The power of words in veterinary medicine

In our celebrity-driven, reality-TV-obsessed world, money, fame, and power are as coveted as ever. But if you're like me, you don't really want the fame. My small but devoted cadre of followers on my clinic's Facebook page are more than sufficient. As for wealth, given the recent economic woes of my clients, I'm fortunate to have a steady job and a nice paycheck.

It's the "power" part of the equation that I find myself dwelling on. As a veterinarian, I have more power than I ever dreamed I would. I'm referring to the way we can completely ravage the lives of others with a simple sentence or two.

Paralyzing news

I became aware of this power in the first few years of my veterinary career in the early '90s. While working at a feline-exclusive practice in Maryland, I was scheduled to see an elderly client. She was a charming, delightful woman in her late 80s with a mind as sharp as a tack. She cherished her cat and doted on him accordingly. She had noticed he had recently begun to favor his right rear leg.

"Maybe he stepped on a piece of glass?" she wondered. "Or maybe he fell and sprained it when I wasn't watching? I'm just not sure."

I told her that I would take a look and see if I could figure it out. When I lifted the cat out of his carrier, I felt a large, firm mass infiltrating his right hip and part of his sacrum. It was something the client hadn't noticed. I knew from experience that this mass was undoubtedly a vaccine-associated sarcoma, it was in a location that was not amenable to surgery, and that this poor cat was doomed.

My heart sunk as I carried the cat to the scale. After weighing him, I brought the cat back to the exam table and performed my exam on autopilot, feigning concern about his mild dental tartar and waxy ears. All I could think about was the tumor and how to break the news to this poor woman. After the exam, I looked at her and said gently, "I feel a mass on your cat's hip, and I think that this is likely the cause of his limp."

"A mass?" she asked.

"Yes, a firm lump," I replied. "Let me show you."

I put her hand on his bulging right hip. I then placed her hand on his other hip for comparison. She immediately felt the difference. The conversation progressed to talk of radiographs and biopsies. I tried to cushion the blow, but this client was very perceptive. She could see through my feeble attempts. She looked at her cat as he peacefully sat on the exam table and she quietly began to weep.

Great power, greater responsibility

Twenty years later, I still get choked up thinking about it. I don't recall the rest of the appointment or the subsequent euthanasia not long after. I just remember how I ruined a woman's life with this phrase: I feel a mass on your cat's hip. The power I yielded in that exam room was colossal, and my awareness of it became deeply ingrained, becoming a significant (and eventually subconscious) component of my style of practice for many years.

Somewhere along the way, though, as the years progressed and the number of cancer diagnoses under my belt multiplied, I started to take for granted this enormous clout that veterinarians possess. In my veterinary hospital we see many cats with weight loss, inconsistent appetite, and vomiting. After ruling out common disorders such as diabetes, hyperthyroidism, and chronic renal disease, we're often faced with a diagnosis of a gastrointestinal disorder. In about 60 percent of these cases, we diagnose inflammatory bowel disease. In the other 40 percent, we diagnose low-grade gastrointestinal lymphoma.

Practically every week (or at least every other), I find myself phoning a client to tell them that the intestinal biopsies have revealed low-grade lymphoma. I then launch into my "lymphoma talk." I tell them that we should start the cat on prednisolone and chlorambucil, and that as far as cancers go, this particular one has a decent prognosis, with a median survival of about 25 months.

Reality check

A few months ago, I noticed a client on the schedule whose cat we had recently diagnosed with low-grade intestinal lymphoma. I had seen the cat initially, scheduled the work-up, and came up with the lymphoma diagnosis.

I called the client, relayed the diagnosis and arranged for her to pick up the medications to begin treatment. I asked her to schedule a follow-up appointment with me in two weeks. However, when I checked our appointment book later, the client was scheduled to see my associate who had distinguished herself as being uncommonly compassionate.

I assumed the scheduling was a mistake. When I mentioned it to my associate, she tactfully informed me that the client had actually requested the change.

"I think you might have underestimated just what a huge blow it was to this client to be told that her cat had lymphoma. The woman has been crying every day," my associate told me. "She has a million questions but she was reluctant to call you because you seemed so ... flippant," she said finally. "You came across as very matter-of-fact about the diagnosis and treatment. I don't know if you realize how much this diagnosis affected this woman's world."

Ouch.

Here I was patting myself on the back for working up the case so seamlessly. Hearing that was a total reality check. After 25 years of practice, a cancer diagnosis had become nearly as common as a urinary tract infection—I had forgotten the power of the veterinary spoken word. Duly humbled, I berated myself for being such a dolt.

"Hey, don't worry about it. She really is grateful that you came up with the diagnosis," my associate said. "She wanted to stay with our practice. Just keep in mind that a diagnosis of cancer—even low-grade GI lymphoma—is still a cancer diagnosis. News like this is like a fist in the face."

Pretty smart lady, my associate. I hope we can all learn from my mistake. I won't ever have the wealth of a Warren Buffet or the fame (nor, sadly, the looks) of Brad Pitt. However, my fellow veterinarians and I will always have more power than we ever could have imagined. We should never take it for granted.

Dr. Arnold Plotnick is the owner of Manhattan Cat Specialists in New York City. He's a feline advice expert on CatChannel.com and Petocracy.com.