Ever by My Side

by Nick Trout

  “How ’bout giving the dogs a once-over?” asked Dad, almost as soon as my suitcase hit the floor.

  Though I returned home for the holidays with little more than some basic physiology, some esoteric biochemistry, and some rudimentary anatomy, I gave it a shot, Bess as generous and tolerant as I would have expected, happy to lie on her side as I slowly worked my way through the muscles of the forelimb. I had discovered something soothing and wonderfully finite about anatomy, the way it was laid out before you, the answer in plain sight. You either knew it or you didn’t, the ultimate proof of knowledge equating to power.

  “This is the region of the omotransversarius muscle, which acts to bring the leg forward, arising from the distal portion of the scapular spine and extending all the way to the wing of the atlas.”

  Dad tried to be impressed, but it was obvious he was hoping for something more practical.

  “You know,” I said, “cats have a clavicle, a collar bone, but dogs don’t. Whereas dogs have a bone in their penis and cats don’t.”

  “Really?” said Dad, his face a parody of edification. “But are you finding anything amiss?”

  Though Bess may have resembled our formalin-infused greyhound cadavers in terms of her temperament—she was completely malleable, savoring this newfangled Reiki spa treatment—her layer of seal-like insulation made it difficult to define the details in her structure.

  “Not really,” I said. “But it’s going to be a few years before I get to all the relevant clinical stuff.”

  “Of course it is. Of course it is. Need to get the basics down first.” And then, as if unable to help himself, “But what about our Whiskey?”

  He was watching me, maybe testing me, waiting to see if I would try to excuse myself. I didn’t hesitate. Crouching down, I beckoned to the big golden to come. Whiskey bounced over, incredulous that he had had to wait for his moment in the spotlight, loving to be roughed up, to shake and tousle his lion’s mane before I spun him around and started scratching around his back and butt. Then, as he settled in, helpfully backing toward me, my hands began to change, fingers flexing, flat palms drifting away from his fur. My playful stroke became a clinical touch, probing, defining, and interpreting. I got a little more than five seconds before the smile vanished from his face and he shot around, snapping and growling in my direction.

  “Hey, hey, we’ll have none of that,” I said, bouncing to my feet, taking Whiskey’s head in my hands, and angling his skull to align our eyes and to let him see my disapproval. It was my turn to growl—a stern “no.” But he was already back—Whiskey the pet, no longer Whiskey the patient—staring up at me with a “Lighten up, I’m just kidding. I save the serious stuff for the real vet, and let me tell you, you ain’t no real vet.”

  Over the next six years I would continue to attempt a “once-over” with Whiskey, seeing how far I might get before he lost it, learning to sense that moment of hesitation when pleasure morphed into suspicion for a few seconds, and then he finally realized he was being played. To be fair to him, I was getting to listen to a few heartbeats, caressing a little spleen before he called time-out, and he never progressed to anything more than a growl or a bristle and quick about-face. I began to liken my once-over sessions with Whiskey to the pebble test performed by the late David Carradine on the TV show Kung Fu. Studying to be a vet might be a little different from studying to be a Shaolin monk, but “Grasshopper” would only have completed his mental and spiritual training when he could snatch the pebble from Master Po’s hand. Maybe Whiskey was my Master Po, the pebble my full physical examination. Either I would get it done without his objection or he would try mauling me in the manner of a starving wolf. This would be my crowning achievement, my ultimate recognition as a professional and, clearly, “time for me to leave.”

