Love Is the Best Medicine

by Dr. Nick Trout

  “I’m sorry about that,” I said, “but maybe you can still answer a few questions about …”

  Without invitation, Henry’s chauffeur had taken a seat, unfolded his newspaper, and disappeared behind the pages of the business section.

  “… about Henry’s problem.”

  My words trailed away to a whisper and he appeared not to notice, turning a page, snapping the paper taut. He eased back in his seat, happy to let me get on with whatever it was I did when I admitted a patient, and I realized here was a man who would rather be stuck at home organizing his sock drawer on Super Bowl Sunday than talking to me about his fiancée’s cat.

  I resolved to battle on.

  “So, Susan would be the person who brought in Henry through the emergency service last night?”

  His head remained level, eyes rolling up above the page to meet mine, transmitting a “you still here?” look before giving in to a reluctant nod.

  “And I see from his record that Henry has a long history of urinary tract problems. Has there been blood in the urine, frequent visits to the litter box? Why did he need to be seen last night?”

  Of course I already knew the answers to these questions. The intern who saw the case in our ER had briefed me on Henry’s predicament, his record having grown to encyclopedic proportions after years of difficulty going to the bathroom. Like many tomcats, regardless of whether or not they are neutered, Henry had a talent for growing microscopic crystals in his urine. Sometimes these crystals can form discrete stones, but oftentimes they produce a sandy, gritty sludge that builds up in the narrowest part of his manly plumbing, which happens to be the penis. The result is a painful and potentially life-threatening blockage because of Henry’s habitual inability to pee.

  “Look,” he said with the raised brows of a man losing his patience, “she brought him in, she discussed the surgery with the doctor, she was told to drop him off this morning, but she had to work so here I am. The only thing I know for sure is he’s costing me a fortune and he wakes me up growling in the night every time he takes a whiz.”

  He tried a smile, like an off-the-rack suit, apparently didn’t like the way it felt, and put it right back as the hypnotic pull of the Dow Jones got the better of him. I let him drift, preferring to head over to the carrier and open the box.

  Henry was an arresting orange tom with a tail that shot up like an antenna, a twitching feeler in search of attention. I lifted his twelve pounds onto the table and he was on me, head butting, pressing his flaming flanks into my chest, sidling to and fro as I reached for my stethoscope, deafened by the steady grinding purr of a flirtatious cat.

  His head was broad, the head of a cat neutered later in life, and his ears and face bore the scars of a former street fighter. When you went to stroke him he pushed into your hand, hard, as though he objected to a delicate touch, his tough old skin longing to be roughed up.

  “Hang on there little man, hang on,” I said, swinging him around so that his head was away from me. Only now did I notice the extra toes on his front feet, the polydactyl paws of so many New England cats.

  “I just want to have a feel of your tummy.”

  Henry stopped purring as soon as I moved my right hand under his abdomen, guarding with a defensive muscular crunch. I gave him a noogie and he relaxed enough for me to feel a bladder that had distended to the size of an orange.

  “I know, Henry,” I said, picking up his tail and hunting for his penis, “this is not very dignified but it has to be done.”

  Henry began dancing back and forth on his back legs and this time the purr had ripened into a grumble. He let me catch a glimpse, no more, but it was enough to confirm redness, swelling, and considerable soreness. Poor thing, his barbed feline tongue had rasped the tip of his penis raw trying to relieve the gritty impaction trapped inside.

  “I’m sorry, little man,” I said, rubbing down his neck. All forgiven, Henry twisted his big head off to the side to make sure I worked a few good scratches into the base of his ear.

  I put him down on the floor so he could explore the room and washed my hands in the sink.

  “So,” I said, turning my swivel chair back to front, straddling it, and sidling up to the back of a newspaper, “according to his records, this is Henry’s third episode of getting blocked. And you know what they say: ‘Three strikes and you’re out!’”

  I didn’t expect the baseball metaphor to get his attention but he angled the paper forward and down so I could meet his steely eyes.

