Animal ER

“I need someone to take the biting end,” said the traveling neurosurgeon to no one in particular.  I looked around the hospital. The cages were full and my technicians were busy.  

“I guess that’d be me,” I said and followed him to our patient, a 178 pound Great Dane.  The surgeon was going to pinch the dane’s rear toes, clamp down on them as hard as he could with hemostats, to determine if the dog could feel deep pain.  Deep pain was good.  It meant the neurologic circuit between the feet and brain was intact.  This dog couldn’t walk.  We wanted deep pain.  

My job was to ensure the surgeon did not get bit.  I’m not particularly interested in revealing my weight but suffice it to say I am five foot two and weigh less than this dog.  

I sat down on the speckled brown floor, a surface made for fancy garages.  We thought the material would be good in our hospital; classy, not too slippery and not showing dirt. I eyed a region that looked suspiciously like dried blood.  So much for hiding muck.    

I wrapped my arms around the dog’s neck and said a fleeting prayer.  I felt like a little girl with my arms wrapped around our Great Pyrenees -- Pepi.  An amiable dog that put up with all my prepubescent poking and prodding.  I only hoped this dog would be as gentle. Because the truth of the matter was if the biting end wanted to bite he was going to do so.  And I would be the likely recipient of said interaction.

But luck was on my side.  Our patient was just that -- patient.  He had deep pain and he did not bite.  Win-win.  

I heaved a heavy sigh and found myself utterly grateful for this gentle giant.  After our encounter I was beginning to feel bonded and was glad for his prognosis.  He probably had a fibrocartilagenous emboli (a stroke to the spinal cord). Given time he might recover. I rested my head on his, thanked him for being good, then got up to talk to his owners.  

The treatment portion of our hospital was separated from the exam rooms and reception area by swinging aluminum doors.  I went through the first set of these doors and skittered past the exam rooms with as much stealth as I could muster.  The rooms were full of clients waiting for my attention.  I went through the second set of swinging doors and out into the lobby. 

The dane’s people were sitting by a large plate glass window that overlooked the strip mall parking lot.  It was dark outside and I instinctively looked for the tree covered in white lights -- my beacon in the darkness.  But the tree wasn’t lit up.  Damn.  

I pulled up a chair, a gaudy fabric covered seat upholstered in a contemporary design, and began to review their case.  

I’d only just begun when the front door swung open and a gust of frigid air poured into the lobby. I shivered. It felt as if a spirit had passed through me and for a brief moment I was creeped out. 

A woman with a nose ring barreled through the door.  In her arms was a small scruffy dog who was actively seizing.  I excused myself, pried the dog from her arms and went back through the aluminum doors leaving them swinging in my wake. 

We gave the seizing dog an injection of valium. The medication worked immediately and our patient’s tremors began to slow.  He looked like an over medicated parkinson patient -- limbs flailing this way and that.  

Then I did it.  I opened my stupid mouth. 

“I’ll bet this dog couldn’t bite if he wanted to.”  

Dumb, dumb, dumb.  Though we practice medicine, science, we also wholeheartedly believe in the power of the jinx.  I had just cast a spell which all but mandated that this dog was going to bite us.   

My technician shot me a nasty look, a well deserved one at that, and took the dog to the scale where, as per my prophesy, he exploded. He threw himself off the scale, a mere inch off the ground, and slammed his head onto the floor. He bit his tongue and began to bleed profusely.  He shat himself and expressed his anal glands perfusing the clinic with an aroma of unsullied fear. 

Though this dog could not walk he began to scoot himself across the clinic with surprising speed, blood and feces smeared in his wake.  Each attempt to catch him was met with a mess of gnarling gnashing teeth.  He was barking, screaming and growling.  I knew, with fair certainty, everyone in the hospital could hear his tantrum, including his owner who remained in the lobby.  

I began hopping back and forth on my danskos muttering “oh shit, oh shit, oh shit.”  The tasmanian devil of a dog was headed across the treatment area -- straight for the great dane.  The dane, who was too big to fit in a kennel, was lying on the floor. 

Now the dane had been gentle with me.  But I had no idea how he felt about other dogs, much less, those of tasmanian descent.  Time slowed and I imagined this dane opening his mouth, cranking it back 150 degrees like a snake, and swallowing the terrier whole.  

And this entire incident would be all my fault. Vexes aside the buck stopped with me. If either of these dogs were injured I would ultimately be to blame.  

I ran over to the dane hoping to intercept any potential interaction but did not move fast enough.  The biting, slithering, mess of a terrier slid right up to our gargantuan patient.  And that gentle giant of a dog simply cocked his head in curiosity.   

