Animal Doctor in Transition

Looking for meaning where there may be none.

2011-04-02T20:00:00.000-07:00

A very pregnant cat came to our SPCA hospital from the shelter yesterday, and according to protocol she could be either euthanized or spayed. Nice and simple choice, kind of like choosing a plan for your wireless phone. The veterinarian doing surgeries was able to fit her in. Any vet I know, including myself, would find a way to get her spayed if the alternative was euthanasia. The logic behind this is seemingly clear-cut: the mother cat is already the subject of a life, but the kittens' lives have not yet begun. I know, many would argue that the kittens are in fact already alive, or at least viable, if the pregnancy is advanced enough. Never mind cats - the question of when a human life begins has still not been settled to everyone's satisfaction, so there's no need to repeat the debate here. In veterinary medicine in a shelter setting we of necessity simplify things: an animal that has already started its life and lived some of it, usually takes precedence over an animal whose life - growing, learning, playing, experiences - has not yet begun. I have no intention of pondering what's right and wrong here. There is no right and wrong, only consequences - and I can't even lay claim to this great saying. The consequences in question are the number of lives that require homes, and that are in danger if these homes aren't found. Fewer lives mean less potential for suffering in our cat-unfriendly world, and lives that have not yet started (in the simple, non-convoluted sense) should not be encouraged to start. Simple math, and no need for moral agonizing.

But consider the other official shelter choice - euthanizing both mother and unborn kittens. The mere fact that it exists is interesting. Even more interesting is the fact that some veterinarians avail themselves of this choice. Think about it: a cat who has not yet become pregnant is entitled to spay and subsequent life, but one who is pregnant has somehow lost these wonderful privileges conferred by humans. Why is that? I doubt it's because the non-pregnant cat is considered healthy whereas the expectant mother is somehow an anesthetic and surgical risk. Spaying a pregnant cat is more involved than spaying an immature one, but it's still a fairly simple surgery (compared to dog spays) with little or no health threat to the mother. So, why would a pregnancy even theoretically threaten a cat's right to be spayed and to continue living?

Brachial plexus injury, and a big spot of doubt.

2011-03-19T22:09:00.000-07:00

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.

Free Lance (or would that be Free Scalpel?)

2011-02-10T12:19:00.000-08:00

Since the beginning of January I am no longer gainfully employed by someone else. Business was slow and work a little too relaxed, and I'd started forgetting what it's like to be a doctor. By mutual agreement with my employer, we said our goodbyes. They tell you not to leave your current job until you have another one lined up (or is it - don't leave your current boyfriend unless you have a new one lined up? I get confused). I had nothing lined up expect for a few locum days at the SPCA hospital. Such perhaps unwise audacity was inspired by a trip to a First Nations reserve in November where a team of us volunteered at a spay-neuter clinic. Just like that, I was happy to be busy, to be run off my feet in a sustained adrenaline buzz. And no longer afraid of making a bad mistake, or of not being able to give people an answer as to what's the matter with their animal. Not that my skills and knowledge were significantly different from what they were a year back. It's just that I'd had time to take stock of what I knew, and cross some invisible barrier from rookie to doctor. Some people cross it sooner than that, and some start out as fully-fledged doctors on their first day of work. I envy them, but I'm old enough to know I'm not going to be someone else.

The few locum days at the SPCA hospital have been a blast. I've picked up more, and have made agreements with other hospitals in BC to work for short periods. There is no way I could have done this kind of work straight out of school. It takes the relatively sheltered cove of a permanent job with a mentor for reassurance if nothing else. Mine was very kind and easy-going but still buggered off on holiday two weeks after he hired me, and I remember being furious with him for having that kind of faith in me. I was particularly furious one night when I had to do a resection-anastomosis on a dog who'd impaled its abdomen on a sharp stick, with the stick tearing up a tuft of fur and driving it right through the jejeunum and out the other side. I felt dumped, abandoned, and somehow deeply wronged. I resented my boss for his failure to understand how hard it is for someone without his 20 years' experience. In hindsight I think he knew what he was doing: forcing me to do things I'd be too timid to undertake on my own initiative. I learned a heck of a lot. But I was scared a lot of the time. Most newbies tend to get scared in various new situations, and until that fear is overcome, it's probably not a good idea to take it with you to different work places where there are new people and new protocols to learn every time. Now that I finally have the same faith in myself as my boss had in me from the start, but no longer working there, I'm trying myself out as a locum. Or locust, as my sweetie likes to say. Hopping off on a new adventure each time.

The nerd knowledge I had on graduation is about 80% gone, by a generous estimate. I no longer remember what exactly happens at the proximal and the distal tubules of the nephron, what gets resorbed or dumped and by what mechanisms. I know where to look it up quickly when the need arises. The new things I learn are, and will remain, the tip of the iceberg of veterinary medical knowledge. I know how to go about the uncertainty without panicking, and how to talk to people without feeling personally responsible for their emotional state. And I also know how to select CE courses that will actually teach me something, now that I'm paying for them out of my own pocket ;-)

Stooping to their level.

