“His prostate is bigger than I would like and seems painful,” I reported. “Maybe he has prostatitis.” Since the lab is already closed, I’ll take X-rays, make a blood smear and run a few other quick tests to see what’s going on.” I paused to clear my throat. “You can stay here for the results, or I’m happy to call you with them.”
“I have a conference call from 6 to 7. I’ll page you as soon as the call is over.” He hurried out the door to his car. When the doorbell rang, Allie came in to see what was going on.
“You won’t believe it, Allie, but I think he’s in septic shock,” I told her.
“Not another one.”
“His temp is 105.4, and his gums look as bad as I feel. Let’s get him in back and start treating him.”
Allie picked up Brady and headed for the treatment room. She set him on the table and pulled up a stool for me. I sat there with my arm around him, enjoying the heat of his body. Allie drew blood, collected a urine sample and set the catheter for his fluids with very little help from me. She carried him into the radiology suite for two quick films, then brought him back to me while she ran them through the processor.
“Will you two be OK if I go work on his labs?” she asked, holding blood tubes in one hand and waving two microscope slides in the other.
I nodded. “I’ll stay with Brady while he gets the fluid bolus.”
When Allie returned, she found me slumped over the treatment table with one arm over Brady.
“You two are quite the pair,” she noted.
I sat up, blinking my eyes, trying to get my bearings.
“You were right about Brady. I saw toxic PMNs and immature PMNs on the blood smear. The urine was clean, no signs of infection. BUN and creatinine are slightly elevated, and the blood glucose is low.”
“Add dextrose to his fluids, make it a five percent drip,” I instructed. “I’ll calculate his doses for the antibiotics.” I pulled a calculator out of my pocket. First I converted his weight from pounds to kilograms then multiplied that number by the antibiotic dose. To think I asked my eighth-grade teacher if I would ever use algebra again. I wish the teacher could have told me I’d use it constantly. It would have made the class much more interesting.
I wrote down the calculations on a scrap of paper.
“Allie, would you double-check me?” I asked.
She studied the numbers while injecting dextrose into Brady’s bad of fluids.
“Looks good. I’ll get the antibiotics as soon as I finish this.”
While Allie mixed up the antibiotics, I rechecked Brady’s temperature. It dropped to 104.8. His color remained muddy, a sickly combination of gray and burgundy. When I pressed on his gum, three full seconds ticked by before the normal color returned. I felt sick to my stomach. I wasn’t sure if was from the flu or a bad feeling about Brady.
“I’ll load up a pack of supplies for you before I go,” Allie said when she returned to the room. She inserted a syringe into Brady’s drip line and slowly injected the first antibiotic.
“Thanks, but we’re going to stay here,” I said. “His color hasn’t improved at all from the fluid bolus.”
Allie lifted his lip, blanched his gum with her finger and looked away with a frown.
“Until his condition stabilizes, I’m not leaving the clinic and the equipment,” I told her.
“But Chica did the same thing,” Allie said. She started the second antibiotic. “She improved after the antibiotics. I’m sure Brady will do the same.”
“I hope you’re right, Allie,” I rubbed my temples with both hands. “But until his color improves, he’s not going anywhere.”
“Then I’ll stay, too.”
“Thanks Allie, but Steve should be here soon. If you can stay until he arrives, I’d really appreciate it.”
“No problem. Go lie down. I’ll get you if anything changes.” Allie took my place beside Brady. She pulled a paperback novel out of her scrub pocket and settled in with one arm around the beagle.
At five minutes after 7, the pager beeped in my ear. I lifted my head off the desk with a crease mark across my forehead. My arms tingled. I checked on Brady before calling Mike.
“How’s my boy?” Mike asked.
“His temperature has dropped to 104.8, and his color is still bad,” I told him. “His prostate looked big on the X-rays. I’m really worried about him, Mike. Have you gotten hold of Anna yet?”
“No, her plane will land in an hour, and then they’re going straight to a show. I doubt she’ll have time to call me.”
“Well, you might want to come down and visit with him,” I recommended. “Just in case.”
