I learned later that Mrs. Moynihan and her husband had purchased St. David’s Church, a crumbling piece of history in the Fort that was slowly bowing to the ravages of time, and had restored it bit by bit to a place of rustic beauty that served as their getaway. Not only had the church been converted by their loving attentions but each of the outbuildings had undergone physical and spiritual transformations as well, till the site was once again a scene of tranquil elegance. You can still see the Moynihans’ craftsmanship if you drive east on St. David’s Church Road in Fort Valley. It will be on the left. You’ll recognize it.
“I haven’t taken X-rays yet, so I don’t know for sure what he’ll need. But I’m almost certain he’ll need surgery to repair the bone. Breaks in this location almost always do.”
“Well, I have complete confidence in your judgment. You do whatever William needs to get him well again. Just let me know when to pick him up. We miss him here at the homestead.”
It struck me that she was expressing such confidence in me even though we had never met and this phone conversation was the first we’d ever had. Rather than making me uncomfortable, though, it filled me with determination to warrant the confidence she was placing in me.
“I suppose we should talk about the expense of the surgery, Mrs. Moynihan.”
“You can if you’d like, Doctor. I know a surgery like that is pretty involved. But my William is worth whatever it is you must charge me to fix him. I’m not worried about that even a little bit. I hope you won’t worry about it, either.”
And on nothing more than her word, I did not. It is a rare gift indeed for a veterinarian to receive—a client who places such high value on her relationship with her four-legged family members and is blessed with the financial wherewithal to provide, without concern for the costs, the medical care her pets need. Not every person who shares with Mrs. Moynihan her love for a pet can do so. And not all who can afford the care share Mrs. Moynihan’s unqualified devotion to a pet. In the many years between when I first met William and when the Moynihans moved back to the city, I have treated a host of her cats. Never has it been necessary to factor costs into the calculus of their medical care.
That afternoon I took William to surgery. The X-rays showed a fracture in the middle of the femur, with a spiral curve to the bone ends that would allow placement of stainless-steel pins and wires to stabilize it. The X-rays made it look like a routine repair. They often do. But once the incision was made, things looked different, what with the bruising and tissue damage.
From the fracture site, I inserted pins into the middle of the bone, driving them toward the hip and exiting them out of the bone at the top of the leg. Attaching a driving device, I then pulled them up farther into the bone’s center, till their tips were even with the broken edges of the bone. Then, after fitting the fracture pieces together like a glistening white puzzle, I drove the pins down into the center of the bone in the lower half of the femur, below the fracture, seating them firmly in the dense bone just above the knee. This prevented the abnormal bending at the fracture site, but it did nothing to prevent the bone ends from rotating around the pins. Placing three wires a centimeter or two apart and twisting them tightly around the bone fragments did. What remained was to cut off the remainder of the pins, which extended above the hip, and to close the tissues with sutures. In an hour and a half, the surgery was done. Postoperative X-rays showed a good repair of the fracture, the pins and wires standing out on the film in stark relief to the surrounding bone and soft tissue. The fact that the top of the pins extended farther above the bone in the hip than I would have liked gave me a moment’s pause, but overall I was pleased with my handiwork.
We set William up in a cage, the fluids dripping into his arm flooding him with waves of pain medications and sedatives while he slowly regained his senses. I left the office with a feeling of accomplishment that evening. I had been a good veterinarian.
I have found it interesting over the years that even though most days end like this, they are offset by a few days when the overarching feeling is a sense of failure, a nagging suspicion that somehow I’ve breached my contract with my patients, that I’ve been more of a menace to them than their advocate. I suppose every professional is burdened with sporadic feelings of inadequacy. But since my patients are so dependent and utterly voiceless, those days for me are especially brutal. So it was an especially good thing to turn the lights off and leave the office with a successful surgery under my belt and a recovering patient in his cage.
I was not expecting what I found the next morning. William greeted me with a mournful yowl and nonstop hissing when I opened his cage door. I had not known him long, but I was quite sure this was not his normal demeanor. When I placed him carefully on the ground, I was pleased to see that he was walking on his operated leg, but with each step he screamed in pain and turned with confusion to bite at his hip.
