Thursday, 30 May 2013

Dog #86324

I recall a drunken conversation, years ago, in a student bar at Bristol University. It's a conversation I'll be dragged into frequently in the future, but this is the first time. A trainee biochemist has discovered that I'm learning to be a vet, and is now informing me at length how much money I'm going to earn.

'Licence to print money,' he slurs, looking at my shoulder, 'it's a licence to print fucking money!'

Not quite understanding why he's getting angry, I try to say that I'm not so sure, that I don't think vets earn any more than teachers, but he brushes this aside with a wave of his hand.

'You, mate,' he says, finally focusing on me, and pointing a finger at my face, 'are going to make a killing.' He pauses for a moment, then concedes generously, 'A small killing.'

* * * * *

Usually, when I'm calling in my next consultation, I say the animal's name; I think it sounds friendlier. Dog #86324 doesn't have a name, just a number, so this time I just call out 'dog warden?' and see if anyone reacts.

At the end of the waiting room, a young woman sitting with a small, thin Staffordshire bull terrier looks up. The terrier sees me and starts wagging its tail. The woman smiles sadly, and stands up. My heart sinks, because this dog doesn't look at all aggressive to me.

I turn back to my consulting room as the woman walks towards me, and I wonder how long this is going to take. There's been a bank holiday this week, which means I have a busy day ahead. Consultations are, of course, fully booked, with a number of extras squeezed in. Downstairs, a dog that I saw this morning may or may not be bleeding into its abdomen from a ruptured spleen; tests are pending. A very busy day.

Dog #86324 runs into my room, pulling on her lead, closely followed by the young woman, who closes the door behind her. I glance at the computer. Our consultations are colour coded: yellow for normal, blue for extra 'fit in', red for emergency. Dog #86324's consultation is dark grey. As I turn from my computer, the little dog jumps up at my legs, wagging her tail. I reach down to pat her, and she takes my whole hand into her mouth and sucks it, thoughtfully. I remove my hand and turn to the young woman, who is still trying to smile.

'Okay, what's the story with this little one?' I ask.

The young woman who works for the dog warden explains that Dog #86324 is a stray, brought in a few weeks ago. No owner has come forward. The dog warden in Plymouth normally has a no destruction policy, but Dog #86324 has apparently been tested twice with other dogs, and has been deemed 'very aggressive'.

'I didn't see the tests myself,' the young woman says, as the terrier runs back and forth between the two of us, 'but I'm told they were pretty bad.'

I look down at the dog and hope that this is true. Because of these tests, Dog #86324 has been deemed unrehomable. Local animal charities can't take her in; they're already full with unwanted dogs that aren't aggressive. National Staffy rescue charities are completely full, and they have been for years now.

The young woman places a form on the table. At the top is written Dog #86324's identification number, and her estimated age (no more than 18 months). Halfway down, there are a few notes on her behaviour. 'Care with other dogs!' one note says. 'Very mouthy.' I think of Dog #86324 sucking on my hand, and the fact that she walked obliviously past two other dogs in the waiting room on the way to see me. The young woman and I both agree its a terrible shame. I turn back to my computer, and print off a euthanasia consent form.

We discuss the options; not of what we're going to do, but of how we're going to do it. We decide that sedating Dog #86324 first may be the best option. Sedation takes a little longer, and sometimes makes the animal feel a little sick, but the terrier is a bouncy little dog, and might get distressed with too much manual restraint. We don't know, of course. We barely know anything about Dog #86324. That's not going to stop me, though.

I walk out into the prep room to draw up the sedation. It crosses my mind that I've been looking for another dog. Maybe if I took Dog #86324 home, she would get on with Katie, our laid-back greyhound. Maybe the tests weren't accurate. I think this while I'm drawing up the sedation, but I don't do anything about it, nor do I ask any of the nurses or support staff if they might be interested in another dog. We've all been asked the question before, and I know none of them are looking. Well, I think I know. It's a busy day. I don't want to bother people with difficult questions today.

