Right on schedule he came back two weeks later, and, sure enough, PC’s leg was healed enough to allow us to remove the splint.
About two months later Mr. Thibodeau was back in the waiting room with that mandarin orange box on his lap again. “Oh no,” I thought. “Another one. And he’s not going to be so lucky two times in a row.”
“I bring Petit Chou for a check-up!” Mr. Thibodeau said when he set the box on the exam table. “’E is doing really good, but I want to be sure.”
“You didn’t release him?”
“Yes, I do, but ’e keep coming back! ’E wait by de door! And now is winter soon, so ’e come inside wit’ me.”
I really debated about publishing this story because I didn’t want people to get the wrong idea. If you find a rabbit with fur and with eyes open, no matter how small, young and alone looking, leave it alone! Often baby rabbits that appear to be orphaned are not. Petit Chou was different because he had an obviously broken leg. And honestly, if he had been brought to me right away, I would have euthanized him. But there was something extraordinary about Petit Chou, and he reminded me to be very careful about prejudging patients. And there was something extraordinary about Mr. Thibodeau, and he reminded me to be very careful about prejudging people.
Every veterinarian has had the experience of a well-groomed and well-dressed client who pulls up in a luxury car and then gets angry over a relatively minor expense and threatens to euthanize or abandon the animal. And every veterinarian has had the experience of a client who looks and sounds like a homeless person who then moves heaven and earth to do everything possible for an animal. Our reflex to prejudge is powerful, but often so counterproductive.
Petit Chou/PC/Petty Chew (the file stayed under that name) went on to live at least two more years with Mr. Thibodeau, hanging out in his yard just outside the city and coming in during bad weather and through the winter. He came to the clinic for occasional check-ups and always looked good and always looked calm. Then the visits stopped, and I don’t know what eventually happened to him. When it occurred to me to call to find out, the number was out of service.
What the Seeing Eye Dog Saw
A little factoid that people have occasionally quoted to me is that the average dog is about as smart as the average two-year-old child. Google it; you’ll see many references. But as with many Google-friendly factoids, it is silly. It is a soundbite oversimplification of complicated science. In fact, the specific research paper that gave birth to this idea only demonstrated that the average dog recognized as many words as the average two-year-old. English words, mind you, not dog words. This actually makes the average dog seem astonishingly smart to me. Especially since my own dog sometimes seems to recognize as many words as a cucumber does (but he’s very handsome).
There is no doubt that human intelligence is extremely broad compared to dog intelligence. Our own intelligence applies itself vigorously to taxes and fashion and philosophy and physics and indoor plumbing and why the freaking OS update won’t install properly and a million more things. Dog intelligence is not nearly as broad, but where it needs to be, it is exceptionally deep. Whenever I think about smart dogs, I think about one particular patient, Sierra McNabb.
Sierra was a Seeing Eye dog. She was a golden retriever from central casting — the kind you see in happy suburban family advertisements for life insurance and Jeep Grand Cherokees. She belonged to Roger McNabb, a spirited single older gentleman, also from central casting — the kind you see at the bar telling boisterous jokes to the bartender and buying rounds for strangers. Roger had not been fully blind that long, and Sierra was his first guide dog. He had flown out east to meet her and to go through the final stages of the training with her. It goes without saying (although watch me say it anyway) that they were inseparable and that she was indispensable to him. Sierra knew how to guide him to the post office, to his doctor’s office, to the 7-Eleven and, my favourite, not just to the liquor store, but right to the specific location in the specific aisle where Roger’s favourite whisky was. Not just a smart dog, but a useful dog. Try to get your two-year-old to do that for you.
One incident made it clear to me, however, that there was a deeper thought process at play with Sierra rather than just a robotic response to commands. As with 95% of golden retrievers, Sierra had recurrent ear infections. Those infected ears were very sore, and Sierra hated having them handled and looked at. She would sit obediently enough and permit the examination, but her eyes said, “Why do you keep doing this? Don’t you know by now what’s wrong, you fool?”
One day Roger was due to bring her in at 10:00 a.m. He lived within walking distance and was always very punctual, making allowances for weather or anything that might slow them down. By 10:10 I was already a little concerned. The receptionist called his home, but there was no answer. Just then we noticed Sierra and Roger walk past on the sidewalk out front. Sierra took a quick furtive glance at the door, but kept moving ahead. A moment later they came back, walking the other way, again right past the door. The receptionist ran out to get them.
Roger was flustered, “I count blocks and I knew we had gone too far, so I turned her around. We went back and forth like that four times! I don’t know what got into her; I know she would have seen the door. I’ve never known her to be so confused.”
Confused? Hardly. Sierra and I exchanged the most fleeting of glances: she knew that I knew that she knew. From that day forward, we would keep a careful lookout at the door when Sierra and Roger were due.
Leroy and the Sombrero
“How long? How long has he got?” Lisa was struggling not to cry.
“It’s really hard to say. Every cat is different, but not long, I’m afraid. Maybe four to six weeks.” I briefly averted my eyes when I said this. These are always horrible conversations to have to have, but Lisa was a friend, so it was even worse.
