Alarm Bells
The day starts like any other day in small animal veterinary practice. A nurse takes a phone call about a seven year old German Shepherd who’s a bit lethargic but only since this morning.
Well, that could literally be anything.
The dog and its humans arrive a few hours later. Now she wont stand up and they need help getting her out of the car.
The first alarm bell starts ringing.
A nurse and I go to the car. The dog’s in the back seat, lying on her chest, puffing softly with her abdomen distended.
A second alarm bell starts ringing.
Before even trying to get her inside the building, I flip her lip to look at the colour of her hums. They are paper white.
A third alarm bell rings, loud and clear.
We hoist her inside on a blanket and waste no time bringing the ultrasound to her. It takes seconds to confirm her abdomen is full of fluid, blood that should have been in her veins. Her breathing changes and suddenly she looks weaker, even more tired than she did before.
A fourth great big alarm bell sounds.
I already know the dog has a haemabdomen. She’s bleeding out into her abdomen, probably from a tumor. In German Shepherds the odds of it being a haemangiosarcoma are almost a certainty, and the average survival time after surgery would be around 60 days. The owners either have to choose between emergency surgery right now, or euthanasia.
But I need them to choose fast because I can see this dog fading, and that last big alarm bell is because this dog is going to die very, very soon, and it wont be a peaceful death unless I step in.
I know the dog’s going to die anyway. But I want her to have a good death, not a frightening, gasping one.
So I make everything happen fast. I explain what’s going on, only two options available and I am kind of rushing to get a catheter in which still explaining to the owners what it going on. The vein in hard to find, it doesn’t pop up like it should, but I can get it first try. The dog’s head it kind of limp in my nurse’s hands, and she gives me a worried look. She knows too.
I manage to perform the euthanasia before the dog becomes distressed.It’s faster than I would like, but at least it’s smooth. The humans have time to grieve afterwards. I apologize for everything happening so fast, and they say they understand, but it’s still fundamentally unsatisfying. It doesn’t feel like a good job, even though diagnosis and treatment were rapid.
Would it have been different if the dog had come in first thing this morning? Maybe. The diagnosis wouldn’t have been any different but the humans would have had more time to understand what’s going on. It’s still the right outcome for the dog, she was trying to die in front of me, and surgery would likely have been too late.
This morning the dog who had been lethargic just for a few hours didn’t necessarily sound like an emergency, but if they had waited any longer she would have had an unpleasant death.
This is one of the reasons I’m loathe to give veterinary medical advice over the internet for a patient I can’t examine. Vague clinical signs could be anything, anything at all, and there’s no way for me to tell what is an emergency and what’s not on the other side of the world. No matter what you might think is going on, I have no way of being certain, so my response will always be to take the animal to a vet.
