The Sin of Wages

There it lay, in my hand, as rare and exotic to me as one of Willy Wonka's golden tickets. I'd seen them before of course - my parents, used to their magical nature, had left them lying around the house from time to time before they were filed. I remembered being fascinated by them as a kid; a small slip of paper, covered in squiggly black ink as if a thousand spiders had been ceremonially squished onto the thin paper in order to prevent unwanted peeping at the contents. It hadn't really struck me before that I might ever have one of my own, but now, here it was. My first pay slip.

            Earlier in the week, aware of the glimmering riches that awaited me at the end of the month, I had driven to Bridgwater's local electrical goods store and gazed avariciously at a huge television until an attendant, noting my gaze and politely ignoring my drool, introduced me to the concept of 'Hire Purchase', and that same afternoon we were driving back to my house with the television in the boot.

            I was so proud. A man provides for his family. At the moment, the family consisted of Kerry and me, and the thing that I was providing today was a massive telly. Literally massive; this was before the days of plasma screens and LCDs, and so the 32-inch screen tube television weighed forty kilos[1]. Kerry was going to be home in an hour or so, and a wise man would have left the TV in the boot and waited for his girlfriend. I, however, was neither wise nor patient, and so I lifted the monster out of the back of my car, screamed in pain, and dropped it on the floor. The front panel that covered the various input sockets snapped off, but otherwise the damage was minimal, and so I proceeded to drag the thing up the small path to my house like a murderer disposing of a small, square, dense body - or perhaps more accurately, like an idiot attempting to move a very heavy television set on his own[2].

            The TV looked wonderful in my living room, but it had been frighteningly expensive. What's more, I had student loans to pay, but none of that mattered now, because the fabled pay slip had been delivered to my in-tray this morning, and now here I stood with it in my hand.

            I tore it open and read the figure at the top of the page. I frowned a little. I read the figure at the bottom of the page.

            'Hmm,' I said.

            The one thing that everyone knows about vets, of course, is that they, along with the Royal Mint, have a licence to print money. It had been at the back of my mind during vet school that the pay was pretty good. It certainly wasn't why I had joined the profession, of course - if it was, I might have looked into it a little more carefully - but I always sort of thought things would be very nice, pay-wise. Seeing practice as a veterinary student, I'd had a few vets tell me 'Well, y'know, the pay isn't quite as good as you might think...'. I had nodded, and smiled, and secretly thought 'Greedy bastards, how much more do they want?'

            I stood and looked at the figure at the bottom of the pay slip. I mentally subtracted the student loans payments, and the first instalment of my now-looking-rather-extravagant TV payment. I added the total to my current bank balance. My face went a little pale.

            The preceding week, I had worked (including on-call work, which certainly felt like work to me) around about a hundred hours. I looked again at the pay slip. Before tax, I had earned roughly three pounds fifty an hour.

            Hm. I wasn't very experienced in such matters, but that didn't sound like an awful lot to me. I drove home, where my huge telly stared accusingly at me, now appearing to me as the product of near-Liberace levels of excess. It did look good though.

            Now, I'm not telling this story for sympathy - I was, being polite to my past self, a bit of an idiot in just assuming that I would be absolutely loaded the moment I became a vet. All that I needed to do was mentally readjust quite how much money I had, and I was fine. Nor am I trying to suggest we're terribly hard done by as a profession: being a vet is hard, and occasionally soul-destroying, work, but it's also tremendously rewarding - there's nothing quite like the feeling that you've made something better when it otherwise may have died. Things have, of course, improved from my new-graduate days, and I feel that I get paid what I deserve - no more, no less - and there's a great deal of satisfaction in that, too.

            No, I'm writing this because I still frequently encounter people who, the moment they learn my profession, get a little glint in their eye and smile at me knowingly[3]. I understand the perception: you go to the vets, you're in there for ten minutes, she tells you to pop these drops down your dog's ear, and you have to pay fifty pounds for the privilege. What may not occur to you is that of that fifty pounds, the vet earns about fifty pence. The rest pays for the receptionist's and nurse's salaries, the rental of the premises, the ear drops that you bought, the electricity bill, and so on. At Beech House, my starting salary was £17,000, plus a house and a car. According to the recent Society for Practising Veterinary Surgeons survey, the average vet salary - including partners - is around the £37,000 mark. That's lower than it was the year before, due to economic pressures, and possibly due to more vet students being available. It's also lower (quite a lot lower, in some cases) than the average salaries of doctors, dentists, teachers, police officers, architects and many other professions[4].

As I say, I'm content with my pay; it would be in very poor taste for me to be complaining about it with so many people in terrible economic difficulties at the moment. I think I'm paid fairly, and I certainly earn my money. All I ask is that, please, when you hear what I do, don't get that glint in your eye. You're liable to get the rest of my drink in it, too.

         

---

[1] Which is nearly ninety pounds, to those of you who haven't come over to the far, far less confusing metric side of the fence

[2] It may have been heavy, but it still works perfectly - unlike three LCD TVs I have bought since then. It wasn't that long ago that we were making things that were actually built to last, you see.

[3] The kind of glint that suggests the drinks are on me for the rest of the night.

[4] It's tangential to my point, but shamefully (especially considering we're an increasingly female-oriented profession) there is still a 10-20% gap between male and female vet's pay

The hardest part of the job

Death. It's not something we like to talk about. It's not something that most of us like to think about, unless it's affected us recently.

            The first patient that I ever saw die was in my second week in practice: a big, young and beautiful black labrador with wide brown eyes, a face that was always smiling, and perpetually wagging tail. When she was admitted (she came in to see Corrie, my colleague at Beech House Veterinary Surgery), she was vomiting badly enough that she couldn't keep water down - never an encouraging clinical sign. It was my ops day - one of my first - and so it was my job to take the blood sample and place her on a drip. She licked my nose as took the blood. A few minutes later, as we were bandaging the catheter in, she was sick again. I got on with my day.

            Just before the start of evening surgery, I went to see how she was getting on - not well. She'd vomited several more times, and was now lying on her sternum, groaning. I lifted her lip, and was worried to see that the colour of her gums had turned a little pale. I went and grabbed Corrie, and asked her to look at her patient. Corrie checked her over, checked her temperature, and nodded.

            'You're right. Not going well. I think we're going to need to operate in the morning, find out what's going on in there. X-ray wasn't all that helpful, but something's clearly not right in there.'

            Corrie was right; the x-ray hadn't revealed any foreign bodies, obvious tumours, or gas build-up. I looked at the labrador. Her tail thumped against the inside of the kennel as my eyes caught hers, and I asked the question that so many owners have asked me since.

            'She's not going to die, though, is she?'

            Corrie shrugged. 'Not tonight, at any rate.' She left. I stayed with the dog for a little while, tickling its ears, still worried. I looked at her. I remember very clearly thinking that Corrie must be right. She couldn't die. She was too big, too vibrant an animal for that to happen to her overnight. Tickling her warm ears, with her grunting in pleasure, it was hard to imagine her dying at all.

            I didn't have to imagine it. By the end of evening surgery, her abdomen was so painful that if you touched it, she was sick. Her colour was now deathly pale, tinged with red around the edges, and Corrie knew she'd have to operate then and there. We never made it that far. As we were prepping for surgery, the beautiful big-eyed smiling labrador stopped breathing. She never started again, despite all our efforts. Half an hour later I was standing in theatre with her dazed owner - a dark haired young woman with a large silver cross around her neck. She had her hand on her pet, who was already growing cold. I was explaining to her about the pancreatic cancer.

            'I just... it can't believe it,' she was saying. 'It doesn't make any sense.'

