She did not know that it was not to be.
Chapter 12
It was only a week after the incident that Sally found herself on the receiving end of a string of emergency cases. On a busy Friday morning, just before the new year, Sally had to deal with a cat bleeding profusely from its throat, a collapsed dog that had been baited with strychnine by an angry neighbour, an epileptic Poodle that nearly died from a prolonged fit, and a beautiful Great Dane that had been hit by a car, which sadly Sally had to put to sleep as its back was completely broken. Then, just before lunch, Sally saw old Mr and Mrs Freeman sitting in the waiting room with their little Maltese Terrier, Muffy. Was its liver coming to the end? Sally thought anxiously. She called the elderly couple into the consulting room.
“Good morning, doctor,” said Mr Freeman, feebly.
“Hello. How’s Muffy doing?”
“Muffy ... Muffy’s not doing very well,” said Mrs Freeman, on the verge of tears. “She hasn’t eaten anything in two days. I’ve tried tempting her with everything, but she won’t touch a thing.”
The little dog coughed several times. It looked as if it must have had a bone stuck in its throat, as if it were desperately trying to spit it out, but Sally knew better. It was the typical cough of a dog with severe bronchitis, only in this case there was a more sinister cause of the bronchitis than a simple infection: the cancer in the lungs had obviously grown larger. Muffy was obviously starting to die.
“And she’s really been coughing a lot,” Mrs Freeman continued.
“I see,” said Sally. She took a stethoscope and listened to the dog’s lungs. They were full of gargling, crackling fluid. The cough was fearsome, heard through the stethoscope. Sally felt the liver and the spleen. Both were larger than before, with more obvious lumps of cancer tissue than ever. The little dog looked up at Sally. There was a look of discomfort in its eyes. The happy, panting smile that was so characteristic of the dog was now long gone. Muffy was in pain.
“It’s not good, is it, doctor?” said Mr Freeman.
Sally shook her head. “No. No, it’s not.”
Mrs Freeman started to cry. “Is it ... is it time?”
Sally hated to see the frail old woman crying, and she hated more the fact that there was nothing she could do to help, other than to put the little dog to sleep. “The cancer in her lungs has grown bigger. The ones in her liver and spleen have grown, too. It didn’t seem to be bothering her before, but now it’s causing her real pain, and she can’t breathe properly. It’s time.”
Mr Freeman felt terribly guilty. “Have we kept her going too long? We didn’t know when to bring her in. She was so much better after her last treatment. We wanted to spend one last Christmas with her. But she looks so bad now, doctor, I feel like we’ve done the wrong thing. I feel like we’ve made her suffer.”
“It’s okay,” said Sally. She put a hand briefly on the old man’s arm. “The main thing is that you’ve brought her in now, now that she really has gotten worse. You did the right thing.”
“We don’t want her to suffer any more, doctor,” said Mrs Freeman, tearfully. “We want ... we want you to put her to sleep.”
Sally felt a wave of emotion rise up inside her, a wave of sadness, a wave of grief. After dealing with all the emergencies that morning, she was tired, especially after seeing the Great Dane with a broken back – having to put that big dog to sleep had really touched a nerve of sadness inside Sally. To see that young dog broken and spent was awful. To put it to sleep had been the only merciful thing to do, since its back was too badly smashed in too many places, but it had still been an awfully sad thing to have to do. Now, here were her favourite clients, this dear elderly couple, and their lovely little dog, whom she had known for a year, and now she had to face up to the terrible responsibility of being the one to put their suffering little dog to sleep. She knew it would not be easy. Sally did her best to stay professional, to suppress the emotions that swam inside her.
“All right,” said Sally. “We can do that for you. That’s no problem at all. Did you want to stay with her?”
“We want to be with her right to the end,” said Mr Freeman.
Sally was afraid of that. It was going to make it worse, but she respected their wishes. “Fine. That’s fine. Now, you know, all we do is give an anaesthetic. She’ll get sleepy in a few seconds, and ...”
Mrs Freeman interrupted, choking out her words between sobs. “We know. We’ve had a dog put down before. We know.”
“Okay,” said Sally. “Okay. I’ll leave you with her for a moment, and I’ll be back in a few minutes.”
Mrs Freeman tried in vain to stop crying. “Thank you, Sally.”
Sally closed the consulting room door, went to the cabinet in the treatment room, and prepared a syringe of pentobarbitone sodium. She was dreading having to go back and do her sad job.
Heather Lorayne noticed what she was doing. “Does that poor old dog need the green dream?”
Sally nodded. “Can you give me a hand?”
“Sure.”
Heather followed Sally back into the consulting room. The Freemans were both crying, talking to their suffering dog, telling it, it was a good girl. The little dog didn’t seem to respond to them much. It was just too sick, and in too much pain. It sat on the table, looking weak. It was all skin and bones now, and there was no light in its sunken brown eyes. Sally knew it would be dead in a matter of days, if she did not put it to sleep immediately, and that in those last days it would certainly not even eat, but would whimper in ever worsening pain, until death came. There was no question of being able to prevent death, no possibility of a cure. All there was, was the mercy of being able to let the little dog fall peacefully asleep.
