The Gift of Pets: Stories Only a Vet Could Tell (4 page)

I carried Greco to the X-ray room, where he bravely submitted to having pictures taken. A stark white object stood out as if in relief at one end of a dark tubular shadow in the abdominal cavity. Greco did indeed like to “chewa de rocks.” This one was obstructing his bowel, trapping gas behind it, and painfully ballooning the intestines. I knew that surgery would be necessary.

I set Greco back on the examination table. He immediately resumed his painful posture, staring at the wall as if engrossed in must-see TV. I turned to Mr. Toumopoulis.

“The X-rays show an intestinal foreign body—probably a rock. It means we should go in surgically and remove it. I don’t think this should wait. I’d like to do the surgery right away.” I could see Mr. Toumopoulis’s dark eyes flare with concern for his friend and suspicion of me.

“Ju theenka he need be cut hopen?”

“Yes, I do.”

“He be hokay?”

“Not without surgery. And the sooner the better.”

He eyed me uncertainly, apparently convinced of neither my diagnosis nor my capabilities. Finally: “Ju do thees … cutting before?”

“Yes, I have, Mr. Toumopoulis.” I tried to be as reassuring as possible while at the same time maintaining a healthy realism. This was a serious condition and the risks were very real. “You must understand that Greco is seriously ill, and though it’s unlikely, it’s possible we could lose him during surgery. But without it, we’ll lose him for sure.”

Mr. Toumopolis studied the floor for a few moments, his dark eyebrows furrowed, almost meeting in the middle over his prominent nose. His hand ran over Greco’s head, absently tracing the dog’s forehead and ears. Greco didn’t respond to his touch.

In the end, it wasn’t my urging that finally convinced Mr. Toumopolis. It was Greco’s quiet grunt of discomfort that brought him around. With a conflicted mixture of resignation and conviction, he turned to face me.

“Hokay, Doctohr. Ju go do cutting now. I waita for ju to call.” He turned to go.

“Mr. Toumopoulis!” I stammered out too quickly. “There’s something else.”

When it comes to my practice, I hate more than anything the need to discuss the financial aspects of treating my patients. Human physicians, understandably, do not have to contend with financial constraints in the treatment of their patients. Veterinarians, on the other hand, are accustomed to these considerations and are always prepared to include financial matters in their discussions about treatment. Throughout my entire career, I have understood the importance of communicating clearly the expected costs of treatment. Few people are situated financially such that these discussions are unnecessary.

Strangely, it is perhaps these discussions that have made it possible—necessary, in fact—for the veterinary profession to remain the best value in the field of health care. In human medicine, with a massive percentage of costs accrued within the last weeks of life, including incredibly expensive diagnostic testing and budget-busting pharmaceuticals, costs have escalated exponentially—costs that are largely invisible to those who actually receive the services.

This is not so in veterinary medicine. Costs for care are borne directly by the ones who must make the decisions about health care. And each individual must consider the costs and the wider implications of those costs on families and loved ones. These factors have forced us to keep the costs for significantly sophisticated care to a fraction of those for similar human care. This is true even though the costs to a veterinary practitioner of providing services are higher than those for the typical family-practice physician. While physicians can refer their patients to the local hospital for X-rays, blood work, a sonogram, surgery, and hospitalization, we veterinarians must provide those capabilities in our offices and still somehow keep the costs manageable for the clients.

I turned to Mr. Toumopolis with resignation, knowing this part of the discussion was never fun.

“You need to know that surgery could be fairly expensive. For some people, that is a consideration. The business office can give you an estimate for the fees and arrange payment options if necessary. So I’ll need you to—”

My words were interrupted by a flash of unhappiness in Antonio’s dark eyes. “No … No … No…” Each word was punctuated by the jabbing of a thick finger in my chest. Then Antonio’s eyes lightened and he addressed me in a rhythmic, almost musical cadence. “I tella ju vhat. Ju teka de responsibility to fixa de dohg; I teka de responsibility to paya de bill.”