            It didn't to me, either. Right up until that moment, I had made it through my veterinary training without ever really believing that death happened like that. Our brains have something of a blank spot to do with death; unless you absolutely and finally hammer it home, it never really sinks in. That evening, it sunk in for me. Death, final and irrevocable, happens. It happens all the time.

            Thinking back to that evening now, all these years later, it seems almost impossibly naive that I thought the labrador couldn't die, but I still clearly remember that thought, impertinent and against all logic, that she was too big to just... die.

*          *          *          *          *         

It seems that every few years a newspaper article is printed about vet suicide rates - solely for the purpose, in my opinion, of worrying my mother. We consistently come at or near the top of the charts - although occasionally we're beaten by doctors or paramedics. There's lots of suggested explanations - the stress of the job itself, the working hours - but for me the answer is obvious. Death isn't taboo for us, just as it isn't for doctors. It's something that happens, and it's not always something to be feared.

            Death happens, but for everyone else life, of course, goes on. As a new graduate, I swiftly learned that one of the first things people say to you when they learn that you're a vet is 'Oh, I couldn't do that, putting all those animals to sleep. It must be that hardest part of your job.'[1]

            When people said this to me, I'd nod, and look serious, because... well, you have to. Obviously it was the hardest part of the job. Except that honestly, it wasn't. In my time at Beech House, I was fixated upon getting the practical things right - talking things through with the owner, clipping the hair on the leg without causing distress, hitting the vein, easing the animal to the floor without letting them fall. A euthanasia consult meant a lot of things at the time - a longer consultation, a practical challenge, a professional challenge. It meant, and there's no denying it, a resolution; an end to worrying about difficult cases, and a full stop at the end of suffering. Owners were often grateful that you've made something they've been dreading for weeks go relatively smoothly. There is - and it's hard to write, but it's true - a great degree of satisfaction to be gained from performing a euthanasia professionally and competently.

            The shock of that evening surgery, where the fragility of life hit me in the way that it's hit so many others, soon wore off, and for a time, euthanasia was just one more thing I did. I was never happy about what I was doing, and it was never enjoyable, but it was, as I say, satisfying - in a way that isn't talked about outside of veterinary medicine. So when people used to ask if it was the hardest part of my job, I would nod, and agree, and think of the hundreds of other things about the job that I was finding more difficult.

            Over the years, however, a strange thing has happened to me. I find euthanasia harder and harder to perform. I suspect it's because, over time, my worries about 'getting it right' have faded into the background - it's almost second nature to me now. This gives me more time to dwell upon what it is I'm actually doing: bringing a life to an end. It's a selfish and irrelevant thought to have in the consultation room - it's far more important that it's done painlessly and quickly than that your veterinarian feels remorse about what he is doing - but nontheless the feeling grows. Now, when people say to me that it must be the hardest part of my job, I nod, and look serious. And I agree.

---

[1] Actually, it's usually the third thing people say; the second is 'Hey, you have to put your hand up a cow's bum!'; but always, always in at number one we have some variant of the time-honoured 'A vet eh? You do all right for yourself then.' This is usually followed by a wink, and the unspoken suggestion that for the rest of evening, drinks are on me. 

Lingua Medica - medical terminology deciphered

It has, of course, been literally the worst week for the English language ever. A bad week for me, certainly; how am I supposed to snigger in a superior and condescending fashion when one of our nurses tells me that 'When the phone rang, I literally turned round and shit myself.'? Sigh.

All is not lost for me, however. Fortunately for me, I have a whole language that was pretty much custom-designed to make me feel superior to normal mortals: medical terminology.

You see (and this may come as a surprise to you, so I'll whisper it) - many years ago, doctors didn't actually know very much. Sure, they could prod you, and prescribe leeches to suck blood out of you, but it couldn't really escape the notice of the general population that your chances of getting better with the treatment weren't dramatically better than the chances of getting better without. A poser. How could one make a living as a quack when it was patently obvious that you didn't know what you were talking about?

The solution: make it sound like you know what you're talking about. Language is, and always has been, a useful tool for those in power to keep the masses subjugated; Orwell's Big Brother understood this, with his doubleplus sinister idea, NewSpeak, and the founders of the Christian religion understood it too. Latin survived as a language largely because it wasn't understood by the poorly educated masses. The bible was always written in Latin so that churchmen (who had a similar credibility problem to the proto-medics) would be able to interpret it for the poor - and thus control the poor. If you know your history, you'll know the violence and consternation that surrounded the eventual translation of the bible into languages that everyone could read, and if you don't - go and read about it! Fascinating stuff.

In a similar spirit, early practitioners of the medical arts realised that suggesting to a prospective patient that 'I'm going to suck out a lot of your blood and hope that you feel better,' tended to garner a less-than-enthusiastic response. However, if you told them 'I'm going to perform a phlebotomy in order to balance the humours within your body,' people tended to nod, smile hopefully, and (crucially) hand over their coins.

And so medical terminology developed largely as a way of keeping knowledge (or lack of it) from the masses. As medical arts slowly transformed into medical science, it became more than that, however; much of medical language has a very specific and precise literal meaning (unlike, ironically, 'literally', any more - in fact, my money is on 'ironic' to be the next one on the list) which can get across a lot of information very quickly, and nowadays it's an invaluable tool to precisely explain your thoughts on a case in terms that, in theory, mean exactly the same thing to any medically trained personnel who reads or hears them.

I've been told a number of times that learning the medical lexicon is like learning another language. I'm suspicious of this claim...

(certainly there's nothing in medical terminology to compare to my excruciating 2nd year French classes, where Mrs McKee used to point at random suspects in the class room and utter the dread nonsensical phrase 'Eresbotty' in a low growl (everyone else in the room seemed to know what she meant, and after a few lessons I was afraid to ask; fortunately, fate never selected me for such punishment and it was only several weeks into term that I realised she was saying 'Error Spotting,' meaning they had to comment on the next pupil's French skills. I'm not sure why I was considered a bright child, to be honest)

... but I can't deny that I get a certain thrill from being able to say that I'm suffering from post-prandial narcolepsy, rather than 'I'm feeling dozy after eating'. However, I am, as you may be aware, a writer as well as a veterinarian, and as a writer it's my job to attempt to make my thoughts as clear as possible. In the spirit of this, I'd like to offer you up a number of medical terms, and explain to you what they mean, how they're useful (and, hopefully, regain some of my sense of patronising superiority that has been cruelly snatched from me by the opening up of the word literally).

1. Shock

I know, I know, it doesn't have ology at the end, or sound particularly clever - but it's a word that arises often in emergency situations - 'Is he in shock, doctor?' (I do get embarrassed when clients call me doctor, but I'm far too polite to correct them. Okay, okay, I get a thrill out of it too).

I chose this one because it's a good demonstration of the preciseness of medical terms - shock, in medical language, does not mean 'surprised' or 'pissed off that a car has just hit them' but that the patient's tissues are starting to run dangerously low on oxygen, because there isn't enough blood getting to them. Shock is further divided into several categories which more precisely define why the blood isn't getting where it needs to be, such as: cardiogenic (the heart isn't pumping the blood around the body properly), hypovolaemic (literally 'low volume' - you've lost a lot of blood), endotoxic (the blood vessels have become leaky due to infection; you've still got all your blood, but it's leaked out of the blood vessels). It's a useful and descriptive word, and nothing at all to do with the emotional shock experienced when, say, discovering that your evil twin brother has been performing an elaborate decade-long revenge against you culminating in them stealing your job and knocking off your wife. For instance.