Back in my consulting room, Dog #86324 is lying on her back, having her belly rubbed by the young woman who works for the dog warden. She jumps up, pleased to see me, and bounces over, taking my hand in her mouth again. Her teeth hurt a little, but not a lot. She doesn't mean it. It suddenly hits me, very hard and very raw, that in a few minutes this dog will be dead, and that I will have been the engine of its destruction. I want to run from the room, and hide downstairs, and get on with the business of saving lives, not taking them. I don't. There's a form on the table saying that I shouldn't. Instead, I ask the young woman to hold Dog #86324's head, while I inject the sedative in the scruff of her neck. The dog's tail stops wagging for a moment, and she looks at me almost reproachfully. Seconds later, my hand is in her mouth again, and the tail is back in action.

I ask the young woman if she'd like to leave Dog #86324 with us now. The woman shakes her head, clears her throat, and says that she would like to stay. She says she always stays. I want to hug her. While she lifts Dog #86324 onto the table, I head out to reception to pick up my own form that I printed off. On my way to the printer, I'm handed the blood results for my critical inpatient. He's definitely lost a lot of blood somewhere. I'm going to have to scan the chest and abdomen to find out where. If we're lucky, its the spleen, which can be safely (if messily) removed. I start thinking my way through a splenectomy. It's a nice distraction.

Back in the room, the young woman and I each sign our respective forms; hers to acknowledge she gives consent for the humane destruction of Dog #86324, and mine to acknowledge to the dog warden that I have indeed put her to sleep. My signing is a little premature - Dog #86324 still has a few minutes to live - but it gives us something to do while the sedative starts to work.

I find I can't stand to be in the room, making small talk whilst we wait. I step out, and begin to gather the materials I will need: some clippers, a swab soaked in surgical spirit, and ten millilitres of pentobarbitone solution. I tell Rachel that I'm going to need a hand with a PTS in a moment. She nods. She's seen the consultation on the list too. We all have.

I take a moment to run downstairs and check on my inpatient. His colour is much improved for going on a drip, and he's already quite a lot brighter. We have a little time. Hopefully the bleeding has stopped for the moment. While I'm looking at him, my mind wanders back to my consulting room, and the inevitability that I have allowed to grow in my mind over what I'm about to do. Just a few months ago, in a similar situation, I brought a cat home rather than put it to sleep. That's not going to happen today. I wonder if it's anything to do with the form from the dog warden. It occurs to me which way I would have probably reacted during the Milgram Experiments in the 50s.

It's been long enough. I head back up the stairs. Rachel is waiting for me outside my consulting room door. I force a smile onto my face as I open the door carrying the clippers, the spirit, and the pentobarbitone-loaded syringe.

Dog #86324 is flat out on my table now, her third eyelids halfway across her eyes. As I enter, I try not to notice that her tail starts thumping from side to side again, weakly. The young woman looks up at me and sighs.

'This is Rachel,' I say, comforting myself with my standard patter. 'She's just going to help me raise a vein on... er... her leg.' I falter a little because of the lack of name. Rachel lifts Dog #86324 onto her front, and extends a small, thin forelimb towards me. The young woman tickles dog #86324's ears, not watching what I'm doing. I clip a small patch of fur over the forearm, and Rachel twists her thumb around the crook of Dog #86324's elbow, raising her cephalic vein. Even with the sedative in her system, her vein is good. Of course it is. Dog #86324 is a healthy young dog.

I flex her wrist a couple of times, ostensibly to help raise the vein further, but there's really no need in this case. It's more of a ritual for me at this point. I take the needle cap off, rotate the bevel of the needle up so that the sharpest part will hit the skin first. I push the needle through the skin, and pull back on the syringe. A red flush in the blue liquid indicates that I've hit the vein first time, and there's at least some professional satisfaction to take as solace there. Rachel releases the pressure, and I begin to inject the pentobarbitone.

Within a few seconds, Dog #86324 is unconscious as the general anaesthetic enters her brain. I keep injecting. Dog #86324 gasps a number of times, and then her respiration, dulled by the overdose, stops. Her heart continues beating for a few more seconds but by the time I've taken the needle out of her leg, and placed the stethoscope on her chest, it's already over. The young woman from the dog warden has started crying, softly, as we lower Dog #86324's head. I look at the small, thin body on the table, and wonder why I have just taken one life, and am about to try and save another. I try and remember taking my oath on the day that I graduated, when I spoke the words 'it will be my constant endeavour to ensure the welfare of animals under my care'.

