Vet On a Mission

by Gillian Hick

  They say large-animal practice is dangerous, and in mixed-animal practice I have occasionally been scratched by cats and bitten by dogs, but nothing could compare to the pain of his talons digging deep into my flesh, connecting with the bone in my hand and digging deep into the soft tissue of my wrist on the other side. I was initially stunned, then thought I was going to pass out. It was late in the evening and I was on my own in the surgery, there was no one to help so I had to brace myself and try to prise the razor-sharp talons out of my flesh with one hand while at the same time trying to ensure that his other foot didn’t take hold of me. I don’t know how long the struggle went on, and at one stage I spotted the large dog nail clippers sitting on the office desk in front of me and was tempted just to cut the talons to free myself from them. But at the time I still hoped that he might some day fly free and if I cut his talons, he would lose his ability to hunt and to perch and do many of the things he needed to do. I have to admit I was tempted, but with a few more attempts, I did finally manage to free myself from his grip and, shaking, carefully place him back in his enclosure.

  That episode was a sharp reminder – and one that I needed – that, despite our relationship, Ciaran was, and needed to be, a wild bird. From then, I tried harder to put some distance between us. It was hard when I would go to feed him; I had always hand fed him up to now, as he would simply refuse to eat otherwise. From then on, I would simply place the food on the floor for him and although he was well able to eat, he would sit on his perch and sing forlornly to me as through begging me to feed him. It got to the stage that I would hear his plaintive cry at night in my dreams and see his beady eyes gazing into mine and I was beginning to wonder which of us had the attachment issues! It took almost three weeks, during which time he lost over ten percent of his body weight and I did occasionally give in and hand feed him and he would sing in delight and gaze into my eye as he eagerly took the meat from me, but then I would leave him to it again so by the end of the month he finally surrendered and would fly down and feed for himself.

  It had been over six months since his arrival and although I hated to admit it, it was increasingly clear that although Ciaran was happy and content and thriving, he was not going to be fit for release. Although the bone in his wing had healed, the scarring and adhesions in the muscle tissue meant that he did not have the full, free movement that he needed for perfect hunting flight. It did make me question whether I had done the right thing in putting him through surgery and months of captivity and all that went with it for what should be a free spirit.

  The options at that stage were euthanasia or permanent homing in a falconry. Although I questioned what I had done to him, deep down I felt that he was content, even in his confined circumstances, and so he was collected one morning by Marc to travel to his new home.

  The red kite reintroduction programme was an incredible success, to the extent that it’s hard to drive certain roads of Wicklow without catching a glimpse of one of the magnificent birds. To this day, when I hear the kites calling and circling in the sky, I always think of Ciaran, with mixed feeling of the privilege of having had such an intimate relationship with one of these birds that most people, if they are lucky, get to see in the sky and at the same time of sadness, that whether or not because of my intervention, Ciaran’s days of flying free were over.

  Chapter 18

  The Final Journey

  I remember sitting in the college canteen one day coming close to our final exams. Our thoughts and conversations were beginning to drift towards life after the five years in the veterinary college. We were discussing the difficulties we might encounter, and one of the girl’s biggest concerns was how to deal with the matter of euthanasia.

  For sure we knew what injection to give and could describe in some detail the physiological and pharmacological effects of the drug that would ultimately result in the animals’ demise but other than that, we had received absolutely no training in how to deal with the client. The longer I am in practice, the more I am convinced that final-year veterinary should include a module on counselling and bereavement with as much emphasis as for clinical and surgical skills. Despite the reassurance on that day in the canteen from one of the lads who boldly declared, ‘Sure you’re killing them anyway, it’s not like it can go wrong’, for me euthanasia is probably the most important job we do as vets. In all other cases, if the patient or the owner has a difficult or distressing experience, that day will pass and there will other chances to provide a more pleasant experience, but for the final visit, those last few precious minutes with a beloved pet will often be the most prominent memories for the owner for many years to come.

  Many seasoned vets will tell you that ‘you get used to it’, but I disagree. Veterinary surgeons are near the top of the list of professionals who suffer from alcoholism, drug abuse, divorce and suicide. This, for my money, is as a result of ‘getting used to it’ – not just the euthanasia, of course, but also the innate hardship of the job, the long hours, the late nights, the demanding clients, the sheer high expectations of an often ‘sole practitioner’ who is expected to keep up to the standards seen on TV shows where entire teams (and endless finances) support the veterinary hero of the day. When clients ask me if I’ve watched the latest episode of the current veterinary series, I usually tell them I do it all day so the last thing I want to do when I go home is watch more of it!

  Without a doubt, for me, euthanasia, although technically simple, is the most challenging aspect of the job. On some occasions, I’ve known the pet in question since it was a tiny hairball, though in a way, knowing the pet all its life helps when making the final decision with the owner. Although I always tell owners that they themselves will know when the time has come, still they often look for guidance or at least reassurance that they are doing the right thing. When I come into the story later on in the patient’s life, it’s harder to know the full story.

