted to point out that she didn't "feel like" dropping $20K, she LOVED HER DOG and wanted to save her life if possible. I'm sure this woman wasn't rolling around in piles of money every night and randomly decided to spend some on her dog, this was a serious decision about all the "stuff" she could do without in order to divert that money to her dog's medical care.
I can't believe your vet lectured you about wanting more diagnostics! What a dipwad.
@AD2B -- sometimes I joke that I have 5 children, 4 fuzzy ones and one fuzzless one. :)
I'm afraid I may have misrepresented the parents a bit in this case -- they really, really loved their dog. I think they were just *petrified* of causing her pain (and of the trauma of seeing her die from an acute bleed at home). I think, given her medical situation, that it was a reasonable decision. I do still think that all of them, the parents AND the dog, would have been better off with at least one more weekend at home, but I don't think they made a BAD decision.
@E -- EXACTLY. It's your money, and you earned it. There are a heck of a lot more ridiculous things you could do with $10K than try to save a dog you love. People buy $60K CARS all the time, for pete's sake! There's no way in heck a car is every going to add 1% as much value to my life as any single one of my dogs does. So if that's what I choose to spend money on, it's a great investment, as far as I'm concerned.
LIVS,
Thank you for clarifying. I did misinterpret their actions... and were it me, who knows. Maybe when they'd dropped off their beloved, in their hearts they'd already said goodbye and could not bear to do so again.
Ad2b
P.S. One of the earliest disclaimers and ejectors in dating that I make is a love of the dogs. No love, no Ad2b.
When I was on Medicine, we had a BC come in. She was old, dying (of cancer), and she looked just like Mer will, in ten or twelve years (God willing she's still with me then). She had so much life in her eyes, watching everything that went on around her and greeting everyone with a tail wag and an offered paw. I couldn't take her case, I just sat there for two or three hours "helping" her student and surreptitiously crying. That's why I hate vet school, you know, and why I'll always always regret applying. Because of all the sickness we see, I'm so hyperaware of how little time we have with our dogs (and cats)...it breaks my heart every day to give up an entire year of that precious time, to the point where I have spent two hours (in total) this week with my dog. I miss her so much, and I am never going to get that time back again.
P.S.--I do agree with you though, about never forgetting what it's like to be a client. But I know you won't, which I why you'll be an awesome vet someday very soon...hmm, maybe I can take Mer to you! Actually, as I'm typing this, that's not a bad idea...I need to ask you where MM's practice is, because Mer's vet is holistic and does more general wellness care than vaccines, etc. Need to find somewhere to get her boosters and titers done this year, and do a SNAP test.
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