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Friday, August 16, 2013

Kids, Reality, And Facing Death

My last case of the day yesterday was a difficult one.  A father came in with his two daughters and an injured hamster.  The oldest girl was about eight or nine years old and obviously very attached to the hamster, Sugar.  Earlier in the day they had noticed a problem with one of Sugar's back legs and had made the appointment to have her seen.

The hamster was in good overall health, very active, friendly and surprisingly sound for being over two years old.  That was the good news.  The very bad news was the left hind leg was badly broken and bone was protruding through the skin.  The fracture had happened in the tibia, and one of the broken ends had worked it's way through the skin, causing damage and infection.  I was actually very surprised that she was acting perfectly normal and had been eating well.  Somehow she didn't seem bothered at all by the fact that her foot was dangling by some skin and muscle.  Unfortunately due to the extent of the injury the only option was to amputate part of the leg.

This is actually something that I've done before.  I've amputated toes, feet, or legs on hamsters, lizards, chinchillas, and birds, all very successfully.  In some ways this is much easier than with a dog or cat as the bones and blood vessels are much smaller and therefore easier to remove and handle.  However, there is greater risk due to the size of the patient and difficulties in typical surgical precautions (IV catheters, endotracheal tubes, monitoring equipment, pre-anesthetic blood testing, etc.).  Even though Sugar was very old for a hamster she was in great condition and so I thought she was a good surgical risk.

The daughter was upset by this discussion.  She knew her hamster was badly injured and didn't like looking at the bone.  I could see her obvious nervousness and distress, which she also was quick to verbalize.  The idea of surgery worried her as there was concern about Sugar surviving.  However, as I talked she decided that she wanted to do the surgery.  In a way it was very sweet and amusing as she was adamant about the need for surgery.

The problem came when I had to start talking to the father about the costs.  This was not a simple procedure, and once I added everything together it came out to around $450.  This is definitely an expensive surgery for a pet that can be purchased for around $10, but is still about 1/3 of what it would cost for a dog or cat.  In this particular case there were really only two options...amputate the leg or euthanize the pet.  There was no intermediate option to bandage or fix it and allow it to heal.

I was trying to be careful how I worded things to the father since the girls were right there beside us.  I wanted to communicate to him the truth of the situation without upsetting his daughters too much.  Unfortunately there is no easy way to present euthanasia versus expensive surgery.  The older girl was still very certain that Sugar needed surgery and if it was up to her we would have done it right away.  But at her age she didn't understand the reality of the expense of doing so, or whether her parents could afford it.

I really hate being in these situations, and it happens more frequently than I'd like.  Kids become very attached to their pets and haven't learned to control their emotions as well as an adult.  They wear their feelings on their sleeves and it comes out quickly when discussing a very ill pet.  I've been in rooms many times when a parent and I have talked about a potentially terminal case while their child was next to us, and then have that child begin crying.  That's never easy, especially since I'm a parent.  We've lost several pets over the years and I've had to help my children through the grieving process, so when I see another parent having to do the same it really hits home to me.  Though I've learned how to handle being around upset and grief-stricken children, I can't say that it ever gets easier.  Often times the parent has an idea of the severity of the situation before they come to me and may have started the discussion at home.  But it becomes more "real" to the child when the doctor is the one talking about it.  And as hard as it is for them, this is a lesson that children have to learn at some point.

Any time I deal with terminal disorders and grief it makes me uncomfortable.  I'm not the kind of person who handles death well around others, whether it is human or pet death, and like many people I have a hard time knowing just what to do with a stranger's emotions.  That discomfort is multiplied when a child is involved as they are still learning how to process those feelings and cannot be consoled as easily.  In 16 years of being a vet I've been in these situations enough to learn how to handle most of them, and have learned that really anyone about to lose a pet just needs compassion and understanding.  And though I still don't like it, this is a reality of being a vet and something I can't ignore.  For the sake of my clients and their families I've had to learn how to balance truth, clinical detachment, and human compassion. 

In this case the father needed to go home and talk to his wife.  We started Sugar on antibiotics and tentatively planned the surgery for Saturday (I'm off work today and my associates aren't comfortable with this kind of surgery on a hamster...also there are virtually no other vets in my area who would even touch this case).  They were supposed to call this morning and let us know what they were going to do.  I won't find out until I get to work tomorrow morning, though they may come in today for euthanasia.  I might be surprised, but typically in these cases euthanasia is chosen for financial reasons, which I completely understand and don't begrudge the client.  But that can be another hard discussion and dose of cold reality for the daughter.

Nobody said that life lessons were easy.  And these are the things that veterinary students typically aren't trained for.