Okay, I promise I’ll find something to write about besides work at some point real soon, but for now just take it for granted that I REALLY need a vacation. Or a chill pill. Or a big fat drink or something.
So for the last six weeks or so I’ve been seeing this woman, a client who’d been in a few times before this, whose dog was just not right. Nothing specific, nothing that we could really put our fingers on as “THIS IS THE PROBLEM”, just not right.
Physical exams unremarkable. Bloodwork, urinalysis unremarkable.
The dog has been getting progressively worse. Energy levels dropping, appetite dropping. I’ve spent a LOT of time on the phone with this woman.
And I’ve spent a lot of time trying to work her into my schedule. The woman was having issues getting to us and several times I double booked myself, stretched my schedule, cut into my chart and phone time just to find a time when we could see her and her dog. And sometimes she’d show up and sometimes she wouldn’t.
And the dog has been getting progressively worse.
I finally, FINALLY talked her into letting me take x-rays of the dog two days ago. The dog looked like ass by that point. She hadn’t been eating, her abdomen was grossly distended (a relatively new development), and she’d developed edema along her back legs and her abdomen and chest –dependent edema.
The radiographs, of course, looked like ASS.
Lots of free fluid in the abdomen, a big SOMETHING in the left quadrant of the abdomen, moderate fluid in the chest.
I showed the owner the images and discussed our options. There were three.
Referral for abdominal ultrasound to better define the big SOMETHING to see if it were a resectable SOMETHING or
Understandably the owner was upset. I talked her through the possibilities of what the SOMETHING could be. Best guess was a liver or splenic mass, but with the radiographs I just couldn’t tell. If it were a splenic mass the SOMETHING could potentially be removed if there weren’t complications elsewhere, but again, with just from the radiographic images I simply couldn’t tell her more.
Having discussions like this I’m always quite up front about the possibility that even if we do the advanced diagnostics to find out what we’re dealing with the answer may be that we might find something we can’t do anything about. I told the owner that if she opted for ultrasound (the best option as the dog was a crappy surgical candidate) she’d have to take the risk that the ultrasound would find something that was non-resectable and that she’d have to choose euthanasia anyway.
Didn’t by any means hold a gun to her head and tell her she HAD to get an ultrasound. Referral to the internist for an ultrasound ain’t cheap and I’m fully aware that my medical recommendations have to be tempered by what people will pay for. I don’t make the decisions, I offer options and facilitate getting things done depending on what option the owner chooses.
So the owner chooses to have an ultrasound done. I pulled some strings and got a short list appointment for the dog yesterday. Report from the internist was on my desk this morning. The SOMETHING was a 5 x 5cm mass in the liver with probable involvement of the gall bladder and spleen.
Well that sucks.
But it wasn’t completely unexpected, at least not on my part. At this point in my career I’ve seen enough that I have that little voice inside my head that says “THIS IS NOT GOING TO TURN OUT WELL”. The internist recommended euthanasia and the owner concurred.
The owner called today to make a euthanasia appointment for tomorrow. Was told the charges for the euthanasia, we like to tell people that up front so that they don’t have to deal the charges when they come in for the euthanasia. Owner was perfectly fine with that.
The owner called up about two hours later PISSED OFF. Ranting that she’d talked with her sister and the amount of money we’d quoted her for the euthanasia was completely unreasonable, she could have the euthanasia done elsewhere much cheaper and we were just trying to squeeze as much money, that she didn’t have, out of her before we killed her dog.
Cancelled her euthanasia appointment.
Okay, I’ve read Elizabeth Kubler-Ross just like everyone else with an undergraduate degree from a liberal arts college. I know that the woman is going through the first stages of a natural grieving process, but I’ve just got to say…
I’ve spent the last six weeks bending over backwards for her, we let her walk the other day still owing us $75 because when she brought the dog in to have the x-rays done she “forgot” her purse and only had a small amount of cash in her purse. We told her not to worry about it that she could pay us later and that our biggest concern at that point was getting her dog seen and treated appropriately as soon as possible.
I guess my mamma just taught me right. When I know that someone’s gone out of their way for me I try not to insult them.
I feel better now.