I suspected that the tips of the pins which extended above the bone on his hip were too long. With each step, the three-quarters of an inch of stainless steel impinged upon the sciatic nerve, trapping it against the pelvis and causing intense sciatica. It took only a few minutes with William anesthetized again to snip off another half inch or more of each pin and, using a surgical hammer, to tap the pin ends gently, seating them again deeper into the bone. In an hour, William was fully awake and walking around the room with barely a limp, an organized row of neatly spaced sutures decorating the side of his leg.
Mrs. Moynihan came to pick William up later that afternoon. My first impression of her had already been formed during our phone conversation. Meeting her only confirmed those perceptions. She was tall and willowy, with silver hair, dark-rimmed glasses, and a smile that was open and engaging. She was dressed in a long cotton flower-print skirt and a blouse of pastel green. A simple string of pearls and matching pearl bracelets and earrings completed the ensemble. She was thrilled that William had been restored to health and was enthralled by the before and after X-rays that I showed her.
William went on to recover from his injury, and just a few weeks later, he was back for a recheck appointment. X-rays showed that the fracture had healed completely; the bone at the fracture site was even stronger now than it had been originally. Even his hair had grown in fully. During a quick anesthetic procedure, I removed the pins that had allowed the bones to heal so perfectly, leaving the three wires encircling the now-whole bone.
After William, Mrs. Moynihan entrusted the care of CeeCee and several other cats to me. In the nine or ten years I treated her animals, I found Mrs. Moynihan always to be the same—perfectly dressed, pleasant, sophisticated, arty, always ready with a laugh and a compliment, and armed each time I saw her with a new joke to share, most of them innocently off-color, an ironic twist to the otherwise-refined woman that she was.
And then suddenly, Mrs. Moynihan came to the office no more. Through other clients, I learned that her husband had aged to the point that closer proximity to their health-care providers was prudent. They had put the old church up for sale and some lucky family had purchased a visionary couple’s dream, resplendent with finery and character. On a trip back to the area many months later, Mrs. Moynihan stopped by the office. She was driving a brand-new pastel blue Volkswagen Bug with a fresh carnation sitting in a small vase on the dashboard. In her typical easy manner and her husky, musical voice, she told me that William had passed away at the respectable age of seventeen, still, like her, in possession of his singular pride and carriage. She brought with her an Art Deco print of a willowy Parisian girl portrayed with a wispy, longhaired Saluki by her side. I cherish that picture and the wonderful memories it evokes. It still hangs prominently in my office. I think of Mrs. Moynihan each time I see it and smile.
So here’s to you, Mrs. Moynihan, and to William and CeeCee. Here’s to all the clients and patients that have made their way into and out of the halls of my office and my memory. I live my life in gratitude for the remarkable privilege my clients have bestowed up
on me in entrusting the care of their pets to me, of including me as an integral thread in the intricate weave of their relationship with them, of joining the emotional ebb and flow of their lives with mine for a time. Cheers to you all!
Playing Keno
I can remember few patients in the course of my professional life that looked as sick as Keno did when I walked into the examination room one morning. A four-year-old female rottweiler, Keno was usually an imposing presence, despite her pussy cat personality. The square, muscular head and jowls, the penetrating intensity of her gaze, and the reputation of her breed made me proceed cautiously the first time we met. However, as is true of most of my rotty patients, who are so often assumed to be guilty of man-eating tendencies, Keno possessed not a single mean gene. She preferred to slather you with slobbery kisses, her front feet planted solidly on your shoulders, rather than intimidate you with her considerable size. Still, at ninety-five pounds, her presence filled the exam room completely. Not so that morning, however.