Oh thank you!  Thank you!  I was becoming more and more bonded with this fabulous black beast.  

We threw a towel over the terrier and tackled him.  He was muzzled and subsequently subdued with medication.  Oh me oh my!

A bit worse for wear I returned to the lobby, reassured the terrier’s owner and resumed my conversation with the dane’s owners.  

Though his medical situation was not ideal the dane had a chance for recovery. With supportive care and time he may be able to walk again.  The couple didn’t say a word. Instead they looked at me, blinked, and then looked at each other.  And I knew.  Fuck.  Fuck it all to hell.  They were going to euthanize.  

They wanted to be present and wanted to get it over with as quickly as possible. I pulled the sickly pink solution into a 20 cc syringe.  I sat in front of this wonderful dog and he looked at me, his mouth open and panting.  He trusted me.  We were friends.  

His owners stood over him and I gave the injection. I caught his bowling ball of a head as it fell to the ground.  His owners turned on their heels and left, leaving me on the speckled floor next to their precious dead dog.  I lowered my head to his once again and began to cry.  

Then the aluminum doors burst open and another emergency beckoned.  I stood, wiped my eyes and, with no other choice, returned to work.   

She Travels with Goats.

This past weekend we loaded up the car with three kids, two adults and one goat.  Buttercup went to her forever home near Portland, Or.  She did amazingly well in the car.  Most of the mess was contained on her comforter and no seat belts were eaten (for this my mother will be particularly grateful).

Buttercup is now living with two other goats in the gorgeous pasture above.  It was a fun little trip and I'm glad we got to do our part to help this sweet girl.

And, as always, I loved driving through the country fantasizing about goats and pastures of our own.  Someday.  Someday.

xo.

What's up Buttercup?

I made a house call this morning to draw blood on our clinic's stray/rescue pygmy goat -- Buttercup.  She's been tucked neatly into suburbia and seems quite content in my co-workers garage.  I'm told she doesn't even want to go outside when she has the opportunity.  But she does wish she could go in the house. If only goats could be potty-trained!

We are testing her from Caprine Arthritis Encephalitis or CAE.  This is a contagious viral infection that can lead to arthritis.  Buttercup is still limping quite a bit.  We are unsure if this limping is a result of her injuries (she was attacked by dogs) or from a potential infection.  Fortunately we'll soon find out.

The good news is she'll likely have a "forever home" either way.  If she tests positive for this disease she'll go to a goat sanctuary in Silverton.  If she's negative then I have a friend whom I am hoping will take her.

She's a very sweet girl -- loves to snuggle and even gives goat kisses.  If I only had my dream farm ... someday.  Someday.

xo.

Up for the Count

I woke to the rhythmic ding Ding DING, ding Ding DING, ding Ding DING of the intercom. Someone was at the front door. I sat up -- dazed and confused. I was at work and had been catching a cat nap on the futon in the office. It was 5:00 am.

The overnight technician answered the door and started intake paperwork. I wiped drool off my face, stumbled to the bathroom and brushed my hair. The results were questionable at best. Though I'd hoped for stellar and erudite I had to settle for tolerably competent. And, given the hour, even that was dubious.

Our patient was a spastic rat terrier who woke his owners with a deluge of diarrhea; bloody diarrhea no less. Not what anyone wants to be greeted with in the wee hours of the morning.

Now we see quite a bit of bloody diarrhea in these parts*. Thus we are fairly nonchalant about the such things. I have to remind myself this is scary for people. They are not here to disrupt my sleep (well okay -- they are but it's not their primary impetus). No, they are here because they are worried and, quite frankly, terrified about their pet's condition. Certainly if my human children presented with similar signs I'd be a basket case and barrelling through the doors of our local ER.

Despite his illness our patient was bright and chipper. We were able to treat him as an out-patient and send him on his way. Hopefully his people, now educated about his condition, left with a touch less worry in their hearts.

After discharging Fido (name changed to protect confidentiality) I surveyed my surroundings; a strip mall parking lot with a dental office and street sweeper in the distance; not exactly a five-star view. But beyond the concrete was the rising sun and clouds, fluffy and golden, radiantly reflecting the light. It seems there were advantages to waking early.

By that time it was six am. Rather than being down for the count I was up for the count; meaning I had (have) a long day ahead of me. I had charts to finish, insurance forms to fill out and a patient to discharge. After that my primary task was (is) to stay awake.

You see I will be working the day shift this weekend. This means I have to switch from night owl to passably human over the next two days.

