It’s the usual summer busy season
in veterinary hospitals. On top of that, we are still in the season of COVID-19,
so add those together and you get complete chaos on some days! As a newer grad,
I am still learning the ins and outs of daily life in practice. I have found
more confidence as the weeks progress, but I still wake up some days with anxiety
about what the day may bring and if I will be good enough for my patients. I am
hoping with more experience those feelings will subside, but in the mean time I
believe I am growing as a person and as a doctor.
I recently had a fully booked day of
appointments with several patients needing diagnostics and treatments done. In
addition, we had about twelve drop-offs added to the schedule that morning. Needless
to say, I was quite busy, and at one point I was managing six hospitalized
cases- a diabetic dog getting a glucose curve, a dog with hemorrhagic
gastroenteritis, a dog with pancreatitis, a blocked cat, a dog with chronic
kidney disease, and a dog with a brachial plexus avulsion. That is quite the variety!
It was one of those days I couldn’t wait to be over so I could breathe.
The demands of daily practice, especially
during this time, can be overwhelming. We are a profession of compassionate
caregivers. We push ourselves and replay cases over in our heads wondering if
we made the right choices. We strive to be perfect and get discouraged when we
can’t possibly live up to that standard. That is too heavy a load to carry even
for the most seasoned veterinarians! Trust me, I need to remind myself of this daily.
It’s okay to not be perfect. It’s
okay to make mistakes and then learn from them. It’s okay to ask for guidance,
and it’s okay to give yourself grace because we are only human and can only do
so much. At the end of the day, what matters is that we’ve done our best to
advocate for our patients. All we can do is our best, and that is enough.
It was the
morning of my first rotation in my clinical year of vet school, and I had woken
up with fluttering butterflies in my stomach! I was assigned to Internal
Medicine, which has a reputation for working long hours, being stressful, and juggling
multiple critical patients at once. On the first day we were to assign
ourselves to a hospitalized patient. The patients’ names and presenting
complaints were listed on the giant dry erase board on the wall of the rounds
room. As I entered the room, my eyes immediately fixed upon the words “diabetic
ketoacidosis.” In simple terms, this was basically an extremely critical
diabetic patient with dangerously high blood sugar and metabolic imbalances
(among other concurrent issues). Continuous monitoring in the intensive care
unit (ICU) was essential for this patient’s recovery. I knew instantly that I
wanted to take over care of this dog. (This stems from the fact that my husband
has Type 1 Diabetes, so diabetic patients always tug at my heart strings.) I
signed my name next to hers and met with the student who was currently treating
her. We discussed when she had been admitted to the hospital, what her
treatment plan was, and how she had been doing thus far.
I went to our ICU
to meet her and instantly became attached! Despite being so sick, she lifted
her head and gazed at me with big chocolate eyes, and her tail began to thump
softly. I started her treatments and made sure she was resting comfortably.
When I had finished, I called her dad and gave him an update on her current
condition and what I had done that morning for her. He asked if he would be
able to come visit her that afternoon, and of course, I said that was no
problem. I finished updating her medical record and speaking with the attending
Shortly after, I heard my name being called on the overhead pager. I quickly walked up to the lobby of the hospital and introduced myself to her dad, an older gentleman who looked to be a farmer. We walked back to the ICU together, and she was sleeping peacefully. I could not help but smile when he started talking to her and she immediately perked up and started wagging her little tail nub. You could just tell there was a special bond between those two. We talked for a short while before he turned to her and said, “You need to get better so we can go home. Mom’s waiting to see you,” just before pulling out a Ziploc bag of beef jerky treats from his pocket. Her nose caught the strong aroma, and her tail wagged harder. He hand-fed her each piece but stopped when a couple pieces remained in the bag. He told me those were her favorite treats at home, and she would probably like if I fed her some when he left. Since she had not shown much interest in food while being hospitalized, I happily obliged.
continued through the rest of the week. He would drive one hour both ways for
his daily visits, even if some days he could only stay for ten minutes. He
shared his favorite stories of her, and his visits became the highlight of my afternoons.
She slowly improved each day, and we scheduled a time for her to be discharged
the following Tuesday.
I continued my treatments through the weekend and arrived at the hospital Monday morning looking forward to her continued recovery. However, as I reviewed her chart and looked at her overnight blood glucose readings and condition since Sunday, my heart sank. Her blood sugar had rose through the day despite appropriate treatment, and she no longer even lifted her head when I spoke to her. She had been moved to an oxygen kennel because her breathing had declined.
Treating very ill diabetic patients is incredibly difficult. Oftentimes they have concurrent disease that hinders their responsiveness to treatment. They can improve one hour and quickly decline the next. In this case, she had multiple other health issues that had begun to work against our best efforts. Still, we persevered and held out hope. Her dad made his usual visit that afternoon. Throughout the night and the next morning, she continued to decline and was just really not in good shape. After completing my treatments on Tuesday morning, I made a phone call to her dad and urged him to come to the hospital. This time his wife had also joined him. She was a soft-spoken older woman with saddened eyes. I walked them both back to the ICU, and we spoke about her quick decline and poor prognosis. The attending veterinarian came by, and we discussed possible options. Due to her current condition, we could no longer comfortably discharge her. We could continue administering treatment though her quality of life was poor or make the difficult decision to euthanize. I sat with the family for over an hour as they deliberated what they believed was best for their dog. I could see the pain in their faces as they processed the news. Today was supposed to be the day they were able to finally bring their dog home—a day of celebration. It was most certainly not supposed to include this difficult decision.
My eyes began to
well up with tears alongside theirs as they contemplated what to do. She was
their loyal companion, and they had a bond that could not be broken. In the
end, they chose to not be present for her euthanasia. She had been through
enough, and they just hoped for her peace. They had already experienced this
process with another dog and couldn’t do it again. I let them say their
good-byes and escorted them to the lobby, giving them my sincere condolences. I
took a deep breath and started walking back to the ICU, fighting back the tears
with every step. I started gathering supplies I needed and found another soft,
cozy blanket for her. By that time, I could barely mutter to the resident that
we were ready to go as the tears streamed down my cheeks.
I wrapped my arms around her and put my head next
to hers. I whispered that things would be okay…that she was a good dog…that I
was sorry I had failed her. Things weren’t supposed to be this way. I was
supposed to save lives. I wasn’t supposed to be standing here in tears next to
my very first patient watching her slowly drift away. It is the worst feeling
in the world to feel so helpless.
On my way home that day, I stopped at Walgreens and picked up a sympathy card. When I got home, I scoured the internet for inspirational poems. I came across the classic Rainbow Bridge Poem. I printed it off, folded it neatly, and wrote a heartfelt message in the card before putting it in the mail, hoping it would provide some comfort as they dealt with their loss.
A couple weeks later, I went to check my mailbox at school and noticed a light blue envelope inside. Wondering what it could be, I carefully opened the flap. Inside was a thank you card that read “Thank you very much for your loving care of our dog. Your kindness makes such a difference.” A soft smile grew upon my face, and one tear trickled down my cheek. In the midst of heartbreak, this couple had chosen gratitude. In the midst of a stressful week of clinics, I was given reassurance that I was doing okay. My first patient will always have a special place in my heart. She will always remind me to focus on the good and to never underestimate the power of a small act of kindness. It may be just what someone needs on his or her worst days. When that’s not enough, a little beef jerky never hurt anyone!