It's been a tough week at the ER clinic. I'm just coming off working five straight twelve-hour days, which is challenging enough. But if you consider two of those days were weekend days, and the final day was short-staffed with me as the only doctor? Well, you could've played a pizzicato on my nerves by the end of the day yesterday.
The "weekend" component is an interesting phenomenon experienced by ER clinics in particular, as our services are sought by families, already distressed by their pet's medical condition, who are now further aggravated by being forced to seek help from someone they don't know: "You aren't our REGULAR vet. He's a GOD!" -- Well, your god chooses to have weekends and evenings off, guy, so you're kinda stuck with us.
The winter season doesn't help, either. For some reason, the holidays seem to be a particularly deadly time of the year for pets, and there are a lot of pets who need to be put to sleep around the holidays. I can't explain it. A former mentor used to cynically remark that he thought it was because the humans are all trapped indoors, due to the cold weather, and they finally look at their pets and realize, "Oh, shit! Fido is sick!" when he's actually been sick for weeks. Or longer. Even more cynically, my mentor would also remark that "No one wants the old dying dog to ruin the Christmas photos." Ouch.
My own experience suggests nothing so coldhearted. The pets I've had to euthanize in the past few weeks have genuinely had conditions that simply weren't present two months ago, or even last week. Cancer is always reliable for a pop-up surprise of the worst kind. Had one of those yesterday. Nice dog with a limp. Bone cancer. -- I don't know why it's worse this time of year. Maybe in the summer ... well, I just don't want to think about it.
And of course, money is also stretched thin around the holidays. People are stressed about family and gifts and cookies and parties and travel, and then here I come with an estimate for a thousand dollars for care of their sick pet, another unplanned expense.
And of course, it's winter. In Alaska. Dark. Cold.
I understand all these things. I have empathy. I have beloved pets of my own, after all. -- And I understand the money thing. I grew up in a family that had about a half dozen cars in the driveway most of the time because we could never be sure which one (or two) wasn't going to start that day. I was told by my mother that I couldn't have a dog because we couldn't afford it. And we couldn't.
So, as a doctor, I get it. It's a crappy thing to get bad news about your pet, whether it's life-ending or just really expensive. All day long, I walk into rooms and give bad news. I listen to stories, hand over boxes of Kleenex, negotiate for what the family can afford. I've even been known to give a hug or two (You can ask anyone: I am not a hugger).
It's an exhausting part of the job, but a necessary one.
However.
Mixed in with all these lovely families who are trying to do right by their little furry friends, are the following people, and this is where I truly struggle:
-- The Inconvenienced: I had a gentleman come in yesterday with a sickly sixteen year old dog (yep, sixteen), and his main concern was that he was leaving for vacation the next day and just really couldn't be bothered to have to deal with this, when, y'know, he's going on vacation! Like, tomorrow!! Can't I just give the dog a shot or something? I mean, they've already got a sitter arranged to come check on him once a day. The dog'll be OK, right? -- It's a nuisance, I sympathize. But some clients at least laugh about it, as they stroke their kitty's head and say, lovingly, "Kid, you've got amazing timing." And then they take proper care of their pet's needs. -- But these other folks are more worried about their tan than their cat's three week history of diarrhea and weight loss.
[I know what some of you kinder gentler readers are thinking. But I urge you to reserve judgment until you've read the closing comments.]
Next up:
-- The Breeder Cultists: The client says, "Well, my breeder says....", or "Can you call my breeder to discuss it?"... This is, of course, mostly a puppy phenomenon. I never know why people think breeders have more medical knowledge than doctors. I do know there are some good breeders out there, but it has to be said that the only requirement for being a "breeder," is that you put two pets in the same room together and allow them to mate and then successfully whelp at least one live offspring from that mating. Not terribly skilled or difficult. And if the breeder has been doing it for thirty years? That still doesn't give them medical credentials. The number of breeders I've encountered over the years who are merely bullshit artists who are good at marketing is astonishing. So if the clients fold their arms over their chests and glare at me while proclaiming how I have to separate out all the components of the vaccine and give them according to the schedule "written on this here piece of paper" (usually scribbled, in pencil), well, I just think the breeder did a lovely snow job and the client is feeble-minded.
("Internet breeder" [whom the client has never even met, nor seen their facility nor met the "parents' of their puppy, etc.] gets extra points).
-- The Negligent: They've known for weeks that their pet is sick and in pain, and they thought she was going to die, several times. But she didn't. So now they're in my clinic, and now they want me to fix her, too late. And -- AND -- they've allowed their pet (with whom my true sympathies lie) to suffer this whole time.
-- The Former Vet-tech (or Nurse): "I used to be a tech, so I can just do this at home. Give me the supplies and I'll treat him at home." And then they continue to ramble on and reveal a number of errors (IV fluids versus SubQ fluids is a personal favorite) which reveals to me they have no fucking idea what they're talking about, and maybe they used to be a vet tech because they sucked at their job and got fired.
