Monday, January 9, 2012

Whose Witness?

I had a very interesting experience Friday; I argued end-of-life issues regarding an 11y old Yorkie with chronic renal failure with two lawyers who are his owners. The problem with the whole situation was that to me, the dog was in a gray area and, lawyers being lawyers, they wanted it to be a black and white decision. The wife was not ready to euthanize, the husband felt it was time. It was odd trying to explain and advocate for the dog while they shot questions at me from both sides. I felt like a witness who isn't really certain whose side to be on...

Problem is, as usual, I could see both sides. The dog first developed noticeable disease back in September. After hospitalization and IV fluids, he seemed to improve quite a bit but, like with most chronic diseases, I can't fix it and he's not gonna be perfect ever again. Slowly over the past several months since, he has declined. Each time I've seen or spoken to the owners, I got the same report: Doing okay, still doing normal things, a little slower, losing some weight, eating / drinking well, urinating, no vomiting or diarrhea. In other words, a typical stable kidney patient report.

I'm not sure if he got into something that set him off or if it was just natural decline but he became nauseous and refused to eat for 3-4 days then developed melena and they finally brought him to see me. At first, the wife came and wanted to try treating again although I told her quite bluntly we were not looking at years of survival. After 48 hours of IV fluids, he felt much better and ate quite well. Then they came in together for a visit and to make a decision.

I found myself alternately agreeing with both of them. Yes, ultimately we are only buying time since I can't heal him entirely (no one can). No, I'm not just trying to buy a couple of days to say goodbye, I think he can do better than that. Yes, I do agree it is hard to watch him decline again; if he stops eating he needs to come back immediately. Yes, I understand you would rather end his life while he feels better rather than while he is miserable. Yes, I know you want more time but no, I cannot guarantee how much we will buy...

Ultimately, they wound up euthanizing after a long and agonizing discussion both with me and between each other. They were both in tears and the husband held the little guy while I injected the solution; the wife had to leave the room.

Besides this one, I felt as if I were running a geriatric clinic last week. It seemed that everything I saw was extremely old and had mostly really bad problems. Like the 17, almost 18 year old Maltese. I had seen him right around Christmas with vomiting and a horrible ear infection. Kidney values were dead normal. A little IV fluids, anti-nausea medication, and antibiotics, etc. for the ears and he was doing great. Until he had a seizure. And continued to have several mini-seizures. My boss sent him home on a day I wasn't there and put him on a little valium. That hit him so hard he couldn't function. Then I saw him again and he was worse although the ear had cleared up so I could no longer blame vestibular disease for his nausea.

I took a LONG time explaining to the owner that my best educated guesses were that he had a brain tumor, cognitive dysfunction syndrome in final stages, or brain inflammation and that the only way to reach a definitive diagnosis would be to refer for an MRI, etc. that I can't do in private practice. She seemed to understand and opted for the other plan of giving some steroids and anti-nausea medication and seeing if he responded at all. The she dropped the bomb and indicated that she thought the medicine would "cure" him and didn't realize that I was saying just to buy a little time where he hopefully felt good and she could say goodbye.

Cure? Right. Wish sometimes I had that power...

The only good geriatric story I have is the little poodle that just keeps going. She got nauseous and was vomiting some but it turns out that it was triggered by motion sensitivity and an injection of maropitant put it all to rights again. And she's still going.

That's all on the veterinary front for now. On the family front, I love my family but I love them much better from a distance. Which is probably one of the many reasons I keep trying to move away. I don't know what to do about the tendency to keep getting dragged back. Brother dear has called after not hearing anything from him in over a month and is supposedly coming here. He was supposed to have already arrived over the weekend but as of last hearing from him he hadn't even left yet. And, of course, he's in trouble and needs money and his crazy wife is crazier than ever. We'll see what happens this time but I wouldn't advise anyone to take me up on a bet; I've won them all so far.

In other news, my cell phone which I have a love - hate relationship is officially dead. It started out with some quirkiness and suddenly went to the blank screen of death yesterday. It is still sounding alarms, though... I just hope that they can salvage my pictures and videos that I wasn't able to save before its death. Guess I'll have to bite the bullet and get a new one. Yuck. I like the freedom of not having one but it is useful in some ways. Now I'm arguing end-of-life issues with myself. Maybe it's time for it to be buried properly and not replaced. I kinda like that idea. No more annoying calls from employees, clients that have been given my number without my permission, family.....Hmmmmmm......It bears some thought!


damia1966 said...

"I'm having end-of-life issues with myself..." I'm sorry, but you made me laugh, a bit. I completely understand not wanting to deal with a new cell phone. Try to think of it as an opportunity to explore a new range of ring tones. :)

Kaplan Step 2 Lecture Notes said...

I would like you to keep up the good work.You know how to make your post understandable for most of the people.I will definitely share it with others.Thanks for sharing.