Wednesday, October 19, 2011

Galliano's dad can curse like a sailor, Lucky for both if us I used to be one

Dr. C came to me asking me to call a client to discuss a mass removal surgery with them. She explained to me that the dog “Galliano”, an 8 year old spayed mixed black and tan shepherd, had been brought to the clinic because she was drinking large amounts of water. We call this polydipsia. She had performed an examination and some blood work on Galliano and found a very high calcium level and a mass in the rectum. For those of us vets this mass is usually an adenocarcinoma and has a very bad prognosis. I told Dr. C that I needed to see the Galliano before I could discuss the surgery because I needed to palpate the mass, identify how close it was to the really important structures that you need to keep intact if you want to be able to poop voluntarily, and because it is pretty close to impossible to give an estimate without seeing the patient. Well, here is where some of client communication broke down. Seems Dr. C thought that I was calling with an estimate and I was pretty positive that she was calling him to tell him to book an appointment. Galliano’s dad called a few days later angry that no one had called him. I picked up the phone to talk to him about his dog and was instead barraged by a very angry very foul mouthed man. He told me that he was “taking his dog to see another Vet because we obviously didn’t care about dogs!” I apologized for the mis-communication and told him that I believed he had been told by Dr. C that he had to bring in Galliano in for me to examine. I also told him that I was the last person on the planet that could ever be accused of not caring. Galliano’s dad finished the conversation with more profanities and then he hung up on me.
A few weeks passed and then the phone rang. It was Galliano’s dad asking to speak with me. I picked up the phone and he said, “I am sorry I was such an Ass.” I replied, “apology accepted.” He then went on to say, “I just left the surgery specialists office and I don’t have any money left to treat Galliano.” “Ok,” I thought, “apology accepted does not mean I will do your surgery for free.” I let him continue without my commentary. He was already angry with me once, and I got a lot of cursing, (believe me I spent 10 years at sea, I am a very good judge of cursing), I was going to keep my mouth shut this time. Galliano’s dad went on to tell me his latest saga in trying to get help for Galliano. He went on to explain that he had taken his records to Mainstreet Vet, to get a second opinion. They had in turn referred him to a veterinary surgery specialist. Once he had arrived there his dog was examined, bloodwork was taken, x-rays were taken, and an ultrasound was done. All of this was done as pre-operative testing. At the end of the day the Veterinary Surgeon came out and told Galliano’s dad and mom that they were awaiting the results and would schedule surgery as soon as they were in. The surgeon also presented them with a bill of $1100. It was at this point that Galliano’s dad started cursing again. Needless to say the meager budget he had for Galliano was spent at the referral office. In actuality he refused to pay most of the bill, and left without the needed (in an ideal world, (I don’t live there, I get to visit it sometimes)), pre-operative diagnostics. He was now calling to ask me if I could do the surgery on a payment plan.
I get the payment plan request a lot. I was foolish enough to try it when I first bought JVC. In three years I wrote off $50,00. Yep that’s right $50,000. I don’t do payment plans anymore. I politely tell people that I tried, it doesn’t work, and I end up broke and bitter. No offense, of course, because “yes, I am sure YOU wouldn’t do that to me, only EVERYONE else would.” And afterall, he had cursed me out. So I stood my ground and said, “no, I am sorry I don’t do payment plans.” Then we needed to re-open that whole can of worms about the fact that I still hadn’t even met or seen Galliano. Back to the painful discussion of needing to do an examination before I even think about signing myself up for surgery on a patient everyone else is trying to refer up the food chain.
I met Galliano the next day. She had terrible skin, (due to the enormous flea infestation she was crawling with), she was thin and had a very large, (golf ball sized) firm/hard mass encompassing the 6 o’clock to 10 o’clock position (we describe lesions on your rectum like a clock, gross, but true) in the rectum. To resect this mass I needed to remove about 1/3 of the rectum and I was likely going to damage the ring-like muscular tissue called the rectal sphincter which is what allows all of us to defecate willingly. Every owner, well, let’s just say, everyone, wants to defecate willingly. I told Galliano’s parents that I would do the surgery for them, and I gave them an estimate of $800. I also went over all of the possible complications. They left with a plan to return the following day with $800 in cash and to drop off Galliano for surgery.
Galliano’s surgery went very well. In spite of cutting a massive number of corners, she did great and I was hopeful that I had removed all of the cancerous tissue. We doctors believe that there are usually microscopic pieces of cancer left behind when we do a mass removal surgery. Or worse yet, that we have missed, or not been able to see/find small clusters of cancer that have spread, or taken up residency in other places in the body. It takes a rather large cluster for us to be able to see/find these on an x-ray. They are often there, but they are too small for us to be able to see yet. This is why the human side of medicine uses MRI to look for tumors, and follows up every mass removal surgery with chemotherapy/radiation.
I followed Galliano very closely over the next few weeks. She did great for 2 months. She gained weight, we got her terrible skin under control, and her incision healed remarkably. Unfortunately the financial constraints made her follow up care sporadic. We had planned on keeping her on a few medications for the long term. It became difficult for them to pick up her medications or bring her in for her re-checks. I spoke to her parents often, and I could hear the desperation in their voices as they reported her deteriorating condition.
The last time I spoke to them they reported that she had stopped eating. I once again urged that they bring her in, and they promised to bring her in as soon as possible. Two days later, they called to report that she had died at home.
I know that they truly loved her, and that they will miss her.
I called to check on them today. They told me that they were” doing ok”, and had actually gone to visit Animal Rescue already to get another dog.

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