2011-01-27T13:39:00.001-08:00

Pets are family in today's world, at least in today's Western world. Good or bad, this tendency is here to stay. And as with anything that is here to stay for the foreseeable future, it is silly to launch into a discussion of whether it should be abolished or not. Like arguing over whether trees should maybe grow roots-up, because that would somehow be more right. It's harmless and very entertaining to have philosophical debates on what it means for a pet to be a family member, as long as philosophers don't delude themselves into thinking that their conclusions matter very much outside the ivory tower. And personal opinion, although we were taught that it matters greatly, matters only to the person who holds it. My own pets are not my family and I use a simple criterion to make that distinction: no family members of mine lick their private parts to wash themselves. But this changes nothing in the world at large.

So I work with what is, rather than with what should be in a perfect world. Sometimes I even have fun with what is. And sometimes in retrospect I can even slip a philosophical foundation under that fun - old habits die hard, if at all. But it always starts out very simply, usually as a fulfillment of prosaic needs. Like hunger.

On many occasions a veterinarian's day lasts well into the evening, and the food supplies we bring with us have run out. We get hungry. It becomes hard to stay focused on cases, medical records and anything else that can't wait till tomorrow. The solution to this predicament is so glaringly simple and yet so shocking in its simplicity that few have actually resorted to it. Which is strange really, because veterinarians are not a squeamish crowd. Somewhere in the hospital there is always enough food to feed patients and boarding animals, even if the hospital does not routinely sell food. Do we just not think of what's in those bags and cans as nourishment fit for ourselves? Food is food, says my Old World heritage, and my rumbling stomach responds with complete agreement. Add to this a little scientific curiosity and a sense of communion with living beings under my care.

I remember well the first food I tried, maybe like a girl remembers her first kiss (and despite what you see it movies, it's usually neither perfect nor even that good). It was m/d, a prescription diet prepared by Hills pet food company for diabetic dogs and cats. This particular one was the canned version we were feeding a diabetic cat boarding with us. My immediate impression was that it was very tasty because it was sweet. And it was sweet because it contained corn; I could see the bright yellow bits of kernel and taste their fragrant sweetness. Corn is not the evil it is often portrayed to be, and its function here was to contribute protein, which it generally does quite well. But it was delightfully sweet. And the cat was diabetic. I've used the word "sweet" too many times in one paragraph, so I'll stop. I'll just say that this corn was in the wrong place at the wrong time. Yes, Hills and other major pet food producers do solid research into the nutritional needs of animals, and they do it remarkably well. They just don't always implement it. But someone else usually does.

Since then I have tried all the prescription foods and many over-the-counter ones. Some taste awful and yet many animals don't mind them, and some taste quite good. A particular kibble designed for intestinal ailments gave me terrible heartburn; maybe it just wasn't very fresh. Some kinds of kibble, especially those made for pups and kittens, are almost devilishly tasty; I'd certainly eat them if I were a baby animal. But then I remind myself that animals' sense of taste is not the same as ours. And no matter what kind, kibble is pretty darn filling. So filling that I don't want any dinner once I finally get home. If a handful of kibble can do this to a 120-pound human, imagine what it can do to your dog or cat. Imagine it well next time your pet begs for more with eyes that seem to say it hasn't eaten in years. Better yet, don't even take my word for it. After all, if they are family, even kids or babies as many people insist, is it not normal to be curious about what the kids are eating?

Next step: a wine pairing.

Justly, a cat.

2010-10-25T13:40:00.000-07:00

On Saturday I saw two cats in need of help and was able to help only one of them. The owner of the other cat was entirely unprepared for the financial reality of treating a sick cat in our day and age. I highly suspected the cat had pancreatitis with the attending host of problems that afflict its digestive tract, and she was not going to get better without aggressive measures. There was no guarantee that the cat would fully recover after a hospitalization on fluids and IV medications, which already was too much in financial terms. Cats are not cars and we are not mechanics, we don't "fix" living beings. Most definitely she would need some degree of followup treatment, at least monitoring, even if it was only pancreatitis (which it rarely is). As a veterinarian I would be careless to offer anything less. As a person who lives in the real world I cannot possibly criticize people for refusing to put a cat through these measures, whether for financial or emotional reasons. To my credit - or shame - I was not about to blame the owner for deciding on euthanasia, had no impulse to do so. Part of me agreed with her. And to the owner's credit, she did not suggest taking the cat home to see if it would get better by itself. She understood very well that it would not.
In my everyday work there is a lack of middle ground between two extremes: doing everything possible for an animal with a serious condition, and hearing "it's just a cat." We seem to have forgotten to say "it is a cat." Not a fur person, not a feline patient, but an animal, with all the dignity of being one. And their dignity may well preclude the involved, often invasive, and undoubtedly troubling (to the cat) measures we are trained to take. We do not know what is going through the animal's mind in the period of medical treatment and recovery - or deferring imminent death, - and tend to forget that they cannot possibly understand that "it's all for their own good." Certainly the animal is alarmed, anxious, and confused - unless it's so ill that indifference and withdrawal have set in.
The fact that we've forgotten to say "it's a cat" was brought home to me in a much lighter context on the same day. Our receptionist has several cats, and one is an avid hunter. Her daughter called to report that the cat had likely eaten a squirrel: she brought home the head and feet, with the rest of the squirrel missing and presumed ingested. The receptionist asked me with a good deal of alarm: what should they do? I said, nothing can or needs to be done now besides keeping a good eye on the cat's appetite and comportment. I thought, how did we arrive at this point? When a cat's normal behaviour is pounced on as a potential cause for medical intervention?

