“No, mate. No way. We don’t have any drugs.”
Sally let out a breath and tried again. “Anything you say here is confidential, Mrs Harris. That’s part of the vet-client relationship. I’m just here to treat your dog. That’s all. And it looks to me like your dog has probably had some marijuana. Could that be right?”
The woman rubbed her face and coughed. She seemed to be having more trouble focussing her eyes on Sally than ever, and she was steadying herself against the wall. It was ridiculously obvious that she was stoned, but she still said, “Nah. We don’t have any mull. I’m not into that crap. No way.”
“No chance at all?”
“Uh ... well, we did have a party last night.”
“Oh?”
“Yeah. I dunno what kind of shit me husband’s mates might have brought over. Maybe Chookie could have got something from them. I’ll tell you what, mate, if he did, I’ll kill those bastards.”
Sally wondered why these people always kept up the pretence. It would be so much easier if they would just tell her the truth, that the dog had no doubt gotten into their marijuana stash, or – worse still – that they had fed the dog the drug deliberately, for a joke. “So, if he got anything, it would have been last night, not this morning?”
“Yeah. Must have been.”
Sally knew the woman was lying. The dog looked to be in the acute stage of poisoning. It probably got into their stash that morning. “Right, Mrs Harris. Leave him with me. We’ll put him on a drip and wash the poison out of his system. Give us a call at lunchtime to see how he’s going.”
“No worries, mate,” said the woman.
Sally carried the puppy out to the treatment room.
“Parvo?” Heather inquired.
“Marijuana poisoning,” said Sally. “Can we set up for a drip, please? We’d better get him on some IV fluids right away. He must have gotten into their stash, but he’ll be okay.”
“Poor little bugger,” said Heather.
“I know. It makes me sick.” Sally patted the little dog.
Sally’s first days in practice seemed to pass so quickly, they were just a blur to her. There was always something happening, and usually several things happening at once. It was stressful and tiring, but she felt a sense of achievement at being a practising vet at last.
One morning, a week after she had started at the practice, she met one of the nicest clients she had ever come across, an elderly man named Gerald Freeman, and his wife, Margaret. They had not been to the practice before. Sally met them in the consulting room, where Mr Freeman had a small, white Maltese Terrier cradled in his arms. The happy little dog seemed to be smiling up at its owners, but it looked a little tired, not quite the bundle of endless energy that one expected in a small terrier.
“Good morning, doctor,” said Mr Freeman.
“Good morning,” said Sally. “What can I do for you, today?”
Mrs Freeman spoke up. “This is our little darling, Muffy. She’s a bit spoiled, but she’s a good little dog. We ... we wanted to come to you for a second opinion.”
“Oh?”
“Yes, she’s not been eating well, the last month or so, and she’s not getting any younger – she’s eleven, now – and then she started to vomit. We were worried, so we took her to see the vet on our street and he said she had liver disease.”
Sally knew the clinic. “Did they do blood tests?”
“Yes,” said Mr Freeman, continuing for his wife. “But we weren’t really happy with they way they treated Muffy. They just didn’t seem to care. And she’s lost so much weight. We wanted to see if there was anything else that could be done for her. I hope you don’t mind us coming to see you.”
“No, not at all.” For reasons of professional courtesy, as well as to learn more about the case history, Sally would later telephone the original vet to discuss the case. “It’s often easier for you to stay with your own vet, since they know the case already, but you are welcome to get a second opinion from us, if you like.”
“Well, doctor, it’s just that we weren’t really happy with our other vet. Maybe it was just that we didn’t like his bedside manner, but we’d rather not go back there.”
“Oh. Well, we can look after Muffy for you. That’s no problem.”
“Thank you,” said Mr Freeman.
“We’d like that,” said his wife.
“Do you have the blood results with you?”
“Yes.” The old lady opened the manilla folder she was carrying, took out some printed lab results and passed them to Sally.
