by JULIAN EARL
It surprises us sometimes when a young child comes in with their much-beloved pet for euthanasia. There is a discussion to be had about the morals in giving a child such responsibility, but it does happen. The best approach I heard was from a nurse assisting, who simply asked the frightened boy, ‘What would your daddy do now do you think?’ The boy said he didn’t really know but maybe would put the pet down. He added that he would like to ask him, because he was waiting in the car outside. We immediately went outside to discover first-hand what his daddy would do. Sure enough, the boy was correct, but it was not right to expect a boy of ten or so to accept that responsibility.
On other occasions, the child merely wants to hang on to their pet, sometimes literally in order to say their goodbyes. A seven-year-old Labrador with extensive tumours had collapsed because of internal bleeding and was hospitalised, although little could be done. The teenager of the family had been with the practice for work experience. He knew that his dog, Honey, was extremely poorly and, fearing the worst, came to visit after he finished school. We watched Honey recognise him immediately; she became more lively and excited than she had been all day. There was no doubt who she thought was her best friend. The lad walked to the large hospital cage, opened the door and, with tears rolling down his face, crouched down to hug and stroke his very beloved pet. Honey struggled to rise to her feet but wobbled and sank down to the floor, half on the lad’s lap, Honey licking and licking away the salty tears, the two of them mutually expressing their love in the best ways they could.
We tried to explain that there were not many options left and fortunately, the lad’s father arrived about half an hour later, the father trying to comfort his son, helping both Honey and his son to their respective feet. The boy whispered his feelings to Honey one last time, and she wagged her tail in response for the last time as well. The father arranged to telephone the practice later to see if a miracle had occurred, but at 7.30 p.m. the father consented to the euthanasia and the deed was done.
When he arrived for work experience the next day and saw Honey’s empty cage, the boy was distraught. Mr M, a vet with a fearsome reputation, took the boy to one side and explained that there was nothing he could have done to save Honey and that it had been the kindest course of action. It was the most sympathetic I had ever seen him.
We later heard that the son had been so upset he refused to agree to the family having another dog as a replacement for Honey, because he only wanted Honey back and no other dog would be the same.
However, some six months later we remembered the distress of this family when a stray Golden Retriever puppy was brought in by a driver who had run the six-months-old dog down. Not wanting to leave the dog in the road, the man brought it to us and we looked at the severe compound fracture of the back leg. Compound fractures are when the bone has broken the skin, and the bone is exposed, risking major complications. A quick telephone call to ‘the Honey family’ and an explanation of the situation led rapidly to a visit from their son, who clearly liked this puppy on first sight, but then went home and asked his family if they would rehome the dog. The risk of complications after orthopaedic surgery was too much of a deterrent, however, and sadly the dog was eventually euthanased because of the painful, severe injury. If there is a happy side to this story, it is this: the ice had been broken for the boy and apparently the family shortly heard of a Labrador called Buster owned by two doctors who could not cope with him. Some family friends had tried to rehome this dog but he was far too boisterous and destructive, so he was returned. The Honey family heard of this and asked the son if he wanted to have a look at the dog. He agreed, so they drove off to inspect the dog immediately. Seeing Buster sitting on the front step in the sunshine, the son fell in love with Buster’s big, floppy, typical ‘smiling’ Labrador face and a new chapter of the lad’s life started. Buster was taken home for a one-week trial in view of stories of his destructiveness, but fortunately the week went by without incident.
Buster was a frequent visitor to the vets because of his genetics; he suffered from terrible hip disease and elbow disease, and although surgery both prolonged his life and improved its quality, his arthritis was very severe, even at a relatively young age. It never stopped him jumping around whenever he spotted another dog, nor from chasing after rabbits. He just had to run more slowly, and perhaps only chased arthritic rabbits.
Buster had been destructive after all when left alone, but not until he had served his probationary week first. The mother of the family had won a gold award with Honey for obedience at training classes, but there was not a chance of that with Buster. He was thrown out and banned from dog classes for being so excitable and trying to be too ‘friendly’ with the other dogs. He always caused much excitement in the waiting room when visiting the vets.