Even so, Sally barely wanted to think about that day again, when it was over. The two old people cried uncontrollably as they watched Sally inject the green dream into the old dog’s arm-vein, as they watched their little dog quickly become sleepy. There was a distinct impression that Sally had of the taught muscles in the dog’s face relaxing, as if it were greatly relieved that the pain was over, as it fell asleep. The little dog almost seemed to sigh in gratitude as sleep overcame it. It went peacefully to sleep. Sally injected a little more anaesthetic, and the heart stopped. Muffy had passed away.
“She’s gone now,” said Sally.
The two old people bent low over the table, crying and whispering to the now dead dog. “You’re a good girl, Muffy.”
“We love you, Muffy.”
They were the same things they had whispered while Sally had injected the anaesthetic, and they simply kept saying them after the dog had fallen asleep, and then after it had died.
After a few more seconds, they stood up and turned to leave. Mrs Freeman was too upset to speak. Her husband spoke for her. “Will you take care of the body for us?”
“Of course I will.”
“Thank you for everything.” With that, Mr and Mrs Freeman shuffled out of the room, and went home alone.
Heather Lorayne took the body out to the treatment room, where she would place it in a black body bag before putting it in the big chest freezer where it would remain until being sent for cremation.
Sally was glad that Heather had left the room so quickly. She closed the door, leaned against the wall, and cried.
In a couple of minutes, Sally had dried her tears. She still had a busy day of surgery ahead of her. Soon, Heather was helping her to anaesthetise a Basset Hound which was suffering from bladder stones. Sally would have to do an operation to remove the stones from the dog’s bladder so that it could urinate properly again.
Sally slipped a needle into the Basset Hound’s cephalic vein, the same vein in the foreleg that was used for putting dogs down. This time, instead of the deadly, concentrated pentobarbitone sodium, she injected thiopentone, another barbiturate anaesthetic but one formulated for ordinary operations, not euthanasia. The Basset Hound fell peacefully asleep as Sally injected the anaesthetic, exactly as li
ttle Muffy had fallen asleep, but although it was completely unconscious, its heart kept beating strongly and it took regular breaths, since Sally injected only a low, safe dose of the thiopentone.
“Okay, let’s tube him,” said Sally.
Heather Lorayne held up the dog’s limp head, while Sally inserted a plastic endotracheal breathing tube down into the dog’s throat, through its larynx and into the airway. When Sally had finished intubating the dog, Heather connected the tube to the anaesthetic machine which would supply halothane anaesthetic vapour in the oxygen that the dog breathed, keeping the dog steadily anaesthetised so that it would be unconscious and not feel a thing during the cystotomy operation to remove the bladder stones.
“He’s fairly deep. Just put him on one and a half.” Although it had been two months since Sally had her first and only anaesthetic death, the memory of the German Shepherd’s heart attack while connected to the anaesthetic machine still haunted Sally. Her own heart rate still went up, every time she anaesthetised an animal for surgery. Although she had done nothing wrong, and the German Shepherd had simply died from a freak heart attack, Sally was still secretly afraid every time she did an anaesthetic. She did not know if she could handle another animal dying. She did not know what she would do if ever it happened. The fact that the owner of the German Shepherd had not followed through with her threat to take legal action against Sally made no difference. She was still afraid.
Heather turned the dial on the anaesthetic machine, setting it to supply a one-and-a-half percent concentration of halothane vapour. The Basset Hound slept steadily under the anaesthetic, taking regular breaths. The anaesthetic was going perfectly.
“Okay,” said Sally. “Let’s clip him up for surgery.”
Half an hour later, Sally removed the last of several large, chalky stones from the Basset Hound’s bladder.
“That’s a big one,” said Heather.
“Hmmm. How’s he doing on the anaesthetic?”
Heather checked the dog carefully. “He’s fine.”
“Okay. Let’s have some three-oh Vicryl, please.”
Heather went to the surgical instruments cabinet and withdrew a sealed, single-use packet of absorbable suture material. She brought the small foil packet across to Sally, ripped open its plastic cover, and dropped the sterile packet on Sally’s surgical tray.
“Thanks.”
As Sally sutured up the bladder with the fine, purple thread, she kept a careful eye on the dog’s breathing. She couldn’t help being a little nervous. It was a fear that never quite left her, although she had done many successful operations since the anaesthetic death and had never had any other anaesthetic problems. But anaesthetic deaths were something that struck every vet without exception, sooner or later, and she knew that one day it could happen to her again.
After the Basset Hound surgery was finished, there was an ear operation on a Rottweiler, to open up its narrow ear canal which had been badly thickened and scarred by chronic ear infections. This was a tricky operation, but it went well. Then Sally castrated a rabbit, something that made her particularly nervous since rabbits were very fragile animals which had a much higher incidence of anaesthetic deaths than dogs and cats. But everything went perfectly well. None of these successes made Sally feel better about the one dog she had lost under anaesthetic, two months before. She still could not shake the feeling that she was not a good enough vet, no matter how much good work she did. She always felt vaguely inadequate.
