Behind the Scrubs: Bites, Scratches, and Other Sundry Injuries
My hand, post-suturing
When The Dog Bites
I was bitten at work eleven days ago. It was a situation I knew I would come across someday in the clinic; every doctor, tech, and assistant knows good and well that working with animals means you might get scratched or bitten. There's levels of injury, sure, and almost everyone leaves the week with a few new scuffs on their skin. But some are the real deal, not just a bandaid-worthy cut or abrasion. And everyone knows it's just a matter of time before you run across that one pet that just has your number.
Mine was a 50-pound labrador retriever who'd had his fill of vet offices as a puppy. Poor kid had been in and out of clinics for parvo treatment, kennel cough, and sundry injuries over a very short one-year-old life. He'd had enough of the Strange Smelling Place with the People In Scrubs. We're the bad guys in the eyes of most animals. I don't blame them. They don't know what's going on, we take their temperature in a very, ahem, rude fashion with no explanation, and then we poke them with needles. It's not fun. I would be a little reluctant to go to the doctor if none of them communicated in my fashion and did stuff to me without my consent, too.
So when he came in for a simple dental cleaning and another tech tried to get his vitals, he bit her on the arm. Not hard enough to break skin, but she was bruised down into the deep tissues. His owners had told us he was wily and nervous, but when we had checked him in he simply seemed excited and agitated. That's pretty common for a pet being dropped off for surgical procedures. So his sudden lunge at my co-worker was a little unexpected, especially since she'd done all the right "how to approach a dog" techniques. She gave up on trying for vitals until the doctor came in, since the doctors are authorized to resort to the next steps and procedures as needed.
I volunteered to help when my doctor on surgery asked for assistance on getting him assessed. We went into the kennel area and he had gone into full-on defense-mode: barking angrily, hair raised, backed into a corner, growling and snarling. There was no way we were getting him out of there normally. The doctor, not wanting to get our hands taken off, grabbed what's known as a rabies pole and pulled him carefully out of the kennel. He fought mightily, and as she held him to the ground at a distance, I tried to get a muzzle on him. Therein lay our mistake.
He snapped and tried to get at me even though my doctor had him very firmly pinned, and succeeded in getting my right foot on one such attempt. Had I not been wearing very thick boots, there would have been significant damage to my foot. As it was, he merely punctured the sheepskin boot. I kept trying. My error. With a twist of his head he grabbed my left hand and shook once. The rest is a white hot blur of pain, a quick assessment of the fact that my hand was now rather nicely laid open, and my doctor electing to call off the attempt in favor of having his owners come and retrieve him. We weren't going to be able to safely work on this animal, and nothing productive was going to come of further efforts.
Eighteen stitches at the emergency room, several injections for numbing the area, an x-ray to make sure none of the bones were broken, and a splint to account for what's called an occult fracture: a break in the bone you can't easily see on x-ray.
The question I find being asked the most often by people outside of veterinary medicine is, "what happened to the dog?" (Not that they didn't ask if I was okay; I'm not suggesting they completely bypassed my well-being to ask if the dog was all right!) Truth is, even I didn't know precisely what the protocol was when a veterinary employee is bitten severely enough to warrant medical attention. At least, not until it happened to me. All I can tell you from here is what the protocol is for my own office.
Put simply, the animal is not held at-fault by the clinic. As I mentioned previously, we all know it's a risk that someone's dog or cat will react badly to being in our care because of strange surroundings, smells, sounds, and people prodding it with pointy things. Even the sweetest cat or most docile canine has what veterinarians call a "threshold": a point at which the animal's patience as come to an end and it is no longer willing to tolerate handling for veterinary procedures. Some have shorter thresholds than others. Techs and vets alike have to constantly observe the behavior of the animal for signs of increased stress to avoid provocation. Sometimes we don't have a choice: if the animal is bleeding out, it doesn't matter how fractious it may become, we have to stabilize the animal or risk its demise. But ordinarily we monitor for signs - a stiff tail, a subtle growl, a lifted lip - to know when we've begun encroaching on the end of our patient's patience.
