Monsieur le Vet

by Sylvain Balteau

  That night I have a nagging feeling that something’s not right.

  *

  It’s a week later by the time I put my finger on it. I’m checking Gitane in for her operation, and by the time I put the little dog in her cage, Monsieur and Madame Hermann have already left. The odour of vanilla is oppressive. I wonder … I wonder whether they aren’t actually hoping that Gitane will die under the anaesthetic. Consciously or otherwise. Like that, they wouldn’t have had to take the responsibility of putting her down, and they would have done everything they could for her, for this companion who has shared nineteen years of their lives, for this little ball of fluff that used to be so lovely. Such a darling!

  There’s a leaden feeling in the pit of my stomach. What if I were to give her just a little too much anaesthetic? Just a fraction?

  She wouldn’t suffer.

  They would be relieved, their consciences would be clear.

  And nobody would know.

  I toy with the idea for a few minutes. The odour of vanilla is all-pervasive.

  I don’t tell a soul.

  *

  Three hours later, very slowly, Gitane comes round from the anaesthetic. She’s on morphine and completely disorientated. In a little basin are ten rotten teeth. Everything has gone like clockwork.

  In the afternoon, Monsieur and Madame Hermann come to see her.

  As they leave, I shake their hands. We’ll keep Gitane for today to control the pain. She can go home tomorrow.

  A few minutes earlier, as they were on their way to the kennels with one of the other vets, I’d heard the uneasy note in my colleague’s voice:

  ‘But she’s still lovely! She’s dribbling a bit just for the moment, and there’s some blood, and she’s dazed by the morphine, but tomorrow you’ll have your little Gitane back!’

  I could just imagine Madame Hermann murmuring, ‘But she used to be so lovely!’

  As the door closes behind the two of them, I turn to look at my colleague, standing hands on hips at the end of the passage. She looks rattled. Fragile. Lovely.

  ‘When I told them everything had gone well they seemed … disappointed.’

  I shut my eyes. Just for a moment.

  Medical vocabulary

  A small cowshed, an elderly couple, their daughter and their granddaughter. Six years old, confident and inquisitive.

  I start on a caesarean, a once-in-a-decade operation on this farm. On a cow that they’ve just bought, a pseudo-Parthenaise heifer that – to judge by the size of the calf ’s cannon bones – must have been crossed with a Charolais.

  I didn’t even try to pull, but just got ready to operate, nice and relaxed. There was no great urgency, mega baby was nice and cosy where he was. I’d only have the old boy to help me pull, but still, that shouldn’t be too much of a problem. He spends his days mucking out the cowshed and shifting bales of hay: he might be elderly, but he’s undoubtedly stronger than I am.

  The heifer’s a little bit skittish, but not too bad. A few ropes, a local anaesthetic, and it’ll all be done and dusted. I shave the animal’s flank. A single cut.

  Everything’s ready now.

  A long vertical incision, the hide and then the muscles parting under my blade. An arteriole sprays me scarlet; in the cowshed silence reigns. As I puncture the final membrane, the peritoneum, air rushes into the abdomen with the sound of a toilet flushing.

  ‘Mummy, does it hurt?’

  ‘No, look, she’s not even moving, she’s not crying.’

  I investigate the abdomen, get my bearings. The calf is huge. It reminds me of my early years in practice, when I used to do C-sections in the Charolais region. Uterine incision. I grasp the back hooves and turn the uterus, lining up the uterine incision with the abdominal incision. The two hooves, red with blood, are now pointing in the direction of the outside world. The old boy attaches the ropes and starts to pull. I help him by lifting the hocks, but the hindquarters refuse to pass. Our efforts become increasingly frenzied. I grab my scalpel, enlarge the abdominal opening. Still no good. One more go with the scalpel, this time it’s bound to come. I can see the tendons standing taut in the farmer’s neck, I’m pulling with all my might, sweating, the effort is so violent, so extreme that I’m almost tempted to give up and drop everything, and bloody hell the damn calf just won’t come out, it’s just sitting there, with the umbilical cord stretched tight, half in half out, its head stuck in the amniotic fluid, it’ll be curtains if we don’t get it out really soon, if it breathes in it’ll drown, it will breathe in, it’ll have to, the cord’s compressed, its ribcage is still inside, the old boy can’t take any more. PUTAIN DE BORDEL DE MERDE DE BITE A CHIER DE MERDE DE PUTE DE VEAU!!

