Ever by My Side (18 page)

Then I remembered that unpleasant little addendum based on my additional research into Delilah’s case, the one that said a conservative approach in a severely paralyzed dog was virtually
guaranteed to result in paraplegia. Of course I had seen hundreds of similar cases over the intervening decades, cases where I didn’t hesitate to reach for a scalpel, but not when my hands were cuffed to equipment meant for teeth and horses.

“Let’s give it a shot,” I told Peanut’s vet and in under an hour I was pulling wads of fibrous and calcified disk material away from a grateful spinal cord.

I want you to know I ached over this decision, worked in a state of regret, certain I would be operating in the wrong space, certain my ill-suited instrumentation would let me down. But I kept coming back to Delilah. Deep down, I knew she never walked again. Why should Peanut be destined to suffer a similar fate? And what was my alternative? By the time we organized the necessary paperwork, boarded a flight, and made it to a veterinary hospital in the United States, even surgery would be unlikely to keep her out of a paraplegic cart.

When back surgery goes well, the certainty of knowing a physical act has relieved pain and pressure on the spinal cord, giving a dog a chance to regain something as fundamental as walking, is intoxicating. That was certainly the case with little Peanut, who was cured by the surgery. I’m not talking about whooping it up and celebrating this surgical war story with stiff drinks. I’m talking about taking yourself off to a place where you can be alone, breathe the biggest sigh of relief you ever breathed, and take a moment to remember a different dachshund from a different era who wasn’t quite so lucky.

Not every practice I visited as part of my required work experience provided a positive lesson. Mr. Malcolm Snide, as I will call him, was a new veterinary graduate who took every opportunity to crush
my line of questioning in front of his clients. In the absence of an audience, he preferred a look of silent contempt over a witty put-down, as though I wasn’t worth the effort when I challenged his educational advantage. To be fair to Malcolm, his facial expressions were difficult to read since he was cursed with a deep furrow cut into the fleshy skin between his bushy eyebrows, like an ax chop on a log, that rendered him permanently vexed, perplexed, or dismayed, depending on what he said.

I, like all the other visiting veterinary students, felt as if I was a burden when I joined him for evening appointments, so the first time Snide actually invited me to help him, to draw up a vaccine from a glass ampoule in front of an owner, I was caught off guard, dangerously clumsy and unsure. Yes, I could flick the glass a couple of times with my fingernail like we’ve all seen on TV, but when it came to cracking it open, I cut my index finger, which forced me to curl it into my palm to avoid contaminating the vaccine with my own blood. When I inserted the needle into the clear liquid and pulled back on the plunger of the syringe nothing happened. Snide noticed I was struggling.

“You have to tilt the ampoule a little,” he suggested, trying hard not to sound testy, but when I did, the vaccine trickled out over my hand, leaving me with less than half the necessary dose.

“I’ve lost it,” I said, referring to the liquid running down my wrists, though from the way the pet owner rolled his eyes, he and Snide obviously thought I was alluding to my overall composure.

I felt humiliated. Vaccines are expensive, and here I was pouring the remains of one down the sink while the owner looked on, a new vial cracked open as if they had only nominal value.

“Sorry about that,” I said as soon as the doctor and I were alone.

Snide turned to me and it was clear there was way too much pleasure contorting the muscles of his face.

“Get it right next time. Or don’t even bother trying, yeah?”

He fixed me with a stare that showed how quickly, how completely, he had forgotten where he had come from, where we all start, as though he had always been incapable of making such a trivial mistake. He kept his cold eyes and the ax chop on me as he picked up the next file, stuck his head out of the door, and cried, “Next please.” Only then did he reapply his mask, his best approximation of the conscientious doctor, showing too many teeth in his wolf smile. I never had a problem loading a vaccine from a glass ampoule again, and came to realize how so much of veterinary medicine depends upon performance under constant public scrutiny.

To my way of thinking, there were far better ways to evolve as a doctor and, in a different practice, I found myself gravitating toward a much older mentor with a very different attitude. Mr. Vaughn was a senior partner and a man permanently on the brink of retirement due to his inability to abandon the pets of a loyal fan base and his love of teaching veterinary students the kind of lessons ignored or overlooked by university lecturers and textbooks. He was irresistible—round and cheerful—the kind of old man who could have made a decent living during the holiday season as a Santa Claus if you ignored his affinity for the Ronald Reagan school of hair dye.

“Come help me anesthetize this dog,” he said to me. “It’s just a neuter, but you may as well knock him down.”

“Fantastic,” I thought, and Vaughn coached as I placed my first intravenous catheter and taped it in place. Before handing me a syringe loaded with a pale transparent yellow liquid, he said, “You got your tube?”

I nodded, and held up a selection of different-sized endotracheal tubes, just in case.

“Laryngoscope?”

I reached out to the side of the dog and produced a metallic speculum fitted with a handle and light source for illuminating and visualizing the back of the patient’s throat.

“Then here’s your induction agent.” He passed the twelve-cubic-centimeter syringe, loaded to the ten-milliliter mark. “Go ahead and knock him down.”

So I did, inserting the needle into the rubber stopper at the end of the catheter and driving home the plunger, all the way, the entire dose.

The dog was lying on a table, but he flopped over on his side, instantly lifeless.

“Did you just kill your patient?” asked Vaughn and, to be honest, I missed the calm unruffled tone of his question. I was too busy inserting the tube into the dog’s airway, fumbling for a pulse that was nowhere to be found.

“Do you know how much drug you used? Did you calculate the dose?”

Of course I didn’t have a clue. I was acting the part, pretending to be a vet, mimicking a performance I had witnessed dozens of times before. I had been so drawn to the action, so focused on the fun stuff, I had overlooked everything that really mattered, the choice of drug, appropriate dosage, speed of delivery, and the vital baseline parameters of the patient. I had never stopped to consider what doctors were doing with a calculator, what they were reading in the patient’s record, why they were listening to the heart for the umpteenth time.

