Doctor of what?

Consulting is an art, not a science. No matter how well you know your medicine (and I am certainly not claiming any special expertise in that department), a consultation can often be spun in an unexpected direction by what we shall charitably call 'the human factor'.

Yesterday afternoon, I opened up the medical file of my next consultation - a booster vaccination for a cat. Something about the surname rang a bell, but I hadn't seen this cat before, and the client didn't seem to own any other animals. Something still nagged at me, however, so I clicked another button in the top right-hand corner of the screen. The button is marked 'Show deceased'.

Three more animals appeared under the clients name, all cats. The names all sounded familiar. Sure enough, I had seen all of them. Not only had I seen all of them, it was me that had been with them for their final consultation. I had put all of the owner's previous cats to sleep. The most recent had been several years ago, and try as I might I was saddened to find that I couldn't bring any of the cases to mind, or the client. Nevertheless, I was glad I had checked; I didn't remember the client, but it was a fair bet that they would remember me, having euthanised three of their previous pets. Now, at least, I could show a little tact, caring and diplomacy in the consulting room, even though I was just vaccinating their last remaining pet.

I stepped out into the waiting room, and quickly located a tall man sitting with his daughter, a cat box on his knee. I smiled at him, and with a quiet, respectful demeanor I called his cat's name.

The man looked up, smiled, and nudged his daughter in the ribs. 'Oh hello!' he called, cheerfully. 'It's Doctor Death!' He stood up and cheerfully walked towards me, while his daughter and I competed on which of us would rather a hole opened up in the ground and swallowed us up.

The man continued his own brand of peculiar gallows humour all the way through the consultation. 'Careful, Misty,' he said as I plucked the black and white cat from it's box. 'He should have a scythe, not a stethoscope!' I smiled politely while his daughter rolled her eyes and folded her arms, staring at the floor.

'Yes,' I said, trying to lighten the mood as I drew up my vaccination. 'It's a happier occasion, today, isn't it?'

'I'll say!' said the man. 'At least we won't need a coffin at the end of it!' I felt like saying that if he kept this up, then I couldn't promise anything, but I remained as ever, calm and professional. Still, it was a surprise that I had no memory of this man. If he was like this during a vaccination, God knew what he was like during an actual euthanasia.

'All done,' I said, putting his surviving cat back in it's box and closing the door behind it. 'There,' I said, smiling at the man, 'All of us made it through in one piece!' The man smiled and winked at me. His surprising attitude was growing on me. There was no malice at all in him. Why not be cheerful? The cats weren't suffering, and I had done a professional job. Doesn't joking about a dark subject make it something less to fear? Maybe we could all learn something from his attitude. I was starting to decide that perhaps I rather liked him.

I opened the door and let the man, his embarrassed daughter and his still-alive cat out to reception, where upon he announced loudly to the packed waiting room, 'This is the first time one of my pets has seen that vet and come out alive!'

I shut the door, and decided that maybe the best thing would be if a hole opened up in the ground and swallowed him instead.

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. 

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.

Visiting Hours

Boil a vet's job down into it's very basic components and you're left with three parts; the elementary particles of veterinary life, if you like (incidentally, please don't boil a vet down into their basic components; you'll just end up with a nasty-smelling soup and an unhappy vet). These three fundamentals of the job are 'consults', 'ops' and 'visits'. I've talked about consulting and operating a few times before (here and here, for instance) but it's the last of the three that I'm going to talk about today. The dreaded visits.

(While I think about it, you could argue that there is a mysterious fourth particle, the OOH particle, representing out of hours (emergency) work - but I would suggest that instead all OOH is merely a dark mirror of the basic work; the veterinary equivalent of anti-matter - for every consult, there is an OOH consult. I'm getting a bit carried away with metaphor, aren't I? Must be the coffee).

