The Gift of Pets: Stories Only a Vet Could Tell (11 page)

“Good morning, Mr. Johnston,” I said, more cheerfully than I felt. I would try to overwhelm him with kindness, “How are you this fine morning?”

The uninterested, somewhat bored expression on his face remained unchanged by my greeting. “I’m not here for pleasantries, if you don’t mind. I’m only here because something’s not right with Thurgood.”

“I’m sorry to hear that. What seems to be the problem?”

“He’s showing a degree of unappetation. And he’s usually a big eater.”

“How long has that been going on?” I asked as I slipped a thermometer into my patient’s rectum.

“Why, exactly, is it that you still insist on using those old-fashioned poobus thermometers?” His reddish face was cast in a pose of sheer ridicule, his unruly hair sliding down over his angry eyes.

“Because I haven’t been able to get my patients to keep a thermometer under their tongues for two minutes yet,” I responded, making a conscious effort not to respond in kind to his attitude.

“You do know they now have thermometers that you just insert into the ear, don’t you?”

“Yes, I’ve tried those and found them not very accurate, I’m afraid. The old tried-and-true methods still work best for me.” I heard the beeping of the digital thermometer and glanced at the readout, then let out an involuntary sigh.

“Is he pyrotechnic?”

“He is pyrexic, if that’s what you mean,” I responded, amused. “His temperature is 105.3 degrees. That’s pretty high for a kitty. How long did you say Thurgood has been feeling bad?”

“I didn’t say.” Mr. Johnston clucked his tongue at me with a disgusted shake of his head. “But it’s been about two weeks now.”

“Okay. And what symptoms has he shown, besides not eating well?”

“Just lying around a lot more, less active, and less interested in things. The weird thing is, he’s been hypersavlivating.”

Mr. Johnston looked at me furtively, measuring my respect for his unparalleled mastery of medical terminology. I was in no mood to indulge silliness, especially from one I knew would just disparage me anyway.

“Hypersavlivating?”

“Yeah, you know. Drooling a lot!” he said, his voice dripping with contempt for my ignorance. “The saliva is really thick and vicious, and it just hangs from his mouth all the time.”

“How can you tell his saliva is vicious?” I knew he meant viscous, but I resisted the temptation to draw attention to his mistake.

“Vicious means thick and sticky and slippery. You should look it up in your medical dictionary when you have a minute.” He laughed derisively, pleased at his naked barb.

“Oh, you mean viscous. Vicious is something else entirely.” I closed the noose with as much innocence as I could muster. “Let’s take a look at his mouth.”

I turned Thurgood to face me and lifted his chin with my hand. Sure enough, a ropy strand of thick, tenacious saliva hung from one corner of his mouth. I lifted his lip and found an area of reddened, enflamed, and swollen tissue around the opening of the salivary duct on his upper jaw, from which the saliva issued. Feeling carefully with my fingers, I could follow the course of the swollen duct as it made its way beneath the skin between the salivary gland and the opening in the mouth. Thurgood didn’t like this probing, squirming in pain as I palpated the gland and the duct. For comparison, I repeated the exam on the opposite side. The duct there was not identifiable; the gland was painless.

“So what’s the diagnosis?”

“Honestly, I’m not sure yet,” I replied, puzzled. “I haven’t seen this type of presentation before.”

“I don’t doubt that. I’m sure there are lots of things you don’t know anything about.”

“That’s very true. But I didn’t say I didn’t know what’s going on. I said I had never seen this presentation before. I think this is a case of sialadenitis. And what you are seeing is ptyalism.” It was time to fight fire with fire. If Mr. Johnston doubted my ability to throw around big words, it was time to lay his fears to rest. And it appeared that my efforts had their effect.

“Si … sinitis?” My salvo had found its mark.

“Sialadenitis. It means inflammation of the salivary glands. And I think that’s what Thurgood has.”