  Inadvertently, visits home were honing my education. The dogs were proving to be an immutable reminder of the family life I used to know—and an era that had passed. Returning home can be awkward for any college-age kid. We spend our teenage years learning to be obnoxious and short with our parents. We prefer to confide in friends. We connive, we become reclusive, we strive to become remote. We may still have a little voice somewhere deep inside pleading, “Just keep loving me, I’ll come back,” but for the most part, coming home from college is like reaching for the end of an umbilical cord we worked so hard to cut. We enjoy the security, the lazy familiarity, but we have left the nest, proven our capacity for independence, and now demand the respect afforded adults. Whiskey and Bess had no interest in this petty convention and all its theatrics. One minute you were gone and the next you were back. They didn’t mourn my departure, miss me, or anticipate my return. Enthusiastic or indifferent, they were a wonderfully reassuring constant, the perfect reminder that I was home, particularly as I clawed my way back from detached offspring and reprised the role of son. Besides, Dad made sure the dogs were never far from my thoughts. He refused to stop acting like a father, knowing that if you hold your hand out long enough, eventually your kids will try to grab it again. While I was at college he wrote to me every week, prattling on about the monotony of his life, about Mum’s schoolwork and Fiona’s desire to become a nurse, but there was always something about the dogs. It might be a minor health issue for me to research, but more often than not it was something trivial they had done, something they had encountered on their walks. Without fail, he always signed off on these letters with love and he always included Whiskey and Bess in the list of individuals sending this love my way. At the time it made me laugh, it made me embarrassed, but as soon as I softened, as soon I matured back into his son, I came to appreciate what he was saying—an endearing and magnanimous reminder of how family will always be the sum of its individual members, be they human or animal.

  For me, becoming a veterinarian would take six years—three years of basic medical sciences with a hint of clinical relevance, two years of clinically relevant material with a hint of hands-on experience, and a final year of masquerading as a real doctor. Through all those hours of study, the necessary mistakes, repetition, and academic information soaking into my brain, the process of veterinary education successfully transfers essential skills and core knowledge to a receptive audience of animal lovers. However, when you think about it, all academic osmosis really does is create the possibility for higher learning, for experiences that resonate in a distinct voice rather than get lost in the murmur of background noise. During vacations, not only was I required to gain skills in all manner of animal handling—grooming horses, feeding pigs, herding sheep, and milking cows—but more important, I had to spend twenty-six weeks visiting veterinary practices around the country and trying to apply my book smarts to practical matters.

  This didn’t leave me much time to mooch off my parents or catch up on my All Creatures Great and Small trivia. Naturally I would check in with Ryan James from time to time, savoring my new status whenever he introduced me—“veterinary student,” a title that sounded to my ears very prestigious and accomplished—but I also traveled all over the country, trying to gain exposure to as wide a variety of techniques, opinions, and styles of working with animals as possible.

  In those early days (except when I was with Ryan) I was pretty much a wallflower, keeping my mouth shut, hesitant to ask the redundant question. I was all about observation—itchy Westie gets a shot of the milky liquid; lethargic Siamese gets a shot of the pink liquid; worms mean big brown tablets; shampoo and little white pills for fleas. I didn’t know what anything was, I didn’t know how anything worked or why it had been chosen, but before long, with about a 50 percent success rate, from a distance of six feet, without even touching the animal, I could prescribe likely cures with the best of them.

  Of course this approach was a wholly unsatisfying guessing game, so I began edging away from the wall, mingling with pets and owners, helping to restrain fractious animals, offering to clip, shave, and prep animals for surgery, timing my questions, weighing their merit, and, most im
portant of all, learning when to keep my mouth shut.

  During this early period in my training, the veterinarian was always right. I never questioned a course of treatment or a diagnosis. I never witnessed a single encounter with an owner who challenged a medical decision, demanded a second opinion, or appeared bullied into a course of action they did not want to take. For all of us nonveterinarians standing in an examination room it was understood that every action was grounded in fact and experience, every action made in good and absolute faith. The same was true in the operating room. From time to time a cat or a dog would be diagnosed with an abdominal mass or a growth, something the vet picked up on palpation but could not isolate to a specific organ. Some owners would pursue surgery, an exploratory laparotomy, where the doctor would look around the abdomen, inspecting the organs hidden and lurking inside. I was introduced to the phrase “peek and shriek,” a facetious colloquialism meant to reflect the surgeon’s awe at what he or she might see, and to serve as a reminder that disease can be formidable, inoperable, and more than capable of besting their intentions to cut and cure. In the quest to separate benign from malignant, the surgeon will fall back on a number of simple guidelines: Is the tumor well encapsulated or does it invade surrounding tissue? Are the local lymph nodes swollen? Is there evidence of spread to other nearby organs? There are no absolutes in medicine: these questions can be helpful but objectivity can be overwhelmed by our instinctive reflex to reel and gawk at something that by its sheer size or ugliness has to be bad. Taking an intraoperative biopsy and waiting on the word of an in-house pathologist are luxuries few veterinary institutions have to this day and therefore, in many instances, the man or woman in the latex surgical gloves is forced to play God. I witnessed many cases in which an animal was simply woken back up, the mass deemed malignant and inoperable, or in some cases, at the owner’s request, the animal was put to sleep on the operating room table.