Vaughn quickly found the dog’s femoral pulse, took my hand, and guided it into position.

“Got it?” he asked, as the dog huffed an enormous breath as if he were blowing out birthday candles.

I nodded, speechless.

“Don’t look so worried. I had a feeling you might do that. I gave you the low end of the dog’s appropriate dose. But have we learned something today?”

There are few more effective ways to learn than thinking you have killed your first patient before you even graduate from veterinary school. From here on out I would pay closer attention to the sleight of hand and not just the trick itself.

A week or so later, I was seeing appointments with Mr. Vaughn when we were confronted with a seven-year-old black Labrador called Shadow. His owners, the Stoddarts, were one of those couples who could have been siblings, sharing short, mousy hair, gold-rimmed glasses, pallor, and height. Shadow sported the English Labrador genes—short legs, meaty black rudder, and broad head that cried out for firm pats.

“He’s been acting off for the past fortnight,” said Mr. Stoddart. “Not that interested in going for walks. That’s not like him at all. Sometimes he even backs off when I try to put his leash over his head.”

Vaughn called his name, but Shadow sat there, looking off into space.

“Shadow!” This time Vaughn shouted and clapped his hands and for a moment Shadow came back, the tail offering a couple of brisk wags but fading fast, as he quickly lost all interest.

We took him outside the building and Mrs. Stoddart walked him up and down while we watched, and I was struck by the poor dog’s utter lack of enthusiasm. It seemed like such an effort for him to just move his legs forward. No spring, no bounce, paws barely getting off the ground, and a tail that belonged to gravity, no beat, no swish, no joy. If I didn’t know better I would have said Shadow was clinically depressed.

“I’d like to run some blood tests,” said Vaughn, “to make sure there’s no metabolic abnormalities going on inside of him. There’s no chance he’s got into some kind of poison?”

Husband and wife shook their heads in unison.

“Not a chance,” said Mr. Stoddart. “We …”

“… never have anything like that around the house,” said Mrs. Stoddart, as though she were used to finishing her husband’s sentences for him.

“And there’s no chance he’s been in an accident, fallen down stairs, or been hit by a car?”

Husband and wife turned to one another, silently conferred, came back in the negative.

“Can you leave him with us?” asked Vaughn. “I want us both,” and he gestured to me, “to keep an eye on him through the day. We might want to take some blood, run some tests, get some X-rays of his head. Nick’s going to do some research into what’s going on and he’ll give you a call later this afternoon. Sound okay?”

Taking Shadow behind closed doors, Vaughn joined me and asked, “What d’you reckon?”

I looked down at the pathetic creature slumped at my feet. We were in a large work area with dogs barking, cats taunting from a bank of cages, doctors and nurses rushing back and forth. At the very least Shadow should have been nervous, excited, or engaged. This indifference to his surroundings seemed all wrong.

“If his blood work is okay, especially his glucose, I guess I might think he’s acting neurological. He doesn’t seem to be all there,” I said, squatting down to pat the dog’s head, noting how he pulled back a little before my palm made contact with his cheek, the action of a dog that was suddenly head shy.

“I think you’re right,” said Vaughn. “And I’m going to leave this one with you, if that’s all right. We’ll go through his cranial nerve
reflexes together, get his blood work started, and then I want you to hit the books. See what you can dig up. If you don’t do it, I’ll have to do it myself because after forty years of practice there’s no way I can keep all that neuroanatomy straight.”

And so, to my surprise and delight, Shadow became
my
case, the first case whose investigation, whose clinical course, would be driven by and ultimately dependent upon me.

Naturally I was all in, making detailed notes about blink reflexes, pupil size, gag reflex, facial twitch, head position, tilt or aversion, ticking off boxes, rifling through textbook pages, trying to make Shadow fit, to give him a label that held up, to assign a diagnosis that matched his clinical signs. By the time I had finished I thought he was clumsy, his responses to external stimuli, including hearing, seemed depressed, and I suspected his ability to balance was impaired. I didn’t think there was a problem with his brainstem, where the facial nerves originated, but other than that I was stumped.

“Could be a lesion in the temporal lobe of his cerebrum or maybe his balance is off because of disease in his cerebellum or vestibular centers,” I said.

Vaughn offered a frown and shrug combo.

“Sounds reasonable. Our in-house blood work is all normal. So now what?”

I suspected he knew the answer and this question meant so should I.

“Maybe I’ll call someone at the vet school. Run Shadow’s history and clinical signs by one of the experts in medicine. See what they think.”

I got a brief smile, but better still an “Off you go then” that told me I was on the right track. After all, a little second opinion never does any harm.

When I reported back, later that afternoon, I had a new appreciation
for the complexities of veterinary neurology. Yes, a detailed history and a systematic examination can help you to pinpoint a problem in a certain area of the brain (in Shadow’s case, a possible lesion of the temporal lobe), but it couldn’t tell you exactly what it was and, more important, what could be done about it.

“They think we should X-ray Shadow’s skull, for the sake of completeness, just to make sure there are no bony abnormalities, but what we really need is either a CT scan or better still an MRI.”

Bear in mind this was England in the eighties and as far as I remember only a few university veterinarians had ever sneaked into human hospitals in the middle of the night to get a shot at cross-sectional images through canine gray matter. On-site advanced imaging specific to animals remained a pipe dream.

“The only other thing to do is a cerebrospinal fluid tap. They said there’s a remote chance Shadow’s clinical signs could be due to an infection or inflammation affecting the brain, and if the fluid is abnormal, maybe we could offer some kind of treatment.”