Lesson In Progress & Holden Update

The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don't play together, the club won't be worth a dime. (Babe Ruth)

The task of trying to figure out "now what" is an unwelcome one, and I find myself alone at the table. The owner of the Pet Emergency Center acknowledges that evidence exists that IV fluids were not appropriate for a situation like Cadi, but also says that he has talked to others who would have given fluids.
I am reminded of my mom asking me, "if your friends jumped off the Golden Gate Bridge, would you?" (Since we lived near the Bridge, it actually made sense -- this would not work if you lived -- for example -- in Iowa). Point taken -- company in a bad idea does not make it a correct one. In fact, the website for the Evidence-Based Veterinary Medicine Association has this excellent quote: "Consensus is not evidence" (Dr. Robert Larson).
But here I am, alone at the table -- my team has abandoned me. I am not sure how to figure out a resolution to all this without a team -- without key players talking to each other. I said that to the Pet Emergency Center owner -- let's try to figure this out, get a mediator -- something. No. Nothing.
Everyone has retreated to their corners and left me alone -- with the haunting, terrible images of Cadi's suffering and death. And a (virtual) pile of literature that suggests it didn't have to be that way. And nobody talking with me about it.
What is the lesson? I don't know yet -- except maybe that successful resolutions require the courage to keep talking to each other, even when it is very scary and hard.
I cut the grass in my dog training arena and set up an obedience ring in it, and in doing so opened the tub where I keep "stuff" for the arena -- and there was the familiar hot pink of Cadi's draft harness. And then in an instant -- there was the familiar flood of grief and tears as I held it close as if it could bring Cadi to me again. This has been a wickedly awful four weeks and one day...
But Cadi left us her family -- and today we celebrate Holden Squeaker -- Toby shares,
"Today Holden weighed in at a whopping 57 lbs, but is still all wiry and long-legged.  He pretty much has lost his baby coat, and now has a nice, still soft, curly black one!  He's very barky, and is my first Berner out of 6 that really is!  It's quite deep-he likes using it in the car, especially at drive-thrus, like the bank!  I now have to be careful at work, as he's decided it's HIS place, and all of my canine patients just don't belong there! 
Today he met two Berner girls and liked how they smelled, so he didn't bark at them.  I fear the hormones are starting to kick in-my hope is he'll be as easy a teenager as my real one, Matthew was!  He's incredibly affectionate and loving-he even has his own theme song now- "I'll Always Love my Mama," by the Intruders :)"
Thank you, Toby -- and Heidi -- I think you will need to go to PA with me! We have a boy to kiss!!!


by Carol Kracht on Mon, 04/23/2012 - 08:59

What you are trying to do here may not only help you MA, but the next dog to face this type of emergency...So thank you for working it through even when others fail you. I was thinking about this and remembering when I first read that Cadi had fluid in her heart I was thinking they must have drained off the fluid from the heart and if not why not? Isn't that what they do with people? So now I am wondering if they did not do that, were they just giving fluids as "standard procedure"? I think sometimes int he Er , when they don't know what to do, they do the basics...normally it is right to give fluids but I can see how this might not have been one of those times... so yes, perhaps the lesson is to not give up trying to find answers which may help the next dog...then perhaps you could write about it in the BMDCA magazine....Take care MA... and thank you...

by Auntie Jill on Mon, 04/23/2012 - 16:13

Mary-Ann: Tomorrow my dear Rev will go to Purdue as a neuro emergency. (he is not quite at emergency status, but we can't get an appt. until May 1st. he does not have that time to wait, so my wonderful Vet is pushing us through)
I am so grateful, that I have good questions to ask that, if I had not been reading your blog, I might not have thought to ask.
I am so sorry that I have this information because you've lost Cadi but am so grateful that you have been willing to share.
Hugs everyone. Hugs.

by Toby E on Mon, 04/23/2012 - 16:31

Jill, what's up? You can email me privately-drtobs@gmail.com.

by Susan Williams on Mon, 04/23/2012 - 17:38

Mary Ann, I totally and completely agree and understand your desire to get some closure on "what went wrong" at the ER. Additionally, I find it disappointing that the ER people seem less interested in investigating this situation .. very sad.

Seems the ER people are circling the wagons and have gone silent. What do they fear?
Also, were they not knowledgeable enough/out of their depth when treating Cadi?

As sad and unnecessary as it was to lose Cadi much to soon the very least the ER could do is work with you to obtain some reasonable understanding. Do you think there is something you can do to get the ER people to restart the dialog?

I also appreciate the fact that you are blogging about this...we all learn from your experience and we can all support you to the best of our ability...albiet, long distance. My thoughts are with you, Susan

by Lori Simidian on Mon, 04/23/2012 - 17:43

I think sometimes the lesson is learned later, as other experiences are seen through the filter of this one very terrible experience. I had an experience with Murphy at a veterinary ER clinic that easily could have turned tragic if not for the intervention of a specialist at another clinic and a huge dose of luck. Every decision regarding my dogs' health care has been influenced by that "near-miss". So the lessons are still being learned.

Mary-Ann, I wish I could help.

by Heidi on Tue, 04/24/2012 - 00:06

When people medicine has a situation like this, we retreat to a M&M "Morbidity & Mortality Meeting," where behind closed doors, we commit to looking unflinchingly at the truth of a bad outcome for a patient, in the hopes that we can humbly learn to be better providers for the next person. It is not easy, and proud people have to look squarely at their mistakes, which have harmed another or even cost a life. It seems to me that all you are asking for is something like this -- a honest and truthful exploration of a painful event with an unintended outcome, in the hopes that for the next animal, there will be more experienced providers with better information available. I'm shocked and disappointed that someone who practices medicine of any kind can not subscribe to the value of the opportunity you are presenting; were it me, I would be so grateful that your grief and pain are not preventing you from participating in this teaching moment, hard as it may be. Many owners would not be able to do what you are asking.

Can your vet perhaps help? When our lab Herbie was very sick and near death from a terrible GI bleed, I had a knock-down disagreement with the ER Vet about the care I was comfortable with for him. I was outraged that in spite of my explicit instructions, she did procedure and gave drugs that I had not authorized. I was very upset. My regular vet went to the DVM owner of the ER vet, and he called me directly so that we could discuss my concerns. It didn't undo the damage, but it did help me to feel better about the overall outcome. I don't think he would have called me without my vert recommending that he do so.

I really hope that you are able to come to a resolution. I am firmly in the camp that is advocating for your proposal.


by Aunt Heidi on Tue, 04/24/2012 - 11:39

I heart Sqeaker!!!!

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