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I was involved in a case recently that potentially could have gone all kinds of wrong. It all boiled down to one thing, as these situations usually do: communication.

When I was in the office last night, I overheard a receptionist talking to the ER doc on duty with me about a poisoning case that was coming in. Somewhere in there, someone thought they heard the word ‘rat’ poison, when what was actually said was ‘ant’ poison. After a little confirmation and clarification, everything became clear but it put me in mind of the importance of careful communication in the medical world. To that end, I let my imagination wander free for a bit and came up with the following hypothetical situation of something that very well could happen if the little miscommunication hadn’t been cleared up right at the beginning. No animals were harmed in the creation of this thought experiment.

A dog (let’s call him Rusty, owned by the Green family) was brought in to the ER for getting into poison. When a pet goes into the ER, usually the whole visit starts with a technician going in and getting a history from the pet owner. Then the doctor goes in, does a physical exam and fills in any gaps in the history that are relevant – usually. This whole order can change depending on the urgency of a case, or how a particular hospital structures its workflow, but this description fits enough of them to be relevant.

Somewhere along the way (no one was quite sure if it was the technician, doctor or receptionist) the idea was introduced that the dog had gotten into rat poison.

Now, rat poison is nasty, lethal stuff, and not all rat poisons are created equal. Some cause uncontrolled bleeding, some cause kidney failure, and some cause brain swelling and seizures. Incidentally, that old saw you’ve heard about rat poison making mice and rats thirsty, which causes them to seek water outside the house before they go off and get busy dying is a bunch of hooey – there’s no poison that does that.

But in all cases, rat poison is bad stuff. Animals need treatment (there’s an antidote for at least one kind) and we need to get the stuff out of them to decrease how much they absorb from their intestines – a process called ‘decontamination’. Yes, sometimes I have to decon D-con. A goodly portion of what I do in the veterinary hospital involves creative ways to make dogs and cats throw up badness. I have a PhD in pukology.

So when we’re faced with a dog that ingested rat poison (technically known as a rodenticide) we usually recommend admission to the hospital and some testing as a minimum, after we make them upchuck the offending substance. In cases where the pets are already showing signs of ingesting the poison, the treatment might need to be much more intense, involving plasma transfusions and some fancy medical footwork. We try and keep ahead of the poison by getting it out of them and maybe save a life or two.

In this case, the doctor (let’s call her Dr. Adams) recommended that the pet stay in the hospital, receive further care and monitoring for what she thought was rat poison. A few tests were run as baseline, and the dog was made to vomit (which didn’t really produce much – even the best case scenario, one can usually only empty about two thirds of a dog’s stomach through vomiting). The owners were kind, intelligent folks who only wanted to do right by the dog; when we recommended something be done, aside from a few routine and well-intended questions, they said “go for it” and we got on with it.

The whole bill ended up being about $800 for the exam, fluids, hospitalization, vomiting, and testing.

The cat did very well and was able to go home in about 36 hours. The owners were quite happy that he never showed any signs of illness and had no problems with the finances. At the discharge appointment, the ER doc who saw the case met with the owners to go over the discharge instructions. He said:

“I’m glad Dusty did so well, Mr. and Mrs. Smith. Rat poison can be really nasty stuff, and I’ve lost a few patients to it over the years.”

The confused look on the owner’s faces must have been the first sign that something was wrong.

“Oh, it wasn’t rat poison, Dr. Jones – it was ant poison.”

Rat poison is deadly. Unless you’re an ant, ant poison is harmless.

In my hypothetical scenario, the doctor involved felt about as tall as an ant when this exchange took place. To make amends for the error, although it was innocent and understandable, the hospital writes off the whole bill.

One little word! With many of the same letters and a close-enough sound made it possible that somewhere along the way someone said ant and someone else heard rat. And that little mutation in hearing, that tweak in the syntax brought on by a modulated fricative, gets propagated along. Both sides start thinking different things in parallel and none are the wiser. Until discharge when it all made sense.

Recall that other than a few needle pokes and a night in the hospital, this patient wasn’t harmed. But imagine all the other miscommunications that could have led to harm. What if we were talking about what chemotherapeutic agents to administer? Or which leg to amputate?

If it had been known that it was ant poison from the get-go, the recommendation would have been much, much different and far less aggressive. Ant poison does absolutely nothing to dogs, and all we do is warn owners to expect some minor diarrhea from chewing up the container.

So when the wrong word goes in the right ear, mayhem can ensue. Like in all areas of life, clear communication is vital and we all have a duty to make sure we understand, as well as make sure our words are understood by others.

Now…did anything else seem amiss as you read this fictional tale of misperceived poison?