Friday, December 25, 2009

Saving The World

Ahh, the Holidays. As usual, not enough time to get everything done, but - also as usual - kind of fun anyway, what with it being all festive and stuff. And I hope you are all having a Merry Christmas, by the way.

To no one's surprise, we are having a white Christmas up here. It has, however, been quite warm (34 to 38 degrees); if not for the fact of a heavy snowfall last week we might NOT be having a white Christmas up here. However: the year has turned. The days are getting longer (by about 26 seconds a day right now, but hey - you take what you can get). I'd say the majority of Alaskans are observant of the solstices (and to a lesser degree the equinoxes) because the seasonal changes up here are so extreme. Hence for many of us, the winter holiday cluster starts on December 21st - my father's birthday, incidentally, and happy birthday to him - and ends on January second. I personally like to extend that to my own birthday, in late January, but while you're all welcome to join me in that, I don't insist that others collude with me in my celebratory delusions. Mostly.

This year for Christmas, two of my sisters got me a gift certificate to Global Giving, an organization which oversees about 800 charities. I get a little email notification and I think: Hmm, what's this? So I open it up and there is a little pile of money that I can give to any of the charities they oversee. All of a sudden I'm aaaall perky. Ooooh. It's winter solstice, a perfect time to start feeling festive and holiday-ish. I'm SO not waiting til Christmas. And moreover, I am shamelessly stealing this idea for my Christmas present to the Wildwood quartet.

Naturally - and here, put on your surprised faces - when spending my gift certificate I went to the section on charities involving animals. I know - who can believe that? Me, interested in animal things! Go figure. Still, odd as it is - or not - for me to be interested in things related to animals, I had SO much fun shopping for pet projects there (so to speak). I can't even tell you. In the end I divided my gift certificate up, trying to focus mainly on things that would provide a sustainable improvement. For instance, I gave money to a livestock guardian dog project in Africa, which provides dogs, puppy vaccines and training for the native farmers so that they can use dogs to protect their livestock (mainly from cheetahs, I understand). This benefits the livestock, obviously, since they're protected from predation. It also obviously benefits the farmers. But in addition it benefits the cheetahs, since the farmers will shoot any cheetah they see on their land, out of fear of predation on their livestock. If the cheetahs stay away, they stay alive.... and there aren't so many of them that we can afford to waste them.

There were lots of other projects that tempted me: ones where you can purchase or help purchase a goat for a family who can then breed the goat and sell or rear the offspring for future income, and dairy off the goat for food; ones where you can help bring sheep flocks up to dairy standard for income and food for the community; ones where you can invest in habitat recovery and education for local people so that they can encourage wildlife recovery and the economic benefit of the eco-tourism that comes with it. Lots of choices. And of course there are tons and tons of other, non-animal-related projects as well. But I'm happy with my little animal projects, because they dovetail nicely with my personal philosophy. My theory is that animals will save the world.

Chief Seattle said that if all the beasts were gone, man would die of a great loneliness of the spirit. This is, in my opinion, unquestionably true. But there's more to it: If all the humans on the earth suddenly died, the world would go on. But if only we remained and all the animals died, the entire world would die. We are not so necessary to the ecology of the world. But without animals to pollinate, to sew seeds, to graze and fertilize the grasslands, entire ecosystems would die. We can't do these things for ourselves. We need them way more than they need us. And for all our intelligence and ability to manipulate the world around us, in the end I think it will be the simplicity of animals that is our salvation.

So it is somehow very satisfying to me to add my little financial nudges to projects that dovetail with my personal philosophy. I love the idea that somewhere out there a family is given a goat who will, by virtue of nothing more than being a goat, will give them a sustainable income. I love it that people are training guardian dogs who will - typically without direct contact - run predators away from livestock, preventing harm to both. I love that wild animals provide income to poor areas by their presence, rather than their absence. I love that these animals, just out there doing no more than being what they are.... one little piece at a time, they're out there, changing things. Saving the world.

Monday, December 7, 2009

So What, I'm Still A Rock Star

One day recently I am with a client in an exam room. As I am bent over his dog's ears, peering into their mysterious depths, he says, "Hey, I saw you in the grocery store the other day, but I was afraid to come say hi."

I look up at him in surprise.

"Afraid to?" I ask. "Was I looking excessively cranky or homicidal?"

"Well, no," he says. "It's just that I figure people probably come up to you and bug you all the time about their pets when you're out and about, and I didn't want to take advantage."

Well. What a thoughtful man.

"Well, thanks," I tell him. "I appreciate your consideration about that... but you can come say 'Hi' anytime - well, unless I'm having a giant fight with my boyfriend or something," I add with a grin. "And to be honest, you aren't the kind of client who takes advantage anyway, so don't worry about it. I hardly ever go anywhere without running into at least one client, so I'm kind of used to it. Most of the time it's not even embarrassing," I say, cheerfully.

"Now I want to hear about the ones where it is embarrassing," he says with a chuckle.

"Oh, trust me - you don't," I assure him, laughing. "I've had more conversations in restaurants with people about their dog's - um - personal habits than you want to hear about. For some reason that subject puts some people off their appetites, but luckily even the most graphic coversation about 'discharge' isn't enough to put me off my dinner. Still," I add wistfully, "it would be nice to be able to actually finish my dinner while it's still hot."

"People bug you while you're eating?" he asks incredulously.

"Oh, yeah... eating, shopping, at the gas station, in the locker room at the gym - although there you can usually bring it to a conclusion by getting into the shower - at the movies, over coffee - you name it. It's a small town and I've been in practice here for 15 years, so I pretty much count on seeing at least one client anywhere I go, sometimes three or four."

He nods thoughtfully. "You're like a rock star," he says, musingly.

"Yeah, except for all the glamor and the money," I agree, laughing. "Plus I think if you're a rock star you proably aren't talking about pus, mucus and diarrhea over your bagel. Just a hunch."

At any rate, it amused me that he thought of me in rock star terms. Nothing could be further from the truth, really... if not for the fact that this IS a small town - and I am one of a very small number of vets in the area - I'd be as anonymous as anyone else. I'm not on TV or in the paper - well, not very often, anyway - and my only in-print publications to date have been in professional magazines, which of necessity have a limited audience. What little notoriety I have is limited to a very small population and a very small geographic area. Ninety-eight percent of the time I truly don't mind when people accost me to discuss their pets - past, present or future - and I sort of enjoy seeing some of my clients in a non-clinical setting. Occasionally, I will admit, it's a tiny bit tedious. It's rare, but every once in a while you do have someone who is injudicious about taking up my non-work time, or who seems to have no sense of social timing. Ah, well. These things happen, and to some degree it comes with the territory. It's not so bad for me, in my little corner of the world. Rock stars and movie stars, though - they have to endure much more intrusion, all over the world, and for less important reasons. After all, it's one thing for someone to come up to me and say "I just wanted to thank you so much for helping my pet" (or me, or my family, or for volunteering your time, or what have you); it's not even a problem if they ask, "Say, Doc, my rabbit has his neck all twisted to the side. What d'you think it is? Should I bring him in?" It's another thing entirely to have someone fling themselves panting at you, attempting to yank out a lock of your hair or asking if they can have your baby.

For me, though, it's mostly related to my work, and not so much to weird fantasies people might be having about who they imagine I am based on a character I played three years ago. And if I really WERE a rock star, I'd be recognizable all over the dang place, and nowhere would be sacred.

At least so I was telling myself this weekend, all complacent, whilst standing in the bathroom at Costco in Anchorage. At home, a store that busy would be virtually guaranteed to contain at least one client, but I'd been peacefully shopping with my friends, Yvonne and Jan, for an hour without the slightest interruption. See? Not like a rock star at all. I'm a mere 60 miles from home, and no one here knows me; it takes next to no distance to outrun my public-recognition factor.

"Aren't you Dr. H?" someone to my left says suddenly.
"Er, yes - oh, I recognize you," I add. "Aren't you one of my clients?"
"Yes; when are you working? I have to bring my dogs in for shots," she says. I give her my work schedule, and she nods happily, promising to see me there within the week, and goes on about her business. Huh. That's unusual, I think, drying my hands.

"Hi, Dr. H, how are you?" pipes up another voice. I look behind me and there's another client, smiling and full of holiday cheer.

"Great, thanks, and you? How are the dogs?" I ask her.
"Oh, we're all fine, thanks," she says happily, wishing me a merry Christmas as my friend Yvonne stares at me, eyebows raised.

"I can't take you anywhere," she mutters to me, amused, as we exit the bathroom. "You're not even in your home town and clients are chasing you down." Well, okay, I admit it's a bit weird to be waylaid in a public restroom, but what are you going to do? It's odd, but so what? I'm still a rock star...

Except for that pus and mucus and diarrhea thing....

Sunday, November 15, 2009

Juggling Chainsaws

Saturdays can be a challenge for me.

For one thing, I am the solo doc that day, so there's not much in the way of backup. For another, lots of people want to get in on Saturdays, since most people have that day off. We're typically booked solid two or more days in advance. Moreover, it's a short day, so if emergent cases happen, we have only so much space to cram the extras in between the already-scheduled appointments. And, to cap it all, many people tend to sleep in a little on Saturdays, so they don't notice there IS an emergent case until, say, 11:00, when we are three hours from closing, and usually already overloaded with other must-be-seen-today cases who ALSO just got up and noticed that giant abscess on their dog's head.