  “What are you saying?”

  “I’m saying, I think you’re making the right decision. It’s about time Henry was plumbed a little differently, down below, if you know what I mean.”

  My turn of phrase had the desired effect.

  “No, I don’t know what you mean.”

  “Really,” I said, feigning surprise. “Susan didn’t tell you all the details of the surgery?”

  “No. Like I’ve been saying all along she just asked me to drop him off. What are you going to do to him?”

  I wasn’t sure whether he was suddenly Henry’s advocate or begrudged being left out of any decision that might affect his checkbook.

  “It’s a procedure called a perineal urethrostomy. Essentially I’m going to amputate Henry’s penis and give him a new, wide opening that will make it much easier for him to urinate.”

  The paper fell to the floor as Deadbeat Dad came to his feet, incredulous.

  “You’re going to do what? Lop off his penis and give him a sex change? Is that what you’re telling me?”

  His hands reached for his hairline, fingers stretching back the skin at his temples to produce an instant frantic facelift.

  “Susan would have told me about this. She couldn’t have understood what was involved. She said the doctor was young. She probably didn’t get all the gory details.”

  I knew for a fact that the intern who saw Henry last night had done an excellent job of describing the surgery, the postoperative care, and the potential complications. She told me the owner had been putting off the inevitable for some time. Susan had done everything she could; modifying Henry’s diet, monitoring his urine for crystals and bacteria, periodically bringing him to the hospital to be catheterized and flushed out when the signs of obstruction started to return. She simply couldn’t stand to see Henry suffer anymore.

  “She’s the one you need to be talking to. Not me. She should have been here. I can’t believe this. I shouldn’t be making these kinds of decisions. It’s not even my cat.”

  “I can give her a call,” I said, “if it will make you feel better.”

  He raised an index finger and rummaged in a jacket pocket and pulled out a Post-it note on which various telephone numbers were written.

  “Yes. Here,” he said, handing it over. “I was supposed to give this to you anyway.”

  I studied the note.

  “Any suggestion where to start?” I said, picking up the examination room phone and getting an outside line.

  He consulted his watch.

  “Try work, she might be in by now.”

  The call was picked up and an insipid recorded voice listed my options and had me hold for three minutes before an actual human being transferred me to the appropriate office, only to get an answering machine.

  I shook my head.

  “Try her cell,” he said.

  I dialed the number and a woman picked up on the third ring.

  “Hello.”

  “Hi, Ms. Sharpe, this is Dr. Trout from Angell.”

  In the background I could hear the click of heels on salted concrete, the sound of passing cars, and the customary refrain of horns. I imagined a woman caught in the daily tide of silent iPod-wearing androids scurrying to work.

  “I have Henry here. What a great cat. But your fiancée asked me to call to make sure you were clear about the exact nature of this morning’s surgery.”

  Static crackled, and the odd syllable filtered through but I was losing the signal
.

  “Ms. Sharpe. Hello.”

  I was talking into the hiss of white noise. I pressed redial and a recorded message informed me the cellular subscriber had moved out of the service area. Perhaps she was belowground riding the T.

  “No luck,” I said, “but not to worry. I’m sure Ms. Sharpe understood exactly what was going to happen to Henry. However, I will need you to sign his consent form.”

  From nowhere, Henry leapt into his prospective stepfather’s lap, an orange ball staring the man in the face, quizzically, adding to the burden of his responsibility.

  For a few seconds I let him stew as he grappled with his responsibility to sanction an unexpectedly radical procedure without a definitive verbal approval from his fiancée. This man’s relationship with Henry’s true guardian was absolutely none of my business, but it was hard for me to ignore his attitude toward her cat. He had made it perfectly clear he was performing a chore, an act of appeasement akin to dropping off a car at the shop for an oil change. His moment of vacillation over the surgery felt like it was borne out of misplaced, virile anthropomorphism rather than genuine concern. Henry’s medical record was a testament to Susan’s dedication, while her unaccompanied visit to the emergency room and her failure to discuss the nature of his surgery seemed to be a testament to their dissociation when it came to this feline member of their love triangle. Henry coerced him into a couple of mechanical pats to his head and I wondered if this man had it in him to change his attitude. Part of me hoped he would have to if he truly wanted to win Susan’s heart.

