That time I ruined Christmas

It was December in Nashville, TN.  I had just moved from Indiana the week prior, and I was battling a horrific case of bronchitis and bilateral ear infections. My voice was nearly completely absent, I felt like garbage, and, naturally, I was working overnights…

A STAT triage is called and I run over to assess the dog – a Chihuahua named Poncho (like the raincoat, not the Spanish nickname). Poncho is having a hard time breathing, and his peripheral oxygen saturation (SpO2) is low but not awful (96% at room air). Poncho has a loud heart murmur and crackles can be heard in his lungs. The technician informs me that the owners know Poncho has congestive heart failure, and he is currently receiving medications for this disease. The owners signed a form allowing for immediate care, so we place an intravenous catheter and give the dog an injection of lasix to help pull some of the fluid off his lungs. We also give Poncho a small sedative and place him in oxygen while I go attempt to talk with the owners.

I enter the lobby and ask the receptionist to call for the dog’s family. A couple jumps up in the corner of the lobby; the wife screams “Oh Thank Gawd” (insert here a THICK New Jersey accent) and they rush over to meet me. I squawk out an introduction and show them to an exam room.

As we sit in the exam room, I begin to take in the scene and realize there is no way I could have prepared myself for this encounter. The owner (Mr) is in a velour tracksuit with a thick, gold chain necklace, and a NY Yankees cap, and the owner (Mrs) is in high-waisted jeans and a Mossimo jacket with shoulder pads. It goes without saying but large hair, copious make-up, and loud lipstick complete her look. Can I just say: Stunning! (insert Pinocchio emoji).

Me (dry, scratchy, hardly audible voice): Please tell me what’s been going on with Poncho.

Owner (Mr): Oh my Gawd! Your poor voice! You must be so …

Owner (Mrs): Oh my Gawd, forget her voice!  What is wrong with Poncho?!

Me: He is having a hard time breathing. I believe he is in active congestive heart failure. Can you tell me what’s been going on recently?

Owner (Mr): OK Doc, please try not to talk. We will tell you everything. Poncho was diagnosed with congestive heart failure a while ago…

Owner (Mrs): A year ago!

Owner (Mr): So anyway, Poncho has been real itchy recently so we took him to the vet earlier this week…

Owner (Mrs): On Monday!

Owner (Mr): Woman, would you let me speak?!

Me – awkwardly waiting but also eating up this dramatic conversation, silently comparing this encounter to a scene from The Jersey Shore

Owner (Mr): As I was saying, we took him to his vet and they gave him an injection of steroid and sent us home with pills. He ain’t itching anymore, but then he started coughing a bunch. And today he seems like he can’t breath so good.

SPOILER ALERT: Steroids cause animals to drink more water than normal and also retain water. This is NOT a medication that should be given to dogs with congestive heart failure. Ever. End rant in my head – Can’t tell the owners this because it would be unprofessional of me to throw their regular veterinarian under the bus…

Owner (Mrs): Now doctor, I know you ain’t got no voice or anything, but you can obvious hear good. (She proceeds to lock eyes with me) – This dog is our baby. He is our only child. You have got to make him better.

Me: OK. So a couple things guys. We need to get some x-rays of Poncho’s chest to see how much fluid is in his lungs…

Owner (Mrs): How does he have fluid in his lungs?!

Me (probably appearing shocked that she doesn’t know anything about her dog’s heart condition and also frustrated because I know this is going to take a lot of talking and I am just really not up for it): Mam, you told me yourself; Poncho has congestive heart failure. Your dog’s heart doesn’t function properly anymore, likely due to a valve that is lazy or maybe torn altogether. His heart is enlarged, and it does not pump as well as it should. Because your dog’s heart doesn’t work well, fluid backs up in his lungs. Your dog is on medications to help his heart function better, but congestive heart failure is a progressive disease. Poncho will eventually die from his heart disease. Truly, Poncho has already had heart failure for a year, which is a long time – longer than the normal survival time for dogs with this condition.

Owner (Mrs): Well I’m not so sure about that.  