Leave your gonads at the door.

2010-10-02T23:06:00.000-07:00

Last week I said to my employer that I miss doing surgery (business has been much slower than usual lately), and the next day they called the new branch of the SPCA - conveniently located almost across the highway - to bring in cats in desperate need of sterilization. The SPCA is inundated with cats. We are not the cheapest clinic in the area, probably the most expensive after the emergency hospital, but we have a discount policy for the SPCA as well as for our clients: the "public service discount," meaning that spay and neuter are for the public's benefit and not just the owner's and the animal's. I will give these cats a chance at longer lives in people's homes, as they have no future unless they are spayed and neutered. Spaying and neutering has become the standard of veterinary care in the New World, so much so that people and vets who fail to do it are looked down upon as morally lacking. Of course, an exception is made for breeders - those who breed more or less healthy animals in good conditions.

The standard of care is a curious concept. It is supposed to be determined by the patient's best interests in terms of health and welfare. Our society does not accept packs of feral dogs or colonies of feral cats sharing living space with people - this is considered barbaric, unsanitary, and unsafe. But another way to look at them is no-kill shelters under the open sky, and this is how it works in many countries and communities where these animals are trapped, sterilized and vaccinated, and released. Not all of them, of course. Many continue to multiply, so the arrangement is far from perfect. Moscow has many colonies of feral cats who live in basements of apartment buildings (the city has no private homes, these are all brand-new and on the outskirts). They access the basements through small ground-level ventilation holes and live in safety and warmth by the hot-water pipes, taking care of any incipient rodent problem in the building. Packs of dogs live in the city parks and take shelter in subway entrances. The animals are fed by self-appointed caretakers. They are much smaller and thinner than the animals we are used to seeing in North America - they do not eat as much food and do not grow as big. Aggression is not an issue if the animals are not deliberately bothered by stupid or cruel people. But Russia is not a culture where the stupid are protected from themselves. The animals have each other's companionship, something shelter animals do not have even if they are fortunate to spend only a short time there before finding a home. In a shelter they smell and hear each other, but cannot interact, which I imagine contributes to anxiety and stress. So there is no reason to think that these feral animals suffer any more, or nearly as much, as millions of shelter animals awaiting adoption - or death. It is another culture's acceptance of the fact that some animals will never live in homes with humans, that this is an acceptable albeit imperfect way to live, and is no reason to destroy the animals.

What about health as a criterion of standard of care? We are taught in veterinary school that spaying and neutering are beneficial for the animal's health. Spaying a dog before her first heat pretty much protects her from breast cancer; after the first heat her risk of this disease increases but is still not very high if she is spayed before the second heat. After that, a spay is protecting her from pyometra and ovarian cancer but no longer from breast cancer. Dogs who are not neutered are at risk of developing prostatic hyperplasia that is often bad enough to squeeze the urethra shut so the dog can't pee. And there are, of course, behavioural issues that hormones contribute to - but habit and training have as much to do with this as hormones. We are also taught that a neutered male dog is more likely to develop cancer of the prostate than an intact one, but this latter piece of information is rarely if ever shared with owners when we discuss reasons for neuter. Stories of testicular cancer, urethral obstruction from prostatic hyperplasia, perianal tumours, and dogs getting hit by cars while seeking a date, are the usual fare dished out to owners in preparation for neuter. Cats may be a slightly different story. Spaying a cat has roughly the same benefits as spaying a dog, and neutering a male averts spraying and roaming. Recently I had the satisfaction but also the challenge of spaying an 8 year-old cat who had never had a litter. Her uterus was warped and her ovaries fragile as butter, tearing with the slightest pull - all that hormonal influence over the years! A confined tomcat makes a very unhappy animal indeed (which is quite different from a male dog kept from mating), while letting him outside guarantees that he will sow his seed and populate the world with more kittens. I don't know of any increased health risks for neutered cats compared to intact ones. Urethral obstruction is a frequent condition in neutered males fed dry diets, but we don't know how this compares to tomcats and whether they are at risk too - they don't stick around to be observed, or to survive when afflicted. All spayed and neutered animals have a tendency to put on weight much easier than intact animals, but - look at our human population. Obesity has more to do with how much a body, animal or human, is eating than with presence or absence of gonads.

So what came first as the determinant of the standard of care - health, or demographics?

More suck-the-fun-out-of-it thoughts ;-)

