Breaking bad news to a client takes thoughtfulness and a soft approach from a veterinarian

Bedside manner is important in any branch of medicine. It comes naturally to some, but others must learn it. And some never do.

An M.D. does not walk up to a patient in a hospital bed and say, "Holy cow! You're sick! You'll never make it!" At least, not many of them do.

That is where the term "bedside manner" came from, of course, but it applies equally to all disciplines. A dentist cannot say, "Look at those disgusting, rotten teeth! Don't breathe on me! Boy, are you gross!" Well, in truth he can, but he would be wiser taking a softer approach.

Likewise, a veterinarian cannot say to a little old lady who has just presented her 16-year-old lap dog to him, "Looks like the little cur's about had it. Here's a plastic bag."

Bedside manner did not come naturally to me. I did not mean to be unkind, and it helped me to know that others had the same problem.

Art

A young man named Art Faries was a senior veterinary student at my alma mater, and he thought he wanted to go into equine practice. John Emery, in at least his second century on the faculty there, suggested he talk to me.

I was not looking for an associate, nor did I want one. But Emery thought I might need some help with my workload. Sure, during the breeding season there was enough work to keep two veterinarians busy, but that was only mid-February through the end of June. The other seven-plus months of the year there was not enough work to keep one man out of trouble.

I told Art that I was not even remotely considering hiring anyone, but then he asked if he could come and make my rounds with me during spring break. That was in March, and March was always pretty busy, so I said he could. We had an extra bedroom, and I could introduce him to some of the other horse veterinarians in the area. Maybe he could find a job that way.

He flew in on a Friday evening. He was out for spring break the whole week, so he would be with me for eight full days before he had to fly back the following Sunday. He was a pleasant young man about 25 years old and certainly better prepared to meet the real world than I remembered being at that point.

March is still pretty early in the breeding season, but even then, the average work day is 12 hours (16 hours in April and May), and the work is pretty routine--palpation, speculum examinations, and culturing mares--on farm after farm, all day long. After a couple of days of this, Art commented on the sameness of everything. I told him that was the way of the real world.

At some farms where I thought management and/or ownership would permit, I let him work on a few mares. I would check his palpation evaluations, and most of the time he was pretty accurate in his assessments. He was sharp.

On Wednesday he asked me again, "Is this it? Is this all you ever do?"

"No," I told him, "I deworm, vaccinate, treat the occasional colic, and suture the occasional laceration. But the reason people call me is to aid in getting their mares in foal, and there's nothing exciting about it."

He sat quietly and appeared to be thinking.

Then the mobile phone (they were not cellular phones in those days) rang. I answered it. When the conversation was over, I told Art, "Now we'll see something a little different."

"What?"

"I'm not sure. That was Joanie McAdams. Remember? We went to her place on Sunday. Her old gelding is acting funny, she said. Maybe he's colicking."

Joanie was an attractive woman in her mid-30s who trained a few horses in the morning and tried to run a breeding operation in the afternoon. She had two mares of her own and boarded two for the man whose horses she trained. She also had a pony teaser and Audley, an aged gray gelding who was the first horse she ever had trained. He was just a pet now, too old to use for anything else. He was treated better than all the other horses on the place, though, because he was well loved.

We went straight to her farm. Joanie said Audley was "standing funny," which could mean almost anything.

Audley was in his usual paddock, which he shared with the teaser, next to the barn. Joanie met us there.

"He just stands there not moving, all stretched-out like," she said. "He doesn't move or anything. I don't think it's colic."

One look pretty much told the story: sawhorse stance, retracted lips, erect ears, flared nostrils, prolapsed third eyelid. It was a classic case of tetanus, and a rather advanced one at that.

"What is it, Brent?" Joanie asked. "Why doesn't he move?"

I was trying to think of some way to break it to her gently. This old horse was very important to her, and he probably was not going to make it.

But then Art, wide-eyed, exclaimed, "It's tetanus! It's classic, textbook tetanus! I've never seen a real case! He's going to die!"

Flashback

Deja vu.

There was an immediate flashback to many years before, to a time when I was only slightly farther along than Art was now.

I had been out of school and employed as a veterinarian for only a few weeks when a friend--an architect--was passing through the area on his way home from a business trip. He called me.

"Brent, this is Ned. I'm in Alexandria, and I thought I'd take an extra day and come visit."