I remembered from my first meeting with Mr. Johnston and Dahmun that he considered himself a linguist and had invented his own language. Perhaps he would have been impressed to know that I had just invented this diagnosis, as well. The fact that I could support the term medically was beside the point. It was a descriptive that certainly fit. This was indeed inflammation of the salivary gland. But I had never before seen the term or the diagnosis printed in the veterinary literature. I was not familiar with a specific syndrome characterized by fever, glandular pain, and excessive salivation. I certainly did not know a cause or a treatment for this problem. Still, the terminology had hit its target and left this man speechless.

“Tie … a what?”

“Ptyalism. That’s a medical term that means excessive salivation. That’s the main symptom of Thurgood’s sialadenitis.” The word just seemed to flow off the tongue now, as if it was a diagnosis that I had dealt with every day for years, rather than one I had just invented.

“What causes it?”

“In Thurgood’s case, I’m not sure. It isn’t seen very often. With his fever, I suspect it’s bacterial. I think we need to do a bacterial culture to see if that’s the case.”

I thoroughly swabbed the opening of the salivary duct with gauze until the hanging saliva strands were gone. Then I massaged the painful gland until more saliva began to flow. With a sterile swab, I dabbed at the duct’s opening, coating the cotton swab with a layer of the slimy material, which I placed into bacterial medium. This I would send to the lab. Hopefully, it would identify whether there was a bacterial infection present and what antibiotic might be effective in eradicating it.

“So that’s it?” Mr. Johnston snorted. “You’re done?”

“Well, it will take about three or four days to get the results of the culture and sensitivity back. It won’t be till then that we’ll know exactly what’s causing the problem and how to treat it.”

“And Thurgood has to suffer until then?”

“I hope not. I will start some antibiotics and some medication for inflammation now. And I hope that will help him. But we may have to change the antibiotics once the culture results come back. I’ll call you when they’re here.”

“Well, you should know that I’m not particularly pleased with your lack of expertise in this case.”

And with that, Mr. Johnston took Thurgood home. I sent along a course of antibiotics for him to give Thurgood and a short course of anti-inflammatory drugs to relieve the discomfort. Four days later, I got the results of the culture and sensitivities back. A very aggressive bacterium was identified, one that was resistant to many types of antibiotics. Fortunately, the particular one that I had sent home with Mr. Johnston was effective.

At the recheck appointment two weeks later, I learned that Thurgood had recovered completely. No longer was he experiencing pain, and the swelling of the salivary gland and duct were resolved. His appetite had returned and his temperature was normal. He was, in all respects, a completely normal cat again. Yet there was a palpable undercurrent of unhappiness as I discussed the case with Mr. Johnston. It was as if this near-miraculous response was a keen disappointment to him; as if he would have preferred his cat to still be suffering rather than have my diagnosis and treatment be right.

To this day, I have never had another case quite like Thurgood’s. I cannot recall a patient with the same constellation of symptoms and physical findings. I have not since diagnosed bacterial sialadenitis, nor seen it in the journals. I still cannot explain exactly how or why Thurgood developed such an unusual problem. But I can look back on a successful outcome to a puzzling case. And there is much satisfaction in that.

For months, though, I seethed inside whenever I recalled the insolence and anger that Mr. Johnston had shown me during the management of Thurgood’s illness. I could have understood the attitude had the patient not recovered completely, or had the medication caused some deleterious side effects. It might be forgiven if the bill had been excessively high or if I had been as hostile and argumentative to him as he had been to me. But none of that had been true.

It is a bit embarrassing how much the frustration nagged at my mind. I vowed that if ever I was presented with one of Mr. Johnston’s animals again, I would be assertive in addressing his demeaning and disrespectful attitudes, and this resolve brought a sense of closure to my troubled mind. Mr. Johnston’s attitude faded from my attention.

My First Veterinary Technician

As the caseload in my nascent practice increased, I needed more help. True, I had a number of staff members by that time, receptionists and kennel attendants. I was no longer walking the dogs during the weekends or mopping the floors each morning. But I did find myself spending more and more time doing things that I could just as easily have delegated to others.

