Tuesday, August 9, 2011

toby's short life

I have shared a few stories so far. Most of them have had happy ending. But medicine is not a series of stories, it is a series of lives. Some live and some die. Most people think that it is the dying part that causes the stress, now don’t get me wrong, we all want to save all of our patients, but we accept that we can't. We all value life, how fragile and fleeting it is. I can’t speak for MD’s, but I will venture to speak for DVM’s, the really tough part is the acknowledgement that not everyone values life the same way. For many there is a monetary value that each pet represents. In almost every case there is some definable point where the funds run out in the treatment plan. It is something you have to accept. It isn’t easy to feel as if you can't present any treatment plan at all because there are no funds available.
To date, this is my best case example of this dilemma.
JarrettsvilleVet is open 7 days a week. We are open on Sundays on a walk-in basis where it is first come first served, or biggest disaster in the building gets to cut in line. At 1 pm, when we opoen, there is usually a small number of clients waiting at the front door. I usually work the Sunday shift. I like the fast pace, the never know what’s coming in the door suspense, and those 2 hours blow by. And best of all, everyone is so grateful that you are open, and understands the concept of there being no set appointments, so you can't complain, because we are running behind. The clients sit, wait, or chat with the other clients. For a free- for-all day it is really pretty stress free.  In the middle of one chaotic Sunday I saw a young mother and two children sitting on the bench in the reception area with a cat carrier. The kids played quietly and their mom sat quietly. They were the last clients to be seen that day. We usually have the clients met at the front door by the receptionist, who checks them in, quickly reviews what the client is concerned about, gets a basic medical history and then hands off their file to the examination technician who will go over these with the owner again in the exam room and perform a basic TPR (temperature, pulse, respiration), check weight, etc. By the time I get around to the file I have already gotten a pretty good assessment from the two employees that preceed me. For this particular client the chart read simply. “Cat. Attacked by animal 4 days ago. Owner has money concerns”.  I have done this job long enough to not base any opinions or make any decisions without looking at the pet, and talking to the owner. I have had enough charts read the same thing before only to find out later that a budget for one person can be very different for another. I once had an owner come in and explain to me that their budget for the care of their pet was $20,000. That’s a nice budget.

 I walked into the room. I could tell the moment I walked in that that little cat carrier held rotten flesh, necrosis, and maggots. Damn it, I hate maggots. I especially hate them on Sundays. Sundays are difficult because I have a staff of two, and a complete maggot extraction requires general anesthesia. That is always a two hour endeavor. And apart from all of that, it’s maggots! No one likes maggots. I asked a few questions before I ventured to look at the patient. I asked if they had other pets? The little girl, about 7 yeatrs old, happily volunteered that they had 2 dogs, and 4 cats. And Oh! To her delight she also now had 5 kittens. Shit, I thought, theres more where this came from. “Are they vaccinated?” “No”, the woman replied. I then proceeded to tell her how important it is to vaccinate for rabies, and how rabies kills everyone it meets along the way. I spared her from the rest of the discussion about other vaccines, flea and tick prevention, intestinal worms, etc. I was pretty sure I was going to go nowhere with all of that. Ok, I haven’t even opened tha carrier or my mouth yet. I opened the carrier. In it sat a 9 or so month old black and white, (we call them tuxedos) cat. He just sat in the back of the carrier peacefully with his big green eyes looking at me. I pulled the carrier into the light so I could see in the carrier better, and there it was. The wound that was making the stink. Once I assessed where the wound was, and that he was a nice kitty, I stuck my hand in to extract him. He came out esily and willingly. I asked the owner if she had seen his wound. She said she thought there was a cut on his neck. I produced exhibit A. The wound on his neck was the whole entire ventral (throat area) neck region. From almost ear to ear the entire throat skin, muscle, everything down to the level of the last layer of muscle that protects his trachea was gone. In its place was an army of very happy very healthy maggots. To make matters worse, this wound had obviously been there so long that those maggots had cleaned the tissue completely. And he was purring contentedly. He wasn’t in pain, he wasn't alarmed, he was just trying to heal the only way his body knew how. With a little help from his new friends. Once I showed the owner the cats neck she threw her head back in horror and gasped. I then asked her if the kids would be alright waiting outside. They went to the waiting area to color. I started to explain that this unvaccinated, unneutered cat needed a lot of care. She told me that she had spent the last 3 days driving to every clinic she could find to try to get someone to look at her cat. She said that everyone else had told her that the cat would require an examination fee. Apparently whatever their examination fee was she couldn’t afford it. I knew this wasn’t a $20,000 budget plan. I then asked her what her budget was. She said $10 was all she had. Ok, now I don’t want you to feel sorry for her yet. You can feel sorry for the cat at anytime. I told her that if I cut every corner possible, including donating my time, it would be over $300. Mind you he needed the following, FeLV/FIV test, surgery, neuter, vaccines, I was donating my services, and waiving the preferred pre-op bloodwork, i.v. fluids, hospital charges. It should have been about a $500 fee. I also told her that to euthanize him would cost $110. She looked at me again and said $10. But that she was starting a job next week and could maybe pay me back later. I have also done this job long enough to have learned that “later” is code for “never”.
Ok, to go back to my statement about felling sorry for her. This mother, in her mid twenties, had a tattoo from her wrist to her shoulder that had been “inked in”. At least that’s what my techs said it was called. I guess that measn that she had the first part of the tattoo just recently done. Where the outline of the artwork was donme, but you still need the coloing in part done. It was hard to miss the fact that she had a large tattoo, I had missed the significance of it “being underconstruction”. The techs told me that that tattoo could be purchased at a cost of about $800. Ugh! That girl has two small children. A tattoo? Really?
I feel that it is very important to offer options to owners. It is not fair to take away hope, and I cannot send a creature needing help into the world without trying. I hate being in this position. I hate standing there with an angel on one shoulder, (she’s wearing an outfit from Wal-mart), and the devil on the other shoulder, (and yes, she wearing prada, yes I like prada better than Wal-Mart). And I am head down in the middle swearing in my head again. Saying things like," damn it I can't take another cat in", "damn it I can't believe this cat has to die because your tattoo is more important", and "damn it, don’t cry infront of me". But what comes out of my mouth is; "your options are, leave here and your cat will probably die in a few days from infection, or, you can keep driving around trying to find someone who will look at him for $10, or you can sign him over to me and I will try to fix him and then try to find him a home".  Any guesses on what happened. She left crying, with her kids crying and an empty carrier. Ten minutes later his FeLV/FIV test came up strong positive for FIV.
 I see this disease a lot in intact male cats. They spread FIV like wild fire to other cats because they are all fighting for territory. SO PLEASE! neuter your cat at 6 months old. I knew that the kind thing to do was put him under, clean his wounds, try to fix the enormous defect, hope he wakes up, hope he heals, and then, try to do the impossible, find him a home with no other cats to an owner willing to accept the fact that he will probably only live a few years, if he is lucky. With a very heavy heart I did what I am supposed to do. I became the statistician. The scientist who knows that this disease will only go away when we take responsibility for it. When we take out the positive members of the colony. I euthanized him. He purred the entire time. And I felt so guilty. I hadn’t chosen to be kind, I felt like I was just trying to take the easy road. And Frost knows that given a divergence in the road…., well I fear that I chose the easy road.

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