2. Cranial/caudal/medial/lateral/dorsal/ventral/left/right

These are among the first medical terms I learned; they're all terms used orientate yourself anatomically so that you can describe exactly where on the body you have encountered a lesion or abnormality. Fans of Jaws (and this will, presumably, include all my readers, as it is literally the greatest film ever) may be familiar with 'dorsal', due to the terrifying image of that grey triangle slicing silently through the water, signifying the arrival of Bruce the Shark. The triangle is Bruce's dorsal fin, named because 'dorsal' means 'on the same side of the body as the spine'. Ventral means the opposite - the side of the body opposite to the spine, so that your belly button is on your ventral abdomen (and if it isn't, a trip to the doctor's may be in order, if you haven't been already).
'Cranial' means, perhaps unsurprisingly, 'towards the head', whereas 'caudal' means towards the tail - so your stomach is cranial to your colon, but caudal to your lungs (unless you really are in trouble) - and you'll see that these terms can refer to internal as well as external anatomy.
'Medial' means towards the midline (i.e. towards the spine) and 'lateral' means away from the midline - so your thumb is (usually) medial to your little finger, and both your eyes are lateral to your nose.
I include left and right as an anatomical point of order - such terms are always from the patient's point of view, so 'left eye' means 'the patient's left eye'.

There's a whole load more of these, for more precise localisation - 'buccal' and 'lingual' for 'on the same side as the cheek' and 'on the same side as the tongue', for instance. Hopefully you can see these terms are very useful for medics, and this help you to understand such gobbledygook as '3mm ulcerated lesion approx 2cm caudal and 3cm medial to most cranial nipple right hand side'

3. Acute and Chronic

A little like shock, these terms are occasionally used correctly, but more frequently abused, by the general public. Taking a history, I often see acute and chronic used as descriptive terms for how severe a condition is, so let's be specific - from a medical point of view, these words say nothing about a condition's severity - all they tell us is about is how long you've had the condition.
'Acute' means the condition appeared suddenly, and has tended to change rapidly - this means, of course, that acute conditions also tend to be more severe when we see them, and more likely to be a crisis - but the term in itself merely means sudden onset, rapid change.
'Chronic' conditions are the opposite - slow to develop and cause symptoms. There can be mixing of the terms; often a chronic disease will arrive in our practice in an acute crisis, because that tends to be when you notice something going wrong.


4. ...otomy/...ectomy/ ...ostomy


Ahh, now we're getting to the good stuff - the Greek. The above are suffixes that we apply to parts of the body to explain what we've done to them, only to do it in such a way that makes us sound clever.

'...otomy' means to cut a hole in something. So, instead of saying 'I have cut a hole in your dog's stomach', we can instead gravely pronounce the far sexier 'I have performed a gastrotomy.' It works with anything you can cut a hole in - bladder (cystotomy), small intestine (enterotomy), large intestine (colotomy), chest (thoracotomy) and so on. To perform a phlebotomy, as mentioned above, you make a hole in your patient's vein so the blood can leak out - usually done nowadays with a collection tube to send the blood for analysis.

'...ectomy' - remove entirely. So, no languishing in the 'I cut your cat's kidney out' for us - nope. We performed a nephrectomy. Works for anything you can chop out, so enterectomy (section of intestine), hysterectomy (uterus), orchiectomy (testicles). The ancient Incas were, of course, skilled practitioners of cardiectomy, although this is generally not good news for the patient.

'...ostomy' means to create a permanent hole in something. We don't do this very often in veterinary medicine - possibly the most common operation (and it's not all that common) would be a urethrostomy, a procedure where we permanently open up a male cat's urethra (the tube that runs from the bladder down through the penis) to prevent it getting blocked (stop wincing, men! It's a life saver) although you may be more familiar with a colostomy, performed in humans with damaged or blocked bowels.


5. Hyperplasia/ Metaplasia/ Neoplasia

All to do with tissue growth - or, more to the point, cell growth. If you have hyperplasia, then the organ in question is perfectly normal, but bigger than it should be. This is rarely anything to worry about, but occasionally this can cause trouble if you haven't got a lot of room somewhere. Prostatic hyperplasia - enlargement of your prostate gland - a common ageing change in men - is the reason is gets harder to pee as you get older, owing to the fact that the prostate gland is annoyingly wrapped around your urethra.

Metaplasia is change from one type of cells to another type of cells, usually as a result of some kind of injury or stress. It's reversible (usually if the stress is removed), and benign, and we don't see it all that often - usually because by the time we find out about this, the cells have moved onto the next stage, which is...

Neoplasia. The medical term for cancer. Similar to metaplasia, except that once they get to this stage, the cells aren't going back to their previous state. They're very different cells to the ones that should be there, and unlike normal cells, which know when to stop growing, they just keep dividing. This, as I'm sure you're aware, causes all manner of problems, which I won't go into know. Neoplasia doesn't necessarily mean a malignant tumour - a wart is a form of neoplasia.

For the record, neoplasia, cancer and tumour are all synonyms - none of them mean malignant or benign by themselves, although 'cancer' tends to be used to mean malignant, nowadays (If I'm being pedantic, tumour simply means 'swelling', in the same way that 'rubour' means redness, but almost no-one uses it in this context any more). The difference between a malignant and a benign neoplasm is not clear cut, but it's related to how they behave. Benign tumours tend to stop growing when they reach a natural tissue boundary, and not spread via the lymph tissue or blood. Malignant tumours, unfortunately, are less respectful of tissue boundaries.

6. Idiopathic and ...opathy

And now we really enter the realms of sounding clever, without saying an awful lot. Very, very helpful terms, these. Idiopathic means, effectively, 'we don't know'. More to the point, it means that the consensus of medical opinion is still unsure as to the cause of this problem. So, when I tell you that your dog has 'idiopathic vestibular syndrome', I might be sounding very knowledgeable, but what I'm really saying is that you dog has a condition that no-one in the veterinary world quite understands.

That's not to say this term isn't helpful - just because we don't understand where a condition comes from, doesn't mean we can't treat it, or at least recognise the pattern of the disease - idiopathic vestibular syndrome, for instance, has a well-understood course (i.e. it usually gets a lot better within 24-48 hours) and, if I write it on my notes, other vets who read it will know what I'm thinking. I'm just telling you that it's a shorthand way of us saying 'Oh, it's that thing where their balance centre goes wrong, but usually gets better again'.

...opathy is along the same lines. It's another suffix, and when attached to a particular organ, it means 'something is wrong with it'. Brilliant, eh? Works with anything. Pneumopathy - lung disease. Dermatopathy - dodgy skin. If I tell you that your hamster has an 'acute idiopathic hepatopathy', I'm telling you that your furry friend's liver has gone wrong. I don't know how, or why, but at least I can tell you it happened pretty quickly.

7. Iatrogenic

A classic face-saver. Iatrogenic means caused by medical examination or treatment. In other words - that thing that's wrong with your pet? I did that. So, iatrogenic Cushing's disease is caused by your vet giving your pet too many steroids. In you vet's defence, they may have had no choice, because the disease that they're giving the steroids for is probably more severe than the Cushing's disease they're creating.

Iatrogenic haemorrhage is a euphemism along the lines of a surgeon tell you 'I'm afraid he lost a lot of blood during the surgery'. He didn't lose it - the surgeon did. It's nice that we have a special word for our balls-ups.

8. Borborygmi

Finally, I wanted to make special mention of my favourite word in the whole of veterinary medicine. It's pronounced BOR-BOR-IG-ME. Say it with me, because this word is onomatopoeic - which is to say, it sounds like the thing it's trying to describe.

