Chapter One: Goodbye Animal ER
Emergency medicine always caused a rush of emotions. Once, I remember, a golden retriever came in with a foot-long laceration spanning the width of his chest. I spent three hours stitching him back together. His owners called me two weeks later to say he was as good as new. I loved every time a tiny, comatose kitten popped back to his feet after I gave him a few drops of sugar solution and warmed him up. Usually, after I treated those kittens for parasites, dehydration, and anorexia, they miraculously recuperated. But over time, I began to worry about each animal who was not improving. Eventually, this worry dragged down my healing energies like weights around my ankles.
Early one warm June evening, I'd found it difficult to come in to work for the whole night when the sun told me it was still afternoon. I had just walked into the clinic when Tanya, the technician, greeted me with one of those "Oh no, this is going to be bad" looks. There was an old black lab in exam room one, and as I entered the white sterile room, a strange, loud, odd symphony of chewing struck me. With a twist of the stomach, I realized that it sounded like a movie theater audience stuffing their faces with popcorn.
I looked at the patient. She was lying on her side in the bottom of a plastic travel crate and was unable to get up or even raise her head. She was thin, dehydrated, and sad, and I felt sure the spirit world had forgotten to send for her. I was so shocked to see her in such miserable condition that I forgot momentarily about investigating the origin of the chewing sound.
The dog's owner was an older, seemingly well-off woman with a thick gold bracelet, and a matching necklace below her freshly bobbed hair. "Why did you wait so long to bring her in?" I snapped. I knew it was good, at least, that she had come in, but it was hard to stay composed. My hands began to shake.
She shrugged and sighed. "My son was supposed to be caring for her while we were in Europe." Her words were awkward and abrupt, leaving me to wonder later whether she was more traumatized than her cool demeanor suggested.
I absentmindedly ran my hand along the dog's back while I listened to the woman's excuses. Suddenly, a large clump of what had been skin fell into my hand, revealing the source of those haunting chewing sounds. Thousands of maggots were making the poor paralyzed dog's back their home. These fly larvae set up shop on immobile animals that sit in their own excrement; they had burrowed deeply into both of the dog's hind legs and even into her abdominal cavity. They swirled and wriggled at the disturbance.
Startled, I stepped back for a second. "I'm sorry," I said, filled with sympathy for this forlorn creature but wanting to strangle the woman. "At this point, there is little we can do for her except euthanize her." I could hardly believe I was saying those words, but they came to me quickly, without hesitation.
Outwardly, she did not seem upset. She shed no tears, and her eyes were cool and focused. "I knew you'd say that," she replied sharply. She looked down at the floor. "Where do I pay?" she said abruptly. The woman left, without turning to say goodbye to her dog. Perhaps she was too embarrassed, or hardened. I wondered if I saw tears confined to the corners of her eyes in the final instant when we made unavoidable eye contact. She might have been wondering how her own son could treat another living being this way.
Tanya and I returned to the plastic crate and the dog nestled within it. She looked through me with a miserable gaze, unable to move. I knew she could read my intent as I kneeled to give her a sedative injection. I felt she knew I was going to end her suffering. Animals may not dwell on death as people do, but they do know pain. I felt the transfer of her pain into me in the form of nausea as I injected the thick pink euthanasia solution into a vein on her front leg. As I euthanized her, I thought I felt her spirit lick my cheek as she bounded into her next life. A little while later, since they had also ingested the deadly solution, the maggots finally ceased their terrible chatter.
The cold steel and white walls that surrounded me now were a far cry from the farms, the fields, and the horses who had originally drawn me toward animals and eventually into veterinary medicine. Sometimes as veterinarians go through life we realize that what drew us to help is lost, that our dream of curing animals has become clouded over -- not by dark influences, but by a toughness that develops over time. I had gone through vet school and had been a practicing dog and cat emergency vet for five years when it finally dawned on me: I was not on the right path.
Late that night, on duty at the ER, I slept on a hard dusty futon crammed into the bathroom to shut out the sting of the bright fluorescent lights. I dreamed about living in England more than ten years earlier, when I'd first thought of becoming a veterinarian; I remembered those months spent in horse boot camp fondly, even though the sagging mattresses had been no more comfortable than this one.
