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Vet On a Mission

Page 18

by Gillian Hick


  When it came to doing our final-year presentations, I couldn’t resist picking Shep as my case study, glad that he had made a complete recovery.

  Probably the biggest disappointment with a career in veterinary medicine is that once you are immersed in the frantic pace of life, there is no longer that time to spend getting to know and gain the trust of the patient. The hours I had spent as a student and before were simply no longer available. On many occasions, when a nervous patient arrives in a busy clinic, there is no option but to carry on without taking the time to get to know them. In some cases, with time that trust comes in a way that fascinated me. Surprisingly, it is often after an animal is admitted for an overnight stay that they get over their fear of coming to the vets. In the early days of Clover Hill, Smokey, a young Glen of Imaal terrier spent a few nights with us with gastric issues, which had required relatively major surgery. He clearly enjoyed his stay so enormously that for many years after, on arrival for any routine visit, he would abandon his owner and run down towards the kennels as though checking in for another stay.

  Despite their anxiety coming in, in general the animals are way easier to deal with than the owners. On one occasion, as I examined the eyes of an elderly Bearded Collie, the owners were distraught when I told them that Oscar was almost blind. Oscar, of course, had acclimatised to his condition so well that the owners had not noticed but even though I explained this to them, they were inconsolable to the extent that the unfortunate Oscar who, five minutes previously, had been perfectly happy, started to become anxious, clearly wondering what tragedy had overcome his beloved owners that had upset them so much. So often, I find myself recommending that the owners observe the dog’s behaviour so that when a lump turns out to be potentially cancerous, I encourage them to be like their dog – perfectly happy, with no anticipation of what may or indeed may not ever happen.

  Amputation is thankfully a rare salvage procedure that we recommend only when a limb can’t be saved and although radical in some sense, it is usually well tolerated by the animal. The main difficulty with this seemingly barbaric surgery is in convincing the owners that it is the best option. I can fully understand the owners’ apprehension as, even to me, it seems such an extreme option and every three-legged cat or dog running around Wicklow haunts me a personal failure. But this is only my issue and really nothing to do with the quality of life of the pets.

  It’s always a delicate balance discussing the surgery with owners as I always try to simply present the options and allow an owner to make an informed choice as to what is best for their pet. Not uncommonly, when presenting the option of amputation the initial reaction from the owner is to request putting the animal to sleep. It takes much talk and reassurance to convince the owners that such drastic measures are in general not warranted.

  Kids always strike me as being more like animals than their parents and it is usually the younger generation who are more open to suggestion that the world-weary adults. Tiddles, an eighteen-month-old neutered cat arrived in late one night after being found by a neighbour. Whatever led her to an encounter with a car, she had clearly come out second best. Despite the dragging hind limb, Tiddles was still feeling feisty and had miraculously avoided any other injuries. After lengthy discussion with the three primary-school boys – Rory, Fiachra and Lorcan – who owned her and their mother, Marie, the next day I attempted to place an intramedullary pin to repair the fractured femur. Unfortunately, although on the radiographs it looked as though this might be a reasonable option, as soon as I attempted to place the pin in the proximal fragment, the length of bone simply crumbled into fragments. Although this is a rare occurrence, it reminded me of a similar situation some years previously, when I had attempted to pin the wing of a very elderly gander who had a significant career as a film star. The bone had simply splintered into fragments and the unfortunate gander had to be euthanised. It took many weeks before tiny white feathers stopped appearing in random places in the theatre.

  Thankfully, in Tiddles case, due to her young age and agility, amputation was going to be a suitable option. The only difficulty was in convincing the mother, who was understandably shocked at the sudden and drastic change of plan. Her main concern was how the three boys would take it. From previous experience, I knew that once Tiddles was back home and able to demonstrate to the kids that life was good, the lads in question would have no difficulty in adapting to a three-limbed pet.

  When the very happy three-limbed Tiddles was ready to go home a couple of days later, the lads were clearly enthralled by the remains of the shaved limb, and their main question was in relation to the fate of the missing fourth limb.

  As vets, we are in the enviable position of regularly receiving thank-you cards and gifts from grateful owners. Sometimes I wonder how we are so much appreciated when other professions work just as hard with no obvious thanks. Probably the best thank-you cards we receive come from children, and over the years I have a collection of the more special ones that sometimes just remind me why we do what we do. On this occasion, when Tiddles returned for a wound check, her minders brought a card. The laminated card was clearly the work of her real owners and bore a picture of myself (I assume) coloured in in full surgical green with a very impressive green surgical cap. In my hand was a large corrugated saw, dripping with blood, while Tiddles was pictured lying dramatically on the surgical table, looking on, watching the entire proceedings. On the floor beside me was drawn a rectangular box, clearly labelled as the ‘limb bin’.