“But his temperature dropped,” he responded. “The fever is breaking. He’s getting better.”
“Or he could be going into the cold phase of septic shock, when the body can’t keep the temperature up anymore,” I countered. “I really think you should come to the clinic.”
“Dr. Nelson, I appreciate your concern but I think you’re overly pessimistic. Since his temperature is decreasing, he’s getting better. I’ve got a lot to do tonight. I’m leading a meeting, and I haven’t read the materials yet. Give Brady a hug and tell him I’ll visit tomorrow.”
I hung up the phone, frustrated by his response. Brady’s blood pressure was dropping with his temperature. I decided to try hypertonic saline to steady his pressure. Allie slowly injected the high salt solution into his catheter. Twenty minutes later, his temperature dropped to 101.2 with no change in the color of his gums.
“Allie, would you mind driving over to Fairview Ridges for a bag of hetastarch?” I asked.
“As long as you’re OK while I’m gone.”
“I’ll be fine.” I ran my hand along Brady’s back. Beagles have soft, velvety fur, especially on their muzzles. “Let me call Mike again, then you can go.” I dialed his number and waited for him to pick up. The phone rang and rang before finally going to voice mail. “Mike, this is Dr. Nelson,” I started. “Please call me right away. I need to speak to you urgently.”
Allie put on her jacket, slung her purse over her shoulder and left with a key ring in her hand. As she walked, a replica of the Star Ship Enterprise clinked against a Spock charm. The drive normally takes about 20 minutes, but Allie made it in nine. The pharmacists were all animal lovers who took a special interest in our cases. They would search high and low for some of the oddball drugs I needed for the exotic animals. The special fluid Brady needed was part of their normal inventory.
When Allie returned, she almost collided with Steve’s Camry in the parking lot. They dropped their bags on the counter in the pharmacy before heading back to the treatment room.
“Hi, Sweets,” Steve said, kissing me on the check. “Another septic shock?”
“I’m afraid so,” I replied, taking the bag of fluids marked “Brady, Minnesota Veterinary Center” from Allie. “Thanks. I appreciate you staying late to help me.”
“Are you sure you don’t need me to stay longer?” she asked, tucking a stray strand of hair behind her ear.
“No, Steve can help me. I’ll see you tomorrow.”
Allie waved goodbye and headed off into the night, locking the front door behind her.
“Honey, why don’t we put him in a cage so we don’t have to sit here?” Steve asked. “I doubt he’ll bother the IV line. I mean he hasn’t moved since I got here.”
“I’m worried that he’s going to arrest,” I replied. I pointed at a trach tube and a tray of drugs behind him. “I don’t want to waste time getting him out of the cage before I start CPR.”
Steve’s eyes widened as he nodded.
At 8:30, Brady’s temperature dropped to 99.9 with no change in his gum color. His blood pressure remained low even after the maximum does of hetastarch. I called Mike’s number again and left another message.
“I’ve never seen a dog this sick,” Steve observed. “He acts like you tranquilized him.”
“He’s using all of his energy to fight the infe
ction. I’m afraid he’s losing.”
Suddenly, Brady lifted his head off the table, opened his mouth like he was gagging and then dropped his head to the table. His eyes remained open with a blank stare. The line on the E.K.G. flattened as a constant buzz announced his heart had stopped. Steve held his head up with the mouth open for me to pass a trach tube. While I tied it in place, Steve attached it to the oxygen machine. Every 30 seconds he squeezed the bag, sending oxygen to Brady’s lungs. I injected epinephrine into the catheter and increased the drip rate to get the lifesaving drug into his system faster. A flat line stretched across the monitor.
I rolled Brady onto his side and placed my hands over his heart. The monitor suddenly beeped. Bizarre QRS complexes danced across the EKG. I kept one hand on Brady’s heart and slipped the other on the inside of his back leg to feel his pulse. I could barely feel it. I held my breath and watched the screen. Slowly, a normal rate and rhythm returned. Brady started to breathe on his own.
“Wow, that was a close one,” Steve said. I called Mike again, stretching the long phone cord across the room.