Mind you, I have some advantages on Saturday. For one thing, I have the mighty SS manning the phones. SS has been in the biz for over 30 years and has worked with me for 14. She has a deep seated, near-mystical sense of the rhythm of a heavy case day, and knows how I work and where she can slip in an extra case - or two or three or eight. She knows - if it's an abscess, or porcupine quills, or a laceration - that unless the owner is insistent on seeing the doctor, she can just make an estimate, get the paperwork signed, and admit the animal, saving me a few minutes in the exam room whilst I juggle other cases. For another, while she is not a doctor, she IS extremely knowledgeable about animal medicine in general, and can often assess over the phone how immediately the animal needs to be seen (and, if she is ever in doubt, the answer to that is always "today".)

SS is backed up by KD, not so experienced yet, but smart and capable and willing to dive in and hold animals for blood draws or sedation if my tech is tied up and we are slammed. My tech is JD, who is new to the Saturday gig but who is catching the rhythm of it now and who is prone to popping up and saying things like "I can run that ear swab for you" or "There's a urinalysis on the microscope for you when you have time" (having already done the dipstick, spun it down, and stained it and put it on a slide for me.) Between the four of us we can usually shoulder a schedule that is at times double- and triple-booked, without compromising patient care. SS is adept at feeling where that break-point is and reining things in just short of that point - although I will say it is not always possible to hold back that tide, and sometimes all hell breaks loose.

This Saturday was a case in point. I saw 24 patients before we closed, 22 of whom I saw in five hours. A small number of them were (most fortunately) short appointments - rabies boosters, for instance, when the animal had had a recent physical, no new issues, and only needed the shot. But most were medicine cases: arthritic pets, sick ones, injured ones, complicated ones with intricate histories. Cases which required workup of various kinds: blood work, X-rays, cytology, aspirates... or else things that needed estimates for workup, or both. Meanwhile, SS has with her one of her Schipperkes, Wicca, a pregnant bitch who is showing signs that she is about to go into labor. Luckily, Wicca is content to stay behind the front desk under SS's watchful eye.

Still, even though I kind of felt like I was juggling chainsaws, we were keeping up with it by means of judicious delegation and stacking cases so that while that X-ray is developing I can get an ear swab which JD will stain and slap on the 'scope for me, and while she does that I can go do that second puppy booster while KD weighs the three adorable Pom puppies for me.

Eventually, though, the overflow starts. I check in three cases in short order that require procedures today - as in, ASAP, most especially in one case, a cat so rocky that even taking the extremely necessary chest film constitutes a life-threatening risk. Right about then we get a call about a vomiting dog which might have swallowed a bone and have a GI obstruction. But he's also had some rich food, so maybe it's pacreatitis, or it could be a virus.

"We can have a look and get an X-ray if the doctor thinks it needs one," SS tells the client, "but if it needs surgery, she may have to refer you. She already has three emergencies ahead of you, and she's double-booked for the rest of the day - except where she's triple-booked." The owners still want to see us - they like us, and don't want to go elsewhere, and they are, of course, hoping that surgery is not going to be needed. Okay, then. Come on down, and we'll work you in whenever we can.

It's over 30 minutes before I can see the dog, 100# of plump black husky who is petrified of our floors and highly unwilling to walk anywhere. JD and I manage to coax him to the back to radiology. We look at each other. The dog is crouched at our feet, all toes clenched against the terrors of linoleum. From experience, we all know that a dog who is this afraid of the floors is somehow magically able to magnify its weight at least 30% when we go to pick it up. I'm not sure how this alchemy takes place; it is as if their fear has a gravity of its own, drawing the dog irresistibly toward the core of the earth.

"Ready?" I ask JD, grinning as I realise that we're both instinctively hyperventilating, trying to pop a little extra oxygen into the bloodstream against the hold-your-breath, grunt-and-heave effort of getting the dog onto the X-ray table.

"Ready," she says, and we squat, scoop and stand, at least one of us cursing breathlessly as the dog grabs the table edge with his clenched toes and shoves hard, trying to return to the floor (which, while scary, is evidently less frightening than the X-ray Table of Death.) We soothe and praise and ease the dog onto his side, into position for the film. The one advantage of his trepidation is that he holds his legs as rigid as steel, so that once he is in position he lies statue-still so we can get our shot. Back to the room with him while I go see the three adorable Pom puppies, who are also hilarious. The black one keeps abruptly disappearing by dropping to all fours inside her blanket-lined box while her siblings stand on their hind legs, wagging and smiling and trying to lick me. Then she pops back up just as suddenly, an adorable jack-in-the-box move rendered even more charming by her sparkling eyes and happy grin - not to mention her wiggly attempts to climb out of the box to give me a kiss. I can't decide if she's doing this because she thinks it's funny - and we obviously do, too, praising her each time with laughter and petting - or if she's searching for cookie crumbs and, finding none, pokes her little noggin up in hopes of being handed a treat. Either way, it's a completely delightful respite from the intensity of the day, and even though I'm doing exams and vaccines the entire time, it feels like a small vacation.

Ah, well. The chainsaws await more juggling. Better get to it.

I snag my film out of the developer and hold it up, not bothering with the X-ray box yet - and there is no need to, as it's a quick and easy diagnosis: the dog has swallowed a rock. Great. Surgery #4 just walked through our doors. I calculate quickly: By the time I am done with the other procedures - all of which will have to go before this one - I won't be getting to it til about 4 p.m. at best, at which time my staff will have worked for 10 hours. By the time we're done with surgery and clean-up, that'll be more like 12 or 13. But the owners don't want to see another hospital.

Okay. Time to punt.

SS calls Drs. S and G to see if one of them wants to come in and cut the rock dog, which can be done while I finish up appointments, clearing the decks for the other three procedures. Those will still not even be started til after we close, but that will most likely put most of the staff out of the hospital after only 9 hours, and me out an hour or so later. That's manageable.... if one of them can come in to cut, that is.

Hallelujah. God smiles. They can BOTH come in - and they do, Dr G. tech'ing for his wife while she cuts - and bless them for coming in on their day off to bail us out. Meanwhile I finish my appointments and give JD an order of operations for the remaining procedures so that she can set up. By the time we send the last client out the door, Dr. S has the rock out and is closing. JD has an X-ray plate in and drugs drawn up for our anaesthetise-and-X-ray, could-be-broken-leg puppy. The pup had been trying to counter-surf and had gotten injured in the attempt, screaming and refusing to bear weight on the right hind leg thereafter. JD and I put that one on while Drs. G and S heave the sleeping rock dog onto a stretcher and take him to his run. JD develops my film while I set up the drugs for the next case. I go have a look at the film: a long oblique fracture of the tibia, and two green-stick fractures of the fibula. Well, it could be much worse: there's a reasonable chance that this can heal with a splint, although surgery would be more ideal. I call the owner, who declines surgery; she'd rather do the splint, given reasonably good odds of success and the approximately $1000 difference in cost between that and surgery. Okay, then. We'll give that a try, and hold surgical options in our back pocket as our bail-out position in case the splint fails.

The leg in question is between splint sizes, but the splints are designed to be cut down to adjust the size. I get to work trimming down a splint, which would be easier if our hack saw blade was even a little sharper. I have the feeling that a tongue depressor would work about as fast, but I persist. Meanwhile Drs. S and G have extubated the rock dog and are now - bless them - cleaning up the surgery table and entering the charges in the computer. About the time I have at last finished strapping the fractured puppy into its splint, Dr. S asks me if she can enter MY charts into the computer and get the meds up for me while her husband industriously scrubs surgical instruments. Well, yes, thanks, if you aren't in a hurry to go home. That would be just lovely. I'll just hoik this giant abscess attached to the bloodhound onto the table - nope, Dr. G is there first, and bends his muscular frame to the task without being asked. And lo and behold, there is Dr. S, shaving a spot for me to lance while I get my instruments ready. Well. That was easy.

The abscess is easy, too, and deeply satisfying. A large volume of rank red pus is soon in the bottom of the sink instead of under the dog's hide, and that's just as it should be. One injection of antibiotics later and the dog is snoring happily in his run, his giant noggin now only slightly larger than the original instructions said it should be. True, he is draining a bit from his incision, which isn't terribly aesthetically appealing, but IS an excellent and necessary component of abscess repair. We'll take it. Drs. S and G admire this happy outcome before departing. SS is close on their heels, as Wicca has started labor, and SS knows she'll do better in the comfortable surroundings of home.

Now on to the thoracocentesis cat. This it the rocky kitty, brought in for respiratory problems and weight loss. On physical I could only hear airways about half of the way down his chest. He's a bit fractious about restraint, and the instant he objects we let him up, because the slightest struggle turns him blue and makes him gape, panting with his mouth open. His X-rays show a large volume of fluid inside his chest, compressing his lungs into approximately 20% of their intended size. He has marked abdominal effort with his breathing - a restrictive pattern, which I have discussed with the owners during the physical exam. Despite this, he purrs nearly incessantly, rubbing his head affectionately against his owners, me , his carrier, my tech, my pen as I try to write in his chart, and his cage wall once we have stashed him in-hospital.

