It’s What’s Inside that Counts [Clinics Series]

Annabelle* huddled in the back of the run, tucked neatly into a ball but watching skeptically as I sidled up to her.

Who the heck are you? she asked, with a distrusting side-eye.  Who gave you permission to just walk in here like this?

“I’m sorry, sweet girl, I know you don’t feel well.”

And you think that some stranger walking in here like they own the place is going to make me feel better?  She started trembling.

“Annabelle’s such a good girl,” I crooned softly, tentatively reaching out a hand for her to sniff.  She glanced at it briefly, then turned away.  I very gently reached for her shoulder, knowing that this situation was prime for an episode of fear-based aggression.  She tolerated my hand, but her trembling increased.  I sighed and very slowly proceeded with her morning treatments.

Annabelle presented to the ER the night before for vomiting, diarrhea, and not wanting to eat.  Bloodwork and radiographs had not revealed an obvious cause of her ailment, but supported a generalized diagnosis of inflammation in her small intestine.  She was hospitalized on IV fluids and antibiotics under the suspicion that her inflammation was caused by a bacterial infection.  We continued to monitor her for two days, waiting for her to show us that she was feeling better.  But her hospital-induced anxiety was so severe that we couldn’t tell if her withdrawn behavior was a consequence of illness or anxiety.  Finally, on the second day, she was willing to eat for us, and we explained to Annabelle’s people that we couldn’t guarantee she was 100% better, but that we felt her recovery would be best at home, where she would feel less anxious.

Annabelle and I crossed the threshold into an exam room where her family was waiting to pick her up, and suddenly a completely different dog was attached to the leash.  She ran to them, wagging her tail and her whole body, licking them enthusiastically, and chattering her joy, no doubt telling them how happy she was to see them.  The doctor and I looked on with happy astonishment.  As it turns out, Annabelle was 100% better, but we never would have seen it if we had kept her in the hospital.

It’s interesting how diverse people are in their reactions to their pet’s illness.  During my 6 week rotation with the Small Animal Internal Medicine service, there were definitely a few clients who brought their pets in for the slightest change in normal, but there were also clients who refused to believe (or couldn’t understand) the severity of their pet’s disease.

Natalia, an 8 year old cat with very advanced kidney disease, came in through the ER for drinking a lot more water than usual, not wanting to eat, and being lethargic.  Blood work revealed very elevated kidney values, so she was hospitalized on IV fluids overnight.  When kidney values are elevated, it means that the kidneys aren’t able to do their job, so giving the patient IV fluids helps to support the kidneys so they have time to recover and regain their function.  The next morning, we re-evaluated bloodwork and our results were essentially Natalia’s death sentence: despite being on IV fluids, her kidney values continued to increase.  Relaying this information to the clients, it became readily apparent that they didn’t accept our conclusion.  They were convinced that if Natalia would just eat, she would be all better.  It’s one thing to tell someone their pet is dying (it sucks), but it’s another thing entirely to try to convince someone their pet is dying when they don’t believe you.  They decided to take Natalia home with them against medical advice, since we knew that her kidney values would continue to rise and make her increasingly sick.  She died at home exactly one week later.  Was it better for her to pass away in a familiar environment?  Was it better for her people?  Does it matter, since ultimately we couldn’t legally keep her hospitalized anyway?  We can share our best medical advice with the clearest explanation we can manage, but after that the decision is really out of our hands.  I know this will always be difficult for me, just as I know it’s difficult for many (all?) of the veterinarians I know.

The internal medicine rotation has a pretty dreaded reputation, and while I do know people who had a negative experience, for me, it was a really great block.  With only a few tiny exceptions, the team of students with me were wonderful and helpful, the house officers were patient and willing to teach, and the senior clinicians maintained a sense of humor and flexibility.  Perhaps most importantly, I feel so much more like a doctor now that I’m on the other side.  To be sure, I still have my doubts, but I learned SO much.  For all my friends who have yet to take the rotation or start clinics at all, don’t be afraid.  Be nice to your classmates, help them whenever you can, protect time for yourself, and know that you are already enough, exactly as you are today.

This post is part of a series documenting my clinical year in veterinary school.  To read more from the series, please visit the Clinic Series homepage.

* All patients’ names have been changed.

2 thoughts on “It’s What’s Inside that Counts [Clinics Series]

  1. Pingback: What Ophthalmology Taught Me About Expectations [Clinics Series] | The Other Side of the Desk

  2. Pingback: Why I Won’t Ever Be A Cardiologist [Clinics Series] | The Other Side of the Desk

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