So last weekend was the Knik 200 - a qualifying race for the Iditarod, a little 200-miler that is one of several smaller races a musher has to successfully complete in order to qualify (unless said musher has already finished in Iditarod, in which case they are considered to have proved their qualifications.) Several years ago I was coaxed into vetting the race (not easily arranged, since it starts on a Saturday, when I am normally working, so one of my bosses had to be roped in to cover my shift.) It was a year when we'd had warm temps and little snow, so the race went off about a month later than usual, with the advantage that there was significantly longer daylight, and better weather.
The fun all started Friday before the race. Dr P - a longtime Iditarod vet - had arranged for me to get the vet kit from the Tustamina (another 200-miler, cancelled due to overly warm temperatures) so that I didn't have to hassle with assembling my own kit. This was really quite thoughtful of him, and saved me a certain amount of trouble and strife. I decided that if it wasn't there by noon Friday, I was going to Iditarod headquarters to raid their stash, just in case. I figured, if I get drugs I don't need, no problem. But if I need drugs I don't get, BIG problem.
Friday noon rolls around with no kit, so over I go. No one had the combination to the drug lockup or knew when JP (the nerve center of the operation) would be back. After a certain amount of head scratching and 'hmmmm'ing, the combination is unearthed and I'm turned loose in free drug Nirvana (not as much recreational stuff as you might think from the "Nirvana" remark... more that there are many tens of thousands of dollars of expensive antibiotics and other medications in there, all neatly arrayed and FREE - for the race. AND there are some drugs that would be tempting if you were an addict, but those are a tiny minority.)
I load up a plastic trash bag with a lot more than I think I need, but better safe than sorry. The 10 o'clock news on Thursday night had announced that there were 60 teams signed up (which would be biggish for an Iditarod field, let alone a little 200-mile race that averages between 13 and 20 teams. Fortunately, they were mistaken, but I didn't yet know it.) The reason I am loading up a trash bag is that amongst other amenities, the Tustamina kits (and Iditarod kits, etc) are made up in an ActionPacker box, a sort of heavy plastic lock box that looks as if it could readily survive a Bison stampede, let alone a paltry 200 mile sled dog race.
Someone calls around 1 p.m. to say the kit will DEFINITELY be there by 6 p.m., but 6 p.m. comes and goes with no kit. Congratulating myself for having thought at least that far ahead, I cart my drugs and supplies (suture kit, splints, bandages, fluids, etc) home and start looking for a suitable carrier for it all. I have an idea that the soft-sided briefcases I customarily get for free when I attend meetings may do the gig, and I'm right: lots of internal pockets to stash drugs, a roomy central compartment for splints, bandages, fluids, etc, AND as a handy fringe benefit, they unzip so you can lay them entirely flat and have at the whole shebang all at once. They are in addition a lot easier to carry, since they have a nice shoulder strap. The only drawback is that they are soft-sided, so my breakable drug vials are a wee bit vulnerable. Oh well. They'll have to do.
Saturday morning I drop off my dogs at the clinic (where they will be weekending, since I won't be home to take care of them), add a few things to the kits that I have thought of over night, and go down to Knik lake. The race starts on the lake (frozen thick enough that 30 dog trucks, 345 dogs, assorted mushers, handlers, spectators and volunteers, and various support vehicles, including the race plane, can all safely trundle around on it for hours on end). I am fortunately there in time to have breakfast, which I do. Pretty soon, though, I'm on the ice doing the pre-race check with the help of CS, a German vet (not licenced in the States, and possibly a bit rusty due to not having practised for several years), and a pair of volunteers who are checking vaccination paperwork while we do physicals. I am at least twice as fast as CS and am having trouble deciding if that's because I'm really faster, or if it's because she is being more thorough. Pretty soon it doesn't matter because teams are lining up in the chute and we have to go like blazes to get them there on time. Teams leave at two minute intervals, so there isn't a lot of time to dink around. We finish in good order, though, and I have time to get my camera out of the truck and take a few shots.
We retire to the Knik Bar (headquarters for the race - rather appropriate, really) to wait for our pilot, MK. MK is the deciding factor in my choice to do the race. I've flown with him before, and I trust him. Apart from that, I like him, and if the lure of his airmanship wasn't enough to tip the balance, then the chance to catch up with him (and by extension, his wife, an intelligent woman and top-notch cook, whose hospitality I've enjoyed in the past), certainly WAS. CS, a bit sleep deprived, is in a hurry to fly to Skwentna, hoping to nap a bit before the first mushers get in. I'm a bit sleep-deprived myself (having stayed up late and gotten up early to finish the medical kits), but I figure MK, who has piloted this race for many years, knows his job way better than I do, and I'm not inclined to rush him. I figure that he is donating his time, his fuel, his plane and his considerable expertise, and if he feels inclined to relax and read his paper and finish his lunch and his cup of coffee, he's entitled. And when I return his call so he can give me an ETA, I tell him as much. I figure that MK is responsible for getting us there in one piece, and whatever way he wants to go about it is okay by me. Furthermore, he's been carting straw and food and God knows what-all up the trail for the last few days, and the poor man might need a few hours peace to relax with his wife in his own house. I tell him to take his time.
Round about 2 or so, Mike lands on the lake and volunteers swarm over and start cramming bales of straw, various supplies, medical kits, cold weather gear and medical personnel into the plane. It's a neat little Cessna 180, sturdy and workmanlike and more than agile enough to do the job we'll ask of it. I love these little Cessnas. Tough little planes, extremely useful for accessing the remote parts of Alaska (of which there are many.) At any rate, to my delight CS offers me the right seat (next to the pilot) and retires to the back. I love the right seat.
MK is a really good pilot, even by my spoiled-rotten standards (bear in mind most of my small aircraft time has been put in with my boyfriend DB - a commercial jet pilot - at the yoke, and I am inclined to use his skill as my benchmark for "really good".) Since MK also flies heavy freighters for a living, his skill is no surprise to anyone, but I find a deep quiet hum of contentment building in my core as he makes a sweet takeoff from the ice. Mike has thoughtfully informed us that he's going to keep it low as he skims above the ice toward the lake end, and that we shouldn't worry if it looks like the trees are getting awfully big in the windscreen. He's just banking speed, and when he has what he wants we're going to jump out of there like a scalded dog, he tells us - apt, I thought, given the context - and this is just what he does. CS, a more nervous flier than I, thanks him for the warning, but I am serene. MK is too good a pilot to let anything happen to us.
We cruise along for a bit, and then MK finds the Yentna River, which comprises a significant leg of the trail. We fly lazy serpentines along its course, looking for teams on the ice, and soon enough we find them. Some are trotting along at an easy mile-eating pace, a few are paused to rest and snack their dogs - they haven't gone so very far yet, but it's a warm day (mid to high 20's) and it doesn't pay to overheat your team. One or two teams are really hauling, the dogs loping easily along, smooth and eager for the trail. Thoughtfully, MK points out the few hazard spots, dropping us down onto the deck to have a close look at the worst one, so that we (as the medical team) have an idea what things we might be soon discussing with the mushers. I am happy as a clam at high tide, loving the airtime, but I later discover that CS is inclined to airsickness and isn't having quite as much fun as I am.
All too soon we land at Skwentna, touching down lightly and taxiing off the strip. A pair of snow machines await us, drivers comfortably slouched astride, watching MK come in. We offload our gear and CS and I pile aboard the machines for the short trip to the Skwentna Roadhouse (our trail headquarters), while MK spools it up and heads back out for the next load of gear and personnel.
The Roadhouse is run by a good-natured and apparently unflappable crew, who welcome us in, point us to our rooms (2 rooms with 2 sets of bunks each, so we'll be sharing with the guys, of which there are a great many more than girls on the checkpoint crew.) Being first in (since we have to be there before the first musher, in case of a need for veterinary care), CS and I are able to stake out our favorite bunks. CS has a bit of a nap while I wander about a bit. It's now 4:15 and I haven't eaten since breakfast. The Roadhouse crew seems thrilled to be able to help me in any way, and are delighted to make me something to eat. I dispatch a bowl of chili and decide to take advantage of the lull, so I go lay down for a bit while CS gets up. About 5:30 I get up from a restless doze. While I am yawning and stretching and chatting with CS, we see from our second floor window the first team into Skwentna checkpoint. They are mushing along handily, the dogs trotting with a floating synchronous ease that is lovely to see - particularly for me, since as the race vet, anything that doesn't look smooth and sound and perfectly flowing is soon to be my responsibility. If that becomes the case we move from the surreal beauty of the pearly light of the afternoon into the sharp-focus reality of sore muscles and sprained wrists and abraded pads and lacerations and ulcers and diarrhea and dogs that are just plain tired from running 87 miles with a full sled behind them.
[Author's note: To keep this post from being excessively long, it is divided into three parts, the way I originally wrote it. Next time: Knik 200 Part II: Midrace At Skwentna Checkpoint.]
Thursday, January 8, 2009
Wednesday, January 7, 2009
Camel Wrestling For Fun And Profit
Okay, I'm kind of joking about the "Profit" part.
Thinking on my time at the zoo, we had this camel case. Their big bull camel (here we're talking Dromedaries) had bitten one of his offspring in the hump. Now, you wouldn't think it to look at them, nor would you think it when you consider that they're herbivores, but male camels have long, sharp canine teeth. These are a set of four big fangs used, one assumes, primarily for fighting with other camels - although every so often someone turns their back on an irritable bull and gets bitten fatally in the head, because I am assured that if a camel can get his mouth around your skull, he's more than capable of crushing it like a melon, and that the long daggers of his teeth can punch right through a human skull, particularly over the thinner temporal bone.
Hmm. THAT'S a vivid image, isn't it?
It seems a bit counter-intuitive, actually. Camels have a pacing gait - they use the two legs on one side of the body in tandem, rather than going left-right-left-right the way (say) horses generally do. This gives them an elegant, leisurely sway and a rather stately air, which is compounded by their long, gracefully-curved necks and the lofty height of their heads, from which they gaze down upon you through luxuriant lashes with their large, liquid dark eyes. This doesn't reconcile so easily with the idea of fatal head-biting. Nor does it seem to fit with the mental image of such an aloof, high-headed animal suddenly reaching down to bite a baby's hump completely through, but there you are.