This cat is unlikely to tolerate anesthesia well; he's 13 years old, thin, and his respiratory system is very compromised. Fortunately, most cats will tolerate a chest tap while awake, because it provides nearly instantaneous relief from their respiratory distress. Even so, this is a tricky gig. If you should be careless with your needle, you can lacerate the delicate membranes of the lungs, creating a pneumothorax and an entirely new life-threatening problem to stack on top of the old one. There is an art to correct placement of the needle, and to feeling delicately with the tip of it when the lungs are expanding to the point where they are at risk of laceration.

The easiest way is to have three people: One to hold the cat, one to hold the butterfly catheter in place and draw the fluid off with a giant syringe, and one to operate the three-way stopcock that allows you, with the turn of a lever, to squirt the fluid out into a bowl, rather than back into the cat, all without having to move your needle. However, with two people you can manage, assuming reasonable dexterity and a cooperative patient - and two people is all we have now, as the rest of the staff has gone home (late, but without complaint, and not before making sure we've got things under control).

This kitty isn't best pleased with being restrained even a little, but consents to have me shave and surgically prep his sides with minimal struggle. He even allows me to pop my butterfly needle into his chest without more than a little protest. Once I begin drawing fluid off his chest he's a little happier, almost as if he's thinking: Hmmm. This might be a good idea, this whole needle thing. After we are 180 milliliters to the good, he pinks up a little, essaying a deeper breath now. I have my needle angled steeply down toward his sternum, as far away as I can get it from his gratefully expanding lung tissue. Still, I am feeling for the delicate grating tick of lung tissue across the tip of the needle; this, or blood, are both warnings to stop now.

Suddenly I feel a vibration in my left hand, the one holding the butterfly in place. My heart takes a leap; this is a much coarser, harder vibrato than the usual delicate tremor that warns me to back my needle out right this instant. It takes me a half a second - and my needle halfway out - before I realise that it's not the shudder of a torn lung I'm feeling: My patient is purring. Bless his pointy little heart. This is the sweetest cat I've seen all week, purring and bumping his head affectionately against JD while we hold him still and stick a needle in his chest.

Still, the better he feels, the less inclined he is to sit around while I re-inflate his lungs. He still can't tolerate much respiratory stress, and when I try tapping his left side I get blood right away, which means I have to stop this instant. I take him back to his cage; we've gotten 400 mls of a clear, light-golden fluid off his chest, and he feels lots better now. Unfortunately, it's likely he will recur with this problem within a week. The owners, who are stretching their resources to manage what we've done so far, elect not to go after further workup today, but instead to treat as best we can and watch for results.

I send JD home after her long efforts today, telling her to pray I don't have to section Wicca. She gives me a thumbs-up. Shortly thereafter I release the cat, now getting briskly to his feet and pacing his cage, mrrowing happily, to his owners. The other two cases have their releases scheduled and I am sitting down for the first time all day, calling owners with blood work results. I have stashed the clinic's on-call cell in my bag in case SS needs help with Wicca, but as it turns out, that was an unnecessary precaution - because I am still at the clinic when SS calls me to tell me Wicca has had a gestational sac bulging at her vulva for 45 minutes and isn't progressing. SS will try one injection of oxytocin to see if she can get Wicca going, but if not, I tell her, come back: I'm still at the clinic. Better now than after I go home.

I release my abscess dog and drink a little eggnog and a lot of water. My back has been hurting all day, and since noon I've been feeling slightly flu-ish, just a hint shaky and cold. Both the water and the eggnog help. I'm still a little bit off, but I can feel a little energy, a little heat, trickling through my veins. It hasn't helped that we've been hellishly busy all day, with no time to eat or drink or sit down, nor that everyone in the clinic seems to have been down with one virus or another for the last 3 weeks - except me, for which Hygiea (or whatever deity is in charge of virus resistance) be thanked. Hey, maybe it's the Kefir. You never know.

SS calls me back about then; Wicca hasn't responded to the oxytocin, and they'll be back in 20 minutes. Okay, then. Thank God I had eggnog at the clinic.

On the heels of that call, in comes my fractured puppy owners. Perfect. I'll get my last release done before SS is in with her laboring Schipp. In fact, SS is back just before that, and she calls Em, our head tech, who (bless her, now, too) agrees to zoom on in and tech for me as I cut Wicca. Meanwhile Wicca wails and squeals piteously at every contraction, and immediately stops pushing. She does extrude a little more membrane, but even with pressure on her belly and traction on the membranes, I can't shift the puppy. I can, however, tear the membranes - dang it - which takes the choice off the table: we're going to C-section land now.

Em has Wicca induced and intubated in no time. I am shaving Wicca's enormously distended belly while Em sets a catheter; as soon as she has it taped in, she takes over shaving and I scrub in.

The trick with C-sections is to get the puppies out as fast as possible. Accordingly, as soon as the bulging dome of Wicca's belly is draped in, I make a long, swift incision. Because SS keeps her dogs trim, there is little subcutaneous fat, and a small miracle occurs: Wicca has a gorgeous linea alba, the thin tendinous band that connects the two sides of the belly muscles to each other down the midline of the dog. This is the best place to cut, as it doesn't bleed and it heals strongly, and Wicca has provided me a lovely one. I am though it in seconds, exteriorising her enormous uterus not more than 5 minutes after she was induced. It takes no more than 90 seconds to get three puppies out of the first uterine horn. I can see the strong pink muscle contracting already, a good sign, as it minimizes bleeding. It's the work of another minute to get the last two pups out of the other horn, and now I can suture the uterus up. I can go a little slower now, but I'm still going as fast as I can and still do it right: I want the bitch awake as fast as possible too, so she can recover from her anesthetic enough to try to care for her babies.

I am not through suturing the first uterine horn before I hear the first warbling cries of the pup that was stuck in the birth canal. I take a deep breath, feeling the tension drain out of my shoulders. That was the pup I was worried about, the one whose membranes I tore. I was concerned about having abrupted the placenta, diconnecting the pup from his oxygen supply, but he is wailing lustily away. I am smiling a little as I surure the other horn, checking my inverting patterns, looking for bleeding. Wicca's uterus is contracting beautifully, firm and pink under my gloved fingers. I am humming a little as I start in on her linea.

SS and Em have all the puppies singing now, three boys and two girls, as I set my skin sutures. It's been a reasonably fast C-section, maybe 30 minutes skin to skin. I barely have my sharps off the surgery tray before Em is bustling into surgery, collecting my drape and gown. I scrub out, draping a towel over Wicca's much-deflated frame. I am starting to feel slightly hollow, hungry and tired as I am. But I am also feeling warm and relaxed, becuase we managed, somehow, to get everything done today - everything and then some - and lost not a single patient. There are five chubby, vigorous Schipps and a live, healthy bitch all stirring drowsily under their blankets, and I can't resist stroking the fine glossy coats of the new babies. There's something luxurious about this, this little pause to savor the fruits of all our labors, while around me bustle SS and Em, cleaning up. I wallow a little in the warm pleasure of new life, smiling to myself. Besides, I'm leaving the hospital only a little more than 11 hours after I got there. If not for Dr. S and Dr. G, that would have been a lot more like 14 or 15. I'm feeling pretty lucky, right about now.

Days like this, it doesn't matter how many chainsaws you have to juggle: Totally worth it.

Tuesday, November 3, 2009

Bawdville Act

Author's note: Okay. I'm apologizing for this post in advance. For any of you who are of a sensitive temperament, this is your warning that the following post is of a lowbrow and earthy nature, and may contain references to the sexual habits of various livestock. I'd try to be delicate about these things, but it's way too late for that. Maybe I could be more circumspect if I hadn't groomed racehorses for a living... nah. Probably not even then.

It's breeding time at Wildwood farm. This is the time of year we run the boys with the girls in hopes of initiating next year's crops of chops. Naturally, this always occasions a certain amount of ribald talk from the wild women of Wildwood. It's a pragmatic, earthy kind of business, running a farm - or being a vet, come to that. People who might in the ordinary course of things shy away from frank discussions of the sexual congress of sheep and goats suddenly find themselves quite absorbed with the subject, and eager to discuss it at length. After all, it's not coming as any surprise to any of us how next year's baby sheep and goats are being made, and none of the livestock are going to be offended if we're a bit indelicate about such matters. Of necessity we do need to converse about the ins and outs (so to speak) of who has been bred when, and what that means for next spring's lambing season. Speaking euphemistically takes too long and leaves room for misunderstanding, so we tend to just cut to the chase... apart from which, life is more fun if you have a sense of humor about these things, so we tend towards the bawdy in the fall.

However, if you're shy, maybe you should just skip this post. The tone isn't likely to improve, given the subject matter. I'm just saying.

I decided to get a marking harness for Trinity this year, to limit the amount of guessing necessary to bracket my lambing dates. S&R needed new crayons for their marking harness, too, so I ordered everything together. It arrived in due course - a day later than I wanted it to, unfortunately; we like to start breeding November first, and so S&R duly ran Trinity into the ewe pen that day, since it was not certain when exactly the marking harness and crayons would arrive and time was a-wasting.

