I know most of you are probably still wiping the laughter tears out of your eyes over the Kasparov video (I know I still am), but I thought I’d provide some clarification about my spoiler from earlier this week….. If for no other reason than it’ll save Dalek from going insane.
Matt and I play a game on occasion called “Pretend You’ve Never Had Any Medical Training” which is the code phrase we use to start a conversation with each other regarding our more interesting medical experiences. The above phrase generally translates into “Oh my GOD you wouldn’t believe the mouth breathing moron that I saw today!”
Although I really think he won the game about 10 years ago when he had a guy walk into the ER in Tacoma where he was working who hadn’t been able to pee for the previous 5 days. Not that this guy didn’t NEED to pee, you understand, it’s just that he COULDN’T. The dude claimed that around about the third day he had thought that there might be something wrong and maybe he should go to a doctor, but then he figured that he’d just wait another couple of days to see what would happen. (For the record what happens is that your kidneys fail and you end up in azotemic hyperkalemic shock, but that is beyond the point.)
ANYway, back to my story about the Veterinary Board of Governors.
So pretend you’ve never had any medical training.
On a Monday afternoon in early December we got a call from a silly woman who said that she had come home from work to find that her terrier bitch was whelping and that there was something green hanging out of the bitch’s vulva. It was 3:45 in the afternoon, we close and leave the building at 7. I had a full appointment schedule, the other on duty doctor had a full appointment schedule for the rest of the afternoon.
Our office manager took the call, came to us at our work stations to tell us what was going on and get our advice on what should be done.
Being as it was late in the day, being that we were both fully booked with appointments, being that WE’RE NOT AN EMERGENCY CLINIC, and it being likely that any bitch, regardless of whether or not she’s had previous litters, that starts having difficulties giving birth is very likely going to need emergency surgery……. We told the OM to tell the silly woman to go away. Not in so many words, you understand, we phrased it more like: “It sounds like the bitch will need surgery and since neither of us is available for the rest of the afternoon the owner should probably just take her into the local ER.” (with an undertone of “shoo, shoo, shoo! Hurry up! NOW!”). Also anything green involved in a prolonged whelping is a BAD sign so there’s more than a little urgency that enters into the case when “something green” is reported to us over the phone.
OM, who is also an experienced dog person and who has assisted at the whelping of more litters than I probably ever will, went back to the phone and told the silly woman to shoo, shoo, SHOO!
Silly Woman bitched, moaned, and complained about why we couldn’t just see the bitch and do an x-ray or something (um…. because it’s likely that the bitch will need surgery and we’re not equipped to do it in the THREE HOURS that we have left before close of business!). Silly Woman also whined about why Dr. Myboss wasn’t there and if Dr. Myboss were there SHE’D do the x-ray and why were we being so unreasonable. However, OM was firm that there wasn’t anything positive that we could or would do if she brought the dog here and finally Silly Woman agreed to take the bitch to the local ER.
Fast forward to Tuesday morning.
Tuesday morning at 10 a.m. Silly Woman’s husband showed up, unannounced, with the bitch in his arms. The bitch had still not produced any puppies, she was still straining, and there was still something green hanging out of her vulva.
In direct contrast to human labors, prolonged labor in a bitch is a VERY BAD THING. Usually if puppies aren’t born and the labor concluded within the space of 6-8 hours it’s game over for the puppies and a really bad prognosis for the bitch. Sadly, people who fancy themselves dog experts just because they can put two sexually intact dogs in a room together and watch them mate, never seem to do any actual research before they participate in this bestiality porn. It’s not uncommon for us to be presented with a bitch that has been in a prolonged labor and have the owner have no idea whatsoever that a 1, 2, or even (my highest number to date) a 4 day labor is FEROCIOUSLY UNUSUAL.
So far as we have been able to determine the bitch had been in active labor at that point for at least 24 hours. Bad. Very, Very BAD.
I was in surgery so it fell to Dr. Myboss to evaluate the bitch and provide Mr. Silly Woman with a treatment plan. She did so, and because I was doing procedures that day the bitch’s care fell to me. Dr. Myboss made it very obvious to Mr. Silly Woman that the bitch would need surgery, at this point the goal of the surgery was to save the life of the bitch and that the puppies were likely dead. Proceeding from that stance we were actually able to stabilize the bitch somewhat before taking her to surgery. This was a good thing because the bitch looked like gently chilled shit on a cracker. She was in shock, she was hypothermic (normal temp for a dog is 100-102.5F, the bitch read at 94F), hypotensive, and painful. We filled the bitch full of warm IV fluids, antibiotics, and pain medications, and buried her in warm blankets and hot water bottles. After 3 hours her body temp was up to 99F (not normal, but much better), her gums had gone from being a nasty grey color to a nicer, if pale, pink, and she wasn’t panting and straining anymore. Lovely. This is a patient who is much less likely to die on the surgery table.
The key to obstetric surgery is speed. You want your mamma shaved and scrubbed at least once before you anesthetize her, you want two surgeons (one to concentrate on mamma and one to deliver puppies) and you want at least one pair of hands per puppy to stimulate them, dry them, and get them breathing.
Honestly the surgery went well. We were expecting a uterus full of dead puppies, instead we got three live ones (including the one whose placenta had been the green thing hanging out of the bitch’s vulva). We spayed the bitch (I almost NEVER do a c-section without spaying at the same time. It’s one of my great joys to be able to charge people this sort of stupid tax), closed her, and discovered that she’d actually done fairly well under anesthesia. Granted the bitch was still hypotensive and hypothermic, but with proper support I was confident that she’d do okay.
It was 2 p.m.