Sally cast an eye over the results. “Her liver certainly is in trouble. These two enzymes, here, ALT and alkaline phosphatase, are quite elevated. And there’s a lot of inflammation, judging by the high white cell count. So, she does have liver disease, or hepatitis. And there might also be a little trouble with her kidneys, too. See here?” Sally pointed at the chart. “Her levels of urea and creatinine are higher than normal. They’re toxins which healthy kidneys normally get rid of. So there is a bit of a problem with the kidneys, too, as well as the main problem with the liver. How is she eating?”
“She just picks at her food,” said Mr Freeman.
“Right. Let’s have a look at her, then.” Sally took the dog from his arms. It was a friendly little creature, with a shaggy, white coat which smelled pleasantly of having just been shampooed. The little dog rolled over on the examination table. Sally rubbed its belly. “There you go, Muffy. You want a tummy rub, eh? You’re a good girl.”
The two old-age pensioners looked on, anxiously.
Sally could see the dog’s belly was enlarged, near the front. When she pressed on it, it was a little tender. The dog looked relatively healthy otherwise, except for being a little thin. “Well, her liver does seem enlarged, I’m afraid, and it’s a bit uncomfortable, too – not actually painful, but tender. It does look like she’s got hepatitis. The good news is that there is no jaundice. See the whites of her eyes, here, and the colour of her gums? They aren’t yellow. That’s a good sign. It means the liver isn’t as bad as it could be. And she’s not dehydrated, either. She could be a lot worse than she is.”
“Oh, thank God,” said the old lady. “The way the over vet was talking, we thought she was going to die.”
Sally thought carefully before answering. She knew that liver disease in an eleven-year-old dog could well be fatal in the long run, but she didn’t want to scare the owners too much. “Well, she isn’t too bad at the moment, which is great, but liver disease is a serious problem, and eventually, as the months and years pass, it can be the end of them if it gets worse.”
“We understand that, doctor,” said Mr Freeman. “But what’s caused this? She’s had all her vaccinations. We thought they were supposed to protect against hepatitis.”
“Hmmm. Yes, we vaccinate against canine infectious hepatitis, which is caused by a virus. That’s the one that mostly affects younger dogs, but we don’t see much of it, these days, since most dogs are vaccinated. But hepatitis can be caused by other things, apart from a virus, and a lot of the time we don’t know what the cause is. Sometimes it’s just something that comes on with old age.”
“You mean, like cirrhosis?” said Mrs Freeman.
“Something like that. Sometimes an old liver just starts to shut down and becomes scarred and inflamed. In people, it’s often due to too much alcohol, but in dogs we’re not sure what the cause is, other than old age.”
“So, what can we do about it?” said Mr Freeman.
“Well, it’s been two weeks since these tests were taken. I think it might be an idea to repeat the blood tests and see if things are getting better, getting worse, or are just the same. And we sometimes get an improvement by putting them on an intravenous drip for twenty-four hours, to flush out toxins from the system, as well as placing them on antibiotics in case there is any bacterial component to the hepatitis. I think we should look at doing all of that.”
“You do whatever you think is
best, doctor,” said Mrs Freeman. “We just want to see Muffy well again. She’s a dear little dog. She’s ... she’s all we’ve got, you see? We’ll do whatever it takes. We just want to get her well.”
Sally hated to be negative, but she felt she had to gently caution their optimism. “Of course. We’ll do everything we can, and I think we can get her to improve quite well. But ... liver disease can get worse, and, if you are really unlucky, it can sometimes even turn out to be due to a cancer. So, we have to be prepared that sometimes we can get bad news.”
The old couple looked horrified, but they tried to be brave. Strangely enough, it was the old man, rather than his wife, who most looked on the verge of tears. Perhaps she just hid them better than he, thought Sally. The old man spoke. “We understand, doctor.”
“All right, then. Leave Muffy with me and we’ll get started right away. She’ll probably feel much better after spending a day in hospital on fluids, and then we can get her home again tomorrow. And we should have the lab results by then. Could you come in tomorrow morning and pick her up?”