  It’s out.

  I’m pretty sure I let out a yell.

  I’ve torn my biceps.

  It’s alive, it’s breathing, I fall back on my heels and exhale deeply, whistling under my breath. The bucket of antiseptic is sitting in front of me: I duck my head into it, then gulp down half a litre of water.

  Shreds of uterus and placenta are hanging from the cow’s flank.

  It’s all OK.

  ‘Mummy?’

  ‘Yes darling?’

  ‘What did the vet say?’

  ‘Medical words. Words that you only ever say during caesareans.’

  Mémé

  The rain was lashing down, a vertical downpour like the pillars of a frozen mausoleum. A drenching, freezing deluge, blotting out the sombre winter sky and extinguishing all hope.

  I was there on my own, quite alone. Why did I have to be on my own?

  Standing there in the field, fists clenched, I called her, I ran and skidded about looking for her, but I already knew. She’d fallen down again. I cried, screamed and raged, opened the boot, grabbed the syringe and the bottle, put them back again. I’d spotted her, lying there, hobbled, tangled up in the straps of her blanket until I undid them. I paused a moment – I shouldn’t have – to pull on my boots. Then I knelt down. Her laboured breaths would have formed little clouds, but for the freezing, stabbing rain. She lay there, drenched.

  How many times before had we got her back up on her feet? How many times had we been convinced it was for the last time? How many times had we known that we were kidding ourselves? That we were wallowing in the pleasure of lying to ourselves, of living in denial? This time, I wept. Great stifled sobs. I went back to the car to get the bottle, then turned round again. Went back one more time. I wanted to put it off. I knew that this time there was no more room for hope. Just cold certainty. I was soaked through. In a fury. In love.

  So I went back again, and I knelt down beside her. I took her adorable great scrawny head of a useless bony old mare, the head that always used to wobble above her skinny neck and twisted legs, and I held it. Caked with grime, soaked through with rain, smeared with freezing, clinging mud, I took her great knackered head on my lap, stroking her, holding her, calling her name. She shut those great big eyes of an old mare, accepting the fussing and stroking that she’d always disdained in her old age. She was trembling. She’d fought and struggled, and I’d only just found her. Because I just happened to drop by to see her on my way to work.

  I think I talked to her the whole time. With her head on my knees I filled the syringe, furious, desperate, overwhelmed by love and by hate. I was there for her, I tucked her in, I held her. She closed her eyes, sighing, letting me. Keeping her bony head in my lap, I leaned over her, applying pressure with my left hand, injecting her with my right.

  ‘It’ll be OK, Mémé, it’ll be OK, old girl.’

  Of course it’ll be OK.

  She gave a shudder, a tremor, then she died, there in my lap, my old bat of an old mare, my most beloved pain in the neck. She died in my lap, and I killed her.

  I’ve never regretted it.

  It was years ago now, and I still miss her. I’m so glad.

  The awkward bugger of a case

  Sometimes you can spot an awkward bugger of a case a mile o
ff, when a client says an animal is ‘not quite right’ or ‘a bit off colour’. But often it can strike without warning. It may erupt as an emergency, it may emerge when least expected during a routine consultation, or it may even blow up out of a simple vaccination.

  The awkward bugger of a case is a familiar companion, known affectionately to me as an ABC. But to my colleagues they’re known as OFSs: Ones For Sylvain. They lob them in my direction, every time: I may not be a particular fan of surgery, but I do like a tricky diagnosis.