Apparently the bull camel at the zoo felt that his young son was being a sufficient pain in the hump - er, rump - that he decided to indicate his displeasure in as unequivocal a way as possible, with the result that the calf had four deep punctures, two on either side of the midline of his little baby hump. Not surprisingly, this is the kind of injury where infection would be a real danger, with the potential for much resultant and disastrous sloughing, or possibly even the risk of death. So, this meant that every afternoon for nearly my entire tenure at the zoo, we assembled a crew of medical staff and went over to the camel house for a little camel wrestling.
The calf - and here I know you'll be surprised - was really not all THAT into being separated from his mother and treated every day. Hence a certain amount of trickery was involved.
First, four of us arrive at the camel house, armed with antibiotics and scrub and flush and dressings. The keeper meets us there. Before anything else can be done, the bull has to be separated from the group. The bull does not like this idea and lays his ears back and tightens his large, velvety lips with every evidence of annoyance. He paces purposefully forward, glaring down at us from an impressive height and making low, menacing rumbling noises in his chest. If you have never stood near a camel making this noise, let me tell you: It's a bit creepy. It apparently resonates at a frequency capable of penetrating your tissues and setting up a vibrato in your viscera. This is not at all painful, but it somehow ignites an intense desire to be elsewhere. Suddenly you are restless, twitchy, anxious to be gone. Once you realize what's happening, of course, you have control of it... but it takes you unawares at first, dumping adrenaline into your bloodstream, driving your heart and lungs, making the hair stir on the back of your neck.
Once the bull has been lured away and gated off (to his great displeasure), the cow and calf are coaxed into the barn. The cow is lured strait through and out the other side, and the calf is unceremoniously detained, with the help of our little camel press-gang. The keeper closes the barn door, trapping the cow outside, and our little gang nabs the calf, looping arms around his elegant neck, haltering his head, blocking his hurried backward shuffle, and (as quickly as possible) blindfolding him. This has the multiple purpose of protecting his large, expressive eyes from injury during restraint, making him less capable of escape, and of decreasing his stress as much as we are able to do and still treat him.
There follows quite a lot of scuffling and various breathless grunting and swearing as the camel calf - who cannot weigh above an hundred and fifty pounds - starts tossing the rest of us around, surging forward for freedom, swinging his head at us like a sledgehammer, kicking and stomping and bawling for his mother (who is bellowing herself, accompanied from the other side of the barn by the incessant gargling rumbles of the bull). I, as the smallest member of our crew, have the job of flushing out the wounds and then packing them with antibiotic ointment whilst the rest of the gang do their damnedest to make sure I don't get trampled to death in the process. Five adults it takes to compel this 150# calf to take his medicine, and we are barely enough. Five adults barely fit in a cluster around this little calf, not more than a few months old, but he is nearly equal to us even so.
I go as fast as I can and still get the job done. The holes in the calf's hump are so deep I can sink my index finger to the last knuckle and still not quite reach the end of the punctures. Two of them nearly meet in the middle, a centimeter from being a through-and-through puncture of the entire width of the hump. The first day was the hardest, both for this reason and because we had to clip the hair away from the wounds, so we spent much longer that day. But even after the punctures start to granulate in and grow shallower with the passing days, it's quite a chore to simultaneously brace my weight against the heaving sides of the calf and at the same time clean and pack the wounds, squinting against the dust we are raising, jostled and bumped on either side by vet and techs and keeper as they strain to keep the calf from running us all over as I treat the left side, and then as I hurry around to treat the right.
At the end of all that, Dr. K injects a wad of antibiotics into the calf and we all peel off like the gantries falling away from a launching rocket: the keeper mans the barn door, and we unhalter and un-blindfold the calf, releasing him as the keeper opens the door and we all melt as fast as possible back into the building. Camels are in general relatively calm - apart from when the bulls are rutting - but the last thing we want to do is hang around to see how forgiving (or not) the cow is.
The very last order of buisness is to open up the opposite side of the barn so that the pass-through is unobstructed and the bull camel is free. The bull, the moment he is released, wastes no time in striding through the barn to inspect his herd, gargling and rumbling, ropey green saliva trailing from his mouth as he grinds his lower jaw from side to side in agitation.
I felt bad for the camel calf, being trapped and wrestled every afternoon, although I did feel good about the fact that his hump neither became infected nor sloughed. I'm sure it wasn't fun for him, and of course he had no way to know that we were doing it to save his life and prevent permanent disfigurement. I will say my sympathies were squarely on him, most of the time - although I admit they were a bit strained from time to time, as (for instance) when he sidestepped and mashed me against the barn wall hard enough to drive all the breath out of me, or when one of his flailing knees caught me in the thigh.
Okay, so I guess I'm kind of joking about the "Fun" part, too - but I wasn't kidding around about the "Wrestling" part. The WWF ain't got nothing on us.
Thinking on my time at the zoo, we had this camel case. Their big bull camel (here we're talking Dromedaries) had bitten one of his offspring in the hump. Now, you wouldn't think it to look at them, nor would you think it when you consider that they're herbivores, but male camels have long, sharp canine teeth. These are a set of four big fangs used, one assumes, primarily for fighting with other camels - although every so often someone turns their back on an irritable bull and gets bitten fatally in the head, because I am assured that if a camel can get his mouth around your skull, he's more than capable of crushing it like a melon, and that the long daggers of his teeth can punch right through a human skull, particularly over the thinner temporal bone.
Hmm. THAT'S a vivid image, isn't it?
It seems a bit counter-intuitive, actually. Camels have a pacing gait - they use the two legs on one side of the body in tandem, rather than going left-right-left-right the way (say) horses generally do. This gives them an elegant, leisurely sway and a rather stately air, which is compounded by their long, gracefully-curved necks and the lofty height of their heads, from which they gaze down upon you through luxuriant lashes with their large, liquid dark eyes. This doesn't reconcile so easily with the idea of fatal head-biting. Nor does it seem to fit with the mental image of such an aloof, high-headed animal suddenly reaching down to bite a baby's hump completely through, but there you are.
Apparently the bull camel at the zoo felt that his young son was being a sufficient pain in the hump - er, rump - that he decided to indicate his displeasure in as unequivocal a way as possible, with the result that the calf had four deep punctures, two on either side of the midline of his little baby hump. Not surprisingly, this is the kind of injury where infection would be a real danger, with the potential for much resultant and disastrous sloughing, or possibly even the risk of death. So, this meant that every afternoon for nearly my entire tenure at the zoo, we assembled a crew of medical staff and went over to the camel house for a little camel wrestling.
The calf - and here I know you'll be surprised - was really not all THAT into being separated from his mother and treated every day. Hence a certain amount of trickery was involved.
First, four of us arrive at the camel house, armed with antibiotics and scrub and flush and dressings. The keeper meets us there. Before anything else can be done, the bull has to be separated from the group. The bull does not like this idea and lays his ears back and tightens his large, velvety lips with every evidence of annoyance. He paces purposefully forward, glaring down at us from an impressive height and making low, menacing rumbling noises in his chest. If you have never stood near a camel making this noise, let me tell you: It's a bit creepy. It apparently resonates at a frequency capable of penetrating your tissues and setting up a vibrato in your viscera. This is not at all painful, but it somehow ignites an intense desire to be elsewhere. Suddenly you are restless, twitchy, anxious to be gone. Once you realize what's happening, of course, you have control of it... but it takes you unawares at first, dumping adrenaline into your bloodstream, driving your heart and lungs, making the hair stir on the back of your neck.
Once the bull has been lured away and gated off (to his great displeasure), the cow and calf are coaxed into the barn. The cow is lured strait through and out the other side, and the calf is unceremoniously detained, with the help of our little camel press-gang. The keeper closes the barn door, trapping the cow outside, and our little gang nabs the calf, looping arms around his elegant neck, haltering his head, blocking his hurried backward shuffle, and (as quickly as possible) blindfolding him. This has the multiple purpose of protecting his large, expressive eyes from injury during restraint, making him less capable of escape, and of decreasing his stress as much as we are able to do and still treat him.
There follows quite a lot of scuffling and various breathless grunting and swearing as the camel calf - who cannot weigh above an hundred and fifty pounds - starts tossing the rest of us around, surging forward for freedom, swinging his head at us like a sledgehammer, kicking and stomping and bawling for his mother (who is bellowing herself, accompanied from the other side of the barn by the incessant gargling rumbles of the bull). I, as the smallest member of our crew, have the job of flushing out the wounds and then packing them with antibiotic ointment whilst the rest of the gang do their damnedest to make sure I don't get trampled to death in the process. Five adults it takes to compel this 150# calf to take his medicine, and we are barely enough. Five adults barely fit in a cluster around this little calf, not more than a few months old, but he is nearly equal to us even so.
I go as fast as I can and still get the job done. The holes in the calf's hump are so deep I can sink my index finger to the last knuckle and still not quite reach the end of the punctures. Two of them nearly meet in the middle, a centimeter from being a through-and-through puncture of the entire width of the hump. The first day was the hardest, both for this reason and because we had to clip the hair away from the wounds, so we spent much longer that day. But even after the punctures start to granulate in and grow shallower with the passing days, it's quite a chore to simultaneously brace my weight against the heaving sides of the calf and at the same time clean and pack the wounds, squinting against the dust we are raising, jostled and bumped on either side by vet and techs and keeper as they strain to keep the calf from running us all over as I treat the left side, and then as I hurry around to treat the right.
At the end of all that, Dr. K injects a wad of antibiotics into the calf and we all peel off like the gantries falling away from a launching rocket: the keeper mans the barn door, and we unhalter and un-blindfold the calf, releasing him as the keeper opens the door and we all melt as fast as possible back into the building. Camels are in general relatively calm - apart from when the bulls are rutting - but the last thing we want to do is hang around to see how forgiving (or not) the cow is.
The very last order of buisness is to open up the opposite side of the barn so that the pass-through is unobstructed and the bull camel is free. The bull, the moment he is released, wastes no time in striding through the barn to inspect his herd, gargling and rumbling, ropey green saliva trailing from his mouth as he grinds his lower jaw from side to side in agitation.
I felt bad for the camel calf, being trapped and wrestled every afternoon, although I did feel good about the fact that his hump neither became infected nor sloughed. I'm sure it wasn't fun for him, and of course he had no way to know that we were doing it to save his life and prevent permanent disfigurement. I will say my sympathies were squarely on him, most of the time - although I admit they were a bit strained from time to time, as (for instance) when he sidestepped and mashed me against the barn wall hard enough to drive all the breath out of me, or when one of his flailing knees caught me in the thigh.
