Cancer schmancer and control freak self-control in vet medicine
There’s always a point in the treatment of any serious case when I’m forced to wonder what I would do if it were my very own pet's life-threatening crisis and not the patient's before me.
For some reason I can’t get past this inevitable moment. I know it makes me a prime candidate for “compassion fatigue” and irrevocably skews my unbiased perspective but it’s one thing I haven’t overcome…not yet…not that I’m too sure I want to.
That’s when I wonder how human pediatric oncologists manage. What with all the inescapable death and parental grief…how do they do it? But that’s another post topic. I don’t really want to wrap my head around that one right now.
This week has been fairly crazy with a variety of cancer or probable-cancer cases in varying states of advancement. Here’s my list:
1-First up, the Siamese cat I’ve been treating since kittenhood I diagnosed with oral squamous cell carcinoma a month ago. He was finally euthanized while I was out last Saturday. These owners were so attached to this nine year-old feline they’d had an impossible time of deciding when to euthanize.
Having treated a great many cases with this aggressive, fast-moving cancer I knew that I would have euthanized him at least a couple of weeks ago were he mine to make decisions for. Yet I fought hard to keep my bias under control, knowing it wouldn’t change the mindset of these hoping-for-Thanksgiving-against-all-hope owners. I kept answering their questions on his comfort level truthfully (lots of pain) but it wasn’t helping.
2-The vomiting-occasionally-for-two-weeks Boxer with an obvious upper abdominal mass whose owner seemed so resigned to the formula (10 year-old Boxer dog = cancer) she chose to take her business trip anyway, opting for ultrasound and exploratory surgery with the specialists next Wednesday.
Were she my dog, I probably would have begged my vet to refer me to the surgeon that night for emergency surgery. But I knew this client had been through it all before with other Boxers. Given her previous firsthand knowledge (and knowing how much she loves her dogs and how responsible an owner she tends to be) who was I to push for something other than what her emotional state demanded?
3-The Weimeraner with a wrist the size of a tennis ball which had started off as a soft bump and was now, two weeks later, a hard sphere of probable joint cancer (synovial cell sarcoma, I suspect). The biopsy scheduled, all I could do was talk the owners down off the ledge and prescribe lots of pain relievers in the interim—which they refused to admit were necessary (drugs = bad, no whining = no pain).
4-And finally, the Doberman with a chronic cough whose owners couldn’t be reached two weeks ago after his bloodwork revealed the presence of a likely bacterial infection and who now (yes, two weeks later) were demanding answers when the antibiotics “hadn’t worked.” X-rays and more follow-up labwork pointed to a soft-tissue mass pushing on the trachea but, now that they’ve left the building again, I haven’t been able to get the owners to call me back to discuss his immediate need for a CT scan, ultrasound, tracheoscopy and/or esophagoscopy.
It’s tough to sit on the sidelines with so many balls in the air and so many possibilities looming. I know people make funny choices in stressfull situations but it’s still hard to control myself knowing I’d often do things way differently were it my pet in need. And then I wonder…is it my communication skills? Just maybe…
I know this self-identification and control-freakiness is something we vets aren’t supposed to do—the perils of taking things too personally are palpably real: chronic angst. But still, it’s impossible to forget that these are living, breathing, feeling creatures who really need attention—right now! It’s one thing when you can’t afford advanced care. It’s another when you can and you still choose Door #2.
Sure, I wish I could take my office manager’s point of view. She’s more logical and impassive about these things and always reminds me to keep a certain distance (in her occasionally annoying way). But I’m just not good at it. I guess I survive by being good at getting it out of my mind with the next (hopefully healthy) patient and some vigorous exercise once I get home.
So here’s where I re-read what I’ve just written and get reminded, yet again, how whiny my posts can be. I’ve been reprimanded on this front already this week (by a self-declared control freak, no less) so I solemnly swear that in the next few posts I won’t mention euthanasia, death or anything that has to do with stress. Deal?
Still, feel free to comment on what you do to keep your inner control-freak at bay when uncontrollable calamity looms at work—other than yoga (that’s my secret weapon). And keep in mind, you don’t need to be a pediatric oncologist to opine freely on this. After all, no one's immune to workplace stress.