Not All Endings Are Happy

By David A. Rustebakke, DVM

Dr. Rustebakke is a long time veterinarian and owner of Rustebakke Veterinary Service

​            Veterinary practice can be exhilarating, challenging, and frustrating.  I like to post pictures and descriptions of medical cases where everything turns out well.  It is fun to do, and fun to read the comments that follow.
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          In the real world not everything turns out the way we would like.  We are constantly faced with cases that have no chance for a successful resolution.  Some injuries and medical problems are irreparable.  Combine that with the fact that farm animals (and many pets) are living outside, often with an owner who has other priorities and doesn’t take the time to check them every day.  Maybe the owner is ignorant on what constitutes an emergency  (ignorance does not equal stupidity or being a bad person; we all have areas where we are not particularly knowledgeable).  Maybe the owner is knowledgeable, has done everything right, calls for professional help in a timely manner, and has the resources to take care of any problem.  And we still may be faced with a situation that has no chance for a successful outcome.  In these cases, the best I or any veterinarian can do is give our best assessment of the case, give our opinion on the chances for a successful outcome, and leave it to the owner to make the final decision.

​​           Primary care providers in human medicine are the family practitioners who see most any case that comes in the door.  The majority of cases are routine and can be handled without specialized equipment or training.  The difficult cases are referred to a specialist.  We are trending that way in Veterinary Medicine.  However as general practitioners we tend to take on more challenging cases than our human counterparts.  For example, most of us do surgery and obstetrics.  We all handle complicated medical cases that in the human medical world would be referred to a specialist.  Most of us have state of the art radiology equipment, in house laboratory support, diagnostic ultrasound, and many other things that a human general practitioner would not typically have.  However, we often run into cases that require equipment, facilities, staff, and expertise that we don’t have.  That is when we refer to a specialist.  Many (perhaps most) cases we would like to refer to a specialist are in fact not referred.  The most frequent reason is cost.  Referral hospitals tend to be more expensive due to the increased cost of having and maintaining specialized equipment and having the infrastructure and staffing to handle complicated cases.  Consequently, we do the best we can with the resources we have available; most cases do well, but some do not. ​
 
          Here are three recent cases to illustrate.  Wednesday I was called to look at a sick goat.  He was a middle aged wether and a family pet.  He had been noticed sick the day before because he was not eating like the others.  When I got there, he was lying down and didn’t want to get up.  When he did get up his abdomen was obviously full of fluid.  His temperature was 94 degrees, normal is 102.  I cleaned up a small area in his flank and inserted a needle with syringe attached and found bloody urine.   A urinary tract obstruction several days ago had gone unnoticed till long after his bladder had ruptured.  Urine had been building up in his abdomen for a few days; he was hopelessly toxic and barely clinging to life.  My job was to make the diagnosis and recommend what to do.  The prognosis was very poor; the owner made the wise decision to euthanize him.
 
          The next hopeless case was the very next day.  A rancher brought in a heifer with a rectal prolapse. She was wild, and in the process of getting her confined she backed into a gate and tore her rectum; continued straining caused her intestines to come out.  Any repair would not be likely to succeed.  She was young, healthy, and edible so the decision was made to slaughter her so the meat could be salvaged.
 
          The following day a yearling filly was found in her pasture lying in snow unable to get up.  I got the call to check on her.  On arrival she was still down, unable to get up, and practically comatose.  Her body temperature was 93 degrees (normal is 99-100), her pulse was 80 (normal is 35-50), her mucus membranes were purple instead of pink, and her abdomen bloated tight with gas.  She was dying and there was no way I had a reasonable chance of saving her. She was euthanized as well.
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          Veterinary practice has its challenges; it is often stressful, and not everything turns out well.  But those of us who do this every day learn to take it in stride.  We learn to enjoy the people and the animals we work with, savor the successes, and not let the failures get us down.  Always remember: the only people who never fail are the people who never try.  I plan to keep on trying!