My Patients and Other Animals

by Suzy Fincham-Gray

  “Mine?” I said, half-raising my hand. I was about to be grilled on Hercules’s blood gas values, PCV and total solids, and every other parameter that had instantly evaporated from my memory. At that moment one of the receptionists appeared to inform me that Hercules’s owner, a Mr. Brown, had arrived.

  “Should I go and talk to him?” I asked the crowd, directing my question toward Matt, the one face I recognized. His posture had changed now that his superiors surrounded him. He’d become intent and serious.

  “Someone needs to, don’t they?” replied the older surgeon. “And it’s not going to be me, so you need to go get permission for us to take this dog to surgery. Now.”

  I hesitated. I knew the owner didn’t really have a choice; the options were surgery or euthanasia. Hercules wouldn’t make it on his own. I was reluctant to leave my patient, but my job was to get him to surgery and then remain in the emergency room to treat whatever came through the door next. Hercules’s life was no longer in my hands. Ignoring the senior surgeon’s urgency, I moved to Hercules’s head, afraid he might not be there when I got back. I was compelled to run my hand down the fantastic softness of his ear. I lingered at his side for a second before rushing off to find his owner. On my way I glanced at the box on the wall where the new patients’ charts waited. There were already three metal files sitting expectantly in the bin. I had another ten hours of emergencies to go.

  I stepped uncertainly into the small, suddenly too-warm consulting room and positioned myself behind the flat expanse of the exam table. Hercules’s owner sat uncomfortably in a plastic chair pushed against the opposite wall. He was wearing the clothes and bewilderment of someone whose plans had suddenly and irrevocably been changed. His dingy undershirt and loose, crumpled pants suggested a day of lazing around the house in the sluggish air of a box fan ill-matched to the humid Philadelphia summer. He was an older man; gray-white stubble dirtied his face, and a wrinkled, confused frown grazed his forehead. I stood straight and attempted a reassuring smile.

  I placed my hands on the table in front of me. The cool steel surface was comforting until I saw the two sweaty handprints that betrayed me when I anxiously shoved my hands back in my pockets.

  “Are you the doctor?” he asked.

  I forced my smile. “Yes, I’m Dr. Suzy Fincham. I’m taking care of Hercules.”

  “Jeez, they make ’em young these days. Shouldn’t you be in school? Where is he, anyway? He’s not dead, is he? He’s all I’ve got.”

  “Mr. Brown.” I swallowed to keep the rising tremor from my voice. “Mr. Brown, Hercules is alive, but he’s a very sick dog. He’s been shot in the chest, and the bullet appears to be lodged in his lung.”

  “Goddamn it, he was just outside for a minute. I can’t understand it. I was in the kitchen, getting his breakfast, when I heard all this goddamn shouting, and then gunshots, and then banging on the front door. He didn’t even eat his breakfast. Has he had any? He must be starving, poor guy.”

  “Hercules is too sick to eat at the moment. He needs surgery as soon as possible to remove the bullet.”

  “Too sick to eat? That dog’s never missed a meal in his life. He loves his food. Don’t always have enough for me, but I always make sure that dog gets fed. He’s the best damned thing that ever happened to me.”

  I wasn’t listening. I was impatient to get out of the exam room and back to Hercules. I didn’t have time for dog stories.

  “Mr. Brown, we need to get Hercules to surgery. His condition is critical. I need your consent to treat him immediately.”

  “Surgery? I don’t think Herc would like that. He’s never slept a night outside his own bed. Do you think we could try something else?”

  “Mr. Brown!” The old man’s face gave way, a crumpling of the hope I’d seen a moment before. He gave a swift, decisive blink, and I understood the impact of my terseness.

  “Mr. Brown,” I said. “Our only option is surgery. If we don’t get him there soon he’s not going to make it.”

  Only minutes earlier Mr. Brown had probably been asking for directions from the bus stop to the Veterinary Hospital of the University of Pennsylvania, with no idea if Hercules was alive or dead, I realized. I’d already spent many hundreds of dollars on Hercules’s care, without his owner’s consent, and I was asking for permission to spend thousands more. But I wanted to save this dog, and I didn’t want to let down the impatient surgeons waiting in the treatment room.