  Sometimes the answer is black and white – like in the case of an animal hit by a car and in so much pain and beyond any form of repair that although the suddenness of it all is heart-breaking for the owner, there really is no alternative. In other cases it’s not so clear cut. Many cats in older age develop kidney failure and many dogs develop lameness or paralysis and these cases can linger uncertainly for months or years.

  Often the owner says to me that they hope to come down some morning and find that their beloved pet has passed in their sleep but while I fully understand their sentiment, I have to advise them that it’s unlikely to happen. To actually die from these debilitating conditions would require letting the animal regress to such a state of misery that no conscientious owner could bear to watch it without making the phone call. I know, for clients, that picking up the phone to ring is often preceded by hours or even days of self-torture so that when the animal finally passes and is resting peacefully there is almost a sense of relief that it’s all over.

  As vets, we are simply not trained to support owners through all of this and have to rely on our own personal skills to develop an approach over years of experience that might best help the owner. Many vets who simply don’t have those skills, develop the reputation of being heartless or uncaring, even though these are often the vets who suffer the most.

  Whenever possible, I try to call to the owners’ home once the decision has been made. Allowing the animal to rest in their own bed or beside their own fireplace while the owners sit with them as they gradually drift to sleep, I know, makes it easier for both the pet and the owner. Sometimes, an owner arrives into a busy clinic having made the decision, without telling the nurses and not realising that carrying out a euthanasia in the middle of a clinic is stressful for all involved. Watching a grieving owner carrying out a body to face the lonely drive home is never easy, especially in a waiting room full of exuberant puppies and healthy animals.

  One such event springs to mind, from not long after we moved to the new premises. The clinic looked nice and straightforward for the evening.
On the appointments screen, I could see a few boosters and routine revisits, plus a new client who had booked in Tabby the cat for a general check-up.

  There were still a few more in the waiting room by the time I admitted Tabby. As the elderly lady carried the cat box into the room, I could get the undeniable stench of end-stage kidney failure. Ida told me that her home-help lady who was a client of ours, had recommended that she come as perhaps the cat’s teeth needed attention. I could see by how apprehensive my new client was that she already knew there was more going on. She looked so frail that I immediately offered to get her a chair to sit on while I examined the cat. Although she tried to insist she could manage, I went out to the waiting-room to evict Striper, the practice cat, from her throne and tried to brush the wad of hairs off it, which thankfully matched the chair cover, as I carried it into the consulting room. Ida seemed relieved as she sank into the old chair and didn’t speak as I lifted Tabby, unprotestingly, out of the equally ancient cat carrier.

  ‘I found her out in the back garden when she was only a tiny kitten,’ Ida told me filling me in on years of history as I examined the emaciated body. ‘I don’t know what ever happened her mother and I never saw any others, but I took her in and kept her in a cardboard box beside the stove. I had to get a little dropper from the chemist to feed her with, but she was never sick a day in her life. This is the first time I’ve ever had to bring her to the vet’s.’

  Without a doubt, it was also going to be her last visit, as I could feel the hardened lumps of kidney clearly jutting out from her bony frame. She objected slightly as I opened her mouth and I almost gagged at the putrid smell. The usual combination of kidney failure and gum disease that go hand-in-hand in so many elderly cats was well beyond any intervention that I could offer.

  ‘When did she eat or drink for you last, Ida?’ I asked gently, not wanting to upset the elderly lady who I could picture sitting day after day, offering all sorts of treats to tempt her elderly companion rather than making the visit today which she could clearly see was going to be the end of her sole source of companionship.

  ‘Well, it has been a while,’ she admitted. ‘I tried a bit of chicken boiled in water, and I got a bit of fresh mince from the butcher, and for a few days she would take a bit of milk if I heated it up, but she has taken nothing for the last few days…’ she trailed off silently.

  Conscious of the waiting queue outside, but knowing that I couldn’t let the little cat go home in such I state, I gently explained her condition to Ida. Her face remained totally expressionless as I explained that Tabby’s kidneys had failed and that the only kind option was to let her go to sleep right away.

  ‘I see,’ was her only reply. She said no more, and I wasn’t sure if she really grasped what I was saying. I continued by explaining that I would give her a tiny injection to sedate her and then when she was fast asleep and unaware of anything, how I would inject and overdose of anaesthetic into her vein.

  ‘I see,’ came the reply again.

  ‘Are you okay for me to go ahead with that then, Ida?’ I asked gently and she just nodded her consent with her face expressionless.

  I offered to place the little cat on her lap as she fell asleep, but she sat without stroking it or talking to it as most owners would do. She clutched the edges of the blanket and remained motionless as I injected the tiny body. Tabby breathed her last and still Ida didn’t speak. I took her hand as I removed the lifeless body from her lap and Ida’s hands were icy cold.

  Wrapping Tabby up carefully in the blanket, I carefully guided Ida out the back door, not wanting to bring her through the busy waiting room. Ida stood looking numbly as I arranged the parcel on her front seat.

  ‘Are you sure you are okay to drive home?’ I asked her, thinking to myself that she looked too frail to be driving at the best of times, never mind now.

