The second I put the phone down and lie back in bed, the uncertainty arrives.
Initially, it’s just a nagging feeling at the back of the mind, but a few minutes later it’s in full flow, whirring around my mind, stopping me from sleeping: did I say the right thing?
It was a very simple phone call, and I’m long in the tooth; you’d think I’d be immune to this sort of thing by now. Working a night on call, I received a phone call from a concerned client.
Bin diving dog
“It’s my dog, Doc. We had chicken for dinner. He grabbed the meat sponge and ate it after I threw it in the bin. Should I bring him in?”
Meat sponge? What on earth is a meat sponge? It sounds like a derogatory term that robots use for humans. I ask and the client clarifies: it’s the small, thin mesh of papery felt that sits between the chicken and the polystyrene tray.
“Should I bring him in?” the worried client asks again. The dog is a Labrador (of course) and is fine. If anything, he seems pretty pleased with himself. I can’t imagine any harm will come from eating a bit of felt, even one marinated in chicken juice.
“I think he’ll be fine,” I say. “It’s very unlikely to cause any problems.”
I advise him to keep an eye on his companion and, if he starts vomiting or seems unwell, to call me again.
The owner is reassured, and grateful. “That’s great, thanks doc. Load off my mind!”
The internal voice of doom
I put the phone down and it starts almost immediately…
He was really worried. Why was he so worried? Did… did he know something I don’t? Perhaps he’d heard that meat sponges were really toxic to dogs. Maybe they are! Maybe I missed an article somewhere. What if they’re incredibly poisonous and I don’t know?
I try to tell the internal voice to shut up; I need to sleep. If I’m wrong, I tell myself, the dog will get ill. I told him to ring back if he did, didn’t I? Just relax.
What about campylobacter? That’s raw meat. Couldn’t the dog get food poisoning?
Sure – but lots of owners feed raw meat diets now, and they’re more prone to food poisoning than their pets. Besides, if that’s going to happen, it’ll happen, whether I see the dog tonight or not.
Maybe. Maybe not. Maybe it’ll just die tonight. And that ‘meat sponge’… what are they made of? Felt? Paper? Can that be digested? Could it get blocked?
Oh for heaven’s sake… it’s really thin, and full of holes, it’s a mesh! It’s not going to cause an obstruction!
It probably won’t. Shut up and go to sleep!
But what if…
Meat sponge toxicity
The “what ifs” continue for some time, despite my efforts to suppress them. Eventually, I get out of bed and pick up my phone. Feeling like an idiot, I start to search for reports of “meat sponge toxicity in dogs”.
There’s nothing, and it’s extremely likely the search is hampered by the fact I have no idea if “meat sponge” is even the right term for the offending item, but it’s late at night and I can’t think of another one. Actually, up until 10 minutes ago, I hadn’t thought about them at all.
About an hour and a half later, I get to sleep. I never hear from the owner of the dog again so it’s probably fine, although my treacherous brain conjures up images of the man in the waiting room in another vets’, shocked and unbelieving that the first vet he spoke to seemed unaware that eating a meat sponge makes a dog’s brain explode.
No matter how many cases I see, no matter how many conditions I treat successfully (or otherwise), I’m never completely certain. About anything. Biology is a wonderful thing, but it’s also complicated and messy. No two cases are completely the same – a thousand different cat bite abscesses are a thousand different variations on a theme – and all that wonderful variation ensures the job is seldom boring, but frequently uncertain.
We spend our days making best guesses, and deductions, and leaps of inspiration. As guesses, they’re pretty good – educated guesses, in a very literal sense of the term – but however much we learn, we can’t possibly know everything about the complex machine full of hormones and enzymes and microorganisms that sits on our consulting room table.
Whenever I take a break from general practice, I forget how much of our days are filled with it. I start work confidently thinking I’m pretty good at this, that I’ve got a lot of years and a lot of happy clients under my belt (not literally), but within three consultations the uncertainty is back.
Should I really have avoided antibiotics in that case?
Will that sample be a waste of the client’s money?
What if I’m completely wrong about that diarrhoea, and there’s something much worse underlying it?
And another thing…
The uncertainty is less now that it used to be, or maybe I’ve just got better at ignoring it. Veterinary medicine has a paucity of evidence at the best of times, and I suspect it’ll be a while until someone submits “A study of the effects of meat sponge ingestion on 20 dogs” to the Journal of Small Animal Practice.
We rely on best guesses for a lot of our day, and that’s fine – our best guesses are generally pretty good – but I wish my treacherous brain wouldn’t keep reminding me of it. Especially late at night.
Bloody meat sponges. I wish I’d never heard of them. Hopefully I never have to think about them again, but there’ll be something else – there’s always going to be something else.