Borborygmi is the medical term for the sound of stomach gurgles. Say it again out loud, and tell me that isn't the greatest word ever invented. Literally.

Some Personal Thoughts on Animal Welfare

You don't need to know much about biology to understand that humans are animals too; exceptional animals, in that we can think, and reason, and imagine esoteric concepts in a way that very few, if any, other species can. Debates have raged for centuries over to what degree animals can even form thoughts rather than act on instinct; the answer, most likely is that some can, and some can't. Humans are at the extreme end of a wide spectrum - but it's still a spectrum. How much are other animals able to reason?

Again, however, it's not a helpful debate. 18th century philosopher Jeremy Bentham realised the problem with this line of thought, cutting to the chaste with the famous quote that has shaped my life ever since I heard it, many, many years ago:

"The question is not 'Can they reason?', nor 'Can they talk?', but 'Can they suffer?'"

As Bentham saw it, the only relevance that higher cognitive powers have on the question of suffering is in the way that they make suffering worse. It is (I believe) self-evident that a human diagnosed with terminal cancer is going to suffer far more than, say, a cat, thanks to their imagination and understanding of the situation they are in, but both parties can suffer from the physical effects of the tumour itself. 

My position here is much the same as Bentham's - I, personally, can see only one distinction between humans and other animals with regards to how much they can suffer - the distinction I mentioned above. In all other respects, how much pain is experienced depends pretty much on how well-developed your nervous system is; which is why I suspect a sprout is less able to suffer pain than a newt, which in turn is probably less able to suffer pain than a primate.

Bentham was the founder of utilitarianism, a philosophy that judges action's moral rightness based on the greatest good for the greatest number; utilitarians are the accountants of the moral philosophers, totting up pain versus pleasure for everything we do - the most moral action being the one that rates highest on the pleasure chart, or at least lowest on the pain chart (there isn't actually a chart, it's a metaphor). The only distinction this makes between the species is the difference in their ability to feel pain or pleasure.

It's as good a philosophy as I've heard of, personally. There are problems with it - some of which we'll encounter below - but for myself, I find it helpful to at least consider my actions from a utilitarian point of view. It helps me think about how much emotion I'm allowing to cloud a particular issue; ultimately, for me, all I care about is relieving as much suffering as possible.

For the last part of my post, I'd like to look at the different positions that animals exploited by the human race find themselves in, and I'd like to discuss my thoughts on the matter. I don't expect you to agree with all, possibly not even some, of what I say, but what I'd like you to do is at least consider your own reaction to these situations, and how it compares with mine. All I can ask, really, is that you think about this stuff, and come to your own conclusions.

The Single Pot of Compassion

Before I do that, though, I'd like to tackle a criticism that anyone who mentions that they're interested in the welfare of animals is likely to come across one time or another - I suppose I'd call it the 'there's children starving in Africa' approach. I have been told, many times, that caring about the fact that animals are suffering, suffering badly, in the world, displays some kind of moral bankruptcy when there are, as I say, children starving in Africa.

Indeed there are. There are children starving in the UK. There are innocent people dying in Syria, and Afghanistan, and in a hundred battle zones across the globe. There are millions of people dying of AIDs, and malaria, and even preventable diarrhoea. It horrifies me. But I fail to see why being concerned about animal welfare takes away from any of this. It's as if there's a single pot of compassion, which humanity can only direct in one direction at a time, and that any attempt to push it in another direction will mean that children die.

There's enough compassion - enough money - in the world to deal with, and at least think of all these problems. One child suffering, terrible though it is, does not reduce the suffering of anyone or anything else. To suggest that we're not allowed to worry about anything until the (in your eyes) most worrying problem has been thoroughly sorted out is, to be frank, bollocks. If you make this argument to me, then I've got to assume that before you've ever complained or worried about anything at all in your own life, you've checked to make sure there isn't someone, somewhere in the world that has more to complain about than you have, thus eliminating your right to worry. 

It's a similar argument to the 'single pot of money' argument about space exploration, as if every single dollar spent upon looking to the stars would have otherwise been spent upon curing malaria. It's a pathetic, pointless point, and I don't intend to spend another second of my life rebutting it (this is where the link to this blog will come in handy again!).

Well, I think that's enough preamble. What do I actually think about animal welfare? As ever, in my blog, I'm going to be totally honest about the next points. I don't mind if you disagree (I suspect many of you will, strongly) but I will show my working so that at least you can understand how I'm coming to my conclusions. If you disagree, feel free to do so to me, but please show your working too, so that maybe we can understand each other.

My Feelings on Animal Welfare

So, as I've mentioned, my general approach to thorny ethical problems is to attempt to apply utilitarian principles to them. When I come up with an answer that I really don't like using this tactic, I then (like everyone else, I suspect) desperately flail about for reasons and excuses to justify the position I have already taken. On rare occasions, if I really can't justify my position in anyway that lets me sleep at night, I change my position; hence my vegetarianism. More on that in a sec.

The utilitarian approach is useful to at least frame questions in a way that you can attempt to answer them. For instance, my question from earlier - what does emancipation even mean to an animal? - is rather woolly, philosophical, and ultimately unhelpful. Framed in a utilitarian way, it becomes - would emancipation of the animals cause less suffering and more pleasure than not doing so? 

Still a strange, emotive and argument-ridden question, but at least one that is, in theory, answerable. So, with that in mind, I'm going to look at some ways in which humanity interacts with/exploits/enslaves (depending on your point of view) the rest of the animal kingdom.

1. Pet Ownership

Yep. Pet ownership. I like to start with the tricky ones. The slavery viewpoint seems controversial here, but with a moment's thought and using a strict definition of slavery, it's hard to argue. Pets are owned, legally, by their masters. They are often neutered without their consent, and are not able to act freely according to their desires. The master has complete control over them, to the extent of even deciding when it is time for them to die.

I, personally, am complicit in the deaths of many hundreds, if not thousands, of such creatures. I endeavour, in my job, to relive suffering, but still I have inflicted many hours of pain and suffering upon pets in the form of neutering operations. Pain relief and good care dramatically reduce this suffering, but I would be lying to myself as well as all of you if I said that being speyed is an entirely painless and stress-free procedure.

It could be argued that castration and speying carries health benefits far in excess of the suffering they cause... but I could argue to same for you, reading this, too, and I'd have to be particularly charismatic to convince any of you reading this to part with their gonads. The point is, given the choice, the pet would rather not go through the operation.

There are other compromises to pet's freedom's too - dogs are walked, but they generally don't roam the streets freely. Cats have more leeway in this regard - except the many of the species that are never let outside at all. Pets eat what they are given, and must accept any punishment given to them; if they retaliate against violence with violence, then they are likely to be killed; in fact, if they attack a human in any situation at all, then they will probably be put to death.

It may seem extreme, but all the above is true, expressed from the point of view of animal slavery. You may argue with how I've written it, but it's hard to disagree with the fundamental truth of it. So, should pet ownership be banned? Should pets be emancipated? There are many people - some vets, in fact - that feel that they should be.

Here's my opinion - living in the wild, is, as I have previously suggested, not fun. Really, really, not fun. It is, quite literally, kill or be killed out there. If you're not on top of your game, you're probably going to suffer a slow, lingering death or, if you're very lucky, get killed and eaten. If you're being eaten by a Komodo dragon, you get to do both.