Buster had few other problems, but at the age of over thirteen years, the same lad who visited Honey almost fourteen years previously walked in with a hobbling but bright, boisterous Buster. The medications available for arthritis then were not as varied nor as effective as the medications that are available now, and the family had decided that this hyperactive dog was not living the life he deserved and requested that Buster be put to sleep. The young man lifted his forty-kilogram Labrador on to the table and asked to hold Buster for his final minutes. Buster clearly enjoyed being held and stroked at this time, his tail beating the table with some vigour. I remember the words spoken to Buster by the lad as he hugged him around the neck and shoulders, trying to make the memory of how his dog felt next to his face and under his hands last forever:
‘There’s a good boy.’
‘I love you, Buster, you know that don’t you?’
‘Be a good boy. It’s just another injection; that’s all.’
‘Be a good boy and stay still, just like during all the other times.’
‘There’s a good boy. Bye-bye Buster, I’ll always love you, Buster.’
I do not know if the young man was religious but on his way out of the surgery, I clearly heard him ask: ‘I miss him now! If there is a heaven, Buster will be there won’t he?’
Yes, young man, expect that the love of our pets will be there waiting for us, and St Peter might be saying to you, ‘Please will you get in here right now and will you please get this dog under control? He is causing chaos!’
Chapter 12
Compliments and reprimands
Bouquets and a justifiable brickbat
The commonest compliment we receive as vets is (I apologise to any doctors who happen to read this), ‘I wish we received this type of care from the National Health Service! I wish they were as thorough and as quick as you!’
Absolutely true I am afraid, so make what you will of that. Having said that, there is one veterinary-only situation where one can make or break one’s reputation and that is undoubtedly euthanasia, where emotions are running high and sensitivity to all concerned is of paramount importance.
While it is very nice to have a technical success, to be told by an owner that one has a reputation for being good at handling cats warms the cockles of one’s heart. For an owner to pass such a comment during a consultation undoubtedly brightens a stressful day. It is not a comment about one’s knowledge, but about how one cares and it is good to know that it is recognised.
I only once received a compliment that was ultimately a bit of a disappointment. I attended a regular client’s house for her poorly and elderly cat that I had looked after for years. I arrived at her house, complimented her on the wonderful Christmas decorations adorning the place (including the cat’s basket) and warned her that I had known a cat that, for whatever reason, decided to chew and swallow a thirty-centimetre length of tinsel hanging from a tree. I then examined her cat and diagnosed some painful but otherwise non-serious condition, at which news she was delighted and relieved. In her delight she said that she would like to offer me a Christmas present for my care of her cat and lifted up a large box of expensive Swiss chocolates. Blimey, I thought, t
hose are a special thank you, at which point she opened the box and said, ‘Yes, you can have one if you like.’ I hid my disappointment and delicately chose the most tasty looking item, thanked her, and inwardly was a little relieved that my calorie intake this Christmas was not going to be excessive after all. The cat lived on for many years after appropriate pain relief.
Arguably, the nicest compliment that I received was from a horse. Golly, short for Goliath, was at one time officially the biggest horse in the world. He was a very, very large Shire horse, nineteen hands and one and a half inches; that is almost two metres at the withers. I had attended to Golly for various reasons over the years and, like most Shire horses, he was extremely well behaved – a good job given his enormous size. As just one example, Golly had fallen down and, being so big and then a bit injured and weak, he was unable to get up again. The only people able to help him stand up were the fire brigade who, to their credit, wanted to be so careful with him, that they insisted they had veterinary permission to lift him up. That was okay with me, and in fact it was essential to get Golly up and about again as soon as possible to prevent further damage. At least lifting up a huge fallen horse would have made a change for the fire brigade from rescuing a cat, or even a cow, stuck up a tree, I imagine.