  In my naïve certainty that I was doing the right thing, it didn’t register that taking a bus to the hospital probably meant that Mr. Brown couldn’t afford a car. That getting shot tended to happen in poorer neighborhoods. That this could be Hercules’s first visit to the vet. That the cost of saving his dog’s life could be more than Mr. Brown would, or could, spend on his own medical care.

  I didn’t tell him how much surgery and aftercare would cost. Or that his dog might die and he would be left with a several-thousand-dollar bill even if this happened.

  “Do everything you can to save him,” he said. He didn’t pause. He didn’t ask me the price of saving his dog’s life. He didn’t ask me the questions I’d failed to answer. I hurried from the consulting room, excited to share my success with the surgeons.

  * * *

  —

  Hercules’s surgery was difficult—a third of his lung was removed to control the bleeding. The small bullet hole was eclipsed by the radical median sternotomy needed to extract it—Hercules’s chest was split down the middle, along his breastbone, to gain access to the injured lung. The surgery was a massive undertaking, involving a bone saw, vicious metal retractors, and surgical wire to close his chest when it was all over. I visited him in the unfamiliar ICU at the end of my shift and tried to understand the pages of treatment sheets detailing his care. I interpreted his blood gas results to see how his lungs were doing, but what I really wanted was to feel the comfort of his head in my lap.

  In the first few days post-surgery, the doors of Hercules’s cage stood open. This meant two things: first, he was too sick to move; and, second, there were so many fluid lines and monitoring devices attached to him that the tangle of wires and tubes made closing the doors impractical. An arterial line to monitor blood pressure snaked from his back paw. A falsely cheerful wrap in Day-Glo green around his neck hid the central line in his jugular vein, which had two different fluids hooked up to the ports. ECG pads attached to a monitor via red, black, and white wires were taped to his paws, where small rectangles of fur had been clipped to improve contact. But those were insignificant patches when compared to the huge swaths of bare skin underneath his surgical dressings.

  This bewildering array ensured I kept my distance. The fierce, random alarms of the ECG machine or blood pressure monitor made me blush with guilt. I was sure that my presence, alone, had caused the noise. I was too shy to pet Hercules, afraid that I would disconnect or dislodge something essential and cause his immediate demise.

  During my emergency shift I would ask Elisa tentative questions about Hercules. Her insider knowledge and friends in the ICU meant she always had the up-to-date information, but I didn’t want to appear too interested. I tried to maintain a professional distance.

  When I visited Hercules after my last shift of the week, the door of his ICU run was closed. His ECG leads and arterial line had been removed, and only one fluid line was connected to the venous catheter in his neck. These were all good signs—Hercules would be going home. It was likely that if he made it out of the hospital he would do well. I’d read that after a lung lobe is removed the others expand to fill the space, resulting in no long-term effects. It was improbable that the body could be so forgiving of a bullet, but watching Hercules resting comfortably in his ICU run, I could believe what the textbook said.

  By my Monday shift, Hercules had been discharged. It was the first thing Elisa told me when I arrived that morning. Desp
ite my joy that he’d made it home, a tang of sadness lingered. I wanted to know more, to have been more involved. Had his owner taken him home on the bus? Had he found a friend to give him a ride? Had Hercules licked the ICU technicians goodbye? Had Matt been the one to discharge him? I felt insignificant and excluded even though I knew that I’d fulfilled my role.

  * * *

  —

  I finished my ER rotation and continued on to other departments, and when I bumped into Matt around the hospital, I would ask about Hercules. Hercules and his owner had eventually returned to have the sutures removed, a week late, Matt told me. But they didn’t come back after that for follow-up visits. And the over-five-thousand-dollar bill remained unpaid.

  Seeing the bullet hole in my neighbor’s front door every day reminded me of Hercules. I wondered what he was doing; I hadn’t known him when he was well. I didn’t know the details of his life, the foods he liked, his favorite toy. I had interacted with him for a moment, yet I felt intimately connected to him.

