abigail414's diaryland diary
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Gummy Bear
Last Friday, I spent over 2 hours intensively trying to keep a 14 year old terrier mix alive. Gummy Bear had come in a couple days earlier for panting and not eating - and for some unknown reason the owner declined X-rays and I didn�t push it (we instead did blood work and cytology of an enlarged lymph node). In hindsight, X-rays would have been more helpful. The owner called on Friday and said Gummy Bear was no better and I said to come in for X-rays. She said she�d watch and maybe bring her in on Saturday. But Friday afternoon she sent her husband in.
We took the X-rays and I saw an enlarged heart and fluid in the lungs. I kicked myself for not insisting on them two days ago, but that is why they call it �practicing� medicine. You don't always get it right the first time unless you do every test possible (and even then it may not be possible to get it right). But, with this new information I could accurately diagnose heart failure, prescribe the appropriate medications and send Gummy Bear home. As with most heart patients, she would get better for awhile before dying, and the owners would be happy that we bought her some time. All would be well.
But, her lungs looked so bad on the X-rays, that I decided to give an injection of a medication to help clear out the lung fluid sooner. I tend to just send home pills that take effect hours later, and realized awhile ago that I should inject more often. This particular drug is standard treatment for heart disease, but right after the injection, I noticed Gummy Bear�s tongue had turned blue.
I don�t know if it was the injection, holding her for the injection, taking the X-rays, the stress of being at the clinic, or just the time her heart decided to go - but she was crashing from fulminant heart failure. Her heart was beating but was no longer pushing fluids through her body. She was put on oxygen and monitored for improvement of gum color. It didn�t happen. She tried to die, and was revived. Her owner came to the back to be with her. I became focused only on this dog and other doctors took my appointments. One doctor stepped in and did a cardiac ultrasound to look for any fluid around the heart that we could drain and help her (there was none). We started giving her oxygen directly down her throat with an endotracheal tube. Her owner called his wife because things looked so dire. Then Gummy Bear went into cardiac and respiratory arrest and died but was revived with CPR � a first for me. We kept her stable for awhile, her gum color improved, and she became alert to her owners (who, btw, were understandably upset that their dog had taken such a sudden downturn).
It was unclear what the next step would be. We aren�t a 24 hour clinic and it was 5:45 pm. With pure oxygen pumped directly into her lungs, she was in distress and taking rapid shallow breaths, but looked OK compared to how she had been. She would have to go to the emergency clinic for overnight care but was not stable for transport. I was waiting for the multiple injections of diuretics to take effect and help drain her lungs but it wasn�t happening the way it was supposed to. So, we decided to take one more X-ray to see if things were getting worse or better, and we would know what to do from there.
Gummy Bear died in the process and the third resuscitation didn�t work. It was heartbreaking for all of us. But the deadly X-ray showed that she now had fluid throughout her lungs and things were deteriorating rapidly in spite of our best efforts. It looked like a heart valve attachment had possibly ruptured, and no amount of medication or supportive care would have worked. I couldn�t help but kick myself once again for not insisting on X-rays two days earlier. Of course, maybe she would have died then from the stress of handling, or maybe there would have been a little window to get her treated and postpone the inevitable crash awhile longer.
These are the cases that hurt the most. The ones you think 'if only I had', the ones you try so hard to save but fail; they give you bad dreams, and wake you in the night with questions. I know that Gummy Bear had a terminal disease, and I was reminded by a colleague that that I have a D.V.M and not a G.O.D. - but wish she wouldn't have died on my watch. Rest in peace, sweet puppy.
9:17 p.m. - 2008-05-31
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