2010-09-26T15:39:00.000-07:00

Three cats I saw this past week have brought me closer to understanding why I have chosen to work with this animal exclusively. (I still feel obligated to justify my preferences rationally. Still feel an envious nostalgia for "Real doctors treat more than one species" T-shirt I never bought and never will now :-) One is a Persian who came in vomiting, not eating, overall miserable and sick. Nothing new about any of these circumstances. But this little Persian was an extreme example of what breeding can do to an animal. She has no face to speak of, and her tongue is forever sticking out of a mouth too short to close over it. The canals that drain tears from her eyes into her nose are twisted shut, so the tears trickle out and soak the fur under her eyes. And I have yet to meet a Persian cat that is not extremely alarmed by a physical exam or any kind of holding for treatment - they are hypersensitive animals, disturbed and upset by the smallest of changes in their surroundings. I can't help thinking that this has something to do with cramming the brain into a box much too short to house it. If you had never seen a Persian before, you'd think this cat survived some horrible accident that chopped off her face and flattened what was left of it. That's pretty much what happened, except it took a few decades of dedicated human effort instead of a head-on collision with a speeding car - which in the end would have been more merciful.
There is only one fortunate circumstance to this story: this little cat and her breed are an exception, in that cats as a species have been allowed to remain much closer to their wild ancestors than have dogs. In dogs, there is just too much variety of human-induced abominations and woes for a wimp like me to push to the back of my mind. Delivering a litter of Boston terriers by C-section did not fill me with joy and dreams for the future, only with sadness and concern. Nor I do not ever wish to excel at being a glorified janitor, at cleaning up a mess I have no power to prevent. (Vets have no official say in what animals can or should be bred.) I'd like to practice in a way that would make my profession obsolete and redundant. I'd like cats to be eating good canned food or well-balanced and carefully prepared raw food, I'd like to see cat kibble outlawed as something bordering on animal cruelty - with special penalties for the label "Natural", but of course I can only afford this attitude on Sundays after sleeping in :-) On working days I diagnose and treat cats with inflammatory bowel disease, cats with failing kidneys, cats who can't pee because they are plugged up by crystals or stones. I get good at doing this, and I take pride in my skills - as long as I remember not to look at the big picture.
The second encounter was with a little animal at a local PetSmart. My boyfriend fell in love with him and started joking about buying or kidnapping him, so of course we had to go see this cat. He was a young Cornish Rex lad, alone in his cage as his brothers and sisters had been sold. He alternated between staring into space and pouncing at his toys, playing with abandon. He had the wrinkled face of a newborn baby - or an old man. Ever so slightly disconcerting. We asked to meet him and an assistant opened the cage and picked up the kitten and gave him to us. He was very quiet and dignified in his affection. A covert ten-second physical exam told me he had all his little testicles well in place, and a umbilical hernia - not necessarily dangerous by itself, but a likely sign that something else might be amiss inside. We asked his price, and were told that it was $1198. I have only heard of such prices for breeding-quality animals, not for pet-quality, no matter how pure-bred. There is no moral to this story, only questions. Such as, will the people who eventually buy him, allow him to breed and pass on his possibly not harmless imperfections? Once again, I completely failed to go "aaaaaah, how cuuuuuuute!" at the sight of this wrinkled little creature. All I wanted was to hold and shelter him from his very uncertain future.
The third cat was a magnificent snow-white Oriental Shorthair - a breed that kind of looks like a Siamese, but is more extreme in the prominence of its long muzzle and cheekbones. He was quiet, shy, and probably all-forgiving. His owner, a very old gentleman who dotes on him but has less-than-perfect vision, had cut his nails to the quick, and apparently the cat had not protested once. The only loud thing about this cat was his heart. This cat had the loudest heart murmur I have heard on any animal thus far: it was difficult to hear the heartbeat behind the whooshing noise. And yet - at home he runs and jumps and flies like a kitten, and shows no signs of illness. I shall see him again this week for a heart ultrasound that will show his heart and the work of its valves from the inside. No moral to this story either. None needed.

Unexpectedly Home.

2010-07-19T08:58:00.001-07:00

What was supposed to be a 3-week stay in the Old Country was cut short by an unusually persistent heat wave that affected a large part of the entire Old World. Not that I wilt easily in the heat, but it does have the capacity to limit your freedom considerably. So it was a combination of feeling even more trapped by demons of the past in the city where I grew up, my mother's categorical insistence on preparing three large meals a day spiced up with apocalyptic comments on the implications of the heat wave, and the adverse effects of self-imposed fussing on her physical and mental wellbeing. (If the world is coming to an end, why is it important to eat so much?) In the relative paucity of things to do I studied the cover of my Canadian passport in detail and read the Latin inscription in full for the first time: Desiderantes meiorem patriam, a mari usque ad mare. Wishing for a better homeland, from sea to sea. And it was already mine. I called Air Canada, waited on hold for the requisite 15-odd minutes, and was never more grateful to pay $750 to have my return trip advanced by an entire 9 days. I can now pretend that I am on a luxury 9-day holiday for a mere $87 a day, sitting on the balcony looking at the snow on the peaks of distant mountains, planning a drive down to the ocean, a walk through the forest redolent with fragrant pine resin and a swim in a lake filled with clear glacier waters. And the sheer luxury of breathing crisp fresh air. This gratitude may not last much longer than the 9 days I "paid" for, it rarely does, but it is always very strong after a visit to the Old Country.

Thirty-Eight Ways to Say "Most Congenial"

2010-06-14T22:18:00.000-07:00

Just when I had thought for a while that no one was reading this yarn, I saw with surprise "1 comment" under the last posting. To my shame I have not posted in - months? I had made a promise to myself, and almost weaseled out of keeping it. And apparently someone was reading. Thank you for the kind words, Elizabeth. You may be responsible for enabling another mediocre writer this world badly needs :-) But truly your comment brought me great joy.

