William's Gift

by Helen Douglas

We drove around for half an hour watching for familiar landmarks. Finally she exclaimed, “There it is!” The worried neighbours appeared as I pulled in. They had thought the police were bringing her home.

  “We’ll stay with her until her son comes,” they reassured me. “She shouldn’t be living alone anymore.”

  “Would you like tea?” Mrs. Weiss asked me. She looked calm and accepting. Perhaps she was unaware of what had happened.

  “I must go home,” I said, feeling overwhelmingly tired. I felt a sudden need to see my own dog. I left feeling drained by the busy day, by the tragedy I had witnessed, and by the overall loss she was dealing with, especially that of her own self. Her dog, her husband, soon her house — all gone, but the loss of her memories of them seemed cruelest of all.

  TWENTY-TWO

  Getting Back Up

  AS LUCK WOULD HAVE IT, the veterinarian I had been waiting for just walked in the front door one day. No well-thought-out ads were placed, no strategies employed. It was at the generous suggestion of a neighbouring clinic that Dr. Leanne Best sought us out. Having applied there for a mixed animal position, she admitted cattle were not really her thing, and the veterinarian interviewing her wisely sent her to us, believing it would be a perfect fit, which it was.

  Our practice was maturing, developing a sense of longevity and stability. We were in a nice rhythm with sharp, conscientious staff. Most of us inherently shared the same value system, and thus our unique practice culture had developed. Even more than when we had so actively sought a young veterinarian in the past, we needed someone who “got us.”

  “You could be a hard group to break into,” one of my friends had said to me. Yet with Dr. Best, there didn’t seem to be any effort to the transition. She just slid in and starting working with us.

  Having a new veterinarian working for me was a delicate balance. One must be able to give appropriate space for a young professional to grow and to resist trying to control every case. On the other hand, the interests of the clients and patients must be protected during the learning curve. Being a mentor means finding just the right balance between these factors and also developing the co-operative spirit that enables each to give and receive information. Lastly, I had to believe I had enough and current information to give. I knew I did. I finally had someone I could truly mentor in the most legitimate sense.

  The only moment Dr. Best really needed me, I was out back of the clinic looking at a lame horse. Things in the clinic were running smoothly. It was a surgery day, something everyone enjoyed. Leanne was spaying an overweight labrador, a task not for the faint of heart. While working in the deep, fat-filled abdomen, it is easy to have an ovarian pedicle slip and a bleed start.

  Erin came out of the clinic with a flustered look and a shaky voice. “We need you in surgery, hurry,” she muttered in a tense voice.

  I ran through the treatment area, not stopping to scrub, and donned a pair of surgical gloves.

  “Open the incision,” I ordered, as I saw her struggling with blood-soaked gauze. It was evident that the abdomen was filling up with blood.

  “Turn up the fluid rate!” I barked. “We’ll need retractors and sterile towels to pack off the bowel.” In a few moments, the offending ligature was located and the bleeding stump tied off more tightly. The dog recovered easily and had no ill effects from the worrisome event. She went home innocently wagging her tail, as labs are wont to do. Leanne never had the same problem again. Somehow it seemed to cement our working relationship. I was just glad I was at the clinic, not on the road.

  We soon developed a supportive style much like Jim and I had had. Dr. Best would cover for me if I was late or on the road. She would willingly change the day’s schedule around if it became apparent my whole routine small-animal day had to be scrapped for a complex equine call. “Let’s just make it work” became our motto. It was refreshing to be able to say “what do you think?” and “do you mind?” and “can you handle more?” to affirmative responses. Dr. Best even agreed to start up and monitor our Web site, knowing we had to join the technology generation. It was met with a great response.

  Shortly after she started, Leanne saw a seventeen-year-old cat as an emergency late one afternoon. The owner was difficult, tending to be taciturn and negative. The cat was not eating and had distressed breathing. She was in a life-threatening situation, but Mr. Timmins did not want to let her go. Leanne explained to him the several serious processes that might cause these clinical signs — all probably fatal — the most common being congestive heart failure. He flat out refused euthanasia; so, frustrated, Leanne came to me.