My point is, from a utilitarian point of view, I have no doubt whatsoever in my own mind, that the vast majority of pet animals suffer far less than their wild counterparts (although not all; there are some very, very bad owners out there). I accept that neutering is a compromise to a pet's welfare. It's a compromise that I feel comfortable (though not too comfortable) about making in order to reduce the suffering of all the other animals that would otherwise exist and likely starve to death (that's nature for you). I see it as part of the pet's social contract - it is neutered, and in return it receives food, board and medical care for the rest of its life. The quality of all three varies from pet to pet, of course. It does make me uncomfortable that the animal is given no choice as to whether to embark upon this contract or not, but I have to be pragmatic. Such understanding is, as far as our best neurologists can tell, beyond the mental capacities of a dog, or a cat (though I wince as I type because in my head, I can hear that sentence being repeated in a Tennessee drawl, only talking about other humans and not animals).

Pets - in the form of dogs and cats - have been with our species for tens if not hundreds of thousands of years. Tradition is no excuse for terrible morals, of course, but I make the point because it's possibly to argue that being a pet is now the natural environment for many dogs and cats. From a utilitarian point of view, pets give a great deal of pleasure to their human owners, and (I suspect, although it is always hard to know for sure) receive at least some of that pleasure in return. I struggle to see how releasing them all into the wild would lead to a net gain in pleasure, or a net loss in suffering. I am very aware that simply being a pet is a compromise to an animal's natural behaviour, and its freedom (and this is ignoring unfortunate pets that suffer terrible at the hands of their masters) but I genuinely feel that the difference in a pet animal's cognitive ability - the fact that, as far as we understand it, they are unable to imagine, and aspire, and dream of more than they are - compared to a human means that this form of slavery is a morally acceptable one, if not entirely as benign as our modern eyes may first assume.

My opinion on this would change if it was demonstrated that our companion animals were able to understand their servitude, and wish for it to end. My opinion does change when it comes to animals where the mere fact of keeping them as a pet means that their freedom is severely restricted. Birds, for instance, denied the freedom to fly, or even leave their cage. Rabbits that never leave a hutch. Fish and reptiles - call me picky, but my feeling is that any creature that requires its own life-support system to exist within your house is not suitable pet material. In these cases, the compromise becomes too much for me.

2. Food-producing Animals

If an immoral act can be defined as one that produces more suffering than other alternatives, then factory farming of broiler chickens must be seen, in my opinion, as one of the most immoral acts ever perpetuated by humanity. Before your gut reacts strongly against that proposal, let me put this to you - I personally believe you would be hard-pressed to find a sentient creature that suffers more during its short life that a factory farmed broiler chicken. Never seeing sunlight, never experiencing even a second of freedom, broilers grow fast enough that by the time they're a month old many of them struggle to walk at all due to their weight. By two months old, they're dead, and in your sandwich.

If you did find a creature that suffered as much, it would probably be a caged hen producing eggs. Unfortunately for them, they live a lot longer, spending all of those years in a box about the size of a sheet of paper. 

I don't want to rant. There are humans that suffer as much in their lives as these chickens, due to illness, war, or disease... but we're talking about millions of creatures. Millions upon millions. You can google the precise details. I have done. I don't want to again. That, my friend, is a whole lot of suffering. From a utilitarian perspective, it's going to take an awful lot of pleasure to counteract that. Quite how much pleasure you get from your chicken sandwich... well, that's up to you. And really, I mean that. I'm not trying to convert you. Those two paragraphs above aren't news to you, are they?

I don't object to the principle of eating meat. It's hard to, really, faced with the evidence of evolution. We're designed for it... well, okay, we're actually omnivores, but many, many animals are designed to eat other animals.

I don't object to the taste of meat. Far from it. I bloody love it. The smell of bacon is still likely to make me dribble, even though I've been a vegetarian for over twenty years now. It would hardly be much of a sacrifice it I hated meat, now, would it? If that was the only problem, I'd call myself a... whatever someone who never allows celery to pass their lips is called. Bleh. Celery.

Here's my point: if you eat meat, you are complicit in the death of animals. Many hundreds of animals. More, even, I suspect, than I am with all the euthanasias throughout my veterinary career. Now, I'm not judging you for that - but I would like you to at least judge yourself. If you eat meat, I would argue that you have a moral responsibility to investigate exactly how the animal that has fed you lived, and how it died. If you do look into it, and you're okay with it, then, and I mean this honestly, you're fine by me. I looked into it, and I didn't like what I saw, so I stopped. 

I try not be judgmental in life; I spend so much of my time being unsure of my own actions that I'd find it exhausting to have to find fault with other people's too. However, there's one area in which I'll brook no compromise. If, in the course of a conversation with me, you mention that you 'don't want to know where your food comes', that 'it'll upset you too much', then you might notice a slight flicker in my eye. I'm British, so I probably won't say anything to your face, but from that moment on you are dead to me. I will, from that point onwards think of you as the worst kind of moral coward. You're quite happy to profit from death, not even wanting to know the nature of the lives that supported you? Then, quite frankly, fuck you. I hope your gonads shrivel up and fall out of your arse.

Even worse than this, however, are the people that tell me 'Oh, I couldn't eat anything that had a name! That would be horrible!' So, you're telling me that because you find it uncomfortable, any creature that is lays down its life to fill your gut isn't allowed to have a name, or a personality, but must remain a numbered egg-machine in a box for its whole life? And this must be so that you aren't in any way reminded that the thing you're exploiting could possibly have a better existence than the one you're forcing upon it so you can eat a fried egg with your toast? Then I hope your next thirty-thousand reincarnations are as a battery hen... except that I don't. Because I wouldn't wish such an existence on anything.

Here's why I'm a vegetarian: I believe that if you're going to kill a creature simply to give you pleasure, then that creature deserves your utmost respect for laying down its life for you, even involuntarily. I believe you should make it your mission that such a creature experiences the best life it could possibly have, given the massive compromise it is going to make, just for you.

I've been in a chicken abattoir. You can't even count them as they whiz over your head, let alone imagine each of them as an individual creature - not reasoning, not talking, but suffering.

The more astute amongst you, however, may have noticed that I keep saying vegetarian. Not vegan. The title of this section is food-producing animals. That includes milk. And cheese. And eggs. All of which I eat. 

Here's my excuses - I only buy organic milk and cheese at home. Organic milk, by itself, is not good enough, but if you make sure it's stamped by the soil association, then you can rest assured this is an association that actively tries to cut down the suffering in the dairy industry. As one example - they try to use milk from beef herds. This means that male calves are worth something, unlike a largely worthless male dairy calf, and so they aren't immediately killed. The calves run with their mothers, rather than being taken from them at three days old, to the great distress of mother and calf.

That sort of thing. You can look into it yourself, and if you take nothing else from this blog, please take that.

I only ever buy free range eggs - not just free range, but freedom food eggs. Never, never never from caged bids, and I check the packs of egg-containing food to make sure it's from free-range sources. I'm not perfect. I'm a hypocrite, like most of us are. But... I've followed by own rules; I've looked into it, and I made my decision. Please do the same.

3. Animal Experimentation

Well, I totally managed to keep my emotions out of the last section, and produce a thoroughly impartial piece of work, didn't I? Go me.

This section probably isn't going to make me many friends. Remember: opinions - model's own. 

I'm a scientist - well, I like to think that I am. It's hard, sometimes, being a vet. Scientific people like evidence behind their decisions. There's precious little evidence in veterinary medicine. A lot of studies are underfunded, or use too small sample sizes, or sponsored by a drug company interested in hawking their new flea treatment or painkiller. The point is, I believe in the scientific method. I believe in experimentation.

