There is a scene in the movie "Dumb and Dumber" where Jim Carrey asks Lauren Holly what his chances are at getting together with her, she tells him that they are not good. He asks. “Like one in a hundred?” She replies, “More like one in a million.” He pauses, begins to smile, and says, “So you telling me there’s a chance!”
Despite the film's title, it’s actually a brilliant example of how one person's assessment of a given set of odds may be very different from another’s.
Buttons is an almost 15-year-old male cat, who lost one of his rear legs years ago to cancer. A neuropathy in the remaining limb can make walking difficult, and at times results in his pelvis bumping and dragging on the floor. This recently resulted in an abrasion that progressed to an infection in his pelvic region. This became a large, infected wound, and led to generalized sepsis.
The abscess and wound were treated aggressively with antibiotics and Hyperbaric Oxygen Therapy, and fortunately was healed, but a concurrent problem was discovered that was just as serious. He had lost function in his urinary bladder and could not urinate.
His bladder could fill, but he could not empty it. This appeared to be a neurologic problem, likely involving his spinal cord. There are a number of possible causes for this, such as a ruptured disc, stroke, tumor, degenerative condition, or even an infection. I (Henri Bianucci) also told his owners that there was a minute chance that the bladder had simply been stretched out during the acute phase of the abscess, and that it may have been damaged at that time.
When a bladder is overstretched by urine retention, it can cause damage to the muscles in the bladder wall, and impair the ability to contract. His physical exam findings, and history, made this seem unlikely, but still a suspect on the rule-out list.
I had a bad feeling about Buttons but explained that the best way to determine the cause was to perform an MRI. I told his owners that I was not at all optimistic that we would find something that we could do anything about, and that I hated for them to spend their money on a procedure that would not be likely to change the outcome. Their response was that if there was any chance at all of finding something they could fix, they wanted to go ahead.
The MRI determined that there was not a tumor, disc, stroke or infection. This narrowed the rule-out list to an overstretched bladder, or some sort of degenerative neuropathy. I told Buttons' family that if this is neurologic, it will not be likely to improve. In the unlikely event that the bladder was stretched, it may not ever regain function, but the only way to know was to place a urinary catheter in the bladder, and maintain it for a week. This could keep the bladder decompressed, and allow healing to occur.
I described the plan, with the same level of optimism as Lauren Holly in the scene above. But they received it like Jim Carrey: totally undeterred.
In the end, Buttons beat the odds to my pleasant surprise and regained complete function.
In addition to managing our cases medically, veterinarians must manage their client’s expectations. To do so, we provide a combination of objective statistics, and our subjective assessment of the patient's chances.
We can never know what will happen, and providing assessments to clients can be a frustrating endeavor. When faced with a critical case, we may think we are telling a client that the chances are slim, but they may simply be hearing that there is a chance.
The best we can do is guide our clients' decisions by providing our honest and frank assessment of a patients status, but clients must understand that this is only a projection based upon medical statistics and experience. The actual outcome, in most cases, is unknowable.