  An awkward bugger of a case is a complex thing: a wide-ranging diagnosis with many possible trails to follow up and investigate. A good ABC will feature lengthy waits for test results, or expensive examinations, or preferably both. In a really good ABC the initial test results will be ambiguous, necessitating further investigation. Or better still, the results will clearly favour one hypothesis that you duly rush to embrace, only to be forced to abandon it again when further tests reveal possible alternative interpretations of the initial one.

  When you try to explain an ABC to a dog’s owner, simply and in layman’s terms, in no time at all you find yourself tied up in a web of comparisons and metaphors that are so convoluted that you get everyone hopelessly confused, yourself included.

  By definition, an ABC appears serious, but sometimes it’s just an illness that’s unpleasant and difficult to manage. Dermatology is the preferred field for this type of ABC. And as complex as these cases may be, in the end they can wear you down and chip away at your motivation. Because you just can’t pin it down, somehow.

  You can deconstruct an ABC visually on a large white-board. You can add loads of arrows and hypotheses, you can cross some out and you can add others on. It always terrifies my colleagues when I do this.

  An ABC stands a good chance of being expensive, and if it requires multiple examinations or a stay as an in-patient it will inevitably end in a hefty bill. We might take an animal in to give us time to work out what the problem is, or to safeguard its wellbeing, by putting it on a drip for instance, in the interim. It’s even worse if the animal ends up having surgery, especially if it’s an exploratory laparotomy, when you open up the abdomen just to see what’s going on inside. Occasionally an ABC will cost a small fortune, be very lengthy, and produce an end diagnosis of something benign. Good news for the dog, not so good for the owner.

  When a case escalates from being simple and straightforward to being an ABC, you have to explain this to the animal’s owner, and this is where things can start to go pear-shaped. People are perfectly ready to accept that their pet may have a complex illness, but not that you can’t work out what the illness is, especially when you’ve had the animal in overnight and done blood tests and X-rays.

  Explaining to a client how we try to distinguish a particular disease from others with similar symptoms can be a nightmare. It’s a long and tedious business, and for people who aren’t used to diagnostic logic it can seem counter-intuitive. But you have to do it, even if some clients don’t care: ‘Just treat him, I don’t want to know.’ Often they get stuck on one point and can’t get any further. In the end they accept the way we prioritise certain tests and deductions, but they have a problem with the various choices associated with purely medical logic, with the feasibility of tests, and with the cost of the tests; and we do too sometimes, because people are seldom clear about what they want for their pet (apart from the fact that they ‘don’t want him to suffer’).

  And then there’s the confusion between correlation and its false friend, causality. Just because event A appears to be associated with event B, we shouldn’t assume that event A is the cause of event B. Or even that there’s any link between them at all.

  I once had a spectacular ABC of this kind. A large puppy was brought in on a regular basis by its owners for a string of minor problems. We found a plausible explanation and obtained a satisfactory recovery every time. But the accumulation of mishaps was odd: there were just too many of them.

  Then one day the other dog in the household came in from the garden with a bottle that had held a toxic product in its jaws; it showed all the right symptoms, we treated it, and it got better.

  For the owners the matter was now cleared up beyond all possible doubt: the puppy had played in that part of the garden on several occasions, and each time it had been poisoned. But for us there was something that didn’t fit. For them it was the same thing. And superficially it was. But for us it was impossible, out of the question. Eventually we put our finger on the diagnosis: the puppy had a malformation of the blood vessels in the liver, a rare but classic condition in an unusual and benign presentation. I’m still not sure the owners were convinced.

  *

  The client in an ABC may be very difficult, thoroughly disagreeable or a complete pain. Or they may be perfectly charming, never let it be said otherwise. In which case the ABC will be far less stressful. Occasionally it is the animal itself that seriously complicates an ABC: spending hours treating a dog that’s doing its best to bite you, a feral cat, or an animal that’s constantly oozing repulsive and purulent bodily fluids is the very definition of a true vocation.

  For an ABC to plumb the depths, the client should ideally make assiduous attempts to help by doing online searches, contacting another vet, or even taking the animal for a second opinion, preferably armed with only some of the test results and none of the details of the diagnostic approach currently being followed.

