End of life…

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As I walked out of clinic at 1am on Monday morning a family were arriving to say goodbye to their pet having been summoned by phone just 15 minutes before when he started to deteriorate so rapidly that it was obvious he only had minutes to live. They made it in time to say bye thanks to the Vets Now ECC nurse recognising what was happening early and allowing them to be summoned.

Through the weekend we’d helped countless animals who left the clinic to go home with their parents, yet there was a high proportion that was never going be leaving, whether or not their pet parents realised it when they arrived. Unfortunately our pets can never tell us how sick they are, how much pain they are in, and that they want to go on over the rainbow bridge.

This is worse as often it is not just that they are seriously ill (and sometimes even dying painfully), but is also so sudden that their parents may not have had time to come to terms with this and accept it. It is not human nature to give up and sometimes when it comes to the decision to end life it can feel this way even though it is really not.

The weekend was a mix of those that came to ask us to help them send their loved pets on over Rainbow Bridge – the request of one parent that nearly made me cry was that someone would cuddle them as they moved on. Then there were those that hadn’t realised how bad the condition was and how much pain their pet was in that let them go on pain free when realising. There were also those that just refused to give up even though it could be considered to be  the kindest thing for their pets.

Vets are legally entitled to euthanise an animal on welfare grounds if they believe the welfare is compromised and the animal is suffering. However , we realise the importance of the bond parents make with their pet and that doing so will not be easy on the parents – in fact it would be very traumatic for the parents which is something we never want.

Instead we rely on our ability to communicate with pet parents. Sometimes it is very obvious to us how bad an animal is because of our experience and training whilst it may not be to their parents. We release that the animal is never going to be able to leave alive, and whilst we may attempt to make the animal comfortable with very strong pain medications, it is the owner that we need to treat.

Euthanasia is one of the most powerful tools that a vet has – read about how it really works here.

The emergency patient…

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Arriving to Vets Now with a quick tour of the practice and introduction to the team I changed and it was time to see my first consult with head vet Rebecca. It was not the bleeding dying dog or cat that I expected but a rabbit with early gastrointestinal stasis that had stopped eating – giving medication against pain and to encourage gut movement we hope that we had caught it early and that the rabbit would be fine.

One of the attractions of emergency and critical care is that you never really know what is going to come through the door. Most patients will go through telephone triage so we may get a little notice to prepare if necessary; however there is always the chance that someone will run a dying pet straight in. If you have time to telephone (or can get someone else to telephone) before you come then it is better because it allows preparation of anything necessary before you arrive. This can be even more important if there are already critical patients as it may be necessary to triage the least critical to a secondary area so we have a table to work on or a connector for oxygen.

The uncertainty of what is next is also one of the challenges of  emergency medicine; you need to be very confident in your ability to deal with whatever comes in. And you have to be able to cope well under pressure  – especially when multiple emergency patients arrive at the same time.

Whilst able to send some patients home, there were unfortunately a few where euthanasia was the best option – either because they were not treatable or because they lacked any quality of life. I’ve written an entire post on euthanasia that will follow in the next couple of days.

The day quickly became one of maggots with what felt like an endless supply of the wriggly white flesh eaters being found on a cat, pigeon and a rabbit. It is amazing how quickly with the summer heat that flies will take advantage of any moist fur to lay their eggs. The eggs tend to hatch rather quickly so within 24 hours there can be a serious problem if not treated so these were emergencies. Fortunately shaving half the cat managed to remove all the maggots and only the top layer of skin was damaged, however the pigeon and rabbit had much more extensive wounds and had to be euthanised on welfare grounds.

For my first day however it was a rather relaxed introduction to emergency practice – I had time to learn how things worked – and to pick the brains of the vets and vet nurses I was working with to get a better understanding of how it worked with Vets Now. It also gave me some time to practice some of the clinical skills such as manual PCV (blood cell counts) that I’d not done for several years.