And that pretty much settled it. I accepted his terms and began work on my patient. Greco was hospitalized, and a large catheter was placed in his leg, through which we pumped fluids into his vein. His head sank in sleep as I pushed the anesthetic into the catheter before slipping a large plastic tube into his trachea, which allowed me to control his breathing and provide the anesthetic gas.

During surgery, I removed a man-size rock, which Greco had consumed during his macho play. It had lodged fast in the small intestine, obstructing the passage of all gastrointestinal contents. The section of intestine containing the stone, now stretched and bruised to a dark purple, had sustained irreparable damage and had to be removed. But after an hour and a half of tedious suturing, I pulled the gloves off my hands and surveyed the neat row of sutures closing the eight-inch-long incision on Greco’s tummy. Surgery had gone well and I was confident that Greco would recover fully.

No sooner had Greco opened his eyes after surgery than he was trying to stand. Within another ten minutes, he was staggering drunkenly toward the door. His sentiments and intentions were unmistakable. “Thanks, Doc,” he was saying. “You did good. I’ll take it from here. See ya later.” We literally had to tie him down till he was fully recovered.

Greco went home the next day, much earlier than most patients do after such invasive surgery. Antonio was pleased that his dog had done so well, and, as agreed, he paid his fees in full with crisp, fresh bills.

I often think of Greco and Antonio. No one before or since has so clearly articulated the contract between myself, my clients, and my patients. It is indeed a sacred trust to have in my care the object of someone’s love and devotion. It’s a responsibility that is sometimes simple, sometimes tough, sometimes funny, but always full of emotion—hope or sadness, joy or pathos. Some patients, like Greco, recover fully and never look back. Others never improve, stubbornly immune to even our best efforts. Some diagnoses are as stunningly obvious as Greco’s stone. Others are unclear and remain just beyond comprehension, straining our knowledge and experience to fit the pieces of the diagnostic puzzle together.

Throughout the meandering course of each case, though, I am aware of the bond between the patient and its person, the owner’s paralyzing fear of loss, the level of trust being placed in me. And I am reminded again to “teka de responsibility to fixa de dohg.”

Milk Fever

All veterinarians can look back to their past and identify a veterinary mentor who fostered their interest in the profession, acted as an adviser and often an employer, and wrote letters of recommendation for admission committees the country over. Mine was Dr. Virgil Boyd, a mixed-animal practitioner in the small farming community of Hutchinson, Minnesota, where I attended high school. He did all of those things for me and more. I worked for him in his clinic in the mornings and attended classes in the afternoons. To this day, I owe Dr. Boyd a huge debt for the interest he invested in me and the experiences he provided.

Dr. Boyd seemed to me, at the age of seventeen, to be a man of considerable intellect, wisdom, and age. Given my age now, I recognize that he was not really very old at all. But at the time, I viewed him as nearing retirement. This misperception seems especially ironic now, since Dr. Boyd, well into his eighties, with a full head of gray hair and a regal beard of the same hue, is still a solo practitioner in Hutchinson. I visited him at his clinic last fall when I attended my thirtieth high school homecoming weekend.

Rural Minnesota is populated by a unique breed of people. Minnesotans are a hardy, self-sufficient, and thoroughly dependable people who are firmly grounded in the values of hard work, family, country, and God. Every community, regardless of size, has at least two things: a grain elevator and a thriving Lutheran church. Every self-respecting Minnesota Lutheran, as a way of life, will go out of his way to help a stranger. They do this as an outgrowth of their strong Christian values, of course. But they also do it with an ever-present knowledge that in the clutches of a cruel Minnesota winter, a person in a broken-down car will in short order become a Popsicle without the assistance of his neighbors. They are also acutely aware that their own car could break down.

Minnesota Lutherans are honest, sturdy, guileless, and strangers to coarseness. This is not to say they are prudes. The earthy conversation in most milking parlors includes descriptions of bovine waste products that in any other setting would be considered swearing. But for farmers who spend their lives shoveling the stuff, it is more professional terminology than expletive. Most devout Minnesota Lutheran farmers would sooner slice off their own leg than unleash a barrage of ear-burning curses.