  Clearly the kids had got over the trauma of the surgery and Tiddles herself was well on the way back to three-legged normality. We kept the card in the surgery for a long time, despite questioning looks from some of the more sensitive clients!

  So definitely, the patients were usually the easiest to deal with, followed by the kids and lastly the adults.

  In the same way as I learned to observe what animals were telling me with their silent language, I definitely think they also taught me how to deal with people. Some animals have better people-management skills than others and I found over the years that older animals seemed to have it all worked out. Treating older animals can at times be more rewarding than treating younger animals, as they seem to have developed a sensitivity and intuition that younger animals are simply too busy for. To me, animals age with way more grace and dignity than many people I know, although there are of course exceptions.

  I was lucky that especially when I have treated a particular pet over a long period of time, owners trust that we have their best interests at heart. If a young dog suffers a severe injury, it is reasonable to me to perform invasive and potentially stressful procedures, knowing that there is good potential that the dog will have many years to benefit from the intervention. When an old dog is clearly struggling and then develops another major injury or illness, although I outline all the available options, I normally advise owners that it is in the best interests of the pet to keep them happy as long as possible, rather than alive as long as possible. Sometimes starting into major surgical intervention or medications that require lots of monitoring and follow with a long list of potential side effects is really just a human reaction wanting to hold on to the pet for as long as possible regardless of the quality of life for the pet. Each individual case is different and each pet has to be assessed for their own unique requirements, but in general the animals themselves are way more accepting of ageing and dying than the owners.

  Working with older pets becomes a three-way bond between owner, pet and vet that lasts until the final breath is released. It is in these situation that I realise what I have learned from my patients in teaching owners to trust my good intention. Although of course in some ways it is understandably a matter of avoiding being the one to make a decision, it amazes me how often an owner will ask, ‘What would you do if it was your pet.’ In ways, it’s a silly question and I can’t be honest and tell them if it was my own beloved pet facing terminal illness that of course I would fall apart and h
ope that someone else would guide me! Although I always try to allow the owner to come to the decision for themselves, in some cases, particularly if the pet deteriorates quickly and is suffering, I often find that by telling them if it was my pet I would let them go, they will allow the decision to be made.

  Over the years in practice, I have found it very humbling to realise just how much trust an owner will place in our hands. As a new graduate it was totally intimidating but at least I knew that I didn’t know enough to deserve their confidence. As time went on, I gradually became more confident in not only outlining the options, but also in guiding the owner as to what would be the best option for them and their pet.

  Probably the best skill I learned was to know what I didn’t know and to have the confidence to tell owners that I didn’t know. All new graduates feel under pressure to prove themselves and I always tried to have an answer for everything, but as real-life experience padded the scant knowledge I had learnt from the text books, I became much more comfortable acknowledging when something was beyond my skill. At that stage, I would more than happily do some research or get in touch with someone more senior than myself for advice or, in some cases, refer the patient to specialist or referral hospital. What fascinated me was how often, having explained the reason for referral, the owner would still want me to continue looking after the medical case or to perform a surgery that I was simply not well enough equipped for or experience at.

  In the early days, I probably put myself under a lot of pressure, trying to look after more cases and patients than I was able for, feeling somewhat obliged to meet people’s expectations of me. Again, with increasing experience I learnt to gently refuse to do something myself that I knew someone else could do better apart from cases where the cost of referral was prohibitive to the extent that the animal would be left untreated.

  In all walks of life, things go wrong. Misdiagnosis, adverse drug reaction, simple human error, all for a variety of reasons are an unfortunate reality of life. Somebody’s beloved pet has to be the one that is listed as being a 0.01 percent risk of a particular reaction. More often than not there is no logical explanations for these outcomes. When things do go wrong I am usually more gutted than the owner and can fully understand how upset or angry they would be.

  On one such occasion, we had a relatively calm and quiet day at the surgery. The clinic was nicely paced with plenty of time to chat to owners and patients which was always nice, especially with new clients.

  With only two patients for surgery, we stopped for a cup of tea which was always a welcome interlude in the day. Although the Labrador for spaying was already overweight at nine months, the surgery was very routine. Apart from her, the only other surgical patient was Squire, a spaniel who had developed a cyst on his lower eyelid that although relatively benign-looking, was causing him considerable irritation. As it was getting bigger, the owner was happy to take my advice that surgical removal would be the best option.

  I almost opted for simple sedation and removal under local anaesthetic, but with Squire sedated, I was better able to examine the lesion and although in the consulting room it had looked relatively superficial, it was actually invading well into the tissue of the eyelid so I decided I would carry out the procedure under full anaesthetic enabling me to remove a small wedge of the eyelid to ensure that the entire mass would be removed with little change of regrowth. I had already discussed both of these option with Peter, the owner, on the day I had examined Squire and he had signed consent for either procedure so there was no need to make further contact as he was happy to let me decide which was best.

