Ever by My Side (17 page)

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 important 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.

Finding the correct disk space was even more problematic. Advanced imaging wasn’t available and the practice’s X-ray equipment was broken, leaving them dependent on a portable unit meant for equine use. As you can imagine a machine designed to discover bony disorders in a horse’s limbs struggles when it comes to the subtleties of a dachshund spine. At best, if I removed my glasses and tilted the grainy image just so while implementing a lemony squint, my vivid imagination could only suggest a faint narrowing between two bones of the lumbar spine.

It was decision time. Should I take this dog to surgery trusting an X-ray that was barely readable, let alone diagnostic, only to tackle one of the most delicate, sensitive, and unforgiving areas of the canine anatomy with equipment as subtle as pruning shears? And suddenly, while I was trying to decide, there she was, little Delilah—her face, her winning attitude, and her awful dilemma—front and center in my mind.

I was as restricted in my ability to operate on Peanut as if Michael J. Fox had bundled me into his DeLorean and taken me back in time to my encounter with Delilah. Sure, I may have been carrying an invisible bag of surgical skills acquired in the intervening years, but my current predicament in terms of limited facilities and equipment was virtually identical. Back then, Delilah’s owner hadn’t even entertained the possibility of surgery. Given the suboptimal service I could offer, was backing down the honorable, most professional way to go?