  “The little cat is suffering and cyanotic,” she explained. “I told him we did not have an oxygen cage, but he also refuses Ottawa. Could you talk to him?” I met the same stonewall. I realized Mr. Timmins would rather have Shadow die at home than make this terrible decision.

  “The last time I saw you was twenty years ago,” he said, still conveying an air of negativism I was soon to understand. “You said my dog was going to die of cancer, and it didn’t even have cancer. Why should I believe you now?”

  I stammered, beet red, “Both of us believe Shadow may die during the chest tap to remove fluid, or have a heart attack soon.”

  “I want you to try; the kids are all upset.”

  “Then we’ll pre-oxygenate her. I’ll test blood in the meantime to see if there are other problems with kidney failure that could mean we shouldn’t proceed.”

  He agreed skeptically, saying, “I just want to take her home tonight and not with a great big bill.”

  I gulped. The situation was certainly awkward and stacked against us, but I carried Shadow to the back and started to work on her. When the blood work came back, it was perfect, giving us no reason to halt. And the oxygen had helped her very much

  “Okay Leanne, lets proceed,” I said. “You might as well learn to do a chest tap.”

  After clipping and preparing her sites, we injected a spot mid-chest on both sides with a local anaesthetic. Shadow was being surprisingly tolerant. Erin held her gently in a sternal position while I inserted a small plastic catheter into her chest. It, in turn, was attached to a valve and a longer tube, and in this way I removed 180 ml of pinkish fluid from her left thorax. Leanne repeated the process perfectly on the right, and soon Shadow was breathing easier.

  “Let’s give her a diuretic and send out that blood for a thyroid test,” I said. “Mr. Timmins said she had lost a lot of weight lately.”

  Hyperthyroidism is a common disease in older cats. It can be linked to heart disease, and Shadow’s x-ray, taken after the fluid was cleared, showed she had an enlarged heart. Perhaps she had something further we could treat. When the test came back the following day, it confirmed her thyroid hormone was way up. If corrected with a daily medication to shrink the enlarged thyroid, the condition can be reversed and the cat will gain weight. As well, the strain on her heart would be less. Shadow was now at home doing well and had started eating and grooming again.

  We added pills for hyperthyroidism to her daily regime of cardiac medication. Her owner was practically beaming “I told you so” when he picked them up. The family successfully administered three pills every day, twice a day, to their little cat for a year before she died one day at home. They truly had the last word and taught Leanne and me a lesson on giving up too soon that we have never forgotten. Sometimes you can beat the odds. The words “Remember Shadow” carry a lot of weight at our practice when someone feels like giving up too soon.

  There were many cases of different and interesting surgeries that I had to expose Dr. Best to. One day it might be a urethrostomy on a male cat who had had several urinary blockages, another day a surgery to repair an eyelid. Our pattern was to do them together once and then Leanne would do one on her own with me available for questions and help. By the end of six months, I felt she could tackle almost
anything I could. Things were going well on the equine side as well, and so I felt blessed. I was learning my share, too, from my colleague just out of school.

  We had had some great staff parties, all building strong bonds of friendship. A spa day and a cooking class were hugely popular, but the most fun of all was a zany staff car rally. With a “redneck theme” proposed in advance, everyone was to show up at the clinic in costume at the appointed hour. I knew I had invited trouble with a best theme car, but had little idea how everyone would go to town.

  Dr. Best and her husband turned up as Lulabelle and Clem complete with rollers and a phantom pregnancy; she looked like a different person. Their car had a camp stove hanging off the back bumper. Others filed in, in coveralls or work shirts with ball caps and blackened teeth. Perhaps the best costumes were two part-time ladies in red and black flannel with tool belts and work boots giving out business cards entitled “Fix it chicks — Get ’er done.” We were off.