I have worked at my new job for two weeks now. A few days before starting, I went through my vet school notes and the research articles I accumulated since school to separate those relevant to cats, and cats alone. Anything pertaining to other species was put in a separate pile as a potential contaminant to the rarefied atmosphere of specialty medicine which I was to breathe from now on. But I mentioned before that life is wiser than our best laid plans. In these past two weeks my feline patients have included two dogs. The first was a Jack Russell terrier whose owner is the senior veterinarian, herself a boarded surgeon. He was sent my way to have a small lump removed from his arm and to test my surgical skills. It was flattering to be trusted with him. The second was a Bichon Frise belonging to the bubbly young receptionist and suffering from bad teeth, a loose kneecap apt to pop out of its groove, and lower back pain. (She had bargained for only one problem - the back pain, - but was sold three, each of which will need attention.)

My other patients were, quite predictably, cats. Quiet and patient cats, loud and alarmed cats, healthy and ill cats. But no ugly or morally objectionable cats. I marvel at the skill of the hospital manager in handling what are surely unhandleable cats in anyone else's hands. A large powerful ginger male chased around his home by a toddler and taking these torments with maturity and magnanimity, turned into a wild sputtering animal lashing out through the mesh of his carrier as soon as he arrived at the hospital. As he stepped out of the carrier he was quickly and decisively scoop-embraced by Jim, using a thick folded towel. He shouted and howled at a volume that was harmful to hearing, especially for Jim who was bracing him with his entire upper body and head. Somehow, everything got done: the cat's teeth examined, his heart listened to, his tummy felt over for anything alarming, his temperature taken, and vaccines injected. The cat was rumbling with indignation, but not frantic. So far I have not once felt at a loss on this new job. I know that between all of us we will get things done, and done with the least stress to the animal.

At the end of my working week I drive home, 100 miles away, to rejoin my own two cats. (I rent a room close to the hospital so as not to commute that distance on workdays.) The cats have a new best friend - an automatic Le Bistro feeder that dumps a preset amount of kibble three times daily. They still greet me at the door, but are not frantic for their food. In fact, our relations are better than ever. When the cats start trumpeting in the morning, I know it is because they miss me and not because they need to be fed - the machine will have served breakfast by then. So my annoyance at not getting to sleep in is short-lived.

I have a rotten and thankless task to perform this coming Thursday. I must judge a photo contest. Pictures of cats submitted by their owners. I must decide which cat is the most congenial. But I will find a way out of this corner yet: there shall be as many categories as there are entries in the contest. This is when my long-forgotten linguistics training will be dusted off and put to good use.

Winner, or just plain old adequate?

2010-03-12T19:53:00.000-08:00

One step closer to a definitive diagnosis for the coughing/stumbling dog, I felt something close to satisfaction at the end of the day. Back in my TV-less home I turned on the radio while I enjoyed a glass of Bear Flag wine, a very enjoyable blend of this, that and the other. It challenged my prejudice against blended wines as coverup for unsuccessful vintages from various vineyards and various years. But maybe I liked it simply because I know nothing about wines. Anyhow, the radio programme covered the latest development in the Canada Reads contest. Books, and very good books at that, are gradually being voted off the list to whittle it down to an eventual winner. What a White Liberal concept: winner vs. everyone else! So many pursuits and endeavours are no longer perceived to be worthwhile unless a winner can be identified in the end. How else do people know if they are any good?! Well, not everyone is a loser either; there is such a thing as a shortlist: the winners among losers? Now translate this into the culture of dog shows and cat shows... . How did the poor animals get pulled into this vortex of human vanity? Never mind that animals chosen to represent a pure breed are often far from fit - they are often far from viable. But as long as these animals are helped along by the humans who bred them, their existence does represent a form of evolution we have taken into our hands. Darwin wrote of the "survival of the adequate" (my italics), not survival of the fittest (a term coined by Herbert Spencer, nor Darwin).

This coughing/stumbling/occasionally vomiting/occasionally drooling dog's diagnosis has been a thorn in my side since it became clear this is not a simple case of kennel cough. I suspect him of a neuropathy that translates into laryngeal paralysis, possibly esophageal weakness, and hindlimb weakness (Ockham's razor tells me to find the simplest - in this case, the most inclusive - explanation). I also suspect him of hypothyroidism which would likewise explain his symptoms, and a comprehensive test in underway to rule that out. But I am warned, by wise and learned people, that treatment for either neuropathy or hypothyroidism may not alleviate his presenting symptoms. I do not live or work in the ivory tower; I will treat him anyway once I know what ails him. I don't care about winning; I just want to do a thorough, adequate, job.

The comparative virtues of aspirins, and an Old Country idealist.

