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Old School, New School: A great Great Dane dilemma

dvm360dvm360 June 2019
Volume 50
Issue 6

What will Dr. Seasoned do when faced with a cash-strapped, long-time client and a patient who can be (expensively) saved? The corporate medical directors not going to be happy ...

Illustration by Ryan OstranderIt's

It's been a long hiatus since we last informed you about what's happening with Dr. Seasoned. (Did you miss the lead-up to this? Dr. Codger finally sold to corporate, and Dr. Greenskin got married and stayed on as Dr. Seasoned. Catch up on the whole saga at dvm360.com/campfield.)

Having enjoyed a nice long honeymoon and indulging new-found interests in things like non-stick cookware and thread counts, Dr. Seasoned is settling into a nice routine of work and family life. The flow of corporate general practice, if not a bit mundane, is providing some welcome stability. For the most part, the post-transition dust is settling within the practice walls. Dr. Seasoned is finding some comfort in following established company policies. She also now has a retirement account and can't wait for the day when that 401(k) balance exceeds her student loan balance (neither can her new husband)!  

It's a morning like any other, with some puppy wellness checks, itchy old dogs and even a case of chronic cat diarrhea to spice things up a little. Dr. Seasoned is in an exam room when she hears some commotion in the lobby. One of the practice's long-time and best clients, Mrs. Giant, is frantically searching for someone to help her bring her Great Dane in from the car.

“I think she has bloat!” cries Mrs. Giant. “You need to save my precious Burpy!”

Dr. Seasoned alerts the technicians to get catheters, fluids, ultrasound and trochar ready while she quickly wraps her current appointment. Upon evaluating poor Burpy, who's only 3 years old, she diagnoses a gastric dilatation-volvulus She quickly and efficiently starts basic care while directing reception staff to reschedule the day's appointments and get the OR ready.

This is when things get a bit hairy. The new practice manager, Mrs. Stern, comes back to the treatment area to talk with Dr. Seasoned.

“Mrs. Giant says she can't afford the surgery,” says Mrs. Stern. “She keeps talking about Dr. Codger's payment plan. and I've told her we don't do that anymore.”

Dr. Seasoned is working diligently as she continues with fluid resuscitation and successfully trocharizes the stomach as she responds: “She caught this pretty early, and I think we can save this young dog. I've known Mrs. Giant since I started working here, and she always pays her bill eventually.”

“I gave her the euthanasia consent form. She's upset, but I think she'll sign it.”

Mrs. Stern pushes back: “I just don't see how we can get this dog in the OR today. I gave her the euthanasia consent form. She's upset, but I think she'll sign it.”

With Burpy a little more stable and some pain meds on board, Dr. Seasoned looks back at Mrs. Stern.

“We're going to surgery,” she says. “I'll take it up with the regional director if I have to.”

“I know they won't authorize this,” Mrs. Stern bites back, “and the interim director is out of the office until next month. Also it's a holiday weekend so we won't be able to reach anyone until Tuesday.”

The rest of the staff keep their heads down and continue working as they feel the air heating up a few degrees.

“Then we'll deal with it on Tuesday!” barks Dr. Seasoned.

With one last nod to the technicians and “Get her on the table!,” Dr. Seasoned heads out to speak with the inconsolable Mrs. Giant.

Dr. Seasoned just wasn't prepared to deal with this sort of thing in vet school, but this is a situation in which decisions must be made in the moment. Dr. Seasoned can almost feel the calming Dr. Codger's presence, empowering her to follow her heart to do the best for this patient and client. The old man may not have always been the most tactful, or the best manager, but there's no way he would have let Mrs. Giant's young dog be euthanized over money. Mrs. Giant's agony is transformed to tears of joy as Dr. Seasoned ensures her that they're going to their best to save Burpy.

Was Dr. Seasoned being heroic or reckless? Does no good deed go unpunished? Would she have done the same thing if she owned the practice? Do we sometimes have to shake things up a bit to save a life, or should professionals always play by the rules? Tell us what you think in the comments below or email us at dvm360@ubm.com.

Dr. Jeremy Campfield lives near Sacramento with his family, including an aging mini Aussie and an obstreperous pitbull mix that some mistake for a chocolate Lab (to the delight of her owners).

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