“We understand,” said Mr Gianelli.
“Do you want to say goodbye to Giotto?” said Mrs Gianelli, to her children. There were tears on her cheeks, but she was trying to be strong for the kids’ sake. “Say goodbye to him, Giovanni. Give him a little pat, that’s right. Say goodbye to him, Susi.”
Mr Gianelli had to hold his daughter up, so she could get high enough to say her farewells. The tearful boy and the confused little girl patted their dog and said, “Goodbye, Giotto,” in soft voices.
Mr Gianelli stroked the dog’s neck. “Goodbye, mate.”
Mrs Gianelli was embarrassed. She was crying outright, now. “You’re a good boy, Giotto,” she said, and then she turned to Sally. “Sorry, you must think I’m so silly, getting upset like this.”
Sally put a hand on her shoulder. “No, of course not. Everyone cries, everyone does. It’s not easy, I know.” And then Sally cursed herself. Damn it, she thought, now I’m starting to cry! Sally felt tears welling up in her own eyes. She was losing her composure. It was the long day that had done it: putting ten dogs to sleep at the pound, and then putting to sleep the savage Blue Heeler and the dying rabbit earlier that evening, and now this lovely family, standing here, and their uncontrollable grief, it was just a bit too much for Sally to take in one day. A tear rolled down her face. She wiped it away and tried to concentrate.
“Okay, then. Heather’s going to hold up the vein for us,” said Sally.
Heather Lorayne stood beside the dog, which was on the examination table, and gently held its right foreleg in her hand, squeezing her thumb down to occlude the cephalic vein.
Mrs Gianelli continued to pat the dog, gently, as Sally prepared to inject the anaesthetic. The rest of the family stood back and watched.
“I’m injecting the anaesthetic now. He’s going to get sleepy and he’ll just relax onto his blanket in a few seconds.” Then Sally whispered to the dog as she injected the anaesthetic. “There’s a good boy, Giotto. Good boy. You’re a good dog. That’s the way. Off to sleep, now. Good boy.”
As if on cue, the little dog totally relaxed. It put its head down and, at once, was fast asleep. There was no sign of any stress or anxiety at all. Giotto just peacefully went to sleep and that was all.
Heather Lorayne walked out, quietly, and left Sally with the family, since she did not want to intrude any further on their privacy.
Sally gave silent thanks that it had gone well. It was difficult to stay focussed, under so much emotional pressure, and sometimes she could miss the vein and have to try again, but she had done everything perfectly. And there was no gasping. It was a textbook euthanasia. The little dog had passed away humanely and its suffering was over.
Everyone was crying now, the children, their mother, and even their father. Suddenly, Sally felt tears in her own eyes again, and this time they wouldn’t stop. She cried with them. It was unprofessional, and she was annoyed at herself, but, for once, she couldn’t help it.
Suddenly, Mrs Gianelli reached out and squeezed Sally by the wrist. “Thank you, doctor,” she said, crying. “Thank you for all that you have done. You are a good person.”
Sally felt like she would burst from sadness and emotion.
Then Mrs Gianelli quickly turned and led her family out of the consulting room, leaving the little dog’s limp body on its blanket on the examination table. The body looked completely peaceful.
Sally stood there for a few minutes and allowed herself to cry.
When the last appointment finally came, it was 7:15 pm. Sally was running a little late. But it was not a consultation she was looking forward to. She was still upset from putting little Giotto to sleep, an hour earlier, and now she had to face yet another euthanasia. It would be the fourteenth animal she had put to sleep that day.
Still, it had to be done.
Sally strode out to the waiting room and called in the Polanskis. Mrs Polanski was a short, plump old lady in her early eighties, dressed rather severely in a tatty, black sweater and an ancient pair of dark blue tracksuit pants. She was a humourless old lady. Her middle-aged daughter and she did not get on. Sally dreaded the inevitable confrontation to come, as she showed the two of them into the consulting room. The old woman held a diminutive Siamese cat in her arms, defiantly, as if she were not going to let it go. Even from a distance, Sally could see the cat was little more than skin and bones. Its coat was dry and matted and the animal looked depressed and very weak. It was an ancient, dying cat, long past its time.