I found her lying flat on her side, ignoring my entrance. She did not even lift her head or raise her ears. It seemed all she could do just to follow my movements with her sad eyes, the nub of her tail still. On the bench in the corner sat Steph Malnotti, her face white with concern. Steph and her husband, Tim, were regular clients who owned three massive rottweilers. Since they were childless, these three dogs held places of high honor in the Malnotti household. I knew from our discussions that attempts at adding a child to the family had met with disappointment and had elevated the dogs to almost offspring status. As I stood looking at Keno, my mind already contemplating the possible diagnoses, Steph’s face clouded with emotion and she started to cry.
“Oh Dr. C.,” she said between quaking sobs, “she’s really bad. I should have brought her in a couple days ago. She didn’t seem that bad until last night. But by then your office was closed. Is she too far gone?”
“I don’t know yet, Steph,” I said, trying to present an optimistic front despite the gathering gloom I was feeling. “When did Keno start to feel bad?”
“She hasn’t eaten much in the last five or six days. I thought it was the new food I had changed her to, so I didn’t worry much about it. But three days ago she started vomiting and her appetite dropped to nothing. Yesterday, though, she got worse, and this morning she was really bad.”
I knelt on the floor and lifted Keno’s lips. Her gums were sticky and dry and a bright brick red color. I gently bunched an inch or two of skin over her shoulder between my fingers, pulled it away from the underlying tissues, and released it. It took three or four seconds for it to fall back to its normal position, another indication of dehydration. I listened to her rapid heartbeat through my stethoscope, timing it with my watch to a rate of 160 beats a minute. Keno was in shock. With the bell of my stethoscope over her lung fields, I listened to the rapid inflow and outflow of air. The respirations were way too fast, as well.
I slipped a digital thermometer into her rectum and watched the numbers on the display begin to rise rapidly, spinning ever upward like an electronic gambling machine. While I waited, I pieced together the information I had gleaned so far: rapid respiration, brick red gum color, dehydration, profound lethargy.… Just then, the high-pitched beep of the digital thermometer went off and I looked at the display. I added a temperature of 105.4 degrees to the list of signs. It looked like Keno had septic shock, a condition brought on by systemic infection. But where was the source?
Throughout my initial assessment, Keno remained lying down, barely responding to the things I had done. But when I slid my left hand underneath her belly and pressed down toward it with my right hand on top, she reacted with a yelp of pain, turning her head to me with indignation. That effort was all she could make, and her head dropped again, her cheek hitting the floor with a loud thunk. I repeated the maneuver to see if her tummy really hurt that much or if she had simply wearied of my probing. Her reaction was the same. She was clearly in pain when I applied any degree of pressure to her abdomen. As I released my hands, I noticed a little ripple rebound along her stomach, like waves on a puddle when you step in it. This fluid wave was not a good omen. Despite her obvious discomfort, I needed to examine her abdomen more thoroughly.
“Hey, Steph, hold her head down on the floor while I feel her belly better, please.” Steph bent to her task, one that was made that much easier by the appalling weakness of the patient.
Carefully, I palpated Keno’s abdomen, starting just in front of her rear legs and working my way forward. Her discomfort was most pronounced as I reached the front end of her belly and gently probed under her rib cage. I leaned back on my heels and faced Steph as she released Keno’s head and slumped back onto the bench, her body language reflecting my concern.
“Steph,” I said, choosing my words carefully, “Keno has what we call an acute abdomen. That is not a diagnosis so much as it is a description. An acute abdomen simply means that there is significant pain and discomfort in the abdomen. It can be caused by any number of things, from blunt trauma to pancreatitis to tumor to foreign-body ingestion. But acute abdomen generally means we need to go in surgically and find out what is going on.”
“Okay,” Steph said without hesitation, “let’s do whatever we have to do to save her.”
“I’m glad you’re good with that,” I replied hesitantly, “but there are some strikes against us here that may make this more complicated. She has a very high fever, it appears that she’s got fluid in her belly, and she’s in shock. Those things in addition to the acute abdomen make me concerned about sepsis.” I could tell from Steph’s blank look that this made no sense to her.
“What is sepsis?”
