I have so often written about personal responsibility, you may think I must be an ultra- responsible individual. To the contrary, and I have a person who can attest to the fact. With that being said, there are some experiences which are so heart rending and drives the message home so succinctly you have to wonder “What if…?”
A frantic client presents with two large dogs she fears has consumed rodent poison. She is not sure how much they may have consumed, which dog may or may have not consumed the poison, or when. Her concerns are prompted by finding the bait trap has been chewed up and the squares of poison missing. She becomes increasingly more frantic as the office visit continues. I access the situation calmly, even as my level of concern rises. The situation is particularly concerning since this poison kills by causing swelling of the brain and death due to violent convulsions. A very nasty way to die, but the condition is very treatable with prompt action. I quickly explain my plan of action and get to work.
I will spare you the gory details of the initial stages of treatment, but at this point things are going well. The dogs were not exhibiting any neurological swings on presentation or after the initial stages of treatment. Since we don’t know how much, when, or if the dogs consumed the poison, we were not out of the woods yet. I consulted with a poison control hotline and as part of my medical management plan, I suggested we hospitalize the two dogs for observation and treatment in the event problems develop. To my surprise, the client declined my suggestion of hospitalization.
I again state the gravity of the situation to her and explain if we can get through the next 6-8 hours without incident, things would most likely be fine. In the event the dogs should start convulsing, it would be better to start treatment immediately since they would be at the hospital rather than waiting for them to return for treatment. She stated she would be so worried about her pets if she hospitalized them and would feel more comfortable with them being at home with her. I acknowledged her concerns and used the phrase, “that is a bad, bad, bad idea.” She had made her decision and was not willing to listen or consider reasoning, no matter how medically sound and practical it may be. They are her dogs and she can do as she likes with them. I don’t have to agree with her decision, but I can document her decision as being contrary to my medical judgement. I had her sign an “against medical advisement” form which documents her choice to not follow my suggestions. I instructed her if either or both dogs should begin to exhibit any neurological signs such as difficulty standing, rapid eye movement, or convulsions, she should bring them both in immediately. As she and her pets departed, I wished her well as I was actually expecting the worse. I wondered what I could have said that may have changed her mind. I didn’t wonder for long since I had other patents and clients needing my attention.
Two hours later the call I was dreading but expecting came. One of the dog was convulsing and she was on her way back to the hospital with them both. Unfortunately one dog was dead on arrival and the second began convulsing during her 45 minute trip and died shortly after arrival and the institution of treatment. The lady was devastated and asked, “Why didn’t you make me leave them here?” repeatedly through her anguish. I didn’t have an answer nor did I offer a response.
The question “What if…?” will echo in my mind for some time to come.
Dr. Pierre Bland is a small animal practitioner who offers office and house call appointments to his clients. His offices are located at 3225 N. Andrews Avenue, Ft. Lauderdale, FL and can be reached at 954 673-8579.