“Put him down, Mum!” Judith Polanski snapped angrily. “Put him down so the vet can take a look at him!”
Mrs Polanski held onto the cat and said nothing.
“What can I do for you, today?” Sally asked. It was a stupid question. She knew perfectly well that they were here to have the old cat put to sleep, but she could hardly say that outright.
“Chang’s no good any more, doctor,” said Judith Polanski. “He hasn’t eaten a thing in over a week. He just sits over his water bowl all day, drinking, and then he vomits the water back up again. He doesn’t even have the energy to go outside. He just messes on the carpet.” There was a look of pleading in her eyes.
“I see,” said Sally. Then she addressed the old lady. “He’s vomiting a lot, is he? And he just lies around all day?”
“Yes, he vomit, but he’s okay. He’s an old cat. He don’t want to run around no more. He’s happy to stay inside with me.”
“Well, let’s have a look at him, then.” Sally didn’t try to remove the cat from the old lady’s arms, but she felt its abdomen – it had tiny, knobbly kidneys, about half the normal size, and it was badly dehydrated. “He’s very dehydrated, Mrs Polanski. Look at how his skin stands up, when I pinch it. That’s not normal. It should go straight back down, only it can’t because it’s too dry. His kidneys are leaking too much water out of his body. He just can’t drink enough to keep up with it. And his kidneys are so small now, there’s just nothing left of them. I’m very sorry, Mrs Polanski, but he really is dying, now. Look at how tired he is. He’ll probably die in the next 48 hours, if we don’t do something to prevent that.” It was a euphemism. Sally knew there was nothing she could do for this cat, other than put it to sleep.
“He’s not dying. He’s just an old cat! You give him some medicine. You’re the vet. You give him some medicine.”
Judith Polanski interrupted her. “Mum, I told you, Dr Kellerman told you, and now this doctor is telling you, he’s dying. You saw the blood tests that Dr Kellerman did! Chang is dying. We have to let him go, now, Mum, before he gets any worse.”
“Bah! He’s not dying. He just needs to stay with me.” Mrs Polanski clutched her cat tighter and tickled its ears. The old cat barely noticed. It was far too sick to be aware. It was dying.
“I’m afraid he is dying, Mrs Polanski,” said Sally. “If there were some medicine I could give him, believe me, I would give it to him. But there’s nothing. He’s had intravenous fluid therapy, he’s had anabolics, he’s had cortisone, but now he’s even worse. The kidneys have just shrivelled up and died. They’re not working any more.” Sally didn’t mention kidney transplants, nor dialysis, since neither were routinely available. In any case, this cat was going to die in a day or two, no matter what Sally did.
“Mrs Polanski, Chang is sixteen years old. That’s very, very old, and no matter what we do, he will die in the next day or two. No matter what, you are going to find him dead somewhere, if you don’t do something about it first. And he won’t just go in his sleep. He’ll keep vomiting. He might even go into convulsions, from the poisons that are building up in his body. I’m sorry, but he really is dying and there isn’t any medicine I can give him.” Sally guessed that the old lady knew it too, that she just didn’t want to admit it. Sally felt bad about discussing old age and death with a very elderly woman, but there was no other way to make her understand.
Mrs Polanski said nothing. Tears welled up in her eyes. She suppressed the tears with a sudden burst o
f anger. “You vets don’t care! You don’t care about animals! You just want to put my cat down, that’s all. He’s not dying. He just wants to stay inside with me. You don’t care about anything but the money we pay you! That’s all you care.”