The next day, a Monday, my box of goodies arrives at the clinic. I find it, open, on my desk chair. The office manager sees me looking into the box and says, "Sorry about opening that. There were four boxes on my desk, and I just cut them all open before I realized that one was yours. I didn't go through it or anything, " she adds, as if concerned she's invaded my privacy.

"That's okay," I tell her. "Although it would've been less embarrassing if it weren't sex toys," I add, frowning thoughtfully. I glance up in time to catch her look of pop-eyed astonishment. "For the sheep, I mean. Why are you looking at me like that? What did you think I meant?"

Luckily, Mary is getting used to me by now. Rather than being horrified, she eyes me speculatively.

"Have you been into the caffeine today?" she asks.

"Only a little," I say, with an innocent grin.

"Uh-huh," she says in tones of deep skepticism, while I do my best to smile angelically.

Later, during a lull in the appointment schedule, I decide to have a look at the harness. The one S&R has is black, composed of narrow nylon webbing, and doesn't look half as pretty as this one does. Mine is made of wider, thicker, halter-grade webbing, smooth and silky and bright blue. All its myriad rings and buckles are shiny with newness. Having only once used a marking harness - last year S&R used theirs on their buck, leaving Trinity without - I am not entirely familiar with the arrangement of all the straps. I take it out of the shipping bag so I can have a better look.

"What's that?" J asks me, happening by.

"Bondage equipment," I tell her. "For my ram," I add - because J is used to me too, and there's a small risk she'll take me literally.

J laughs. "What is it really?" she asks me.

"It is bondage equipment - kind of. It's a marking harness. I'm trying to figure out how it goes," I tell her, lining it out til I think I have it right. Fortunately I am certain that S&R can figure it out if I've made any mistakes. Meanwhile another tech walks by and also asks what that is I'm playing with. When I tell her it's bondage equipment, she just nods - without the slightest look of skepticism or astonishment, mind you - and walks off. I'm telling you. It's bad when people you work with aren't shocked to hear that you've ordered bondage equipment. Maybe I've been working here too long.

After work I go to Wildwood to drop of the harness and the crayons. R answers the door.

"Come on in," she tells me. "Want a glass of wine?"

"Umm... well, just one; I should go do chores before it gets too late," I say, kicking off my shoes.

"Look, she brought presents!" R says to S.

"Just the marking harness and crayons," I demur.

"Okay, good," S says. "Unfortunately we've just eaten dinner," she adds.

"Don't worry about it, I'm fine," I say. "A glass of wine will be plenty. It smells good, though, what was it?"

"Roasted kid, with Chinese spices," S tells me. R is fishing in the roasting pan and locates a chunk of meat, which she spears on a fork and hands to me. I taste it. It's delicious: exotic and slightly sweet with hints of cinnamon and mace and nutmeg. Mmm. Have to get me some of that Chinese seasoning.

"Well, we have exciting news," S tells me, gleeful. "Our new buck bred JoJo, and Trinity bred Jacinto today."

"You saw him?" I ask in some astonishment, since Trinity seems never to be seen breeding anything, although everything he's put to comes up pregnant.

"Yep," S reports. "We were feeding. Trinity's attitude toward breeding is to go over, do the job, and then immediately shove his way into the grain pans for something to eat."

"Nice," I say, ironically.

"Here's Jacinto's attitude toward breeding," S adds, leaning toward the counter and miming eating.

"Oh, that's nice. Doesn't even stop eating," I say in mock disgust. "Trinity is going to get a complex."

"I think we're fairly safe there," S says with a laugh. "It'd take a lot more than that to hurt his feelings this time of year."

Well, fair point there. Trinity is not easily offended. He's a methodical ram, systematically checking out his ewes and philosophically accepting any demurs as a hint that he would be better served to seek affection elsewhere. There are, after all, other ewes in the pen. If this one isn't ready, maybe that one over there will be.

As it happens - and here put on your surprised faces - one glass of wine turned into two. And then there was ice cream. And there was kind of a lot of laughing and some injudicious remarks about various things, followed by more laughing and escalations into even more injudicious remarks. And pretty soon it was 8:30 and I still hadn't done my chores. Which is how I found myself still doing dishes at what should have been bedtime.

I'm telling you. I'm giving up on sleep. Between days of howling winds banging around my house and being on call, I've barely had one good night's sleep in two weeks. So how on earth is it that I am doing dishes at midnight, when I should be sleeping? When it comes to beauty sleep, I need all the help I can get. I'll be lucky if I can cobble together an appearance for work tomorrow that doesn't frighten small children and cause adults to ask timidly if I've been feeling all right.

I blame Wildwood for this.

Friday, October 30, 2009

Whips and Chains

It's not what you think. (Is it ever, with me?)

This weekend I was back at Katie's cabin, helping her move some things; she's thinking of selling the cabin, and even if she keeps it there are some things that can be moved back to her house. Even this year, with its long hot summer and leisurely fall, winter will eventually come, and it's not likely that she'll need her canoe and her volleyball net for a while.

Up at the cabin it is colder - it usually is, the deeper you go into the Interior - and there is ice on some stretches of the road. We drive through any number of frozen-over puddles, crunching through inch-thick ice overlying 6 inches of water. In places the ice is muddy brown, but in others it's as clear and sparkling as chandelier crystal, rock-candying the margins of the puddles where others have gone through before us. The stream, in motion, has no ice at all yet, and even a fish lingering there in the chill current. There are deep red cranberries and rose hips still adorning the denuded and skeletal thickets, and a late lupin with purple blooms still clinging to the flower spike. Here and there in a protected lee, a deciduous plant still bears some green and gold.

At the cabin the view is glorious. The Mountain is out in all her glory, sharp against a blue sky. Off her right flank rises the sheer cliff of Moose's Tooth, catching the morning light across her face. The autumn sun shines silver at that hour, and the cliff face beckons, a smoky lavender-blue in the light, declivities and seams picked out clear, yet somehow still speaking of mystery. I turn away from this enticement with difficulty; we've had coffee on the way up, and more prosaic concerns intrude. It's time for a last memorial pee in the legendary Necessary House at Katie's cabin, and then on to practical matters.

Katie has her canoe stored keel-side-up on a little ridge. This allows it to drain and keeps it from filling up with rain water. It also, however, allows water to run down the hull and puddle under the gunwales, with the result that when we flip the canoe right side up, there are several 6-inch-wide platforms of frozen mud perched along the gunwales like little tabletops. Katie begins tugging at these, but they seem welded to the canoe, clinging stubbornly.

I tug at one myself, finding it hard as steel and unwilling to budge. Hmm. I glance around, looking for a tool of some kind. Ah, perfect: an oar.

"Hold her steady for a sec," I invite Katie, and I slide the blade of the oar under the ledge of ice across from me, seating it against the gunwale. Holding the oar shaft at the balance point with my left hand, I thump my right fist down sharply on my end of the oar. The oar blade pops up just as sharply, neatly levering the entire ice table off the gunwale.

"There. Just the tool for the job," I say with satisfaction, moving to the next ice table.

"Gimme that other oar!" says Katie with a gleam in her eye, and in a matter of seconds we have de-iced the canoe. We give each other a grin and slide the canoe into the bed of her truck, where Katie straps it in.

Here I will freely admit that I didn't magically develop the knack of MacGuyvering useful jury-rigged tools out of ordinary objects all by myself. No, the credit for this, I feel, must go to my friend Judi. Way back in the day, before my stints as racehorse groom and barn manager, Judi and I rode together at the barn that I eventually would manage. One day we were at the barn and I realized I'd locked my keys in my Karmann Ghia. It was a hot, muggy eastern day and I'd left the window cracked about 2 inches to prevent myself from being instantly parboiled on opening the car door. I tried reaching my arm through this gap to try to grab the door lock; it was a vintage car and had the little mushroom-capped lock stems that you never see any more, and I thought if I could juuuust get my arm far enough in.... But no such luck.

Judi exited the barn and sauntered over with her long-legged stride, eyeing my dilemma.

"I locked my keys in the car by accident," I said - rather unnecessarily, because who does it on purpose? - and withdrew my arm from the window, frowning at the car.

"Hm," she said, and without a moment's hesitation she stepped to the side of the car, slid her riding crop through the gapped window, hooked the little mushroom top of the lock stem with the loop at the end of the crop, and popped the lock.

"There," she said, with satisfaction. "Done."

My eyes sprang open wide for a moment, and then I laughed. "Man, are you a tool-user," I said with some admiration, shaking my head and retrieving my keys from the floorboard, where they had apparently fallen, unnoticed, when I'd gotten out of the car. "I'm pretty sure I've never even heard of anyone using a whip to jimmy a car door before, let alone seen it." Judi gave me a grin and a shrug, and sloped off leisurely to her own car.

I have to say I was rather impressed with that quickness of thought, the ability to see a solution to a problem - instantly, in this case - by applying novel uses to familiar objects. She didn't stop to think about it: It was immediately clear to her that she had in hand a tool that could be adapted from its original purpose to solve the problem at hand. That kind of stuck with me. And, following Judi's example, I've done a little MacGuyvering of my own, here and there, in the years since.