2010-03-08T22:32:00.000-08:00

Yesterday I got reassurance that if I never treat another animal they will still be well taken care of, I will not be missed. A woman ahead of me at the checkout started telling the cashier that her breeder had recommended this coated aspirin for her dog who had pulled a muscle. She was very proud of her breeder and very pleased with the advice she had received from her over the years. Upstart that I am, I had to pipe in and say that she needs to be very careful about giving aspirin to a dog and that buffered is better than coated because that will just slip through the dog's stomach before it has time to uncoat. I chose to remain undercover as to my profession; it would have been awkward to announce it. She said that mine was very good advice but she would stick with what her breeder had suggested. I keep forgetting that my answer needs to be voted "best answer" before it can be accepted. What kind of dictator do I think I am, to expect members of a free society to accept my word without putting the matter to a vote? A similar level of consumer freedom and empowerment applies to the diagnoses I put forth; these are often perceived as initial offers met with counter-offers fished out on the internet or suggested by breeders or people who own similar animals. As a former prof I explain my reasoning in as much detail as the owner will tolerate. On exhausting days I often feel tempted to choose one or two diagnoses from my differentials list that are most pleasing and comforting to the client; I have never given in to this temptation. As for prognoses, I will err in the "glass is half-empty" direction and prepare the owner for that, cushioning the blow of a sad outcome that I foresaw at least as a possibility. So far I have been able to maintain the dignity of a doctor while still ministering to the customer service aspect of my work. But I will admit that life, a.k.a. that which is not in our control, is often far wiser than some of our best laid plans, and in hindsight I am very glad the woman bought the coated aspirin which will hopefully just slide through her dog's digestive tract.

Yesterday I also got reassurance of another kind. This was on the way to the store with its aspirin encounter. Outside the store is a gas station, and outside this gas station a man was speaking on the payphone very loudly and articulately. He spoke loudly because he was passionate, and because his voice needed to carry across the ocean to Russia where his friend was listening. For once I was not embarrassed to see a fellow Russian in Canada; I was elated and proud. Because the subject of this man's monologue were the flowers he saw in Vancouver. He declared with the solemnity of a nuclear scientist presenting his discovery that never before had he seen such a variety of tulips in bloom. Fifteen minutes later, as we walked out of the store, the man was still there and still speaking. And the chestnuts, he said. A whole street lined with chestnuts! When I translated the eavesdropped conversation to my boyfriend he had to be cynical and suggest that this was all code for drugs and their delivery times, and no wonder he was using a payphone and not a cell phone, etc. But I'm confident the man really was talking about flowers; it's impossible for a Russian to fake this.

Saturday evening in spring.

2010-03-05T21:42:00.000-08:00

"Canine patient"?! It's a DOG, for pete's sake.

2010-03-05T20:58:00.000-08:00

In school we were taught to use certain words instead of certain other words. Avoid language used by the commoners, the unwashed masses. How else would clients know to respect us as doctors? And yet every day I see proof that our clients are just that stupid. They hear me say "cat" and "dog" left and right, and they still think I'm a doctor with advanced knowledge. I even go as far as to use words like "poop" instead of "feces," and still they are fooled, they ask my opinion, they listen to it. I come from a background in linguistics. There is more than one way to say many things and I try to remember to do this. Sometimes I catch myself talking in stereotypes and cliches, and feel disgusted. Often when I come home at night I have no energy or desire to use words, to write or to say anything. Then I wonder if my job is making me stupid and robbing me of the little imagination I have. On these nights I rent some movie and become a consumer of other people's language and ideas. It is so much easier to consume something ready-made than to create anything.

There are languages that contain tens, dozens of words for a seal: a seal moving in this or that direction, submerged in the water to this or that degree, in such-and-such position relative to the ice floes, with its nose pointing here or there, lit by a bright or dim or setting sun, and so on and so forth. This gets pretty elaborate. But I wonder if it leaves room for disagreement between two or more people as to which seal this one is. For the past three day I have been following a very frustrating case, one of those where most available in-house tests have been run or sent off, and still there is no answer. Throughout these three days I have been getting reports from the two owners. Comparing these reports gives the impression that two entirely different dogs are being observed; they just happen to look the same and bear the same name. Admittedly, this reflects on my own questioning ability or lack thereof. Tomorrow the dog is coming for a test that I hope will finally yield an answer. He is staying for a few hours for me to observe. Thus a third dog will be added to the first two. And maybe a fourth, if my boss has time to give me a second opinion :-) In the end I just want one dog and one working diagnosis and one course of treatment to follow.

One for the reading list.

2010-03-04T20:31:00.000-08:00

Here is a quotation I found in the waiting room of the city emergency clinic while waiting to borrow a bottle of methocarbamol for two quaking cats their owner had accidentally treated with dog Zodiac.

"We need another and a wiser and perhaps a more mystical concept of animals. Remote from universal nature and living by complicated artifice, man in civilization surveys the creature through the glass of his knowledge and sees thereby a feather magnified and the whole image in distortion. We patronize them for their incompleteness, for their tragic fate for having taken form so far below ourselves. And therein do we err. For the animal shall not be measured by man. In a world older and more complete than ours, they move finished and complete, gifted with the extension of the senses we have lost or never attained, living by voices we shall never hear. They are not brethren, they are not underlings: they are other nations, caught with ourselves in the net of life and time, fellow prisoners of the splendour and travail of the earth."
From "The Outermost House" by Henry Beston (1888-1968)

By the time I got back to our hospital with the medicine the cats had stopped quaking. Somehow they must have absorbed enough oral Robaxin despite drooling a river.

Back to the roots.

2010-03-04T19:15:00.000-08:00

Could you still love an animal if you could never cuddle it?