Many memories have stuck with me from the nearly two years I spent in England training to be a horseback riding instructor. White sheep speckled the green rolling hills surrounding the cobblestone and brick horse stable where I trained. Since I have been around horses all my life, I can't smell horse manure but I sure remember the piercing smell of sheep dung every morning. I recall the purple face of my stern and stout instructor, Carole, as she shouted orders. Most of all, I remember Fiona Wainwright's bright red hair bobbing against the deep green of the beautiful fields of western Dorset. Our trails had been trodden upon for hundreds of years and Fiona and I would ride along hedgerows and stone fences whenever we could sneak away from our busy barnyard schedule. Fiona was a fellow British Horse Society student instructor who did not share my fear of jumping.
My memory of my first day at the Dorset School of Equitation is one I'll always treasure, the way one fondly remembers things that, at the time, were definitely no fun -- like losing baby teeth. I remember Carole pulling my body into a new position she thought would improve my jumping. I was standing in the middle of the arena on a nice ex-event horse named Sam, who seemed thoroughly bored with the whole heated conversation. "No, not like that!" Carole grabbed my riding pants to scoot my bottom back the way the British jump. "Bring your hips back over the saddle. You bloody Americans jump too far forward." I noticed, as the other girls would later concur, how Carole's purple lips bulged and her posture grew more rigid the more aggravated she became. I wasn't sure if it was my new riding position or my nervousness, but as I approached the three-and-a-half-foot jump, in slow motion, the earth became the sky and I tumbled off the horse, hitting the ground with a loud thud.
In that moment, as I sat stunned in the dirt, I heard a voice, maybe an old riding instructor or maybe my mother from years ago, tell me, "Donna, falling is something you are good at. People learn a lot from falling." It was true. As I fell, instead of clenching to fight the fall, my body had instinctively relaxed, as if I were bareback on my cousin's farm again arguing a no-win battle with the old barnyard pony Flicka, who fortunately was short enough that the falls were less painful. It was a simple argument: she wanted to go to the barn and I wanted to go riding into the field. She would buck and swerve and buck and eventually lie down until she had pinned my seven-year-old body to the ground. Round over: Pony wins again. But my mother would coach me, into the twilight, from on top of a tattered toolshed overlooking the barnyard. Comforted by the summer night sparkle of blinking fireflies, through tears and turmoil she would make sure, at least, that I got back on, no matter what.
My mother's coaching taught me to search for my own truth. While growing up, I listened to her discuss her work as an international studies professor. We had visitors from other countries who ate, spoke, and treated their medical ailments differently than we did. I learned that the conventional American way was not necessarily the best way -- that we all see the world through only our own narrow window of experience. Many years later, when I found myself in my first year of veterinary school with formaldehyde-induced nosebleeds from spending so much time with preserved dog cadavers for anatomy class, I called my mother for advice.
One time my mother and I went hiking, near vet school in eastern Washington, with my little black dog. I had rescued Smudge, but her emotional turmoil had scarred her to the point of submissive urination. Veterinarians always seem to own abnormal animals with complicated histories. "How can my classmates kill normal pound dogs, bought for fifty dollars, supposedly just to learn surgery?" I asked my mother. We were at the top of Kamiak Butte, overlooking the treeless rolling hills of the Palouse. She had no answer, and I guess I couldn't have expected one. I would have felt better about taking those lives if I'd believed that what students learned made up for it in some way. But I didn't feel sure of that. I decided to take alternative surgery, in which we performed procedures on dead animals euthanized for terminal illnesses. Headed by Dr. Karl White, the veterinary chool at Washington State University was known for its progressive non-kill surgery classes, and for that I was thankful. Otherwise I would not have made it through veterinary school.
During one of my most difficult nights at vet school, I was on rotation with Teresa, now a racetrack vet, who was always tougher than I was, more the way I thought an equine vet should be. We were walking a young former racehorse to prevent him from getting colic, a life-threatening stomachache horses experience because they can't vomit. Walking colicky horses helps keep their digestive tracts moving, and can even save their lives! The horse had probably come from a second-rate racetrack. It was obvious that he had had an awful life. As part of a research project on how drugs affect intestinal motility, one of our vet school teachers had done an experimental surgery on the horse. The sickly horse had hardly been an ideal surgery candidate; thin and crawling with lice, he had been acquired by the vet school via a horse trader.
