I often wondered how her husband felt about the investment she made in her pets. I assumed from her wedding ring that she had a husband, though it was not until several months after my first exposure to Mrs. Laughlin that I actually met him. When I finally did, I understood for the first time that in this world there is someone for everyone.
The Laughlins made quite a pair. Mr. Laughlin was as thin as his wife was not. At six feet three and weighing only about 140 pounds or so, his clothes hung loosely from his sharp shoulders. His skin and hair seemed to do the same. While she jabbered incessantly, he rarely spoke. After years of heavy smoking, his voice, when he did speak, was throaty and choked, croaking out gravelly words in short bursts.
But Mr. Laughlin shared with his wife a common love for their dogs. He suffered her indulgences with amazing patience and unapologetic complicity. Once, after I had successfully treated Blimpie for an episode of disk disease and a painful back, he gripped my hand firmly and locked eyes with me in a steady, tear-laden gaze of gratitude before turning and leaving without a word. None was necessary.
One day, after I had become familiar with the Laughlins, Mrs. Laughlin presented her dog Susie for evaluation of a cough. On examination, I found harsh, moist lung sounds, an irregular heart rhythm with a loud murmur, and a moist, choking cough. X-rays showed dramatic heart enlargement and fluid accumulation in the lungs. Susie was in congestive heart failure. I sat down with Mrs. Laughlin in the examination room. I knew that times were tough for the Laughlins financially, and she needed to hear the straight scoop.
“Mrs. Laughlin, things don’t look good for Susie. Her heart is very large, and there is fluid leaking into her lungs as a result of poor heart function.” I could tell by the increase in the frequency and severity of the facial twitching that the news was hitting home. Her face and neck were racked with nearly tetanic spasms.
“You know I take care of my dogs way too well, don’t you, Dr. Coston?” Her verbal response belied her emotions. “I probably take better care of them than I do of myself or my husband.”
I didn’t find this difficult to believe. I could tell that Mrs. Laughlin needed a little time to process the news before coming back to the discussion at hand. Part of being a good veterinarian is sensing not only the medical needs of the patient but also the emotional needs of its owner.
“I know you love them very much,” I said.
“That’s right! You know I have five dogs.”
“Yes, I’ve met them all.”
“And not many people would let all five dogs sleep with them, would they?”
“You mean that all five dogs sleep with you?” I feigned surprise, thinking instead that few other living things would be interested. Trying to lighten the moment, I added without thinking, “I hope there’s still room for your husband.”
I knew instantly that this had been a mistake. One should not inadvertently open doors that one does not wish to walk through. And some people have no aversion whatsoever to barging through doors that should have remained closed and entering rooms where visitors should not be invited. If I had doubts about whether or not Mrs. Laughlin was one of these people, they were quickly erased as she pushed past me through the door I had opened.
“Heavens no! My husband and I haven’t slept in the same room for years.”
“Oh.” I kept my voice deliberately disinterested, trying desperately to close the door behind her. “So…”
“No. He makes all those disgusting noises when he breathes. They’re so loud, I just can’t sleep,” she continued.
“Oh really?” I said flatly. “Now, back to Susie.”
“No, we have separate rooms now. It really works out best that way. Good riddance, as far as I’m concerned.” She pressed on, despite the fact that I was now putting Susie’s X-rays up on the view box and pointing with my pen to the enormous heart framed by lungs that, because of the accumulated fluid, were altogether too white. “You know, just a few months ago my husband came to me and said he wanted to try it just one more time.”
This was precisely the discussion I was trying to avoid. “Here are the X-rays I took of Susie this morning.” I turned my back to her and tapped my pen tip on the films, as if to demonstrate a vitally important point.
Ignoring me completely, Mrs. Laughlin continued. “Even though I didn’t think it was such a good idea, I finally gave in. But do you know what happened?”