I proceed into a coughing fit – difficult to say if the coughing is from the bronchitis or a reaction to the sheer audacity this woman has to say I am wrong about a disease that she literally knows nothing about.

Me: OK, well, irregardless. I’m going to want to keep Poncho overnight for oxygen therapy and a constant rate infusion of lasix. Once his respiratory rate and effort are normal in oxygen, we will wean him out of oxygen and get him home to you guys. I will get you an estimate and we will review that together.

Owner (Mr): We don’t need no estimate doctor. This dog is our life.

Me: I will get you an estimate. It is hospital policy.

Sidebar here: Whenever an owner says they don’t need an estimate, they ALWAYS need an estimate. Literally, when I hear owners say that (“I don’t need an estimate”), I get chills because I know they are going to freak when they see the cost.

I put together an estimate, and the total comes to around $800-1,000 for exam, diagnostics, hospitalization, oxygen, go home medications, etc.

I walk in the exam room to review the estimate. Before I can even start to go line by line over the charges, the owner (Mr) loses it. SHOCKING!

Owner (Mr): You have gotta be kidding me! You can’t be serious! How do you sleep at night charging people this?!

Me: I don’t sleep at night, sir – I am an overnight emergency doctor.

Owner (Mr): Listen doc, it’s nearly Christmas. There has got to be another option.

Me: We can give Poncho another injection of lasix and send him home, but I can’t guarantee he won’t decline. Furthermore, all dogs in congestive heart failure are at risk for acute death. You might be back later tonight with the same concerns or Poncho might be even worse.

Owner (Mr): And the cost will be cheaper then? If we come back later?

Me (obviously confused): I’m sorry I don’t understand. The cost will most definitely be the same.

Owner (Mr): You’re killing me, doc!  

Owner (Mrs): Our vet would never charge us this much!

Me (losing patience and feeling like garbage and sick of being yelled at): I’m very sorry you feel that way. This is an emergency hospital, and there is a premium to be paid for outstanding medicine. I understand you can’t afford it, and I am sorry. It is not ideal, but we can try to treat your dog as an outpatient.

We also discussed Care Credit and other options, but the owners elected for outpatient care. I type them discharge instructions that stated they were taking the dog home against medical advice and instructed them to call with any questions or concerns.

* * * * *

Several hours later, the phone rings, and it is the ever-so-charming owners of Poncho – both of them – talking at the same time. They state that Poncho is no better. My technician speaks with them on the phone, as my voice is now toast after the extensive, argumentative conversation with them earlier. Hospitalization is again recommended, but the owners elect to keep monitoring him at home.

* * * * *

At 3am, the phone rings. My technician answers and is greeted only by the sound of wailing.

Poncho. Is. Dead.

The owner (Mrs) is screaming into the phone.

Meanwhile, another phone line in the hospital rings. Another technician answers that call, and it is the owner (Mr). I get on the line with the owner (Mr).

Owner (Mr): You killed my dog!

Me: I am very sorry you see it that way, sir. I recommended hospitalization and oxygen therapy and you declined keeping your dog here.

Owner (Mr) – yelling at his wife (still on the other phone line just wailing into the receiver): HOLD HIM! ROCK HIM! DO NOT STOP HOLDING HIM!

Me: Sir, I am very sorry for your loss of dear Poncho.

Owner (Mr): You better be sorry, doc! I am coming for you and your license! How can you mistreat animals like this?! You should have fixed him! YOU HAVE RUINED CHRISTMAS! 

Me: Sir, your dog had congestive heart failure. As we discussed, this is a debilitating disease with a mean survival time of 9 months. Poncho lived for over 1 year with congestive heart failure.

Owner (Mr): He would have lived forever if you had just treated him right! (Diverts conversation to his wife) – HOLD HIM! HOLD HIM!

The other technician is still on the line with owner (Mrs), who is now shouting “That b**** killed our dog!” over and over again.

Me: Sir, I am going to let you guys go. I will call tomorrow to update your regular veterinarian. Again, I am so sorry for your loss.

Owner (Mr): We aren’t done here! Justice will be served!

 

Justice was indeed served in the form of a scathing Yelp review.