Now, every time we students stopped walking him, he would attempt to lie down and roll on or kick at his stomach. We switched off who walked him, as we had been told to do, and between us, we kept him moving and medicated all night. I turned to see his face in the moonlight. His body was coated with sweat, and his terror-filled eyes showed their white outlines bright against his dark body. His legs were riddled with scars, knobs, and bumps, evidence of life on the track. Even though he would rather have lain down, he followed each of us obediently, as thoroughbreds have been bred to do.
When Teresa walked the horse, she did not complain; with each step, she seemed more complacent, more resigned to the fact that it didn't matter what she thought, anyway. I screamed at her from over the fence, "This sucks! He should have known not to cut this one," and numerous other colorful complaints lent to me by my fiery Irish heritage, a habit that hadn't won me any brownie points with the powers that govern a veterinary college.
But I knew that people like Teresa fit in well at the racetrack. All these years I'd looked up to her because she was a hard scientist, so interesting and tough. Through vet school, her freezer was filled with roadkill to be studied and dissected. Her shelves were decorated with skeletons of snakes, possums, and raccoons. I loved her like a sister, but as I watched her calmly lead the pained horse by his tattered rope, I knew that my veterinary career would need to move in a more compassionate direction.
I wondered if there was a safer way to treat animals through the veterinary curriculum. Discussions about "iatrogenic" (doctor-induced) disease worried me. Why should we be the cause of any disease? These questions festered within my consciousness, but when I looked around, most of the other students didn't seem to share my concerns. They might have been more concerned with the next exam.
I knew from my years with horses that sticking with it through difficult times would be worthwhile. In vet school, I felt as if I were falling off a horse again. Eventually, I thought, if I dusted myself off enough times, like with Sam in England and Flicka in the old barnyard in New York, I would be pleased with my endurance. I believed that when I graduated and began working as a veterinarian in the real world, I would love my job. But that night on ER I felt like I was still falling.
At 1:00 A.M. we got the call most ER vets have come to dread. Tanya came to tell me, "A breeder is on the phone. She says her boxer is straining but can't have her puppies. She's on her way in." Nervous twinges began churning in my stomach as I checked to make sure all the surgical equipment needed for a C-section was sterilized and ready to go.
Tanya warned me after she left the exam room that this was going to be a difficult breeder. When I entered the room, I saw the boxer bitch on the floor, pushing, with no results. "She needs a C-section, just like last year," the breeder ordered.
"How old is she?" I asked, resenting being pushed into anything, since it's my veterinary license on the line.
"Seven, and been bred every year of her life. I've made thousands of dollars from her puppies. I would have gone to my regular vet, but he's out of town," she said in a snippy tone, as if she were trying to annoy me.
"Well, because of her history, I hate to rush right into surgery," I said. "I'd like to take a radiograph and try an oxytocin injection first."
"I guess, but it's a waste of time. How many C-sections have you done? You couldn't be more than twenty-five years old." She leaned forward, staring right at me. Although there are responsible breeders, they never seemed to come in on my shift. I questioned the idea of breeding dogs when less high-strung, more unusual, and healthier mixed-breed dogs are euthanized every day in animal shelters.
"I've done quite a few, and I look young for my age." I hoped she would lay off. "If you want to go to another emergency clinic, by all means, we can refer you somewhere." An extended silence accompanied the building tension between us. Only the quiet hum of the fluorescent light above us filled the exam room. She sighed, resolved to let me handle things, and went home.
Unlike her owner, Madeline was very forgiving and kind-tempered. She groaned and tried to push a puppy out every few minutes, turning nervously to see if she had been successful. I took her over to the X-ray table. Tanya and I laughed a little, despite our unspoken stress, while we took her radiograph. "Well, at least she's nicer than that bulldog we had last week," Tanya said. Unlike boxers, by and large bulldogs can't give birth without C-sections.
"Yeah, but this breeder is a real gem," I said as we turned Madeline on her back for another view. My cynical East Coast side always became more pronounced in the middle of the night.
