“We’d have paid anything to get Mischief back to health again. But it sure did set us back.” Mrs. Garner chuckled and gave me a good-natured shake of her head.
“I know the treatment was expensive, Mrs. Garner,” I said sympathetically. “But Mischief did do something that no other patient has ever done in all my years of practice.”
The two turned to me expectantly. “What was that?”
“Seventy-six cents may not be much, but she’s the first patient that has contributed cash to help pay the bill.”
Snakebite
I was delighted to see Megan dragging Elaine into the lobby of the hospital one warm late-summer morning. Though it had been a couple of years since her injury, Megan’s attachment to me had not flagged. She still came in the door each time looking for me, calling out to me with a little boof, ears erect as she listened for my response. Megan and Elaine, though, were not alone this particular morning. Max limped in behind them, completely devoid of Megan’s eagerness.
“Megan!” I said loudly. “How’s my girl?”
This greeting threw her into spasms of delight, her mouth wide and laughing as she strained against the leash. Elaine released the leather handle and Megan launched herself at me, vaulting onto the reception desk between us. I met her at its summit, to find my face slathered without apology by Megan’s licking tongue. It’s nice to be worshiped, to be viewed by another as wonderful, heroic, handsome, and worthy. Though I had been the one who had put her through the intense discomfort of treating her badly mangled leg, this is exactly how Megan saw me still. And it was flattering! I indulged in this completely unwarranted devotion shamelessly.
When we could finally dislodge Megan from the desktop and settle her enthusiasm, I recognized the reason for today’s visit. Max hunkered down behind Elaine, head low and tail between his legs, holding up one grisly front paw. He looked very much like Megan. Both had been adopted from a local shelter within a month or two of each other. As far as Ms. Farmer knew, there was no relation between them. But you would have expected them to be siblings, so similar were their markings, size, and features. Like Megan’s, Max’s nose was long and straight as a collie’s. He, too, was longhaired and brown, though shaded with deeper reds. Like her, he was lean and had a deep, narrow chest. But that’s where the similarities stopped. Max’s personality was much more reserved than his infatuated sister’s. Instead of incessantly seeking attention, he was more inclined to hide behind Megan or Elaine and act as if I was not present. Apparently, he had plenty of friends and felt no need to make more, especially one dressed in a white smock with a stethoscope around his neck and, God forbid, a thermometer in his hand.
Though he didn’t want me to see him, it was clear that he needed my attention. His left front leg was swollen from the elbow to the toes to three or four times its normal size. The skin was darkened from a strawberry red at the top to almost a plum purple color near the foot. The twin trails of dark blood that seeped from two small punctures on the inside of the leg, at which Max licked incessantly, made the diagnosis obvious. Snakebite!
“How long has Max’s leg been like that, Elaine?” I asked, concerned.
“Well, I didn’t think much about it at first. He came home two nights ago limping some. By yesterday morning it was pretty swollen. But it got really bad throughout the day yesterday, and I knew I had to bring him in this morning. It’s a snakebite, isn’t it?”
In Virginia we have two species of poisonous snakes, water moccasins and rattlesnakes. A bite from either can result in serious tissue damage. The consequences of a snakebite do not allow one to distinguish between the types of snakes. Neither did the location in which Ms. Farmer’s home was situated. Both species could be found in the Fort. So I wasn’t sure which kind of bite I was treating. In as rural a setting as that in which I practice, I have always been surprised that I don’t treat more snakebites. Because they are quite uncommon, though, I do not keep the extremely expensive antivenin on hand to treat them. Antivenin works best when it’s started soon after a bite, anyway. I knew it would have little effect if started this late. Fortunately, snakebites are not usually life-threatening problems.
Max’s temperature was elevated from the severe inflammatory response his body had mounted. He was dull and lethargic, and his leg was extremely tender to the touch. Even the slightest pressure of my probing fingers evoked from him a quiet whine of pain and a feeble attempt to wrest his hurting leg from my grasp. But, though he clearly was suffering intensely, he remained ever the gentleman, turning his head away from me in resigned submission, rather than challenging me, as many dogs would have done.
Treating snakebite patients in the absence of antivenin is a symptomatic endeavor. The pain is relieved with powerful drugs. Shock is countered with high doses of intravenous fluids and anti-inflammatory medications. Secondary infections are prevented with antibiotics. Hot and cold soaks help to reduce swelling and local tissue damage. Sometimes even these measures fail to combat the mounting pressure from the swelling, and incisions must be made in the area to release the buildup of fluids in the limb. All of these treatments were necessary for Max over the next several days.
Each day, Elaine brought Megan in to the hospital to visit her brother. They had become fast friends over the years, and she missed his presence at the house now. However those visits affected Megan, they were miraculous for Max. His ears would perk up and his nose would begin to twitch as soon as they entered the building, and he would commence to whining and nosing the cage door. After her first visit, Megan knew exactly which cage was Max’s; and once she had greeted me exuberantly, she would make her way there and return his affection through the bars. Though you would think this would have made Max depressed after she left, it was amazing how much he would settle down after her visit, eating his food only after Megan and Ms. Farmer had been to see him. His attitude would remain upbeat for an hour or two before sinking down again into his discomfort.
