What would you do if it was your pet?

What would you do if it was your pet?  This is a question I get asked a lot in my field, more so when I was in ER medicine, although working with an internist (we treat a lot of cancer patients) has caused this dilemma to remain.  It is a tough question to answer, because every case or situation in the veterinary field is different, but there is one commonality: determining your companion animal’s quality of life when making these decisions, And it is tough, because they cannot tell you what they want, yet they can communicate what is best for them in subtle ways-if their owners are observant and are able to take themselves out of the picture……

Which leads to another question: When is it time to let go? 

My most recent case that really touched me was several weeks ago at work. It was so draining, that I have not been able to write about it until now. No matter how burned out I feel with my profession, my patients still touch me. This is a good thing, as it lets me know that no matter how jaded I think I’ve become, I still have at least part of my soul left…
The dog’s name was Theo, a charming and rambunctious pug who presented to us with acute vomiting and pancreatitis. Theo was only 4-5 years old, but looked way beyond that; he apparently was a rescue dog, so his sketchy background perhaps aged him. When Theo came to our clinic, he was literally bouncing off the walls!  He would jump into my arms every time I’d open his cage. We did blood work and treated him with IV fluids, and were going to send him home the next day, but the vet decided to keep him one more night….that was when Theo had a seizure from which he never recovered…

I walked in on a Wed morning (Theo came to us the previous Monday) to the sound of an EKG machine and an inexperienced, harried overnight tech, anxious to give me rounds and have me take over. What on earth have I walked into, I asked myself….
I have 5+ years of experience in emergency medicine. I have seen it all, from gunshot wounds to severe trauma to abuse to sudden death; you name it and I can probably tell you a story. Yet it doesn’t get any easier, despite my experience and expertise.
So I get rounds on Theo, who is pretty much comatose and on anti-seizure meds (Valium and Phenobarbital). Throughout out the day, he does not get better, yet the owners want to pursue treatment. At this point, I cannot blame them. They want their dog to pull out of this and they also want answers. We aggressively treat Theo in an attempt to give them both…
The next morning, Theo is worse. He has had more seizure-like activity and is now a shell of a dog lying there hooked up to IV fluids ad an EKG. Looking at him, it’s hard to believe that this is the same happy go lucky dog we saw just 2 days ago. Now the question is, how far do the owners want to continue?

I am a veterinary technician. For those of you who don’t understand what I do, I am the equivalent of a nurse in a human hospital. So I carry out the doctor’s orders; I care for the patient, and report anything usual or unusual back to the doctor. I am the doctor’s eyes and ears, I am her right hand, and all too often, I become her heart. The latter is what makes my job the most difficult. While the doctor is caught up in tests, client wishes, and how to make the patient better, (which all too often becomes a “case”-see my last blog), I see firsthand the patient’s quality of life. Which makes me wonder all too often, why are the clients continuing treatment? Why are they putting their pet through this? And how do you know when is it time to stop?

Such became the case with Theo’s owner. I knew at this point that he was not coming back to us. Yet with the client’s go ahead, the doctor kept ordering more tests and coming up with more treatments; all to no avail.

This is when it becomes very difficult to do what I do. There is a point that I KNOW the animal is not getting better; I can see it, feel it, sense it….and convincing the doctor is difficult enough, but convincing the owners is a different story; most people do not feel comfortable making these decisions or do not see the big picture, and yet it is a part of being a caretaker for their pet. Some people look at this as “playing God; I see it as being a compassionate, informed and responsible caretaker. And taking yourself out of the picture.....

Theo’s owners were not ready to make that decision. And I can understand their plight. Yet additional tests revealed nothing, except that he was declining. Their once happy dog was now just a shell of his former self, lying in a cage, and they were no closer to an answer than they were when he was transferred to us 2 days ago. Except that perhaps their answer now was that they were never going to have one and that maybe it was time to let their beloved dog go. Unfortunately they couldn’t, almost up to the very end. They came to visit Theo in the afternoon and sat outside his cage, hoping for some sign, that he might come back. My heart went out to them; Here they were were, consumed in their world of grief, hoping against hope that their dying dog would turn around, amidst the hustle and bustle of well animals being discharged; an often too ironic turn of events in my field. Even more ironic was that “mom” was a nurse. So she understood all of the medical terminology. But she was just too close to the situation..….

