I was living in Edmonton, AB. It was Christmas, 1998. There were three vets at the small animal practice where I worked. The boss and owner was named Sue, but I’ll call her Schmoo, because that is what I used to call her when I was not speaking directly to her. There was also another associate. Her name is not important. My husband decided to go back to Ontario to be with his family for Christmas right around the time that Schmoo decided that I would be working for the holidays. I was (mostly) okay with this, as I have never been a very Christmassy person. Also, the other two female veterinarians that I worked with had children and you know how it is, people with children always seem to think that they have the right to more time off at Christmas (and evenings and weekends) than people without children. What would a childless person possibly do with their off-time if they are not spending it with offspring? Christmas is basically meaningless if you have not experienced this miracle yourself in a slightly less immaculate fashion.
The set up in this late-nineties practice was that we were closed over the holidays, but there were patients that were boarding with us. I had to check on them once a day and to make sure that nothing happened to them during their stay. We were not on-call for emergencies because there was an emergency clinic in town for this. The sick pets that were at our hospital over the holidays had options. These options included either being transferred to the emergency clinic for continued care or being transferred to Jesus. (Sorry, bad vet humour, but it’s true.) Some people try desperately to get their dying pets to make it through the holidays and then bring them in for their post-Christmas euthanasia. This is not a good plan. Pets are really not that into celebrating the birth of Christ or any other holiday fun. Keeping them alive when they are terminal or suffering in the name of having them for Christmas is something that most people will regret after the fact.
It was the afternoon of December 24th. Every case had been appropriately transferred. I was doing a last check of the boarding patients and working on paperwork. I heard Schmoo on the phone. She was talking about a blocked cat and saying, “Yes, that is fine, you can bring him here”. Actually, she was trying to convince the person on the other end of the phone to bring him here. This was bad. Very bad. Schmoo got off the phone and told me that her sister was bringing her cat in to the hospital. From Calgary. The cat had blocked the day before. This is a condition where male cats develop crystals and sludge in their bladder, likely due to their commercial diet. The crystals and sludge then accumulate and obstruct their extremely small urethra that runs through their extremely small penis. The small penis-size is possibly due to being neutered young. Fuzzy the cat, was doing just fine. The obstruction had been relieved and he was in a veterinary hospital in Calgary, with a urinary catheter in place. It is possible that the vet in Calgary was trying to clean-out the hospital for the holidays, just like I was, and encouraging Fuzzy to find another place to convalesce. Schmoo and this vet convinced her. Fuzzy was en route to Edmonton.
You would think that if you invited your sister’s cat to spend the holidays recuperating at your veterinary hospital as a favor to your sister, that you would be the one taking care of him. So did I. I assumed wrong. Fuzzy became my responsibility over Christmas. Christmas 1998 was a Thursday. I know this because I Googled it, not because I remember. I do not have hyperthymesia (also had to look this word up). So I tucked Fuzzy in for the night with his urinary catheter and his intravenous fluids. Christmas morning, I went in to see him and he was still doing great. He had had the urinary catheter in place for over 48 hours, so I decided to remove it. In retrospect, this was not a great plan, but I couldn’t leave it in until we opened in four days time. I went back to check on him again that afternoon and he was crying and straining in his litter box, with a bladder that felt like a big hard orange. He had reblocked. Treating this obstruction would require general anesthesia to recatheterize and unblock the urethra. There were no technicians on-call to help me because it was Christmas and because normally you would go to a fully staffed emergency clinic if you had a blocked cat on Christmas Day. So I called Schmoo. Partly to ask her to come and help me and partly to let her know that her sister’s cat had a life-threatening urethral obstruction. Schmoo then gave me an earful about how I should be able to anesthetize the cat and unblock him on my own. Blah blah blah twelve people at my house blah blah blah Christmas dinner blah blah blah I can’t help you.