-- The Internet Junkie: You know I have a special place in my heart for these folks. They've researched their pet's condition on the Internet, they know what their pet has, they know the treatment, but they need me to give them the drugs. That's it. Just a shot of [insert wrong drug here]. --- Mostly, these clients are gravely mistaken. They aren't doctors. Many of them aren't even intelligent. (Sorry, but there are some non-intelligent people out there, and many of them have pets.) They're usually way off on the wrong track from the get-go, so the pet does not have a chocolate toxicity but Diabetic Ketoacidosis. Or both. -- Or, they haven't read any scientific articles but merely blogs written by other non-medical people who have exactly as much experience with the condition they've written about as the clients themselves. The blind leading the blind, indeed.
-- And, truthfully, I have learned not to roll my eyes at these folks mainly because I must admit, I do the same thing. It's normal these day to google something that's new in your life to find out a bit more. I don't even really mind a little bit of, "I read on the internet [insert stupid thing here], Doc. What do you think about that?" Then we have a chat and I calmly explain why that's not correct. -- No, I reserve my hackles for those who pair Dr Google with:
-- The Righteously Indignant: I should stop right here and say that I'm fairly scrappy. So the best way to raise my ire is to come straight at me, distrusting me and accusing me without even having had a civil conversation first. One of my philosophies is a paraphrase of a Goethe quote: Never attribute to malice that which can be explained by negligence.
Which is to say, people aren't intentionally trying to fuck up your day; they're just plowing ahead with their own lives, oblivious of the toes they're stepping on. In any case, I don't know why some people approach life as if everyone is out to screw them over, but they must feel it works for them.
And then they meet me. I do not eat shit, especially from someone I'm trying to help. The dogs? Yes. They try to bite and scratch and kill -- I get it. We're an alien species, and the cats & dogs don't understand we're just trying to help. But the humans? They should know better. Or at least be civil.
So, the woman who strides into my clinic declaring to the receptionists that she already knows we're just out to take her money and overcharge her and "do a bunch of unnecessary tests,".... Well, why doesn't she understand the receptionist is going to tell me that, and, see, now I already dislike her? I am already compromising on what I think is best for her pet, before I've even met her or seen her pet? She isn't telling the doctor: "Alert: this woman will not be fucked with!"; she's putting me on the defensive, right off the bat. And isn't that just what you want in someone who's trying to care for your loved one: someone who is now more focused on you & your shit than they are on taking the best possible care of your family member? (My sister is a human nurse & says the same thing happens to her. I really wish people would get this through their heads: Don't piss off the waiter, or they'll spit in your food.)
I know what a lot of you kinder, gentler people are thinking: These clients are just frightened. Maybe they don't have much money and so they cloak their insecurity behind a big blowhardy personality. Or maybe they know they aren't very book-smart, and having to talk to a doctor is overwhelming because they already know they aren't going to really understand what's going on with their pets. Or they love the shit out of their pets and they're just really scared, so they aren't thinking much about their words or actions?
I agree. In my estimation, this is about ten percent of the people who come into my clinic and act like this. The rest are just assholes.
And here's the kicker. After all the theatrics and grandstanding and gnashing of teeth and tearing of hair, after the half-dozen different estimates for various step-down plans of care (each one cheaper than the rejected one before), after the dozen conversations where we explain to first the husband and then a half-hour later the wife what each line item means, and we have gritted our teeth to calmly indicate we aren't going to explain exactly how a pancreatitis test works (not kidding), ... After all this time and energy and effort, many of the families elect euthanasia. And then, then, I have to be compassionate.
I cannot, as I frequently wish to do, give them fifty verbal lashes about how they shouldn't have waited until the seventeenth seizure before seeking help just because the internet said the dog would "snap out of it." Or how I know the reason they're truly making this decision is so they don't have to be inconvenienced by worrying about their pet while they're lying on a beach in Maui somewhere later this week. No, I have to suck it up and sympathize, because regardless of what has happened up until this moment, I do understand that for most of these families, it is a heartbreaking thing to say goodbye to their pet.
As I said earlier, my ultimate empathy is for the pet. These pets are suffering already, and are going to continue to suffer in these homes where their needs are so far down the list of the family's priorities that they might not even be being fed each day. In fact, sometimes my heart breaks more for those I "treat and street," providing outpatient care then discharging to their owners, than for those I humanely euthanize. It is for these discharged pets that I especially grovel to the client, in hopes that my beneficent attitude somehow will encourage that family to gather some more funds and come back for follow-up or continued care.
So, when I go home at the end of a long work week as this one has been, and I pour myself a Big-Gulp sized glass of red red wine, I try to focus on the woman I saw today who brought her dog in for a swelling under the neck. She was a new client. We were not "her regular vet." She was leaving for Hawaii in two days but her parents would be taking care of the dog while she was gone. I poked the lump, and it was an abscess: messy, requiring some home-care and oral medications to be given -- and she raised her arms and smiled, "Yay! It's an abscess!!," not put off by the inconvenience or expense, merely relieved & happy it was nothing serious for her pet's health. -- These are the clients that refill the well, and I'm grateful for each and every one of them.