After a painfully long visit in the treatment room, Theo’s owners elected to visit with him privately in our grief room. At this point, they had decided to discontinue treatment as death was imminent, but they still weren’t ready to let go. This makes it worse; for those of you who have never seen natural death; it is not pretty, especially when one is unprepared for it. Our greatest concern at this point was to ease the owners through what was bound to be a very difficult situation. I was on standby with an anesthetic injection, in case Theo went into respiratory arrest. This meant that I had to keep checking on them and intruding into their world of privacy and grief in the best interest of both the clients and my patient……

Finally, Theo’s owners decided to let him go quietly. After 3 grueling days, Theo died peacefully in his owner’s arms, with the help of an anesthetic overdose. This was clearly the end of a short but powerful chapter for us; the end of a long and meaningful chapter for Theo; and hopefully the start of some healing for his owners.

There are those of you who wonder why I am so private, especially as of late; why I maybe don’t volunteer much about myself; why I take so much personally. Perhaps this is one explanation; my work demands SO much of me, physically, mentally, emotionally. Lately it has consumed me. Many times I get home and find that there is nothing left of me to give. Currently, I am trying to find a balance; I'm hoping that writing about my experiences will help. All I ask is your patience, understanding, friendship and acceptance.  And when you come home at the end of the day, take time to be thankful for the way in which your companion animals have touched your lives. And give those that are still with you extra love….........for me.

Ellen  
11/22/06

What do you get asked most often?

What do you get asked often? This was a question posed by one of my friends on a recent blog. Ironically, I was composing a blog in my mind (after a draining week at work) that I thought about entitling “a day in the life of a vet tech (or something unoriginal like that). Instead, I think I’ll address his question, but with a different twist:

“What comment is made to you often?”….

“Oh you get to work with animals; that must be so much fun.” If I had a dollar for every time I heard this comment, I could open my own clinic. It never ceases to amaze me the idealistic vision that people have of my profession. And then I have to listen to them say how they always wanted to do what I do. Give me a break….

I’ve worked in emergency medicine for 5 years; Recently, I switched to specialty practice (surgery and internal medicine). So the animals I see are either very sick, or are in need of surgery, and will consequently nursing care. This is not “fun;” it does not involve playing with my patients while whiling the day away, as many people would believe. It involves seeing animals in pain, and in some cases, having to inflict it to help make a patient better. It involves comforting distraught caretakers, remembering being one myself at various times in my fur children’s lives. It involves knowing in many cases, that a precious little life is in your hands. Sometimes it involves losing that precious life, in spite of your best efforts. And it involves walking that fine line between caring too much and becoming too jaded.

I am a healer. I’ve known that from an early age, whether it is listening to someone’s problems or providing comfort, sympathy and empathy- even at my own emotional expense. I’ve accepted it and embraced it as one of my Life’s paths. And I’ve always felt a connection with animals, much more so than with people. I changed careers to be in this field because of my love of healing, of comforting, of offering care, hope, sympathy and empathy; and of course my love of animals. Yet lately I’ve been questioning whether or not I want to/should stay in this field.

I think I’m jaded by what I see or have seen as objectivity; when the patient is no longer a living, breathing thing, but “a case.” I’m sure it happens in human medicine, although I think it is worse in veterinary medicine, because the animals cannot speak for themselves. I recently cared for a cat, (”Toro”) who came in to see our internist. The cat had not been eating for several weeks, so we performed an ultrasound. I still remember the trusting way that Toro looked into my eyes during the procedure as I held him and tried to reassure him. At that moment we bonded, and I felt a connection to him that I cannot describe. I felt like I was looking into one of the most beautiful souls, and I felt an understanding that I cannot describe…

The ultrasound revealed a need for exploratory surgery. The next day, the surgeon took over the case and operated. It was not good; pancreatitis and an abnormal liver (hepatic lipidosis secondary to pancreatitis). They put in a J-tube for nutrition-to bypass the stomach, and a feeding tube for Toro’s subsequent recovery. The next day, he took a turn for the worse. And all I can remember is 2 doctors going back and forth about what tests to send out, while in the meantime this poor cat is trying to die….. “We need to draw blood for a CBC/Chem;” I’d draw it, only to hear, “I think we need to do in-house electrolytes so we can check his potassium”….so I’d have to draw blood again; never mind that we were already putting this poor animal through too much already. I wanted to ask these doctors, when did this animal stop being a patient, when did he stop being a sentient being; when he start being “a case?” And why did that even have to happen?

Toro’s owner’s came back visit him and elected humane euthanasia; the best and most caring decision for all involved. Yet I can’t help but wonder if we could have spared him some of his suffering by better planning, better medicine, and a better vision of the entire situation….

“Oh, you get to work with animals, that must be so much fun.” While my work does have its rewards, it also bears a heavy price. I do not regret what I do, and I try not to allow myself to be too jaded. All I ask is that people try to understand my field a little more realistically.

And for those who tell me, “I couldn’t do what you do-I love animals too much.” My response is: “No, you don’t love animals enough!”

Ellen