Okay, so I guess I'm kind of joking about the "Fun" part, too - but I wasn't kidding around about the "Wrestling" part. The WWF ain't got nothing on us.
Sunday, January 4, 2009
Snow Leopard Tuesdays
When I was a junior in vet school, we had to choose the rotations that we would take as a senior. There were some minimum core requirements - a certain amount of surgery, anesthesia, neuter/dentistry, etc - but there were electives, too. Based on how you ranked them, and how many people applied for the available slots, the electives were assigned. There were some other programs as well, externships and preceptorships that you could apply to and request be worked into your schedule. Since a year of school at my U was about 9 months of coursework, there was also a three-month hiatus scheduled in, which you could take at any of three times: you could elect to have the summer off after junior year, and start rotations in the fall, or to take off the fall semester or the spring semester. The graduation ceremony was in May for all of us, but some of us would have finished our rotations three months prior to that, and so conceivably some of us might have had jobs (if all liscensure was in place) prior to going through commencement.
One of the ones I applied for was a preceptorship at the Zoo. I didn't get it; based on how I'd ranked my choices, how other people had ranked THEIR choices, and when my required rotations were scheduled, it didn't fit. But as it happened, another preceptor had had a conflict of some kind, so the two weeks before the fall semester (when I had elected to resume my rotations) were left without coverage. I was on the alternates list, so they called me. Would I like to use the two weeks I had left to do a mini-preceptorship? Why YES, thanks, I'd LOVE that.
As it turns out, the first day of those two weeks was a holiday, so I started on a Tuesday. I found my way to the secluded, mysterious back side of the zoo, the place most people never even think about: the place where orphan babies are reared, where sick animals are treated, where deceased animals are necropsied so as to learn as much as possible about the animals in life and in death, with an eye to improving management for both wild and captive animals, and preventing other deaths.
The vets and techs were expecting me, and made me welcome. I stashed my backpack and, all bright-eyed and bushy-tailed, waited for what came next. Which, as it turned out, wasn't quite what I was expecting.
"One of the keepers called this morning and said she'd seen blood in the snow leopard enclosure," announced Dr. C, the head vet. "You and Dr. K can go over and get the cat while we get ready over here."
Well, all righty, then. I guess we just jump right in to the fast lane here at the zoo.
Dr. K assembled a group of items: a dart gun (taken out of lockup and carefully inspected), two large plastic tackle boxes full of drugs, syringes and other medical flotsam, a stethoscope, and a large blue tarp, folded into a neat 2x2 foot square. We took these items out to the electric carts that the vets use to travel around the zoo. These are similar to golf carts, except that they have a little flat bed behind the tiny two-seater cab. We loaded the tarp and tackle boxes on the bed, Dr. K secured the dart gun, and we set off.
The zoo gates were not yet open. We had the place to ourselves as Dr. K zoomed along the asphalt paths criss-crossing the zoo. Dr. K is an intrepid driver, and in the absence of human traffic he zipped along at a pretty good clip, ignoring whatever dips and creases there were in the road. We were quickly at the snow leopard enclosures, where we toted our supplies into the building and spoke to the keeper. She had seen blood for a few days, but no evident injuries, on visual inspection. Initially she had not been sure which cat it was, but by rotating cats in order she had determined it was one of the males, and she pointed him out.
The way the zoo was at that time - and I've not been to that particular zoological garden for 15 years or more, so I can't say how it is now - there was a display habitat, where the cats would be during the day, and a second, indoor enclosure, which was more utilitarian in appearance, but provided area for privacy, rest, play and feeding, and where appropriate, breeding and birthing. The display habitats for the leopards were rather gorgeous; depending on the type of cat, it might be glass-fronted on one display side and/or barred on the other, with grilled skylights recessed into the ceilings to provide natural light. There were murals on the walls to depict the animals' natural habitat, along with rocky ledges and/or cleverly-made and realistically-painted concrete trees for perching and basking, whatever vegetation was appropriate to the habitat, and little waterfalls and streams both for aesthetic appeal and for the practical realities of providing drinking water. They were connected to the indoor enclosures by (literally) cat-walks, overhead walkways that were completely enclosed with metal grilles. There were doors on either end - cleverly concealed in the display habitat - which could be opened or closed to control the movement of the cats between enclosures.
The keeper let the injured cat out of the indoor enclosure and into the cat-walk. She closed the doors, trapping him in the cat-walk. The leopard walked to the end of his cat walk, where normally the door would be open for him, and stopped. He looked around at us. For an instant his eye met mine, direct as a spear to the heart.
Dr. K loaded the dart gun, took careful aim, and fired. The cat jumped and hissed, flattening his ears in annoyance. The keeper opened a door so that he would leave the cat walk and go into a habitat area, where we could go in and retrieve him once he fell asleep. Dr. K loaded a syringe with an anesthetic cocktail while we waited, explaining that it would be given IV to keep the cat asleep while we transported him to the hospital.
When the cat was out cold, Dr. K and I went into the enclosure.
"Here," Dr. K said, handing me the syringe. "Give him this. I'll hold off the vein."
My heart took a big hop and started doing a quick-time march. Better not miss.
Dr. K held off a vein in the back leg of the cat. I did an alcohol wipe-down and, lo and behold, a vein the size of my pinkie finger popped right up. Well, can't miss THAT. I pushed the drug and capped the syringe. Dr. K was already in motion, spreading the tarp on the floor and grabbing the leopard's back legs. We moved the cat to the center of the tarp and picked up the corners, carrying it quickly out to the cart. The keeper hurried behind us with the tackle boxes, setting them behind the cab.
"I'll drive. You monitor the cat," said Dr. K. I hopped backwards onto the cart, letting my legs dangle over the side and helping Dr. K drag the cat half into my lap, still draped in the tarp. I jammed the stethoscope into my ears as he folded himself back into the cab, and by the time he'd switched it on I'd found the cat's heart, a slow and reassuringly powerful thump in my ears. Dr. K maneuvered the cart through a tight turn and out onto the path. And then he put his foot down and we rocketed off at top speed.
I'd thought Dr. K was driving pretty fast before, but now I gained some new perspective. Naturally you can't risk the cat waking up in the middle of the zoo - which had opened by now, although on a weekday morning there weren't many people around. Still, you can't have a drugged leopard wandering around loose no matter HOW few people are there, so speed is of the essence. Dr. K clearly enjoyed speed for its own sake, and now that he had some incentive to push it a little, he wasn't going to stint.
So there I am, perched on the flat bed of the cart with my feet dangling and 150# of somnolent snow leopard draped across my lap. As one hand is holding the stethoscope and the other is hanging onto the leopard with a death-grip (because it wouldn't do to have it go flying off my lap in some high-speed turn), I have no means of hanging on. We are not slowing down for bumps. Every time we hit one - and for some reason there seem to be approximately six times as many now as there were on the way over - the tackle boxes hop into the air, the cat hops into the air, I hop into the air. The tackle boxes crash down and slither around, rattling happily. I am having a hard time keeping my 'scope on the leopard's heart. After about two minutes I remind myself that respiratory arrest precedes cardiac arrest, so if the cat is still breathing, the heart is still beating. I can feel the rise and fall of its furred chest under my hands, so I drop the bell of the stethoscope and use both hands to hold onto the cat.
As we come streaking into the bay area behind the hospital, all hands are on deck. Dr. C is there and so are the techs, C and D. They descend upon me in a group, gathering up the tarp corners and shuffling fast into the building. The cat is weighed and then shuttled with all haste to the OR, where he is intubated and connected to the gas anesthetic.
Big sigh. Now we can relax a little; the cat is safely anaesthetised, he is on oxygen, he has a heart monitor on him.
The vets begin their physical exam. The source of the blood is quickly found: the cat has an abrasion on one pad, deep enough to ooze blood every time he steps on it. While that is being treated, C is scraping tartar off the cat's teeth and D is setting up the endoscope; as long as the cat is out, you do everything you can. Dr. K sets up a syringe and tells me to pull blood samples off the jugular (he does have a gift for making my heart jump into my throat) and watches without comment as I manage to do a jugular stick without fumbling or shaking. Despite the thick hair on the leopard's neck, the jugular is luckily quite large and palpable; I'm grateful this isn't a marmoset we're working on. Dr. K gives the bloods to the clin path tech and he and Dr. C start the endoscope.
While everyone is circling around, doing all that can be done, I am suddenly in a tiny one-person oasis of stillness. I have a moment to look - really LOOK - at this glorious animal. He is long and slender, but somehow he seems dense and substantial and real in a way that is hard to describe; it is somehow both arcane and immediate, as if the weight of his leopardness is a thousand times greater than the weight of bone and muscle, as if it gives him a gravity that draws my orbit toward his. I pick up his heavy paw, feeling the dense, robust bones of his muscled forearm, the thick tendons, the meaty bulk of the upper arm. At the same time I am thinking of the lightness and grace with which this animal moves, marvelling at the combination of these opposites into one creature. But as it happens, the snow leopard is a creature of opposites. Rare, but easily bred in captivity. Shy, but direct of gaze. Lithe but amazingly powerful. Fragile in numbers, but tough enough to survive in one of the harshest environments on earth.
On his shoulder, I find a tiny mat, a hairball not much bigger than a pea. I pull it out of his coat, smoothing down the dense fur, shaded and subtle even in the strong light of the OR. I move out of someone's way, to the end of the table. There his tail trails off, relaxed, drooping lazily toward the floor, nearly as long as his body. I lift the end of it gently. I've never had a tiger by the tail, but I've had a leopard. A sleeping leopard, but still: not an experience to be forgotten.
Around me, time suddenly snaps back into place. Dr. C and Dr. K are talking about moving the cat back to his house. They crank the anesthetic gas all the way up for a few minutes, getting him deep, and the we reverse our earlier frantic activity. The leopard goes back onto the tarp, and we shuffle him fast out to the cart. I hop into the bed and gather him up, and Dr. K is behind the wheel and firing it up at the same time. We have less time now than before; the injected meds have worn off and the gas anesthetic will only hold him for a few minutes. By now, there are more people in the park as well, and Dr, K can drive only so fast. I have one arm around the leopard's belly, the other around his chest, my hand buried in fur and feeling for breath. His big head rests heavy on my thigh, buffered against the bouncing of the cart as we fly back the way we came.
At the leopard house, the keeper is waiting anxiously, pacing and watching for us. She has been radioed we are on our way, and she has the door to the building open by the time we have the tarp slung between us. On a bench outside the display there are two people; one asks us anxiously if that animal is dead.
