Due to the nature of today’s topic I feel the need to speak in first person…2 am in the morning wide awake replaying a case from work over and over in my head. It is greatly bothering me on a personal level and I feel the need to jot it down. Maybe it will give my mind some peace and comfort, so I can go back to sleep…
The case in a nutshell: a sweet couple came in yesterday morning with their 1 1/2 year old labrador with sudden onset of vomiting, decreased appetite, and a left sided head tilt. Another doctor saw her before I inherited the case in the afternoon. It was thought that she may have had an acute gastrointestinal inflammation and a very bad left middle ear infection, but based on how dehydrated she was, she was placed on IV fluids and other supportive care.
Her blood results did not came back until late in the evening after the owners had left with the patient, and it scared the bejesus out of me. Acute renal failure with kidney values off the charts. What the heck?! Antifreeze toxicity?! Unlikely, we live in California, that stuff is rarely needed…salicylate toxicity?! Possible…never know what a young lab can shove into their stomach, a bottle of aspirin won’t be a suprise…Leptospirosis?! Well we are all fucked then considering none of us who were exposed to the patient had taken any personal protective measures against Lepto…a deadly bacteria that causes acute renal and or liver failure in both animals and humans. Praying to God that it’s not Lepto, I instructed my staff to scrub themselves clean and bleach the kennel. Cancer?! Well…it would explain the enlarged lymph nodes and weird eye inflammation…
By now, after 3 years of working as a vet, I have came to the conclusion that I tend to inherit cluster fuck cases from other doctors and that I am a magnet for disaster cases and rare conditions.
I called the owner after hours; it was the wife who picked up the phone. I told her that the bloodwork looked horrible…patient needs 24/7 care at local emergency veterinary clinic…Maybe it was the way I structured my sentence, or maybe it was how bleak the situation had turned for this poor dog, but the wife turned into an emotional mess. What’s worse is that she was driving…fuck…I contacted a local emergency vet letting her know that the dog maybe on its way to her place later that night…
Nope…morning came. The couple showed up with the lab looking more depressed than yesterday…they never went to emergency. Financial constraints…I understand… it’d be at least 3-5 grand to save this dog by now…wife cried. I can see the despair in her eyes and her hand gesturing to her heart. I know that pain really well…didn’t have the heart to tell her that her dog really, really needs 24 intensive care…a general practitioner like me is probably not going to be able to do much to save it…
Owners were hoping for a miracle…I am usually a very blunt person because when dealing with medicine, cost of diagnostics and treatments can get out of hand with a blink of an eye and I don’t want that to happen to my clients when they are not financially ready. For them…however it’s more about closure…a young dog full of life suddenly presented at Death’s door. I understand…I offered to do further diagnostics so they can have some answers on what was happening to their dog…
Fine needle aspirate of the dog’s enlarged lymph nodes revealed tendrils of fungal hyphae underneath the microscope. Fuck…fuck…fuck…chances for survival on top of acute renal failure is like, I don’t know, slim? 5% or less? Disseminated aspergillosis infection with kidney, lymph node, eye and possible brain and other organ involvement…=.=…what’s worse? Antifungal medications are ridiculously expensive. Damn the human pharmacy! Monopolizing some of the life saving medications! The dog needs to be on it…indefinitely…with no guarantee for cure, because systemic fungal infection is one of those disease that forever haunts the patient. They linger in the shadow and strike when the immune system is compromised…go figure…”systemic asper infection, rare to see. If you see it well prognosis is grave. On to next topic” as my professor would say…
Wife and son came in the afternoon to pick up their dog. As expected it did not show any improvement. Since our clinic does not regularly stock that particular antifungal med. I need owner to pick it up at local pharmacy. Wife broke down into hysteria. Bouts of crying turned into extreme guilt turned into hyperventilation turned into panic attack. I offered her my hand. Told her it’s not her fault. She was not there with me, already long gone to the land of despair and self-loathing. Sounds familiar…I knew I needed to pull her back to reality or she’d faint if her hyperventilation persist. If I can get her attention even for a second or two…So I told her of my pain when I lost my mother. Thank god she listened. Her eyes locked on mine, and I told her to let go. Exhale…inhale…repeat two more times. She listened. Instructed her to drink water and told her to give that antifungal med a try. A slim chance that she could hold on to…the pessimist in me wanted to tell her the prognosis is grave, euthanasia is inevitable …but I need to help her grief, help her ease into reality. One more day of IV fluids and supportive care tomorrow and start of antifungal…maybe there will be a miracle, life is mysterious in its own way.
I worry about her and her inability to cope. That extreme self loathing is scary for me and hit really close to home. I won’t be there for her tomorrow, because I am due to rotate to another clinic…fuck…at least I gave her my phone number so she can reach out if she want…hope she will be okay…