Some time later, the Centre where he lived had an open day during the local school summer holidays and we had foreign visitors so thought we would take them to the Centre as a local attraction. We arrived, I said hello to the owners of the Centre and we took our guests into the large barn where everybody could meet and pat the horses. There was a large crowd of probably nearly a hundred people mostly bunched up behind the barrier keeping the horses in their pen. The horses would approach to receive attention. I was standing at the back of the crowd about one metre from the barrier, when suddenly a large shadowy shape appeared directly in front of me, blocking my view. The very large head of a very large horse – Golly, of course – was stretched over the top of the crowd and, as horses do, he blew out through his nostrils to greet me. I blew back; he continued to stand there and receive the hefty patting from the crowd and, I felt enormously flattered that Golly recognised me through the large crowd and voluntarily came up to find me.
I have since discovered that Mr S, the owner, told Golly that I was there and that Golly actually had to push his way gently through the throng of people just to greet me. My wife thinks it is because I must smell strongly (of veterinary matters, I think she means), and that is why Golly looked for his personal physician. I think that he merely recognised me by looks alone. Sadly Golly died, at a great old age, a few years later. He was truly a memorable horse indeed. I have regretted not being there to help Golly on his way because we did have a bond and I always felt it would be my responsibility. Golly’s ashes are now buried in the garden of the Centre.
Golly might have been relatively pleased to recognise me, but I cannot be the only vet who has had a completely strange dog stop in the street and stare at me suspiciously before barking aggressively. Perhaps we do smell distinctly after all, to dogs, at least. I used to collect a weekly magazine from a newsagent’s nearby, and every single time the black Labrador living there, who was an occasional patient of mine, would bound up to the counter, jump up and place his front feet on the counter, his head just in front of me as he barked loudly at this nasty person who came into his territory. Luckily he never went any further than merely protesting noisily.
Brickbats sometimes arrive instead of bouquets, of course. For example, when I was a new graduate, there was a suspected foot and mouth outbreak in or around Sheffield, some distance away from where I was working. But I was old enough to remember the black and white television pictures of pyres of burning carcasses in 1967 as a consequence of foot and mouth disease, so took the possibility very seriously when I was called to a cow with a badly ulcerated mouth. I visited, something I would not have done in the confirmed outbreak of 2001, and was later correctly reprimanded for leaving the farm (and risking spreading the disease myself) as far as the farm entrance on the main road before the official vet from the ministry arrived to check the cow. Fortunately, it wasn’t foot and mouth. Then about one month or so later, on a very dark winter’s evening, I was called to a hill farm, very isolated in the rural hills. It was a different farm from the previous one, situated in the middle of nowhere and for a lame cow with ulcerated feet. Because of the recent scare in Sheffield I again called the ministry vet out, but this time received a reprimand for not standing at the bottom of the long track into the hills so that Mr Ministry Vet didn’t have to drive up and down the country road in the pitch-dark while he looked for the farm. Sometimes you never win. On the bright side, that wasn’t a case of foot and mouth either, but I had thought ‘better safe than sorry’.
It was a real shock to have to deal with one genuine epidemic in 2001. We became paranoid about any reported lame sheep, or cows suddenly off their food, just in case the disease was striking close to home. On that occasion, I absolutely never stepped on or off a farm without thorough disinfection.