  I hadn’t anticipated the emotional attachment to my patients I was experiencing, and I didn’t know how to manage this aspect of being a veterinarian. There weren’t any textbook chapters to explain it. It was something I was going to have to navigate on my own, along with the myriad other unexpected situations vet school hadn’t prepared me for.

  I’d never considered how much saving a life cost. Or how much saving a life was worth. When I was a student I’d been sheltered from the financial transactions that accompanied healthcare. In Britain, I was used to a National Health Service for human patients, and at the Royal Veterinary College most of the pet owners had purchased insurance to cover medical costs. I hadn’t been aware of the economic implications of pursuing the best course of treatment. I hadn’t had to think of what would happen if treatment couldn’t be afforded. Now these were questions I encountered daily.

  I had landed in the United States with little more than fierce determination. In the front pocket of my carry-on sat a small notebook containing what I considered to be essential veterinary information—drug dosages, differential diagnosis lists, normal blood values—which I quickly realized was useless at VHUP. I was confronted by the reality that my professional life, rather than being the scientific oasis I’d imagined, was more influenced by humanity than by medicine. The animals I had so passionately wanted to work with were only a fraction of what I was learning about. Insight into the uniquely human love for animals I’d only ever known as patients would be the most difficult, but vital, understanding I had to gain.

  CHAPTER THREE

  Monty

  The handle of the cat carrier dug into my palm as we hurried along Baltimore Avenue with a lurching momentum. Monty let out an unsettling, throaty meow, and I stopped to raise the carrier and peer through the wire door at my new companion.

  Monty’s black, skinny body was pressed to the floor of the cage. He raised his head and stared at me with panicked ocher eyes.

  “It’s okay—we’re almost there,” I murmured and quickened my step, hustling the last few blocks. It unnerved me to be causing him such distress. I didn’t have a differential list to run through, no diagnostic or treatment plan to implement. It was just my first real pet and me, making our maiden trip home.

  Back at the apartment, I placed the carrier on the scuffed floor of my bedroom. The feeling of solid ground beneath Monty’s feet silenced him long enough for me to realize that I, too, had been anxiously panting the whole walk home. Taking a deep breath, I made sure that the windows were closed and the bedroom door latched; I wasn’t ready for Monty to meet Max and Tye, our canine roommates. Safety checks complete, I unlocked the door of the carrier. Monty was standing at the front of the cage.

  “Come on, then,” I said, resisting the urge to bundle him into my arms.

  A paw tentatively dabbed the floor and retracted quickly, as if testing its temperature. I waited. The same half-moon of toes padded silently onto the worn wood, followed by a leg, shoulder, and head. Carefully, the rest of his sleek body emerged. His tail flicked upward and he crouched, alert and considering his next move. The sound of German shepherd feet rushing down the corridor sent Monty scampering under the bed, leaving a trail of small moist paw prints on the floorboards.

  Only a week earlier, around Halloween of my intern year, I’d received a group email sent by two veterinary students searching for a home for an older black cat they’d found wandering the streets of West Philadelphia. I’d offered to foster him for the weekend, but the name I’d chosen and the litter box, food bowl, and cat bed I’d purchased before bringing him home revealed my intentions for a more permanent relationship.

  I didn’t examine the implications of my decision too closely. I was several thousand miles from the place I still called home, and, for Monty, returning to England would mean a five-hour trip in the cargo hold of a plane, plus a mandatory six-month quarantine once we landed. But I had no set plans to stay in the United States beyond the year of my internship. My visa would expire in June 2001, and, only four months into my time in Philadelphia, the tang of homesickness made it difficult to imagine a future anywhere other than back across the Atlantic Ocean.

  Even before I’d met Monty, I’d made space for him in my tiny bedroom and in my heart. His need for a home wasn’t the only reason I responded to that email; I needed someone, or something, that would anchor me in the States; a reason to stick it out despite my loneliness. There was no shortage of social engagements to keep the hours outside the hospital filled. We had a standing Thursday night happy hour at a local sports bar. There were barbecues and parties and plastic pitchers of Yuengling or Rolling Rock after work—a uniquely American way to drink beer. But going home to my small room in the apartment I shared in name only with my intern mates kept my solitude close.