For a while, I wondered if we were going to win the battle. But three days later, I began to notice a subtle turning of the tide in our favor. Max’s attitude improved, and he showed renewed interest in his meals even before Megan’s daily visit. At first the swelling simply remained unchanged from one day to the next. Then it began to subside. The intensity of the color changes in the skin began to fade. And his fever broke. When on day four he again started to bear a bit of weight on the leg, I knew that we had won. I called Elaine and told her he was ready to be discharged.
“That’s wonderful, Dr. Coston. I wasn’t sure we were gonna pull this one out.”
“I was pretty worried for a while there myself,” I responded. “But your dogs just won’t give up. And with Megan encouraging him every day, he had no choice but to get better. I know he’ll be glad to be home.”
“I don’t know about Max, but I do know Megan appreciated the chance to see you every day. She still has such a crush on you. It’s unbelievable.”
I chuckled dismissively. “She is a sweetie.”
“I’m not kidding, Dr. Coston. If I just say your name, Megan will go outside and try to climb into the truck. She just loves you. I’m not sure she didn’t get Max bitten by that snake on purpose.”
“She wouldn’t do that.”
“I’m pretty sure she would. You know, for weeks after her leg healed, she would go out and jump into the creek, then bark at the door of the truck, fully expecting me to take her to your office. She had that figured out. And when we didn’t go, she would sulk.”
“Maybe she just wanted to get away from your property. It seems to be dangerous for your dogs. First Megan’s leg, and now Max’s.”
“What am I going to do to prevent them from getting into another dicey situation?” she asked seriously. “I can’t afford any more accidents. One of these days I’m gonna lose one of them. And I really can’t afford that.”
“I guess you’re gonna have to move!” I laughed. “Anyway, keep up the hot and cold soaks on Max’s leg
for another three or four days. And try to keep him off of it as much as you can. It will take a week or longer for the bruising to go away completely. But I do expect him to recover fully. We’re lucky, you know.”
I watched Elaine and her two dogs make their way out the door and head to the pickup truck, Max limping noticeably on his left front leg and Megan limping just barely on the right. What a grand sight it was to see both dogs walking. One had nearly lost her leg to a vehicle, the other to a venomous snake. Both of them, I noted with pride, owed their ability to walk at all to the care we had provided. With a feeling of satisfaction, I watched Elaine assist the pair into the truck.
But I couldn’t squelch the nagging thought that played unwelcomed at the fringes of my mind as I indulged this moment of satisfaction. I didn’t even want to acknowledge its presence or give voice to the ridiculous notion. But neither could I quite fend it off. It was just an old wives’ tale, after all, that said bad luck always comes in threes. And Max’s snakebite had only been Ms. Farmer’s second.
Shortness of Breath
I watched with interest as Lisa deftly slipped a tiny intravenous catheter into the thin blue line that was the shrunken, dehydrated cephalic vein in the front leg of a three-pound kitten. Her success in performing this task would doubtless mean the difference between life and death for this gravely ill patient. I marveled at the skill she displayed with this impossibly difficult chore.
For just a moment I allowed myself to consider the path Lisa had charted over the preceding several years. Somehow she had navigated the desperate waters of grief after her husband, Steve, passed two years before. Steve had suffered burns over 70 percent of his body after a terrible accident. After cleaning his paintbrushes and rollers with paint thinner, he had gone home and stocked the fireplace. Vestiges of the paint thinner on his sleeve had ignited, and he had not been able to extinguish the flames before his upper body had sustained serious injury.
Steve had lingered for over a week in the burn unit at the University of Virginia teaching hospital in Charlottesville before finally succumbing. Lisa had become a single mother and widow before the age of thirty-five.
But in the time since that tragedy, Lisa had managed to find love again with a neighbor who had befriended her after the loss. Dave had known loss himself, having buried his wife, whom ovarian cancer had claimed much too young. Dave knew like few others the depth and breadth of Lisa’s sorrow. They had shared a common bond, finding comfort in the circle of those who had overcome unthinkable sadness. Their bond had grown into much more—a sincere love and an abiding trust in each other that was born of shared and satisfied emotional needs. I had watched Lisa’s mourning turn to morning again, little by little, her heart dawning new and fresh under Dave’s care.
Dave had not been inattentive to Melanie and Steven junior, either. The concern he had shown for them had, with time, allowed them freedom to place their father’s death into perspective. Both had matured into successful young adults. Melanie engaged her interests in fashion by becoming a costume designer for the Wayside Theater, a local live-theater company. Cynthia and I occasionally saw her there when we attended the company’s productions. Steven joined the military after high school to pursue his interest in aviation. The enforced discipline of the armed services gave him needed structure and confidence. Dave became for them a steady and positive influence.