Blessedly, I don't have time to think any more. There are already more people waiting to be seen. Within minutes, the heroic young woman who works for the dog warden, who always puts herself through this even though she doesn't have to, has gone, and Dog #86324 is being placed into a thick black plastic bag. I am consulting again, and thinking about how to perform a splenectomy.

I feel bad, but I'll be okay. I'll tweet about it later. I might even write a blog about it, show that I'm upset, even though how I feel makes no difference now to Dog #86324, who is as dead as she would be if I didn't care at all.

My splenectomy is doing well. It strikes me that the drunken biochemist, years ago, was absolutely right.

Dog #86324. A small killing.


  1. Your patients are profoundly lucky to be in your care. I don't mean your clinical practice... Your hand being forced, you still care.

    That's astounding.

    Thank you.

  2. I'm pretty sure that someone "doing it for the money" wouldn't have the same empathy, care, and concern that you do. That person wouldn't be touched by the many lives (big, small, human and otherwise) that cross its path.

    You regularly show us that you are a veterinarian because you care about animals and their people, even when those people might make mistakes, even when its not the animal's fault, or even their human's.

    You are a good vet and a credit to the human race.

  3. I work in a veterinary emergency and specialty facility in the US. I work overnight in the ER/CCU. What you have written here is exactly the way we have to look at our jobs in order to survive. If we don't survive the cases like Dog #86324, we do not have the capacity to save the splenectomy, the hit by car, the abuse case that we are concurrently wrestling with. And if we do not have the capacity to do it, no one does, because no one else can, and will, endure the daily heartbreak and stress of making decisions such as these.

    Stay strong, for the very reasons you took your oaths.

    1. Thank you, Brenna - to hear this from a veterinary professional means more to me than you can know. Thank you.

  4. Thank you all for your comments. They mean quite a lot to me at the moment, and I appreciate you taking the time to read the blog and comment on it. I just put my feelings down, honestly, so it means a lot that you have responded as you have. This has been my most personal blog (along with the blog called 'Mistakes') and I'm gratified by the (for me) overwhelming response to it.
    Thank you all. I will try harder next time.

  5. Wow, Nick, what a powerful story. As a fellow veterinarian I've been right there in the same situation. You've done a great job of capturing the competing emotions and responsibilities involved. Thanks for sharing with us.

  6. Jessica Berlyn23 July 2013 at 21:50

    Hey Nick, I'm a vet student from South Africa. Thanks for your blog. I'm just beginning to (attempt to...) learn how to rationalise euthanasing perfectly healthy animals because their beautiful existence is an "inconvenience" or a "liability" to some clients. One of the worst situations for me, so far, is when a family brings two dogs to the consult room - their ancient companion of 15 years, recumbent who having lost all sensation to his front legs has self-traumatised so that bare skin remains, and a bouncy new puppy. Of course one gets the blue juice and a lonely stairway to heaven in the back room, and the other gets a 5-in-1 vaccination.

  7. There are some strange paradoxes in our job, for sure, Jessica. I remember I few months ago I was discussing a cat's diet with a client - it was on a rabbit and chicken diet.
    My next two consults after that were a pet rabbit and a pet chicken.
    Best of luck with your career!

  8. Being a vet, or a doctor, must at times seem a very lonely experience. Be glad you aren't going home to a house share full of drunk biochemists, but to a loving wife who understands if you want to talk about your day.

  9. You linked this blog to a discussion in Not One More Vet. I just read it and am holding back tears, unsuccessfully. I have always wondered, too, if I would have killed puppies because someone in a white coat told me to (your reference to the Milgram experiments). I'd like to say no, but I'm not so sure. I am a rule follower. I'd like to say I question authority, but there I was, as a new vet, twisting tails off puppies for some ridiculous breed standard. "They don't feel it", my mentor told me. I remember thinking to myself, "so it's just a coincidence that they scream at the exact time I cut their tails off?" But I still did it, and other things I didn't think were right. Even 25 years later I have trouble saying, "no" to my boss. Luckily, the place I work doesn't cut ears or tails or "declaw" cats. I know as much about pain management as I can, and I do everything possible to manage pain in my patients. I believe in Fear Free techniques, and use them. I even found a job where I don't have to euthanize! Even though I had the luxury 99% of the time to only euthanize animals when I agreed it was best for them, it still deeply affected me. I would always get home exhausted and then realize it was because I put a pet "to sleep" that day. Thank you for sharing your experience.