By Adam Hoover, VMD
Being a veterinarian is often a rollercoaster ride. I think that we experience the entire range of all the human condition has to offer. Some days, we are rock stars: we can diagnose the cases from outside the rooms, clients love us, animals don’t try to hurt us, and the thank you cards roll in. Other days, we are less stellar. Every case is baffling, the necrotic tumor incision is now dehiscing, everything that comes through the door needs a muzzle, and the clients are angry at us for missing the simple diagnosis that they were able to find by a quick search on the Internet.
We are also many things to many people. Some view us as God: able to fix any problem despite the odds and incapable of failure. To some, we are counselors to help them through the painful decision of euthanasia and the vortex of emotions afterwards. To children, we are often a mysterious figure to look up to that lets them listen to their animal’s heart with a stethoscope. To others, we are the face that they associate with their animal’s death. To a few, the realists, we are simply humans doing the best that we can under the circumstances.
Being a veterinarian means experiencing all of the above, sometimes over the course of a few hours. As I sit in front of my computer tonight typing this, I am reflecting back on my day today. I had two patients come in. One of them, “Chuck”, was diagnosed with diabetes a month ago. He was a happy dog of around ten. At sixty-three pounds, he was full of life, joy, and house-soiling. We diagnosed him with diabetes and began insulin. He came in for a few rechecks in the following month. The blood glucose was dropping steadily and the house-soiling was getting better.
The other patient was “Griz”, a seventy-five pound chow mix near Chuck’s age that had to be separated from the owners to examine given his protective temperament and propensity for anger. Where Chuck had joy in his eyes, Griz had mistrust. He had started to cough a week and a half earlier. Chest rads revealed a horrendous case of pneumonia. We started him on two different antibiotics to cover our bases and something to help him breathe better.
Both came in today. Griz came in first. After six days, the owners had conceded defeat and they were not able to get any oral medications into their dog, despite a valiant effort. A rather pricey injectable antibiotic had been given three days prior. He came in extremely weak, slightly neurologic with hind limb ataxia and a head tilt, and very raspy breathing. Bloodwork simply had elevated white blood cells and he was given an IV, more meds, and put into an oxygen cage.
Chuck wasn’t much better when he came in later in the morning. Chuck was recumbent, barely conscious, had been vomiting and not eating for the last three days, and the owners had not given the insulin for three days or called our hospital on emergency for advice. His bloodwork showed a high white blood cell count, azotemia, and a glucose that was higher than our machine could read. We placed an IV, started him on regular insulin, gave anti-emetics and antibiotics, and continually monitored his blood glucose. It never went below “HI”.
Both owners declined referrals to a referral practice for advanced diagnostics. Both owners were told of other diagnostics that could be performed to help us diagnose their problems. Both owners were told of the guarded to poor prognosis.
I think that in those moments, despite how others perceive us, this is when our humanity shines through. After we have consulted the other vets in the practice, hit every reference book available, and spent an inordinate amount of time scouring VIN, all we have left to do at that point is to sit back and watch the race between our medicines and our patient’s condition. Once you have been doing this for a while, have some experience, and have a feel for how a case will turn out, it feels like you are simply left with sitting there and helplessly watching your patient die.
I went in to check on both of my patients at nine tonight. Griz was still laboriously breathing. Chuck was on his side, rasping. He looked awful. I called Chuck’s owners and asked for permission to euthanize him. They consented. By the time that I had drawn up the euthanasia solution and walked to his cage, Chuck had passed away. I called the owners back and told them this. As I finished placing Chuck into his body bag, I noticed the silence. Griz’s laborious breathing wasn’t present. As I looked into his cage, I already knew what I would find.
Both of my patients died within five minutes of each other. As I was preoccupied with Chuck, Griz may have passed at the exact same moment. Their conditions were in no way related. Their attitudes could not have been farther from each other. As they lay in their cages, alone and away from their families, perhaps in their altered states, they bonded and made a pact that they would not be alone anymore. They silently communicated that they would take the next stage together. Fearful biter and happy companion left on their final adventure together.
When a case goes well, we often attribute it to our superior veterinary skills, despite the fact that I believe many of our patients will get better in spite of us. My coping may not be healthy for me, but when things go wrong, I think of what I did wrong. I think of what I could do better next time. I think about diagnostic avenues I did not pursue and differentials that I brushed off. I like to think that this rigorous self-evaluation makes me a good vet. I am very good at turning my various psychoses into positives. When even something small comes up, I kick myself. When I can think of nothing else I could have done, I feel awful for losing a patient despite the inevitable outcome.
I placed Griz into a body bag and called his owners. I did all of the necessary paper work. As I walked up to the front of my hospital, I had a collar in either hand. It struck me what a symbolic moment that was. I thought that this image would make a good painting that symbolized what it was to be a veterinarian. It illustrated my humanity. I did not have all the answers. I did not have a magical cure to overcome several days of progressive illness. I did not have a hidden technique that could have saved their lives. I did not have God-like powers. I did not have the ability to do any more than I had already done.
The only things that I had were two empty collars and the hope that tomorrow would be a better day.