Dr. Boyd was not a tall person, but he was large in every way. He was barrel-chested, with a prominent stomach. He had a huge head with a wild shock of prematurely graying hair set on top of his head like the flame of a torch, uncontrollable and waving indiscriminately; and similar to dealing with a flame, he made few attempts to constrain it. He had a large beard with streaks of gray in it that looked to be contaminating their surrounding neighbors. Even his glasses were large and dark, with huge lenses. These and his immense personality gave him an impressive presence.

Dr. Boyd was not a farmer, and he did not share a burning religious fervency. But he was a Minnesota Lutheran veterinarian serving Lutheran Minnesota farmers. Any good Lutheran knows that justification is the work of a moment. But sanctification is the work of a lifetime, and this process in Dr. Boyd was not yet complete. Though he was a churchgoing man, I had seen on occasion his penchant for emotional explosions and colorful language when things fell apart unexpectedly. Heaven knows, I had once been the recipient of a verbal volcano when I had accidentally broken the glass barrel of a syringe he needed for his next farm call. Despite these idiosyncrasies, he was adored by the farmers in the community. I looked up to him immensely.

I knew he knew this about me. And it was clear that he took his responsibilities as my mentor seriously, carefully instructing me in lessons of animal husbandry, veterinary career choices, and a life well lived. I accompanied Dr. Boyd often on his rounds in the truck, careening around the county at top speed down roads piled on each side with mountains of salt-slicked snow, like the dry ground in the Red Sea upon which the children of Israel crossed. Every large animal veterinarian I know drives the back roads like a drunken soldier on the last night of furlough. This is essential, it seems, as every farm call is considered by the farmer to be an emergency. Besides, more calls can be crammed into the span of time between sunrise and sunset when they are done at full throttle. Though I would be wise to follow Dr. Boyd’s example in navigating life, I would be a fool to navigate country roads as he did.

I was not permitted to attend Dr. Boyd on his rounds until he had escorted me to the local dry-goods store and outfitted me with a pair of blue coveralls and rubber boots that fit over my shoes. The fact that the boots were rubber allowed me to scrub them carefully before leaving every farm. I doused them with a solution of warm water, which he dispensed from the tank in his Bowie veterinary box, mixed with the dark green and luminously scented disinfectant Roccal. So much a part of rural Minnesota veterinary practice was this ceremonious cleansing that every mixed-animal practice I had ever been in smelled strongly of Roccal, a pervasive medical smell with a lingering metallic odor. To my mind, it is still what the color green smells like.

Whether this habit truly prevented the spread of contagious diseases between farms or was merely a way for Dr. Boyd to impress the farmers with his thoroughness and keep the interior of his truck clean, I really don’t know. But I can still picture him sitting on the tailgate of his truck, one leg thrown carelessly across his knee while sloshing the Roccal solution over his muck-covered boots with a blue-bristled brush, his head glistening with sweat and the frost from his breath circling around his head as he chuckled easily with the farmer. It was an entirely comfortable and wholesome scene.

The time I spent in Dr. Boyd’s truck was invaluable for me. I had no previous cattle experience, so each trip was filled with new occurrences. I particularly remember one perfectly clear and bitterly cold day in late January. I had classes in the afternoon and was scheduled to accompany Dr. Boyd on three farm calls that morning. I had arrived early at the office, an old house situated one block off Main Street, to clear the empty glass bottles out of the truck from the previous day’s calls and replenish the sundry supplies and medications. I was just pulling on my coveralls as Dr. Boyd drove in and approached the truck, carrying a steaming Thermos of hot coffee.

The first call was to a farm on the northwest end of town. I was relieved to see that the patient was standing in a thirty-by-forty-foot pen in a building that was enclosed on three sides and well protected from the northern arctic wind that blew easily through even the thickest layers of clothing. On one end of the pen, the fences narrowed to a chute with a head gate that immobilized the cows, enabling us to safely examine them. On the other end, there was an acute angle in the corner where the fences met. Our patient was a yearling Holstein heifer standing in the middle of the pen with a foot held up awkwardly, the skin around the top of the hoof red and swollen.

“Bruce,” called Dr. Boyd as we approached the pen, “go on in there and chase that heifer into the chute so I can catch her head. We won’t want to deal with that foot without some restraint.”