So I got to work anesthetizing Fuzzy myself. Yes I could do it alone, but you can’t monitor anesthesia and unblock a cat at the same time, so patient safety is severely compromised and I was not keen to be responsible for the anesthetic death of my bosses’ sister’s cat. I was working on trying to catheterize him when Schmoo showed up. Pissed off at I don’t know what and coming to help, only at this point I didn’t need her help anymore. I think she was just breezing in to improve the optics of the situation and to try to relieve her guilt for being such a bitch to me on Christmas. Too late. The cat was anesthetized, lying on his stomach, cat-butt hanging off the table and I was kneeling on the floor behind him, trying to get the catheter back in his urethra. Schmoo came over and palpated his abdomen, which was unnecessary and offensive because it suggests that I might now know how to diagnose a blocked cat and that this might all be some sort of elaborate Christmas practical joke that I was playing. She was squeezing his bladder at the exact same time that I was able to pass the catheter through his urethra into his bladder. She then said something like, “Oh, I can’t really feel his bladder any more.” It wasn’t really apparent if this was because his obstruction had been relieved or if something had happened to his bladder. Then she turned to leave and said, “Well, it looks like you have it under control. I have to go, there are twelve people at my house, waiting for Christmas dinner.” and she left. I got some urine out of his bladder, but not as much as I thought I would get. I think that Schmoo might have ruptured Fuzzy’s bladder and I also think that she knew this because she is the one who was holding his bladder in her hand when she popped it like a water balloon.
If I could redo Christmas 1998, I would have either resigned on the spot (better) or just taken Xrays of the cat right then and there. I didn’t because: I was a relatively new vet; I was doubting what had just happened and I thought that surely she would have stuck around if she thought that she had just ruptured her sister’s cat’s bladder (surely); and, most importantly, I didn’t have anyone to help me take him to surgery anyway, so I wasn’t sure how Xrays diagnosing a ruptured bladder would be useful. Fuzzy did not recover well from his anesthetic. Actually, he never fully woke up. This is likely because of the toxins that were in his system due to his bladder rupture. So I did what so many veterinarians have done before in small towns or before the advent of the big city emergency clinic, I took Fuzzy home for Christmas. I set up a little ICU in my bathroom. I kept his urinary catheter in place to drain his bladder/abdomen of urine and I kept him on fluids. It was like A Weekend at Bernies, Christmas Edition, only Bernie was played by Fuzzy the Cat.
Fuzzy and I had a rough night. I barely slept because I was sick with worry and Fuzzy slept too much because he was suffering from life-threatening azotemia. Boxing Day morning (December 26th for our American Friends), the hospital was still closed, but I started calling around for technicians until I found someone to come in to help me. We used the urinary catheter in his bladder to inject a material that shows up as white on Xray and took Xrays of his abdomen. Instead of remaining in a bladder-shaped bladder, the contrast material was throughout his abdomen. My superb technician started getting Fuzzy ready for surgery. I called Schmoo again and said, “You know how you thought you might have ruptured Fuzzy’s bladder? Well, you did.” She then replied, “Do I have to come in to help you?” I told her that I wasn’t calling her for help, but I thought she might want to let her sister know that Fuzzy was going to have surgery today.
Fuzzy’s surgery was surprisingly uneventful. I closed the large rent in his bladder and we recovered him with intravenous fluids and the catheter stayed in place for the rest of the weekend. On Monday, when the hospital was fully operational again, Schmoo and Schmoo’s sister came in to retrieve Fuzzy. They ran over to his cage and said, “Fuzzy!” That was the only thanks I got. That, and Fuzzy not being dead, for which I am still grateful. They never even acknowledged that I had spent my Christmas trying to save their cat.
Fuzzy the Cat and Christmas 1998 taught me some valuable lessons that I still keep with me today. One is that there is always a disaster case like this, every Christmas. I have one in this hospital right now. There is no fighting it, so you might as well just give in and go with it if you are a veterinarian working over the holidays. Fighting it will just make you miserable (or more miserable). The other lesson is one that has helped me through many difficult times as a veterinarian. Through adverse events, holidays, difficult clients and colleagues, and guilt trips (usually self-imporsed), and that is to always focus on the patient, no matter what else is going on. Doing what is right for your patients medically and ethically will always lead you to the right answer.