The truth was, Sally was an outstanding new graduate, not only academically (she had been one of the best students in her class) but practically. Most new graduates would not do half of the surgeries that Sally had boldly launched into, and most would not have so rapidly come up to speed with the constant time pressure of getting consultations, hospital treatments, and surgery done by the daily deadlines. Sally was an excellent new graduate, and Kellerman, as he went over the daily profit figures, had been delighted with her rapid progress, although he did not tell Sally that, as he didn’t believe in mollycoddling his staff. Staff should stand on their two feet, he believed, without any praise. In fact, Kellerman thought the best way to get more out of one’s staff was to criticise them, constantly challenging them to do better. Kellerman was always ready to criticise but loathe to compliment. Sally simply did not know she was good. She did not know she was an outstanding young vet, by comparison to the average new graduate. All she knew was that she felt desperately stressed – she felt inadequate.
When Sally had finished the last surgery of the day, she was relieved to be able to get fifteen minutes of rest before evening consultations began.
Sally was trying to relax, in the office, when Heather walked in and broke the silence. “There’s a Mrs Smitherington out the front. She’s pretty narky. She’s going on about her English Setter dying of heartworm.”
“What?” said Sally, puzzled.
“Oh, this stupid woman says it’s your fault her dog died of heartworm. She says that you should have prevented it.”
Sally took the clinical record card from Heather. There was only one visit on the record, an annual booster vaccination three months previously. In Sally’s neat handwriting, it said: ‘C4 vaccination. Recommended heartworm test as dog not on tablets. Owner declined to have test done.’
“Are you saying her dog is dead? When did it die? We haven’t seen it since September, and it was perfectly healthy then.”
“Apparently it died a week ago, at another vet’s. She says they did a heartworm test, and it was positive, so they treated the dog for heartworm, but it died during the treatment.”
Sally groaned. Heartworm was a deadly worm infestation, transmitted by mosquitos, where the adult worms grew in a dog’s heart and obstructed the blood flow. This could be fatal, and dogs would often die even with the appropriate treatment. The whole problem could be prevented in the first place simply by using heartworm prevention tablets, which would keep the dog safe even if it were bitten by an infected mosquito. Like malaria in people, heartworm in dogs was prevented by regularly taking a tablet, and, also like malaria, an ounce of prevention was worth a ton of cure. The woman was obviously mad that her dog had not been put on the preventative tablets. Sally groaned because she knew perfectly well that she had told the woman to have her dog tested for heartworm, but that the woman had declined to do so. That much was written on the card. And now the woman wanted to blame Sally, when in fact the woman had simply disregarded Sally’s advice. This was too much. “Bloody hell. We can’t do any more than tell people to have their dogs tested and, if they are negative, to put their dogs on preventative tablets. If they don’t listen, it’s not our fault!”
Heather replied sarcastically. “No. It is our fault. It’s always our fault. That’s what we’re here for, to take the blame for the mistakes that people make themselves. Who else is she going to blame?”
“Right,” said Sally, with a heavy sigh. “I’ll speak to her.”
Mrs Smitherington, a dour, grey-haired Englishwoman, went straight on the attack as soon as she saw Sally. She spoke in the reserved, clipped tones of an upper-class woman who was not amused with the folly of a common veterinarian. “You! You’re the girl who saw my Josephine, aren’t you? Well, now she’s dead.”
“I’m the veterinarian you saw, Mrs Smitherington, yes.”
“Well, for God’s sake, why didn’t you tell me to put my dog on those heartworm prevention tablets? She’s dead because of you. They told me, at the other veterinary clinic, that if only she was on tablets, it all could have been prevented. They did everything they could for her, you know. They were wonderful. But they couldn’t save her. It was too late.” She said the last two words with particular venom.
Sally was not going to stand for this. “Mrs Smitherington, I’m very sorry that your dog had heartworm. It’s a terrible disease. But, if you’ll think back, I did recommended that your dog have a heartworm test, since she was not on the tablets, but you declined to have the t
est done.” Sally knew that if the woman had agreed to the test, they might have been able to catch the disease early. It was possible they might have saved the dog.
“What? What rubbish! I most certainly never did decline anything of the sort. You never even mentioned heartworm, and you certainly never mentioned any test. How dare you accuse me of not having a test done! I loved my dog. There’s nothing I wouldn’t have done for her, and I would have spared no expense. You never mentioned anything of the kind. My husband’s terribly upset at Josephine’s passing. He has cancer, you know, and this was an awful blow. How dare you accuse me of not taking care of my own dog!”
Sally was amazed. The woman was lying. Not only was it written on the card, that she had declined the test, but now that Sally saw the woman face to face she remembered her original visit to the practice. She clearly remembered the woman declining to have the test done, and that the woman had said she didn’t want to waste money on things like that. The woman was lying. She was lying, obviously because she could not cope with the guilt of knowing that if only she had listened to the vet, her dog might not be dead. Therefore the woman had to lie, had to blame the vet, so that she would not have to admit to herself her own guilt, and probably, Sally thought, so she would not have to admit it to her husband. She could see a man waiting in a Mercedes, through the windows at the front of the clinic. Sally assumed that must have been the husband.
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