Tough Cases and Tough Decisions – Doing the best we can with what we have

Ashley Kroyer, AVC 2020, traveled to Nain and Natuashish in 2019 as one of the student participants on the Chinook Project.  As part of the experience, the students craft various pieces of reflective writing. 

When I applied to be part of the 2019 Chinook Project team, I was determined. I wanted an experience that would be unlike any other of my senior rotations. A remote, mobile veterinary medicine, far from exam rooms and surgery suites was just what I was looking for. I wanted this chance to learn how to improvise and to plan with and utilize limited medical and surgical resources. I wanted to grow both as a person and as a budding veterinarian-to-be.

Neutering in Natuashish! Becoming more independent by the day.

The first unwell patient I saw was in Nain on our first day of clinics. Her name was Monster; a small brown mixed breed dog with a giant bushy tail and little short legs. Monster’s owner, Pearl, brought her to us concerned her appetite had been very poor; she had vomited, and passed a piece of tapeworm in her stool. I did a physical exam and immediately began thinking “diagnostics”. With such vague clinical signs as inappetance and vomiting, I wished for blood counts, chemistry values, and abdominal imaging to help me determine Monster’s systemic status and what might be causing her trouble. Being without any of these things, I had my first opportunity to improvise a “next best” plan. With Dr. Foley’s guidance, I was reminded that even without testing and imaging, I still had a patient in front of me and valuable physical exam findings that I could make use of. We discussed Monster’s problem list and decided we could offer treatments to alleviate her dehydration and target her parasitic infection.  We treated her with subcutaneous fluids and deworming medication. Two days later we got happy news from Pearl, Monster was eating!

The last unwell patient I saw was in Natuashish, on day 9 of our trip to Labrador. His name was Buddy, a black Labrador mix carried into the fire hall on a pile of blankets. Buddy was unable to walk or stand, having been hit by a truck a few days before. Buddy’s owner, Delrose, had been bringing him food and water, and cleaning the urine and feces away from his fur as he passed it. On physical examination, it was not difficult to find Buddy’s problem, his right hind leg was incredibly painful. Again, I wished for more diagnostics.  Buddy needed radiographs of his legs and pelvis, as well as, a scan of his abdomen and chest. It was impossible to tell what damage had happened inside, impossible even to tell what had happened to exactly which of his bones. My eyes filled up after we had a better feel of his femur, the bone was in pieces. It was decided that the best choice for Buddy was humane euthanasia. Sadly, even if our questions had answers, we were without the resources we needed to fix any of it.

When I applied to be part of the 2019 Chinook Project team, I was determined. Chinook helped me learn first hand that tough cases and tough decisions will be a big part of the rest of my career. All of the cases we saw in Labrador were prime examples that even without having lab equipment at our disposal, our job can still be done in settings like these with only a stethoscope and our senses. We as veterinarians-in-training are learning many skills and incredible amounts of information that we use to put together all the different pieces of a clinical picture. Chinook taught me not to forget nor take for granted the pieces I can gather from seeing and touching a patient in front of me. Upon reflecting on Monster’s and Buddy’s cases and other similar cases seen in Labrador, I also remembered that throughout my veterinary career I am going to be faced with cases where I won’t have endless options available, where resources in one way or another will be limited, and where sometimes the perfect Plan A turns into a good Plan B or even an okay Plan C. In the end we know we are doing “the best we can with what we have”.

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