Compassion can lead to heartbreak
It was the Jewish holiday of Simchat Torah, when we celebrate coming to the end of the Five Books of Moses contained in the Torah scrolls, and going back to the beginning. There's music, dancing, and, of course, food. I was the veterinarian on call that Saturday. My cell phone was in my pocket set to "vibrate," since the wailing klezmer clarinet was sure to drown out any ring tone. My phone buzzed. Call the Animal Control Officer (ACO). A cat had been hit by a car. Sigh. When something as small as a cat collides with something as big as a car, it's rarely good news. "Is the cat alive?" I asked, when I reached the ACO. She was en route to the scene and didn't know yet. "Call me when you get there," I advised, collecting my things. "If it's alive, I'll head for my office." When she called back minutes later, she wasn't hopeful. The cat was breathing, but had lost a lot of blood. "Is the owner there?" I queried. Negative. No owner in sight. No collar. No tags. Double sigh. Here we go again, I thought, as I gave my kids a quick hug, and headed out of the party.
I knew only too well the possible scenarios. The cat might be so severely injured that it would die no matter what I did. It's not uncommon for vets to go racing to our offices after hours, only to find our patient DOA. The cat might not die but the trauma might be so extensive to warrant immediate euthanasia, even if we could not locate an owner for permission. I remember many years ago, the ACO brought a cat that had gotten caught in a haying machine. One front leg was completely severed, the two hind limbs badly broken. The cat was wide awake. After a minute, I couldn't bear it and decided to anesthetize him. At least he would be unconscious while we sorted out what to do next. Sounds simple, yes? Not really.
First of all, I was not the practice owner and my employer was understandably concerned about who was going to foot the bill. How long do I keep him under? We might not find an owner for hours or even days, if ever. Do I try to fix his injuries in the meantime? What if no owner is located? Could we find a home for a three-legged cat? Who would do the months of intensive nursing? I don't recall whether we found an owner, or whether my employer got paid. I do recall that several hours later, we euthanized him, and I remember my emotional struggle, witnessing this cat's pain, as we navigated the stormy waters of financial, legal, and ethical responsibilities and realities.
Who owns this cat?
On the other end of the spectrum are patients that arrive with injuries that turn out to be minor. Since the ACOs aren't veterinarians, if they are not sure, it makes sense for them to seek professional input. I can wrap those cases up quickly and economically, sending them off to the pound with the ACO until they are identified. But the most challenging scenario is the one I was about to encounter again - the injured animal without identification that might be saved, but needs a significant amount of immediate intervention.
The ACO arrived, the cat swathed in a blood-splattered blanket. As soon as I unwrapped her, the kitty ran down the table. "Good," I thought, " no broken back or legs." I turned my attention to her head. The copious bleeding had come from her nostrils. One eye was closed, the side of her head puffy and her jaw slightly askew. Little Noname had probably bounced off the car tire, landing head first on the pavement, sustaining a broken jaw, concussion, and bloody nose. There was a chance the concussion was minor and the jaw reparable, but there was no question she was in shock and needed immediate care. There was also a chance the concussion was serious. Head trauma symptoms can often be delayed, so intervening quickly with medications to minimize brain swelling is recommended. The jaw injury could not be fully assessed until she was stabilized enough to anesthetize.
If Noname had a microchip, or other identification, I would have called her owner to discuss options, but she had none of these. With no owner to consult, I had to decide what to do. Legally, and ethically, I am bound to provide basic emergency care when the ACO brings me an animal, for which I am guaranteed to be paid the grand total of $20 dollars by the county. That's right. Twenty dollars. Then if no one claims the pet after 24 hours, I can legally "dispose" of it. But if this were my cat, I would hope some kind veterinarian would give her the best chance at survival, within reason, and control her pain, at least for a few days, until I was found. Sure, we could argue that the owner was at fault for allowing the cat outside, or for not putting identification on it, but when holding that little life in my hands, laying blame doesn't seem productive. I would never want to lose an animal for lack of trying, and then have to tell an owner, once located, that we withheld potentially lifesaving treatment because we didn't know who would pay the bill. But who does pay the bill? Who bears the ultimate responsibility?
When owners can't pay
In the best-case scenario, we provide all reasonable medical care, then locate a grateful owner who happily pays the bill. If we never find an owner? There are charitable organizations that sometimes assist in these circumstances. We might try to fix her up and find her a home. Usually this means that I don't even cover my expenses. That's OK now and then, but I can't do it for every stray animal that arrives at my door. But all too often, after providing all reasonable medical care, we locate an owner who refuses or is financially unable to pay the bill. What then? The law says owners are responsible for the bill. Although it was the town ACO that brought me the animal, the county is only obliged to pay me $20 for my troubles (although some towns budget additional funds, for which Island veterinarians are very appreciative.)
After that, I am left to my own devices to try and collect the remainder from the owner. I can head down the long and unpleasant road of collection agencies or Small Claims Court, which may or may not be successful. Or I just get to take the rest of the unpaid bill as a loss.
I started Noname on intravenous fluids, medications for shock and the concussion, pain medications, and antibiotics. I worked on her for several hours on Saturday, and again on Sunday. By Monday, she had stabilized. Her concussion was no longer an issue, but her jaw was badly misaligned and needed to be addressed soon. No owner had come forth. I had decided not to "dispose" of her, but rather to anesthetize her to evaluate her jaw fracture, hoping one of the charitable organizations would help with the expense. Then the ACO called. The owners had been located and were requesting euthanasia. They were not in a financial position to pay even the current bill. Triple sigh.
At this point, I hated to give up. Noname had survived her concussion. I had spent my weekend caring for her (probably for $20) but maybe it wasn't a total loss. Maybe I could fix the jaw. The owners agreed to sign her over to me if I wanted to try (at no charge to them) and then find her a new home. As soon as I had her anesthetized, however, I found her jaw fracture would require the services of a specialist and probably a long period postoperative nursing. She was a middle-aged cat. Should I start calling and see if someone would help with all of the above, arranging funding and transportation to a specialist, and long-term nursing care? Or did it make more sense to save those resources for another case? With a final sigh, I complied with her owners' original request and euthanized her.
There is no real moral to this story. Maybe it's to put identification on your cat. Maybe it's just to ponder the dilemmas veterinarians face with finding the balance between compassionate care and limited resources. Maybe it's just to share how sad I felt that day.