Brachial plexus injury, and a big spot of doubt.

Last Saturday I had the honour of meeting a young marmalade cat who'd been hit by a car and found his way home a couple of days later (judging by the dried blood on his chin and the degree of dehydration). He had a broken lower jaw, a broken upper canine tooth (fang), and an injury of the front leg that made it impossible for him to use it. A fracture would have been much better, medically speaking. But this cat had a brachial plexus avulsion (torn or badly stretched nerves that run through the armpit to the front leg) which happens when the arm is suddenly and violently thrown sideways. With this injury there is almost no hope of meaningful recovery. In the best case scenario, the animal 1. is a dog, 2. has a calm and patient temperament, and 3. has undamaged nerves running from the back to the muscles above the elbow. Then they may learn to throw their leg forward to unfold the wrist onto the ground. If they are not so fortunate, the wrist buckles under and is dragged along, making it necessary to amputate the leg. Either way, they are unable to actively move the wrist and position the foot. This cat had two major disadvantages going against him: his injury was bad, making amputation necessary, and he was an inveterate outdoor cat.

I explained the injuries to the owners and said that physically the cat would recover just fine after a leg amputation - he was a robust young cat with the will to live, and ate a whole plate of food after the painkillers had kicked in. (He would also have needed dental surgery to remove the root of the broken fang and to wire the lower jaw together.) I told them that he would have to be an indoor cat for the rest of his life, as it is not safe to let a three-legged cat outdoors - he can neither run fast enough nor climb to get out of harm's way. Then I asked the owner about this cat's day - what he does, what he likes to do. The answer I got told me he was a dedicated outdoorsman, and would probably be miserable if confined. Unless he was frightened off the outdoors by his experience. My broaching of the subject, and asking the owner about his lifestyle, may have sealed his fate. Because an hour later, after we'd given the owners a financial estimate of the surgeries and hospital stay, they called back to tell us they'd made the decision to euthanize.

The things I've learned since starting in this career are the tip of the iceberg of what I want to know and be able to do. Yet one thing that came naturally (and perhaps too easily, given other veterinarians' typical reaction to the issue) was reluctance - or inability - to judge most people for life-and-death decisions relating to their animals. Of the things we do, passing judgment has to be one of the most exhausting procedures. I know this from the times when I was unable to resist. I'm actually quite easily annoyed by people, but this is different from feeling morally indignant at their choices. In this case, I did not feel the cat was being done a gross injustice. I needed to know his lifestyle, and I needed to tell the owners that the only safe life for a three-legged cat would be an indoor one. The God complex that afflicts many veterinarians made me feel responsible for the owners' decision - even now I can't help thinking the cat might still be alive if I hadn't stressed indoor lifestyle or if I'd been more forceful with the possibility that he might not even want to go outside from now on. Alive and recovering from a major surgery to see if his new life was livable to him as a cat as opposed to feline patient. He spent his last hours free of pain, ate a hearty meal, and dozed off slowly as the barbiturate I injected into his belly took effect. Then the receptionist told us that she got a vibe from the owner when he first brought the cat in that morning - he would not go ahead with any involved procedures. She has enough experience with people for this to be believable. And enough kindness to say things that would make us feel better. I still think I may have swayed their decision, but it must have been ready to be swayed.