  She nodded and then fumbled to open the driver door. As I handed her her handbag, I took her icy hand once more and then hugged her for a few moments, sensing her total loss and wishing that in some way I could help. She seemed surprised, but held onto me for a few moments before she let go and stiffly got into the car.

  With Striper restored to her throne, the rest of the evening was uneventful, with the remaining boosters and a stomach upset. I hoped Ida had made it home safely but didn’t feel I could ring to check as apart from the time in the clinic I had never met her before.

  It was about a week later that a card arrived in the post. The carefully stepped in address and the spidery handwriting instantly identified it as being from an elderly person.

  It took a few minutes to decipher the shaky hand as Ida wrote to thank me for helping her to make the decision to let Tabby go to sleep. She apologised if she had let her go too far, but explained that she was her only companion. I was stunned as I read the closing lines.

  ‘Thank you for the kindness of your hug as I left. It is the only time I remember being hugged in my life and I will always treasure it,’ she ended.

  Thankfully, not all euthanasias are so poignant.

  It was only a few months after that another elderly client arrived in, but this one with his wife and two adult sons. I had known their two collies since first opening the practice, so although I had missed their early years, I felt I knew them well enough to be part of the decision when the time came. The two dogs, Sally and Sheba, had enjoyed a great life, ranging freely over the owners’ vast estate by day and slumbering in front of a stove in the kitchen by night. Strangely, they had never so much as looked at sheep and so had enjoyed great freedom over the years.

  Slowly, with the passing of time, age had caught up with the two buddies so instead of galloping around the field, they were more likely to go for an occasional potter before returning to the comforts of the kitchen.

  The start of the end came one evening when Mr Lambert, as he always referred to himself, rang to say Sheba had collapsed and was unable to get up.

  ‘I suppose that’s the end of the road for her so,’ he stated matter-of-factly.

  But it wasn’t. Although Sheba was the younger of the two by at least three years, it seemed she had suffered a minor stroke, but responded well to a few days’ hospitalisation and returned home to Sally on long-term, but low-dose, medication. Her check-ups became more frequent, with the minor issues that can be expected with advancing years, but still she enjoyed her life roasting herself in front the fire and shuffling around the front garden with her buddy for a long time after. But the day came when despite increasing her medication, Sheba was no longer able to get up. I always tell clients that if a dog is sleeping comfortably, eating and drinking and able to get up and shuffle out to the toilet then, in dog terms, they are still enjoying life. Sheba was no longer able to get up and refused food for the first time since her hospitalisation.

  As I drove up the long, stony driveway, I wasn’t expecting any high emotion or drama as the Lamberts, although taking excellent care of their dogs, were usually quite matter-of-fact about life in general. Sheba looked tired, stretched at the stove and I was glad to be able to help her as I injected the sedation which would allow me to give the intravenous anaesthetic without any distress to her. Sally sat nearby, but was not overly interested in the entire proceeding. Although there was no great show of emotion, I sensed a bit of friction between Mr Lambert and his wife, Emily, and the two adult sons but I didn’t comment

  ‘Poor old Sally,’ I said as I injected Sheba. ‘She’ll miss her buddy.’

  ‘Well, we have decided,’ spoke out Mr Lambert, ‘to get the two dogs put to sleep together. Kindest thing to do,’ he affirmed.

  I must have looked as stunned as I felt as Mr Lambert immediately interjected, ‘It’s been discussed and decided,’ and immediately I understood the tension that had been simmering since my arrival. Clearly Emily and the sons didn’t agree, but Mr Lambert was always in charge of everything in his kingdom. In hindsight, I recalled that all decision had to be ‘run by Dad’, in the same way that a
ll the cheques were signed by himself only.

  Thankfully, however, I was not in a position where I had to succumb to Mr Lambert’s wishes and I knew before I spoke that it was going to be a case of four against one not even counting Sally whose fate was being decided in front of her.

  ‘I’m sorry, Mr Lambert. I really don’t think that’s a good idea. Sally is still in good health, even though she is older than Sheba. Of course she will miss her, but I know from experience that in time, with plenty of attention and maybe looking at getting another dog she will go on to live out her natural life span.’

  There was total silence as Mr Lambert took in what I was saying and I noticed tears welling up in Emily’s eyes. The sons shuffled awkwardly against the kitchen countertop, clearly avoiding Mr Lambert’s eyes.

  I could see that he was not pleased with my interference, but before he had a chance to speak, I continued.

  ‘As a vet, I can only ever justify euthanasia if the animal is suffering and that’s certainly not the case with Sally.’ As far as I was concerned the discussion was over.

  Sally, on hearing her name, thumped her tail on the tiled floor as though agreeing.

  ‘Bloody ridiculous if you ask me,’ he muttered and there was tension for a few minutes as nobody spoke. By then however, Sheba was feeling the effects of the sedation so I carried on with the job and all the attention was back on Sheba as I clipped her vein and she took a few slow breaths as I injected the blue liquid into her vein.

  Sally ignored the entire proceedings, but as I checked Sheba’s heart for the last time, I turned to Emily and said, ‘If I was you I would leave Sheba here with Sally for a few hours before you bury her. Dogs can understand, in a way that we don’t, what is going on.’