The Gift of Pets: Stories Only a Vet Could Tell (18 page)

“Branson’s really under the weather this time, Dr. Coston. I can’t imagine what got all this started. He was fine earlier in the day.”

“You say he vomited some blood?” I asked.

“Oh my, yes, a whole lot of blood. I can’t believe he could lose that much without it affecting him.”

“Oh, he’s affected all right, Mr. Kovac. Look how pale his gums are,” I said as I pulled up Branson’s lips. They were pasty and white, with hardly any visible pink.

“I just knew he was in real trouble. What do you think is going on?”

“He’s got to have a bleeding ulcer in his stomach for him to lose that much blood. But the question is, Why?”

My mind fumbled for the possible causes of bleeding in the stomach. Regardless of the inciting cause, the bleeding had to be stopped right away.

“Mr. Kovac, this is a serious condition and it needs to be treated quickly. I’ll need your help.”

With Mr. Kovac acting as assistant, I placed an intravenous catheter, started fluid administration, and drew some blood for testing. Mr. Kovac was then dispatched to the corner convenience store for a bag of ice. While he was gone, I anesthetized Branson and placed him on his stomach on the surgical table. After giving him antacids, medication for shock, and antibiotics, I looked over the results of the blood tests. Things were not looking good for the home team. Branson had lost a lot of blood; his red-cell count had dropped to half of what it should have been.

Mr. Kovac returned and I began to flood Branson’s stomach with ice-cold water laced with epinephrine, a medication I hoped would shrink the size of the vessels. My hope was to stop the bleeding by constricting the vessels in the stomach with the medicine and the cold shock. A simple plan, perhaps, but my only hope, I thought. I knew that in his present condition, Branson would certainly not survive an operation, and that was the only other way I knew to stop the bleeding.

The next two hours were spent repeatedly filling Branson’s stomach with the ice water, then draining it out again with a large tube. Little by little, the returning fluid became progressively less red, till finally there was no sign of blood. The crisis was averted, but we were no closer to answering the question of why the bleeding had started. Once stabilized, Branson would still need surgery. But that would have to wait a day or two, until his condition improved.

The next morning I dragged myself, tired and deflated, to the clinic with a feeling of dread. The night had been long and the rest had been short. But more than anything, I feared what I might find. In those days, before there was an emergency hospital staffed throughout the night with veterinarians and technicians, we were left with no options but to leave critically ill patients unattended in the hospital overnight. The following morning I might come in and find a patient either improved or deceased. I wasn’t sure which situation I might find in Branson’s cage that morning. It wasn’t good. During the night, Branson had vomited again. The anxious look was back in his eyes and flecks of clotted blood speckled the bottom of the cage. His gums were just as white as before.

Feeling defeated, I lifted the phone and called the Kovacs’ home. Mr. Kovac answered.

“Things are really no better, I’m afraid.”

I hate this part of the job perhaps more than any other. Not every patient can be saved, despite all our efforts. I know this intellectually and am reminded of it often enough, but each time the emotional sting is still intense.

“I think we need to make some decisions. Can you and your wife come over this morning as soon as possible?”

In the meantime, I took some X-rays and could just detect what looked like a small nodule in the wall of the stomach. Things began to make sense. My suspicion was that Branson had a tumor in his stomach that was producing a hormone that damaged his stomach’s protective lining and increased the acid secretion in the stomach. Over time, the increase in acid had created ulcers, which had bled profusely. I was speculating, of course. Only surgery would confirm my suspicions, and I was sure Branson could not withstand such an invasive procedure. In the examination room, I faced the Kovacs with a heavy heart.

“Things are not looking good for Branson. I think he has a tumor in the lining of his stomach that is bleeding. It may be causing other ulcers, as well. I can’t know this for sure without doing surgery to see if I can remove the tumor and stop the bleeding. The problem is, all the blood loss has left him weak and very compromised. I’m not sure his chances of pulling through even with surgery are very good. But without it, his odds are even worse.”