"No," says Dr. K, laconically.
"Only sleeping," I add, panting, as we do our shuffling quick-step back into the building.
We settled the cat into his enclosure, waiting until he was lifting his head and rolling onto his sternum. Dr. K left instructions with the keeper, who nodded repeatedly without interrupting, intent on his words. We went back out into the sunny August morning, the Zoo awake around us, bustling now; the cat awake behind us, drowsing in his private domain.
I was only there for two weeks, but every Tuesday turned out to be a snow leopard day; unlike some of the keepers, the snow leopard keeper trusted the vets to do right by her charges, and didn't hesitate to call them in if something was amiss. Aware, perhaps, of their rarity, she was a vigilant defender of their well-being, guarding them and their genetics against a hoped-for day when wild populations might be re-established in some of their lost range; and more personally, fiercely protecting their best interests whilst in her care.
You can't blame her for that ferocity of feeling on their behalf. I defy anyone to be around such an animal without feeling awe.
I still have that little mat of snow leopard hair.
One of the ones I applied for was a preceptorship at the Zoo. I didn't get it; based on how I'd ranked my choices, how other people had ranked THEIR choices, and when my required rotations were scheduled, it didn't fit. But as it happened, another preceptor had had a conflict of some kind, so the two weeks before the fall semester (when I had elected to resume my rotations) were left without coverage. I was on the alternates list, so they called me. Would I like to use the two weeks I had left to do a mini-preceptorship? Why YES, thanks, I'd LOVE that.
As it turns out, the first day of those two weeks was a holiday, so I started on a Tuesday. I found my way to the secluded, mysterious back side of the zoo, the place most people never even think about: the place where orphan babies are reared, where sick animals are treated, where deceased animals are necropsied so as to learn as much as possible about the animals in life and in death, with an eye to improving management for both wild and captive animals, and preventing other deaths.
The vets and techs were expecting me, and made me welcome. I stashed my backpack and, all bright-eyed and bushy-tailed, waited for what came next. Which, as it turned out, wasn't quite what I was expecting.
"One of the keepers called this morning and said she'd seen blood in the snow leopard enclosure," announced Dr. C, the head vet. "You and Dr. K can go over and get the cat while we get ready over here."
Well, all righty, then. I guess we just jump right in to the fast lane here at the zoo.
Dr. K assembled a group of items: a dart gun (taken out of lockup and carefully inspected), two large plastic tackle boxes full of drugs, syringes and other medical flotsam, a stethoscope, and a large blue tarp, folded into a neat 2x2 foot square. We took these items out to the electric carts that the vets use to travel around the zoo. These are similar to golf carts, except that they have a little flat bed behind the tiny two-seater cab. We loaded the tarp and tackle boxes on the bed, Dr. K secured the dart gun, and we set off.
The zoo gates were not yet open. We had the place to ourselves as Dr. K zoomed along the asphalt paths criss-crossing the zoo. Dr. K is an intrepid driver, and in the absence of human traffic he zipped along at a pretty good clip, ignoring whatever dips and creases there were in the road. We were quickly at the snow leopard enclosures, where we toted our supplies into the building and spoke to the keeper. She had seen blood for a few days, but no evident injuries, on visual inspection. Initially she had not been sure which cat it was, but by rotating cats in order she had determined it was one of the males, and she pointed him out.
The way the zoo was at that time - and I've not been to that particular zoological garden for 15 years or more, so I can't say how it is now - there was a display habitat, where the cats would be during the day, and a second, indoor enclosure, which was more utilitarian in appearance, but provided area for privacy, rest, play and feeding, and where appropriate, breeding and birthing. The display habitats for the leopards were rather gorgeous; depending on the type of cat, it might be glass-fronted on one display side and/or barred on the other, with grilled skylights recessed into the ceilings to provide natural light. There were murals on the walls to depict the animals' natural habitat, along with rocky ledges and/or cleverly-made and realistically-painted concrete trees for perching and basking, whatever vegetation was appropriate to the habitat, and little waterfalls and streams both for aesthetic appeal and for the practical realities of providing drinking water. They were connected to the indoor enclosures by (literally) cat-walks, overhead walkways that were completely enclosed with metal grilles. There were doors on either end - cleverly concealed in the display habitat - which could be opened or closed to control the movement of the cats between enclosures.
The keeper let the injured cat out of the indoor enclosure and into the cat-walk. She closed the doors, trapping him in the cat-walk. The leopard walked to the end of his cat walk, where normally the door would be open for him, and stopped. He looked around at us. For an instant his eye met mine, direct as a spear to the heart.
Dr. K loaded the dart gun, took careful aim, and fired. The cat jumped and hissed, flattening his ears in annoyance. The keeper opened a door so that he would leave the cat walk and go into a habitat area, where we could go in and retrieve him once he fell asleep. Dr. K loaded a syringe with an anesthetic cocktail while we waited, explaining that it would be given IV to keep the cat asleep while we transported him to the hospital.
When the cat was out cold, Dr. K and I went into the enclosure.
"Here," Dr. K said, handing me the syringe. "Give him this. I'll hold off the vein."
My heart took a big hop and started doing a quick-time march. Better not miss.
Dr. K held off a vein in the back leg of the cat. I did an alcohol wipe-down and, lo and behold, a vein the size of my pinkie finger popped right up. Well, can't miss THAT. I pushed the drug and capped the syringe. Dr. K was already in motion, spreading the tarp on the floor and grabbing the leopard's back legs. We moved the cat to the center of the tarp and picked up the corners, carrying it quickly out to the cart. The keeper hurried behind us with the tackle boxes, setting them behind the cab.
"I'll drive. You monitor the cat," said Dr. K. I hopped backwards onto the cart, letting my legs dangle over the side and helping Dr. K drag the cat half into my lap, still draped in the tarp. I jammed the stethoscope into my ears as he folded himself back into the cab, and by the time he'd switched it on I'd found the cat's heart, a slow and reassuringly powerful thump in my ears. Dr. K maneuvered the cart through a tight turn and out onto the path. And then he put his foot down and we rocketed off at top speed.
I'd thought Dr. K was driving pretty fast before, but now I gained some new perspective. Naturally you can't risk the cat waking up in the middle of the zoo - which had opened by now, although on a weekday morning there weren't many people around. Still, you can't have a drugged leopard wandering around loose no matter HOW few people are there, so speed is of the essence. Dr. K clearly enjoyed speed for its own sake, and now that he had some incentive to push it a little, he wasn't going to stint.
So there I am, perched on the flat bed of the cart with my feet dangling and 150# of somnolent snow leopard draped across my lap. As one hand is holding the stethoscope and the other is hanging onto the leopard with a death-grip (because it wouldn't do to have it go flying off my lap in some high-speed turn), I have no means of hanging on. We are not slowing down for bumps. Every time we hit one - and for some reason there seem to be approximately six times as many now as there were on the way over - the tackle boxes hop into the air, the cat hops into the air, I hop into the air. The tackle boxes crash down and slither around, rattling happily. I am having a hard time keeping my 'scope on the leopard's heart. After about two minutes I remind myself that respiratory arrest precedes cardiac arrest, so if the cat is still breathing, the heart is still beating. I can feel the rise and fall of its furred chest under my hands, so I drop the bell of the stethoscope and use both hands to hold onto the cat.
As we come streaking into the bay area behind the hospital, all hands are on deck. Dr. C is there and so are the techs, C and D. They descend upon me in a group, gathering up the tarp corners and shuffling fast into the building. The cat is weighed and then shuttled with all haste to the OR, where he is intubated and connected to the gas anesthetic.
Big sigh. Now we can relax a little; the cat is safely anaesthetised, he is on oxygen, he has a heart monitor on him.
The vets begin their physical exam. The source of the blood is quickly found: the cat has an abrasion on one pad, deep enough to ooze blood every time he steps on it. While that is being treated, C is scraping tartar off the cat's teeth and D is setting up the endoscope; as long as the cat is out, you do everything you can. Dr. K sets up a syringe and tells me to pull blood samples off the jugular (he does have a gift for making my heart jump into my throat) and watches without comment as I manage to do a jugular stick without fumbling or shaking. Despite the thick hair on the leopard's neck, the jugular is luckily quite large and palpable; I'm grateful this isn't a marmoset we're working on. Dr. K gives the bloods to the clin path tech and he and Dr. C start the endoscope.
While everyone is circling around, doing all that can be done, I am suddenly in a tiny one-person oasis of stillness. I have a moment to look - really LOOK - at this glorious animal. He is long and slender, but somehow he seems dense and substantial and real in a way that is hard to describe; it is somehow both arcane and immediate, as if the weight of his leopardness is a thousand times greater than the weight of bone and muscle, as if it gives him a gravity that draws my orbit toward his. I pick up his heavy paw, feeling the dense, robust bones of his muscled forearm, the thick tendons, the meaty bulk of the upper arm. At the same time I am thinking of the lightness and grace with which this animal moves, marvelling at the combination of these opposites into one creature. But as it happens, the snow leopard is a creature of opposites. Rare, but easily bred in captivity. Shy, but direct of gaze. Lithe but amazingly powerful. Fragile in numbers, but tough enough to survive in one of the harshest environments on earth.
On his shoulder, I find a tiny mat, a hairball not much bigger than a pea. I pull it out of his coat, smoothing down the dense fur, shaded and subtle even in the strong light of the OR. I move out of someone's way, to the end of the table. There his tail trails off, relaxed, drooping lazily toward the floor, nearly as long as his body. I lift the end of it gently. I've never had a tiger by the tail, but I've had a leopard. A sleeping leopard, but still: not an experience to be forgotten.
Around me, time suddenly snaps back into place. Dr. C and Dr. K are talking about moving the cat back to his house. They crank the anesthetic gas all the way up for a few minutes, getting him deep, and the we reverse our earlier frantic activity. The leopard goes back onto the tarp, and we shuffle him fast out to the cart. I hop into the bed and gather him up, and Dr. K is behind the wheel and firing it up at the same time. We have less time now than before; the injected meds have worn off and the gas anesthetic will only hold him for a few minutes. By now, there are more people in the park as well, and Dr, K can drive only so fast. I have one arm around the leopard's belly, the other around his chest, my hand buried in fur and feeling for breath. His big head rests heavy on my thigh, buffered against the bouncing of the cart as we fly back the way we came.