  With Squire sleeping peacefully on the theatre table, taking slow steady breaths of the mix of oxygen and anaesthetic gas through his endotracheal tube, I filled his eye with a lubricating gel to protect it as I carefully clipped around the eye and disinfected the area. Preparing for eye surgery is always tricky, but before long I was happily dissecting out the cyst. I always enjoyed suturing the edges of the eyelid as it has to be exact to ensure that once the hair grown back there is no obviously abnormality especially as the dogs eyes are such an expressive feature of their face. Once I was happy that the margin of the eyelid was exactly apposed, I quickly sutured the outer and inner eyelid and carefully flushed the eye with gently heated saline to remove any blood. Squire was soon back in the recovery kennels while I went to fill in his surgery report and discharge sheet before going for lunch.

  With my back turned to Squire, I was startled when I heard a loud bang. I turned around to see him having a full-blown epileptic seizure. In the early days, when anaesthetic agents were not what they are now, animals could have small seizures while going to sleep or waking up, but modern anaesthetic agents just don’t result in these reactions, and this was a major seizure, so aggressive, that I had to quickly restrain Squire, putting most of my weight across his body to stop him from damaging himself within the confines of the kennel.

  Although such a dramatic reaction is an incredibly rare occurrence, the theatre is always prepared for these emergency situations. Within seconds, Amanda was handing me the emergency crash box from which I drew up a dose of anti–seizure medications. She had to use considerable effort to hold him steady as I injected it into his intravenous cannula. Soon he was relaxed and breathing normally again, but his heart rate was high and his mucous membrane colour was poor.

  The prospect of lunch was now history as we wheeled the anaesthetic machine into the kennels enabling us to oxygenate Squire to help his recovery.

  Despite the sedative, in less than five minutes Squire was seizuring again. It took a higher dose this time to control the seizure, so once he was calm I connected a giving set so that we could allow continuous medication to be administered with more ease. Usually an adverse reactions after an anaesthetic resolves quickly but it was well over an hour later with Squire still needing continuous medications that I was able to leave him with Amanda and ring Peter. He answered with his usual bright and cheery voice but quickly became silent as I explained how despite the routine surgery, Squire was in difficulty now. There was a silence as I came to end, not knowing what more I could tell him other than we were doing everything we could to stabilise him. After a few seconds, Peter asked in quiet, unfamiliar tones, ‘So tell me, is he going to pull through or not?’

  ‘I don’t honestly know, Peter,’ I answered. ‘I’ve never seen such a severe reaction and we are having difficulty stabilising him. He just doesn’t seem to be responding as I would expect.’

  Again there was a pause, before Peter spoke again.

  ‘Just do whatever you have to do either way. I’ll leave all the decisions in your hands. If you think he’s not going to make it just put him to sleep.’

  This time it was me that paused, not knowing what to say, but before I could think of anything, Peter had hung up. I couldn’t blame him, as the healthy dog that he had left in for routine surgery that morning was now critical.

  Squire did pull though, although it was well after tea-time before we could leave him and I wearily made my way over to the house for a quick sandwich before I headed back to the evening clinic. I kept him in overnight to monitor him, but he never looked back. Peter was delighted when he came to collect him the next morning.

  ‘You’re causing me a lot of drama for no reason,’ he told Squire, clearly relieved to see him in one piece. ‘I was thinking to myself after you rang yesterday to say it wasn’t looking good for him. If it was anyone else, I would have been raging, but at least I knew when he was with you, whatever happened he would be in the best hands.’

  I didn’t know whether to cry or to hug him, but was just more relieved than anything to see Squire going home in one piece.

  As they were going out the door, I called after them.

  ‘Just one thing, Peter. If that cyst grows back again, it’s staying there!’

  One vet I knew had come up with a novel scheme to motivate staff, so that instead of offering a Christmas bonus, he allowed t
hem to choose ten clients they would throw out of the practice. Over lunch one day, many months after Squire’s episode, we sat down and tried to imagine who we would pick. Despite a client register that by now was well over three thousand, between us we couldn’t think of ten people to choose. After the first five, we were sort of stuck, as most suggestions after that had some sort of redeeming quality that gave them a free pass. We actually spent much more time then discussing how many lovely clients we had.

  Despite the drama and the ups and downs, and despite the fact that as a child, I only wanted to work with animals and have nothing to do with people, the years spent dealing with the owners had made me over time grow to like people a whole lot more.

  Epilogue

  It seemed like very recently that I had first stood on the steps of the University College Dublin Veterinary Hospital campus. I can still clearly remember that first morning of college, having first gone up the wrong road in a vain attempt to find the place, then finally finding my way to the large metal gates and taking a deep breath as I walked through the entrance.

 

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