  I had planted clues at ten stations, creating our own mini-Amazing Race. There were trick directions to get there, times to adhere to, and questions along the way. I had eighteen people running the roads of Lanark for four hours picking up everything from pumpkins to road kill. They were not all pleased with me, as some got lost and had to backtrack many times. Retrieving condoms at village stores and flags from buckets in rapids were only a few of the pranks. Points were deducted for phone calls home for help, where I anxiously awaited the post-event party. I had tried to make the trip worthwhile, with good prizes, and the most competitive teams made it to all stations and back on time. It was a good exercise for everyone on how to keep your cool with your team. No one thought they would ever want to enter the real Amazing Race after experiencing the Brentwood Car Rally. As with all our parties, it was fodder for conversation for days and a chance to blow off steam.

  My interest had been piqued at a conference where the newest veterinary “must-have,” a digital x-ray system, was the hot topic. I came back to the clinic excited about the prospect of getting one. For years, veterinarians and doctors have developed radiographs using a film and wet chemistry system similar to photography. This system had been reliable enough, but plagued with problems of quality, not to mention being smelly and messy. Should we consider another brave leap into the age of technology? Leanne thought we should. I carefully worked the figures — could we afford it? I decided to take the plunge

  A laser imaging system translates the image of the animal into a digital format, making it possible to view it on a computer. Of course, these New-Age images could also be emailed, lightened, darkened, and magnified, as well as put on the animal’s computer history. It would be fun as well as progressive. Our days of playing in the smelly darkroom were drawing to a close. Now, we would just have to deal with electricity failures, software glitches, and a steep learning curve. We unpacked the many large boxes three weeks later, and I can say I have as yet not lost the thrill of seeing those x-rays pop up on the computer screen. We have the extra positive experience of seeing our clients’ delight when asked if they would like a printed copy to take home. A foot-dragger in the past, I was now a technology convert.

  Aero was a beautiful and stately six-year-old male German shepherd, a classic Rin-Tin-Tin fellow. One day, he was presented to me with a three-week history of straining to urinate. His owner could see that his problem was worsening quickly. I thought immediately of small bladder stones moving out to block his urethra. These small crystalline calculi can form in the bladder, then move out and get lodged at the os penis. This is a bone in the penis of the male dog, limiting the diameter of the outflow tract. I snapped an x-ray of the bladder, pelvic area, and penis. To my great surprise, no calculi were visible. They would have shown up as iridescent white pearls.

  I decided to sedate Aero and pass a urinary catheter. Although he was usually gracious, the next procedure would really push his limits of tolerance. Once sleepy, the 100-pound dog was easily slipped sideways onto the floor into a position of complete lateral restraint. I lubricated a long rubber catheter, but could not pass it. What was going on? I would have to do a dye test next. At that moment, I discovered a walnut-sized lump between his hind legs. It had been well hidden in hair and by the thick skin, but I kicked myself remembering many past resolutions to do a thorough physical exam. I called Aero’s owner, Gladys. “I think I’ve found the cause of the problem. We’ll have to biopsy the lump I found. It appears to be growing around or pushing on his urethra.” She readily agreed, even though an anaesthetic would be needed, but then asked cautiously “What will we be able to do about it? And what will we be able to do to help him pee while we wait for the results to come back. Shouldn’t you just remove it?”

  “I won’t know if I can until I get him under,” I said. “ I’ll get the catheter in and leave it there so the bladder can drain. He’ll have to wear an ‘E collar.’”

  It didn’t seem to be a good solution to either of us. Not only would Aero be dripping urine constantly in her meticulously clean-carpeted house, but the exuberant dog would be bumping into the door frames and furniture with his own personal lampshade on his head. I sighed, feeling stuck. Clearly I didn’t have the answer to this one yet. I only knew I had to deal with “the lump.”

  “No promises, but I’ll see if I can remove it,” I answered, “first thing tomorrow morning.” Aero’s bladder being drained, he went home overnight.