At the leopard house, the keeper is waiting anxiously, pacing and watching for us. She has been radioed we are on our way, and she has the door to the building open by the time we have the tarp slung between us. On a bench outside the display there are two people; one asks us anxiously if that animal is dead.
"No," says Dr. K, laconically.
"Only sleeping," I add, panting, as we do our shuffling quick-step back into the building.
We settled the cat into his enclosure, waiting until he was lifting his head and rolling onto his sternum. Dr. K left instructions with the keeper, who nodded repeatedly without interrupting, intent on his words. We went back out into the sunny August morning, the Zoo awake around us, bustling now; the cat awake behind us, drowsing in his private domain.
I was only there for two weeks, but every Tuesday turned out to be a snow leopard day; unlike some of the keepers, the snow leopard keeper trusted the vets to do right by her charges, and didn't hesitate to call them in if something was amiss. Aware, perhaps, of their rarity, she was a vigilant defender of their well-being, guarding them and their genetics against a hoped-for day when wild populations might be re-established in some of their lost range; and more personally, fiercely protecting their best interests whilst in her care.
You can't blame her for that ferocity of feeling on their behalf. I defy anyone to be around such an animal without feeling awe.
I still have that little mat of snow leopard hair.
Thursday, January 1, 2009
The Mouths Of Babes And Children
One of the good things about living in a small town is that I get a chance to do some volunteer programs at the local schools. This all comes about because I'm one of a very small number of vets in town, and clients who work at schools feel comfortable asking me, because we're all just folks here, if I'd like to do school programs.
I admit I love the thank-you notes that I get from the little kids. But there are compensations to the older kids as well.
One of my annual gigs is to go to the local middle school for mock interviews. This is a program in which the kids are asked what they might like to do for a living, and then to create a resume, a cover letter and fill out an application. Based on the kinds of jobs the kids are angling for, the school counsellor contacts local professionals and asks them to come in for a morning to interview the kids as if they were actually applying for a job. The professionals are asked to rate the "applicants" on appearance, demeanor, cover letter, CV, and preparedness. Because my little land-locked town in not bristling with marine and other wildlife biologists or equine trainers to the stars or TV animal trainers, I generally get tagged for those as well, not to mention all the vet-tech stuff.
Now, these are middle-schoolers, so most of them are about 11 to 13 years old. We don't expect them to come in with all guns blazing - although some of them do - and while many of them are laboring under some serious misconceptions about what is involved in becoming a vet, I always try to find something encouraging to say. I don't want to crush their little egos, after all. On the other hand, I also don't want to be so easy on them that they think it's a cake walk getting into vet school - or having a career in veterinary medicine, come to that. It's not fair to them to lead them to expect that it's just a fa-la-la, I decided to go to vet school and they have to take me because I have the tuition. Unfortunately, some of the kids who think they want to be vets are probably barking up the wrong tree. It's not so much my place to tell them "This is not the career for you" as it is to introduce them to the realities of it and get them to think about what they propose to let themselves in for. Vet school is expensive and gruelling, and although it was also really great (at least for me), it's not for everyone. If you're not cut out for it, or vet med isn't really your cup of tea, it's probably better to discover that BEFORE you go to the trouble and expense of vet school.
It's a delicate balancing act; I have to tell the truth but do it kindly and with some finesse. Hm. It turns out that being a vet has trained me to do a few other things besides medicine, because the delicate balancing act is one at which this line of work makes you adept, whether you want to be or not.
Mind you, being a middle child in a large family has instilled diplomacy into me from the cradle. This has come in handy many a time, and often long before vet school. Once as a grad student I was trying to describe to a colleague a particular student who they needed to talk to. A fellow grad student, who also knew the student in question, was standing with us. Well, how do you actually end up describing faces? They nearly always have the usual number of eyes and noses and mouths, and there are only so many shapes a face can take. So I said, "He's about 6 feet tall, clean-shaven, has dark hair and eyes and - um - a youthful complexion - "
The other grad student burst out laughing. "You are SO diplomatic!" she said.
"What do you mean?" asked our colleague.
"She means he has acne!" exclaimed the other grad student.
Um, well, yes. But there's more than one way to present the facts, don't you think? You don't want to obscure the truth, but there's no reason to be harsh.
At any rate, one year when I was doing my interviews, I had in front of me an absolutely petrified 12 year old boy. As always, when doing the interviews, the student had been provided with a list of questions intended to act as a guideline to get them thinking and asking about the realities of the job. I had been provided with the same list of questions (so as to be prepared). In addition, I'd been doing the interviews for several years by then, and had my patter down, my stock answers at the ready. So, when this boy was sitting in front of me, so terrified that his hands were actually shaking, I was able to smile encouragingly at him and wait calmly for him to stutter out the question, doing my best to let relaxation ooze out of me and across the table and seep into him before his heart actually leapt out of his chest.
Maybe that's why I wasn't expecting it.
"Wh-what is th-th-the best thing ab-b-b-out your job?" asked my little student, reading from the paper trembling in his quaking hands. Remembering the interview skills with which he had been coached, he then looked up at me, pupils dilated with terror, but expression trusting and earnest. Maybe it was that, that disarmingly trustful look, reminiscent of a thousand anxious pets and clients I've seen and treated and tried my best to help, that did it: that look that tells me they're frightened, but they have placed their hope and faith in me, and believe that I will not willingly see them come to harm. I opened my mouth, ready to give him my usual answer, and then it happened. Someone hijacked my lips. Instead of what I meant to say, this is what came out of my mouth:
"The best thing about my job is that every day, when I go home, the world is a better place than it was when I got up - because I got up."
The boy nodded earnestly, thinking this over, and completely unaware that I was hearing this for the first time, too - or that, having had something else entirely in my head, I was far more surprised to hear it than he was. My heart gave a deep, thudding beat, knocking hard against my sternum as if to punctuate my words, as if to tell me: Pay attention. This is the Truth.
I've said it before, and I'll say it again: twelve year old boys. They'll break your heart. Wide open, sometimes.
Because that is the truth. That's it. That's why I do this. That's why I get up at 4 in the morning and 40 below zero when someone calls me. That's why I am willing to literally crawl through blood and shit to try to save the life of a parvo puppy. That's why I drag myself out of bed after a long night of emergencies in the clinic and go in and do it again: It's because when I'm done, the world will be better off. I'm just one little person in one little town, and I only change this one small corner of the world - but it takes me, specifically, to do that bit of good. These are the skills I chose to learn, and worked very hard to acquire; not everyone has them. So it's up to me to take my brain and my hands and whatever else I can bring to it, and do my little part to make the word better.
It's not like I'm creating world peace or ending poverty or world hunger, and I'm by no means the only person who spends their days making the word a better place. Probably most of us do that, in one way or another, every day. But still. There's something deeply satisfying about building good, one little piece at a time, and being able to see the results of it. And it's humbling to realize that if I don't do this part, the part that is mine to do, it won't get done. Maybe that wouldn't be as true in a bigger community where there's more overlap, but here - there aren't many of us, so maybe it's more obvious the ways in which all of us count.
It's a humbling thing, and one that I am grateful for: to have work that I love, and which helps the community in which I live.
Humbling too, and full of a strange and lovely grace, that I learned this, the central Truth of why I do what I do, from one young, earnest and slightly terrified boy.
Out of the mouths of babes and children....
I admit I love the thank-you notes that I get from the little kids. But there are compensations to the older kids as well.
One of my annual gigs is to go to the local middle school for mock interviews. This is a program in which the kids are asked what they might like to do for a living, and then to create a resume, a cover letter and fill out an application. Based on the kinds of jobs the kids are angling for, the school counsellor contacts local professionals and asks them to come in for a morning to interview the kids as if they were actually applying for a job. The professionals are asked to rate the "applicants" on appearance, demeanor, cover letter, CV, and preparedness. Because my little land-locked town in not bristling with marine and other wildlife biologists or equine trainers to the stars or TV animal trainers, I generally get tagged for those as well, not to mention all the vet-tech stuff.
Now, these are middle-schoolers, so most of them are about 11 to 13 years old. We don't expect them to come in with all guns blazing - although some of them do - and while many of them are laboring under some serious misconceptions about what is involved in becoming a vet, I always try to find something encouraging to say. I don't want to crush their little egos, after all. On the other hand, I also don't want to be so easy on them that they think it's a cake walk getting into vet school - or having a career in veterinary medicine, come to that. It's not fair to them to lead them to expect that it's just a fa-la-la, I decided to go to vet school and they have to take me because I have the tuition. Unfortunately, some of the kids who think they want to be vets are probably barking up the wrong tree. It's not so much my place to tell them "This is not the career for you" as it is to introduce them to the realities of it and get them to think about what they propose to let themselves in for. Vet school is expensive and gruelling, and although it was also really great (at least for me), it's not for everyone. If you're not cut out for it, or vet med isn't really your cup of tea, it's probably better to discover that BEFORE you go to the trouble and expense of vet school.
It's a delicate balancing act; I have to tell the truth but do it kindly and with some finesse. Hm. It turns out that being a vet has trained me to do a few other things besides medicine, because the delicate balancing act is one at which this line of work makes you adept, whether you want to be or not.
Mind you, being a middle child in a large family has instilled diplomacy into me from the cradle. This has come in handy many a time, and often long before vet school. Once as a grad student I was trying to describe to a colleague a particular student who they needed to talk to. A fellow grad student, who also knew the student in question, was standing with us. Well, how do you actually end up describing faces? They nearly always have the usual number of eyes and noses and mouths, and there are only so many shapes a face can take. So I said, "He's about 6 feet tall, clean-shaven, has dark hair and eyes and - um - a youthful complexion - "
The other grad student burst out laughing. "You are SO diplomatic!" she said.
"What do you mean?" asked our colleague.
"She means he has acne!" exclaimed the other grad student.
Um, well, yes. But there's more than one way to present the facts, don't you think? You don't want to obscure the truth, but there's no reason to be harsh.
At any rate, one year when I was doing my interviews, I had in front of me an absolutely petrified 12 year old boy. As always, when doing the interviews, the student had been provided with a list of questions intended to act as a guideline to get them thinking and asking about the realities of the job. I had been provided with the same list of questions (so as to be prepared). In addition, I'd been doing the interviews for several years by then, and had my patter down, my stock answers at the ready. So, when this boy was sitting in front of me, so terrified that his hands were actually shaking, I was able to smile encouragingly at him and wait calmly for him to stutter out the question, doing my best to let relaxation ooze out of me and across the table and seep into him before his heart actually leapt out of his chest.