This hurt Sally deeply. Sally loved animals, she had dedicated her professional life to studying their diseases and how they could be cured, she had learned surgery and anaesthetics and medicine and pathology and pharmacology, all to care for animals, and here was one of the very people she was trying to help, telling her that all she wanted to do was kill animals, that all she was interested in was money. But Sally understood that some people simply could not cope with the grief of losing a pet. She guessed the old woman knew her cat was dying, but that she needed to blame her daughter, and the vet, for putting it to sleep, so that she herself would not feel responsible. But it still broke her heart, to be accused like that. “Look, Mrs Polanski. I think you know he needs to be put to sleep. He’s really suffering, now. You know he’s dying, and you don’t want to find him going into a convulsion and dying under a bush in the backyard, do you?”
Judith Polanski was quiet.
Her elderly mother spoke at last.
She spoke in an angry torrent of words. “That’s right. You and my daughter, together, you just want to kill my poor Chang! You don’t care about anything but money. And I’ll report you, I’ll report you to that Vet Board I see in the paper, that you make an old lady put down her cat!”
Sally felt a stab of pain in her stomach. She felt stressed. A veterinary surgeon had a legal right to put to sleep any animal that was suffering badly, if that was, in her professional opinion, the only appropriate course of action. But it was a right that Sally never wanted to have to invoke, because, legal right or not, the thought of being dragged up before the Veterinary Board by an irate client, and of the newspaper publicity from reporters who would not know the first thing about whether or not the cat truly needed to be put to sleep, was Sally’s worst nightmare. It could certainly cost her, her job, since Kellerman would act quickly to distance himself from any adverse publicity concerning his new associate, and, of course, in some cases, the Veterinary Board might even decide to strike a vet off the register, and that would be the end of her career, the end of everything she had worked for. The stress of that kind of an end to her career was always hanging over Sally’s head, since it was always possible for an upset and vindictive client to lie to the Board in such a way that might make it look like Sally had not acted properly, even if she had acted entirely properly. Sally knew she didn’t live in a perfect world, and these things sometimes did happen. It worried her.
“Mrs Polanski, I am not going to put your cat to sleep without your permission. It’s your decision. But I must tell you that, in my opinion, it is the only humane thing to do. Honestly.”
“Come on, Mum. You know the vet is right.” Judith Polanski was determined not to let her mother’s cat suffer any longer.
After a moment of silence, the old woman spoke in anger. “Take him, then! Yes, I give my permission. You take him and put him to sleep. You put him to sleep for me. If that’s what you want!”
Sally couldn’t cope with all this, at the end of a long and awful day, but somehow she stood there and listened.
The old lady handed the tiny cat to Sally, then stomped out of the room. Sally looked down at the cat and decided that she had been too optimistic – it would not have lasted two days, it would have died that very night. It was just a skeleton, and it should never have been allowed to suffer for so long as it did. She would have to be very thorough on the clinical record card, reporting the poor cat’s condition at length, in case the angry old woman decided to take legal action against her. Sally was glad that the dying cat would not have to suffer any longer, but she felt terribly stressed and alone. It had not been an easy day. She wondered if it was all worth it.
Judith Polanski patted the cat one last time. “Good boy, Chang. Thank you, doctor. I’m sorry about my mother.”
“That’s okay.”
When Judith Polanski had gone, Sally took the little cat to the treatment room, where Heather Lorayne helped her to put it to sleep.
“There you go, little fella,” said Sally, as she injected the pentobarbitone sodium. “There’s a good boy, Chang. Good boy.”
“That’s just disgusting,” said Heather, after it was over. “This poor cat should have been put to sleep a week ago. Look at it, it’s just a bag of bones. Poor thing could barely hold its head up. It must have been in agony. How can people put them through that? How can they do that to their pets? It makes me sick.”
“I know,” said Sally. “It’s awful. He really would have been suffering. The daughter said he vomited all day, just hanging over his water bowl – he was dying by inches. But the old lady couldn’t let go. She even threatened to take me to the Vet Board, you know.”
“No! She didn’t, did she?”
Sally nodded. “Yeah. She did. She said I didn’t care.”
This made Heather angry. “You don’t care? It’s her that doesn’t care. That’s the sort of person the RSPCA should talk to. Letting her cat suffer like that.”
