Monday, August 15, 2011

Things Are Never So Bad That They Can’t Get Worse: Part II

Even though Espresso was hospitalized in worsened condition, one of the advantages and one of the reasons I chose the private vet hospital was because I could call day or night for updates.

I called once at 9, then again at 2 am. They told me she was much the same, but had eaten a little bit at midnight. She was resting comfortably.

She had eaten something! Maybe this really was going to pass in 48 hours or so. I went to bed somewhat hopeful. It would be the last time I slept well in a week.

I woke up early on Saturday morning to call for an update - I was left with hold music for a long time, I was nearly shocked when I found Dr. Pathetic talking to me. He must have had the morning shift.

He told me how she was basically doing the same, lethargic, not eating, and that she was still receiving fluids. He sounded very concerned, very solemn.

The damn bitch was feeling pretty damn guilty I’m guessing and thats why I talked to him personally and not a tech like I had for the other updates. He sent me home with no plan, no diagnosis, and there she was in worsened condition the very next day, under careful observation and another vet’s care. Someone done fucked up.

I got off the phone as quickly as possible with him - I had nothing to say and he was next to useless about making me feel any better. I waited impatinetly to call again after noon when Dr. Competent would be back in. I called in saying I wanted to come visit - we arranged to have me swing by around 2. They told me the vet wanted to talk to me and she may be able to fit me in when I visited.

When we were escorted to a private room, I had my suspicions things may not be normal. A tech came in and handed me my beloved puppy - she was completely lethargic still,

but gave me a kiss and showed she was happy to see me. She lay in arms. I looked at her eyes and noted they were red, discolored, different. My mom said she looked jaundiced and I scoffed - in retrospect realize it was denial. Dr. Competent herself walked in to meet us, no appointment or anything, and I knew it was bad.

She explained how the jaundicing indicated that Espresso’s liver was failing. They were in the middle of running another blood test - it would be about 30 more minutes or so - and then they could fully assess the damage. It was either a serious obstruction of the bile duct or other type organ, some serious disease that was causing liver failure, an infection like pancreatitis, or a toxin. We had moved beyond hopeful recovery on her own. Whatever it was, it was serious, and life threatening.

She left me and my Mom to be with Espresso. I looked at her eyes which had a tint of off-white, but it was when I flipped her ear that I saw her normal pink skin be a vivid shade of dandelion yellow. It was the first time I cried about Espresso. I sat there, tears leaking out, holding my sleeping, dying and jaundiced puppy. I could barely catch my breath. My mom did her best to comfort me, but there was nothing she could say, or do, that made this situation fair, okay, livable.

I just sat there holding my beloved puppy not knowing what came next, waiting for the blood tests. What felt like an eternity - or maybe just a millisecond, its hard to tell - later, Dr. Competent came in with my test results. Her liver enzymes were through the roof indicating a high level of liver failure. Her bilirubin, the bile that makes you yellow, was highly elevated compared to her normal levels yesterday. She was deteriroating, and fast.

At a private vet hospital, they couldn’t get the radiologist to ultrasound her gut until Monday. I could wait and hope she made it. Or I could transfer her to Cornell where she’d be admitted to Emergency, but with no promise of ultrasound until Monday either. They never guarantee that they will call the team in or if they will make you wait. I could hope maybe they team was already there for some other trauma and she would be seen before Monday. Or if she looked so serious, so on the brink of death, they would call in the team for her.

At Cornell she would have a chance to be seen sooner, and if she did start crashing, they would bring in whoever was necessary, and option Colonial did not offer. The choice wasn’t hard. Dr. Competent said she’d been talking to the head of Emergency, explaining the case, campaigning for the ultrasound team to be brought in, but she would call again, fight again for me, and call ahead so they would be expecting me. I bundled my puppy up, IV insertion in her arm and all, and handed her to my Mom so I could discharge her and get her ass to Cornell.

It was the longest 10 minute drive of my life. She just rested peacefully in my Mom’s arms, even looked out the window a little bit. Thank God I had driven by the vet hospital a few times in the last week - it’s not really on my way to much, except a back scenic but longer way to Target. I enjoyed the drive and had taken that route several times, seeing the signs for the Companion Animal Hospital on my way.

The picture is of Cornell Companion Animal Hospital - just a googled photo, but I figured I should show what would be the home of Espresso for the next days.

Cornell was open only for Emergency care- we had to push a red button in the hallway to be let in.