Maybe that's why I wasn't expecting it.
"Wh-what is th-th-the best thing ab-b-b-out your job?" asked my little student, reading from the paper trembling in his quaking hands. Remembering the interview skills with which he had been coached, he then looked up at me, pupils dilated with terror, but expression trusting and earnest. Maybe it was that, that disarmingly trustful look, reminiscent of a thousand anxious pets and clients I've seen and treated and tried my best to help, that did it: that look that tells me they're frightened, but they have placed their hope and faith in me, and believe that I will not willingly see them come to harm. I opened my mouth, ready to give him my usual answer, and then it happened. Someone hijacked my lips. Instead of what I meant to say, this is what came out of my mouth:
"The best thing about my job is that every day, when I go home, the world is a better place than it was when I got up - because I got up."
The boy nodded earnestly, thinking this over, and completely unaware that I was hearing this for the first time, too - or that, having had something else entirely in my head, I was far more surprised to hear it than he was. My heart gave a deep, thudding beat, knocking hard against my sternum as if to punctuate my words, as if to tell me: Pay attention. This is the Truth.
I've said it before, and I'll say it again: twelve year old boys. They'll break your heart. Wide open, sometimes.
Because that is the truth. That's it. That's why I do this. That's why I get up at 4 in the morning and 40 below zero when someone calls me. That's why I am willing to literally crawl through blood and shit to try to save the life of a parvo puppy. That's why I drag myself out of bed after a long night of emergencies in the clinic and go in and do it again: It's because when I'm done, the world will be better off. I'm just one little person in one little town, and I only change this one small corner of the world - but it takes me, specifically, to do that bit of good. These are the skills I chose to learn, and worked very hard to acquire; not everyone has them. So it's up to me to take my brain and my hands and whatever else I can bring to it, and do my little part to make the word better.
It's not like I'm creating world peace or ending poverty or world hunger, and I'm by no means the only person who spends their days making the word a better place. Probably most of us do that, in one way or another, every day. But still. There's something deeply satisfying about building good, one little piece at a time, and being able to see the results of it. And it's humbling to realize that if I don't do this part, the part that is mine to do, it won't get done. Maybe that wouldn't be as true in a bigger community where there's more overlap, but here - there aren't many of us, so maybe it's more obvious the ways in which all of us count.
It's a humbling thing, and one that I am grateful for: to have work that I love, and which helps the community in which I live.
Humbling too, and full of a strange and lovely grace, that I learned this, the central Truth of why I do what I do, from one young, earnest and slightly terrified boy.
Out of the mouths of babes and children....
Wednesday, December 31, 2008
Love Her Or Liver
Ah, yes, liver. Some people love it, some people hate it. Some have never tried it. Myself, I love the liver. I don't especially like it cooked for dinner, but a nice liverwurst (on dark rye with a thick slice of crisp Bermuda onion and some mustard) can be a real treat. Moreover, this is my ace in the hole for medicating tough-to-pill dogs. It doesn't work for EVERY dog, but I'd say a good 98% would go for it. Liverwurst has a strong aroma (which helps disguise the smell of medication) and the flavor is enticing enough that most dogs don't care WHAT you put in there, they'll eat it. You could butter a scorpion with liverwurst and most dogs would eat it. Handily, liverwurst is easily shaped into a little meatball around a pill, too, so dosing is typically quite easy. I advise using the less-expensive kind, however; the gourmet version is stickier, and the meatball can be hard to get off your finger. It's like trying to throw peanut butter.
One important note: You should use only the amount of liverwurst necessary to get the pill into the dog.
I hit on the liverwurst idea several years ago, when I had a dog who needed long-term pain management. She took only a week to go through most of my pilling tricks: bread, cheese, canned dog food, hot dogs - all of those she learned to peel off the pill, eating the treat and spitting the pill cheerfully at my feet. She was difficult to pill otherwise - an American bulldog, she had a tongue that was capable of swelling at an instant's notice to a size that would fill a small cooler, let alone the back of her throat. Let me tell you, trying to get a pill past the muscular hump of her tongue whilst wrestling the rest of her muscular body was not a job for wimps. I'd have done it though, three times a day, except for the fact that it was an exercise in futility. Being an American bulldog, she was never offended by the pill wrestling; she appeared to consider it a good game. A good game which, at its conclusion, would wind up with me all hot and sweaty and covered in dog spit, her panting happily with a big goofy grin on her face, and the pill in a wad of unusable mush somewhere in the room (perhaps smeared across my thigh, perhaps mashed into the carpet, perhaps festooned along the wall in artistic loops and swirls.)
One day in desperation I tried liverwurst. For the next six months, three times a day, she never spit a pill. Not one. I believe in the power of liverwurst.
Mind you, pilling is not the ONLY power of liverwurst. One day while I took the pills to the bulldog, one of the Border collies counter-surfed the remaining package of liverwurst from the worktop. I returned to the kitchen in time to see him eating the yellow paper wrapper that had, only moments before, contained perhaps a quarter pound of liverwurst.
Oh, well. I resigned myself to a night of interrupted sleep, since I was sure I would have diarrhea (and lots of it) to deal with that night. As it turns out I was half right: no diarrhea, but Finn developed a horrific, cornea-melting gas that lasted for three days. It was powerful enough to wake me from a sound sleep (GAH! What is that SMELL?!?) It was powerful enough to imbue itself into any surface Finn laid or sat upon. It was powerful enough to sear the lining off your mucous membranes. I didn't dare wear my contact lenses. I think it was a close cousin to some of the lethal gasses released on WWI battlefields. I've never seen the recipes for any of those, but I wouldn't be surprised if they started with "First, find a dog. Next, feed it a pound of liverwurst..."
Poor Finn. He was sure I didn't love him any more, because I would not let him sleep on the bed, and any time he came near me - and at random intervals during the night - I would suddenly seize him and spray his behind liberally with grooming spray. (Hint: DO NOT use a food-scented spray such as pina colada. This will make you gag and put you off of pina coladas forever. Stick with baby powder scent or something similar.)
Apart from its culinary properties, the liver is an amazing piece of work. It processes our food, it stores fuel, it metabolizes medications, it manages our blood sugar (in concert with the pancreas); it makes bile and clotting factors and proteins, filters out bacteria from the blood, detoxifies poisons, conjugates and excretes all manner of things. Without it we would die miserably. Fortunately for us and our alcohol-swilling ways (amongst other behaviors), the liver has an enormous reserve capacity. You could go in there today with a tiny little hammer and whack 70% of your liver cells on the head and kill them - and so long as you left the support structures of the liver intact, it would repair itself. Alternatively, you could have a surgeon divide your liver in half and give half to a worthy liverless recipient, and (given a little support) each half of the liver would grow back, so that in the end you'd have two functioning livers, one in each person.
An amazing organ, the liver. Little wonder that when things aren't going well for the liver, things aren't going well for any other part of an animal.
Mind you, when things go badly for the liver, sometimes it's not the liver's fault, really. Sometimes it's that pesky gall bladder that's responsible.
The gall bladder's job - and here I know you'll be surprised - is to store gall (otherwise known as bile). It doesn't just store it, though; it is supposed to contract when we eat so that bile flows into the duodenum, where it will start to emulsify and break down our food (which, if the stomach has done its job, will by then be an indistinguishable mush of everything we ingested a while earlier). Once the food items are sufficiently tiny, they can pass through the lining of the gut and into the bloodstream, where they will be taken by the portal circulation to the liver, at which time the liver will perform its complex magic.
However, if your liver and your gall bladder do not get along, there will be trouble. If bile is backing up, for instance, because the gall bladder isn't sending it into the gut, the liver will end up being bathed in bile - which, after all, is intended to break down things like food, things like, oh, I don't know - the liver. If the gall bladder is infected, or has a stone or a tumor, your liver will be sad.... and so will you. Sometimes we can, by means of a combination of meds, fix this problem. Sometimes we end up at surgery. Sometimes, most unhappily, we lose. Even the mighty liver can become so damaged that it cannot rally in time, or develop cirrhosis, or have a tumor. But mostly, bless it, it gives us a fighting chance to win.
It's been a week for liver problems at the clinic. One of my nurses has just had her gall bladder out. Not three days later one of my liver patients - who had responded well to meds - came back for a routine recheck, only to have high liver enzymes again. Drat. Out comes the ultrasound, and - well, lookie here: a gigantic gallstone. Maybe you'd like to see the surgeons for that?
You know I'm going to have a third one, don't you?
In this case it's Pepper, my nearly-thirteen-year-old step-dog. She doesn't LOOK sick, does she? Pepper has had a prior bout with hepatitis, about a year ago. She really wasn't showing a lot of signs; she didn't vomit or act ill, but she ate only half her meal one night and refused it the next morning. This is a dog that never refuses food. In her, skipping one and a half meals is cause for concern. So, I emailed my boyfriend in Asia (where he was flying at the time) and asked for permission to do some workup. He green-lighted me, naturally, so I started hunting around and came up with some iffy liver enzymes and a few other things. Nothing very far off normal, but I put her on meds. A month later she was perky and lively and bossing around all the other dogs, just like usual.
All her follow-ups have been normal, and she's been well. But last night she refused dinner, and this morning she refused breakfast. And guess who's in Asia again? Sigh. Well, that's one of the perks of dating a vet; we notice these things and go after them. So, in we went (on my day off) and did some bloods. Hm. Liver numbers are off again, less so than last time, but off. While we're at it, let's just have a peek at that gall bladder. Which means laying Pepper on her back in a padded trough and shaving her abdomen for a little ultrasound action. None of these ideas is really okay by Pepper, but with the assistance of J and E and some soft talk, we prevail.
Hmm. Gall bladder doesn't look too bad, but those bile canals aren't looking quite right. Plus there are patchy areas where the liver looks swollen. Time for meds, prescription food, nursing care. Especially nursing care, which means cossetting and snuggling and keeping her toasty warm, dosing her food with active-culture yogurts for the probiotics (and the taste, no doubt), and of course letting HER sleep with my down comforter.
And of course, the meds. Guess I'd better go get some liverwurst.
Tuesday, December 30, 2008
White New Year's
To no one's surprise, I'm sure, we had a white Christmas up here. Not only was there good snow on the ground, snow was actually falling on Christmas day. SO pretty.