Not when it comes to animals, though. And here we go. I know. I know that huge leaps have been made in medicine using animal models. I know that some of my friends, diabetic or with severe inflammatory diseases, would almost certainly be dead by now if it wasn't for animal experiments. It's entirely possible that you're boiling with rage reading these words because your mother, or your son, or you yourself would be dead right now without them. I may be too; so many of our drugs used have come down from animal work. I would also save fewer lives than I do at the moment - almost all my drugs come from animal testing. I know how many bodies would be left in its wake if it had never happened. I know.

The utilitarian approach is hard to apply here; it's hard to know exactly how much suffering would have been caused if animal experiments hadn't provided the many breakthroughs that they had, although it is, I think you might even agree, indisputable that animal experiments themselves have caused immense amounts of suffering to the subjects of the experiments themselves. Utilitarianism helps with some aspects of animal experiments, however. Any animal test which causes suffering to the animal, but that is unlikely to reduce suffering in itself (including all cosmetic testing, animal experiments where the benefits to knowledge are dubious or already known) is, according to our rulebook, morally wrong. Let's not do that.

My gut, however, tells me it's wrong. I know I said I shouldn't think with that thing (even though it is, sadly, much bigger than my brain) but... well, if it were morally clear-cut, an obvious choice, or even a slightly more grey area than it is already, I would accept it. It isn't. Not to me, at least. However much I may nod in sympathy when you tell me your child today is alive because of medical tests performed on animals, however much I need my pharmacy at work or be rendered largely incapable of fixing any animal at all, my heart would leap for joy if I woke up tomorrow to find that all animal experiments were banned forever.

I know you probably don't feel the same. Maybe I have a different perspective. It's a hard thing, morally, to explain why the drugs I'm using to get dogs better were developed using experiments on dogs. Was one dog worth more than the other? Was it because one dog had a name? One dog was lucky enough to be deemed a pet, another a lab animal. You can substitute rats, rabbits, cats, guinea pigs or mice in there. They're all experimented on. They're all kept as pets. I find that a very hard position to defend, morally. Being pragmatic about it - okay, we have had our breakthroughs. Now, let's stop. There are other ways. They're slower. They're more expensive. Some breakthroughs will never be made if we stop. But they cause suffering. Real, tangible, terrible suffering. Knowledge for knowledge's sake, absolutely, but if that knowledge came at the expense of pain and death of an unwilling creature... I'm afraid that I, for one, don't wish to know.

4. Animals for Entertainment

This can be where utilitarianism falls down. How about if one person, or one creature, was tortured to death in front of a baying crowd of people? An incredible amount of suffering is caused to that one creature, but... what if the crowd enjoyed it? I mean, really, really enjoyed it? Is one hundred people's pleasure enough to cancel out the suffering? No? Okay. How about five hundred? Screw it, let's televise it. How about five million?

How many people have to enjoy it before the pleasure outweighs the suffering? You could fudge the numbers a bit, so that suffering is worth, far, far more than pleasure, but still, that implies that if enough people enjoy a spectacle, then any amount of suffering is fine. You could use utilitarianism to suggest that the Roman gladiatorial games were morally right... but I suspect you still wouldn't think it so.

Whenever you get a strange result like this, it's worth taking a hard look at the facts, and seeing how much emotion is playing into it; and there is some. The natural disgust that I (and I hope you) feel at thinking about the scenario above is to do with the pleasure. There's something obscene about people taking pleasure at suffering being caused to another; at least, there is to our modern eyes. 

This is where the emotion comes in; the pleasure or lack of it makes no difference to the individual being tortured (well, not quite; it's quite conceivable that a baying crowd may add to the suffering experienced) so, as ever in life, it depends upon your perspective. Let's break from the 'greatest good for the greatest number' for a moment, and look at things from the point of view of the crowd, and of the victim.

Firstly, the crowd - their pleasure comes from the suffering of the victim. If there's no suffering, there's no pleasure. However, if the crowd can be fooled into believing that the victim is suffering, we can imagine a situation where a great deal of pleasure is created with no suffering.

Secondly - the victim. Their suffering is dependent solely upon being tortured. Whether the crowd experiences pleasure or not makes no difference. If the torture isn't carried out, the suffering does not happen.

So (and bear with me here) we have now imagined a situation where the crowd experiences the same pleasure, but no suffering is caused. This is an alternative to the suffering situation, which is, according to our utilitarian rules, a more moral position than the first. Therefore, the first situation is, at least from this perspective, immoral.

Phew. Took a bit of rules-bending though, didn't it? There's two important points to take from it, though, that inform my views upon this.

First point - the disgust at the pleasure of the crowd. It's the same reason that people who hate fox hunting (and I must be honest and include myself as one of those people) generally hate it more than they hate the suffering caused by factory farming. The suffering of the fox, though extreme during a hunt, is small compared to that experienced throughout its life of your average broiler chicken, yet I suspect that not all those opposed to fox hunting are vegetarians. The point I'm trying to make is that the passions inflamed at the thought of animals hurting each other for entertainment are somewhat exaggerated by the disgust of other people's pleasure. I still hate such events, deeply and profoundly, but I try to keep in mind that objectively the suffering is less, perhaps, than other forms of animal exploitation.

Second point - any way of simulating such an event must be more moral than the event itself. We all have TVs and smartphones now. Let's not cause suffering in real life.

Third point - (and a bit more personal) if you take pleasure from watching pain caused to another living being, whether I try to think like a utilitarian or not, I'm going to think that you're a sick fucker, and not want anything to do with you.

My thoughts. Please add your own if you made it this far. And show your working if you want a response!

The Easy Diagnosis

It's been a week of textbook bashing. Where is this oedema coming from? Why is he insulin resistant? Is the GGT value significant? The kind of cases that make me tear what little hair I have remaining out, and pray to Hippocrates for a nice, simple diagnosis.

I've forgotten a fundamental truth about the easy diagnosis, though.

*

'... just not been quite right for few weeks. I know it's probably the hot weather, but we thought it would be best to check.'

I'm nodding sagely as I reach into the box, and even as I'm lifting the cat out I've got alarm bells ringing; under it's long hair, it feels like a skeleton wrapped in a thin blanket. I place it on the table to see that it's lost weight everywhere - everywhere, that is, except for it's abdomen, which is incongruously swollen.

'We thought he might have lost a bit of weight?' the old lady adds. Her husband nods helpfully and smiles.

'We just wanted him checked,' he says, adding with a chuckle, 'don't know what we'd do without you, littlun.' He reaches across and tickles the cat's chin, who starts purring. I smile up at the old couple then look back down at the cat, my hands reaching down to palpate it's abdomen. It doesn't take much squeezing before I feel the large, knobbly mass just behind its liver. We're seconds into the consultation and already I have a fair idea about what is going on. There is, of course, a chance that the mass I'm feeling is nothing to do with my patient's weight loss and inappetence, but that's not too likely.

'We thought that maybe he needed worming?' the old lady says, while the cat contentedly rubs his face into the old man's hand.

Whatever happens from here, the cat is going to need blood samples, x-rays, scans, possibly exploratory surgery, and there is a fair chance that whatever we do it's not going to make it. There are going to be difficult decisions about whether it's fair to put him through any of that at all, and their are going to be tears in the night, far from my surgery, over a companion who probably isn't going to journey along with his owners for much longer. All this I know within the first sixty seconds of my consultation.