So when we misgauge an animal's tolerance, or if they didn't have any to begin with, we don't blame the animal. We don't press charges, we don't sue, we don't lambast the owners for having an animal that attacked someone. (Granted, if the owner knowingly has an animal that attacks people and doesn't tell us, that's a different story. That's a pet that is liable to injure someone regardless of circumstance, and we generally don't let them into our clinics in the first place.) We do, however, have to file an Animal Bite Report, whether we want to or not. Laws are laws, and as I found out, the instant I told them what happened at work, they called security to come and take down all the information I had. That said, as long as the animal doesn't go about wantonly biting people, all it ever does is sit in a file somewhere in the police records office.
I looked up the legal ramifications and protocols for in-clinic bites after it happened out of curiosity. There's a very nice little neat breakdown of the legal precedence on Nolo.com, with the various citations and chapters and articles that make no sense to me in terms of legal terminology. (Link is below if you'd like the full legal rundown.)
In short, nothing happens to the animal itself, and even the owners don't have much to handle if the clinic reports the bite. (There has been at least one case in my clinic where an animal bit its owner's mother the day before we saw it for an appointment, and the police showed up at their doorstep to take down an animal bite report. The only reason the police were notified was because the bite was severe enough to warrant medical attention and the doctors called it in - not us.)
The biggest concern we have after any bite - cat, dog, or otherwise - isn't blaming the animal. It's whether or not we're going to be okay, need medical attention, and if the animal is up to date on vaccinations. If the dog or cat that bit us doesn't have rabies records, that's when the legal complications happen.
Nolo.com - Legal Encyclopedia
- If a Dog Injures a Veterinarian | Nolo.com
Usually, injuries from dogs are just a risk every veterinarian takes.
Cats vs. Dogs
I've also been asked the question of, "which is worse, a cat bite or a dog bite?" In my humble opinion, both are bad, but in different ways. Here's a breakdown.
Dog bites are fairly straightforward, but a lot of the damage is based on breed. Depending on the breed, there's an average of 400-700 PSI's worth of pressure, so there's the high possibility of broken bones, especially in hands. It's unlikely you will end up with a cast if you're attacked by a Chihuahua, but a Labrador will potentially take a finger off if you're unlucky. Certain breeds, such as terriers, will "shake" whatever is in their mouth. This can remove large quantities of tissue and cause multiple lacerations even if they only get a hold of you once.
Main worries with dog bites are tissue damage (including severed nerves, ligaments, tendons, and muscle tissue), broken bones, and - yes - infection. The concept that a dog's mouth is "cleaner" than a humans may be accurate in terms of bacterial count, but bear in mind that a bite is still a bite. There's still bacteria present, and to make matters worse, dogs have a bad habit of putting their mouths on things that may be contaminated with fecal bacteria. If you find yourself in a situation where you are being sutured for a dog bite, expect your doctor to leave a certain amount of the laceration open to allow for bacteria to escape, and buy some probiotics - you're going to need them to counter the effects of the antibiotics your doctor will prescribe to you.
With cats, the issue is bacteria. Cat mouths are notoriously infectious, resulting in very swift infections from even a single puncture. Cats have teeth like small spikes, and the bite is less likely to tear tissue as it is to drive bacteria deep into tissue layers, not unlike stepping on a nail. So while the observant damage may be less, it is likely that you will want to see a doctor anyway to be sure that you're treated for possible infections. Cat bites also have a strange habit of severing blood vessels, so you'll find that they bleed quite a bit. Get it checked by a physician to make sure it stops appropriately, as well as getting the antibiotics you're probably going to need.
