The hardest part of being a veterinarian, even after years of experience, is having to tell an owner that his animal's chance of survival is next to none. It never gets easier. Most of the time my prognosis unfortunately comes true, with any efforts at medical treatment ultimately failing.
Some diseases are inevitably fatal. The most common is severe chronic kidney failure. In such cases there is so little functioning kidney left that if the animal were human, it would have long been on a dialysis machine awaiting an organ transplant. No one has pioneered kidney transplants for animals in Hong Kong yet, although they have been performed successfully overseas. Another common terminal illness among pets is a malignant mammary tumour that has already spread to other areas of the body. Any surgery would be palliative at best.
The worst terminal illnesses are those the owner never expected. With such problems as kidney failure and mammary cancer, the owner usually has some idea of what is going on before coming to see the vet because the symptoms are pretty obvious and the animal is probably elderly.
The disease I dread most is feline infectious peritonitis (FIP). It is a viral infection that afflicts young cats, usually about eight months old, and is usually contracted at a cattery. It is insidious, with no prior symptoms to warn owners or vets.
In the typical scenario, an unsuspecting owner brings the cat in for a regular check-up because it has mild diarrhoea, maybe a bloated abdomen. The owner thinks it may be a case of intestinal worms. The cat has been fully vaccinated, is eating and drinking, has been to the vet several times before and no one has ever mentioned anything out of the ordinary.
One look at the cat and its age and I know it's probably FIP. A few blood tests usually confirm my suspicion. Then I have to tell the unsuspecting owner the cat has an invariably fatal illness and has less then two months to live. You can imagine the shock of the owner, who has just gone through the trials of raising a kitten seemingly unscathed to find his cat is going to die for sure. The situation always leaves me at a loss for words, because there is no explanation I can give to make the owner feel better. It is so abrupt and sudden that it feels as if I have just punched the owner in the face without warning. You can see the whole grieving process happen in front of you, the shock, denial, anger and acceptance all dynamically displayed right there on the spot.
In some cases, where the cat is clearly suffering and not eating, I may even have to advise euthanasia. That usually totally wrecks my mood for the rest of the day.
There are times when an animal is brought in and its clinical situation is almost hopeless, but its owner through an act of supreme effort can work a miracle.
A few months ago I had a case where a lady had brought in a newborn Labrador puppy. This was a very dedicated owner, very careful, and the pregnancy of her dog was well planned. I remembered she had come before conception to ask about how best to approach the pregnancy and had both the mother and father checked for discernible genetic defects.
When it comes to bringing a new life into the world, there can never be perfect planning. From X-rays, we knew there would be eight puppies. But five were stillborn, leaving two healthy female pups and one very small male. It was clear the male was probably conceived a week after the females and hence a week premature.
In a dog's world, a week premature makes a huge difference to survival. This dog was very underdeveloped and its chances were extremely slim. The owner did everything I instructed her to do, including force-feeding every four hours. She had taken annual leave from work to give this puppy all her attention. After a week the other puppies in the litter were four times its size, but amazingly it was still alive. Another week went by and it was strong enough to be nursed by the mother. The puppy was saved. Through sheer force of love and care the owner had pulled this puppy back from the brink of death.
This story had a happy ending, but unfortunately my prognoses are usually correct and I have seen many owners try their best to no avail. Most of the time these sad stories occur not because of lack of effort and love, but simply because of bad luck.
Nothing demonstrates the bad-luck factor in veterinary medicine more than cancer. The animals don't smoke, they don't drink, they are active and most eat a healthy diet, but some still get cancer. The only reason is simple bad luck. The living body is intrinsically flawed and there is nothing we can do about that.