Friday, 14 May 2010

One of those days...

It's been, as the cliche says, one of those days. It was one of those days, in fact, that made me start this blog in the first place. I don't know where those days come from, but wherever it is they can piss off back there, as far as I'm concerned.

It was the kind of day, in fact, that reminds me that we are, all of us (except for our mighty Robot Overlords, of course) basically fleshy machines, and that when something goes wrong with a bit of the machine that happens to house you, well, it's not great news.

Not a revelation to rival the Buddha's, perhaps - but it is a very obvious fact, the more you work in any kind of medicine. We're machines. Very complicated, self-repairing, self-aware and quite amazing machines, but machines. And machines break. And there's no reason behind this any more than there was a reason behind my Xbox breaking (THREE TIMES you bastards Microsoft! Ahem. Sorry.)

And that's the point of this blog. In fact, it's a bit of a cheat of a blog because it's really just an introduction to my very first blog, which I had to delete from my site (you'll find out later why. Just keep reading, you inpatient bugger. Or skip to the end. I'll put a joke there, I promise.)

So, the reason I'm in that kind of mood today - I came in this morning to find one of my inpatients, a very sweet cat called Humphrey (it really shouldn't matter whether he was sweet or not, should it? He didn't deserve what happened. But I'm getting ahead of myself, hang on...) feeling very poorly indeed. He'd been on intravenous fluids since Wednesday, and this morning his blood results were waiting for me from the lab. And they were not good news. Humphrey was very severely uraemic - that is, his blood urea and creatinine were something in the order of fifteen times the normal upper limit - that is, Humphrey's kidneys were buggered. He hadn't passed urine since he came in, despite all the fluids we were pouring into him, which meant his kidneys had pretty much shut down. Maybe better medics than me could save a cat like Humphrey, but I've never managed to get a cat in this state any better.

So, with a heavy heart, I phoned the owner (who must have seen the number calling, because she answered the phone with a hearty 'Hello! How are you?', which made me feel great). Humphrey was five years old, and I had no idea his kidneys would be in anything like the state they were. Fortunately, being the cautious chap I am, I had admitted him straight away for fluids, which was the right thing to do in such a situation. Unfortunately, for Humphrey especially, it hadn't made a blind bit of difference.

Now, there's not many things that can balls up a young cat's kidneys so severely and so quickly. A blocked bladder would do it, but Humphey had been peeing fine before this happened. Which leaves a rather short list, top of which would be poisonings. And top of that list would be antifreeze.

(which reminds me - please please don't use antifreeze in your nice water features in the garden. Cat's love running water. Antifreeze kills cat's kidneys, followed fairly quickly by the cat. Learn to love your frozen over water feature!)

But, talking it through with the owner, it wasn't antifreeze. Here comes the heartwarming part of the tale (I'm using a sarcastic voice here, if you wan't to read it to yourself like that. Ta.). The other poison that destroys cat's kidneys very quickly and irreperably is lilly pollen.

And as it turns out, Humphrey's owner's house had a lot of lillies in last week. On account of her father dying suddenly and unexpectedly the week before.

I put Humphrey to sleep today, because he licked a lilly plant last week. Because his owner's father died the week before.

I guess what I'm trying to say here is - there's no blame, there's no malice or hatred, or anything, behind any of these events. They just happened. Just like one day, they'll happen to us. I don't know why we seem to have this inate feeling, this need that life should be fair. To the point where if it isn't we tell each other its our fault that it isn't, because of what we like to do in the bedroom, or because we eat fish on the wrong day, or pray pointing in the wrong direction, or some other crap like that. I see, every day of my life, that life isn't fair, it isn't anything other than life, and it still surprises and upsets me when it isn't.

My wife has had a bad day too. A Staffordshire Bull Terrier that she operated on today, and removed an enormous tumour from it's spleen, died suddenly a few hours after it woke up, likely from a pulmonary embolism. It was less of a shock, because we already knew that the tumour had spread to the dog's liver (and possibly heart), and it almost cetainly wouldn't have lived more than a few months. They would have been comfortable and mostly normal months, though, at home with his owner, and he had them all snatched away in the space of a few seconds.

So, in the spirit of that, I'm re-instating my old first blog post, which was inspired by much the same sort of thing, and it expresses it better than I'm managing here. It might be grim, but keep reading! I promised that joke at the end, didn't I?

* * *

Life, death, and blogging.

As I walked into work today, I was immediately rushed downstairs by Chris, to help one of my vets. On the operating tablet was Maisie, an eighteen-month old Dogue du Bordeaux (if you don't know this breed, think of a slightly more canine version of Bungle from Rainbow and you won't be far wrong. Man, Bungle used to scare the crap out of me when I was a kid)

As I rushed into the theatre, wrestling the stethoscope from around my neck, Maisie gave a great shuddering cry, and vomited copious stinking bloody fluid all over the floor, and all over Jenny, one of our junior vets.

Several minutes later, despite much ER-alike injection, pumping, tubing and thumping, Maisie was dead. Not one of us could do a damn thing about it. When we opened up her abdomen, her guts were purple, and stinking. She had an intussuseption - where the intestines telescope into themselves, effectively causing a blockage - but this was likely secondary to the inflammation in the bowels.

Two hours earlier, Chris had walked Maisie out from the practice to go to the toilet - Jenny had admitted her the night before to keep in for observation for her vomiting - and she had wagged her tail, and walked (if slowly) out to the grass verge opposite the hospital, sniffing around in the way that dogs do to show they know more about the world than you do.

Jenny and I have both spent the rest of the day feeling miserable and useless. Partially because it's one of those cases where we feel there are no lessons to be learned - if we saw a case like Maisie's again tomorrow, we wouldn't have treated her case any differently. There was never any indication to operate before - Maisie's abdomen felt normal, her temperature was normal, she was bright and wanting to eat - but mostly because it was just so damn unfair. What did Maisie do to the world to deserve to die in such a terrible way? She wasn't even two years old.

Is there a point to this blog? I'm not sure. Nobody ever said the world was meant to be fair. I deal with death and suffering ever day of my life, but there's still some part of me that's hard-wired to think that there should be some justice in the world. Today I had yet another reminder that life is fleeting, and precious.

So I'm starting this blog - to remind you all of this simple fact, possibly the hardest one for any human to digest. The blog is primarily about my work life. I'm hoping to show you what it's like being a vet in a world like this. Hey, it's a living.

Also to vent my spleen. Trust me, I'm a vet, spleens need to vented regularily or damage will ensue.

More tales from the front line to come.

* * *

Okay, you've made it to the end! Well done! Hopefully you don't need counselling at this point. The reason I deleted that post originally was because the case concerned, and both myself and Jenny, became the subject of a Royal College investigation at the request of the owners. This was sad, but not surprising - you've just read how I felt about the case, imagine how the owners felt. It was a senseless death, very depressing and very unexpected.

I can post it again because the investigation concluded that we had done nothing wrong, and there was no case for us to answer. The owners don't believe that of course, and without understanding, neither would I. The simple fact is, we did our best to save her, and she died anyway. It's a hard thing for our society to accept.

Right, you've made it through all the depressing stuff, now here's the joke....

There isn't one! It was a cruel literary subterfuge all along to further illustrate the point of life's unfairness. Except in this case it was a quite deliberate unfairness orchestrated by me. So it doesn't really make the point at all. Sorry.

Ah, never mind. I'm getting a drink. Anyone want one?

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