Busy Days at Work

Well I have had some really busy days at work...and still have two more to go...today is Sunday and that means pure chaos at the clinic!! I have seen some interesting cases though...another dog that ate a sewing needle....got that one out with endoscopy also. The other night had an old LARGE black lab come in collapsed, I look at gums - pale white - uh oh I already know what this dog has, palpate abdomen - huge fluid wave, dog is so obese and full of fluid that I can't really palpate anything in the abdomen, talk to owner about my fears of hemangiosarcoma in spleen, bleeding out, etc...we do ultrasound and find gigantic mass on spleen, wife says euthanasia but goes to get husband..who comes in like a pistol saying absolutely that euthanasia is not an option (this is two hours later and meanwhile dog has been bleeding out...)...SO I bolus liters of cystalloids, some colloids, and a unit of blood...knock him out...scrub...and $4500 dollars later head in to surgery at 11PM!!!....Getting through the layers of fat is challenging, finally able to see abdomen and blood starts pouring out as soon as I open the peritoneum...suction on....I locate spleen...gigantic nodular mass - about the size of a softball...it has little bleeds but not huge hemorrhage...hmmmm....go to look at liver...oh shoot...riddled with small masses and then some large nodular masses that are actively hemorrhaging....contact owner...they opt for euthanasia on the table...sad story...but unfortunately this is a bad disease and why a lot of times people don't go for surgery...especially since survival after is still only 5-9months. Had a case last night...8yo male neutered Bernese Mtn Dog...came in with all peripheral lymph nodes enlarged...uh oh...I already have a diagnosis in my mind before I aspirate and plop slide under microscope...yup...sheets of round cells...lymphoma...the story gets more sad...I tell the owner and he breaks down and bawls in the room...then says his wife's father just died of cancer, his father has it, his mother is in the ICU in New Mexico for something and he is going in for surgery on Thursday...WHAM!!!...I felt really small!!...but talked a lot with him, lymphoma fortunately is a cancer that does respond well to chemo and can go into remission...he is all for chemo...so we started him on prednisone...sent out the aspirates for professional pathological review...and he is coming in today to induce with chemo...I hope he responds!!! Had a really cool cat that ended up with an abdominal mass...sad...he is still alive though, doing great, eating as soon as I placed the nasogastric tube (of course - nothing like a therapeutic tube down your nose to make you decide now you want to start eating!! oh well...if he goes to surgery he will need the tube because for sure he won't eat afterwards!!). What else...millions of ultrasounds last night...a couple masses...a couple hyperchondriac owners...but hey...I always joke with the other docs...we are always like "I can't believe that owner is spending all this money when it is hopeless"....but at the end of the day...put apache, cosmo, or webster in that position and I would drop any amount of money even if it meant I got an extra 5 minutes to spend with them...because in those 5 minutes I could hug/kiss/tell them how much I have enjoyed them/thank them for being in my life...so I try to keep that in mind when I talk to owners who just are not ready to let go because in the end...is there ever gonna be a good time to let go?? The answer sadly is no....so we do what we can in the meantime...and when the end comes... cry and mourn but don't forget to smile for the good times too!!