Dumbfounding human behavior

May 02, 2008

At this time last year, shortly before I married, I could not imagine doing full-time emergency medicine. Even now, it seems like a daunting task. Last year, our local emergency clinic was looking for two full-time veterinarians and recruited heavily for local DVMs. At the time, I was new to the area. I had no intention of switching jobs so soon, despite the monetary benefits.

Now, our situation is slightly different. When we were in house-buying mode, it was blatantly obvious that with my student loans, our current earnings were not enough to afford a mortgage on a house that we wanted. It would have been imperative that I pick up some extra shifts at the emergency hospital. One or two a month would be sufficient to nearly cover the mortgage. I was willing to give up a weekend night or day twice a month to afford a house. It seemed like a fair trade.

As it turned out, with all of the full-time positions now filled, giving me one to two shifts per month wasn't going to be feasible. However, all three of the full-time emergency veterinarians were given my name and phone number and told that I was available to fill in on occasion. While it is not reliable income, Mark and I decided to use it to establish a down-payment fund. Hopefully when we are ready to start looking for a house of our own again, we'll be better situated financially.

On Thursday, my day off, a number I did not recognize popped up on my caller ID. I answered. My voice was still raspy from all the coughing that I had been doing during the past two weeks. The caller was one of the emergency veterinarians. He needed someone to fill in for his Sunday shift, 8 a.m. to 8 p.m.

Despite being sick, the potential income seduced me. Instead of staying at home, resting and having quality puppy time, I agreed to work for him. In the back of my mind, I figured I might be able to rest. After all, when there were not patients walking in the door, I could retreat to the doctors' bedroom, curl up under a blanket for a snooze.

After going through rounds with the overnight doctor, I did just that. I turned on the Sunday edition of the TODAY show, propped my head up on some pillows and closed my eyes. I drifted off. I heard a soft knock at the door. The technician came back to tell me that the first emergency was on its way.

From then through the end of the shift, the flow of emergencies did not slow much. I had a few minutes in the early afternoon to sit down in the lounge area and eat a turkey sandwich. I realized later that I never did drink the milk that I brought with me. It was probably better to stay busy and not focus on how miserable I felt. The longer the day went on, the weaker I felt and the worse my cough sounded.

By the time the German Shorthaired Pointer arrived, I was slowing down but also nearing the end of my 12-hour shift. I was aching to take the p.m. version of Tylenol Cold, too. At the time, I had three other clients and patients in exam rooms at different stages. The fourth room, the room with the Pointer, had just been brought in and the technician was taking a history.

It was another 15 minutes before I got to go into the room. The technician told me that the dog was stable, so I went about trying to close out at least one of the other three rooms before starting the next. I walked into bloody paw prints scattered all over the floor, indicating that the dog was pacing around the room, awaiting my arrival (or anxious to go home).

I sized up the owners -- a younger couple, probably mid-30s, dressed in outdoor gear. The woman threw a look of scorn at me when I introduced myself. I had been warned that not only was the dog anxious, but the couple was restless, too. After all, they had been waiting about 25 minutes. For emergency medicine, this was not a terribly long time. Indeed, the look of scorn was because they had been forced to wait longer than what they thought was acceptable.

The bloody paw was bandaged in a peculiar manner. The couple had been in the mountains, enjoying the weekend weather and noticed the dog limping with a bloody paw early that morning. To stop the bleeding, they used what was around them. This is where the saying "duct tape fixes all" applies.

The right rear paw was wrapped in several layers of paper towels closest to the wound. On top of the paper towels were three white kitchen trash bags. The entire wrap was bound with duct tape, yet blood had soaked through the multiple layers.

After removing the wrap (bandage scissors do not work that great on duct tape, in case you are wondering), I noticed that the paw was swollen, probably twice its normal size, and there was a wound matted with hair and dirt. It was impossible to visualize if there was a foreign body still in the wound, and the dog resisted a more thorough exam of the paw.

I finished the rest of my physical examination and offered the owners sedation to clean, explore and possibly suture the wound. The technician went in the room to discuss the estimate. After several minutes, I began to wonder if the clients had more questions. Usually, the technicians are in and out of the room when discussing an estimate. I walked toward the door and listened from the outside. While no one had raised voices, it did not sound good. Several more minutes later, the technician emerged and said the owners were not amenable to the plan.

If sedation was not an option, the next best alternative was to attempt to clean the wound and apply a bandage to get the dog through the night and start antibiotics. Tomorrow, the owners could take him to their regular veterinarian who could do exactly what I suggested but without the emergency room prices. So, I revised the estimate. Once again, I sent the technician in to relay the news.

The same scenario happened. The technician was in the room far longer than I expected, and when he emerged, the owners still were obstinate about the treatment plan. In fact, this time when the technician came out of the exam room, he shrugged his shoulders as if to say, "I tried." The owners opted to take their dog home, reapply their duct tape bandage, and take it to their veterinarian. The owners even rejected my offer of antibiotics and pain medication.

The technicians were not the only ones shrugging their shoulders. I had no idea why the clients were so irritated by the time they spent waiting for me when they apparently had so little intention of following the treatment plan anyway. I hope that the duct tape and kitchen trash bag bandage made it through the night. I hope that whatever he cut his foot on was not lodged deep in the wound. I crossed my fingers for the patient as the owners left the building, somewhat exasperated. I'll never know how that dog did after I saw him. That's the nature emergency practice; follow-ups don't exist.