The radiographs showed that Madeline had six large puppies, and the one in the birth canal was positioned sideways. After putting some exam gloves on, I tried to turn the puppy around, while Madeline strained against my fingers. It was no use. I couldn't even feel the puppy; my fingers were too short. Oxytocin wouldn't help here, since the puppy was just too big for the canal.
Within ten minutes, due to Tanya's fast preparation, Madeline lay anesthetized, belly and snout up, all four feet tied to the corners of the steel table. With tubes and intravenous lines draped everywhere, I was already cutting her open with a scalpel blade. I felt as if Madeline knew the ropes better than I, having gone through all of this before so many times.
I had always said that surgery made me nervous, but at least C-sections were rewarding. I just hoped the puppies were alive. Madeline seemed so much older than seven. I used scissors to cut the wall of the uterus, which was scarred and very unhealthy because of the number of litters Madeline had endured. I squeezed the first puppy through a small hole in the uterus, and passed it to Tanya to resuscitate, amniotic sac and all. She caught the puppy in a towel and wiped it to stimulate and revive it, just as Madeline would have done if she had given birth by herself. "Looks like a little brindle girl," she said. We read one another's minds. This puppy's tan and brown color would ensure her survival. If she had been white, it would have been customary for her to be killed, either by the veterinarian who delivered her or by the breeder because of breed-standard biases.
One at a time, assembly-line style, I delivered and Tanya revived all six puppies: three girls and three boys. We had only one problem as we woke Madeline up from anesthesia. One little boy puppy was white. I didn't know what to do. Tanya suggested I keep it quiet. "Just don't tell her. You know what she'll say. We'll find him a home ourselves," she said.
If I were to take the puppy home and not inform the breeder, I could lose my license. Of course, euthanizing the puppy would be what she would want, and I wouldn't do that. Maybe she'll be reasonable, I thought. So against Tanya's wishes and my better judgment, over the phone I begged the breeder to take the puppy home.
"If you don't kill him, I will," the breeder snapped at me.
"I can't and won't do that," I said, but I was getting that nervous feeling in my stomach again. "I could find a home for him," I persisted. Many breeders don't even like that, because if the gossip spreads, the boxer community might think a breeder's bloodline is substandard. It's a dark secret. Some veterinarians turn a blind eye, facilitating life only to end it, becoming like the cold steel we hover over. Finally she said, "Okay. I can see you won't back down, so let's forget we ever had this conversation. I'll pick up the bitch and the other pups within the hour." I took that to mean we could save the white male, and I breathed a sigh of relief.
Tanya and I gloated over the white boy pup like he was ours, wrapping him in a towel and watching him wrinkle his face, sucking on a bottle. We thought it was sad that he wouldn't meet his mother, but we started to plan what we would do with him. I would make sure he got a great home.
The end of the night was approaching; as Madeline went home, I could see the blue light of early dawn on the horizon. Relieved to see this shift coming to an end, I went into the office to finish writing up my records. But at that moment Tanya came in, munching on a cookie, to tell me that we had a cat on its way.
A short while later, I met a very upset but thankfully kind elderly lady and her calico kitten in the exam room. The lady stood next to the exam table stroking her kitten, who was open-mouth breathing. "Please don't let her die," she begged. "I lost my husband last week to cancer and I really need Pounces now." She took the kitten into her arms and rocked her like a baby.
I quickly glanced at the kitten's medical record. "I see here that she had a vaccine yesterday. Was she sick before the vaccine?" Trained to remain objective, I had to brush aside for now the comments about her husband dying or my thinking would be even more clouded than it already was from another sleepless night. Pounces, herself, seemed confused about what was happening to her body; breathing took all her effort.
"No. She was her frisky self before yesterday, but after we came here, she vomited all night long," the woman said, fidgeting nervously with the yellow scarf tied tightly around her neck. I quickly examined the kitten. It was clear that the woman's distress was almost as great as her pet's. By her broken words, I knew that she felt the worst dread imaginable at the prospect of losing the small kitten who kept her house alive. I imagined Pounces climbing her curtains and springing from countertops to sofa backs, providing movement in a house that was now otherwise so still. Perhaps this little kitten was all that was keeping her going right now.