I called Silly Woman, gave her an update and told her that she should show up to pick up the bitch and puppies as close to 7p.m. as she could.
We kept the bitch in a heated cage with warm IV fluids and she recovered well, if slowly, from anesthesia. She was even taking care of and nursing her puppies.
My one big mistake, and I admit there were some less big ones too, was that I didn’t tell Silly Woman that she had to take the dog to the local ER for overnight monitoring. Of course it wouldn’t have mattered if I had told her because she wouldn’t have done it anyway, but the point is moot. I should have recommended it and then documented that the owner declined.
Silly Woman and her husband show up to pick up their just whelped post surgical hypothermic bitch and her three newborn puppies with….. a sweatshirt.
This is December.
No blanket, no box, nothing at all to protect the four very vunerable creatures in their care from the FREEZING BLOODY OUTDOOR TEMPERATURES AND THE NASTY SPITTING RAIN. When told by my technician that she needed to monitor the bitch’s temperature closely Silly Woman said, and I quote “Oh, I don’t need to take her temperature with a thermometer, I can just put my hand on her forehead!”
We provided her with a box, blankets, and hot water bottles, crossed our fingers, and sent her home.
In her complaint to the Veterinary Board of Governors, Silly Woman claimed that the bitch “never recovered from anesthesia and died in my arms at midnight”. What we suspect is that Silly Woman took the bitch and the puppies home, put them in a crate overnight and got up the next morning to find the bitch dead. If the bitch was doing so poorly that she died at midnight, why didn’t Silly Woman call the number for the 24 HOUR EMERGENCY CLINIC that we had given her the night before, at some point before the bitch died? If the bitch had been that closely monitored that she died in the owner’s arms, don’t you think you’d notice that something was wrong BEFORE THEN?
Regardless of whether or not Silly Woman witnessed the bitch’s death at midnight, she didn’t let us know about it before 11:00 the next morning when she called to find out what she should be feeding the puppies.
In her complaint, Silly Woman also “[took] full responsibility for not taking the bitch to the emergency clinic the night before, but [I] refuse to take my animals anywhere where they will use scare tactics to force you to do things that you don’t think are necessary.” I worked at the ER that we referred her to and I’ve had, and have been witness to the same type of conversation that Silly Woman had with whomever she ended up with on the phone there. I know the gist of her end of the conversation was “I want you to do the c-section for my bitch, and oh by the way I don’t have any money.” Which would have gotten her the discussion about options for payment (they work with a credit company called Care Credit and if you don’t qualify for Care Credit you’re pretty much SOL) and when Silly Woman complained about their awful, evil policies and said that she’d just bring the bitch to us in the morning she was warned that waiting could have serious consequences on the health and life of the bitch and puppies. I KNOW that was the conversation she had with the ER, I’ve had the EXACT SAME conversation with god knows how many people.
Silly Woman filed her complaint with the Veterinary Board of Governors one week after the bitch died. She alleged that our care was negligent, that I discharged a patient that was not fully recovered from anesthesia (lie), that we shouldn’t call ourselves a “Veterinary Hospital” if we aren’t able to provide care 24 hours a day that we should call ourselves a “Veterinary Clinic” (what?), that she didn’t understand where it was that we got the idea that medicine is a 9 to 5 job and that if we were truly dedicated to animals like we SHOULD BE (her emphasis, not mine) that we would have seen the bitch on Monday and stayed open late just for her (oh, and not charged her for it by the way…..She didn’t actually say that, but that was implied. Pardon me for having a life, but that’s what the local 24 HOUR EMERGENCY CLINIC is for.), that all the patients of mine that she had seen discharged from the hospital that evening had all been so sedate they couldn’t walk (blatant lie), that I had been defensive and hurried when I went to speak with them before the bitch was discharged (Hurried? Yes. I had done 9 hours of surgery that day, had barely stopped to eat before seeing another 2 hours of appointments, I was exhausted and I wanted the hell OUT, so sue me. Defensive? That I’ll argue.) and a whole raft of additional hateful and mis-represented nonsense.
I have a friend who works in emergency medicine in Los Angeles. He claims that if you don’t get about one board complaint per year that you’re not practicing aggressive enough medicine. On the other hand he works in emergency medicine in Los Angeles. I can’t begin to imagine the crazies that he gets to see on a daily basis and I am so obscenely happy that I DON’T.
I’d never had a board complaint. I’ve been in practice for fourteen years and while I’ve had my share of loonies and while I’ve had my share of lawsuit threats and hate mail, no one had ever forced me into a review by my peers. Peers that I don’t know personally. Peers that have the power to remove my means of making a living. This is seriously scary shit folks.
First I was pissed. Then I was scared. Then I was pissed again.
Then I called my liability insurance carrier and had them hook me up with a lawyer who works exclusively in their license defense department. The lawyer took me through the process, gave me advice on what, and more importantly what NOT, to write in my response to her complaint. Lawyer helped me (us, actually, the complaint listed Dr. Myboss as well) to bundle together all of our paperwork, medical records and so forth to send to the board then he told us to chill the hell out.
It was a frustrating three months between the time we sent our response to the board and the time that we got their ruling. The ruling reads as follows:
“Dear Dr. Hammond
The Veterinary Board of Governors investigated a complaint regarding allegations against your veterinary practice.
After careful consideration of the records and information obtained during its investigation, the Board has determined there was no cause for disciplinary action. The case is being closed as no cause for disciplinary action, as conduct was within the standard of practice.
Blah, blah, blah, if you have any questions please call us.
Someone at the Washington State Department of Health”
Dear Silly Woman
Kindly shove it up your ass.