A little 'no-how' helps deliver the cold hard facts

I finished the surgery with feelings of pride and accomplishment. There were enterotomies in four places. The abdomen was closed, the skin was closed, and the drain was in place.

Within minutes, Mrs. Getim was on the phone. She didn't ask about the surgery. She didn't ask about the prognosis. Wanda Getim just had one question. "Can I come take him home now?"

I explained that my treatment plan called for a few days in the hospital where I could treat the pooch and monitor his progress. She didn't buy it.

"You know Doctor," she said. "Now that the surgery is finished, there isn't one good reason why he should have to stay in the hospital."

I was forced to go over the facts.

The poor dog just had major abdominal surgery. He had peritonitis, kidney failure and was on intravenous fluids and antibiotics. His abdominal drain needed regular attention, and his prognosis was iffy at best.

"Those things don't bother me," was her reply. "I grew up on a farm. Why, one time I even helped our vet neuter a cat. Besides when my cat, Molly, got spaded I took her home the same day, and she healed fine. I'd like to take him home right now, before he wakes up. That way, he won't be too excited by the car ride. Won't that be better for him than to wake up in a scary hospital?"

I formulated an answer to her question. It went something like this: "No."

"Well then, doctor," she said. "I'll wait until after he's awake if you think it best. But I still think he should come right home then. Will it be OK if I pick him up right before I close tonight?

I tried the same answer as before: "No."

She vowed to stop by later to visit my patient and to re-visit my decision. In the mean time though, I had to get back to work. My very next office call was Ellis Ware. He was upset with my hospital's post-operative policies as well. As I entered the room, he gave it to me with both barrels.

"You recommended that surgery, and now poor little Gooey is sicker than ever. On top of that, your office manager said that I would have to pay for this office call even though the surgery you told me she needed has obviously made her worse."

I glanced at the record. Three weeks ago I diagnosed a pyometra and recommended surgery. The cat had been very sick at the time. As far as I could see though, surgery had never been performed.

"Oh, I didn't have it done here," he said. "Not at your high prices. I waited a week or two until they could take her at the spay clinic. Her operation was five days ago, and she isn't better yet. In fact, I think she's worse. Why did you tell me she needed an operation if it wasn't going to make her well?

I reminded him of my other recommendations concerning fluids, antibiotics and most of all, attacking the problem rapidly.

"Wouldn't those things just mean more expense?" he asked. "It seems to me that everything you recommend costs me money. Now, I can hardly believe you want me to pay for more care when the surgery didn't do what you said it would. I still think you should treat Gooey for free."

I tried the same answer that I used on Mrs. Getim. "No."

Gooey stayed in my clinic for treatment, and, by the end of the day was looking much better. Unfortunately, the end of the day also brought with it the much-anticipated visit from Wanda Getim.

"I'm ready to take him home now, Doctor," she said. "Just show me that drainey thing, and tell me what to do. Remember, I grew up on a farm. I've seen it all. Did I tell you that I once helped neuter a cat?"

This time, I didn't tell her, "No." Instead, I brought her back to see her dog, showed her the bloody drainey thing and explained what she would have to do at home. Luckily, she made it all the way to the parking lot before she threw up.

Dr. Obenski owns Allentown Clinic for Cats in Allentown, Pa.