Mrs. Kovac stood stock-still, her back straight as I spoke. But her eyes didn’t once meet mine and her chin quivered with emotion. Mr. Kovac stooped slightly, his hands clasped behind his back. Each avoided the gaze of the other. The room was quiet for a long time. Then Mr. Kovac spoke in his quiet, measured way, this time punctuated by frequent emotional quavers.

“Dr. Coston, Branson’s been a better friend than most any dog we’ve ever had. Better than a lot of people we’ve known, too. He’s been even-tempered and loyal. He’s been with us at home and kept us company at the office. He helped us raise our boys and comforted us when they left home. Even though we’ve had to doctor those ears and his skin all these years, it’s never been a moment’s bother to us ’cause we love him so much.”

Mrs. Kovac’s eyes never left the spot she had been studying on the tabletop. She was now rocking slowly from toe to heel and back again, the hem of her skirt swaying with the motion. She remained silent, her emotions just barely under control. I couldn’t help noticing a tear drop from her cheek and land on the table as her husband continued his eulogy. She saw the splash as it landed and directed her gaze to the spot of wetness, but otherwise she did not respond to his words.

“You know, Dr. Coston, how much we love him and how much we have done for him in the past. And you know that if we thought he could recover, there is nothing we wouldn’t do for him now.”

Not trusting my voice, I nodded a reply before he continued, which he did after searching my face for any hint of hope or optimism. I could muster none, so I avoided his eyes. He sighed deeply before continuing.

“But I know that part of loving him is being willing to say good-bye, too. Branson is almost fifteen years old and he’s lived every minute of those fifteen years at full bore. He wouldn’t understand it if he had to be throttled down now. Marion and I discussed it on the way over here and I think we’re in agreement on this. We just cannot justify continuing a hopeless fight, especially if his chances are poor either way.”

He paused briefly and glanced at his wife. She nodded her head resolutely but otherwise didn’t move.

“Branson has been a gentleman all his life. He doesn’t owe us anything. But we owe him something now. We owe him the right to say good-bye with dignity and not endure a hopeless struggle just to preserve our selfish emotions.”

There was a pause while all three of us gathered ourselves. Then he continued.

“So we’d be obliged if you’d allow us to be with Branson as you help him along. Would you do that?”

I choked a too-brusque response and fled the room to collect the medication. Through bleary eyes I drew the solution into the syringe, knowing that what would come next would be torture for the Kovacs but release for Branson. Back in the room, I summarized the procedure for the Kovacs so that they would know just what to expect. Then I slipped the needle into the hub of the catheter and squeezed the plunger on the syringe, sending the blue solution into Branson’s vein. His strained and anxious eyes relaxed for a brief moment before the spark of life left them. The muscles of his hard, tense abdomen eased their grip of pain. I knew Branson’s suffering, pain, and discomfort were finally over. But the knowing didn’t change the burden of loss and sadness.

The Kovacs continued to lovingly caress Branson’s coat and smooth the graying muzzle long after I listened to the rhythm of his heartbeat fade. As I left the room, with those two lovely people bent over the still form of their noble friend, I heard Mr. Kovac in his quiet, now-choked voice whisper his last thoughts to his dog.

“Thanks, Branson. You’ve been quite a friend.”

An hour later, after I had somewhat regained my composure and the Kovacs had paid their final respects, I picked up the record for my next patient and walked into the same room the Kovacs had vacated. This would be, I thought, a much-needed reprieve. Mrs. Allen was bringing her new puppy to see me for the first time. This would be a happier appointment than her last one. She had finally adopted a new puppy after losing an ancient shih tzu to cancer several months previously. I was eager to meet the new addition to the family.

But when I opened the door to the room, Mrs. Allen’s eyes were brimming and red. I knew that sometimes the first visit after a traumatic loss can bring back painful memories. My first reaction was to reach around the exam table and give her a comforting hug. After she pulled away, somewhat embarrassed, she nodded to the whiteboard on the wall that I used to draw medical illustrations for my clients.

“That just brought back everything,” she said by way of explanation.

I turned around and looked at the board. There in a faltering hand were written these words: “Thank you so much for understanding and caring. We loved Branson so much. The Kovacs.”