She gasped a quiet “no . . .”
“I’m so sorry, Lisa.” I put my hand on her shoulder.
Leroy seemed supremely unconcerned by all of this and was attending to the important business of licking the ultrasound gel off his chest. Lisa and I kept staring at the screen, where a short video clip of Leroy’s heart was looping continuously. I had only been doing ultrasound for three or four years, but I had already seen at least a hundred normal hearts, which was enough to know that this one was profoundly different. In fact this was possibly the most abnormal heart I had seen so far. The two chambers that pump the blood out of the heart, called ventricles, were misshapen and contracting spastically, and the two chambers that receive the blood into the heart, called atria, were ballooned out to at least three times their normal size because of the backup from the flailing ventricles. Even a lay person who had never seen a heart ultrasound before could easily appreciate that this looked bad.
For serious and life-threatening diseases, deciding on prognosis is often more difficult than deciding on diagnosis and treatment. Coming up with Leroy’s diagnosis was easy — restrictive cardiomyopathy — and his treatment was sadly easy too — not much other than symptomatic relief — but his prognosis was impossible to determine with confidence. Often there are no studies at all to guide you, so you are left in the position of having to give the client an educated guess based on what you know about how aggressive a disease usually is, and based on your past personal experience with it.
As it happened, just a week prior, I had had the horrifying experience of watching a little dog’s heart rupture live on the ultrasound screen. One of his atria had become so distended and stretched out that in the middle of the ultrasound examination, it developed a tear in its outer wall and began to rapidly bleed out into the space around the heart. I had never seen that before, or frankly even imagined it happening. He lost blood pressure so quickly that he just slumped. The owner began to scream — “What’s happening! What’s happening!” — while I struggled first to comprehend it myself and second to find a
way to quickly and clearly explain it to her. Even though I knew it was hopeless, we rushed him into the treatment area where we kept the emergency supplies. There was nothing we could do. I know that I couldn’t have prevented it either because he came to me that sick, but I felt absolutely horrible nonetheless. All these years later I can still clearly hear the poor woman’s screams in my mind’s ear. At least the dog didn’t suffer because he instantly blacked out when this happened.
Even though that dog had an entirely different disease than Leroy, they both ended up with extremely dilated atria. I’m sure this fresh memory coloured my estimation of Leroy’s prognosis. However, I did go on to explain that prognosis is almost always on a bell curve. I told her that the majority of patients that look like this on ultrasound cluster around an average prognosis of four to six weeks, but there are a small minority at either edge of the bell who go a little quicker than expected on the one side or manage to survive a bit longer on the other. What I didn’t really have a clear grasp of at that point in my career was how much the shape of the bell varies. In fact, for cats with cardiomyopathies, it looks less like a bell and more like a sombrero. Sure, there are quite a few patients who hang out in the average zone represented by the crown of the sombrero, but the brim is very wide in all directions, with room for plenty of cats. Some unfortunately do very poorly and die quickly, and some, who look exactly the same on any test you care to administer, do very well and live well beyond the average. Nobody knows why.
No doubt you’ve guessed by now that Leroy’s heart kept ticking past the four to six weeks. In fact, Leroy made it all the way out to the far edge of that sombrero brim and lived two more years. I was amazed, absolutely amazed. But people who had a deeper respect for the old saying that cats have nine lives just smiled and nodded. You just never know which of those lives they’re currently on.
A Thing I Am Terrible At
The appointment looked innocent enough: “3:00 — ‘Count Basie’ Simmons — collect sample.” I did wonder briefly what sort of sample, but figured it was probably a needle biopsy of a lump as the techs do all the blood draws.
I entered the room and introduced myself to the owners, an older couple, he sporting a Tilley hat and a bushy white moustache, and she elegantly turned out and clutching a red notebook with “Count Basie” written boldly on the cover. Smiles and solid handshakes all around. There were two dogs in the room, both rough collies (Lassie dogs, in case you’re not sure).
“The Count has a friend along for moral support,” I said, chuckling lightly. I crouched down and invited them both to sniff me.
“In a manner of speaking,” Mrs. Simmons replied, also chuckling lightly. “Ella is his teaser.”
Uh oh.
“Teaser . . .” My heart dropped. I knew what I was collecting. Ella and the Count seemed relaxed about the whole thing. Mr. and Mrs. Simmons smiled at me. Obviously, it was my turn to say something. “So. Um. I am just collecting for analysis, then? Or are we . . . um . . . using it?”
“To analyze, please. He’s been a bit of a dud, I’m afraid. Such good bloodlines, but no luck so far.” Mrs. Simmons said this in a pleasant, matter-of-fact tone.
“They said you were the best!” Mr. Simmons added enthusiastically.
I made a mental note to track down the comedian who told them this. It’s not that I am in any way embarrassed by the procedure (I am a doctor), it’s just that I am not good at it. In fact I am terrible at manually ejaculating dogs. For example, there was that time with the pretty young woman and her toy poodle stud, Robert. God.