  I have no reason to suspect that any of these decisions were wrong or inappropriate; however, I was struck by our inherent tendency toward pessimism and resignation based on how disease looked to the naked eye and how it made us feel. It got me to thinking, and about a decade or so later (okay, so I think slowly) I published a scientific article about a particular liver tumor that affects cats. Pull back the muscular curtains of the kitty’s abdominal wall for your peek and this particularly unsightly growth will certainly get your attention. It’s big, covered in cysts, invasive, butt ugly, and yet surprisingly benign. Catch your breath, cut it out, and most cats will return to leading a normal, healthy life. Believe me, it’s not a scientifically earth-shattering publication, but I like to think a few veterinarians might have read it and, when next faced with something attached to a cat’s liver that looks like an alien parasite, hesitated and decided to give the animal the benefit of their doubt.

  Veterinarians the world over, far better ones than I, develop this uncanny knack for being able to root around in their long-term memory and dig out pertinent recollections for the benefit of future patients. Though it might feel like these cases play emotional hide-and-seek, details blurring until they get lost and eventually disappear, certain characteristics and minutiae somehow endure, all the more precious for having been found. As a fourth-year veterinary student, while I was doing the work experience thing in an unfamiliar small animal practice in East Anglia, Delilah, a black and tan smooth-coated dachshund made such a mark, though for the longest time I failed to appreciate her significance.

  “I came home from work and found her like this at the bottom of the stairs.”

  Delilah’s owner, a young woman in her late teens or early twenties, put her down on the floor, and after a moment’s hesitation, Delilah began scampering around the room, racing over to say hello to me.

  Though it pains me to admit it, I was still learning to get comfortable around small breeds of dog. Life with Patch, Whiskey, and Bess had predisposed me to a certain type of dog. Give me something big, intimidating, and boisterous and I was fine, but any dog that could be carried in the manner of a running back holding an American football gave me pause. It must have been a throwback to my experiences around Marty. I had trust issues—I found them difficult to read, flighty, likely to bite first and ask questions later. Delilah, however, belied my harsh generalizations. She was delightful, racing over, all smiles, eager to lick my outstretched hand, seemingly ignorant of the disastrous blow to her mobility. She wasn’t walking so much as dragging herself across the tile floor, both back legs lifeless.

  “And she was fine when you left her this morning?” asked the vet.

  “Perfectly.”

  “And what time did you leave the house?”

  The young woman looked a little thrown by the question

  “Sevenish.”

  “What time did you get home?”

  Kneeling down, the vet joined Delilah and me on the floor.

  “I don’t know, usual time, five thirty. As soon as I saw she couldn’t walk we came straight over. Are her legs broken?”

  The vet placed his hand under Delilah’s tummy, offering support, trying to place her back legs into a normal position, then extending them like the legs of a folding card table only to discover that they had the consistency of palm-warm gummy bears, bendy and weak, incapable of supporting weight. And weight was something Delilah had in spades. She wasn’t just a “sausage dog”; she was a “stuffed like a sausage” dog.

  “Just distract her,” the vet said to me, and I did, letting Delilah shatter my stupid myth about small dogs, as she charmed me with her perfectly timed lilting head movements, offering a look of disbelief if I stopped scratching under her chin for more than a second.

  I watched as the vet pinched the toes of her back legs between his fingers before pulling a mean-looking surgical clamp from his pocket. He must have noticed how my eyes had become a little too wide.

  “I’m just trying to work out how much sensation is left in her toes,” he said by way of a justification as he crushed pads and black nails between the serrated metal tips.

  In a split second I realized what most dogs would do in response to this stimulus—cry out, turn, and bite—and that if Delilah could not reach her target she might have to make do with a little collateral damage, someone with his fingers closer to her mouth. But nothing happened; Delilah remained completely focused on me and my attention to her chin. The clamps were reapplied, more forcibly this time, and still nothing registered.

