Kristina Kiefer
This has been haunting me for a while. I’d love your input on it, as I think many minds are needed to solve this problem. Here’s the case summary:
Daisy is presented to you for ADR (ain’t doing right). The family is very concerned, because she just isn’t herself. She’s been a member of the family long before the kids came along, but her behavior and quality of life has radically changed over an undefined period of time. The last few years, perhaps? She used to be a super energetic ball of energy- unstoppable. Herding the kids to and from the bus stop, as any good border collie would do. Keeping Jack company when he got home from work or puttered around the house on weekends. Making everyone laugh, and a super keen sense of intuition to know when someone was just “off”, and doing everything within her capacity to help them. But Daisy just hasn’t been acting like herself anymore. She has no interest in herding the kids. She’s up all night pacing and yelling at the moon. She’ll disappear for hours and come home and go straight to sleep. Her appetite is erratic. Sometimes ravenous, other times going days without eating. She’s had a few accidents in the house and doesn’t even seem to realize it’s happening. She’s snapping at the children. She even snapped at Jack a couple times. She’s just downright miserable and doesn’t seem to enjoy the family or anything else in life the way she used to! You’ve tried medications to try to alleviate any pain, because she is definitely no spring chicken anymore, but it just doesn’t seem to work. She gave the family a really big scare the other day when she was walking through the living room, growling to herself, and just collapsed mid-stride. Out cold. And within a few minutes popped up and snapped at one of the kids trying to hug her. The family is beside themselves. They love Daisy, but are frankly scared of her. Nothing seems to bring their Daisy back, and even more heartbreaking, nothing makes her happy anymore. To make matters worse, Jack just lost his job, and their youngest child is scheduled to undergo the fourth in a series of six operations to save his life. They are at their wits end.
Pretty sure we all know where this is going…. What treatment options are on your list to discuss with this owner? We all have this sinking feeling that we know the end to this story. The family is there to have that end of life discussion, aren’t they?
Take a few minutes and reread this entire history. Only now, pretend Jack brought Daisy, his wife, to you, her primary care physician, Dr. Soand Sew, MD. I’ll wait.
What treatment options are you going to discuss with this family? What are the big differences? Would you calculate their quality of life as significantly different?
Now, read it a third time. Read it knowing that Daisy is Dr. Daisy Doolittle, DVM, looking over the state of her existence. With the added secret knowledge that she is several months behind on the mortgage for her clinic hospital because there just hasn’t been enough revenue after the series of horribly false, but extremely shocking accusations made against her clinic and staff on-line. She has also started receiving anonymous death threats from some random person who read the on-line reviews and thinks Daisy “is the most incompetent, cruelest excuse for a human being that ever that walked the earth, and you should do the world a favor and die a death as miserable and painful as those you’ve inflicted”. And she just found out Jack has been having an office affair, and lost his job because of it, so finances are going to be even more scary than they were. And those pain meds she tried using to cope with her fear and pain? Her practice manager discovered them missing from the lock box, and conscientiously reported the missing drugs. Which probably means her DEA license is going to get yanked, and that’s the end of her ability to keep the hospital going. So, pretty much, she is sucking at life in all possible ways.
What quality of life do you think Dr. Doolittle is going to give herself, compared to our other two patients? What treatment options do you think she is going to consider?
What do you think we can do for our profession to reframe euthanasia so that it is limited to our clinical practice? What do you think we can do for our profession to try to stimulate looking at a problem from multiple different perspectives and generating multiple options to solving a problem? What do you think Dr. Doolittle (or you) would feel if Dr. Soand Sew was trying to treat Daisy, the dog? How do you think Dr. Soand Sew should feel knowing that Daisy Doolittle, DVM is trying to self-treat the one species she’s not licensed for?
My thoughts are we need to start shifting to a mindset of realizing their are multiple ways to treat a problem. And we need to be as protective of the human medical profession, as we are of our own. Let them treat their species. Let them treat us. And be as fiercely opinionated about making sure that Daisy, in any form, gets the medical help she needs and deserves, by the appropriate medical team. And if we start talking about this as a profession, maybe we can remind each other to find better solutions to temporary problems.
What are your thoughts? How are we going to solve this problem?
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