Cat scratches aren't better. While they tend to be shallower, the lacerations from a cat scratch can be deep enough to cause a fair bit of damage. They're also not much cleaner than their teeth, and are just as likely to cause a resultant infection. Main concerns with both cat bites and scratches other than infection are tissue damage, potential damage to tendons, and vessel damage. Depending on the depth of the laceration, you may or may not need stitches, but you'll still probably be put on antibiotics.
You may be noticing the pattern. Animals carry a lot of bacteria, and injuries associated with bites and scratches will always need to account for that. Make sure you have your vaccination records on hand, as your doctor will want to know when you most recently had a tetanus shot.
So ultimately? Neither is "better" or "worse" from my perspective. It's less likely a cat will kill you outright if it goes for your throat, but that's about where the benefits stop.
Biters and Breeds
So which breeds are more likely to bite? I've heard a number of people express surprise when I tell them my bite was from a young Labrador, but when I spoke to a veteran emergency room physician, he nodded knowingly and said he had seen multiple Labrador bites in his ER before. Most people assume it was a Pit Bull until I inform them otherwise. But who are the real biters?
Turns out, there's no clear-cut answer to that question. In December of 2005 a pack of Chihuahuas attacked a police officer, sending him to the hospital for minor injuries. There are a number of groups out there who will tell you that Pit Bulls are vicious and are directly responsible for over half (59% seems to be the most quoted number) of all fatal dog bites, with Rottweilers coming in at a distant second place (14% being the most common number I see). But further research into the actual report statistics leads to no clear answers. According to the National Canine Research Council, there hasn't been a reliable means of reporting dog bites to base accurate data. Police reports are made, but the identifier of what a "bite" actually is inconsistent - whether it broke skin, whether there was contact with saliva, etc. - and then there's the issue of breed identification.
There are a number of owners who will swear up and down that their dog is a Pit Bull, when it's really no such thing, but a Boxer mix. Conversely, there are even more owners who will promise that their dog isn't a Pit Bull (especially in a locale such as Denver, where Pit Bull ownership is technically illegal) and tell us instead that it's an American Bulldog mix. I have met a dog who looked exactly like a black Labrador, from the face to the ears to the body to the tail, who turned out to be everything from Akita to Great Dane in his DNA markers. So when a dog bite is reported, are we identifying dogs correctly? Do we actually know who is doing the biting? According to the NCRC, quote:
The authors report that the breed of the dog or dogs could not be reliably identified in more than 80% of cases. News accounts disagreed with each other and/or with animal control reports in a significant number of incidents, casting doubt on the reliability of breed attributions and more generally for using media reports as a primary source of data for scientific studies. In only 45 (18%) of the cases in this study could these researchers make a valid determination that the animal was a member of a distinct, recognized breed. Twenty different breeds, along with two known mixes, were identified in connection with those 45 incidents.
So where does that leave us? Dogs bite. So do cats, but no one asks the question of what breed was the cat. Plain and simply put: we need more data, and we need better identifiers. Until then, it's impossible to say even whether an intact male is more likely to bite than a spayed female, much less which breeds are more prone to biting than others.
At the end of it all, bites happen in the field of veterinary medicine. Dogs and cats both bite and scratch us. It happens. We hope to avoid them as best we can, not just for our safety, but for the well-being of our patients as well as the peace-of-mind for our clients. When they found out I'd been bitten by their dog, the lovely family sent me flowers with a Get Well Soon card attached with an apology.
They didn't have to do that. I didn't expect them to. I was just doing my job, the dog was stressed and reacted, there was no fault there. Honestly, we should have just called the whole thing off the instant he bit the other tech, despite the lack of broken skin. We didn't, and that was the result. But I would be a liar if I didn't say I was moved to tears by the kindness of the gesture. Hey, getting bit hurts, and I apparently turned from pale to slightly green from the shock of it all while they attempted to stop the bleeding. It's not precisely my favorite memory of work. But it happens, and we're never going to blame an animal for that. It's just part of the risk we take when we put on our scrubs in the morning.