“We’ll be here,” said Mr Freeman.
“Great. I’ll see you then, and don’t worry, we’ll take good care of Muffy for you until tomorrow.”
“Thank you, doctor,” said Mrs Freeman.
“It’s Sally.”
“Thank you, Sally,” said the old man, as the couple left. He cast one final look at his beloved dog. “We’ll be back for you, Muffy.”
The little dog didn’t seem worried. It was too busy making friends with Sally. She carried it out to the treatment room. Here, with the help of Michelle, Sally took a blood sample, set the dog up on an intravenous drip, and gave it injections of an antibiotic and of a multivitamin, before settling it down in a comfortable hospital cage.
“Cute dog,” said Michelle.
“Yeah. Isn’t she lovely?” Sally replied.
“What’s wrong with her?”
“Liver disease. And kidney trouble, too. We’ll need to get these bloods off to the path lab, right away. Can you do that for me?”
“Sure,” said Michelle.
“Thanks.” Sally rushed back to the consulting room. There was still a waiting room full of people to deal with, and a full surgery list. There was no time to stand around. She was already running behind.
By seven o’clock that evening, Sally was exhausted. She had been busy all day and had done several surgeries. As she finished her last consultation for the day, the evening nurse, Petra, called out from the treatment room. “Hey, Sally. We’ve got the lab results for the little Maltese. The lab just faxed them through.”
“Okay,” Sally called out, and walked through the treatment room to the small office at the back of the clinic. When she read the results, she was pleased. The liver enzymes weren’t any worse than before – in fact, they were slightly better. And the kidneys seemed a little better, too. The next day, when the Freemans came in to pick up their little dog, it would be with the good news that at least things were no worse, and that indeed Muffy had picked up overnight with the fluid therapy and had eaten a solid breakfast.
But, for now, Sally was just glad the long Tuesday was over. What she wanted and needed, more than anything, was sleep.
It was after ten o’clock when Sally finally fell asleep. She had checked Muffy and the other animals in the dark, deserted hospital, and then retired, at last, to bed. Sleep was wonderful, when it came, but an hour and a half after she fell asleep, the loud buzz of the clinic telephone woke her.
Feeling almost in pain, having been roused suddenly from a deep sleep, Sally groaned as she reached across her bedside table and grabbed the phone. “Emergency after-hours service. How can I help you?”
“Yeah. G’day. Is that the vet?”
“Yes, this is the vet. What’s the problem?”
“Yeah, right. Well, how are you this fine evening, and all that?”
“I’m fine,” Sally growled. “What’s the trouble?”
“I’ve got a dog.”
“Yes.”
“Well, he’s been vomiting pretty bad.”
“Vomiting?” Sally was barely awake. She had to force her tired mind to keep up with the conversation. It wasn’t easy.
“Yeah. I feed him, and then he chucks up.”
“I see. And is he still pretty active?”
“Oh, yeah. I took him for a big run, today.”
“And has he lost any weight?”
“Nah. He’s a fat bugger.”
“So, does he hold down any of his meals?”
“Oh, yeah. He just chucks up sometimes. Not every day.”
“For the last two weeks?”
“Yeah, that’s right. For a coupla weeks.”
Sally looked at the fluorescent hands of the little alarm clock by her bed. It was midnight. Why, she thought, desperately tired, did this drongo have to ring her at midnight, when his dog was bouncing around happily with a mild stomach upset which was no kind of emergency at all. “Right. It’s probably a stomach upset. Can you bring him in, in the morning.”
“Oh, yeah. I can do that. What time do you open?”
“Nine o’clock.”
“Righto. We’ll be there, then.”
“Goodnight,” said Sally, as she crashed the receiver back down. She couldn’t believe she had been woken up for that. It took her twenty minutes to get back to sleep, feeling vaguely sick all the while. But at last she found the peace of sleep once again.
