Emergency pain control for pets (a real life example)
Yesterday’s emergency patient arrived after she’d collapsed at the groomer’s after a rough night of intermittent restlessness. She’d perked up with a pain-reliever by breakfast-time (prescribed for her severe osteoarthritis), which is presumably why her owner thought she’d keep her appointment with the groomer.
In hind-sight it’s obvious her first step should’ve been the vet’s—though the end result of the morning’s trials would have been the same.
Soaking wet, lying on her side and breathing hard, ten year-old Stormy was alert enough to register severe pain. Bloody diarrhea was pouring from her backside, which her devoted groomer bravely sought to contain with a blanket.
This man deserves a medal, I thought. He’d be losing all his Saturday morning business to be here at Stormy’s owner’s request—no small percentage of his weekly take, I figured. Yet he felt especially responsible for her well-being, considering he’d known she was feeling poorly from the look in her eyes before he carried her into his tub for a bath.
That’s where she’d gone down, even before he’d applied the shampoo. Ten minutes later he’d driven her to our hospital himself when it was clear her owner could not make it back from a faraway site in time.
Now he was here, wishing he’d heeded the advice of his inner voice when he’d first seen Stormy walk in that day. “It was more than just her arthritis,” he’d confessed to me in his Portuguese-accented Spanish. “She looked defeated. In her eyes.”
By this time she’d received fluids and pain relievers and we were hauling her 100-pound bulk cautiously onto the stretcher for X-rays. Meanwhile, I’d reached Stormy’s owner on her mobile and wasn’t getting the “I’ll be there immediately” sense of urgency I sought.
By this time I was beginning to feel pretty downcast about her chances since I thought I could feel a large mass in her abdomen (despite the presence of abdominal fluid and her painful reluctance to be palpated) and I was hoping to demonstrate its enormity by way of impressing upon her owner the need to make quick decisions—in person, preferably.
No dice. Despite the presence of a grapefruit-sized hulk of firm tissue staring at us from the film, the owner was still a no-show. She’d asked me to wait until she could locate her family before making a decision as to the next step: surgery, specialist, 24-hour care, etc.
And here’s where my moral dilemma for the morning makes its debut in the story:
Stormy is still painful but just barely registering decent blood pressure and tissue oxygenation. Do I provide more pain relievers and risk the poor outcome of a surgical approach if this is what the owners ultimately elect? Or do I simply administer the drugs, accepting that pain relief trumps everything in a crisis like this?
At issue is the difference between how we minister to animals and how humans are treated in critical care settings. We humans are typically granted the right to suffer extremes of pain and discomfort in our sometimes slavish acceptance of the fact that the end justifies the means when it comes to saving lives through medicine.
The same is not true for animals. We assume that suffering is perceived differently by animals, that their limited cognition means an understanding of their own pain eludes them—especially because we believe they cannot see beyond the pain to a time when they will be free of it.
I the end that’s why I gave another whopping dose of pain reliever. I had warned the owners that the longer they waited the greater the chance that Stormy would succumb. The way I see it, the need for me to provide pain relief in lieu of definitive treatment is one of those time-sensitive factors that often plays into the ultimate cause of death.
In the end it was worth it. After another thirty minutes, Stormy’s widening pool of owners called with their collective decision to euthanize her. By this time she had finally relaxed somewhat. Her breathing had become more shallow and her heart rate had slowed.
Sure, she was closer to death after I’d relieved the bulk of her pain. If the decision to treat her surgically had been handed down it’s true that my heavy-handedness with a syringe might have forestalled an eventual recovery.
Nonetheless my philosophy stands: If an animal is in so much pain that his demise via pain relief is a potential outcome, I feel even more justified in pushing it.
RIP, Stormy. Feels better now, doesn't it?