I was the only one, for instance, who could legally give injections, take X-rays, place intravenous catheters, induce anesthesia, or draw blood for laboratory testing. In Virginia, these tasks, many of which are similar to the tasks a nurse does in a human hospital, require education, training, and licensure. Since these were routine procedures in my office, it was necessary for me to devote a significant amount of my time to accomplishing them—time that I needed to commit instead to other patients. I needed a veterinary technician.

At this point in time, I cannot conceive of practicing without the assistance of veterinary technicians. Currently in our hospital, we employ five technicians. They are the ones who really allow my training and skills to blossom. I can see a patient, evaluate its condition, formulate a diagnostic plan of blood tests and X-rays, and prescribe a course of intravenous fluids and a smorgasbord of medications to treat the diagnosed condition. I then turn the patient over to my crack team of technicians and assistants and move on to my next patient. Their work makes my efforts a thousand times more efficient and increases exponentially the care provided to each patient.

When I was first starting out, though, I could not afford to hire a technician. Those tasks fell to me. This worked out okay for a while, when the caseload allowed me enough time to be a technician, as well. But my ability to treat my burgeoning number of patients efficiently was hampered by that lack as the practice grew.

This realization actually hit me full force one incredibly busy day as I was developing an X-ray in the darkroom. In those days, the job required a person to go into a closet-size room in absolute darkness and remove the X-ray film from the cassette, attach it to a metal frame, and dip it sequentially into the three tanks, which contained, respectively, the fixing, rinsing, and developing chemicals. It is much like a photographic darkroom process and requires that these things be done entirely by braille in almost palpable blackness. Because I could not open the door during the two or three minutes the X-ray was in the fixative and developer, the darkroom was often a haven for me during an incredibly busy and stressful day. Regardless of what was going on outside the darkroom door, I knew I had at least three minutes of uninterrupted calm. In the relaxation of complete darkness, I could, for a moment, completely empty my mind. I loved to develop X-rays.

It was at the beginning of this three-minute interlude that day when the receptionist banged on the door and informed me that a very serious emergency had just arrived unexpectedly and my presence was required in an exam room. No minutes ever went slower than those three minutes in the darkroom that day. Before I emerged to treat my patient, I had come to the unmistakable conclusion that I needed to hire a technician.

Unfortunately, knowing that you need to hire one and actually doing so are two completely different animals. At that time in the state of Virginia, we were experiencing a significant shortage of veterinary technicians. The two schools in the state with vet-tech programs were graduating only about sixty or so graduates each year to fill the hundreds of slots in veterinary practices across the state. Most of the graduates were snatched up immediately by practices in larger cities and major metropolitan areas, where salaries were high. My chances of competing with those practices and attracting a technician to tiny little Woodstock were remote. Hourly wages for technicians in northern Virginia and the D.C. area were even higher than what I was able to pay myself at the time.

I placed a call to Dr. Potter, a friend and colleague of mine who headed a veterinary-technician program, one of two such programs in the state. He was not very encouraging, either. His graduates, he said, were in high demand and accepted positions often about a year in advance of their graduation dates. He had no current students who were not already committed to employment after graduation. He suggested that the best course of action would be for me to identify a worthy candidate among my staff to send to school, in the hopes that this person would choose to return to my practice after graduating.

“But that would mean more than a two-year delay in hiring a technician,” I protested.

“You’re right, Bruce, but I think that’s your best hope,” he replied. “And you’d better hurry. Applications for the next class are due next week. If you’ve got someone to send, you’d better get right on it.”

Lisa came to mind even before I had put the receiver down. She had proved to be committed and responsible in her duties, duties that had grown as she had demonstrated her willingness to learn. But she also had some incredibly difficult challenges to consider. She had two children, one in elementary school and one in high school, who demanded a lot of time and attention. She also had very real financial constraints, which might make full-time schooling impossible. Finally, her background as a teenage mother who had not completed high school had left her with real self-esteem issues, which had hampered her ability to reach her potential. Still, I had confidence that all of these barriers could be surmounted if only she’d be willing to try. I called her into my office.