Sally didn’t want to talk about it. “I know, Heather. I know.” It had been a very long day, it was seven-thirty, and all Sally wanted to do was go to her tiny flat, collapse on her bed, and sleep.
And that is exactly what she did.
Chapter 9
Michael recognised the name of a familiar pet in Sally’s diary.
Wednesday, 19 July, 1995
Dear Diary,
Mr and Mrs Freeman came in again today. It was sad to see Muffy still not going well. When we did more tests, the results were much worse than I hoped ...
Sally had been pleased, that morning, to welcome Mr and Mrs Freeman into the consulting room. They were nice people and it was only the third time she had seen them. Their little Maltese Terrier, Muffy, was eleven years old. Its liver disease would always be a problem, but Sally thought its condition would have stabilised by now, four months after she had first seen the dog. On the contrary, Muffy had recently taken a turn for the worse. Her appetite was adequate but not good, and she had been a little lethargic. Nevertheless, Sally had been jovial when she spoke to the elderly couple. She told them she would repeat the blood tests, to see how the liver was doing. But then, when she had farewelled the Freemans, taken the dog to the treatment room and carefully palpated its liver and spleen, she was shocked to feel some small lumps. These should not have been present in a dog with simple hepatitis, and they hadn’t been there previously.
Now, Sally was standing in the X-ray room, next to the drowsy dog. She had given Muffy a light sedative, since she wanted to X-ray the abdomen to see what was happening with the liver and the spleen, and also the chest, just in case her worst fears might be true.
Michelle called out. “The X-rays are ready.”
“Okay.” Sally walked out and took the developed X-rays from Michelle. “Watch Muffy, will you? She’s on the X-ray table.”
“Sure.”
Sally put the X-rays on the viewer in the consulting room and switched on the viewer’s light. She looked at the abdominal X-ray first. The liver was enlarged, which she already knew, but she couldn’t make out any lumps on either it or the spleen, so this brought her no closer to a diagnosis.
Then she looked at the chest X-ray.
“Oh, no,” Sally whispered to herself, sadly.
In the caudal lung lobes, where there should have been nothing but a dark space on the X-ray, were several small, white, fluffy smudges. They looked like tiny tufts of cotton wool, innocent enough in appearance, but deadly by nature. They were clumps of cancer in the lungs, metastatic neoplasia – cancers that had spread through the bloodstream, presumably from a cancer that must have originally been growing in the liver before it spread to the lungs. It must have been in the spleen, too, which would explain the little lumps she felt, even though they were too small
to show up on the abdominal X-ray.
Sally dreaded having to tell the Freemans the bad news.
She told the nurse, first. “Bad news, Michelle.”
“What is it?”
“Cancer. She’s almost certainly got liver cancer.”
“But wouldn’t that have shown up on the blood tests?”
“No. The blood tests just tell us that the liver’s inflamed, that it’s being damaged. That’s what liver inflammation is called: hepatitis. The tests don’t tell us what’s causing the damage. In Muffy’s case, it’s being caused by a cancer. Now it’s spread to her lungs, too – we can see that on the X-ray – and I can feel it in her spleen, as well. It’s getting worse.”
“Can you operate?”
“No way. You can’t remove that much cancer. It’s everywhere.”
Michelle patted the drowsy dog. It was standing up, but only just, since it was drunk from the sedative. “But she looks so comfortable. She doesn’t seem to be in any pain. How could she have all that cancer?”
“Sometimes they don’t feel that much,” said Sally. “She’s one of the lucky ones. Pain doesn’t seem to be a problem. But she still has cancer.”
“Poor girl. How long do you think she’s got?”
Sally stroked the dog’s fluffy, white coat. “I don’t know, Michelle. It’s hard to say. She could go for weeks, maybe even months, before she feels any pain. And there’s no reason why we can’t keep her going until then. But when she stops eating, that will have to be the end. Until then, we just try to maintain her quality of life. Anyway, let’s get her on a drip for a few hours. That might give her a bit of a boost before we send her home.”
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