I took a deep breath, turned back to her, and flopped into my seat with a sigh of resignation. I had only myself to blame for this; I was the one who had started it. But honestly, I had not expected her to plunge headlong into the room as she had done. And, heaven knows, I had not expected her to turn the lights on.
“No, what happened?”
“Well, when he came into the room, Blimpie was lying on the bed. He bristled all up and started to growl at Jim. The closer Jim came, the more Blimpie growled. Why, he wouldn’t even let Jim in the bed. Finally, Jim just gave up and left. Said something about it not being worth all that. And he hasn’t tried again since then.”
Choking back a laugh and quashing any temptation to ask further questions, I dived at the chance to gain control of the discussion again. Clearly, Mrs. Laughlin’s own discomfort about this topic was not enough to veer her away from it, and the blushing awkwardness I was experiencing obviously hadn’t occurred to her. I figured that perhaps she could be gently led away from it. This digression was, after all, only an excuse to avoid an even more uncomfortable and painful topic. I hoped a bit of gentle leading would work.
“Your husband hasn’t been well lately, I’ve heard. Is that true?”
“Gracious yes. Jim’s developed throat cancer and has had to have a tracheostomy tube placed. So he can’t go out much anymore. Dr. Coston, you just wouldn’t believe how much his medications cost us now. We’re not wealthy people, you know. We’re on Social Security and that’s about all. It just about puts us under each time he has to get a prescription renewed. Sometimes we have to choose between drugs and food.”
“That gets us back to Susie, Mrs. Laughlin. Her heart is not doing well at all.” I waited to see if she was following my lead. She remained quiet, her eyes cast dejectedly to the floor, where Susie struggled for each breath.
“I just knew something was seriously wrong with her this time. She’s almost thirteen years old this year. But I want you to do everything possible for her, Dr. Coston. She’s all I’ve got.” Mrs. Laughlin’s voice cracked.
“I know she means a lot to you, Mrs. Laughlin. But she’s not all you have. You have four other, younger dogs that are in pretty good shape. And you have a husband at home who needs you very much.” I tried to provide some perspective for her. “Susie’s condition is very serious. It is possible to use medications to try to help her heart function as efficiently as possible for as long as possible, but…”
“Good. I knew I could count on you to make her better, Dr. Coston. That’s just what I want you to do.”
“Let me finish, Mrs. Laughlin. Medications may help, but it’s also possible that we won’t be able to improve her condition. And even if she does improve, it may be for only a short time. In the best of scenarios, maybe only a few weeks or months.” I purposely painted a bleak picture for her, knowing that she would hear only the most rosy of predictions. For a moment, Mrs. Laughlin was uncharacteristically quiet, and I thought she was beginning to grasp the gravity of the situation.
“Now, I know how much she means to you,” I continued, “but I also know that you’ve got to think about this in relation to all the other things you are facing right now, too. Maybe it wouldn’t be in your best interest to pursue Susie’s treatment aggressively right now. We could give her some medications to make her as comfortable as possible and…”
“I know what you’re saying is right, Dr. Coston. But it’s awful hard to think about it like that. I want to do everything I possibly can.” I could sense the agony of the decision for her.
“I just don�
��t want you to be in the position where your budget is stretched too tight for you.”
“Don’t you worry about that a bit, Dr. Coston. Money is no object. We’re in pretty good shape financially, all things considered.”
“Now, Mrs. Laughlin, you just told me that things were really tight with all of Jim’s health-care costs. I know they can be exorbitant. And you shouldn’t be forced to decide between buying medication for your husband or buying medication for Susie. Given those alternatives, your decision is a lot easier, don’t you think?”
Mrs. Laughlin was quiet for a moment before shrugging noncommittally. “No, not really. Jim … he’s almost gone anyway.”
Clearly, Mrs. Laughlin was not able to process things objectively at this time. Someone would have to make a decision, and that someone had to be me.
“Okay. I’ll tell you what I’m going to do. I’m going to prescribe some medications to try to pull some of the fluid from Susie’s lungs. That should make her feel much better. I’ll want to recheck her progress in a week. Can you do that?”