  “At least she moved her leg,” said the owner, noticing that Delilah did pull her leg away, even though the movement seemed slow and mechanical.

  The vet got to his feet.

  “I’m afraid that was just a spinal reflex. I was more interested in seeing if her brain could register a painful sensation in her toes. And as you can see, she doesn’t appear to feel a thing. The information from her toes telling her brain to make it stop isn’t getting through.”

  “So, she hasn’t broken her legs?”

  “No. Her legs are physically fine, they’re just not working properly. I’m guessing she’s slipped a disk in her back.”

  He gave us both a brief synopsis of the purpose of intervertebral disks, those clever little shock absorbers that lie between the bones of the spine. Dachshunds, like Lhasa apsos and Pekingese, are designed with short legs and long spines, focusing a great deal of stress and strain across the middle of their backs. Add a few extra pounds of lipid love and you have a recipe for disaster—a significant risk of a ruptured disk causing sudden and severe paralysis to the back legs.

  “I was asking about the time because I was trying to work out how long Delilah might have been this way. Course we’ll never know for sure, but from what you told me, it could be getting on twelve hours. What we do know is that she has no deep pain sensation in her back legs and that is as bad as it gets.”

  Hearing this, Delilah’s owner bent down and picked her dog up, extending her chin and tears into Delilah’s kisses. How scary, I thought. You leave
your dog in the safety of your own home and return to a natural disaster. I could see a little shoelace tail poking out between the fingers of the owner’s splayed hand and from the look of satisfaction on the dog’s face I suspected Delilah thought it was wagging, even though nothing moved.

  The vet offered to take an X-ray of Delilah’s back to see if there was any evidence of narrowing between the bones of her spine where a disk space might have collapsed, but her owner declined. Money was a big problem and she would have to trust a conservative approach—oral steroids to reduce inflammation, muscle relaxants, and, most important of all, strict cage rest. Surgical options were never discussed. Maybe the vet had a better feel for the owner’s fiscal situation than I realized or maybe he wasn’t convinced that surgery could save poor Delilah. Back then, in the minds of some old-school general practitioners, spinal surgery was impractical, expensive, limited to academic institutions, and, to their way of thinking, yielded inconsistent results.

  I wish I could tell you what became of Delilah, but I don’t know. That said, as a curious veterinary student with complete access to pertinent and current data on all manner of disease, I did try to discover what her future might hold. I tracked down several scientific articles that suggested this conservative approach was destined for failure in a dog with such severe neurological deficits. Not what I wanted to read. In my mind I clipped this depressing pearl of wisdom to a mental picture of Delilah scuttling across the floor and simply kept going. I never thought about her again until decades later while visiting a practice in Bermuda, when the recollection of Delilah’s sad case paid me an unexpected visit.

  Perhaps I should clarify that for the last thirteen years I’ve been working at the Angell Animal Medical Center in Boston, one of the premier state-of-the-art facilities in this country. However, from time to time, I hop on a Delta flight out of Logan and in less than two hours I’m driving on the left-hand side of the road in a former British colony famous for pink sand and a style of shorts. I consult and perform surgery at a general practice run by a couple of friends of mine and I know what you’re thinking—nice excuse to go sipping Dark and Stormys and work on my tan—but the truth is I’ve pretty much got a scalpel in my hand from the moment I arrive until the moment I depart. The fundamentals of this particular Bermuda case were practically the same: another charming dachshund (this one far more slender and fawn-colored, and named Peanut) presenting to the primary veterinarian acutely paralyzed, no deep pain sensation in either of her rubbery back legs. Ordinarily, at Angell, a “down dog” would undergo a CT scan or an MRI to precisely define the location of diseased disk, immediately followed by a surgery aimed at meticulously cutting a tiny window into the delicate bone of the spinal canal with the aid of a high-speed drill and a steady hand. But I was in the real world, in a general practice that had no such drill. When we scrambled around for alternative spinal surgery equipment, the closest thing I could find to what I needed lived in a pack labeled “dental.” With luck, I could still access the ruptured disk by nibbling and chipping away at the bone with a variety of handheld instruments, but this would be the surgical equivalent of mowing a lawn with a scythe.