But I knew what to do. I excused myself to “get what I need,” which in fact was mostly just a few deep breaths and a couple minutes to quickly scan the net and the books for tips. It is not, as the saying goes, rocket science. The procedure is essentially what you imagine it to be. Although a cool dog penis fact, if you didn’t know this already, is that it contains a long bone, the “os penis.” For real. This makes things easier in some ways. I’ll leave the obvious jokes to you.
I stepped back into the room. Gloves, lube, collection vials. Everything ready. I looked at Count Basie, and he looked at me. Mr. and Mrs. Simmons smiled encouragingly. I made sure that Count Basie had sniffed Ella, who was apparently just coming into season, and then he and I began.
[Fade out for the sake of decorum.]
It wasn’t working. Mr. Simmons offered, “Maybe the white coat is putting him off?” I took it off, vowing to myself that that was as far as I would go.
It still wasn’t working. I kept trying, varying rhythm and pressure from time to time, reapplying lube, trying to look relaxed and professional, but the Count just stood there, panting, not even glancing at me. My hand was getting tired.
“Oh dear,” Mrs. Simmons said and wrote something in her notebook.
I was determined to succeed this time, but my hand was really beginning to cramp, and Count Basie remained as unmoved as a blind man at a Van Gogh exhibit. “I’m sorry, but this just doesn’t seem to be the day,” I said weakly.
“Don’t feel bad, this happened to the last vet too.”
I booked them to try again in a week when Ella was more in season. I knew I’d be away then, so they’d have to see my colleague. “He really is the best at this,” I assured them, smiling a wicked little smile to myself.
Edward’s Really Bad Day
I imagine that this will come as a surprise to you, but the worst day of Edward’s life was not the day we cut his penis off. No, it was the day before. The day before we cut his penis off, Edward tried to pass a very small bladder stone. But it was not small enough. It made it into his urethra, but not out again. Consequently, he could not pee, and consequently, he was having an increasingly bad day until it became the worst day of his life.
First thing the next day Mrs. Heinzel brought the poor howling Edward in. He was a large, sandy-coloured cat, the third in a series of large, sandy-coloured cats the Heinzels had owned. His bladder was the size of a Texas grapefruit. We quickly anaesthetized him and attempted to pass a catheter, but no amount of coaxing and flushing on our part could get the little stone to budge. Crystals are a common cause of urinary obstruction and are generally fairly easy to dislodge, but this was different. The only solution was going to be to perform a perineal urethrostomy (cut his penis off) and anatomically turn him into a female with a wider urethra. Females almost never obstruct.
Mr. Heinzel had recently died, and Mrs. Heinzel didn’t drive. Their son lived in Winnipeg, so he was often able to bring Edward and Mrs. Heinzel to the clinic, but it was sometimes difficult to fit into his schedule and sometimes impossible, in which case she used taxis.
Around this time Edward began to hate me. He had always been a bit of a hisser but had been manageable with a calm and slow approach. But since his procedure he had become more or less unmanageable. I don’t think he blamed me for his sex reassignment, but he almost certainly blamed me for the hospital stay that followed and all the attendant injecting, pilling, temperature taking, close examining and other undignified manipulations. Because of the increasing difficulty with transportation, and because I hoped that Edward’s hatred of me was connected to the clinic, I offered to start doing house calls. We don’t advertise house calls because there is no way to make it financially viable to have a doctor and a tech out of the building for a span of time during which they could see three or four patients in the clinic, but for special clients and with enough notice, we will occasionally do it. And in fact I like it as it feels like a break to do a little driving and to get away from the ringing phones, barking dogs and, at times, frenzied staff.
But Edward still hated me. The first time we went to Mrs. Heinzel’s house he came up to the front hall to greet us, took a few sniffs of my extended hand and began to hiss. Sigh. But Mrs. Heinzel really appreciated the house call, so even once Edward no longer had any immediate medical needs, I still went to her house once a year
for his regular annual check-up and vaccinations. It became part of my springtime routine. I became familiar with the potholes and the ice ruts of her West End street, but every year I forgot which way to drive down the street in order to be able to park, and the March ruts were so deep that I couldn’t turn my little Beetle around to face the right way. The tech would come along with a thick blanket and heavy leather gloves to hold Edward on the small kitchen table while I performed what can at best be described as a cursory examination while he screamed at us and attempted to flay us with his claws. All the while, Mrs. Heinzel would chuckle, “Oh Edward, you’re such a bad boy.” But from her smile it was clear that she didn’t mean it.
As the years went by Mrs. Heinzel became more and more stooped and wizened while Edward became more and more rotund. He was gaining at the pace of roughly a pound a year. When I pointed this out as gently as I could, Mrs. Heinzel would chuckle again, “Oh Edward, he’s such a bad boy.” Then one year he lost weight — quite a bit of weight, in fact. While he shrieked at us, I explained to Mrs. Heinzel what the possible causes could be. I told her that the best thing would be for us to take him back to the clinic with us for tests as there was no way we were going to be able to get blood samples from him at home and, in any case, he might need an X-ray or an ultrasound.
The Accidental Veterinarian Page 15