  “Tell you what,” I said. “I’ll give Susan a call back in the next fifteen minutes. That way there won’t be any surprises.”

  He picked up his paper and I traded Henry for a written estimate and a consent form for him to sign at the front desk.

  “Don’t worry,” I said, “I’ll take good care of him.” The fact that I seemed to interpret his consternation as concern for Henry only seemed to amplify his unease.

  We shook hands, his grip firm, the exchange feeling more like an endorsement of a major deal. He was probably just grateful for me bailing him out. But the romantic in me liked to imagine he was finally seeing me as a doctor and not simply a mechanic, seeing himself as a concerned party and not simply a chauffeur.

  PERINEAL urethrostomy for the surgical treatment of feline urethral obstruction has been around for nearly forty years and I can honestly say that I have never thought about it as a gender-bending exercise. Henry’s surgery was everything it should be, a textbook modification in his anatomy designed to provide as patent an outflow as possible. Surgery would not prevent him from producing grit and sand in his urine. It would, however, minimize the potential for this sludge to create a blockage. Susan’s fiancé would not be out of pocket for hormone therapy. Henry was not about to become a feline fashionista or develop an affected, effeminate meow. He would be the same little man he always had been—fiery, demonstrative, and macho—though he would be required to wear a satellite disk for the next few weeks to stop him from licking at his stitches.

  With Henry recovering nicely and Susan thrilled that everything went according to her plan, I crossed paths with Dr. Beth Maganiello in the surgical prep area.

  “What’s with this Min Pin of yours, little Miss Cleo?” said Beth.

  Dr. Maganiello is a critical care specialist, but given her interest in anesthesia and pain management, she is intimately involved in protocols and monitoring for many of our more challenging or brittle surgical patients.

  “Quite the character, isn’t she?”

  “I’m sure she’s lovely,” said Beth, scrolling through the pages of her record, “but I’ve yet to meet her. I was actually referring to her history. You think she’s healthy apart from fracture number three?”

  Beth wore gray scrubs and a red headband that seemed redundant given the shortness of her hair. Her trademark pair of retro tortoiseshell glasses had been discarded for contacts, clearly a recent transition given the frequency of her blinks.

  “As far as I can tell. Two different vets have looked for an underlying cause of bone weakness and come up empty-handed.”

  She frowned, visibly underwhelmed by the blood work.

  “Maybe she’s just unlucky.”

  “Maybe,” I said, and then, moving ahead to the crux of what this was about, “When you anesthetize her, will you be serving a well-balanced but robust narcotic for starters, followed by a smooth, clean induction agent, finishing with aromatic and intoxicating gases mingled with the delights of your legendary epidural cocktail?”

  She regarded me with a weary expression, the sharp intake of breath, the one that says “are you finished?” overplayed enough to reveal her amusement.

  “Don’t worry,” she said, “we’ll make sure she’s nice and comfortable despite what you have planned for her leg.”

  I smiled, knowing Cleo was in truly excellent hands, and half an hour later I was paged to the surgical prep area in time to see her fall asleep, relaxing into her anesthesia.

  A tube was inserted into Cleo’s trachea and she was hooked up to a machine that would deliver anesthetic gas and oxygen. A heart monitor designed specifically for veterinary use was turned on, firing up with its electronic rendition of “If I Could Talk to the Animals” from the Rex Harrison version of Doctor Dolittle. Colored leads were fastened to her skin and a white probe gently attached to her little pink tongue, measuring the oxygen saturation of her blood. A small square of fur was shaved on the underside of her front foot, positioning a Doppler ultrasound probe to assist in recording the highs and lows of her blood pressure. All was well as Cleo sailed into oblivion.