The Complacency of Routine

In the course of my practice, some things are done so frequently that they become routine. This is true, no doubt, in all professions. I suppose it is routine, for instance, for Tiger Woods to nonchalantly flip a golf ball out of a deep sand trap to within a few inches of the hole, or for Michael Jordan to fake a drive and instead put up a jump shot that hits nothing but net just at the buzzer. It is routine for Michael Phelps to slice with such speed through the water, pushing his body to shave off that extra hundredth of a second and set a new world record. For world-class athletes, their feats are routine because they have done them countless times before. For me, surgical sterilization is a routine task. I suppose I have performed many thousands of spays over the years. I could probably spay a dog or a cat in my sleep.

But the truth is that there is really no such thing as a routine medical procedure. Each time I make a spay incision, I remind myself that, for this patient, it will probably be the most dramatic event of her life so far. What is routine for me is definitely not routine for my patients—or for their owners. The challenge with routine surgeries is to remember that at any moment it may become a complicated, life-threatening emergency. Consequently, I, must maintain meticulous attention to detail and strict adherence to correct protocol. Muffin was an example of just how quickly things can change.

Muffin was a twelve-year-old Yorkshire terrier owned by the Ardens, who doted on her altogether too much, though neither Muffin nor her owners would have admitted it. Mr. and Mrs. Arden were the quintessential American retirees. He was perhaps in his eighties when I first met him, of medium height, with puffy eyes and hair fixed into position with Brylcreem. He wore wire-rimmed glasses and polyester slacks. Generally, he was pleasant to deal with. His wife, a short, worried woman with bluish hair and a thin face, was a few years younger than her husband and had clearly left the details of life to him for decades. The pair had, unfortunately, lost a bit of their sharpness with age, usually breezing into the office with Muffin tucked into the crook of an arm. They seldom had an appointment, though they always distinctly remembered having made one.

Their befuddled approach extended to Muffin’s health as well, making her preventive care a bit haphazard and their office visits challenging. I learned, for instance, that trying to garner a history from them was an impossible task, as they would invariably veer sharply away from my question to subjects far afield from the topic at hand. To their confusion was added a significant degree of hearing loss—his worse than hers—which was accentuated by the shrill whistled duet of their hearing aids. Until I figured these things out, conversations with them about Muffin’s issues toggled between confusing and downright amusing.

“So, have you had any health concerns with Muffin since I last saw her?” I would ask innocently.

Mrs. Arden would look at me, confused, then begin fiddling with the volume on her hearing aid. With utmost confidence, Mr. Arden would fix me with a benevolent smile and say something like “You, too! Thanks for the compliment.” Then he would slap me good-naturedly on the shoulder, chuckling.

“Jim, I think he was asking about Muffin,” Mrs. Arden would bay, pointing repeatedly at the little dog in his arms.

“Yes, Lovey, that’s why we’re here.” And then they would both look at me expectantly, smiling sweetly.

I’d try again at higher decibel levels. “So has everything been going okay with Muffin?”

“Oh yes, yes,” he’d respond, “without any trouble at all. And almost every day for the last two or three weeks.”

“Almost every day, what?”

“What’s that you say?”

“You said she had done it almost every day. Done what?”

“Sure has!” he’d reply. “But that’s no different from before. She’s always done that.”

“Done what?”

And Mr. Arden would throw his head back and laugh appreciatively, like I had just told his favorite joke again. Who knows, maybe I had. Usually at some point during the appointment, they would get around to describing their concerns and I would be able to get across to them the most salient of Muffin’s health-care instructions. Some days were definitely better than others.

I took to just looking at the record and administering whatever vaccines or tests were due, giving Muffin a thorough physical examination and prescribing any necessary medications. I always made sure the directions were clearly printed on the easy-to-open vials. This seemed to work best and always satisfied the Ardens, who would shake my hand appreciatively and trundle Muffin back into the car.

Though it was often unclear just how much of the information I gave them truly sank in, there was no doubt about how much they adored Muffin. They showed their devotion to her in the loving attention they paid her and the frequent visits to our office. In the many times I saw her, never did I see her feet hit the floor. Mr. Arden carried her everywhere, tucked like a purse into the crook of his arm.