This youngster's picture was taken on his "tutoring" day when he was about seven months old. He's a magnificent animal, already quite large for a 7 month-old, with long legs and huge feet. Unlike many dogs that are touted to be part-wolf (very popular claim in this neck of the woods), he actually is part-wolf. I do not know what he sounds like because he never barked or howled. In the exam room he would spread out on the table and settle into a nap while I was doing my thing. He reacted to nothing - not to temperature-taking, not to vaccines. In his kennel he spread out and settled into a nap. After his neuter he woke up, sat up, and settled into a nap. He took every opportunity to save energy. He did not address himself to anyone, complain about anything, or call any attention to himself. In fact he acted as if none of us was present, as if there was nothing to be expected from us. This dignity and calm acceptance were fascinating in such a young animal in strange surroundings. Many people would not want a pup like this, or the dog he would grow to be. He interacts with his family and accepts affection but does not return it in any obvious way, and nips quite hard with his incisors when he plays. (He did not attend enough of our puppy classes to learn bite inhibition :-) He digs up the ground as if it were a construction site. Fortunately for everyone he lives on an acreage. In him I had the honour of observing the birth of the dog - not yet dog as we know it, but already not quite wolf.

I caught myself wishing more dogs were like this; I've met a few such dogs, each very memorable. Very loyal yet somehow less dependent on humans, less apt to look with unconditional faith into our eyes (kudos to those who really feel they deserve such faith), less like the perpetual puppies we have bred them to be, more capable of playing all by themselves with no one watching. More likely to tell us if and when we're full of shit, and incapable of putting up with it. Cats seem to have retained this primitive independence (mistaken for haughtiness by people who take things personally) and that's one answer to why I'm more comfortable around them both as a person and as a veterinarian.

A detour.

2010-03-02T20:44:00.000-08:00

A carefully planned hike took a life of its own when we decided to see the diesel donkey and the view from the top of a never-before visited hill. One of the many British Columbian sawmills operated in this forest sixty years ago and its owner blasted a road through rock to the top of a minor mountain that was given his name - DeBeck hill. The diesel donkey turned out to be a huge pulley used to clear felled trees out of the way. In local terms this forest-covered rock towering about 700 metres over the valley below is indeed only a hill. At the top of it are radio beacons and the trailhead of an extreme biking trail which turned out to be a dead end and made us retrace our steps all the way up the mountain (for it did not feel like a hill at that point) before we could descend. The rain was falling on the water of Alice lake and a rapidly moving mist changed the appearance of the sky and landscape by the minute. It's early spring and one of those days that looks like late fall. A grouse sounded his mating call - the first of the season.

Yesterday I received my first issue of the Journal of Feline Medicine and Surgery mailed all the way from Elsevier publishers in Germany, a little welcome into the world of cat medicine which may be my future. Many lay people are cat people or dog people, and so be it, that's an accepted fact or stereotype. They may poke fun of each other and that's the end of it. But when a veterinarian put in charge of protecting animals, assumed to be all animals, decides that they want to work exclusively with ...cats of all creatures, he or she often feels they have some explaining to do (which I promise to do later). And they no longer get to wear the terribly conceited T-shirts that read "Real doctors treat more than one species." So in a few months I may be no better than a plain old M.D.! :-)

Too tired to do any explaining or to write in complete sentences, but not too tired to sample some delectable unpasteurized cheeses from around the world. A sweet and ripe Ossau Iraty made from the milk of Basque separatist sheep, an 8-year old Cheddar from Quebec, a Papillon Noir Roquefort which my boyfriend keeps mistakenly calling Black Death, A Morbier Fermier made of morning and evening cow's milk separated by a layer of ash, and a Fontina d'Aosta whose rind is a joyful celebration of putrescence. If it turns out that I am entirely unfit for private practice, I'll become a lab rat and research how to fight allergies with food-borne pathogens in manageable quantities ;-)
Tomorrow is the start of a new working week.

Same forest, different trail.

2010-02-28T20:38:00.000-08:00

With not much time left to live here I need to finish exploring all the woodland trails I have not yet taken. The "local" mentality says they're not going anywhere, I can do it some other time, - until my time as a local comes to an end and I feel more like a visitor on holiday, and familiar places acquire an allure that is not mundane. Almost an anticipation of the nostalgia I know I will feel after I leave. The trail I took was new to me but eventually rejoined a well-known one that led through a deep forest to Alice Lake. It was unbelievably warm and smelled like April on this last day of February. I got back just in time to grab some groceries and a bottle of wine before heading home to watch the Olympics closing ceremony. At the store I ran into one of our clients and my first, uncharitable, thought was "Oh great... " seeing as he is a very chatty man and I never discovered the secret of putting a polite end to a conversation. But what he wanted to tell me was that their cat had lost a third of her bulk and was bounding around as they finally got her to eat wet food on my repeated advice. Oh, and her poops were no longer little hard pellets, they were nice and juicy. The things that fill a veterinarian's heart with gladness... . Elated, I proceeded to the meat counter to find something appetizing.