Lisa’s skills were invaluable to me now in the practice. Time and again, her ever-widening inventory of clinical experience and techniques had provided just the thing needed to save a patient’s life, as was the case with this kitten. Because she grew to anticipate my every therapeutic move and diagnostic thought, she made my work simple and efficient. Her remarkable ability to connect with the patients put them at ease and allowed her to do even the most uncomfortable procedure with little restraint. And for those patients who would not be calmed, she was the best restrainer I could imagine, able to keep the meanest dog or the most fractious cat still enough for me to inject a cocktail of calming sedatives into their veins.
There was now little of the old Lisa left. Gone was the insecure, unsure girl who had first begun working for me six or seven years before. No longer were her interactions ingratiating and apologetic. She had earned for herself, through effort and commitment, success and accomplishment, the most coveted of respect: her own. On the heels of that, the respect of others followed naturally. Lisa’s evolution confirmed the observation that you reap what you sow. Plant the seeds of success and you will harvest success, achievement building upon achievement, accomplishment upon accomplishment. And the converse, of course, is also true. Invest nothing and your return will be nothing. Failure, too, is cumulative. Lisa had worked for these gains, and it was a wonderful thing to see the results etched into her self-assured face, her easy smile, her proficient clinical expertise.
My reverie was interrupted as Lisa finished taping the intravenous catheter in place and turned to me.
“What rate of fluids do you want this kitten to have?” she asked, then erupted with a deep and coarse cough. It took her a little while to regain her composure before she addressed me again. “Wow, I can’t seem to shake this cold.”
“How long have you been coughing like that?”
“Oh, it started probably a month ago or so. It’s a real hanger-oner. At least I haven’t been all stuffed up.”
“You know what I’m going to say now, don’t you?”
“Yeah, I know. I gotta give up the old cancer sticks.” Lisa laughed. I had been giving her good-natured grief about her smoking for years, ever since she started working for me, in fact. But smoking was a given among her family members. All of them, including now Steven and Melanie, smoked constantly. It was a habit I simply did not understand, not ever having been tempted to start.
Two or three days later, I came upon Lisa, who was standing uncharacteristically still at the top of the stairs. She was breathing hard.
“You all right?” I asked. “You look like you just finished a marathon.”
“It’s really strange,” she replied, laughing, “but that’s just how I feel. I’ve gotten so completely out of shape, it takes my breath away just to come up the stairs. I gotta start exercising more. Dave and I have talked about starting to jog in the evenings, but I just can’t muster the energy.”
“I don’t know, Lisa. With that cough and this shortness of breath, I might go see a doctor. Maybe you have a touch of bronchitis and need some antibiotics or something. No cough should go on for that long.”
In my case, the stresses of veterinary school manifested as shortness of breath. It was awful: the tugging to breathe, the refusal of my lungs to expand fully, the unsuccessful attempts to suck in a full complement of oxygen. I had gone to the doctor, fearing some awful malady, and had watched him write “SOB” on my record, insulted that he thought so poorly of me. He had assured me, though, that SOB was the medical abbreviation for shortness of breath. After finding nothing amiss, he had suggested that the shortness of breath might be a consequence of the stresses and pressures of veterinary school. I had thought the suggestion ridiculous, but I was surprised when the symptoms magically and immediately resolved, not from medical intervention but from a simple psychological response to being named. So I had real empathy for Lisa’s symptoms. I was sure hers would resolve, too, with a little medical attention. She had certainly been under a constant barrage of stress over the last couple of years.
“I’ve been thinking I ought to get checked out. I’ll make an appointment soon.”
That was the last I thought of it for a while. I did notice with concern that Lisa’s cough did not go away and that she avoided stairs and physical exertion as much as possible. But it wasn’t till about three weeks later that Lisa mentioned anything more about it.
“I went to the doctor yesterday.”
“Oh yeah? What did he say?”
“He didn’t think it was bronchitis, but he put me on some antibiotics just in case. He
was a little concerned about walking pneumonia, so he sent me over to the hospital to get X-rays taken. I get the results of those back in a day or two. He said he’d call me.”
“I’m glad you got looked at, anyway. I hope you get to feeling better.”
“That’s just the thing,” she said. “I feel just fine.” While this should have made me feel good, somehow it did just the opposite.
“Oh, and by the way,” she added, “he wants me to quit smoking.”
“Good man.”
In the back of my mind, the details of this situation were not settling well. A bothersome, wholly unsubstantiated worry nagged at my mind. Why would Lisa be coughing and having significant shortness of breath with the slightest physical exertion but not feel at all ill? But Lisa was young and in good health, and she had certainly been under enormous pressure recently. There was no reason to suspect the worst. Besides, I was not a physician and had no business considering potential diagnoses for her. I pushed the concern from my mind.
A few days later, though, Lisa was called to the phone. I watched from the corner of my eye. The call clearly caused her some concern. After a few minutes, she came to me, obviously upset.
“Doc, the nurse from my doctor’s office called. They got the results from the chest X-rays back. They want me to go to the office to discuss the results with the doctor. She said it was important that we set it up as soon as possible. They want me to go in this afternoon.”
“That sounds like no fun.”
“I gotta say, it’s got me a little spooked.” She chuckled wryly. “Anyway, I’m gonna have to be gone for a little while. Is that okay?”
The Gift of Pets: Stories Only a Vet Could Tell Page 20