Once I was picking my mother up at Anchorage International. My mother suffers a bit from hypoglycemia, and knowing that airline food was unlikely to be much help with that, I'd come prepared with a bomber-sized bottle of Alaskan Amber. I knew from experience that beer was, for her, a quick fix for the hypoglycemia, and would hold her til we could get some real food into her. The problem was that I didn't have a bottle opener, nor was one available at the liquor store where I stopped to get the beer. I felt certain that at least one of the airport gift shops would have a bottle opener, but in that I was sorely mistaken. So there I am at my truck, with my hypoglycemic mother (looking a little pale around the edges), her luggage and a bottle of beer, and no way to get the beer into my mom.

But not for nothing did I know Judi. I set the crimped edge of the beer cap against the bumper of my truck, struck the top of the cap smartly with the heel of my hand, and popped the cap off the bottle.

"There," I said, in tribute to Judi. "Done." My mom laughed, but I think she just figured this was an Alaska thing: We ALL open our beers with our truck bumpers and repair our airplanes with duct tape, right?

The MacGuyver thing isn't just for Alaska, though. Back when I was in grad school, I was once taking care of a fellow grad student's dog while she went into the field. Nickie had an old collie with arthritic wrists and a ceaseless, cheerful grin. He needed fed and medicated twice daily, so I stayed at Nickie's house, driving her little VW Rabbit to and from school. Nickie, doing a little MacGuyvering herself, informed me that the screen door latch was broken, but she'd discovered that it could be opened from the inside by means of a spoon.

"Don't let it latch when you leave, though," she warned me. "You can only open it from INSIDE with a spoon. You can't open it from the outside at all."

"Okay," I said, and I was careful to pull the screen door to when I left, but to not allow it to latch.

Things went along swimmingly for a while, and then one day I returned from school to find that the door was latched tight. Crap. I was sure I'd been careful not to latch the screen door, but maybe the wind blew it shut or something. I could hear Nickie's dog inside, doing his "Welcome-home, I-really-need-out" bark. Poor dog. He needed his pain meds too, and his food supplements, and a good scritch. I looked around. Nickie had one half of a duplex, and the neighbor's back yard was divided from hers by a four-foot chain link... but the whole of both yards was surrounded by six and a half feet of solid cedar privacy fence.

I knocked on the neighbor's door, thinking they could let me into their back yard and I could hop the dividing fence and go in via Nickie's back door. Unhelpfully, the neighbors were not home. Crap. I went around to the side of the fence, where there was a gate. This had a latch on the inside, but it was padlocked shut. Even though I had a key, it had to be unlocked from the inside. I grasped the top of the fence, gave a little hop and tried to walk up the fence face, using the iron gate hinges as steps. Nope: Not enough purchase for my toes, and I was getting splinters in my hands. I gave that up and eyed the terrain. Maybe I could drive the Rabbit up the curb and get it near the fence, then stand on top of it... nope. There were two ornamental shrubs in the way, and I was fairly certain the property owner would not be happy to have his tenants - or their house-sitters - expensively destroying his landscaping. Not to mention what it might do to Nickie's car.

I looked at the hinges again. Maybe Nickie had something in her car that I could use to lever the pegs out of the hinges so I could just take the gate off. No such luck: she had no tool box in the back of her car. All she had was a thick wool blanket, a set of tire chains and a gallon jug of water -

A set of tire chains.

Suddenly I'm having a Judi moment.

I pull the chains out of the Rabbit and flip them over my shoulder, a little grin forming on my face as I carry them to the fence. This first set of chains I hang over the top of the fence, snugging them tight into the notches between the tops of the cedar boards and draping the chains down the fence. The second set I loop over the upper gate hinge, wedging a link into the crevice around the hinge as securely as I can make it go. I fold my jacket into a rectangle and flip it over the top of the fence to defeat the splinters. I put my toe into the stirrup of my lower tire chain, test it for slippage (none), and mount it like I'm mounting a horse. I grab the top of the fence - much nicer with the jacket over it - and, peering down between my knees for aim, step my right foot into the other tire chain. I step up onto that one, swing my left leg over the fence, toe it onto the latch so I can get my right leg over, and hop down into the yard.


I hurry to let Nickie's cheerful old collie out into the yard, then go around to the front door. There is a book between the door and the screen; evidently the postman put it there, as it was too big to fit in the mailbox, and shut the screen door tight to hold it in place. I open the screen door with a spoon, go around to the side yard, and deconstruct my improvised ladder, stashing the chains back in the Rabbit.

When Nickie gets back I tell her that the postman shut a book in her door, locking me out of the house. Her eyes go a little round.

"How did you get in?" she asks.

"Made a ladder out of your tire chains," I say, describing the method in case SHE ever gets locked out in a similar fashion. And what do you know, Nickie is as impressed with my improvisational tool-making skills as I was with Judi's.

It's a nice little legacy Judi left me: the knowledge that when something brings you up short, with no evident solution to hand, looking at things a little slantwise will often deliver you a solution with no more than you have to hand. Even if it looks like you're stuck, you can always bail yourself out... as long as you have whips and chains.

Wednesday, October 28, 2009

Slow Fall Into Winter

Author's note: Writing time is being consumed a little by editing time. Sorry about that. Things may be a bit slower on the "posting" aspect for a while, as I work on editing for the book. I hope you can all bear with me for a bit....

It's been a beautiful fall here.

We deserve it, after last year. Last year we came out of winter into a late, chill spring, and endured a cold summer, a raw overcast fall and an early, bitterly frigid winter. By the time we got to this spring, we were getting a bit cranky - well, I was anyway - and it didn't help that this spring was late and unseasonably cold as well. It was quite a pain lambing in it, not least of the reasons being the incessant worry - til things warmed up - that the lambs would be suffering or at risk.

This summer, though - glorious. It was hot. I mean ACTUAL hot, not just Alaska hot. We had temps over 90 this summer in the valley - the first time that's happened since I moved here. We had a whole week where it was in the upper 80's when I went home at night, every evening, consecutively. I actually used the air conditioning in my truck. I know! Amazing!

Normally, I am not especially heat-tolerant, most particularly when it's combined with humidity; that heavy, muggy weather blankets me in oppression and saps my energy and my will to do anything. (I realise the irony of this, given that I used to make my living grooming racehorses on the east coast - in the summer. I think it was the horses that made that tolerable... they make everything more enjoyable, don't they?) But this summer - wonder of wonders - I actually revelled in hot, humid weather. Revelled. Just a little, mind you, but actual revelling occurred. I kid you not.

Maybe because we'd just recovered, by dint of our beautiful hot summer, from what seemed like 19 months of winter - winter-winter, spring-winter, summer-winter and then winter-winter again - most of us were a little reluctant, maybe even a little apprehensive, to see fall coming this year. Because warm and glorious and restorative as this summer was, maybe we weren't quiiiiite ready for winter to come back again. I admit I was disquieted when I had yellow leaves falling in my driveway - just a few, mind , you but there they were- in July. Could that mean an early, cold winter coming? No, I told myself. That's just heat stress. La la la la la, I can't hear you!

Denial ain't just a river in Egypt.

Still, you face what you have to face. So I braced myself for a cold, hard fall and a colder, harder winter. After all, I did it last year, I can do it again, right?

As it turns out, so far I haven't had to.

It's the 28th of October today. The leaves finally all came down about 2 weeks ago; there were actual green leaves - GREEN, I'm telling you - still on some of the last hold-out trees until about 3 weeks ago. So far, my lake has yet to freeze. We've had one day where there was a thin scrim of ice on the surface, but it melted off by afternoon. There have been four days when the neighboring marsh - shallower and faster to freeze - has had that same thin, clear crust of ice on it, just for the day. The swans only left my lake 10 days ago. There are still ducks flying around my house, swift and sturdy as they launch themselves through the air on fast-beating wings. Last night it rained. I'll grant you there was about an hour during the middle of the day when there was a sleety look to it, when there was a faint scurf of white on the grass in the lees of the hedges, but that didn't last. By nightfall it was gone, melted by rain. In late October. In Alaska.

This morning there is the faintest ice-fractal on the surface of the water dish on my deck, but none on the lake or the marsh. No frost slicks my deck or clings to the trees. It's cool out, certainly - 33 degrees on my thermometer - but that's nothing. Nothing at all.

We had a winter, a few years back, where it never went below zero at my house all winter. To zero, yes, twice - but never below. It snowed, and the snow stayed, but it was mainly in the teens and twenties all winter. None of this 40-below-zero crap for THAT winter.... and certainly none of that never-gets-warmer-than-twenty-below-zero-for-three-weeks-strait nonsense. My lake didn't ice til the tenth of December. Given that I have some congenital abnormality that has me convinced that winter is over as of about February tenth, for me winter was only three months long that year. I enjoyed every minute of it - but springtime in Alaska is so full of vigor and life and burgeoning light that you can't regret the fade of winter, no matter how much you like it.

Hmmmm.... I think I could live with a reprise of that, this year.

This won't last forever, this long, gorgeous slide toward dark and cold. Sooner or later we'll be in short days and snow and ice. But for now... it's been a long, slow fall into winter.