  When I got the big dog anaesthetized and on his back the next morning, I could clearly feel the lump. I did manage to pass a very small catheter and discovered that the urethra appeared to go right through the middle of the hard mass. Not only did I have that complication, but I would have to cut through the penis, a very vascular tissue prone to hemorrhage and full of nerves, even to do the biopsy. The prospect of totally removing the mass seemed unlikely. I set about optimistically. Working with a magnifying loop and watching for nerves, I dissected carefully through the spongy tissue using electrocautery to try to control the bleeding. The white, grisly mass did seem to attach to the urinary tube, but I tried my best to detach it and leave the urethra intact. After Aero was sewn up, I called Gladys.

  “I will leave the catheter in place, and he’ll have to stay here overnight to recover, but I think I got it all. I can’t guarantee there are no microscopic cells left. In five to seven days, we’ll know what it is,” I said.

  By day three post-surgery, we were all frustrated, thankfully not knowing how far we still had to go. Aero had his E collar off many times a day, had chewed at parts of his incision, and now there was extensive bruising evident under his tail and down his inner thighs.

  “There is ongoing slow bleeding,” I explained. “We must keep him quiet and monitor his blood values.” Despite her reluctance, the owner agreed to keep him mildly sedated.

  After a week, I got the pathology report back describing the tissue from the troublesome lump. It was a rare urethral tumour and had only been recognized and written up once in North America — in a German shepherd! I called a urinary specialist. They told me in no uncertain terms that I could not have removed all the cancer cells and that Aero should have a complete penile amputation and perineal urethrostomy — a drastic procedure that would leave him urinating from a hole under his tail. Heartsick, I called Gladys. He had just started healing.

  “Aero will have to have another big surgery — one that I will call in a specialist for,” I said. Not surprisingly, she started to cry.

  When I told her the cost, she simply stated, “I’ll go into my savings. All I care about is that I’ll have my dog in the end. Will he really be able to live that way?”

  I assured her he would. I had done many urethrostomies on cats and knew there was a chance of complications like scar tissue around the opening, but it was unlikely. We booked the Board-Certified Surgeon to come to our clinic.

  When Aero was finished, he had a smooth abdomen and a two-foot inc
ision. A two-centimetre pink opening of mucous membrane under his anus showed where he would void. Dr. Phillips had done a masterful job.

  Aero continued to challenge us with his aftercare. He was getting less and less magnanimous about medical interventions. Gladys had to drag him into the clinic, and several days he dragged her back out. For three weeks solid, we cared for Aero every day as his exhausted owner went to work. By this time, she had observed every urination around the clock for six weeks. In time, his long incision healed well and his urethrostomy worked perfectly. It did everyone at the clinic proud to see him lift his leg on our front step — and always elicited a laugh from his owner, as he marked his territory with gravity, not knowing he was aiming in the totally wrong direction.

  My nieces were turning out to be great riders. Several years of showing ponies had made them tough and determined horsewomen. Although Anne no longer rode, she was a great teacher, and they had jumped many a jump by my fiftieth birthday. I had only one request for my half-century celebration: I wanted to go on a cross-country ride with them. Sophisticated preteens, they were definitely more interested in showing than riding across fields and ditches and jumping solid obstacles, but they indulged me. It was, unbeknownst to me, the last time I would talk them into such a bold, fast-paced ride over solid obstacles.

  The day was as perfect as only September days can be, with the leaves turning, and a fresh, fall crispness in the air. Elizabeth had decided to join us, and, steaming mugs of coffee in hand, we all loaded up and trailered to the best cross-country facility in the area. Our four horses were perfectly turned out, and, with cross-country tack and boots on, they looked splendid. Their coats were gleaming with dapples, and the brass on the bridles was shining. I remember thinking how amazing it was to be there with my most special people and four beautiful animals. For all of the people and animals involved to be healthy and fit and together to fulfill my birthday wish seemed almost too good to be true.