Not a single thought I put out here is a new insight, all has been said before by people wiser and better than myself. So with all the wealth of wisdom out there, why are my fellow veterinarians still burning out and even committing suicide? I had no desire to think about this on a day like today but was reminded of the fact as I did a search for blogs by and for vets. Yes, there are lots of reasons for frustration: people who haggle or weasel out of paying, people with a sense of entitlement and no sense of responsibility, people who are determined to see us as greedy, new clients who start the appointment by declaring as a general reproach that they have already spent X amount of dollars on their pet's problem, people who hoard animals and neglect them, etc., etc. But nobody ends their life out of annoyance with other people. I can't see it being about the failings of other people or the entire rest of the world, it has to be more personal, a case of "it's not you, it's me" if a cliche is at all appropriate. I suspect it is the most conscientious, the most self-demanding among us who come to accuse themselves of something they deem unforgivable. Like not being able to give people an answer after batteries of tests, and their animal still ill or even dead before an answer is found. I can see how enough of these would shape into a self-accusation. I don't know if this is what drives some of us to end our lives. There is also depression which casts a horrible gloom and hopelessness over anything else a person is going through. My own depression years are behind me, I dealt with it and grew out of it before I started vet school. So I cannot fully empathize with a veterinarian afflicted with this blight, although I can empathize quite well with a depressed civilian. Here is what I mean by this.

The language we use to refer to our work - "from the trenches" - is a reminder of the military origin of medicine as we know it. Field surgeons, expected to work for days without sleep: this image is at the heart of medical and veterinary training to this day. Few people question whether this is still necessary; this is after all how previous generations of medics were trained and forged, and the power of inertia is great. So we are an army of footsoldiers in the midst of a society encouraged to get in touch with its feelings and coddle them. (Oh, the cult of feeling! Don't let me get going :-) But a war has to be against something, so what is ours against? Disease seems like a good and obvious answer. Or how about a war on consumerism toward animals? As in no more perpetuating of really cute breeds that can't give birth on their own or that suffocate to death on a hot day. Something nice and manageable like that. Maybe there should be no war at all; maybe we should all go home and become civilians, conscientious objectors. Eh?

Two howling cats say they have not eaten in years. Time to step down from that soapbox in the clouds.

You think too much!

2010-02-27T21:40:00.000-08:00

Maybe the early arrival of spring in February had something to do with it, but I felt a relief and lightness after I announced to my boss that I will not be renewing my contract once it is up in three months. The longer I waited to summon my courage, the less time he would have to find a replacement. Not fair to anyone. He said he was very sad about my decision. So was I - but only a little, and for a little while. And ever so slightly guilty for waiting almost two years to admit that this line of work is not for me.

This is not a Hallmark story of the evil uncaring boss and the overworked employee with a strong sense of justice. The terms of my employment are very fair, and I have been fortunate to work among people who had more faith in me than I had in myself (this, however, is not difficult :-). As the recession rolled by and I gave away more and more recheck exams for free, I was never chided for this but rather reminded to value my own time and efforts. The staff knows that I like to recommend EVO and Wellness canned foods for enormous cats on the brink of diabetes, and no one has suggested that I recommend m/d instead. My opinion, albeit based on meticulous research rather than non-existent experience, was respected and solicited from the first day I started here. My boss and I share a very similar sense of humour and do not hesitate to use it to diffuse the inevitable tension that comes with our work. And yet here I am - backing out, giving up, quitting, (insert chiché of choice here). This post started as a rough draft of an explanation I feel owe to my boss but probably more to myself.

My work appeared in a different light once I knew I would no longer be here in three short months. Quite abruptly I stopped having the little panic attacks I had been having for months every time the phone rang after hours to tell me of an animal that needed help. I was no longer afraid of not knowing what to do or how to do it. My knowledge and skills had not changed, only my propensity to worry about their absence. I drew some strength from the fact that I had already been through the worst, - my personal idea of the worst, - so nothing could happen now to trump that. That worst consisted of a little Boston terrier whose owner dearly wanted pups, who was made to conceive them despite her steadfast indifference to any male sent her way, and who like most Boston terriers could not give birth naturally and needed to be cut open to be delivered of her pups. Something was wrong before she ever conceived them. Her uterus tore like rice paper with the gentlest pressure, but I needed to get the three pups out before they were starved of oxygen and had to suppress worry about anything else (which for a worrywort takes a huge effort). Two of the three pups were not breathing after five minutes, after ten minutes, then a shrill little voice, then silence again. As my nurse and assistant worked to make them breathe I turned my attention to the mother and closing the rents in her uterus. I was sick to my stomach with a despondency and anxiety for which there is no English word, the two puppies were still silent and trying not to think about them was futile, and the task of repairing the torn and disorderly flesh seemed endless. Only one puppy lived, she is now a strong and pushy youngster. The mother dog recovered without a care in the world and needed to be reminded of her motherly duties for days before she caught on. Two days later my boss delivered two pups from the breeder's other Boston terrier, and neither of them survived beyond a day. The breeder was devastated by the outcome and her pocketbook by the bill. This was the beginning of my decision to leave, to never put myself in the way of such unhappy turmoil again.

My problem is that I think too much, and as a habit carried over from my previous life I take the inherent uncertainty and imperfection of my work as a personal failure. (And our work is inherently imperfect because our best guesses - called diagnoses - cannot keep up with the changes in the living body we call the patient.) I launched into veterinary medicine at the tender age of forty after a career of teaching at university - subjects that had nothing to do with the sciences. Nice leisurely subjects that invited long leisurely discussions that were, as it seemed all too often, of no consequence. Something in me chafed at this suspected insignificance, and at the dust that settled in the library on articles published by my colleagues and read by no one. I wanted to do something of consequence, at least to see if I was capable of this, and I wanted it to involve my high-school love of science. This is how this story began.