Sunday, October 4, 2009

The Way Of The Peaceful Vet

Author's note: this started out to be a post about something else entirely, but sometimes you just have to go where the writing takes you. Sorry about that.

Early on in my career as a vet, it was easy to be unsure of myself... or easier, I should say. I still question myself daily - many times daily, in fact - wondering if I'm getting the right diagnosis, am I on the right track, what's best for this patient, how can I best achieve that within the limits of what both the client and the patient can afford, how should I handle that client so as to get the maximum benefit for them and their pet. That can be a tricky balance; some people need so much attention themselves that it distracts from the patent's care, and technically it's the patient I am there to care for. But realistically, no animal walks in and slaps down a gold card and says, "Hey, I have this bump on my neck, can you have a look at it?" The patient always comes with an owner attached - and ideally, this is how it should be. It is a good thing in the world that there are so many people who have the love of an animal - or several - in their lives, and vice-versa. So often I see that some part of the personalities involved - either that of the pet or that of the owner - would never have reached their full expression if not for that relationship. It immeasurably enriches them, and us, and the world; and if in some small way I am party to helping that along, then I am well-content.

To that end, I sometimes have to find ways of dealing with people and animals that I would not naturally feel an affinity for. The vast majority of my clients are wonderful, as are the vast majority of my patients; but I will admit that it is at times difficult to feel a sense of oneness with a dog who is trying to rip my lips off for no greater offense than walking into the room. It's perhaps more difficult to feel companionable with someone who refuses to even hear what I am saying - who declines to view the situation in terms of what is best for the patient, who refuses to listen to my best advice, who sets their own prejudices and judgements above what is, to my eye, clearly obvious and of critical importance - and which I have told them in no uncertain terms is the case.

Still. There are ways for most of this; and I imagine that as I go along I will find more ways, better ways, to handle the difficult ones. It is, after all, my job: to help. And if I learn something along the way, so much the better.

So I check myself constantly, making sure I've provided the information that is needed to make decisions, trying not to make the decision for the owner - that is their right and their responsibility, to make the best choice they can for themselves, their family, their pet. It is not always done well, and I may disagree with them; in their shoes, I might do differently. But I am not in their shoes, so I have to trust that they have chosen rightly for themselves and their pet. I try not to judge their choices - after all, I do not live their life. It's enough work living my own, and I have not the energy nor the wisdom to choose for them.... only to advise, to counsel, to guide and support, and then carry out their will as best I can.

I am often asked "What would you do if this were your pet?" - and I typically answer the same way each time:

"I'll answer that question, but I'll apologize in advance for that because it's a bit unfair of me to do it. This is different for me than it is for you; I can come in at 3 a.m. and Xray my dog if I want, because I have a key to the clinic - so these choices are easier for me than for you, because I can change my mind any time and go a different way, and I'm less intimidated by these procedures than most people, because I do them every day. That said, if this were my pet..." and then I'll tell them what I WOULD do if it were my pet.

So in this way I carry on my little war, my small fight against the dark. It's not a fight against death, really... I do want to help my patients have the longest, best-quality lives possible, but death comes to all of us in the end; and when it comes for my patients, I try my best to see that it comes with some dignity and some peace for the patient and the client both. In my imaginings, I think that death might not be so bad - it might, in fact, be an amazing good thing. And certainly the end to suffering - which it is my burden and my honor to bring to countless patients, past and future - that is something of value. From the simple view of an animal, suffering is just suffering. It is not ennobling, it is not enlightening. It is not a chance to learn grace and courage, as it might be for a person; animals have this in abundance already and hardly need the lessons of pain to bring it to them. No cat is thinking, "If I can just make it 'til Christmas" and no dog is hoping to live to see his grandson graduate from medical school. They live in the day, and if I cannot provide a reasonable hope that better days lie ahead - if I can only see that worse ones do - then it seems a mercy and a kindness to all of us, though to them most of all, not to let it go there. The hardest part of this being, of course, that while I am ending the animal's suffering, I am starting the owner's. It can be devastating to not only say goodbye to such dear friends as our pets can be, but also to have to be the one to make the choice that this is where that friend's life will end - and God forbid that we ever have to make such a choice for any family member but a pet. But still there is the hope of healing there, the redemption of knowing that you eased the pain of one you loved by the exercise of courage and compassion in making a difficult choice; of knowing that the last thing that animal knew would be the hand of a friend. There is, I hope, some comfort in that, and in knowing that you delivered your good friend into whatever comes after this life, as gently as it was possible to do. Death really is not the enemy here.

So no, my fight is against the dark: The darkness of ignorance, of carelessness, of failure of compassion, of indifference and neglect and cruelty and fear. My fight is to bring the light, maybe just a tiny bit, but to bring it where I can. My fight is not to give in to righteous anger when confronted with ignorance and thoughtless cruelty, but instead to find a way to change that; to stop it from happening next time, maybe. It's hard, sometimes. I have a temper that is slow to rouse, but once roused, is fierce and implacable: Scots to the core, my brother would say. That's a big horse to keep a rein on, and there are times I fail. But failing to rein it in does nothing to help the world. If I let that horse run, it will just run over things and smash them; it is only in harnessing it that it becomes a useful force.

So this is my battle with myself, to find a way to learn from all of this, so that next time I will be better at it, faster, kinder, stronger; so that I will not give in to the demands of ego, so that I never make it about me. It's not about me. It's about those I serve, who are in some ways the most deserving among us: the innocent. So if I must doubt myself in order to do this well, I will doubt. If I must sacrifice the need to be right, I'll sacrifice. If I must resist the temptation to judge, I'll resist. If I must hold tight to the reins of my temper, I'll hold. If I must stand my ground when I am afraid and tired and beset on all sides, I'll stand. If I must gather up all my courage and take the leap of faith, I'll leap. If I must yield my desire to dominate the growling dog or the fractious client, I'll yield. If I must submit myself to the burdens of this path, I'll submit.

One way or another, I still find my way along this path, arduous and gruelling as it may be at times. Because the gifts are great: It seems that the more I give myself to this way, the more I become who I came here to be. And I find my way strewn thick with the gifts of those I serve: Courage, humor, empathy and grace. Forgiveness and gratitude. Patience. Humility. Joy. Love. Mostly I think it is they - my patients, and often my clients as well - who bring me the light that I try to bring to others.

It is a path of irony, because it is composed of opposites: It is my left brain which processed the education, but the right brain that drove me to it. It is my intellect that gathers the information, but my intuition that best applies it. It is a way of fierce kindness and gentle ruthlessness. It is art and science entwined in a passionate embrace. It is where the clarity of knowledge and certain fact reveals the vast unknowable Mystery.

It is a juxtaposition of opposites, all right, and I still have much to learn about how best to stand at that juncture. But I'll keep trying.

Wednesday, September 30, 2009

The (Tall) Thin Man

When I was in vet school, I had a mustang mare, Cascabella by name . She was actually a Christmas present form my sister M. An accomplished horsewoman, M had adopted Cassie from a group that had underestimated the mare's age. Once M realised that -and that consequently Cassie wasn't likely to grow much more and would therefore be a little smaller than M likes to ride - she started thinking about placing her.

"Well, she's the perfect height for me, so wrap her up and mail her," I said, jokingly. But as it happens, my sis thought that was a dandy idea, so she shipped Cassie to me mid-winter of my first year of vet school.

Well, how cool is that? I got a pony for Christmas. I was 28 years old at the time, mind you, but hey: It pays to keep asking.

Cassie arrived in good trim late one night in November. (Okay, so she was an early Christmas present.) She was wearing a custom-fitted black denim horse blanket (lined in gorgeous teal green wool) and matching shipping boots - all custom made by M, who is (besides being an accomplished horsewoman) also an excellent seamstress, a software engineer, a professional dancer (belly and ballroom) and a sheep farmer.

What can I tell you? It's an interesting family. We might be described any number of ways - some less flattering than others - but "dull" never enters into it.

Meanwhile, back at the ranch - or at least, sophomore year of vet school - Cassie decides one morning to lacerate her pastern in some manner I have yet to determine. I go out to find that she has a cut that encircles two thirds of her pastern. Blood has run down her hoof, staining it a dark red-black color, and I can see little crusty half-moons in the dirt where she has stood long enough to leave standing blood, now clotted into small, grim coronas on the ground.

Well, hell. I have class this morning - a cadaver surgery rotation, and moreover it's the first day of the rotation, the one least likely to have any flexibility in schedule. On the other hand - this is my horse. I love her, and even if I didn't, I am responsible for her. Any horseman knows the saying: "No hoof, no horse". This isn't something to be blown off.

I step between the strands of the fence and pick up her foot. I can see tendon along the back, a sight that makes my heart leap into my throat, leaving a sick, hollow place behind. Cassie doesn't seem unduly distressed; in fact, she seems markedly impatient for her breakfast. She stands on the injured leg without complaint or lameness and attempts to encourage me to feed her by means of judicious nudging and nickering deep in her throat. I look at my hands; the blood on her hoof is dry, leaving not the slightest trace or stickiness on my hands. This didn't just happen; she did it sometime in the night.

I feed up and go inside for Neosporin, which I slather liberally over her laceration, and, thinking furiously, I get ready for school. I sort through my options and place a call to the University's Equine Ambulatory service, who needs to know when I want her looked at: They need me to be there to catch her up and hold her.