This was great. He had gotten through school a few years before me (he did not have the inconvenience of having to spend four more years in veterinary school) and moved off to the big city to make his fortune. We did not see each other very often, and I really liked Ned. I gave him directions on how to find me.

He spent the night, and the next day he said he would like to ride with me as I made my rounds. It was a relatively light and routine schedule: I had only six calls on the book.

We headed out, and everything went smoothly--encephalitis vaccinations for a band of eight horses, deworming three at another farm, castrating a calf, tuberculosis testing for about a dozen head of cattle, and so on. Really ordinary stuff.

Late in the morning I got a call on the mobile radio. "Base to unit two. Brent, go to Lucy Kidwell's place. She's got a horse acting funny and she needs someone to look at it."

I did not know Kidwell. I did not know 75% of the practice's clientele at this point. Richard, my employer, had told everyone about me and introduced me to a few, but basically I was given directions to each place and presented myself as Dr. Spencer's associate when I got there.

I talked back to the radio. "Edna, where is Lucy Kidwell? And is it an emergency?"

"She says she'd like someone right away," Edna responded, and then gave me directions.

I was still learning my way around the county, so it took me longer than it should have to get there. When we did arrive, I introduced myself to a plain young woman--maybe in her late 20s, but I am terrible at ages--who was obviously distressed at the length of time it had taken me to get there.

She took me to a nondescript, medium-sized gelding and said, "He's not moving right." She led him a few steps.

He was not moving right, and there were considerable other abnormalities, as well. In fact, he was almost a textbook case, not quite as obvious as Audley, but pretty close.

"This horse has rather advanced tetanus," I proclaimed. "He's gonna die."

I thought Kidwell was going to keel over. Her eyes filled with tears.

"Get out of here!" she shouted. "Get off my farm!"

I had no idea what her problem was. As I got back in the car, I said, "His only chance is to put him in a dark stall and give him high levels of penicillin."

"Get out of here!" she screamed, and burst into tears.

As we drove away, Ned said, "Maybe you should have handled that differently." That was pretty obvious, I thought, but it still had not occurred to me what I had done wrong. I said as much.

"Bedside manner, dummy," he explained. "You can't just walk up to a person you've just met and tell her that her horse is 'gonna die.' "

"But it is," I protested.

"But you can't just blurt it out. You have to soften it."

Later that day I stopped by the office (Richard's house). Richard was there.

"Brent, Lucy Kidwell called. I just got back from there," he told me.

"Her horse has tetanus," I said.

"Yes. And he's probably going to die. We've started him on penicillin, and he's in a boarded-up stall, but I don't think it'll do any good.

"A couple of months ago," he continued, "her father died of a heart attack. Her mother has been diagnosed as having terminal cancer. The day before you came here, her dog was run over and killed.

"Now, two minutes after you meet her, you tell her that her horse--her favorite horse--is going to die."

I am sure he was angry, possibly irate, but he was talking to me as calmly as if he were just giving me directions to another farm. "Brent, even if she'd just been named Queen of the May, you can't do that."

I never did it again.

Back to Art

But back to the present. Joanie stared open-mouthed at Art for a moment, then said, matter-of-factly, "He is not going to die." Tears came to her eyes.

"Joanie," I said, "he's right. Audley has tetanus. There's very little chance from what we see here, but we'll do all we can." I gave Art a dirty look.

"He will die," Art insisted. "Just look at him. There's no chance!"

Joanie's tears began flowing. Art looked puzzled. "What's wrong?" he asked.

We treated Audley. We placed him in a dark stall, gave him a high dose of tetanus antitoxin, and began giving him high levels of penicillin, but it was too late. He could not swallow (remember, tetanus is lockjaw), and in a couple of days Joanie chose to have him put down rather than see him starve. It was the right choice. She said she did not want Art to be there when we performed the euthanasia.

I explained bedside manner to Art. I probably was not as angry with him as Richard must have been with me, and he said, yes, he could see where maybe he should not say it quite so bluntly. "But I was right!" he insisted. "I don't see why she was so upset."

As I said, Art was sharp. He went back to school the next Sunday (the day after I put Audley down) and eventually graduated third in his class (I did not have that problem). Instead of entering the boring real world, though, he received an internship at another university and decided to stay in academia. Bedside manner is not nearly as important there.