“Hi, I’m Lindsay with my mini dachshund Espresso, Colonial Animal Hospital called ahead, they should be expecting me”

“Yes we are, come right in.”

The doors opened. I took her to the receptionist who opened a glass window. I signed her in, signed for my truck in the parking lot. I held my baby. A friendly ER nurse came out and asked me a few basic questions and told me take of Espresso’s harness so it wouldn’t get misplaced. I placed it in my purse and cuddled my puppy. She told us it was a good day to have brought her in at least - the night before had been made it but it was very quiet that afternoon. At least she’d be getting lots of attention from bored vet students. The ER nurse then took her, still bundled to the back.

A vet student then took me and my Mom to a room to get her history. I gave the whole spiel I had given Dr. Pathetic and Dr. Competent again - about how I had just moved and we had traveled across the country, how we’d stayed here a week, how she had the roam of my yard which had all sorts of wildlife, how we had done a day trip to New Jersey and the progression of symptoms. No, she hadn’t eaten anything strange that I saw, no we hadn’t had a change of diet. No, we weren’t in contact with any other dogs.

My mom and I sat in the room. It was the first time I felt...relieved. I did everything I could do by taking her to one of the world’s first class veterinary hospitals. We talked, about everything and nothing. I even laughed about something I remember.

The student came back with the ER vet - let’s call her Dr. Reason. They told me that they had admitted her, started her on fluids again, and that they were going to call in the ultrasound team for her. They didn’t know what it was - it could be surgical and an obstruction - likely a bile duct obstruction explaining the excess bilirubin and elevated liver enzymes - in which case after the ultrasound showed what was up, they would bring her straight to the operating table. If it wasn’t surgical, she would be transferred to Internal medicine and kept in the ICU and be treated forthwith.

I asked all the typical questions - what were the risks, what was the worst case senario. I signed all the paperwork and the cost estimates. I was escorted out to pay the deposit.

Espresso was in the hands of the best I figured. I would get a call after the ultrasound and otherwise be updated in the morning.

They were calling in the ultrasound team for her. It was so bad, that she was the emergency case that would bring the team in. I was relieved my life wasn’t on hold waiting, but terrified I was such a critical case. I went home feeling the best I had been since the start of everything though. I knew she was in good hands, she had every faculty science could provide her at Cornell, and I live 5 minutes away from the vet hospital (I really did pick the perfect apartment).

The call came sometime later. Dr. Reason told me there was no obstruction as was expected - her pancreas, stomach, liver, and kidneys looked fine, were of normal size. However, there was some fluid that was found in her stomach, around her kidneys and bladders. It would be sent to the lab for further analysis, but there were no obvious bacteria or cells or even discoloration of any kind in the samples. Since she wasn’t an emergency case needing surgery, she would be transferred to internal medicine where she would be treated and cared for. I thanked Dr. Reason for her time and prayed that my puppy would be okay overnight.

A surgical problem would have been a relief - maybe not financially, but it would mean there was a tangible, easy to identify problem that could be fixed by a doctor immediately. Yes, surgery means introducing a series of other risks, but it meant there was an obvious source of Espresso’s failing liver and other symptoms. But she had no diagnosis. She was worsening but with no evident cause in sight. I had to start considering the worst. I had a deep feeling in my gut that I couldn’t get rid of that this was serious - gravely serious. I was having to face that I may seriously lose my puppy.

On that Sunday morning, I got the call from who would be the internal medicine vet to follow me through the rest of Espresso’s journey. I am going to call her Dr. Got-it-Right for her determination, panache, and veterinary skill. Although I really should call her Dr. House.

She told me about Espresso’s serious condition. She explained that a group of internal medicine had met and discussed her case. Basically they still didn’t know what was wrong with her, but they were damn sure going to treat her for everything. Instead of taking the time to test more extensively or see which treatment worked, they put her on everything for anything it could be. She was on pain medication for her increasing abdominal pain, anti-naseua medication to encourage her to eat, fluid support for the liver, steroids in case it was Addison’s disease, antibiotics in case it was get the idea.

A team of Doctor’s meet to discuss a medical mystery and then treat her for everything to see if anything works? Very Dr. House.

All we could do was hold out to see what treatments would work. Dr. Got-it-Right righty pointed out that a mere night of treatment wouldn’t be a long enough time to see if anything helped. At least she was on pain medication and being treated for everything. Espresso held throughout the day, showing no real improvement. Still no eating, still yellow, still ouchy.

But things are never so bad that they can’t get worse.

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