"I don't know," I say. "I'm a vet student and I have rotations this morning. Let's plan on noon, and I'll go in and ask my professor if I can come back earlier."

Once at school - 15 minutes early, and in a welter of nerves - I hunt down the tech who is assisting with the surgery lab and set out my dilemma in front of her.

"You're in luck," she tells me. "The lab is being run by Dr. Sydney, who used to be an equine surgeon. He'll know whether you have to go back right away or if it can wait til noon."

I set up beside a cadaver - a dog that was euthanized at Animal Control, one of the heartbreaking cadre of animals who have no home. As sad as it is that these animals die for lack of homes, it's a small comfort to know that their sacrifice is redeemed at least a small bit by allowing us to learn surgical skills on animals who will not suffer should we make mistakes. In this way they serve us... but they also serve our future patients, their brethren, by letting us learn where our errors can do no harm.

Dr. Syndey arrives in due course and I explain my circumstances. He looks at me, his eye both keen and calm.

"Was the blood on her hoof still wet?" he asks me.

"No," I say definitely, having checked specifically.

"Then it won't make a bit of difference if you see Ambulatory now or at noon. I'll let you go now if you want, but I promise you that if the wound has already dried, a few hours will make no difference. She'll be fine," he adds with a smile, seeing the tension in my body. His voice and manner show not the slightest doubt,and I feel my shoulders loosen and drop, reassured by his expertise.

"I don't want to miss the lab," I say. "I'll stay and do it, if you're sure."

"I'm sure," he says, with a smile. His eye is level and kind, and he pats me sympathetically on the shoulder.

Comforted, I do the lab without distraction, and make it out to my house in good time. Ambulatory calls me to tell me they'll be there in 20 minutes and to be sure of the directions to my house. I give these to the student on the phone, who I can hear relaying directions to the clinician (who is, of course, the one driving).

"As a by-the-way," I add to the student, "this is a mustang mare. She's very manageable, but she'll be a little shy at first. It would be best if you didn't all just pile out and mob her all at once. She'll need a minute to get used to you."

"Gotcha," says the student. We hang up and I go catch Cassie up, bringing her out of the fence and letting her graze on the lawn while we wait.

A few minutes later Ambulatory pulls in in their big white truck. This is a crew-cab pickup, absolutely jammed with vet students. All four doors pop open and vet students come boiling out like clowns out of a VW beetle, so many that you can't figure out how they all fit in there. They immediately descend on Cassie and I like a plague of locusts. Cassie takes two quick steps back and tries her best to hide behind me. I step in front of her face, offering what protection I can, and tell the vet students, "Whoa, stop! You have to go slow with her, she's a mustang. She's going to flip if you crowd her."

The students nod and essentially ignore me, fanning out to either side, pulling stethoscopes from around their necks and getting out clipboards. The clinician, an extremely tall, lanky fellow wearing a battered Stetson and worn cowboy boots, unfolds himself from the cab. At a glance he takes in the situation. Behind me I can feel Cassie starting to coil like a spring, preparing for flight but unsure where to go; she trusts me, but she is a wild horse. The first two years of her life she lived where flight was a matter of life and death, and though she is unusually good at managing her fear - you can see her thinking when presented with a new situation, evaluating it to see if she should stand or run - when she decides it's time to run, she does it as if her life depends on it - which, often enough, I'm sure it did.

"You all want to hold up now and back off of that horse," says the clinician in a quiet voice. His tone is conversational but the effect is immediate: The students seem to suddenly melt back and stand off to the sides. Cassie is still vibrating like a recently-plucked guitar string, pressing her head against my back and feeding her tension into my body. The clinician ambles up to her, unhurried and relaxed. In his stocking feet I imagine he is at least 6 foot 5, and the battered heels of his boots add another couple of inches to that. I step to the side, giving him room, and he sets his feet apart, straddling them wide to bring his face closer to Cassie's without leaning over her. He takes the sides of her halter in his long hands, his knuckles curled up against her cheeks, and gives her head a gentle shake.

"Hey, babe," he says to her in his deep, quiet voice.

The effect is instantaneous and astonishing. Cassie, who one second ago was barely controlling her need to bolt, relaxes instantly into his hands. Her ears relax, her eye half-closes, and she lets her head fall into his hands, taking a half-step forward to butt her head up against his sternum. This, her body tells me, is my kind of person. Here is someone who speaks my language. Here is someone I can trust.

"Why don't you all get a temp, pulse and respiration," he says then, in his mild way. "Dr. Stace," he adds, nodding at me. I look at him, cradling Cassie's head, and close my hanging jaw.

"Pleased to meet you," I say. "Although not half as pleased as she is," I add with a crooked smile, looking at my mustang, who now has her eyes closed and is rubbing her forehead on Dr. Stace's clinic coat as vet students swarm around her. "Sorry about your smock," I say, as black and white hairs begin to accumulate on the front. Dr. Stace gives me a slow smile and looks back at Cassie, who is now allowing him to rub her ears.

"She's all right," he says, dismissing his increasingly hairy clinic coat as a matter of no importance.

The students report their findings and Dr. Stace has a look at Cassie's pastern. Completely relaxed now, she stands patiently while everyone looks, while she is given a mild sedative and clipped and scrubbed and sutured up, while she is bandaged and injected with antibiotics. Her sedation wears off while Dr. Stace details her aftercare and she gives him a little nicker as he hands me the meds she'll need. He gives her a little sidelong smile, a secret thing, that warms the back of his eyes: something that is just for the two of them, some shared recognition.

"That's a nice little mare," he says in tones of approbation, gives me a nod, and takes himself off into the Ambulatory truck, now tightly sardined with vet students once more. I find myself staring after them as they back down the driveway and disappear down the road.

"Well. I never saw anything like that before," I say to Cassie, who is now lipping at her aftercare sheet with an interested expression, as if contemplating eating it. I walk her back to the pasture and offer her a carrot instead, which she feels is a fair trade. I turn her loose and she wanders off, her bright blue bandage jaunty against the steel grey of her leg. In the end she healed well, with barely a scar to show for her adventure.

I never got to go on rotations with Dr. Stace, as he left the University and went back into private practice before then; he missed it, he said, and I could see why. The next time I needed a horse vet I tried to get him - willing to bypass even the student discount I got from the University's Ambulatory service - but as it turns out he had as many clients as he could handle and wasn't taking new ones. Well, I can understand that; there's only so much time in a day, and anyone lucky enough to have Dr. Stace as their horse vet isn't likely to give up their spot. But even though I regretted that I did not have the opportunity to have him as a professor, I'm pretty sure I learned nearly as much from Dr. Stace that day as I did in a week of Ambulatory rotations when I went on them myself. Don't get me wrong: I loved my ambulatory rotation and I learned a lot from a good professor - and had a great time with my rotation mates, who teased me (the only woman on the rotation) like brothers. I teased them back, mercilessly, and we all got a lot done and learned a good bit about equine medicine and enjoyed the doing of it. What I learned from Dr. Stace was less about the "what" of medicine and more about the how and why, I think. Why we do this; how we keep doing it and doing it well; what it is that brings us joy in this work, despite its many burdens; how the essential inner heart of who we are is perhaps the most important thing we bring to our patients... more important, sometimes, than our knowledge and our skills, than our intelligence and reasoning, than our meds and sutures and bandages.

I imagine Dr. Stace is either retired now, or considering it; I would hope he's still amongst us on this earth, walking it with his long, ambling stride, his pace all leisure but his eye as keen and quick as a striking hawk. I can be sure of one thing, though: Wherever he is, he walks on the side of the Angels.

Monday, September 28, 2009

The Red Hand of Death (And Other Ways to Stay Sane During Vet School)

Vet school is a stressful gig. It's not just the responsibility of it, the knowledge that you are undertaking to go out and save lives, do surgery, make tricky medical diagnoses; undertaking to be the expert, to have people rely on you for help in matters of life and death. It's not just the astonishingly fast pace or the intense workload or the massive amount of information and skills you are trying to master. It's not just the expense of it, the long hours and the early realization that, rather than floating somewhere near the top of your class, an academic over-achiever, you are suddenly average: EVERYONE in your class is an academic over-achiever and ALL of them are from the tops of their classes - and at least half of them (and probably more) were better students than you were.

No, there's also the sneaking suspicion that your admission was a dreadful administrative error, and that you don't really belong here. This feeling will be emphatically underscored by the realization that the stunning girl who sits next to you - who is beautifully made-up and has her long strait hair perfectly curled, who has a husband and a house and a job.... this girl is not just smart enough to get into vet school, but she's SO smart she also has time to manage a full life AND look like that. Every day.

That's when you're pretty certain you're sunk.

Maybe it's not a big surprise that I went a bit frantic on the studying the first semester. We had an exam every 10 days, because if they stretched them out further, the amount of material to master was just too vast to be contained within one exam.