I knew saving the kitten would be a race against the clock. "I'll have to hurry up and treat her," I said. "Her temp. is 105 F, three degrees above normal, and I think she's having a vaccine reaction." How dangerous vaccines can be, I thought, but there was little time for thinking.
"I have to get started right away," I said anxiously to the woman, and noticed myself scratching my head even though it didn't itch -- one of many nervous habits I didn't remember having before working emergency.
After I told the woman we would need to hospitalize her kitten, she turned to go back to an empty house. I carried the kitten toward the back treatment area. There was no trace of the playful, carefree kitten she must have been until the day before. All her facial muscles were strained and tight with the effort to keep breathing. This terror could leave a shadow upon her.
"Get the oxygen, guys!" I shouted, slamming through the door. Oxygen was a necessity because the kitten's tongue was turning blue, and I slipped her nose into the rubber opening of the mask. She breathed easier. What injections should I use? I hastily debated with myself. If I gave her a steroid injection, she would probably improve quickly -- but then her suppressed immune system would affect the vaccine's efficacy. I thought she was too young for such strong medication. But I had just been to a seminar on treating acute emergencies with homeopathy and, I decided, this was a perfect time to put this form of holistic medicine to use. Steroids could be a last resort. I rummaged through my personal supply bag to find a small amber bottle marked "Apis 200C." I poured the pellets into the kitten's mouth and hurriedly placed her nose back into the oxygen mask.
Tanya and I watched, glancing at each other nervously, as the kitten breathed. Although I didn't mind Tanya knowing I had used homeopathy, I really didn't want the other more conventional vets to know how I was treating the kitten, because homeopathy was still considered "fringe medicine." After fifteen minutes, she was still lying on her side, breathing with difficulty. Her temperature was now a little lower, 104 Fahrenheit. There were so many other patients waiting that I had to put Pounces in a cage and go to my next exam room. Tanya was to take her temperature every ten minutes.
It seemed like just minutes, but over an hour had gone by when Tanya stopped me in the hallway. "That kitten is up and walking around like nothing happened!" she exclaimed. I ran back to see her. She was standing in her cage, crunching her upper lip and whiskers in between the bars, as only cats do to show their happiness. She was breathing normally now; the terror was gone from her eyes.
I became angry at my profession's hand in causing Pounces's reaction, as well as the powerful vaccine-producing companies that feed our fear of infectious organisms to the point that, without any solid scientific evidence, we vaccinate our pets annually. Were the words of our veterinary oath, "Above all, do no harm," just empty sentiment handed down by ancient physicians, or were they wise words not to be taken lightly? As I handed the purring kitten over to her human parent, the woman cried tears of relief that Pounces was alive. She waved goodbye, and the kitten took one last look at me before the two vanished from my sight.
As I entered the doctor's office to write up records, I looked up at my picture of Smudge on the beach. In the early morning hours, after a busy night, I began to see that I needed to discover another way to treat animals. As I said goodbye to Tanya, that morning I also bid farewell to animal ER: the surgeries, lacerations, and abscesses. ER veterinarians have a tough job, especially given that they're paid about one fourth of human doctors' salaries. I'm comforted to know there are great conventional veterinarians helping animals at night as well as in the daytime. Although I believe there are serious problems with vaccines and with certain long-term medications, I know most veterinarians are trying their best and working from their hearts.
I drove home, smuggling the cute little white boxer puppy with me. Snug in a towel on my lap, he suckled on my finger, pretending I was his mother. In two days, when his littermates would be getting their tails snipped off without anesthesia to maintain breed standards, this little puppy would be with a technician friend who saves white boxers. In a few weeks, when his siblings would be getting their ears cropped, he would be adopted by new parents, and, with tail and ears unharmed, he would be able to communicate his emotions with an intact body. When he was sad, he would still be able to tuck his tail under and lower his ears. When he was overjoyed to see his new parents, he'd wag his tail and prick up his ears with happiness, I imagined.
It occurred to me then that I was on my way to finding a compassionate way to heal animals. I decided to practice holistic veterinary medicine. Although it meant more school, plane trips, and studying, I had to find a way to practice from my heart. For a moment, as I drove to drop off the puppy, I picked up the pace just like horses do when they know they are on the way home.
Copyright © 2003 by Donna Kelleher, D.V.M.