People sometimes ask me why I keep this blog. What would motivate anyone to wake up early or go to bed late just to write something alternately pedantic and soul exposing? Here’s my secret: If I hadn’t forced myself to start writing things down, I might not have the chance to rid myself of daily demons that would otherwise plague me. And I might have progressed to the deadening burnout common to mid-career veterinarians—a state I’ve always feared to emulate.
Today’s workday was a timely reminder that the words I compose in the wake of a seemingly endless day are typically self-indulgent. They’re penned to purge rather than proselytize. In short, I need you, my readers, more than you need me. But you’re smart—I’m sure you’ve already figured that out.
It’s been about an hour since I arrived home—really late and dangerously underfed—after performing after-hours surgery on an emergency pyometra (a toxically infected uterus). And I’m feeling mighty low. The patient made it OK—not to worry. But I’m not exactly feeling quite right after the ordeal—and neither is she, I’m sure. Still, it was one of those “I’ll-never-forget-that-case” situations where my stress level was way beyond it’s normal plane.
Lola is one of those patients I’ve known since she was a wrinkly Shar-pei pup (need I say more?). Her mom was one of my “eccentric ones.” As the years have gone by I’ve learned to accept her owner’s personal deficiencies as part of the landscape—and I’ve managed to work around them (sort of). While I never managed to convince her owner to get Lola spayed (anathema to her personal cultural code), I somehow managed to gain her trust. So when Lola’s “period” became obviously effusive, she easily accepted that her dog required surgery.
I’m feeling rather low, for starters, because I failed Lola—I should have somehow managed to convince her owner—long ago—that it would all end in one night on the surgery table in a nerve-wracking emergency surgery. I did try—I have witnesses, even. But I didn’t manage it. Maybe I was too nice. Perhaps I didn’t make my point sharply enough. I try to read my clients and tailor my approach to each one’s needs, but this client—not the normal read—has defied me at every turn.
Lola would come in frequently (she’s a Shar-pei, after all) for skin issues (never definitively dealt with), eye issues (her inverted eyelids were never corrected surgically as I’d begged her to), and more recently, crippling arthritis (exacerbated by Lola’s severe obesity) She has liver enzyme elevations and probable Cushing’s disease, too. She’s a classic Shar-pei train wreck.
I’d have liked nothing better than to keep Lola in-house for a few weeks to get her comfortable. Her owner’s personal health concerns (increasingly obvious at each subsequent visit) were clearly no match for Lola’s spiraling decline. If I won the lottery, I can imagine treating Lola to a month at Spa Sunset Animal Clinic to get her skin, eyes and weight under control—and get her spayed after a sensible amount of weight loss. If only.
I could yell and scream about Lola’s owner’s obstinacy. I might have sent her packing long ago in a stalemate ultimatum. But I always felt I could fix her. And that’s probably where I went wrong. It’s possible—just possible—that a firmer stand might have altered the outcome.
You see, as a vet, we have pets and clients we fall for for no particular reason. They just move us in unseen ways to work hard for them. I always saw Lola and her owner as one of these pairs. It’s something I can’t explain. My techs and receptionists have no idea how I can put up with her BS—but I do. Because I know I’m working at this client’s limits and I confidently believe no one else could get further with her. Ego, again.
I always knew it would come to this—a dramatic, last minute salvage procedure. Now that I have her here, I’m planning to keep Lola as long as I can. I left her tonight in a haze of morphine-dosed pain. But I’ll be back in the morning with renewed vigor after writing this post. I’m sure of it.
I once read that writing should not be therapeutic. But this author was someone tremendously gifted, someone whose every line exists as a beautifully crafted gem. I lay claim to no such talent. Therefore, I reason I’m free to write what I need to in order to sleep well at night. Thank God for blogs.
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To me it sounds like you have done what you could over the past years. It is unfortunate that Lola's owner didn't heed your strong advice, but you can't force people to do things even though YOU know it's right.
Is also sounds to me like you could use some ((((((((((hugs)))))))))).
Carolynn May 18th, 2007 11:02:00 AM
Thank God for you.
Lynn May 18th, 2007 11:03:00 AM
<i>Maybe I was too nice. Perhaps I didn’t make my point sharply enough.</i>
Or maybe, if you'd been sharper, firmer, less "nice", Lola's owner would have walked out on you, with Lola, and not come back. Or come back, if other vets wouldn't put up with her, but not given you her trust--and maybe not believed you when you said Lola needed surgery this time.
You're vet, not Dr. Svengali. You've done the best you could for the dog over the years, and this time you saved her life. Take a nice pot of tea (or something stronger as you prefer), and don't call anybody who's going to upset you for a few days.
Lis May 18th, 2007 11:12:00 AM
There, there.
Have a good weekend.
Thing One May 18th, 2007 12:25:00 PM
I've always said it took a certain kind of person to work with children and senior citizens - a certain compassion and patience. (Something I lack in large doses...) I think it is safe to add you to that list of rare persons.
You are doing a good thing and trying to make someone else do a good thing. Since we only have control over ourselves, you can only do what you can get away with. That you don't give up is a testimony to your goodness.