  “Where would you like me to shave her leg?” said a technician armed with an electrical clipper. She followed my finger as I delineated the margins of what was about to become Cleo’s surgical bald patch. The technician nodded her understanding and then appeared to disregard my design, defining a tidy small square over the base of Cleo’s spine where Dr. Maganiello herself would deliver Cleo’s epidural.

  At this stage in the proceedings I usually have about fifteen more minutes before my patient will be ready for surgery, and I took this opportunity to leave Cleo in the surgical prep area and pass by the scrub sinks, through the swinging door, and into the OR to go shopping for orthopedic implants and all the necessary instrumentation. I was going to need power tools, tissue retractors, bone-holding forceps, bone-reduction forceps, suction, electrocautery—the usual, indispensable stuff of all orthopedic surgery.

  Armed with the X-ray of Cleo’s broken leg I scoured the aisles for a plate with the appropriate length, width, number of screw holes, and thickness. We have it all in stock, from tiny plates you can break with your fingers to plates so thick you need huge table-based bending pliers to produce the smallest kink in their stainless steel. After all, veterinary surgeons routinely repair fractures on dogs as small as a Chihuahua and as big as a Great Dane or bullmastiff. Is it any wonder our stock of orthopedic implants needs to be so versatile?

  One of the other surgeons on staff pushed through the swinging operating room door, dripping hands out front, and muttered behind his mask, “I think you might want to check on your patient.”

  Then he was past me, headed for his sterile gown and latex gloves, his suggestion delivered on the fly, but it was still easy for me to catch its gravity, even if I could not comprehend its reason.

  My first thought was of Henry the cat, recovering from his surgery, and the possibility of a little postoperative hemorrhage given the vascular geography of his procedure. Hiccup, yes. Major complication, unlikely. A mixture of faith and confidence in my work had me heading out of the OR and back toward the prep and recovery areas, yielding to concern but keeping panic at bay.

  Nothing about the scene before me felt credible or reasonable, but from a range of thirty feet, the image punched into two separate parts of my brain—passive, visual pathways recognizing that the problem lay with Cleo, followed by the emotion
al recognition, as I screamed her name over and over inside my head.

  Cleo appeared in glimpses, in the gaps between swarming scrubs, the critical buzz of their body language easy to read. As I drove forward, wanting in, there was a split second in which I closed my eyes, really little more than a blink, but enough to visualize all the details smoothing out, becoming clear and discernable. The crisis had been averted, everyone wearing smiles of relief, riding the high of an adrenaline rush with a happy ending. There had to have been a leak in the endotracheal tube sitting in Cleo’s windpipe. The tube had been pushed in too far. The tube had become kinked. A monitor lead had become dislodged. Cleo had been swimming in the safe waters of her tranquil anesthetic void but she went down too deep. Now she was back on the surface, breathing fresh air, no harm done. They say that anesthesia is 99 percent boredom and 1 percent sheer terror, and on this occasion relief had triumphed over regret.

  But the blink had come to an end by the time I reached her, and it was as if someone had handed me my glasses, a soft impression swiftly replaced by a sharply focused image.

  Cleo’s vibrant pink tongue had turned a listless crimson. The orderly blips and spikes of a normal heart rhythm were replaced by static interference of seismic proportions. with the anesthetic gas turned off, a dissociated hand squeezed a one-liter bag, driving pure oxygen into lungs that no longer wanted to breathe for themselves.

  Beth Maganiello’s voice penetrated my head, her calm piercing the turmoil, hooking me with her certainty and control. I could feel the groundswell of commitment all around me. Beth had become the conductor, the technicians her orchestra, and it was clear everyone had practiced long and hard for this performance. Every instruction came across as clear, incisive, and calculated, as though she had been waiting for this moment her whole life, knowing precisely which resuscitative drug to use, at which dose, and when.

  Anesthetic emergencies require one leader and I believed Cleo would be better off with Beth. Besides, I needed to be physically involved, connected, drawn to the organ that mattered most—Cleo’s heart.