  The excitement of a new country, new housemates, and new patients with new problems curdled into homesickness with the passing months of my internship. Even though I’d mastered which way to look when I crossed the street, I still hadn’t found bread that tasted remotely like the sandwiches I used to eat for lunch, or the toast I’d slathered with Marmite for breakfast. I’d had no idea that one day I’d yearn for the ordinary brown bread, without high fructose corn syrup, that I’d bought on my vet student budget.

  But my longing for England was in direct opposition to my furious commitment to completing my internship—and I was relying on nine pounds of black cat to tip the balance. In my mind, my determination only had to outstrip my antipathy toward wintergreen toothpaste and waxy Hershey’s chocolate, the unthinkably small, essential parts of life that constantly reminded me how far I was from home.

  In this sea of newness, my patients were furry islands of familiarity. American cats had the same heart rates as British ones, even though a ginger moggy was now an orange domestic short-hair. Upon abdominal palpation, their kidneys had the same firm smoothness under my nervous fingers. Their pulses had the same rapid regularity. And it was equally difficult to perform a full neurologic examination on a reluctant American or British cat.

  Sometimes, however, the similarities ended in the soft nap of their coats and the warm solidity of their bodies. Diseases were different in America, especially infections carried by insects and wildlife alien to Britain, or caused by fungal agents lurking in the new ground that I walked on. I came from an island where rabies and heartworm disease didn’t exist. Fungal organisms such as Blastomyces dermatitidis and Histoplasma capsulatum didn’t favor British soil, and I’d never seen a case of the tick-borne Rocky Mountain spotted fever. I had to learn to recognize, diagnose, and treat these new diseases on the job, and it felt like I’d learned French from a textbook and was dumped in the middle of Paris asking for directions. I struggled to find the place for these diseases: I couldn’t yet gauge their weight or texture, and I didn’t know where to rank them as possible causes of my patients’ illnesses.

&nb
sp; The intake questions I’d memorized in England had to be expanded to include the administration of heartworm preventive and my patients’ rabies vaccination status—first-year history-taking for the students I worked with. I vigilantly added rabies to my differential diagnosis list for any dog or cat presenting with neurologic signs such as changes in behavior, seizures, weakness, or paralysis.

  One of the first decisions I faced in my new role as an owner was whether to vaccinate Monty against rabies. Despite my fears that the vaccine would cause a sarcoma—a serious tumor—at the injection site, I decided to immunize him before bringing him home. It was only one of the many unexpected choices I would run into that could affect Monty’s health. I struggled with questions from whether a scented cat litter increased his risk of urinary tract problems to the best type of food for my senior, male, indoor cat. The language of animals I spoke was one of disease. I understood normal only in the ways it could be disrupted and altered by illness, and it was difficult to ignore my education when it came to my new pet. I saw every choice from the perspective of a veterinarian tasked with preserving life, when all I wanted was to be Monty’s devoted owner. How could I expect to treat my patients if I couldn’t make the right decisions for my own cat? Monty’s health became another test of my veterinary skills—one I was terrified to fail.

  On some level, vaccinating Monty against rabies felt superstitious, like crossing the street to avoid a black cat in my path. Rabies had always been a mythical disease to me, existing in faraway lands less fortunate than the British Isles, where it had been eradicated by 1922. It had been a hard-won battle, with tens of thousands of stray dogs slaughtered in the fight to control the disease. Such measures were not introduced for the well-being of the canine population. Rather, it was the risk to human health—the grotesque, inevitable death suffered by those bitten by a rabid dog—that demanded such aggressive control measures. Zoonoses—diseases transmitted from animals to humans—such as rabies are a side effect of living alongside animals. Whether from sharing our homes, consuming infected animal products, or encountering those carrying disease in the wild, human cases of anthrax, rabies, tuberculosis, and, in more recent times, West Nile virus and Ebola can all be traced to animal hosts.