“Come on, pick up,” I shouted into the phone. It went to voice mail. “Mike, call me right away. This is urgent. Please call the clinic right away.” I hung up the phone with a heavy heart.
Steve and I sat in silence, waiting to see what would happen next. The sound of the E.K.G. seemed to take on a life of its own, beep by agonizing beep. I kept my hand on Brady’s leg and my eyes on the monitor, watching and hoping for a miracle. Fifteen minutes later, Brady’s heart stopped again. I gave him epinephrine and thumped his chest while Steve squeezed the bag. After two minutes of CPR, I stopped for a few seconds to look for a heartbeat on the monitor, only to be disappointed with a flat line. I administered more epinephrine, more CPR and more epinephrine.
This time, Brady didn’t come back.
After 15 minutes, Steve put his hands on mine. “Honey, he’s gone.”
I looked at the lifeless body on the table and started to cry. I listened with my stethoscope, hoping the machine was wrong. I heard nothing, absolutely nothing.
“You are a great dog, Brady,” I whispered in his ear. “We will all miss you.” I kissed his forehead, feeling his soft fur one last time. Steve put his arms around me and drew me to him. We stood together, staring at Brady’s body, when the phone rang.
“Now he calls,” I said as I answered.
“Dr. Nelson, what’s wrong?” Mike asked. “How’s Brady?”
“I’m afraid I have bad news for you, Mike.” I paused for a deep breath. “Brady did not respond to the treatment, his temperature kept falling, and he never came out of shock. At about 8:30, he went into cardiac arrest. I got him back for about 20 minutes, and then he arrested again. I couldn’t get him back the second time.” I sighed. “I am so sorry, Mike. He was a really great dog.”
“He’s dead?” Mike said in disbelief. “That’s impossible. He was fine this morning.”
I waited for him to process the information.
“He’s only 8 years old.”
“And he was in great health,” I added. “But the infection was too much for his body. He fought hard, but I’m afraid it wasn’t enough.”
“But he looked fine. Where was the infection?”
“Prostate, I think. But I would like to have a necropsy done at the University of Minnesota to confirm it, if that’s all right with you.”
“Yes, I want to know exactly what happened and what could have been done to prevent it. When will the results be ready?”
“I’ll take his body up tomorrow morning, and they’ll do the gross examination on the same day,” I explained. “They’ll take samples for culture and microscopic analysis. Those won’t be ready for several days.”
“Call me as soon as you hear anything,” he instructed. “Anna and I want to know everything.”
“I will. Again, I am so sorry, Mike.”
He hung up without saying another word.
I closed my eyes and exhaled loudly. When I was young, I watched the sitcom M*A*S*H. I remembered one episode when Hawkeye walked out of the OR and collapsed on a bench after losing a patient. The C.O., Henry Blake, sat down beside him to comfort him. He told Hawkeye about learning two rules at officer school. Rule No. 1 is that young men die in war. Rule No. 2 is that doctors can’t change rule No. 1. I didn’t like the rules any better than Hawkeye. It was always hard for me to lose a patient. My head pounded worse than ever.
The preliminary necropsy report confirmed my clinical impression — Brady’s prostate was infected. Over time, the testosterone produced by Brady’s testicles caused the prostate to grow in size, a condition called benign prostatic hypertrophy. If bacteria can gain entrance to the organ, the inside makes a perfect petri dish. Prostatitis, which technically means an inflamed prostate, occurs. In some cases, dogs develop large prostatic cysts that can extend into the abdomen. I remember looking at one film, thinking the dog had two urinary bladders because the prostatic cyst was so large. Neutering prevents all of these conditions because removing the testosterone makes the gland atrophy.
Four days later, Steve and I sat in our kitchen, enjoying a meal together. With my sore throat gone, I could enjoy real food again. Fang sat on the ledge above the table, pretending he wasn’t interested in our food. When Steve got up to get napkins, the thief jumped onto the table. I blocked him before he could reach the unattended plate.