“It means that she also has active infection throughout her system. With the fluid in the belly, I’m concerned that the cause of her sepsis is peritonitis—an infection in her abdominal cavity. If that’s the case, then there could be a rupture of the bowel somewhere, and that is a very serious condition. I won’t know till I get in there, but if there is peritonitis, the likelihood of Keno’s recovering may be pretty low. If we were just playing the odds, I wouldn’t bet any money on it.”
Steph was quiet for a moment as she considered the sobering words. Then she turned to me hopefully. “Is there no chance at all?”
“Well, again, I won’t know for sure until I get into surgery. But if it is really peritonitis, the chances are low.”
“Are they zero?”
“I wouldn’t say zero, but probably less than twenty percent.”
Steph fidgeted in her seat, her eyes searching the floor around where Keno still lay motionless. “I’ll have to talk to Tim for sure, but I know what he’ll say. Keno was named for a game of chance. And I know we will want to give her that chance if there’s any hope at all. You get started and I’ll call Tim and talk it through with him. If he thinks we should quit, I’ll call you.”
“I don’t know what part finances play in your thinking, Steph. But this could be expensive.”
“Yeah, I figured as much. Tim and I will discuss that, too. But unless you hear from us, plan on doing whatever is necessary.”
Because Keno was too weak to walk on her own, I got a stretcher and, with Lisa’s help, carried her back into my treatment room. I drew some blood for testing, got some X-rays, and started intravenous fluids to combat the dehydration and shock. I blasted her with powerful antibiotics and gave medications for pain. The X-rays confirmed fluid accumulation in Keno’s abdomen, and the blood work showed a dramatic elevation in the white-cell count. Keno’s system was mustering all available soldiers to fight off the invading bacteria.
Within an hour or so, I had Keno in the surgery room and was incising through her skin, the surgery lights blazing over my shoulder. As I lifted the abdominal wall with forceps and cut through the body wall, I was met with a gush of foul-smelling reddish fluid that erupted from the wound and spilled across my sterile drapes and onto the floor. My heart sank—peritonitis! The flow of the
sickly reddish yellow fluid continued unabated. I had to empty perhaps two or three gallons of the stuff before I could even begin to assess the abdominal cavity. When I finally achieved a clear field, it was obvious that the internal organs were suffering ill effects. Instead of having the glistening pink surface of normal intestines, Keno’s intestines were red and enflamed and injected with tiny vessels that throbbed and oozed.
With my gloved fingers, I felt along the entire course of the intestines, starting at the south end and working my way upstream. Not finding any foreign material present, I turned my attention to the stomach. I first located the spot at which the esophagus enters the stomach on the left side. Then I felt along the bulging curves of the stomach, where the bulk of a meal is stored. I could identify nothing other than the residue of the last meal Keno had eaten, almost a week ago, which still had not passed out of the distended organ.
As I followed the stomach to its outflow tract with my fingers, I bumped against something firm. Sure enough, down deep, where the pylorus dived almost out of reach below the right lobe of the liver, I could feel something hard and rubbery. In fact, as I curled my hand around the region, I could make out several similar pieces of the same substance wedged into much too small a space, completely obstructing the passage of food. Something else, too, made my blood run cold. As I grasped the affected tissue gently in my hand and pulled it closer to the surface, I noticed an area of ugly dark purple tissue that looked mostly devitalized over where the foreign material was firmly wedged in place.
Even more disconcerting was the slimy yellowish fluid that oozed through a rent in the middle of this angry, bruised intestinal wall. This was the source of the infection in the abdominal cavity. And it was my worst nightmare. Not only had the intestine ruptured, but it had done so in perhaps the worst-possible location. That region of the duodenum, which was the most inaccessible and also the place where the pancreatic and bile ducts emptied, would have to be removed and reconstructive techniques employed to restore as normal a digestive function as possible. It would be a dicey bit of surgery, fraught with a host of possible complications and a high risk of catastrophic failure. It was a race I was destined to lose—one in which I was handicapped beyond description by the inescapable fact that Keno’s raging peritonitis had already beaten me to the punch.
The Gift of Pets: Stories Only a Vet Could Tell Page 17
