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Human/Animal Bond

How One Veterinarian Answers the No. 1 Question
April 13, 2012 (published)

Photo by Karen James

“What would you do if it were your dog?”

As an emergency and critical care veterinarian, I have to say this is one of the most common questions that I am asked – nearly every day of practice. (Followed closely by “Is that spinach in your teeth?” and “Why no pants?”)

Owners of sick and injured pets often face a hard call on what to do when they need to make medical decisions; on the one hand they want to give their furry companions every chance at recovery, but on the other hand they don’t want needless medical testing or treatment, don’t want to see their beloved pets suffer in vain and there are significant financial concerns about the high cost of some medical interventions as well.

So, they often look to me to help guide them. I am a pet owner (as someone once said; “Don’t trust a skinny chef” – same would seem to hold true for a petless vet…) and I have medical knowledge that could potentially help them make the right decisions.  That seems to be what everybody wants – to make the right call. Not to stop treatment the day before their pet gets better, or to have treatment drag on, long after any hope or dignity has fallen away, running up a soul-crushing medical bill in the process.

But they are asking me to straddle the fence. I can’t be the loving, caring pet owner at the same time as I am an emergency clinician.  When my pets take ill, I have another doctor take over, and I go into pet-owner mode. Medical decisions have to be made with consideration and compassion, but without emotion, and emotion is central to the bond between a pet and their family.  I have learned to dodge this question when I am asked, and give the truthful answer that…I don’t know what I would do. When I am evaluating a patient, I do see the individual, I do consider the weight of the life before me, but I can’t allow (too much) emotion to cloud my decisions. Pet owners, and my patients, deserve clear thinking (as much as I can muster, anyway – college took its toll on the grey matter) that is devoid of irrational thought.  Before you start thinking that my home planet must have been called Vulcan – I am not just a series of ‘yes/no’ algorithms when deciding what to do with patients; I take the owners wishes and capabilities very seriously and I consider the entire pet; not just a collection of moving parts. But I try to separate what I want for the patient from what I can offer them and the family.

It is a curious thing to live with pets – these furry, once-wild critters sharing our home and hearth with us. We trust our children’s lives (and facial features, and fingers) to their good nature, we feed them, sometimes clothe them (Paris Hilton – you logged on, honey?), and spend money on their medical needs and food.  The pets of those of us who treat animals for a living (the pets of vets) are a curious breed as well – more so than your average dog or cat or capybara or chupacabra (had one of those as a pet once – didn’t go so well for me or the goats).

If you took an accounting of the number of legs, eyes and ears of the pets of vets and divided by the number of hearts (typically, one per being is all that is allowed, except on my home planet of Vulcan…) you would almost certainly get an odd number, because these are usually odd pets indeed. Missing this bit or that, invariably named “Lucky” and usually cast off from some troglodyte member of society who either did it grievous bodily harm, or adopted them and just couldn’t cash that ‘promise to take care of you, feed you and get you fixered up when yer busted’ check.

We see them in practice; they come into us on a gurney, and we say, ‘this one time, I will not kill this pet because the owners can’t pay.’  If the owners can’t do what it takes to fix them, we step in and see if there is just a little bit more room in our home. Negotiations are started with spouses, introductions are made to the current administration. We do it to offset the sometimes shocking amount of careless death and casual taking of life that takes place in a veterinary emergency facility: we do it to preserve our humanity just a little bit. There are nights in the ER when I will euthanize 6 or 8 pets, and have to hold the hands of the family while I do it. “Compassion fatigue” is the name that counselors have given the phenomenon of someone who just can’t work up the emotions any more; in the ER we just call it ‘burnout.’

In addition to my two-legged love, Gretchen (also a critical care specialist) and my son, Connor, we share our place with five mammals, a handful of fish and a nutty Parakeet named Fontina (we have always wanted to name a pet after a cheese product; Gretchen is from Wisconsin, natch).

We do have some ‘normal’ pets (well – I think they might be a bit touched in the head, but they look OK from 10 paces), but most of them have been run through with arrows, had limbs lopped off or been set afire by the aforementioned troglodytes.

I am sure you can guess what happened to our little cat, Crispy.  Sterno was first runner-up for naming.

So until you meet him, take care of the ones you have, and try not to set them on fire. Don’t ask your vet what they would do if it was their pet on the exam table; chances are you won’t get an answer. At least, not from me.

