OK. Not EVERYTHING. But it can seem like it. They say that negative experiences stick with you more than positive ones, and you need something like 100 good experiences to negate one bad one. Today could use a few really good things to give me some balance back.
You have a rational mind that tells you that you made good choices, you tried your best, you did the right things. There’s also that emotional side of your brain that just eats at you, that asks, “what if…?” What if I had reception call and move that appointment up to an earlier time slot? What if I took the dogs for a walk as soon as I got home instead of waiting that 15 or 20 minutes? What if treating neonates was the same as treating an adult animal or even a 3 or 6 month old one? What if wildlife rehabs were closer to my house or open later? What if my brain didn’t freeze and go basically blank in emergency situations? So many, “what ifs…” I could stay up all night coming up with more.
First thing this morning, one of my techs walks in with one of her two-week old foster kittens and says it isn’t doing well. I always tell my techs with these bottle babies that I have no idea what I’m doing with them. I don’t like treating them, and I don’t want anything to do with neonates of any species. I don’t want to see them until they’re “self-sufficient” or at least 8 weeks old. I told her I’d look at it though, so I did, and I then texted my former coworker who lives and breathes for disaster cats and kittens for her advice.
As my colleague pointed out, the baby likely had some trauma in its history since it was missing part of its tail, and she said these little kittens love to go septic, sometimes quickly. We tried to warm her up, gave her warm fluids under her skin, started antibiotics and dewormed her. My tech returned from her own doctor’s appointment and thought she might want to euthanize. I said we should give her at least an hour or two to see if she seemed to respond to her treatments at all. My colleague agreed and even offered to drive down after she finished work and take over care of the kitten. Unfortunately, the little girl just got worse. My tech returned a couple of hours later, and I helped her end the kitten’s suffering.
It was the right decision. She was struggling to breathe and near death. Sometimes two week old kittens just don’t live.
In the afternoon, I had an older (but not very old) dog on my schedule for increased coughing. I knew the dog had a history of heart failure because when I last saw this patient in December of last year, I diagnosed her with it and transferred her to the university hospital. I expected the same would happen again: we’d take chest radiographs, diagnose her heart failure and transfer her to her cardiologist.
One of my receptionists tried to get my attention as I was about to go into the room. I told him it would have to wait because I was pretty sure this patient was in heart failure. As I walked into the room, the patient was walking around by the owner’s feet, and I started to review the history with the owner. I got about half of a sentence out before the patient appeared to start rubbing her face on the floor, fell over and extended her neck out. The owner immediately started panicking, for obvious reasons.
I placed the dog on the table, confirmed a heartbeat and heard some crackles in her chest, as the owner proceeded to ask me if she was dead. When I told her she wasn’t, she started asking about transferring her to the university. I told her she wouldn’t make it there in her current state and that I needed to get her to the back for oxygen. Somewhere during those likely seconds that felt like 15 minutes, my brain went, “Shit! This dog is dying. Right now.” It’s a terrible realization.
I am not, never have been, and never will be, an emergency clinician. I hate emergency medicine with every fiber of my being. My brain shuts down, and I can’t think clearly or remember anything I’ve ever learned. Thank goodness my staff can function better than I can in these situations, and thank goodness my colleague picks up ER shifts all the time and came out of her appointment to help direct the techs and oversee CPR while I talked to the clients about the state of their dog and her grave prognosis.
When I rushed the dog to treatment, I called out that she was dying, to get oxygen. The techs got that turned on, placed an IV catheter and asked me if we were doing CPR. The client didn’t actually say to start it, but from past interactions with her, I knew that’s what she would want. They needed it almost instantly. As I was about to go talk to the owner, one of techs yelled out about giving epinephrine. Again, thank goodness for my colleague because I don’t have those doses, approximate or otherwise, memorized, and she told them the amount to give.
The staff came together in a big way and really tried their best. (In case you were wondering, CPR almost never works, at least not for our animals. We don’t have defibrillators readily available for them, and as Justin reminded me while I was talking about my day, in humans, you perform CPR until you get paddles to the patient. That’s its purpose: to keep blood moving and the heart pumping long enough to get a defibrillator. CPR itself doesn’t often bring the patient back.) If you’ve never been part of a CPR situation, it’s traumatic, stressful and adrenaline-filled. No one feels good in the moment or after it’s passed.
After about 15-20 minutes, the owners finally accepted that their dog was gone and not coming back. They spent at least 45 minutes with her afterwards. They asked repeatedly while I was in the room with them, waiting for them to give permission to stop CPR, what they had done wrong. They stated that she might still be alive, had they just not stressed her out with the visit. She ate lunch today. She only coughed once last night. They had been monitoring her resting respiratory rate and effort, and it had been only mildly elevated for a day or so. I heard about all of their other recent losses in their lives. They couldn’t believe how quick it was, but also recalled that they had been told in December last year that she only had a few months to live. She had just been to her cardiologist a few weeks ago. She has just started new medication. They always gave all of the medications. She was only 10.
You would think that things could only get better after that. I had two appointments to go: a senior cat well visit and a dog with itchy feet. Thankfully, those were unexciting.
While walking the dogs, we heard a bunch of crows making a ruckus. I looked over and saw a large bird on its back under a car across the street, flopping back and forth. I passed Justin Rook’s leash and went to investigate. A young red tail hawk was on its back, trying to right itself. I gently rolled it over and scooped it up. Of course it wasn’t well. Birds of prey don’t generally allow anyone to just pick them up and carry them 2-3 blocks. A couple of my neighbors saw me and commented, not necessarily that I’m crazy, but that they would never consider such picking up a raptor.
Justin got the dogs home and inside and found a cat carrier in the basement. I put the hawk in there and started looking up our local wildlife rehabs, which of course all close at 6pm, and it was, you guessed it, 6pm. I called my exotics vet friend, who started talking me through things I could do until morning. While on the phone with her, the bird, of course, died. She told me not to call it really dead until it was “dead and warm,” so I moved the carrier from the garage and stole Felix’s basking light to put on the body. After half an hour, the bird was just as dead as it was in my garage a short time earlier.
Honestly, I didn’t expect it to end any other way. There was something very wrong , likely neurologically, with that hawk. Also, some days are just the kind of days when everything dies, and that was today. Part of me wants to cry, but mostly I’m just depressed about this day and my awful outcomes for these three animals. The other part of me, inappropriately I know, wants to just laugh because sometimes life gets the best of you with death, and there is absolutely nothing that you can do about it.
I had plenty of patients that lived today. I can’t tell you about any of them though. (I think a lot of them had skin problems?) These three are the ones I will remember. These are the ones I hold in my heart tonight. My colleague told me it was good of me to try for the kitten. My neighbors commended me for picking up the hawk (and also for taking Ferne in and giving her a good life as a side bar conversation while waiting for Justin to find that carrier in the basement). My exotics friend and Justin both said that least the hawk didn’t die being pecked to death by a murder of crows. Still, my heart hurts, and my brain questions what I could’ve or should’ve done differently, even though I know there was nothing more to offer any of them.
Some days it feels like everything dies. Your heart just hurts, and you hope that tomorrow is a happier day. (P.S. The hawk was still with us in the above image. I debated not including it because it’s so obviously not how a healthy hawk should look or act, but it was a still a beautiful animal. I’m always a little awed by them and saddened when bad luck befalls them. I hope everyone can appreciate why I’m sad it didn’t make it, even when I didn’t expect it to.)
“No one actually knows what the hell they’re doing. Everyone is just working off of their current best guess.” ~ Mark Manson