All things considered, it's unlikley to be a restful night, even with a diazepam assist for the dogs; people are likely to go even crazier than usual, since it's the 50th anniversary of Alaska's Statehood. We're unlikely to get to sleep before one in the morning, if we're lucky. The next morning, we'll be trying to sleep in (calls permitting); it's likely to be a bit cold for skiing, and besides, I have to stay within striking distance of my truck for the on-call duties. We usually get to sleep in at least a little on New Year's; the people who stay in have been watching their dogs and keeping them home, for the most part and don't need me; the people who went out and partied, on the other hand, are all hung-over or tired and hence sleeping in. If all goes well - and no one needs my help - we'll be cozying up in our little house, tying to stay warm and wishing everyone all good blessings in 2009.
The snow kept up til Boxing Day, when I went back to work; fortunately my plow guy had been and gone; I'd have been surfing my truck backwards in snow up to the bumper otherwise. The truck on the left has not been shovelled out and is sitting on bare ground under all the snow (this is my "extra" truck, which I should probably find a home for, although it is almost old enough to order its own drinks if I took it to a bar.) The truck on the right is the one I drive; it's not really higher clearance than the other one, it's just sitting up on the snow pack.
Sunday the wind started; it knocked all the pretty snow off the branches and dropped the chill factor into the below-zero range. I tried to take pictures of the pine grosbeaks; it's tough to get a clear focus when the branches are swaying in the breeze. It's also tough with the wind numbing your fingers to the stiff-and-clumsy level and making you shiver so hard your whole body is shaking hard enough to clack your teeth together (hence the imperfect focus, sorry about that.)
Sunday the wind started; it knocked all the pretty snow off the branches and dropped the chill factor into the below-zero range. I tried to take pictures of the pine grosbeaks; it's tough to get a clear focus when the branches are swaying in the breeze. It's also tough with the wind numbing your fingers to the stiff-and-clumsy level and making you shiver so hard your whole body is shaking hard enough to clack your teeth together (hence the imperfect focus, sorry about that.)Monday driving to work was interesting: all that beautiful snow on the ground, now being driven across the roads. Some places it becomes a low, fast-flowing river across the road, swift and opaque, obliterating all signs of the road itself. There you have to guess where the lanes are, where the shoulders are, where the pavement edges break off into the ditches. Some places it eddies in whirling snow-devil funnels, glittering and brilliant in the headlights. Some places it is flung thick and hard into the air, giant billowing sails of it, now hiding the oncoming traffic from view, now drawing aside its curtain of sparkling white to reveal the headlights in the other lane. Some places your best hope of avoiding a crash is to follow the red glow of the tail lights on the vehicle ahead of you. Some places you can't see beyond your own hood, let alone to the tail lights ahead of you.
For fun, in the places where the wind hits hard, driving the snow up to hiss and scour like sand against your windows, it also grabs your truck and bounces it around, tugging it fitfully toward the ditches and rocking it on its suspension.
Kind of makes you happy to get to work, you know?
The wind is gone now, but it's a good 25 degrees colder than normal for the time of year. One of my clients reported - as I was standing on tip-toes in the icy parking lot, trying to reach high enough up into his dog boxes to vaccinate his sled dogs - that he had 39 degrees (F) below zero at his house this morning. I feel like a piker: I had a balmy six degrees. (I even plugged my truck in last night. What a wimp.)
It looks like it will be cold and clear at the turn of the year; all the better to view the planetary conjunction that I hear will be occurring that afternoon (or night, I presume, for people in the lower 48). I'm on call New Year's Day, so I plan to have a quiet New Year's Eve at home, stuffing diazepam in to my dogs; two of them, plus the BFs' dog, have fireworks phobias, and we always have a lot of those on New Year's Eve. We kinda get screwed on the July 4th fireworks, as it isn't really dark enough to enjoy them, so people go nuts at New Year's. I live on a lake, so every last echo rolls across the ice to the waiting ears of my pooches. On the plus side, I get a great show (for free), and the one dog who isn't troubled by the noise runs from window to window looking for the best display.
All things considered, it's unlikley to be a restful night, even with a diazepam assist for the dogs; people are likely to go even crazier than usual, since it's the 50th anniversary of Alaska's Statehood. We're unlikely to get to sleep before one in the morning, if we're lucky. The next morning, we'll be trying to sleep in (calls permitting); it's likely to be a bit cold for skiing, and besides, I have to stay within striking distance of my truck for the on-call duties. We usually get to sleep in at least a little on New Year's; the people who stay in have been watching their dogs and keeping them home, for the most part and don't need me; the people who went out and partied, on the other hand, are all hung-over or tired and hence sleeping in. If all goes well - and no one needs my help - we'll be cozying up in our little house, tying to stay warm and wishing everyone all good blessings in 2009.
Monday, December 22, 2008
String Theory
I work alone on Saturdays, which can mean they get pretty crazy. Every so often there's more work than one person can do, and I have to call in another doc to handle the overflow. This last Saturday was pretty uneven; slow to the point of stagnation in the morning, it gradually got busier until noon. After that it was pretty much death, destruction, war, devastation and horror. It seemed that everything came in at once, and all of it was in need of big intervention: a cancer patient, induced into remission on meds, who had developed anorexia, a distended abdomen and bloody diarrhea; a dog in sudden collapse; a dog (most unfortunately) arriving DOA, most probably as a result of a cardiac event; a lethargic and vomiting cat which might have a urinary tract obstruction; a dachshund with a possible blown disc in its back; a lab with an ear infection whose owners had come in without an appointment, in the midst of all this, and who didn't mind waiting.
All of the above came in within two hours. The DOA was (sadly) not very time-consuming, there being exactly nothing I could do to help the dog, although I did my best to comfort the owners. The painful doxie was also pretty quick, as it had (most fortunately) no neurologic signs, and a sore hock instead of a blown disc. The ear infection, as the least critical and the only one without an appointment, had to wait til last. That left me with a collapsing dog, an ill cat and a cancer patient with a big belly and bloody stools, all at the same time.
I do my physical on the collapse first, advising bloodwork (which the owners agree to) and pulling my bloods. The owners want to wait for results, so I leave them and their recumbent Aussie mix in the exam room and go on to the bloody diarrhea. The dog's abdomen is grossly distended and soft; the dog is a bit portly to begin with, so the abdomen is always a bit indistinct, and with the added distension I am unable to distinguish structures. Additionally, the dog's respiratory pattern is a bit rapid and shallow. I take the dog back for an Xray (during which time we relieve at least some of his abdominal distension in the form of copious emissions of a paint-melting gaseous miasma emanating from the "buttockal area", as Jay Leno is inclined to call it).
Returning the dog to his owners to wait for the Xray to develop, I go on to the next room, in which the vomiting lethargic cat is waiting. When I walk into the room, the cat is lying quietly on the table, his demeanor a little withdrawn. Because SS has warned me this cat might have a bladder obstruction, I palpate his abdomen first thing, but his bladder is small and pliant. I do discover, however, that he is a little dehydrated and has some mid-abdominal discomfort. His chest sounds normal -although he is purring steadily, making it a challenge to listen to - his color is good, and he has no fever. I am discussing workup with the owners as I am doing my physical, laying out options.
"Let me just check one more thing before we decide what to do first," I say, rotating the rightward-pointing cat to the left, a move he tolerates with good grace. Grasping his head gently with my right hand, I press the pad of my left thumb between the arms of his mandible and hook the nail of my index finger over his lower incisors. I carefully pry the cat's mouth open, pressing up against the base of his tongue with my thumb to elevate it into view, and discover the one thing I was hoping not to see.
All along the root of the tongue is a knobby furl of inflamed tissue, infected and bleeding slightly. In the cleft of this, nearly buried amongst the thickened, reddened tissue, is a strait dark line.
Oh, crap. This cat has a linear foreign body. This means that he has swallowed a string, or a thread, or a bit of dental floss or tinsel, or something of a similar nature (ribbons, rubber bands - you name it). It has gotten hung up around the base of his tongue, and the ends are proceeding down into his GI tract. This is a bad situation; unfortunately, unless the string is pretty short, it works its way past the stomach and into the intestines. There the peristaltic contractions of the gut pleat the gut up on the string, the way that tightening a drawstring pleats up the fabric through which it is threaded. Because the string is anchored at the base of the tongue, the pleating tightens until the string starts to saw through the delicate inner tissues of the gut. If this is not relieved via surgery, the string will eventually cut all the way through it, leading to peritonitis and death. I have a particular "thing" for the looking for the linear foreign bodies, having been burned on one once as a freshman vet student. I've never forgotten. At that time I didn't know the trick of looking under the tongue for the string (having not yet gotten on to clinics, where the skills of physical exam are learned), and though I suspected a string, I didn't know how to find it. As a consequence of that and other circumstances, the cat ultimately died, despite surgery. In one sense, it was beyond my skill level, so it is perhaps not surprising that I didn't find it. But it bothers me to this day that I didn't know how to find it, and I'll never miss another one for want of looking.
I explain the consequences of the linear foreign body to the owners, who look grave. "How much would it cost to take him to surgery?" asks the mom. I ballpark her an estimate. Tears swim in her eyes.
"Let me talk to my husband," she says softly, in a voice husky with sorrow, "but I think he'll say no."
I step out to give them some privacy and go back to see my Xray on the cancer dog. I discover the reason for his anorexia and his abdominal distension. His stomach is so full of food that I can barely find his spleen and kidneys. His liver is mashed up against the diaphragm (gee, hmm, d'you think this could this be the cause of the rapid shallow breathing? Yikes.) In addition to which it appears the dog has swallowed two coins, most probably a quarter and a nickle, based on the size. They're small enough to pass through the gut, but there is the possibility of toxicity from the coins. This is most common in pennies, which have in more recent years been made with a high enough zinc content to be an issue. Unfortunately it's not possible to read the date on coins found on Xray, so if you suspect penny ingestion the safest thing to do is to remove them either via surgery or the induction of vomiting.
The owners are hilariously relieved that the dog isn't eating because he's obviously eaten WAY more than his usual share. I discuss the likelihood that the bloody stools are also a consequence of his dietary indiscretions, and warn them about the potential consequences of coin ingestion. The elect to observe the dog and call back if problems arise; the fact that the dog has an underlying cancer and is on borrowed time makes them understandably disinclined to put the dog through anything particularly strenuous or expensive. I release the dog to the owners' care, with some misgivings; it probably isn't a penny ingestion, but I dislike leaving the coins there. On the other hand, given the enormous amount of food present, and the fact that the stomach is so enormously distended that it overlaps the entire front half of the abdomen, it's entirely possible that inducing vomiting will be ineffective; the coins may have left the stomach and could currently be residing in a loop of gut that merely overlays the giant gastric shadow. Alternatively, even if they are in the stomach, it might not be possible to get the dog to vomit them up. I might be able to get them out via gastric lavage, but the owners don't want to anesthetize the dog. I guess we'll have to see if he can pass them safely on his own.