“Sorry, buddy,” Steve said as he put him on the kitchen floor. The pager started beeping and buzzing on the counter. Steve picked it up and handed it to me. I studied the number.
“Who is it?” Steve asked.
I shrugged and dialed the unfamiliar number.
“Hello, this is Dr. Nelson. Did you call for a veterinarian?”
“What happened to Brady?” Anna screamed into the phone. “I walked in the door to find him gone. Mike told me he died at your hospital.”
“I’m afraid that is true, Anna. I am so sorry,” I replied calmly. “Brady went into septic shock from an infection in his prostate.”
“That’s impossible,” she argued. “He was fine when I left.”
“Septic shock can kill people and animals quickly. The bacterial infection overwhelms the body, causing death.”
“No!” she screamed into the phone. “I’m not an idiot. Antibiotics kill bacteria. If you had given him antibiotics, he would still be alive.”
“I gave him two of the most powerful antibiotics there are, one for the gram positives and one for the gram negatives. We also gave…”
“But he was so healthy,” she interrupted. “If I had been there, he would still be alive.”
For the next 10 minutes, I listened to Anna vent. She yelled at Mike for not getting him in soon enough and for not staying with him. She accused me of malpractice. She yelled and yelled and yelled. Anna was mad at the world, and she was going to get justice for her dog. Someone was going to pay.
“What should have been done to save him?” she asked in a sarcastic tone. “I mean, if I ever brought my dog back to you.”
“Neuter,” I replied without hesitation. “If he had been neutered, he would probably be alive today.” I heard Anna gasp and then only the background noise of the phone. I waited for 15 seconds before asking, “Anna, are you OK?”
“Neutering would have prevented this,” she stammered.
“Yes. Without the testosterone, the prostate atrophies away. In most neutered dogs, I can’t even feel it.” I heard her sniffle softly. “Anna, I know this is a horrible shock. Brady was a terrific Beagle, and we will all miss him. But now we need to focus on keeping Brady’s brother healthy. Promise me you will get Artie neutered right away.”
“I will, Dr. Nelson,” she replied. “I will.”
Chapter 20
A New Addition
Months ago, I promised to give a kitten born without eyes a home. Now I drove through an Apple Valley neighborhood clutching directions in my hand. A blue plastic carrier sat
on the passenger seat with “Minnesota Veterinary Center” labeled on the front. The swoop of the “M, V” and “C” identified the artist as Allie. I could spot her handwriting anywhere.
I wound my way along a curving lane, dodging huge chunks of ice that fell off of cars and trucks. Snow came to Minnesota in time for a white Christmas, fulfilling Bing’s wish. Five days later, a layer of gray slush covered the roads. I turned right onto a street marked with a yellow dead-end sign, feeling the back end of the car slide around the turn.
The houses on this street looked like a holiday card with a thick layer of snow blanketing the roofs. Long icicles hung from the edges, resembling fringe around a pillow. The windows glowed with light, making the houses warm and inviting under the gray skies.
“One, two, three,” I counted after the turn. I turned into the driveway of the fourth house, a split-level built into a small hill. A string of multicolored lights decorated the railing up the steps to the front door. A wreath with a long red ribbon decorated the door. I pulled a red scarf over my face and headed up the stairs with the carrier.
I pushed on the doorbell but it didn’t move, frozen in place. I set the carrier down, removed one of my red knit mittens and knocked. A minute later, a pleasantly plump woman opened the door. With her silver hair and rosy red cheeks, she could have filled in for Mrs. Claus at the mall.
“Hi, Dr. Nelson,” she said, waving me inside. “Did you have a nice Christmas?”
“Hi, Sonya.” The strong smell of cat urine made my eyes water. “I uh, uh,” I struggled to speak. “Yes, we had a lovely time.” I cleared my throat before asking, “How about you?”
“I went to my son’s house for Christmas. I would rather have Christmas here at my house, but my daughter-in-law thinks my house smells like a litter box.” Sonya rolled her eyes. “She refuses to come inside. I don’t know what my son sees in her. She’s such a prima donna.”
Coated With Fur: A Blind Cat's Love Page 21