It is spring break. Though my girls are visiting Grandma and Grandpa the boy is home. As is Mr. Peculiar. This week he worked Sunday through Wednesday, has today, Thursday, off and works again tomorrow. As per our moniker we hold peculiar hours. The boys want me to go thrifting with them. I think I will. After all I have to do something to stay awake.

Now you have been given fair warning. If any wackado items appear in the shop you may turn me in to Regretsy. I will steadfastly blame any and all oddities on a lack of sleep.

Thank you for stopping by and have a joyful day.

XO.

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* Bloody diarrhea has many causes from pancreatitis to parvoviral enteritis to hemorrhagic gastroenteritis. It always warrants a trip to your local veterinarian.

What I Want

I don't often talk about work here. It's a touchy subject. Veterinary medicine has gotten expensive. And yet veterinarians are not walking around with wads of cash in their pockets. You see the cost of running a business is also quite expense. We have to pay for leaseholds and utilities, medical equipment and supplies, employee wages, continuing education, licensing fees, etc, etc. And, in order to stay in business, in order to be there in the middle of the night, we must charge for our services.
This doesn't sit well with some people. And I understand. Believe you me I know times are tough. I know money is tight. I know. Oh how we wish we didn't have to charge. If only we could provide free service to all. But we can't.
Now some folks will apologize for their financial state. Some will shut down and simply not talk. And then there are those who are flat out rude.
One frequent comment is "... well if I'd known it'd cost that much I just've taken 'ol Fido here into the backyard and shot him in the head." Now here I just smile politely and say that I don't recommend that particular route of treatment. A different commentary is simultaneously running through my head.
Another frequent comment is "... hell. This costs more than the emergency room." Meaning, of course, human medicine. Sometimes it's hard to keep my mouth shut. I've been to the human emergency room with my husband, my daughters, my son and myself. I've seen the bills. I've paid the bills. I will tell you emphatically our services are a fraction of the cost of human medicine.
And, finally, "... I can git me a new dog from in front that there Walmart. Why'd I want to pay to fix this here mongrel?" Why indeed? A question worth asking is "do you want a dog or do you want this dog." (Which, by the way, is how I've ended up with my menagerie of pets -- turns out if you don't want your dog (or cat or bird) I may just take him home).
And this is a very long segue into want I really want to talk about. My new to me sewing machine. The relevance will be seen shortly (I hope).
Recently I found a steal of a deal at a garage sale. A 1971 Janome New Home Sewing Machine (similar to one pictured above). She was missing a bobbin and needed a new needle but otherwise seemed to be functional. I brought her home and with one of my bobbins and needles got her running -- sort of. She placed a few stitches and then stopped.
Well as much as I'd like to know everything about everything I do not. And so, today, I took her to a sewing machine repair shop for expert advice. My husband came along for muscular (that machine is HEAVY) and, as it turns out, moral support.
It seems the check in gal at the shop does not have an appreciation for vintage machines. "Do you know," she said with disdain, " this machine blue books at $14.50?"
I stared at her blankly.
And your point is?
"I just want you to know you'll be putting more money into this machine that you'll ever get out of it."
"That's okay," I said sweetly, "I'm not planning on selling this machine. I plan to use it."
"Well," she asked, "What kind of machine are you using now?"
"A very basic, inexpensive machine." I replied
"You might find," she retorted, "that with a newer machine you wouldn't be frustrated and might actually enjoy the process of sewing."
Who said I was frustrated? Who said I didn't enjoy sewing?
And then she got to her real point. "We can always trade this one in towards the purchase of a new machine."
Now if I wasn't at the one and only repair shop in this small town I would have grabbed my machine and stormed out. Rather I would have made the hubbie grab the machine and storm out (heavy people, seriously heavy). But I didn't know where else to go.
Fortunately Mr. Peculiar chimed in. "We really like this machine. It's got beautiful clean lines similar to a vintage car. The colors are gorgeous. Plus we don't believe in simply throwing things into the landfill just because they are old. My wife and I feel sewing is an art, an old art, and how better to sew than on an older machine?"
It was the check-in lady's turn to stare blankly.
Finally she said with a little tsk tsk, "all right, whatever the customer wants."
And it is indeed what I want. For the price I'm paying to potentially fix up this machine (fingers crossed) I can not buy a new one.
And truth be told I don't want a new machine. I want that machine.
Just because something is inexpensive (or free) doesn't mean it doesn't have value. It might be easier to start over. To get a new dog. To get a new machine. But that's not what I want.
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TWO roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;	5
Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same,	10
And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.	15
I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference. ~ Robert Frost

Last Night

Dogs, like humans, have three stages of labor. The first stage is often called pre-labor which includes early mild contractions and dilation of the cervix. The mama dog’s temperature will drop and she will begin to nest. She will also pant and appear uncomfortable. The second stage of labor consists of active contractions and pushing. During this stage we veterinarians do not like a dog to be actively pushing for more than an hour without producing a puppy. If this occurs then veterinary care and intervention is highly advisable. The third stage of labor is the involution of the uterus and expulsion of any remaining placentas after all pups have been born.