  There’s one variation on this last point that reduces me to abject despair. This is when clients start to talk about homeopathy, Bach flower remedies or other forms of ‘alternative medicine’. ‘Those goddamn bastards have introduced midi-chlorians into the pure sanctity of the Force’, or some such claptrap. Just don’t bring this nonsense into my work. Or failing that, feel free to carry on without me.

  Best of all, though, is when a doctor for humans condescends to meddle in an ABC, tossing a diagnosis or a trenchant comment in my direction, and incidentally putting the animal’s life at risk. I dedicate this thought particularly to those endocrinologists and trainee endocrinologists who confuse diabetes in dogs with diabetes in humans.

  Sometimes ABCs are known to congregate in gangs. As far as I’m concerned, one ABC in any given week is quite enough. Two or three at a time is sheer hell. That’s when I start to lie awake at night.

  The ABC is the quintessence of cases that are complex, severe, nuanced, hard to explain, expensive and offer a poor prognosis.

  When an ABC works out, I’m a hero. In my own eyes, at least. Sometimes – often, even – the owner remains blissfully unaware. It’s no big deal.

  When the animal in an ABC dies, I’m sometimes a hero and sometimes an incompetent – and moreover an incompetent who has the brass neck to present the owner with a large bill, to cap it all. Meanwhile I’m in bits, usually.

  In the end, an ABC is not that different from an interesting case, just with an extra dose of empathy and emotional investment.

  Have you seen my pills?

  When I was a vet student, I had an image of organic farmers as youngish, dreadlocked, and with suspicious-looking crops in the woods behind their house. At the same time I viewed them as quite scientific in their approach, choosing organic production methods not only as a reaction against a system that bugged them, but also as a way of fostering certain qualities in their products, not so much in the domain of health and hygiene but more in the area of taste and flavour. I saw them as concerned for the wellbeing of their animals, and stubbornly resistant to any external intervention in their herds.

  It’s a caricature that doesn’t really fit any of the organic farmers whose animals I now treat. Some of them are in their sixties, and none of them sport dreadlocks. In at least a couple of cases I have my suspicions about the crops they grow, but they’re not the only ones after all. Some of them are fairly ‘scientific’, but no more than that. Others are emphatically not, watching their cows grow like dandelions in a field. And not always with poor r
esults, either. Some of them like to ask for lots of advice, often call me, enjoy having a talk, ask me to help with coproscopies before considering worming – that sort of thing. It doesn’t give me a lot of work, but then livestock rearing isn’t about providing me with a livelihood. ‘My’ organic farmers may be concerned with the wellbeing of their animals, or not particularly. They may take enormous pride in offering products of the highest quality, or they may care so little that it’s depressing.

  I also imagined that all organic farmers would be on the left politically, or would vote Green. I never expected to find myself working with an organic farmer who was right-wing. Really, really right-wing. An extremist even. A dyed-in-the-wool supporter of Jean-Marie Le Pen. Maybe of his daughter Marine Le Pen, I don’t know. Highly mechanised, highly technical, highly organic, far beyond the required standards currently in force. With a large and splendid herd, moreover, and intelligently farmed land, as far as I can tell. I hardly ever make visits to his farm, as he thinks he knows how to do everything, or at least that I don’t know any better than he does. Normally we see each other once a year, for the national prophylactic programme that involves taking a blood sample from every cow and testing it for a range of diseases. I always try to go myself, as I know we’ll argue for four or five hours every time.

  Well, perhaps not argue exactly, but certainly we’ll have a lively discussion. We’re never stuck for a topic for debate. Not politics: we did that the first year and kicked it into touch. We avoid the subject now. We focus more on my area, on the medical and hygienic aspects of livestock breeding. It’s another field in which he has very definite views. He has his big homeopathy bible, a penchant for Bach flower remedies, and a tendency to believe that if something works once it will work again, every time, and if it doesn’t work it’s because of something. Or someone.