I sit with Gus, my French bulldog, and wait for my long-time colleague, Dr. Veterinary Specialist, in a room that feels like a hunting lodge. I’m a general DVM who sometimes has to consult an expert. His is a dream clinic, and I don’t mind waiting for Gus’s appointment. Dr. Specialist is one of the hardest-working veterinarians I know, and he has my deepest respect.
“How’s everything going?” he greets me as he walks into the exam room.
“Great. I love my job,” I respond. “It’s wild, as usual.”
“Tell me,” he says. And so, I do.
Concerned but Unaware
A client brought in a 5-year-old, emaciated female Belgian Malinois reeking of urine and with severe, open sores on her legs, feet and chest. She was weak and did not want to stand, and her stare was vacant.
The young owner recounted that he tried to put weight on Artimus and had searched the internet for ideas. He said he was giving Artimus a name-brand commercial diet daily, and she was cleaning it up. I asked about the sores, and he said he kept her crated for about eight hours a day while at work. She would urinate and defecate in the crate and scoot to get out of the excrement.
I made an estimate for bloodwork, IV fluid therapy and hospitalization, and somehow the client came up with the initial funds. Diagnostics revealed severe anemia (HCT 21%) and hookworms. Her white count was mildly elevated at 23,000, but the serum chemistry results were surprisingly normal. I asked the client when Artimus’ last estrus occurred, but he didn’t know.
All this suggested neglect and abuse, but I treaded lightly because the client seemed concerned about his dog and genuinely unaware of her needs. After all, he had sought veterinary help.
Some 24 hours later, Artimus was brighter and stronger, with a ravenous appetite. Four days later, her HCT was 30%, and she had gained 3 pounds and was walking and barking.
Dr. Specialist was appalled. “Why would you keep a dog in a crate all day?” he pondered.
“Oh, listen to this one,” I began.
Money Talks
Buddy, a Great Pyrenees puppy, was presented with bloody vomit and bloody diarrhea. He reportedly had chewed a sticky mousetrap. I examined the adorable snowball, who had blood-tinged perineal hair and pale gums, and headed to the lobby to query the client.
A nicely dressed woman sat with her daughter, who appeared to be about 7. I asked whether the sticky trap could have had a mouse on it, but the owner assured me it had not. I asked whether the puppy had eaten any of the sticky trap, but she had no idea.
I made an estimate for bloodwork and radiographs, which our staff reviewed with the client. Buddy’s owner tried unsuccessfully for about an hour to come up with the money for the diagnostics. Finally, I caught up with her outside, parked in a handicapped spot and driving a late-model SUV.
I explained the tests I needed to do. She said she didn’t have the money and told me how much the puppy meant to her family. She had bought Buddy with her daughter’s birthday money. They loved him and fed him. “But you can’t take care of him,” I said.
She asked if he was going to survive. I told her predicting the outcome was difficult when I wasn’t sure what I was dealing with and when “You won’t let me do any tests to find out.”
“It’s not that I won’t let you,” she said. “When I got pregnant, I quit my job, so I don’t have the money.”
Anger and Sadness
I went inside and glanced at Buddy. Could he have been saved? My impulse was to drop everything, run the tests, administer medical care and take him home. I did that two weeks earlier with a blocked tomcat whose owners wanted euthanization. Bebop joined my family, which includes Rowdy, the bulldog I was asked to euthanize because he had a lot of ear infections and was “suffering.”
Sadly, Buddy’s owner decided to euthanize him and wanted to be present. Struggling with my anger, I tried in vain to get another veterinarian to do it. As I walked into the exam room where Buddy, the client and her daughter were waiting, I couldn’t look at them. The little girl asked me, “Whatcha doing?” and tried to play with my syringes.
I did my job. “I’m sorry for your loss; he might not have made it anyway,” I mumbled through clenched teeth.
After listening to those stories, Dr. Specialist declared, “That’s why I’m not in general practice.”
The Good Times
Reflecting later, I realized how depressing those two cases must have sounded. Some of the situations I encounter nearly break my heart. Others, though, make my heart soar and remind me that I make a difference.
For example, Apollo, a beautiful 4-year-old Great Pyrenees, was brought in for euthanasia because he had been diagnosed with Addison’s disease. The clients were discouraged that they couldn’t manage his care and couldn’t bear watching him struggle through his episodic weakness and lethargy. They had made two expensive trips to critical care hospitals and were overwhelmed. They told me they were faithful with his “cortisone” treatment, but upon further questioning, I discovered they had not understood that he needed two hormone replacements: the prednisone they were giving plus a mineralocorticoid available in a monthly injection or a less-expensive daily oral tablet.
Scared but hopeful, with tears streaming, they agreed to try the oral medication. Their gratitude that day, and the sight of beautiful Apollo, were worth a hundred deadbeat pet owner encounters.
The Survivor
On my cellphone is a video I never get tired of watching. A small terrier-mix dog was brought in by a next-door neighbor who noticed her lying in the backyard, unable to whelp her puppies. She was spent and couldn’t lift her head after struggling to deliver a puppy lodged in the birth canal. We located her owner, who OK’d a C-section. Worried that she might not survive but determined to save her, I started IV fluids and got to work, delivering four stillborn puppies and one large, vigorous baby. I crossed my fingers as mom and pup went home that evening.
When they returned the next day for a recheck, the puppy was pumping his forelimbs against mom’s abdomen, nursing for all he was worth. I fumbled for my cellphone and captured the video. As I gently stroked the weary mom’s head, she raised it and gazed at me with a look that said, “I’ll be OK.” I could watch that video a thousand times.
I work for a walk-in clinic on the rough side of town, where clients are as likely to cuss out the receptionists and veterinarians as they are to lavish us with praise for the miracles we perform. We often prepare costly treatment plans for medical problems owing to a lack of basic preventive veterinary care, such as vaccines and heartworm drugs.
I work closely with an outstanding group of practitioners, technicians and kennel workers who proudly take good care of animals. They are my tribe.
That’s why I am in general practice. It’s my area of expertise.
ANOTHER ONE
Like Dr. Lou Anne Wolfe, Creative Disruption columnist Dr. Bob Lester chose to be a general practitioner, “a choice I would make again,” he wrote in 2021. Read his article, “Just a GP,” at bit.ly/just-a-gp-TVB.