It's hard to just blurt out that I'm pretty certain that we're dealing with cancer before the old couple have realised I've started examining at all, so I continue my checks. The rest of my clinical exam ticks more worrying boxes; mild jaundice, a low-grade heat murmur, pale mucous membranes. I return my hands to the abdomen, not really because I need to feel the lump again, but because I need to owner's to see that I'm starting to get concerned. I grow quiet, my usual smiles and nods tailing off, as I feel. If I was consulting with anyone else at the moment, I would say to the couple that I just want to 'take him out the back for a moment and ask my colleague for another opinion, because I'm just wondering if I might be able to feel something unusual here'. I don't really need the second opinion - the tumour isn't subtle - but it gives the enormity of what I'm about to tell the clients a little preparation. As it happens, this afternoon I'm consulting on my own. I briefly consider saying the same and taking the cat into the prep room for a moment anyway, but it feels too much like deception. Instead, I weigh the cat, and allow a concerned look to creep across my face. I return to the abdomen, and palpate the tumour while the cat purrs for a good thirty seconds; enough time for husband and wife to grow silent, and look at each other nervously. I take my hands off the swollen belly, and open my mouth to speak...

*

'You tell him, Emma, he's yours, after all!'

The young girl - maybe eight? I'm never good with child's ages - lifts the wriggling white rabbit from the box, and drops him onto the table. I swiftly grab him to stop him from bouncing straight back into his box, or, even worse, several feet onto the floor.

'What... er...,' I say, trying not to show how hard I'm having to grip the rabbit, 'what can we do for Dillon today?'

The little girl goes silent, and looks shyly at her mum. The young woman rolls her eyes, grinning. 'Okay, okay, but next time you say!' The girl nods, and the young woman looks at me. 'He's fine in himself,' she says, 'but Emma found a little lump around his mouth. I thought it might be a cyst.'

While she's speaking, my hands have found the little lump. It's about eight millimetres in diameter, attached to the bone of the jaw, firm, tense and unwelcome as hell. I look at it, seeing the skin stretched taut over it, so thin as to appear transparent. The parts of it that aren't bony are filled with what appears to be a thick, white fluid. It's not a cyst. It's not a tumour. It's an abscess. It's going to mean a long, protracted course of treatment and probably multiple surgeries and if we're very, very lucky, it might just not kill Dillon. It probably will, though.

The young girl finds her voice. 'We think it's a cyst,' she says, then turns back to her mum.

*

'She's just been a little lame the last few weeks. I thought it was probably the hot weather, it's been hard for her, of course, at her age.'

The greyhound stands at the edge of the consulting room, looking at the door. You might think she was aloof, but I've owned greyhounds, and I know they're just nervous with new people sometimes. It's partly why I like them; they're just like me.

'I was told you know a little about greyhounds, so I wanted to come and see you,' the woman says. 'I was thinking it might be time to start on some arthritis treatment, maybe? She's already on glucoasmine, of course.'

Of course. Everyone is nowadays. I smile, and start to feel down the left fore leg. It's not far before I feel the swelling in the bone.

'I had wondered about cod liver oil too,' the woman continues, 'but I thought... oh!'

I've squeezed the lump in the bone, gently, and the greyhound has yelped and turned to her owner. Painful on palpation. Ten year old greyhound. It'll take an x-ray to confirm it, but I'm already almost certain that I'm dealing with an osteosarcoma - a bone tumour. There's something like a sixty percent chance that it's already spread to the rest of the body, but even if it hasn't, we're talking amputation plus chemotherapy, with a very low survival rate. If we don't do anything, the tumour will erode through the bone until, one day soon, it will just snap - a pathological fracture.

Standing in the consult room, I remember the sunny day when I felt that same lump in the humerus of my own dog. I remember standing by the x-ray developer with Kerry next to me, both of us hoping against hope. I remember the very next day, Kerry looking at me with tear-filled eyes, cradling her head in her lap while our colleague finished injecting, whispering the words unbelievingly, 'Beattie's dead.'
I look up at the woman, and wonder if she will the remember the words I am about to say for the rest of her life too. I take a deep breath...

*

Here's the truth. Sometimes the easiest diagnosis is the hardest one to make.

ENnie-thing goes!

Hello blog readers/spambots/ghosts in the machine

This a quick (and rather excited) post merely to mention that my book, The Express Diaries, is up for an ENnie award - so, yay, go Paul, Eric and me!

If you've read the book and enjoyed it, please consider nipping over to the voting booth and voting for us - it's in the RPG related category - and, not that I'm trying to influence your voting or anything, but '1' is for first choice etc.

Thanks for reading! New proper blog post to appear here soon, I promise. Unless you don't vote for us, I which case I'll throw my laptop out of the window in a huff. Yes, you.

Nick :)

The Bluffer's Guide to Neutering

Firstly, congratulations are in order, for today is graduation day for the veterinary students of Nottingham University - well done, new vets! Well-deserved! My lord, you all look so young. I hate you.

Ahem. Apologies. Also, I don't hate you. You have a long and likely happy career ahead of you, but you've got a bit of a learning curve ahead of you now. Well, okay, not so much a curve as an Everest.

Thinking enviously about your cheerful, fresh faces, has got me thinking about being a new graduate myself, you see, and of all the things I started worrying about the moment I realised that bloody hell, I had only bloody qualified as a bloody vet!

I'm good at worrying (and at whinging, as regular blog readers are no doubt aware). After I graduated, I was at the very height of my worrying powers, and could probably have worried for Team GB. Amongst the many, many things that I worried I wouldn't be able to do (blood sampling, consulting, driving the practice car without writing it off (it turns out I was right to worry about this one)) one that loomed very, very large in my mind was surgery - and, particularly, given my woeful experience at the time of graduation (five cat castrates and a half a dog castrate), neutering.

Neutering. The bread and butter of the general practioner's day. If you can't neuter something, you might as well hang up your stethoscope before you've even bothered to (very cooly) drape it around your neck.

I am here to tell you, new graduates, not to worry about it. Well, that's not entirely true. I'm here to tell you why it's totally pointless worrying about it (a subtle distinction), by showing it to you from my perspective as a equally fresh-faced, enthusiastic new graduate; and I'm going to do that (along with telling everyone else what neutering actually entails) that with the aid of my (please insert a fanfare mentally at this point)

BLUFFER'S GUIDE TO NEUTERING! (Or, how I stopped worrying and learned to love the ops)

(You didn't do that fanfare, did you? Tsk)

Neutering is the generic term for removal of an animal’s reproductive ability. For males, it’s castration (removing the testicles. You might think this is rather too obvious to spell out, but I have, in my career, been confronted by a furious owner demanding ‘where the fuck’ her dog’s testicles were after I had castrated him. A few awkward moments passed while I explained the procedure that she had signed for that morning. The owner had been under the impression that castrating her dog merely meant ‘giving it the snip’. She was especially annoyed because now, all the other dogs in the area would pick on him because they would spy his conspicuous lack of love spuds, and realise that he was an easy target. We sorted it all out in the end but it was, as I say, an awkward consultation). For females, it’s speying (or, if you’re American, spaying; all I’ll say on the matter is that you’re wrong about grey, and you’re wrong about this).

Castration is a relatively simple (if eye-watering, for male readers) procedure in both dogs and cats – relatively low risk exercises in ligation (tying off blood vessels) and suturing. As with all surgical procedures, there are a few variations in technique, based on personal preference, but they were good procedures for my new-graduate self to sharpen my surgical teeth on (if you’ll forgive the slightly disturbing mental image that metaphor creates). Speying... speying is a different matter. The medical term is ovariohysterectomy – the surgical removal of both the uterus and the ovaries (As opposed to the human hysterectomy – removal of just the uterus (hystera being the Greek word for uterus, and the same root word from which we derive the word hysteria – which probably tells you all you need to know about the male attitude towards women throughout history)) is much more involved surgery. The ovaries are inside the animal – just below the kidneys, to be precise – and so harder to get to. Ligation is trickier, because the blood vessels supplying the ovaries and the uterus are similarly harder to manhandle into a position where you can tie your knot (incidentally, our domestic pets don’t suffer from hormone deficiency problems in the same way that humans do, on account of having a different reproductive cycle – the oestrus cycle, as opposed to the human (and other primate) menstrual cycle. This explains both why female dogs and cats don’t go through a menopause as they age, and also why humans don’t come on heat – which is why you never see un-neutered male humans leaving their homes searching for other women. Oh, wait...)