Last night, at 2:45 am, a Shih Tzu presented to our clinic. We’ll call her Lola. She had been in stage two labor and actively pushing for nine hours. Nine. I can not say why she was not brought in earlier. Perhaps her owners were uninformed and had not researched labor. Perhaps they were holding out for a natural (and thus free-of-charge) birth. Perhaps a combination of the two.

At any rate this little gal needed a c-section, and sooner than later at that. But, before surgery, finances had to be addressed. These folks were financially strapped. They had poor credit. They knew of no one who would lend them money or a credit card. They had not planned for any potential complication. Nonetheless they would gladly pay us Tuesday for a c-section today.

I had a judgement call to make; perform surgery with a hope and a prayer of getting paid or not perform surgery with a hope and a prayer the dog would survive until she could see a day practice. I chose the former. If the checks don’t clear my head will be on the chopping block. All I could wish for was a neat clean and quick procedure which minimized costs but did not jeopardize the health of the animal.

As we were prepping Lola for surgery her owners came back to say goodbye. “We have a little girl at home,” they stated casually with no indication of the bomb they were about to drop.

“She’s six. This dog means the world to her and she would be absolutely devastated if anything happened to her or the puppies.” Criminy. A child. Children pull on my heart strings and this statement definitely upped the ante. But wait, there was more.

“You see last year she lost her brother. This dog was meant as a replacement. This baby for our baby, our human baby.”

And there it was. The whole package. Neatly wrapped in brown paper, placed gently on the floor and slid nonchalantly in my direction. Doctor. Not only are you responsible for the financial wherewithal of this family, you are also responsible for the life of this little dog and her unborn puppies. And, to top it off, you hold the mental well-being of a young child in your hands.

Needless to say the pressure was on. This dog had been in labor way too long and I was very concerned the puppies would not be viable. Everything rested on my shoulders. Fortunately our emergency clinic has an amazing and highly trained staff. There were only two of us, my technician and myself. Yet we were ready. We could handle it.

We went to surgery immediately. Luck was on our side (and believe you me we have been on the other side of the luck equation). Last night the procedure was quick and mama's uterus was in good shape. The first puppy came out gasping. It was alive! The second pup, the one stuck in the birth canal, did not show signs of life. His head was swollen and as I suspected he'd been stuck too long. But one live puppy and a live mama. That was good. We could salvage something from this mess.

My technician worked on stimulating the first pup while I finished surgery. As I was closing my incision the technician gasped. “Oh my God,” she exclaimed, “the other puppy is breathing!” Revival efforts began immediately. Against all odds that puppy also survived.

Last night the universe was on our side. We returned the neat brown package to sender embellished with a bright new ribbon. Inside was mama dog, two healthy puppies and a little girl’s heart and soul. Now, if we're really lucky, we might even get paid.

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I am not an advocate for dog breeding. There are too many wonderful animals already in need of homes. And I should know given all my cats (3) and dogs (2) have been rescues. These animals are amazing. The labradork, Walterino, Mickey, Emmie and camera shy Mew Mew. I couldn't ask for a better crew. Each and every one of them was left for naught.

If, however, you ignore my plea and choose to breed please be prepared. Study and read about the birthing process. Consider Whelp Wise. Set money aside ($1000.00 to $2000.00) in case a c-section becomes necessary.

And, by all means, do NOT count your puppies before they hatch.

Night Shift

I apologize in advance for the imagery. My mind is, on occasion, warped. This job, this life, will do that to you.

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I lie on the futon and stare at the ceiling with its fluorescent lights, acoustic tiles, and sprinkler head. The futon is definitely a step up from the abandoned gurney with mold creeping along the bottom of the pad; a gurney no longer fit for man and therefore donated to beast. We, however, did not differentiate between man and beast and returned the gurney to man, or woman as it were, as temporary sleeping quarters. Thankfully this used futon has taken its place.

Musty cologne wafts from the pillow case. I know who worked the night before and contemplate changing the sheets. Instead I close my eyes and picture dust mites, eight legs a piece, crawling in and out of the fabric like maggots burrowing through rotten flesh; with each breath millions of microscopic creatures are torn from their nests and plunged into alveoli then ripped from tissue and flung into space. In and out, in and out; I breathe steady with knowledge. The carnage is mine.

