The shadow that stalks

As I finished looking at the somewhat dishevelled six-year-old Westie I reviewed my findings; TPR normal, skin a little greasy with saliva stained paws, axillae, groin, ears lichenified and stenotic, abdomen relaxed and nothing abnormal, an overgrown claw (now clipped).

Ears really should be seen by the regular day-vet, but not really the realm for me, a night vet, to get too involved in because it would take a long time to get them under control. I could find no clinically apparent reason for this dog’s vomiting. He had no previous history of any particular illness. He wasn’t even dehydrated, and he hadn’t vomited for a couple of hours, now.

As I washed my hands I went over what I was going to say next; give options of precautionary blood profile and then “symptomatic” treatment, or skip the bloods for now and go with symptomatic treatment.

I turned around and looked the stooped elderly owner in the eyes. She beat me to it; “Is it… is it… is it… The Cancer?” she asked with watery eyes.

That caught me by surprise. “Eh?” I blurted rather unprofessionally.

“Is it The Cancer? Tell me straight, doctor.”

Tell me straight? The Cancer hadn’t crossed my mind ’til then.

In that second I realised a couple of things; that a person’s fears for their pets can be mirrored by their fears for themselves, and The Cancer is a shadow that stalks us all, but particularly as we get older. I also realised that in this world where the public are increasingly aware of the litigious side of the law and getting redress and revenge through the legal processes, we as the clinicians necessarily have to protect ourselves but in so doing we often hold off on providing a caring human reassurance.

I gave a hitherto-rare response, one uncharacteristically confident, “No, I really don’t think so. But I’d suggest a few tests to reassure us both, and then give him something to calm his stomach down.”

When I discuss this and our approach to cases and clients I use the cliché “don’t blame the player, blame the game”. In bringing increasing numbers of complaints and legal cases against vets and other medical professionals, it could be argued that the public (as a generalised body rather than specific people) is bringing this approach upon themselves; the huffing, hedging of opinion, the warnings that things could be much worse than it looks, more tests and documentation than would normally be considered “necessary”… Some people, like that old lady, need a slightly more human approach.