Monday, March 12, 2012

Monday 12, 2012

Another Monday for the record books.

Crazy busy, lots of patients that had to be seen today, and some of the normal chaos that seems to be unavoidable.

My day started with a phone call from Dr. H at 8:45.

I know that if she is calling me that there is a problem. Her babysitter called her this morning to tell her that she was very sick and couldn't watch her 18 month old. As much as we all love her 18 month old we can't keep him entertained and manage the day to day Monday tasks. She was calling me to see if I had any ideas as to how to manage her dilemma. I said "call everyone and see if anyone can babysit." Turns out luckily one of our technicians cousins had the day free. She called me back to say she "would be in by 10:30 and asked if I could see her 10 am appointment?"

"Sure," I said. I am much better at covering her appointments than I am at watching her child. ( He is adorable, but I am not adequately trained in the baby department.)

It was 9 am, I had to put my fast pace face on. (That means that I skip the hair-do and make-up. I am not glamorous on Monday, I am efficient and try to be out of the building before we close, 8 pm).

I headed off to work, thinking to myself, "It's OK, I only have 1 surgery scheduled, I can help Dr. H out and still get it done."

I arrived and was happy to see that things looked like they were under control.

I assessed my only surgery for the day, Cassidy. Cassidy is a very old Lab mix. She has a grey muzzle, dropping eyes, and a smile. I opened her cage to meet her and give her her pre-op exam. I had gotten a phone call from Dr. C over the weekend about her and I knew that I needed to look her over before I could plan the rest of my day. Dr. C. had seen Cassidy on Saturday when her owners arrived with her unannounced and without an appointment. I only say this because it doesn't happen that much anymore. I still find it odd that people just show up, unless of course it is an emergency. But I guess that Cassidy's parents thought it was an emergency? So here they were.

Cassidy's story as it was relayed to me from the technician day was that she had fallen down the stairs the day before and had been limping ever since. When Dr. C. examined her she thought that the knee was the problem but she wasn't sure that it was the only problem.

Dr. C. called me to discuss what she had found on Cassidy's exam. She was concerned about a few things. First that Cassidy's knee had a lot more "play" in it that she thought was normal. Usually a knee injury is a ruptured cranial cruciate ligament. (In football players we call it the ACL, for anterior cruciate ligament.) Dr.C thought that maybe she had ruptured both the cranial and caudal ligaments. She also was not sure of the status of her hips. And her bloodwork was not normal.

As I gazed at smiling Cassidy I thought, "Oh, yeah, I remember why I don't do orthopedics on Mondays." She was not an easy surgery, and she was not an ideal surgery patient, and I still had a long list of unknowns.  I called her dad to introduce myself and discuss my Cassidy concerns.

After a long debate and a thorough review of her case he gave the thumbs up for her knee surgery. I now had a cruciate repair as my afternoon task.

The 10 am appointment was a very soft spoken gentle man in his 70's. He carried his tortoiseshell long haired kitty in a carrier and gingerly placed her on the exam table. He then introduced himself and his kitty to me. He warned me as I opened the carrier that she could sometimes be a little rambunctious and asked if I would prefer that he take her out. As I peered in the box I saw the usual cat in a carrier pose. Smashed to the back and trying to look invisible. I could tell by her eyes that she was just frightened but not aggressive. She came out with one scoop. (As a hard and fast rule Vets NEVER let owners take out their pets. They all get bitten and then we have to human first aid, which is equivalent to thumb screws and water boarding. We like patients that we can muzzle and sedate.)

As I placed her on the exam table he started with her recent medical history. He told me that she had been diagnosed as a hyperthyroid kitty a few weeks ago. Because he and his wife are elderly and feared the dreaded task of pilling a cat he had elected to try the new transdermal medication for over active thyroids. Despite her treatment she seemed to be still losing weight and now seemed to be drinking more and peeing more, (we call this PU/PD for polyuric/polydipsic). It is a common indication of kidney disease, but can indicate other things. After a little chat about thyroid disease, kidney disease, and my own personal experience with both, we decided to collect some blood and urine and submit it to the lab to see where her numbers were now.

I also gave him some pointers on pilling a cat. These pointers are often overlooked and we foolishly just expect that the owners can figure it out on their own at home. If you are having difficulty with any aspect of your pets care ask for advice. We are always happy to give it, and we know that without you your pet won't get the care they need. And then practice. I promise with a little stubborn persistence that even the most difficult cat can become a good at home patient.

The 10:30 appointment was supposed to be a very very sick dog that I had met on Sunday. She was supposed to be brought back to us for euthanasia today. But her owner called to say that she had overslept because of the clock change and wanted to reschedule for tomorrow. The receptionist rescheduled her and came to me to report the change in plans.

"WHAT?!!!" I said. "You let her hang up? Get her number for me."

She very quickly pulled her file and hand delivered it to my already dialing hands.

(Mental note and practice mantra, "Be nice and don't yell.")

"Mrs. Sleepy," I said in my most calm and patient voice, "I met your boys and KayLee yesterday and discussed with them how ill she is. Did they tell you this?"

"Yes, they did. But I have to work today and I don't have time to take her in, and I can't afford the treatments she needs."

I had met her boys with KayLee and I had  explained my concerns and made my treatment recommendations. I knew that KayLee needed help immediately. They had tried to call their mom to notify her of how sick KayLee was and to try to get permission to start treating her. They were very upset, crying, and conflicted as to what to do. I knew that they loved their dog, and I knew that the estimated $700 was probably going to be difficult for them to come up with. They were unable to authorize the care that I thought their dog KayLee needed due to the estimated cost, and they didn't want to authorize euthanasia without their moms OK. I told them that I would be here all day on Monday and I gave KayLee a bolus of SQ fluids, prednisone and an antibiotic on the house. I have done this job long enough to know that I don't always see the sickest patients back again. I assume that they won't come back and I offer a small dose of whatever treatment option that I can.

"Well Mrs. Sleepyhead I explained to your boys that she is going to die without an aggressive treatment plan, and that I am very worried that she may have a disease that humans can get from their dogs. I am afraid that your family is in danger and that KayLee is dying without treatment or humane euthanasia."

Mrs. Sleepyhead then began to cry and explain that her husband had been laid off, and that she had tried to get CareCredit to cover her treatment expenses but that she had been denied credit. I could hear the sadness, and despair in her voice. As she finished her explanation she told me that she had to go to work today but that she would bring her in tomorrow. I hung up and reminded myself that I am doing the best I can, and I can only do that much. After that it is the pet owners responsibility.

And that was just my day from 9 to 11 am.

The best part of my day was getting a text from my sister that her 2 boys were officially adopted by her and her husband today. I could tell by the tome of her text that she was at work in a sea of tears of joy. I took a moment to reflect on how happy I was for her and how much I knew she loved her kids.

At 7 pm I arrived home, tired and drained. I walked into the the cat room to say my hello's to my kids. I found Squeakers under the table and unable to stand. She opened her mouth to meow and not a sound was audible. She was calling for me to pick her up, as I always do. But her eyes were hollow and vacant and she was just saying goodbye. I held her and said goodbye and for the first time in her whole life Squeak Box was quiet and she left this world.

Squeak on the left, Donner on the right, There are about 7 other beds around them.

My husband came home a few minutes later and we laid her to rest with songs of the peepers amongst the crocuses and daffodils under the light of a lantern and the moon and the angel who keeps watch over them.
Those Mondays.


  1. God Bless Squeakers & the songs of the peepers & a husband with a soul & a vet with the biggest heart around.

  2. You have the strength and the soul of a saint. Your passion and perserverence are amazing. You are truly admirable for all that you do. God bless you.