Chapter 13
Removals
Lumps, bumps and large calves
One remarkable patient was a very friendly, fairly young ginger cat that developed a large swelling on the head by one eye. Examination revealed this to be a solid tumour, not an abscess as cats often suffer from around the face, and the only option was exploratory surgery to attempt removal. Beforehand, we told the owner that this would be difficult, the outcome uncertain, and thus to be prepared for bad news. The cat was admitted, I opened up the skin around the mass and carefully dissected around the area, proceeding warily as I realised that the mass extended behind the eyeball and into the bony orbit containing the eyeball. It was not, in fact, very complicated technically because the bony surface of the orbit provided a firm and definite border for how deep I needed to dissect. Until that is, the hard surface that I could feel developed an edge. I managed to lift the bulk of the growth out of the orbit without apparently damaging the eyeball, and could then clearly see into the orbit around the cavity that contained the eyeball. It was apparent that the tumour had eaten through the bone behind the eyeball and I could see a distinct thick white layer of membrane across the back of the cavity. Through the membrane, I could also see a greyish/corrugated organ, millimetres away from the deepest part of my dissection. I was not expecting to visualise the cat’s brain this way when I started the operation! I had been only two or three millimetres from penetrating the dura mater, the outer lining of the brain. It was now time to put the cat’s head back together and the only problem I had was that there seemed to be a shortage of skin compared to before the operation. The skin over the skull of a cat is not very elastic and is firmly attached to the tissue and skull underneath, and some minor cosmetic surgery allowed me to extend the skin of the head over the large wound where the tumour had been. Although the cat lived, he had a surprised expression for the rest of his life, probably similar to my expression when I realised how close I had been to performing brain surgery that morning. That was something they never covered at university; fortunately, general surgical principles carried me through the unexpected finding. Whenever I think of this cat, I call him Roger, as in Roger Moore, the actor with the upwardly mobile eyebrows. I sometimes describe this case as the one where I removed a cat from a tumour. At least I managed to leave his brain where it was supposed to be.
One condition that we see frequently in middle-to older-aged bitches (and occasionally in cats) is something called a pyometra, a hormonal imbalance leading to a gross enlargement of the uterus with pus. This is very common indeed in dogs occuring about one or two months after bitches have been in season. The bitches show increased thirst, loss of appetite, sometimes vomiting and some have a horrible vaginal discharge. The usual therapy is surgical, removing the pus-filled uterus. Although they are often desperately ill, most bitches are vastly better within three or four days of the surgery. When the uterus is removed, it is no surp
rise that the bitches are so poorly. A normal non-pregnant uterus of a medium-sized bitch is approximately half a centimetre thick, twenty centimetres long, and weighs perhaps one hundred grams. I had a shock when I removed a pyometra-uterus from a bitch that weighed twenty-eight kilograms before the surgery and just twenty-two kilograms without her uterus afterwards. She must have felt as if she was very heavily pregnant until her diseased uterus was removed.
It is not really fair to describe removing a baby animal as removing a lump or bump, but caesareans on cows are definitely a significant removal of one sort or another. I had to carry out a caesarean section on a beef-breed calf from a dairy cow, which set my personal record for a calf. When I started to pull the calf out of the caesarean wound in the side of the cow, I thought someone else on the inside was trying to pull the calf back in. I discovered why when the farmer later weighed the calf. Dairy or beef calves usually weigh between forty and fifty-five kilograms at birth and are born normally, but this particular calf weighed in at ninety-two kilograms at three days old, so would easily have been eighty kilograms or more when I had to pull him out of the side of the cow. The farmer named him after me owing to my effort in removing the calf. I think it was meant as a compliment.
But the worst calvings and caesareans are those involving the grossly abnormal; of which I find the most difficult something called a schistosomus reflexus, often called the inside-out calf. These are calves born with the spine bent backwards into a U-shape, meaning that the skin and muscle never grow over the internal organs. You puts your hand inside the mother having difficulty giving birth to one of these calves, and you either feel four feet pointing at you, and usually no head, or a lot of slippery calf intestines. You hope initially that you have identified twins, hence the four legs, but other abnormalities show that only one calf is present. At this point your heart sinks because you know that you have a very major operation about to start. The head is usually pointing in the opposite direction from the feet, away from you. Because the calf is curled up in effect, it has to be born by caesarean, but the proportions of the calf’s body make the calf abnormally wide and a huge incision is normally required in the side of the cow in order to extract the calf. As with all operations, it always takes longer to put the animal back together than to open it up, so making a large incision means essential extra work for the stitching up. Worst of all, these calves are still alive because, inside the mother, they do not need their lungs. When removed, they blink, kick and slowly suffocate as their exposed lungs do not work. Euthanasia is immediately necessary. Having not seen one of these in the first six years after qualifying, I then saw three in a period of two years. The cause is unknown and I think that I have eventually recovered from the shock of seeing three in quick succession.
