Gazette Vet: Working in the Gray

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By John Andersen, DVM

After graduating from veterinary school, I spent a year doing a rotating internship at North Carolina State University’s veterinary teaching hospital. This was an excellent opportunity to get another year of training in medicine and surgery while working in the “ivory tower” of a respected and busy veterinary school.

Although I indeed learned a lot of medicine and surgery that year, I learned an incredible amount of intangible “stuff.” Stuff like working in the gray between what we can do and what we should do with a sick older pet. Stuff like simply showing owners that we care. Stuff like working hard to find the answer when we don’t know the diagnosis, only to find there isn’t always an answer.

Enter “Tom” White, a 12-year-old cat who presented to the teaching hospital with a recent history of blood in the stool and a suspicion of a colon mass. Being the intern, you typically interact the most with the pet and the owner, but it’s often the residents and senior clinicians making the final decisions on care.

Tom’s mom was immediately a very nice and kind person. She admitted that Tom was a very special cat to their family, but that she was so glad to be at the teaching hospital and that she knew he was going to get the best care. I assured her I would do my part to ensure that did indeed happen.

We started with an abdominal ultrasound that quickly confirmed the diagnosis of a donut-shaped colon mass that was getting close to obstructing his bowel. Being academics, the clinicians wanted a colonoscopy, too. On one hand, did we need it? On the other hand, more information is always better. But I did feel really bad when we had to pass a feeding tube through Tom’s nose and syringe him the GoLytely to cleanse his colon. He was such a sport, even purring through the whole procedure. I felt like I failed him a little because I knew that was uncomfortable and led to a rough night of diarrhea.

Colonoscopy the next morning was predictable—a donut-shaped mass, and they got some biopsies, which did confirm the growth was cancerous. Surgery was scheduled the following day.

Mrs. White came in that night to visit Tom, and I went over the day and the plan with her. She was concerned but not surprised. She then opened up to me and told me that Tom had belonged to her son Andrew, who they had lost several years ago when he was just a 12-year-old boy. She started to cry but did not elaborate anymore.

Now I was on a mission. If I didn’t already like Tom and his family, I was now committed to making sure he got the best care and that she got the best communication we could offer. To make a long story short, Tom had surgery the next day, which went well and was uneventful; however, the following day he stopped eating and spiked a fever. Tom’s mom came back to visit him and this time brought her daughter, Andrew’s sister, who was now about 18. My heart ached seeing them visit Tom and thinking about their loss.

The next morning, Tom deteriorated further and we finally found that Tom’s colon incision was leaking and he had a bad abdominal infection. I can still remember picking him up one time and he gave this awful yowl because his belly was hurting so bad. I again felt like we had let Tom and his family down.

I told Mrs White that we had to go back into surgery, which she understood. Going back in, the surgeons found their incision opening up, and despite cleaning things up and repairing, it was all too late. Tom continued to go downhill and finally in the middle of the night in the ICU, he died from complications.

It broke my heart to call and tell Mrs. White that Tom had died. I felt like I had let her, her daughter, and certainly Tom down. We had done everything we could, and yet everything went wrong.

About a week later, Tom’s mom called me and said she and her husband wanted to take Michelle and me out to eat. We accepted and had a nice evening out. I think they truly enjoyed just feeding a young newlywed couple, and the elephants in the room—Tom’s and Andrew’s deaths—never came up.

But at the end of the dinner as we were saying out goodbyes, she handed me an envelope. She said she just wanted to share her story since I had helped her with Tom. We all hugged and went our separate ways.

When we got into the car, I opened the envelope and found some newspaper clippings of her story. A family vacation out to Colorado turned tragic. They were all on a snowmobile tour, Andrew and his mom on one snowmobile and her husband and daughter on the other. Heading up a narrow mountain trail, they lost control of their snowmobile and it veered off the trail and off a cliff. It took rescuers several hours to reach them. Mrs. White had a badly broken and mangled arm, but Andrew had suffered a ruptured spleen and was bleeding internally. He died in her arms as they waited for help to arrive.

Michelle and I both shed some tears in the car after that. We drove home mostly in silence as I wondered just how I got into such an emotional case. I learned that whatever your profession, you are going to have significant interactions with other people. You can choose to listen and to care about them, even though they may be perfect strangers. I learned that people may be opening or closing a significant chapter in their lives, right when you meet them, and sometimes you are there just to play a part, and to do so with love. And I learned that sometimes, you just plain lose.

This case was 13 years ago. I have since taken these lessons with me into the real world of private practice where they have served me well. We are often faced with tough decisions, strong emotions, and uncertain outcomes. All we can do is do our best and have faith in the people around us. Though we have since lost contact, Tom and his family made me a better veterinarian and person. They have remained with me.

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