(To read Parte Uno, click here). San Miguel de Allende, GTO, MX, August 24, 2014:We had to give our patient, recently anesthetized to repair a tongue injury and undergo sterilization, to the technician to care for because we had a very sick three month old puppy with Parvo that had been dropped off by its owners. This dog was fading fast, but we did get fluids started, having to place a catheter in the jugular vein because it was so dehydrated that all of its peripheral veins were impossible to find. When you place a catheter in the jugular vein you use a specially-designed long catheter, since this is clearly a high-motion area, and the typical short catheter will always kink when the patient moves its neck, and stop working. The rescue doesn’t have these long catheters, and this is exactly what happened with this puppy’s catheter. The vet made a decision to give it a small dose of “anesthesia” to keep it quiet while fluids were running. Once again, I’m standing there, not saying anything, and watching this dehydrated, minimally responsive one and a half pound puppy get xylazine. Into his kennel he goes, so that we can look at the next Parvo puppy.
Turns out that puppy had died, waiting to be seen. We all felt terrible, but the vet had to keep moving because another puppy that has been brought in for vaccinations.
Every veterinary clinic has to have a system, or some type of structure. This not only helps to ensure the safety and well-being of the patients but also the sanity of the staff. At my hospital our system is that while one doctor is performing surgery another doctor is seeing appointments, in order to minimize anesthesia time and allow the surgeon to focus on surgery. In addition, the number of people involved with animals suspected of having infectious diseases is limited to one technician and the doctor who is caring for the patient. Gowns, gloves, and foot baths are utilized to lower the risk of transmission to other patients. I could write a book about how we do this, but suffice it to say when we follow procedures we have good outcomes, and that’s what we’re all striving for.
At this rescue there really isn’t a system. People bring in their pets and wait out front until they can see the vet. At the same time the vet has to work in surgeries for both shelter animals and paying clients as well as take care of sick patients. This means that she’s often forced to take care of an animal with an infectious disease and then move right on to seeing an animal that’s never been vaccinated against the disease she’s treating. This actually happened twice that morning, and I asked her if she was worried about transmitting Parvo to these healthy puppies. She washed her hands and sprayed her clothes with disinfectant and shrugged, and told me that yes, she was.
At this point I was developing a severe case of anxiety, along with a deep longing for my beautiful, sparkling clean hospital back in Colorado with its isolation ward, its highly educated staff, and its seemingly endless reserve of top-of-the-line supplies and medications. An ominous feeling started to wash over me, and I went back to the isolation room to check on the first dog, the one with the tongue injury. I put my hand on its femoral pulse; nothing. Hand on its chest, nothing. Pulled it out of the kennel and shouted for a stethoscope. Nothing, nothing, nothing.
There are no words to describe what that realization is like, not feeling that reassuring thump, thump, thump that was just there thirty minutes before. Your first thought is that you’re crazy, the dog must be alive, it has to be. Maybe you’ve just contracted a serious neurologic disease and your hands have lost feeling? Maybe your stethoscope is broken, or turned around backwards? Perhaps you’ve lost your hearing? But no, none of those things have happened, and a life that was in your care is extinguished.
I’ve been lucky that in seven years as a vet I’ve not had this experience often, if ever. But having seen two dead dogs in a thirty-minute span I walked over to the kennel holding the tiny puppy with Parvo in something of a dream-like state, only to find it dead as well. I somehow knew before I got there that I would find it dead.
Chances are good that the two Parvo puppies would have died even if they had immediate and aggressive care, but it’s also likely that the sedation hastened the second puppy’s death. Without the additional dose of sedation the dog with the tongue injury would probably have recovered from the anesthesia, but possibly died anyways, since it’s likely that there was something very seriously wrong with it that we didn’t know about. I’ll never know for sure, but it’s hard to find a place to put these things. You can’t neatly file something like this away under “Experiences Encountered While On the Job”.
As a veterinarian you’re expected to counsel families through the difficult and final act of euthanasia, perform the act with compassion and skill, then compose yourself in sixty seconds and walk beaming and blissful into the adjacent exam room to see an exhuberent family with brand new puppy. But private practice veterinarians walk a flower-strewn path compared to our colleagues who care for homeless animals. They see the abuse, the neglect, and the overpopulation every minute of every day. This rescue is a wonder and a gift – a no-kill shelter in the middle of Mexico, a country where just a few minutes ago a woman knocked on our door and had her little girl ask for money for food. They are doing what they can with what they have, but hopefully I can help them do better.
I walked out of the rescue that first day, bought myself a Coke, and walked the thirty minutes home, lost in my thoughts. I began to imagine what I would tell them, such as “Hey, listen, I know I said I’d help you guys out, but I just don’t think my schedule will allow it”. From somewhere else in my brain came a chorus of taunts, such as, “Liar. Coward. These people need you, so step up your game and figure out how you can help them.”. So I went back the next week, and the next, and the next. Every day has been exponentially better than the first. I feel a bond developing with Roxanda, the vet there, and I am slowly starting to talk to her about better anesthesia techniques and infectious disease practices. She still feels unsure of herself when performing spays, so I’ve been handling those, and we’ve done four or five together with great results. I showed her how I remove dew claws and tie a Miller’s knot, and I’ve gotten her to start treating Parvo cases more aggressively. There is a big veterinary conference in Leon (about an hour away) in September and the rescue is paying my way so that I can help her pick out some new equipment and supplies. We joke about Cat Ladies and clients who lavish praise on the guy at the front desk for saving their dog’s life. It seems that at least some part of the veterinary experience is universal, and for that I am grateful.