I’ve deliberated all weekend over whether this story needs telling, especially given my general sensitivity to mental health issues among my clients. And so I disclaim: any resemblance in this tale to persons living or long-dead is a mere coincidence. Rest assured, I have also changed the names and physical characteristics of this client in deference to his privacy.
(Is that acceptable enough of a disclaimer? Let me know if you think it was still unfair of me to tell his story in a blog format.)
So this guy comes into the hospital on Saturday morning and he’s got his cat in his arms and his wife by his side. Fluffy is apparently visiting the doctor to have his skin checked. I look all over and find a couple of bald patches and so we begin to discuss whether or not Fluffy is grooming excessively, seems itchy, etc.
Fluffy happens to be wearing a thick collar for a small cat. Because I always look under clothing and collars for rubbing sores, etc., I [apparently] made a gesture foreshadowing the impending removal of Fluffy’s collar. The owner almost jumped out of his skin. You could almost see him say “Noooooooo….” in slow motion as the collar came off the neck and landed on the exam table.
Inexplicably beside himself, his wife tried to console him, simultaneously giving me the “I’m so embarrassed by all this” look.
Beneath the collar, the apparent cause of all this alarm, was a small puncture wound the size of a pencil point with a hairless area perhaps the size of a dime surrounding it. I gave them a curious look and proceeded to ask gently what the problem might be.
“Omigod, honey, now she’s seen it. But doctor, that’s not what he’s here for. Can you please just forget you saw it?”
(Ummm….OK, but it just looks like a small tick or spider bite. It should go away pretty soon. Don’t worry.)
“I’m not worried. But it’s not going to go away. It’s been there for over a month.”
(If you’d like I can take a photo of it and email it to the dermatologist if that would make you feel better.)
No way! We can’t involve anyone else in this!
(No problem. But it should go away soon, OK? I can give you a salve to see if it will help...)
“No! Look how it’s healing. Nothing heals like that. It’s absolutely unnatural. See how it’s shaped like a square? Don’t you feel the chip there?”
(OK so now I think I know what’s going on…the microchip is the issue and the guy doesn’t want to blame someone for implanting it incorrectly, etc.)
“Not the microchip! Omigod she just doesn’t get it.” (looking at his wife, who’s now not making any eye contact with me)
Finally, the technician grabs my arm and pulls me out of the room. Then she explained what I’d been missing in this whole bizarre conversation:
Omigod is right. This guy was obviously having some sort of paranoid psychotic episode and, if my tech is right, truly believes his cat has an alien implant at the base of his skull.
As he was walking out the door I thought, maybe I should have offered to take an X-ray so he could see there was nothing metallic there. But, then again…I don’t know what kind of materials aliens use…
As it stands, I don’t think I helped his frame of mind too much—or the cat’s skin, for that matter. Sometimes my expectation of boring normalcy in my clients clouds my vision and leaves the truly disturbed laid bare for this bull-in-a-china-shop vet to trample on. I really feel terrible when I think about how my stupid questions must have alarmed him.
But what’s a vet supposed to do in these cases? I guess next time I’ll be better prepared and concentrate on my patient, instead.
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The thing is, you didn't do anything wrong. You were doing your job and part of your job is to ask questions and yes, occasionally remove a collar when there is a questionable skin problem underneath the said collar.
If you were being rude to this man or mistreating his cat, that would be an entirely different story, but since what was going on in his mind had nothing to do with you specifically, I wouldn't sweat this one. If you start making yourself crazy over your clients mental health, it will eventually start taking it's toll on you which will effect how you do your job.
If anybody was lacking in that situation, I would have to say it was the wife. She must be aware of what his episodes are like and maybe (?) what triggers them, so she should have atleast been more active in being a voice of reason other than leaving you in the dark. She didn't need to get into his life story or anything, but being alittle more pro-active than what she was may have helped?
Stacy March 5th, 2007 04:17:00 PM
Based upon what you've shared with us it's possible that it was not actually a delusional episode involving aliens, but that certainly is a valid interpretation of what happened. My immediate thought in this was that there was animal abuse and that's why the owner didn't want you to see and examine the cat's wound. The owner could've been trying to cover the abuse with a faked delusional episode. I have no clue which's more likely to be true.
As for how you behaved, I think you handled it as well as could be expected. You are not trained to recognize human psychological disorders, and even if you were your focus is on the animal, the patient, not the human client. For the future, you could at some point in time ask the man and his wife separately which of them is the better to speak to regarding facts and decisions about the cat's care - this way you would have a guideline for how to react should they conflict with each other, though I presume that right now only one person's name is on the animal's records and that's probably who you should go with. You may also want to make sure you always have a tech or another individual you know in the room with you, in case the man should act upon his delusions. Otherwise, you did the right thing: examine the pet, and treat what you see.
And regarding whether you should have shared it in the first place, I'm not sure. I wouldn't share anything that could allow someone who knows the individual to identify him - for example, not saying the cat's color was a good thing. As the MAN was not your patient, just the customer, you are under no legal constraint to not disclose. Similarly, I am legally bound to not talk about my students, but there is no restriction should a student's parent come talk with me. I probably would not share it with the internet at large though.
zandperl March 5th, 2007 04:53:00 PM
First, I don't think you did anything wrong or unethical by describing this case, although I can certainly relate to the difficulty of figuring out where the line gets crossed. I don't quite agree with zandperl's comment that because "the MAN was not your patient, just the customer, you are under no legal constraint to not disclose." This might be the case in Florida; you'd need to check the state practice act to be sure. In other states, this might not be the case; again, you'd need to check the practice act. Regardless of the legal reality in your state, though, I think veterinarians and veterinary support staff have an ethical obligation to protect a client's privacy.
Second, your story reminds me of a much more serious case we saw a few months ago at my wife's practice, also involving a mentally disturbed person. A cat was presented on emergency with what the owner described as wounds inflicted when the cat fell on a carving knife(!). Close examination of the cat revealed two penetrating, stab-like wounds (the cat fell twice?) on the cat's back (the cat fell on its back? not impossible, but cat's are pretty good about righting themselves as they fall). We knew from prior experience with this client that she had a daughter with a mental/developmental disability that could manifest violently, so the associate who saw the cat quickly suspected the possibility of animal abuse. In our state veterinarians are required to report suspected cases of animal abuse to the police. We did so and with the police involved the truth quickly came out. The daughter admitted to stabbing the cat (she had been off her medication at the time). New homes were found for it and the family's other animals. A sad situation for everyone involved.
catmanager March 5th, 2007 05:56:00 PM
Catmanager: How horrible! I would feel terribly for the family but disclosing it to authorities is abviously your only option. On the privacy thing: I think the clients might recognize themselves if they read this but no one else would. I was trying for privacy but I guess I'm the only one who knows whether I changed things around sufficiently to accomplish that. I worry sometimes about these things. Believe it of not, none of my clients have yet to recognize themselves in my posts--even after I tell them about it. They've all assumed I get a lot of cases just like theirs.
Stacy: I also thought about the abuse thing. In fact, that was right up there once the owner started acting freaky. I discounted it based on the strange speculation about the nature of the wound and its not being "natural." We discussed it again among the staff and decided the alien thing was the only possibility. One of our techs (the one who took me aside) has apparently read that this is a common psychosis among paranoid schizophrenics. Who knows? Maybe they're right and we're the delusional ones.
Dr. Patty Khuly March 5th, 2007 10:21:00 PM
whoops. Here is the correct link for Pocket Farm:
http://www.pocketfarm.com
enjoy!
caroline March 7th, 2007 10:37:00 AM
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