When the telephone rang the second time, it was three-thirty in the morning. Sally came suddenly awake, feeling genuinely ill this time, and found it impossible to answer the phone with more than a few slurred words. “After-hours service.”
An excited voice, the voice of a young woman, said, “Hello? Oh, Thank God. My dog’s been hit by a car. He’s bleeding ... I don’t know what to do.”
Sally managed to clear her drowsy mind. “Right. Okay. Is he able to stand up, or is he just lying down and not moving?”
“He ... he’s standing up. But there’s blood ... I mean, he’s bleeding. And I think he’s broken his leg.” The woman began to cry.
Sally replied as calmly as she could. “All right. As long as he is standing up and moving around, that means he isn’t in shock, so you don’t have to be too worried, but I’d like you to use a cloth or a bandage to stop the bleeding. Where is he bleeding from?”
“It’s his hind leg. There’s a cut ... and I think it’s broken.”
“Okay. All right. Now, you don’t have to panic, because he’s going to be all right. We can fix broken bones. If you can just pop him in the car and bring him down to the clinic, we can give him something for the pain and settle him down, right away. Okay?”
The voice seemed less hysterical. “All right. I’m leaving now. I’ll be there in five minutes. I’m just up the road.”
“Okay,” said Sally. The line went dead.
Sally put down the phone and switched on the bedside lamp. The light blinded her. She hauled herself out of bed and pulled on some jeans and a jumper. The client would be here soon, she thought. She had better go through to the hospital and set up an intravenous drip and a cortisone injection to prevent shock, before the woman showed up.
When the client arrived, banging on the front door of the clinic in the darkness, Sally went out to the waiting room, opened the wooden front door of the clinic to see the young woman and her dog, a German Shepherd, and let them in. The woman thanked her profusely, when Sally explained that the dog had a broken femur but that the bleeding wasn’t serious and that he would be fine. Sally got the woman to help her, as she put the dog on an intravenous drip and gave him an injection of dexamethasone to prevent shock, and she explained that tomorrow she would take an X-ray in order to determine exactly what kind of fracture it was and how best to repair it. Sally locked the front door again, once the woman had left, and wandered out to the treatment room, where the dog occupied one of the large floor-level cages. The young German Shepherd st
ill seemed agitated.
Sally decided that this was a dog that needed pethidine, to better control the pain from its broken leg. She went to the clinic safe and got the pethidine bottle and the drug book. She filled out a line in the book, to indicate that she had withdrawn two mls of the powerful drug from the bottle into her syringe, and signed her name. Pethidine was a wonderful drug for pain control. In animals it had less side effects than the more familiar opiate, morphine, which was such an effective painkiller in humans. Like morphine, pethidine depressed the respiratory system and at excessively high doses could even result in a sick patient getting drowsy, falling asleep, and stopping breathing. Also like morphine, pethidine was an addictive drug, one which produced pleasant feelings of relaxation in human beings, and so its use had to be carefully controlled by keeping a logbook and signing out every injection. Even so, the easy temptation for vets or their nurses to abuse drugs was always high, and Sally had heard of one or two who had become drug addicts. For this reason, most clinics no longer carried addictive drugs, and used non-addictive alternatives instead. After all, clinics were sometimes broken into by junkies in search of a hit. It wasn’t worth the hassle.
But Sally was glad that this clinic did stock pethidine, because the dog needed it. As she injected the painkiller into the dog’s quadriceps muscle, she knew that in fifteen minutes, and for the rest of the night, the dog would feel relaxed and comfortable. The pain would no longer bother the dog because it would be merely a dull, almost insignificant ache instead of a sharp, searing pain. That was the characteristic of all the opiates, like morphine and pethidine: the patient could still feel a little of the pain but would no longer be bothered by it. The patient would feel comfortable. And there was no risk of respiratory arrest at the low dose that Sally gave the dog. She would have to give quite a bit more of the drug for that to occur. At the dose she was using, the drug was perfectly safe. Sure enough, ten minutes later, the dog calmed down. Satisfied, Sally went back to bed.
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