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Saturday, Jan. 26, 2007

Article

Something stirred me from sleep. A sound that was distant, but somehow close. Five minutes later, as my eyelids came unwillingly apart, my brain registered that I had fallen asleep on the couch after my husband left for work.

Most of our doctors work every other Saturday. It's a half day, working until noon. Often, the only thing typical about Saturdays are the atypical appointments. Most of the cases are emergent, with the occasional vaccine appointment for those clients who cannot come in at any other time. Friday evening, I reviewed my schedule and saw that I had a 13-year-old cat coming in with the chief complaint listed as “urinating and defecating outside of the box; vomiting also.”

Mrs. Fable (names of clients and pets have been changed), her husband and daughter all arrived on time with their cat, Trouble. I introduced myself politely and commented on the husband's college football sweatshirt. (I'm one of the few Ohio State football fans in a Penn State world.) After reading the chart and having a discussion with the owners, it became clear that this cat had not been to the veterinarian since his kitten visits. He had been vomiting at least weekly (or more, according to the husband) since then. And as for the urinating and defecating outside of the litter box, that bad behavioral habit had been ongoing for about two years (or longer, again, according to the husband).

I did a physical exam, and other than dental disease as you would expect, nothing spectacular jumped out at me. I made some recommendations for diagnostics and environmental modifications at home and offered to take Trouble to our treatment area for a blood sample. With a blank look from Mrs. Fable and a quick glance between Mr. and Mrs. Fable, she asked if they could speak with me outside of the room. My technician stayed behind with the daughter, and I spoke with the Mr. and Mrs. in the next exam room.

As it turns out, Mr. and Mrs. Fable were very frustrated with this cat, and in their mind, had done all that they could with the feline.

The appointment was a farce. After discussing their annoyance, they wanted me to tell their young daughter that the cat was very sick, and there was nothing that could be done for it.

I offered a transfer to a no-kill shelter, or even a farm (with plenty of those in the area), but the Fables were not hearing it. Ultimately, I told them that ethically I would not lie to their daughter. My ethics were tested again when they asked me to euthanize Trouble.

Later that same day, my husband and I drove over to Philadelphia for a Flyers' game. The Flyers were playing the New Jersey Devils, which according to the veterinary hockey fans I meet, was a rival match-up. While neither of us are hockey fans (we're baseball people), a particular pharmaceutical company was sponsoring a continuing education event, followed by dinner, drinks and the game in a private box. I tried to watch the action on the ice, but quickly became frustrated by a lack of knowledge of the game. And contrary to what I expected, there were not any knock-down, drag-out fights on the ice. I've seen better brawls in baseball! I had more fun interacting with the other attending veterinarians and their guests, including two of the doctors from our practice.

One of those veterinarians has been practicing for many years and has much wisdom in handling difficult situations with clients. I told him of the morning's appointment; he smiled and said he would have put the decision back in the Fables' court. By explaining to the daughter that more tests were needed to determine what, if anything, was wrong with Trouble, he would have then waited for permission from the parents to continue.  I'm not a parent yet, and the thought of using the daughter to my advantage never occurred to me. It was a situation that I filed away in my memory bank, hoping never to have to use such tactics again. I also mentally kicked myself for not thinking of a better resolution for the Fables and their cat.

Live and learn, and move on to Monday.

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