10.17.2016 Emergency, South Bay, CA

Case Count: 11 (Euthanasia Count: 5, DOA Count: 1)

"The pink juice"

Long shift, got slammed in the evening hours. I played Dr. Euthanasia a lot...five very involved cases sprinkled throughout the shift. Sad day. I went to the lobby to grab enough coffee to fortify me for the drive home, and there was a gentleman sitting with his seated, perky Cavalier King Charles. He'd come in while I was busy with two early-morning cases that both turned into deaths.

"You do those euthanasias?" he asked me.

"I do. Five of them tonight."

The man shook his head and I could see memories flit across his face. "I had to put down two of my dogs. I don't ever want to do it again, though I know I'll have to. I don't know how you do your job. I wouldn't do it."

I hear some variation of that often, but this time it hit home. It felt nice to be appreciated, for someone outside my experience to acknowledge the demands of my work. I started with my standard reply, "I only do it when I know it's my best medicine," but I added, "Thank you for understanding. It means a lot. Have a great day."

On a side note, I avoided a crummy situation with my last case, an old Beagle with rear leg paralysis (probably spinal disc problem). Sometimes pets will have involuntary muscle contractions (twitching) or big breaths after death (agonal breathing). Even when it happens as part of death, they don't experience any pain or stress because the euthanasia solution is an overdose of anesthesia - they're completely unconscious well before they die. I try to caution people about this possibility beforehand, but that doesn't always happen, either by circumstance or oversight. 

When people aren't expecting it, these can be extremely distressing and sometimes they make people doubt that the pet is dead. Today, I confirmed absent heart beat, pulses, breathing, and neurologic function in my last patient and left the room for the owners to visit with his remains. When I checked back in, they mentioned that he'd "Started moving." I confirmed death once again to make sure we were all on the same page, and then his chest heaved reflexively, making a snorting sound through his floppy lips and throat. I braced for the owners' reactions. 

"He sounds just like he does when he snores!" they said with a tearful laugh.

Not the worst outcome.

Cases of the Day

1yo female Spayed Domestic Shorthair cat (DSH)
Ingested part of a toy
     This cat was playing with a dangling cat toy with her owners, when she succeeded in breaking the string and making off with the plastic bobber attached to about three inches of string. Her owners chased her around the house and just as they cornered her, she swallowed the whole thing. We tried to get the cat to puke, but our puke-meds don't work as reliably in cats as they do in dogs, and she maintained possession of the toy. This is a difficult decision. Do you a) go straight to endoscopy, where we anesthetize and hunt in the stomach with a camera to avoid surgery, or b) give it time, some symptomatic care and hairball treatment and see what develops. With option "a", we might pull the thing out without surgery, but run the slight risk of anesthesia/scope complications, mild risk of not being able to remove the object for a variety of reasons, and definitive risk of a couple thousand dollars minimum. With option "b", we might get away with it, or we might end up in surgery to take the thing out of the intestines. Also more dollars. I've been burned in both directions and I can name three other "a" docs and three other "b" docs off the top of my head. The owners at first wanted to scope, then decided to wait it out. While they were consulting, I tried another dose of puke-meds and...success! Went home for a couple hundred bucks, no longterm risk. Happy day. Except for all the euthanasias :(