I go back to the recumbent dog, give them the results of the CBC (while the chem panel is still pending) and then back to the cat. The owner reports her husband has, with great reluctance, elected euthanasia. Both the owner and her teen aged son are crying, but realistically, the only possible outcomes we have are surgery, euthanasia, or a slow ugly death from peritonitis. If we can't do surgery, that means there really is only one choice.
I'm sorry, little man. But at least I can stop your suffering.
The owner signs papers and I take the cat to the treatment area where my nurse, E, and I gently and quickly euthanize him. Poor kitty. This is sad, especially so near Christmas.
While we are doing this, the receptionists are loading the ear dog into one of of the two recently-emptied exam rooms. Since my chem panel is still cooking, I go in, do my exam and collect an ear swab, while E is doing the body care for our string cat. I make a slide and am just heat fixing it when E hands me the bloods. I let her finish the stain while I go talk to the owners of the recumbent Aussie mix. The bloods show that the dog has one of two likely problems: either an infection or a tumor masquerading as infection (tumors can outstrip their blood supplies and become necrotic and infected). I can locate no primary mass, but sometimes you can't. I discuss options with the owners, who elect to have an expensive but effective injection of an antibiotic which is effective in the bloodstream for two weeks from a single injection. The dog has rallied a little, pinking up and seeming less distressed than before, so maybe all will be well.
At last I dispatch the ear infection and we close only 45 minutes late. I am sad about he string kitty, but realistically, it was either surgery or death for him. Poor little man. Any other alternative would have been a miserable suffering exit, something he never deserved.
Monday morning I come in and my nurse E tells me her cat - who had been anorexic and vomiting the day before - had defecated several lengths of thread (which, knowing better than to just pull on it, she had carefully trimmed away from his anus a bit at a time as he passed it over 12 hours). We checked under his tongue. Nothing hooked there. Big sigh of relief.
Meanwhile Dr, M brings in a cat back in a carrier.
"What's that?" I ask him.
"Vomiting cat, getting some bloodwork done," says Dr. M.
"Bet it has a string," I say sourly. "We had one in on Saturday and E had one Sunday, so we're due for our third one."
Dr. M looks startled, and I go up front to take an appointment. When I go back, the cat is being added to the surgery list. Because Dr. M looked under the cat's tongue. Guess what he found?
Sometimes things DO come in threes.
All of the above came in within two hours. The DOA was (sadly) not very time-consuming, there being exactly nothing I could do to help the dog, although I did my best to comfort the owners. The painful doxie was also pretty quick, as it had (most fortunately) no neurologic signs, and a sore hock instead of a blown disc. The ear infection, as the least critical and the only one without an appointment, had to wait til last. That left me with a collapsing dog, an ill cat and a cancer patient with a big belly and bloody stools, all at the same time.
I do my physical on the collapse first, advising bloodwork (which the owners agree to) and pulling my bloods. The owners want to wait for results, so I leave them and their recumbent Aussie mix in the exam room and go on to the bloody diarrhea. The dog's abdomen is grossly distended and soft; the dog is a bit portly to begin with, so the abdomen is always a bit indistinct, and with the added distension I am unable to distinguish structures. Additionally, the dog's respiratory pattern is a bit rapid and shallow. I take the dog back for an Xray (during which time we relieve at least some of his abdominal distension in the form of copious emissions of a paint-melting gaseous miasma emanating from the "buttockal area", as Jay Leno is inclined to call it).
Returning the dog to his owners to wait for the Xray to develop, I go on to the next room, in which the vomiting lethargic cat is waiting. When I walk into the room, the cat is lying quietly on the table, his demeanor a little withdrawn. Because SS has warned me this cat might have a bladder obstruction, I palpate his abdomen first thing, but his bladder is small and pliant. I do discover, however, that he is a little dehydrated and has some mid-abdominal discomfort. His chest sounds normal -although he is purring steadily, making it a challenge to listen to - his color is good, and he has no fever. I am discussing workup with the owners as I am doing my physical, laying out options.
"Let me just check one more thing before we decide what to do first," I say, rotating the rightward-pointing cat to the left, a move he tolerates with good grace. Grasping his head gently with my right hand, I press the pad of my left thumb between the arms of his mandible and hook the nail of my index finger over his lower incisors. I carefully pry the cat's mouth open, pressing up against the base of his tongue with my thumb to elevate it into view, and discover the one thing I was hoping not to see.
All along the root of the tongue is a knobby furl of inflamed tissue, infected and bleeding slightly. In the cleft of this, nearly buried amongst the thickened, reddened tissue, is a strait dark line.
Oh, crap. This cat has a linear foreign body. This means that he has swallowed a string, or a thread, or a bit of dental floss or tinsel, or something of a similar nature (ribbons, rubber bands - you name it). It has gotten hung up around the base of his tongue, and the ends are proceeding down into his GI tract. This is a bad situation; unfortunately, unless the string is pretty short, it works its way past the stomach and into the intestines. There the peristaltic contractions of the gut pleat the gut up on the string, the way that tightening a drawstring pleats up the fabric through which it is threaded. Because the string is anchored at the base of the tongue, the pleating tightens until the string starts to saw through the delicate inner tissues of the gut. If this is not relieved via surgery, the string will eventually cut all the way through it, leading to peritonitis and death. I have a particular "thing" for the looking for the linear foreign bodies, having been burned on one once as a freshman vet student. I've never forgotten. At that time I didn't know the trick of looking under the tongue for the string (having not yet gotten on to clinics, where the skills of physical exam are learned), and though I suspected a string, I didn't know how to find it. As a consequence of that and other circumstances, the cat ultimately died, despite surgery. In one sense, it was beyond my skill level, so it is perhaps not surprising that I didn't find it. But it bothers me to this day that I didn't know how to find it, and I'll never miss another one for want of looking.
I explain the consequences of the linear foreign body to the owners, who look grave. "How much would it cost to take him to surgery?" asks the mom. I ballpark her an estimate. Tears swim in her eyes.
"Let me talk to my husband," she says softly, in a voice husky with sorrow, "but I think he'll say no."
I step out to give them some privacy and go back to see my Xray on the cancer dog. I discover the reason for his anorexia and his abdominal distension. His stomach is so full of food that I can barely find his spleen and kidneys. His liver is mashed up against the diaphragm (gee, hmm, d'you think this could this be the cause of the rapid shallow breathing? Yikes.) In addition to which it appears the dog has swallowed two coins, most probably a quarter and a nickle, based on the size. They're small enough to pass through the gut, but there is the possibility of toxicity from the coins. This is most common in pennies, which have in more recent years been made with a high enough zinc content to be an issue. Unfortunately it's not possible to read the date on coins found on Xray, so if you suspect penny ingestion the safest thing to do is to remove them either via surgery or the induction of vomiting.
The owners are hilariously relieved that the dog isn't eating because he's obviously eaten WAY more than his usual share. I discuss the likelihood that the bloody stools are also a consequence of his dietary indiscretions, and warn them about the potential consequences of coin ingestion. The elect to observe the dog and call back if problems arise; the fact that the dog has an underlying cancer and is on borrowed time makes them understandably disinclined to put the dog through anything particularly strenuous or expensive. I release the dog to the owners' care, with some misgivings; it probably isn't a penny ingestion, but I dislike leaving the coins there. On the other hand, given the enormous amount of food present, and the fact that the stomach is so enormously distended that it overlaps the entire front half of the abdomen, it's entirely possible that inducing vomiting will be ineffective; the coins may have left the stomach and could currently be residing in a loop of gut that merely overlays the giant gastric shadow. Alternatively, even if they are in the stomach, it might not be possible to get the dog to vomit them up. I might be able to get them out via gastric lavage, but the owners don't want to anesthetize the dog. I guess we'll have to see if he can pass them safely on his own.
I go back to the recumbent dog, give them the results of the CBC (while the chem panel is still pending) and then back to the cat. The owner reports her husband has, with great reluctance, elected euthanasia. Both the owner and her teen aged son are crying, but realistically, the only possible outcomes we have are surgery, euthanasia, or a slow ugly death from peritonitis. If we can't do surgery, that means there really is only one choice.
I'm sorry, little man. But at least I can stop your suffering.
The owner signs papers and I take the cat to the treatment area where my nurse, E, and I gently and quickly euthanize him. Poor kitty. This is sad, especially so near Christmas.
While we are doing this, the receptionists are loading the ear dog into one of of the two recently-emptied exam rooms. Since my chem panel is still cooking, I go in, do my exam and collect an ear swab, while E is doing the body care for our string cat. I make a slide and am just heat fixing it when E hands me the bloods. I let her finish the stain while I go talk to the owners of the recumbent Aussie mix. The bloods show that the dog has one of two likely problems: either an infection or a tumor masquerading as infection (tumors can outstrip their blood supplies and become necrotic and infected). I can locate no primary mass, but sometimes you can't. I discuss options with the owners, who elect to have an expensive but effective injection of an antibiotic which is effective in the bloodstream for two weeks from a single injection. The dog has rallied a little, pinking up and seeming less distressed than before, so maybe all will be well.
At last I dispatch the ear infection and we close only 45 minutes late. I am sad about he string kitty, but realistically, it was either surgery or death for him. Poor little man. Any other alternative would have been a miserable suffering exit, something he never deserved.
Monday morning I come in and my nurse E tells me her cat - who had been anorexic and vomiting the day before - had defecated several lengths of thread (which, knowing better than to just pull on it, she had carefully trimmed away from his anus a bit at a time as he passed it over 12 hours). We checked under his tongue. Nothing hooked there. Big sigh of relief.
Meanwhile Dr, M brings in a cat back in a carrier.
"What's that?" I ask him.
"Vomiting cat, getting some bloodwork done," says Dr. M.
"Bet it has a string," I say sourly. "We had one in on Saturday and E had one Sunday, so we're due for our third one."
Dr. M looks startled, and I go up front to take an appointment. When I go back, the cat is being added to the surgery list. Because Dr. M looked under the cat's tongue. Guess what he found?
Sometimes things DO come in threes.
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