* * *
About a month later, Mrs. Laughlin brought in Blimpie for his annual vaccinations. She was strangely subdued. Her usually incessant blather was absent, though the violence of her facial contortions was not, and her face twisted into painful-looking spasms every few seconds. After Blimpie had received his shots and I had once again undertaken the fruitless task of instructing her on the benefits he would receive from calorie restriction, Mrs. Laughlin fixed me with an unusually vulnerable expression.
“Thank you, Dr. Coston, for your help with Susie. We did the right thing. You know, I lost Susie and my husband within a week of each other.”
Her grief was clear and deep, and my heart went out to her. My mind replayed the profound sadness I had experienced many times at the passing of a beloved pet. I thought of my first dog, Thumper, and of Ollie and Rush. Such losses cut deep at the core of every animal lover. But the death of a spouse is a loss of a magnitude that I can neither conceive of nor bear to imagine. Mrs. Laughlin had faced both in the span of only one week. Nothing I could say to her, no matter how thoughtful or heartfelt, could offset the gravity of such pain.
A question played at the edges of my mind as I watched a tear make its way down the twitching face of Mrs. Laughlin that day. It was a question that I did not have the nerve to ask, one that would have been completely inappropriate to pose. Which loss had been the hardest for her?
As I stood at the desk and watched Mrs. Laughlin and Blimpie wobble up the sidewalk, one of the receptionists made an offhanded observation that summed up our impressions of her. “You just never know what makes some people tick, do you?”
Sialadenitis
Mr. Johnston’s name was on the appointment book for a problem with his cat, Thurgood. This was good and bad. From my previous interactions with him, I knew that an appointment with Mr. Johnston would always be entertaining, so distorted would be the dialogue. But over the years, his attitude had gone from mildly disdainful to blatantly disrespectful. This made for incredibly frustrating engagements. I was not looking forward to my appointment with Mr. Johnston, so later that morning, as I picked up Thurgood’s record and made my way into the examination room, I took a deep breath of apprehension.
“Good morning, Mr. Johnston,” I said, more cheerfully than I felt. I would try to overwhelm him with kindness, “How are you this fine morning?”
The uninterested, somewhat bored expression on his face remained unchanged by my greeting. “I’m not here for pleasantries, if you don’t mind. I’m only here because something’s not right with Thurgood.”
“I’m sorry to hear that. What seems to be the problem?”
“He’s showing a degree of unappetation. And he’s usually a big eater.”
“How long has that been going on?” I asked as I slipped a thermometer into my patient’s rectum.
“Why, exactly, is it that you still insist on using those old-fashioned poobus thermometers?” His reddish face was cast in a pose of sheer ridicule, his unruly hair sliding down over his angry eyes.
“Because I haven’t been able to get my patients to keep a thermometer under their tongues for two minutes yet,” I responded, making a conscious effort not to respond in kind to his attitude.
“You do know they now have thermometers that you just insert into the ear, don’t you?”
“Yes, I’ve tried those and found them not very accurate, I’m afraid. The old tried-and-true methods still work best for me.” I heard the beeping of the digital thermometer and glanced at the readout, then let out an involuntary sigh.
“Is he pyrotechnic?”
“He is pyrexic, if that’s what you mean,” I responded, amused. “His temperature is 105.3 degrees. That’s pretty high for a kitty. How long did you say Thurgood has been feeling bad?”
“I didn’t say.” Mr. Johnston clucked his tongue at me with a disgusted shake of his head. “But it’s been about two weeks now.”
“Okay. And what symptoms has he shown, besides not eating well?”
“Just lying around a lot more, less active, and less interested in things. The weird thing is, he’s been hypersavlivating.”
Mr. Johnston looked at me furtively, measuring my respect for his unparalleled mastery of medical terminology. I was in no mood to indulge silliness, especially from one I knew would just disparage me anyway.
“Hypersavlivating?”