Computer beacons penetrate eyelids; constant reminders that I am not home. I pull the threadbare blanket over my head and wonder how many animals died nestled in its creases; how much urine and vomit caressed the stitching? What organic matter was set free in the wash and what remains?

A dog cries out. He’s been rebuilt. His pelvis more metal than bone. That doesn’t diminish the pain of being turned; rotated every four hours to prevent bed sores. He’s been here a week. He’s still not walking. Is it worth it to continue the fight?

What have I done? How did I get here? What am I doing? I need to rest. Soon the phone will ring and I’ll be called into action; expected to be lucid and intelligible while cohorting with the moon. I lie on the futon in a modified savasana, a corpse pose, and dream of sleep.

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Two Dogs, Two Owners and Two Outcomes

Photo courtesy of Paul Clark

Client #1: Hiya Doc. Nice ta meetcha. First off you need to know I’m a physician. A doctor. And as a doctor I’ve made the decision not to spend a large amount of money on my dog. I’m not willing to spend several thousand dollars. That’s just assanign. I love him but, after all, he’s just a dog.

Veterinarian: Okay. I understand. People have financial limitations. Let me take a look at Duke.

I have to tell you. I’m concerned. Duke is very sick. He’s severely dehydrated, his mucous membranes are injected, he’s weak, lethargic and painful in the abdomen. I’m worried he may have an intestinal foreign body.

Blood work and x-rays are in order.

Client #1: Like I said I’m not willing to spend a lot of money. Plus he doesn’t eat things he’s not supposed to. You can start with blood work.

Veterinarian: Okay.

(Dog taken for blood draw then returned to owner. While blood work is being run client summons the veterinarian to the exam room).

Client #1: Doc. He vomited. It’s foul, putrid. I think you’re right. He has a foreign body. You’d better take x-rays. You’d better take them now.

(Dog taken for x-rays. Veterinarian returns to discuss results).

Veterinarian: I’m afraid I have some bad news. These radiographs are highly suspicious for a foreign body -- specifically a linear foreign body. My best recommendation would be to take Duke to surgery and explore his abdomen.

But I know you have financial constraints and unfortunately surgery adds up. Including the exam, the diagnostics we’ve done so far, surgery and hospitalization were probably talking in the range of $1500.00 to $2000.00.

I’m afraid this is an obstruction that won’t pass on it’s own and Duke is already in poor condition. Your other option is euthanasia.

Client #1 (with tears rolling down his cheeks): I said I didn’t want to spend a lot of money but it doesn’t seem fair not to treat him. Do it. Take him to surgery.

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Client #2: Hello doctor. Nice to meet you.

Veterinarian: Hello. I see Sage has been here before. She had a foreign body surgery.

Client #2: Yes. She swallowed a nylabone. I guess they’re still manufacturing them. They’re made to swallow and supposed to dissolve. It didn’t. It doesn't seem it was her fault.

Veterinarian: And now she’s showing similar signs?

Client #2: Yes.

Veterinarian: Well let me take a look at her. She’s pretty bright and alert. She’s not too dehydrated but she is a bit painful in her belly. Given her previous history I think we should take x-rays.

Client #2: Okay, sure, sounds good to me.

(Dog taken for x-rays and veterinarian returns to discuss results)

Veterinarian: Well I’m afraid Sage is obstructed again. It appears she’s swallowed a rock.

Client #2: A rock? A rock? Why would a dog swallow a rock?

Veterinarian: I don’t know. Dogs can be weird that way. They eat things that a typical person wouldn't even think about eating.

Client #2: This is not normal. This dog is not normal. She digs holes. She runs away. And now rocks. What dog swallows rocks?

Veterinarian: Actually it’s not an uncommon occurrence, especially in puppies. And really she’s still a puppy. She’ll begin to mature in another year or so. I recommend we take her to surgery.

Client #2: I suppose some people can’t afford the care. Simply can’t pay for it. That’s terrible. Horrible. This, we can afford this. We've been through it before. But this dog is not normal. Rocks!

Veterinarian: I assure you it is quite normal. Sage isn't the first dog to swallow rocks.

Client #2: Well, you see, here's the thing. My wife doesn’t like this dog. We were thinking of finding her a new home. Yet it seems a shame to withhold treatment for bad behavior.

Veterinarian: Yes it does. And she’s young. She’s likely to outgrow this type of behavior.

Client #2: And I want my boys to have both their dogs. I want them to understand responsibility and compassion. That's my job as a parent. As a citizen.

But this dog. She’s not normal. Just not normal. I’m afraid we’re going to have to put her to sleep.

Veterinarian: Are you sure this is what you want to do?

Client #2: Yes.


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