With cat speys, the added complication, just to make things interesting, is that in the UK we have decided to make the flank approach to the uterus our approach of choice. Flank means what it sounds like – making an incision in the side of the cat’s abdomen, rather than the midline approach that we choose for every other abdominal surgery we ever do. I’m still not entirely sure of the reasoning behind this; I’ve heard arguments that it’s quicker, that you get less post-operative reactions, or that if you get a hernia it tends to be less serious in the flank – but I’m not convinced by any of them. A well-practised surgeon will be equally speedy with either technique, I’ve see my fair share of post-operative reactions with flank cat speys, and if you get a hernia then you need to surgically repair it whichever hole the internal organs happen to have popped out of. I can just about see the argument that it’s a useful technique for animals that are lactating, because your wound is further away from the teats, and so the mother is less likely to reject the kittens when they come to suckle. You’re less likely to get milk leaking into your wound and causing an infection (because if there’s one thing that bacteria love, it’s a bit of milk) – except that in lactating dogs we still operate midline and don’t seem to see any of the attendant problems.

The main problem with the flank cat spey is that if you make you incision in just the wrong place it is an absolute bugger to find that bloody uterus. In these early months of my career, I spent many, many hours peering into a cat’s abdomen, fruitlessly searching for its reproductive organs like Gollum forlornly searching for his lost ring, only to discover that I had yet again failed to penetrate the peritoneum (a thin membrane coating the abdominal organs, that shrink-wraps them away from hapless surgeons that fail to make their cut deep enough), or that my incision was to dorsal, or too ventral, or (on one occasion) so far back that I had managed to enter the poor cat’s abdomen through the muscles of its hind leg; this last individual seemed fine when it woke up but I made sure it had extra pain-relief at home. Even though my days of elusive uteri are long behind me, I have spent enough hours since helping out stressed and sweary foreign locums attempting this strange technique to wonder why it is we persist in our approach. Tradition, I suppose. I guess it's no weirder than putting trees in our houses at Christmas.

The last, and by no means at all the least of the ‘routine’ neutering procedures is the bitch spey. Ahh, bitch spey, my old nemesis. The bitch spey is the same surgery as a cat spey, in that you’re performing an ovariohysterectomy, but it’s much, much harder. I would contend, in fact, that speying a fat deep-chested dog is about the most difficult surgical procedure you’re likely to encounter before you start entering the realms of certificate-level surgery. There’s a feeling that only surgeons know – a warm, prickly, feeling, experienced during an operation that isn’t going very well; the surgeon’s sweats, we’ll call it: a terrible feeling that you want to escape, you want to be anywhere but standing here in this hot, humid operating theatre wondering what the hell you are going to do to sort this mess out. In my early years, I came to associate bitch speys with the surgeon’s sweats.

Here’s how I saw it: a bitch spey is a no-win procedure. You’re starting with a completely healthy animal who, given the choice, would probably rather not have you ferreting about in its abdomen, and you’re performing major abdominal surgery upon it. Those blood vessels of the ovaries, those difficult to get to ones up by the kidneys, are no small potatoes. If you don’t ligate them properly, the dog could bleed to death. Now, it’s worth pointing out that in my decade (and a bit mumble mumble) as a veterinary surgeon since, I have never once seen or even heard of a bitch spey bleeding to death either during the procedure or afterwards (although I have seen a handful need to be re-operated on to re-tie oozing blood vessels) but the knowledge that it was at least theoretically possible was very much on my mind as I learned my surgical skills. When abdominal fat, which obscures your vision and makes everything – including your suture material - as greasy and slippery as a bacon sandwich, is added into the mix, then you have a recipe for a young veterinary surgeon such as myself turning the air blue as he attempts to complete a procedure that he wishes he had never started, in the full blush of the surgeon sweats (although, apparently, it's not when I start swearing that my nurses get worried nowadays; it's when I stop swearing and go quiet). As well as that horrible feeling, I discovered to my surprise that during a long, hot and unpleasant surgical procedure is the time that I seem most likely to be afflicted with an ‘earworm’ – the internet term for a song repeatedly playing unasked in your head. There were many times in my younger days when I stood with my hands placed inside a still-living animal, surgical gloves covered with a slippery sheen of fat, feeling hot, stressed, sweaty and miserable, with ‘Memories are made of this’ inexplicably blaring at full volume within my skull. After several of these long, stressful and strangely lonely experiences, I started to develop something of a 'thing' about bitch speys.

Much as I started to do with consultations that I might have to see the next morning, I started to check the ops board the day before my ops day. A board that featured a bitch spey larger that fifteen kilos, or older than a couple of years (and so likely to be fatter) would mean a restless and worried night’s sleep for me. I grew to loathe them. However, I decided that the best way to deal with my ‘thing’ was to confront it full on, and do as many as possible, rather than try to avoid them (which is what I desperately wanted to do). 

I sweated and swore my way through a lot of speys. They got easier, but I never stopped worrying. what if I get a bleeder? What will I do? How will I cope?

Eventually, of course, my worst nightmare – the one that had deprived me of so many hours of sleep worrying about it- came true. During the spey of a particularly chubby Doberman, one of my ligatures slipped off an ovarian stump, and the dog’s abdomen began to fill with blood. I panicked, and called for a colleague, who very calmly scrubbed in with me, helped me find the stump, made me ligate it again, smiled, and walked back out whilst I got on with the rest of the spey. 

This was a surgical epiphany for me, because I realised that all that worry and fear over what would happen if one of my stumps wasn’t ligated properly had been for nothing, because all that actually happened was that the operation took about ten minutes longer that it otherwise would have done. That’s all. Everyone, at some point in their career, has a bleeding stump from a bitch spey, and everyone goes through that same realisation – what was all the worry about? It didn't completely cure my nervousness of bitch speys, but it was the beginning of the end of it. It took a lot more bitch speys before I began to see them in my own mind in the way we describe them - routine - but I did get there eventually.

(Having written that personal odyssey through my earliest surgical steps, it occurs to me that the conclusion that may be drawn from it is that the best way to stop worrying about a surgical procedure is to immediately cause the worst complication that you can imagine on the basis that it will all get better from there. Please don't follow that advice, or crucially, if you do, please don't mention this blog to the Royal College of Veterinary Surgeons)

So, the months passed, and the stresses of surgery began to recede. Neutering, taking bloods, hitting veins, placing catheters (intravenous and urethral), placing ET-tubes and the scores of other practical things that I had lain awake at night wondering whether I would actually be able to do became easier an easier, as things do when you’re doing them all day, every day. All that worrying, for nothing. You see what I hadn’t realised is that, in veterinary medicine, as with every other aspect of life, it’s not generally the things you worry about that end up becoming a problem. 

It’s the things that jump out upon you unexpectedly, like a phone call at three in the morning, that really cause you trouble. Err... have fun with that out of hours work.

Right, well that's all the worries of today's Nottingham graduates (well done again!) eliminated, as well as, I suspect, the worries of all future veterinary graduates from here on in. A good day's blogging, I think. Now, to relax in the sun with a drink. Oh rats, I can't, I'm on call. Can anyone hear the phone ringing?