Going too far, too long

There are not many veterinary clients I have genuinely hated, but there was one in my first job that definitely qualified.

While I have certainly learned to be more understanding and empathetic over the course of my career, even with the benefit of hindsight I cannot come to forgive this human’s intentions and selfishness even all these years later.

The last week of December is a busy time when a vet practice offers its own after hours. You don’t really close, you just take on less routine surgery that can be put off for a couple of weeks. This is because the general public want to save their money for Christmas, and other smaller practices in the area do close and fob off all their urgent cases to you, so you are extra busy with harder things.

We were on after hours services only on the 25th and 26th of December, and I was working them with one other vet to share the load. We were only seeing cases that couldn’t wait, and this was one of them.

The dog in question was a little fluffy thing that had been sick with quite a while. Her primary problem had been heart disease, but now she ‘hadn’t eaten for days’ which meant the owner now decided she was an emergency on Xmas day, as they do.

And this dog was indeed very sick. She was on frusemide to manage her chronic heart disease, among other things, and the frusemide had done what frusemide does, and was now causing chronic kidney failure as well.

She was dehydrated, vomiting, struggling to breathe as her lungs were slowly filling with fluid and generally looked miserable. But the owner didn’t want to euthanise, they wanted to treat.

This was against medical advice for a number of reasons.

Firstly, the dog was actively suffering with two chronic illnesses which would not be cured, only managed.

Secondly, the treatment for those two conditions were basically opposite to each other.

  • To treat the chronic kidney disease, we needed to rehydrate the dog with lots of intravenous fluids and absolutely no frusemide.
  • To treat the heart disease, we needed to dehydrate the lungs (and the dog) and use lots of frusemide to do that.

And we were not staffed 24 hours as a critical care hospital. The only blood tests I could run in the clinic were glucose, PCV and Total protein. I had no way of monitoring urea without sending blood to the local helpful human hospital, or potassium. Nor could I afford to sit cage-side by this patient all night, which was Christmas night, by the way, to monitor it while we tried to both rehydrate and dehydrate it at the same time (which is pretty darn close to a physical impossibility), and in the meantime this dog is suffering.

But they wanted to treat. And at that stage I did not have the will or stubbornness that I have now to put my foot down. They wanted to treat. And they wanted a phone update every 2 hours through the night.

I did it. I came in, checked her every two hours, and called them with an update more or less on time unless I was seeing another patient (and they flipped out on the phone when I was 20 minutes late with an update because I was seeing another patient at the time) and every time I called, I recommended euthanasia.

The dog had two organs failing, and they wanted to take her home or continue struggling to treat something that would never get better instead of letting her pass.

By morning we were all exhausted – that’s what happens when you demand 2 hourly updates all night – and the dog was no better. She was probably worse, but the owner decided to fixate on the fact that she hadn’t urinated overnight as evidence that something was ‘wrong’. Never mind the heart and kidney failure.

So I performed an ultrasound on her bladder, only to find a liver tumor next door.

This was still not enough. Heart failure, kidney failure, a liver tumor and actively suffering with no response to treatment and they still refused to euthanize.

I gave up. I’d only been working for a year and I was ready to euthanize this dog without consent, but the owners were already there and making noise about taking her home. If she hadn’t been hooked up to a drip, they probably would have snatched her and left already.

I handed the case over to the other vet working that day. I had to, I was too tired to be nice any more. It took them another hour to finally get consent for euthanasia, and I don’t think she was particularly nice about it at this stage either. But she had to be.

The owners wanted to continue this cruelty, and they were dragging us into it as well, beyond what was a reasonable attempt at preserving life.

And I have to say, they hated us for not letting them have their way. And they argued about the bill for months later.