Famous last words

I was doing relief work for a local clinic a few days this week. This particular clinic is often slow when when I'm there as many people prefer to wait until the owner/doctor is back in town.  That's not uncommon in single doctor practices, especially if they don't often leave town.  Anyway, the schedule for Friday morning was very light.  So when a friend who works at a nearby clinic called to ask if we could see an emergency as they didn't have a doctor in yet I said " sure, we're not doing anything here."  You can guess see where this is going right?

About twenty minutes passed quietly.  Then everyone showed up.  Seriously, everyone.  Apparently the clinic owner and announced of the clinic facebook page that Friday would be free nail trim day.  So by 8:30 we had two exam rooms full of dogs for nail trims, two dogs who also requested exams for medical conditions, boarding dogs were dropping off, as well as drop-off appointments.  On top of this the kennel help had not gotten all the runs cleaned so there was no where to put all the dogs.  One got tethered to the wall, another turned loose in the radiology room.  It is at this time that the emergency arrived.  We knew it was a dog with labored breathing and pale gums, but we didn't expect it to be quite as bad as it was.  The owner-an older man dressed in sweats and reeking of alcohol and cigarettes, carried the dog to the back, flopped him on the table and went outside to light up again.  The dog took about two more breaths and died.  Seriously, not a good start to the morning.

I listened for a heartbeat, checked for reflexes, etc.  Found none.  Trucked out front to find the smoker and tell him the dog had passed on.  I was not quite prepared for the emotional breakdown he proceeded to have in front of the clinic.  But on our way back to see the dog I was able to extract some information from him.  Thought the dog had been poisoned (common owner concern, uncommon actual scenario).  Had been sick since last night (probably longer, but there are some things that may have only become noticeable last night). Was about 8 years old (not geriatric, but old enough for bad stuff).  I offered a few possible differentials for the sudden illness-ruptured hemangiosarcoma, immune mediated anemia and the man went to take his dog home to bury.

Back at the car the dog started agonal/reflexive breathing which is common after death.  Owner wanted me to listen again just to be sure.  Not an uncommon request.  It is uncommon to find a heartbeat still present. And yet, there was one.  I was a bit perplexed and somewhat disturbed that I had failed to make the diagnosis of "dead."  Still, I knew this dog wasn't going to live.  While not technically dead yet, he most certainly would be by the time they got home.  No real breaths, no reflex, weak heartbeat.  But I obviously couldn't just send him on.  So, we hauled the dog back in.  Nail trims still waiting.  Dog still tied to wall.  Other dog pooping in radiology.

Intubated the dog, started artificial respirations and drugs.  No response.  No spontaneous breaths. No reflex.  Weak pulse.  Dog is basically a vegetable but won't die.  Hoping for something more concrete to tell the owner I grabbed a needle and syringe and tapped the abdomen.  Blood.  High likelihood he had a ruptured tumor and bled out into his abdomen.  Nothing to be done.  Owner agreed.

Slowly, we worked through the backlog of waiting animals and by noon things were back on track.

Later in the day the man came back bearing a large potted plant, thanked us for our professionalism and apologized for his loss of composure.  He left promising to bring his remaining pets back to us for care when they needed it.  I was surprised to say the least.  For one, I didn't think we came off as looking super professional in all the chaos, and second, he didn't seem like the type to bring flowers.  But I guess my impression of both of us was wrong!

Kind of a sad story but goes to show what we get for saying we "weren't doing anything."  As far as the dog goes, maybe if he had been seen last night, had surgery and possibly a transfusion he might have lived.  But by morning, he didn't have any chance of getting stabilized.  And if it was hemangiosarcoma, the most likely differential, surgery only buys a short amount of time, assuming he survived it.