Now, the upperclassmen and the faculty were all well aware of the fact that the first exam of vet school was the most stressful of all of them - until it came time to take the National Board Exam and the Clinical Competency Test in senior year (plus or minus a state board exam, depending on the state in which you proposed to work). It's tradition that an outgoing Freshman - now a newly-minted sophomore - "adopted" a "little sib": an incoming and somewhat petrified freshman. In my case, I had my regular big sib - who, on the morning of the first exam, brought me a plate of home-made snicker doodles and a nice encouraging card, which was bright and cheerful and full of moral support - but I also had my neighbor's big sib, a very kindhearted girl who had met me via a work-study situation and to some degree taken me under her wing. She brought both of us - me and the kind, funny, intelligent and intimidatingly beautiful girl who sat next to me, who was her ACTUAL little sib - a new and freshly-sharpened #2 pencil, a brand-new eraser, and a petri dish of m&m's, labelled "m&m culture, eat on [date of exam]". My neighbor also got a few extra goodies, but it seemed her big sib didn't want to leave me out. Isn't that sweet?

Next we are all ushered, trembling, sleep-deprived and sweaty-palmed, into the lecture hall, where they are to pass out our exam papers and tell us the rules (the exam being half written, half practical). There is a strange murmuring noise, which you quickly realize is composed of 131 freshman muttering last-minute aides-memoirs to themselves or their neighbors. The professors proctoring the exam are on the lecture stage as the second hand sweeps away the remaining time before the exam. Suddenly it's 8:00. You can almost hear a hundred and thirty-one hearts skip a beat in synchrony.

The lab coordinator gets up to tell us how the practical stations are set up in the lab: there are no more than four students allowed per station at any one time, though we're allowed to go back and forth between stations as many times as we like, within the 4 hours we are allotted to take the exam. We are also welcome to take the exam sitting in the lecture hall or go back to our cubicles and take it sitting at our desks, or anywhere else inside the building, as the honor code applies: we are expected not to cheat. (Although an honor board exists - a group of students who self-police their peers, with advice and supervision from a professor - it is rarely needed over the next 4 years, and never is a student actually found to have been cheating, at least in my vet school class).

Now there is a slight pause, and the lab coordinator tells us a joke. A pretty good one, getting roars of laughter. A bunch of students shuffle in at one side of the lecture stage; they are upperclassmen, and they put on a skit to loosen us up. It's pretty funny - although to this day everything that happened before that exam is a blur to me, and I have not the faintest recollection what the skit was about. What I do remember is laughing so hard I was nearly crying, while one part of my brain stood off to the side, looking at me and saying: Man. You are REALLY stressed out. Get a grip on yourself.

But the joke and the skit do their jobs: I am feeling cheerful and upbeat and a bit more relaxed as I start my exam in my cubicle, with my snicker doodles and my m&m culture, looking at a picture of my pony I have taped to the wall. (Okay, it's one of the racehorses I groomed right before I came back to school, but you get the idea.)

After the first exam, when I realise that I did well, I start to relax just a little. Maybe it wasn't a huge administrative error after all and I really DO belong here. I don't let up on the work, but I'm not so freaked out any more, since I've proven to my personal satisfaction that I can in fact handle the material, as long as I apply myself.

Still: it's a big deal, being in vet school, and I never want someone's animal to pay for me not paying enough attention in school, so like my vet school brethren, I work hard. Which means that we have to play hard - and we do.

At least some students go out dancing every time an exam falls on a Friday night, as there are no classes the next morning. I am amongst those who find this relaxing, and I'll dance til I fall over. Not well, mind you, but with great enthusiasm. Then there are various FACs (Friday Afternoon Clubs) at various bars and eateries around town, which vet students are adept at ferreting out, as many offer free or half-price appetizers and cheaper drinks from (say) 5 to 7 p.m. on Friday afternoons. There's my usual Saturday coffee date with my friend SF, at which we would vent and commiserate. We never said where we would meet; one of us would call the other and it would be:
"You want to meet?"
"Sure, what time?"
"How about noon?"
"Okay, see you there!" [click].
Then we would meet at noon, having never specified WHERE we were meeting or what for. It didn't occur to me until senior year that the only thing we ever specified was the time.

Sometimes I would take out my little mustang mare (or my thoroughbred mare, or one of the horses I boarded in my pasture for extra money) and ride in the beautiful old cemetery across from my house. Sometimes I would go for a walk or a run in the same cemetery. Sometimes I would just sit and listen to music, or watch a movie or a little TV whilst meditatively knitting or spinning yarn, or play silly games with my dog. Sometimes I'd just sit and stare out my window, or go down by the irrigation ditch running through my property and watch the ducks and muskrats playing in the water. I also developed a few culinary hobbies, the B list: making bread, beer and biscotti (all of which had the significant advantage that you could eat or drink the results of your stress-relieving hobby, providing further stress relief.) Sometimes I would write - can't seem to help that, no matter the circumstances - and sometimes I'd get out my pad and sketch, or just draw pictures in the margins of my notes.

In vet school I was also a hiking fool. I had a ratty old Dodge Dart, which half the time had to be started by arcing two poles on the starter with the assistance of large slotted kitchen spoon, but which limped me through the first couple of years of vet school. I took my dog hiking probably at least five times a week for the first three years - less often the last year, as the workload increased, but even then we probably made about three times a week or more (except for the month I spent on the ICU rotation).

But maybe the single most important thing that kept me sane through the first three years of vet school was the discovery of racquetball.

This was introduced to me by MT, she of San Juan rafting fame. For 7 weeks of the first semester of vet school (for me; she was finishing her Master's degree) we had a weight-training class three days a week and would warm up by playing racquetball for an hour or more first. Then we'd do our weight training and then we'd walk to Pescado Bay for fish tacos afterwards. Naturally MT was a much better player than I was, but by the time she graduated, I was hooked. Not because I was so good at it: more because it just felt so good to hit something.

So I developed other friends to play racquetball with, and was on the courts at least 5 days a week the first two years of vet school (during which we were up-campus and within walking distance of the students-only rec center), and on a slightly slower schedule for the third year, when our classes moved down-campus to the teaching hospital. I did have two unfortunate events associated with my racquetball obsession: One was that I tore my calf muscles badly on the court one day early in our sophomore year and was laid off for three weeks; that made me nearly crazy with restlessness, and to this day that calf has never been quite the same. And the other was that, consequent to my years making my living at the end of a pitchfork, I had tendinitis in both wrists. This made for a certain amount of strain on my right wrist during play, with the consequence that sometimes, as my hand grew slick with sweat, the racquet would spin in my grip, ruining a shot.

Well. I can't have THIS. I need to hit the ball so hard I split it along its seam. Need to, I tell you.

So I went shopping for a glove of some kind, something that would keep its grip no matter how sweaty my hand got. But naturally I didn't need TWO gloves, since racquetball is a one-handed game. To my annoyance, I could find goggles and balls and racquet covers, sweat bands and court shoes and all manner of workout clothing - but nary a racquetball glove to be found. Not one.

After much poking about I realised that golf gloves come as a single glove. Well. This looks promising.

So I tried on all kinds of different golf gloves of various sizes and makes, until I found the one that fit me the way I wanted. It was thin and light and didn't ruin my feel of the racquet, but it was made of leather that would absorb the sweat and would, if anything, become stickier if the sweat soaked through the palm. Perfect.

The first day I tried it out I was playing with a male classmate, C. He had thick curly brown hair and smiling dark eyes, and in some way reminded me of both my brothers - the curly dark hair and twinkly chocolate eyes of one, and the teasing demeanor and bratty-younger-brother spunk of the other. He was not so very much taller than me - perhaps six or seven inches - but he was significantly more athletic - well, or at least looked it, with a diver's build and a general lazy ease of motion.

We get on the court and I unzip my racquet cover, taking out my golf glove and pulling it on. It just so happens that this glove, the one that fit me just right, is bright red. C takes one look at it and starts laughing.

"What is that?" he asks me.

"The Red Hand of Death," I tell him with narrowed and menacing eye, trying not to grin. For some reason this makes C laugh all the harder. (Hmm, I can't think why THAT would be). On the other hand - the Red Hand of Death hand, no doubt - I beat him two games to one that day... maybe because he was laughing at me the whole time.

I'm telling you: It doesn't do to laugh at The Red Hand of Death.

Nowadays I find my stress relief in some ways differently, and some ways similarly. I no longer have a horse, and my gym does not have a racquetball court (although there is a gym in town that does, the fees have gotten ridiculous, and I have no partners anymore, so it hardly seems worth it.) I traded making beer for making wine, and baking for making kefir and roasting lamb. I still play silly games with my dogs, of course, although some of those games are a bit more serious - working sheep, for instance. There is less regular TV and more PBS and movies, although music and staring out my windows are still good. I do less sketching and more photography, less hiking and more flying, but I still meet friends for coffee. I have no patience for spinning anymore - in part because the minute I turn my back on it some Border collie snatches the end of the yarn and runs all over the house with it, unreeling it madly and tangling it in a giant spider web upstairs and down - but I still like to knit and crochet, especially while watching TV... it seems less wasteful somehow if I'm making something at the same time. And of course... I still write. I still can't help that. It's almost a compulsion.

These things do me fine, for the most part. Every once in a while, though, when I've had a particularly trying day I can feel a little itch in my palm, and I think: I wonder if I could get away with wearing it to work... The Red Hand of Death.