“Yeah, you know. Drooling a lot!” he said, his voice dripping with contempt for my ignorance. “The saliva is really thick and vicious, and it just hangs from his mouth all the time.”
“How can you tell his saliva is vicious?” I knew he meant viscous, but I resisted the temptation to draw attention to his mistake.
“Vicious means thick and sticky and slippery. You should look it up in your medical dictionary when you have a minute.” He laughed derisively, pleased at his naked barb.
“Oh, you mean viscous. Vicious is something else entirely.” I closed the noose with as much innocence as I could muster. “Let’s take a look at his mouth.”
I turned Thurgood to face me and lifted his chin with my hand. Sure enough, a ropy strand of thick, tenacious saliva hung from one corner of his mouth. I lifted his lip and found an area of reddened, enflamed, and swollen tissue around the opening of the salivary duct on his upper jaw, from which the saliva issued. Feeling carefully with my fingers, I could follow the course of the swollen duct as it made its way beneath the skin between the salivary gland and the opening in the mouth. Thurgood didn’t like this probing, squirming in pain as I palpated the gland and the duct. For comparison, I repeated the exam on the opposite side. The duct there was not identifiable; the gland was painless.
“So what’s the diagnosis?”
“Honestly, I’m not sure yet,” I replied, puzzled. “I haven’t seen this type of presentation before.”
“I don’t doubt that. I’m sure there are lots of things you don’t know anything about.”
“That’s very true. But I didn’t say I didn’t know what’s going on. I said I had never seen this presentation before. I think this is a case of sialadenitis. And what you are seeing is ptyalism.” It was time to fight fire with fire. If Mr. Johnston doubted my ability to throw around big words, it was time to lay his fears to rest. And it appeared that my efforts had their effect.
“Si … sinitis?” My salvo had found its mark.
“Sialadenitis. It means inflammation of the salivary glands. And I think that’s what Thurgood has.”
I remembered from my first meeting with Mr. Johnston and Dahmun that he considered himself a linguist and had invented his own language. Perhaps he would have been impressed to know that I had just invented this diagnosis, as well. The fact that I could support the term medically was beside the point. It was a descriptive that certainly fit. This was indeed inflammation of the salivary gland. But I had never before seen the term or the diagnosis printed in the veterinary literature. I
was not familiar with a specific syndrome characterized by fever, glandular pain, and excessive salivation. I certainly did not know a cause or a treatment for this problem. Still, the terminology had hit its target and left this man speechless.
“Tie … a what?”
“Ptyalism. That’s a medical term that means excessive salivation. That’s the main symptom of Thurgood’s sialadenitis.” The word just seemed to flow off the tongue now, as if it was a diagnosis that I had dealt with every day for years, rather than one I had just invented.
“What causes it?”
“In Thurgood’s case, I’m not sure. It isn’t seen very often. With his fever, I suspect it’s bacterial. I think we need to do a bacterial culture to see if that’s the case.”
I thoroughly swabbed the opening of the salivary duct with gauze until the hanging saliva strands were gone. Then I massaged the painful gland until more saliva began to flow. With a sterile swab, I dabbed at the duct’s opening, coating the cotton swab with a layer of the slimy material, which I placed into bacterial medium. This I would send to the lab. Hopefully, it would identify whether there was a bacterial infection present and what antibiotic might be effective in eradicating it.
“So that’s it?” Mr. Johnston snorted. “You’re done?”
“Well, it will take about three or four days to get the results of the culture and sensitivity back. It won’t be till then that we’ll know exactly what’s causing the problem and how to treat it.”
“And Thurgood has to suffer until then?”
“I hope not. I will start some antibiotics and some medication for inflammation now. And I hope that will help him. But we may have to change the antibiotics once the culture results come back. I’ll call you when they’re here.”
“Well, you should know that I’m not particularly pleased with your lack of expertise in this case.”
The Gift of Pets: Stories Only a Vet Could Tell Page 8
