September 26, 2006

Unexpected Emotion/Ethical question

In PBL (problem based learning) today, we were discussing a hypothetical old, skinny cat who had an infection and renal disease and who couldn't stand up. Medically, we spent the past couple weeks figuring out all the things that were wrong with it and what we could do for the animal. Good medicine meant taking an ultrasound of the kidney, giving it fluids, keeping it in the hospital for 5 days, doing a blood transfusion and checking in on the animal every couple of weeks thereafter, and keeping it on antibiotics, high blood pressure meds, etc. All in all if it were a real animal it would have cost ~$2000-3000. The animal had gained weight and seemed bright and alert and was doing better a month later.

As we discussed the case, I just broke down inside, wild confusion in my head, "This medicine is exciting, how neat that we can actually help the poor cat. But it still has renal failure and is an old cat. Is it worth two or three thousand dollars to try to fix an animal that will never be a perfectly healthy animal again? Two or three thousand dollars plus all the resources that go into my education to be able to work up this case, plus all the physical resources to do the medicine (plastic, plastic, plastic, ultrasound technology, lab work, blood work, more plastic...)---it seems so wasteful; there are so many more pressing issues in the world that would benefit from those resources than an old cat with a chronic disease. Things like conservation/ecological education, starving people, political corruption, alternative energy sources, stopping genocide, promotion of peace...... Yet, to that single person that owns the cat, this may be just as important. Or maybe not. And as the veterinarian, the doctor, what I present to her will make the difference in how this is handled. So do I tell her to just euthanize the animal? Do I go ahead and do all this medicine (that most clients, especially in states like Kentucky where the health and wellbeing of the people is fairly degenerate, and animals are a far second in priority) or just maybe a couple of the treatments which would cost significantly less but not give the animal as great a quality of life?"

I brought some of these issues up to my classmates, frog in my throat, tears welling--and they took my concerns seriously. But they also were quick to rationalize it. Which made me confirm that they are made for cat/dog work, and I am not. I simply can't see working in a field that seems based on luxury. Owning pets and feeding them is a luxury that we in this country take almost for granted (I have had poor clients not pay their electricity bills in favor of their animals' antibiotics, so I see how important it can be for people to have companions, but this is an extreme case). Owning horses is an even greater luxury (though I wish we all owned horses rather than cars at this point). And therefore I can't see myself working as a small animal or horse vet. Cows, goats, sheep, llamas, etc---these are owned by people for sustainance and clothing which seems more basic a need. Of course, in this country, the way cattle are "grown" is deplorable and I'd have even more problem working in a field that supported that industry. Sigh....

Just 2 nights ago I was saying that I could maybe work as a feline vet since I love cats so much (petting 6 cats in a day=good day for Alyssum) and seem to have a "way" with them. I just didn't expect to get so upset about this, it came out of nowhere, I didn't see it coming.


Mick said...

not too long ago, I was talking to my uncle a life-long doctor and dieter, too.. He has always been ahead of the curve on a variety of diet-based healthy living trends, w/o being drastic or trendy (despite the occasional head-shaking of other less-healthy relatives). I was asking him about this or that nutritional notion that I was considering, and he said the damnest thing: "The thing is, that people don't want to talk about frequently, is that eventually, people die."

He didn't say this with a particular disdain, but merely as a fact.

And it raised in me a moment of clarity, about how I sometimes believe on some basic level that if I eat right or exercise or whatever, that I won't die. Crazy thing to think, but not uncommon, I realized after hearing what he was saying!

I also think that there's a bizarre tendency in western medicine to deny death as a natural part of life. Which leads to a never-ending wonder at the THINGS MEDICINE CAN DO. But at what point do we "let it die?" w/o seeing that as insensitive or callous or cruel or whatever.

onewooga said...

Well, girl, I must say. Welcome to my life. I deal with this issue all the time. And there are no easy answers. Every person is different. For some, paying that much money is worth it for a possible year or two more of health. Others are more conservative, and either feel it isn't fair to put their pet through that kind of intensive work-up. Still others would do whatever they can, but can't afford the care. The thing is, maybe the real trouble is not just one of whether western medicine denies death (it certainly does frequently, and yet, as a veterinarian this is a unique question, because we CAN offer death) but also one of legalities and other questions. First of all, you can't tell people to put their pet down. Or rather, you can, but it's a foolish move if they later decide to blame you for that decision. Secondly, while pet ownership is a privelege and a luxury from a general perspective, I for one would still never give up my old sick ferret without trying what to me seems reasonable. And that's just it. ise my job as one where I can only outline options. I can say, here's what we can do, here's how much it costs, and I can't always guarantee your pet will live after all that you've tried.

On the other side of the coin, I often get people whose pets are very ill who want them to jsut die at home. I feel conflicted because I too understand the deep desire to die at home peacefully. The problem is, most death is ugly and painful and not peaceful. While I think we definitely have a crappy cultural ability to deal with death, we also can offer peaceful death to our patients, unlike people). Kind of ironic, huh, that we can't deal with death as it truly is, so we try to only think of it as a quiet and peaceful thing.