And write away. We'll read it.
kelli May 18th, 2007 05:42:00 PM
Dr K, I understand your frustration. On some issues, my vet and I have differences of opinions. Mine is mostly on over vaccination.... Until recently, I didn't have my guys on heartworm pills, because my standard poo had a bad reaction , and I decided I'd rather take my chances on the slight risk of heartworms rather than poisoning my guys every month. Oh, I did my reading... I learned more about the heartworm cycle than most people care to know. And I made my decision. Then my pittie got heartworms. We're back on heartworm meds. The poo takes Heartguard instead of Intercepter and does great.
My vet sat down with me and took the time to find out WHY I stopped the heartworm meds. She listened to me, then gave me HER opinion. She presented a great argument, and also gave me an alternative to the Intercepter. I had told her my concerns previously, but not forcefully enough. Now, I am content that we both have my dogs health as our main concern, and that between us, my guys are taken well care of.
I am a fanatic when it comes to nutrition and holistic animal care. But when my dog became ill based on MY decision, I had to have enough of an open mind to trust my vet and try her way.
Sometimes, no matter what we say, we can't change how people think. Like racism.. you can argue til you are blue in the face, some people don't WANT to change for the better.
agadore's mama May 18th, 2007 07:02:00 PM
Last I heard, they weren't teaching prognostication in veterinary school. You did the best you could. You don't know that if you had been firmer, the client would have behaved just like that witch you wrote about a few days ago.
Is the doggie at least without a uterus now?
Diane May 19th, 2007 12:13:00 AM
Thanks for your comments (beats being told I have my head up my backside as in this weeks rabies post!). I apreciate your support--even when you don't agree with me. And, yes, Lola's without a uterus now. That's the basic premise of a pyo surgery--get rid of the infection by getting rid of the whole kit and kaboodle. She's doing well. Now we're just giving her plenty of fluids in the hopes of warding off renal failure--a relatively common complication in these cases.
Dr. Patty Khuly May 19th, 2007 07:13:00 AM
Doc, we are certainly of the same feather (like many vets). We take our jobs seriously, are compassionate, and worry way too much (there's a fine line between concern and obsession when it comes to our veterinary patients).
You did great. Medically speaking, though, not all intact bitches get pyos. Yes, some do, but not all.
As long as the owners were aware of the risks of not spaying her, you cannot carry that guilt on your shoulders. Regardless of the outcome, you did your job - and well.
By the way, I write for exactly the same reasons as you do: catharsis.
TorontoVet May 20th, 2007 05:36:00 PM
I am sorry Patty to see such rude comments posted on the vaccination thread. There's something sad about a society in which the presence of a Comments section imbues people with the mistaken idea that (1) their angry thoughts are a valuable contribution, (2) their opinions are my-way-or-the-highway truths, (3) reading your blog entitles them to tell you what you should believe and what you should post, and (4) all issues come down to black and white choices, and (5) verbal abuse is a form of recreational activity now that it's free of the consequences that come with being identified.
When it comes to diet, medicine, vaccinations... clearly there is little agreement on the right approach and I wish that pet owners could take a step back and allow that they no more have the definitive answer than anyone else. Some of these approaches may well be the best in the long run and for some pets more than others but none of them have been proven yet. Only the passage of years will ultimately determine how successful things like alternative medicine, lack of vaccinations and heartworm preventative, prescription diets, all meat diets, eat-like-a-wild-animal diets, etc. will be.
Take the idea of feeding our dogs like they are wolves, for example. It's an interesting theory but no one really knows whether dogs will be better off fed this way. Or, for that matter, whether wolves are best fed that way. Not to mention the umpteen years that have passed since dogs were genetically or practically wild animals...
I make decisions with my pets' best interests at heart and with limited definitive information about the long-term consequences of my actions. And I make those decisions based on my values and concerns and the particular characteristics of my pets and the area in which I live.
We humans are not so good at appreciating shades of gray and I wish we could do better in that regard.
Natalie May 21st, 2007 07:45:00 PM
Well, I am sorry you think SharPei are a train wreck waiting to happen as that is not the case in all Pei. I recently retired from breeding Pei to go to work for the Vet who asked me to work for him. I guess all the years of us working as a team on a unusual breed, he decided I may be an asset to his office. But, then we both did our research and worked together and I do know not all owners work well with their Vets. The worst cases we see are those wanna be Vets who want their mistakes fixed. Oh, the people medicine fix. Some people should not have refills or any extra meds around for any reason. Trying to convince people that some things should not be given to animals and early treatment is much less costly and Vet meds are made for the animals and get on the right track first and don't wait until the organs are a mess and want them fixed. Ah, the biggest problem is..getting them to admit they gave something BEFORE any meds are given in the office.
But, just for the record, not all SharPei are train wrecks. Mine are very healthy and happy and love life and the world they live in. All, except one that I ahve sold have been the same, she is healthy, but just has a terrible attitude as she hasn't figured out she is a dog. I am trying to decide if I am going to do the owner a favor and retrain the little lady and make her realise, she is a dog and doggie drugs should be taken sometimes for various reasons. She is one beautiful girl, but a BRAT. She is too smart for her own good and even the Vet won't give her meds, I ahve to as I don't take any crap off them and she has everyone in her life scared of her and is just too proud of that fact. Otherwise, the rest of the pups I have sold since 1999 have been awesome and no problems health or attitude. But, I did keep my line clean and bred for quality not quanity and for health not wrinkles. That is where so many Pei ahve so many issues is they have been bred for the wrinkles and that is not correct.
Jo June 19th, 2007 06:23:00 PM
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