8 Comments

Joan
May 17, 2012
Great article --- and comments. Like Lucia, I'm not (quite) 100 years old but often feel as though I am. One of the many reasons I'm a DVM and not an MD is the option we have of not having to watch our patients go through long, draining (physically, financially, emotionally) end of life scenarios. However, with this option there is a great ethical burden that is placed on us. In most instances, I cannot know all the factors that an owner must consider when deciding whether to treat or not to treat. Although I approach the answer to "What would you do?" differently as time goes on, I (after living with and losing a multitude of cats, dogs, and birds) can usually come up with an example of a personal situation that was comparable to the one facing the owner at this time. Then I'll go through the thought processes that led to my final decision. With any decision that is made, I always try to validate the owner's decision. At least ONE other person needs to be standing with you when you decide that it's time to say good-bye to Fluffy OR to give Fluffy another 24 hrs. and readdress the question again...and that person is often me. Unfortunately, we have to pay our bills just like the owner and we cannot treat animals for "free" (as much as we may want to). In times of stress, an individual often has to have someone to blame for a decision that has to be made and I've found myself as the scapegoat because I'm too "money-grubbing" to treat this poor, emaciated, dyspneic, stage 3 heartworm case (that was "fine" yesterday) pro bono and guarantee a rosy outcome. When I no longer feel a pang euthanising a creature, I need to find another profession. Until that happens, humane euthanasia (as well as prolonged treatments) are a part of the profession and we have to realize that it is our job to communicate potential outcomes to owners and be willing to accept any personal heartbreak that may come along. Human medicine has been both a boon and a curse to us as there are so many treatments available now that weren't available years ago. However, even in human medicine, many of the long-term outcomes are not favorable. It's not an easy profession we've chosen but, after almost 50 years, I still find it extremely rewarding.
Kathy Morris-Stilwell
May 8,2012
Great, Tony. As everyone else, I have changed my "shpeel" over the years. I do try to help my clients make the best decision for THEM and for the PET. On an occasion I will actually suggest euthanasia, as I feel it's my duty as the animals advocate. Most of the time I will go through "quality of life" issues, as well as telling them how I make decisions, including, "I put myself in the dog/cat's place. What would I want if I were this pet?" Additionally, I have come to that point in my profession that I accept that I'd rather end it too soon than too late. Kathy

JC
May 5,2012
I agree with Eden's answer. People want guidance--not always to be told what to do but help thinking through their options. I think there are some similarities with human pediatric medicine, which I wrote about: http://thelearningvet.wordpress.com/2012/05/05/how-veterinary-medicine-is-like-pediatric-medicine-and-how-its-not/

Sherri
May 3, 2012
Great topic, Tony : ) I think my answer to this question has changed over the years as well. I've recently been going through a pretty heroic effort to treat one of my dogs, and have been thinking about how for this dog I have done a LOT (emotionally and financially draining but hopefully worth it) and for other animals I haven't done as much...not because I don't love them as much, but because there are so many factors that go into the decision. Not the least of which is what I think my pet wants e.g. I had a cat with FIV who developed a big infection. I should have taken him into the hospital where I worked, but he was so timid/frightened there, that I brought all the stuff home and tried to treat him there. I lost him ultimately, but don't really regret protecting him from being in the hospital. Anyway, I think the point I was trying to make was that it's a really personal decision that is 'case sensitive'.. My job as the vet is to explain what's possible and what that costs and what it would look like if we got the best case scenario or worst case scenario. I can also give my best guess as to which scenario we're going to get. But ultimately, I cannot decide what to do FOR the owner...I can decide WITH them.
Eden
April 28,2012
As a vet I used to go with the 'no answer' answer. I've gradually changed over the years to the 'I'm not you but here's who I am and because that's who I am here's what I would do" answer. It seems to help people to hear how someone else works though the process. And since I am who I am, I've dealt as a pet owner with the common scenarios my clients find themselves in- not enough money, not enough time, no good medical options, no more room in the home, no more room in the heart. So I guess sometimes I am telling them, not what I would do if I were them, but what I did when I was them, or someone similar. Only wearing a different hat. Or brooch. Or a pterodactyl...

Carl
April 28,2012
Sometimes you just gotta save something!

Lucia
April 27, 2012
Great article, made me laugh and cry....my pets, Hazel, Ethel and MewLee well, all have histories and the cats adopted me, but the names.... - no I am not 100 years old.

Brenda
April 26, 2012
I laughed at Crispy and Sterno. I, too, enjoy naming pets with some relation to their situation. Hence, my dog Dyson; he eats dirt and my cat, Arson; the sole survivor of a house fire.

 
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