So, visits are the part of the job where you leave the practice and visit your patient at their home. So...dreaded? Why dreaded? Why when a visit pops up on the board does that procedure you've been trying to avoid all day suddenly look a lot more attractive? (A visit? Oh, I'd love to, but, erm... well, I've got that constipated cat that I really need to clean out. Shame.)

Well, as with anything in life, there's pros and cons to visits. Let's do the cons first - I'm that type of person, you see.

(And I should point out at this stage that this blog is written from the perspective of a small animal vet; it can't help but be, because that's what I am. I'll just mention here that for a large animal vet (or the increasingly endangered 'mixed' vet) much of this doesn't apply, as their whole job consists of travelling from visit to visit, with brief trips back to the practice to scrape the worst of the cow shit off. Their visits are a little different though, as they are often to people that they already know and have visited many times before, and are often combined with some kind of surgical procedure (usually on the patient) and

First up - finding the place. People live in the craziest places - on top of hills, beside rivers, squeezed into the tiniest possible gaps on housing estates. Couple this with many people's complete inability to give directions to their own home, and you have a problem before you've even pressed the doorbell (I don't exclude myself from this group - never ask me directions to my house. I seem to notice landmarks that mean nothing to normal people. 'Go left after the tree that looks a bit like a pirate, and you'll come to a scary wood that would be a great setting for a ghost story...')

This isn't so bad if you're just heading out to clip a puppy's claws, but I have uncovered a hitherto unknown physical law, which states that the later the hour and the more urgent the call, the harder the clients house will be to find. Writing this, I can think of many stressful middle-of-the-night calls attempting to drive with an A-Z on my lap, swearing at the car, the map, my legs and life in general. Of course, now everybody has SatNavs, so complaining about this makes me sound as bad as someone moaning that there has been no good music made since 1994 (but seriously, have you heard what they're listening to nowadays?), but SatNavs are neither infallible nor particularly good at calming you down when you're stressed, so the problem still periodically raises it's head.

Secondly, people. I suspect that it won't be news to my readers if I suggest that people, although many of them can be caring, compassionate, big-hearted, generous, grateful and charitable, are, more often than not, just plain weird; and if they're weird when they're in the bank or doing their shopping, then that weirdness is likely to dramatically increase when they are safely back in their houses, away from the judging eyes of the rest of humanity (and if, incidentally, you don't understand what I'm getting at, then I'm afraid there's a fair chance that you're one of the people I'm talking about).

Partly this is a problem because you're out of your comfort zone on a visit, away from your safe consulting room where you know where the thermometer and hand wash is, and in a place where you don't know what the sticky patch on the floor is, or what that peculiar smell is, or just who that person is at the back who isn't saying anything, but just staring it you wearing only a towel. If I say that the village closest to my first practice had 'twinned with Royston Vasey' scrawled across it's welcoming road sign in black spray paint, you may understand why I've become slightly nervous of visits.

As well a people who are a little...well, different, there's people who are just plain unpleasant. I've been personally threatened with violence a couple of times on visits. Both times I had been called out to put an animal to sleep, and arrived to discover that some members of the family disagreed with that decision. Sadly, in both cases it was the members of the family with the largest fists and the shortest tempers.

That last point touches upon another problem with visits; what you're actually going out there to do. In most situations, people will bring their animals in to the practice, and visits usually only happen when people are housebound with no way of getting in to see us, or if the pet is of such a personality that it gets in far too much of a panic when it gets brought in - this often means that the animals we're off out to see are more skittish and possibly more aggressive than those we normally see in the practice, and we're going to see them with less manpower (usually just one vet, or one vet and a nurse), and we're invading their home territory to boot. Not really a recipe for fun.

The other situation you'll visit an animal at home, of course, is when it is the last visit they will ever receive. Some people choose to have their animals put to sleep at home, in familiar surroundings, so that they don't go through the stress of being taken in to the practice. Who can argue with that? It's what I'll do for my animals, too - but it does mean that a high proportion of home visits are euthanasia visits. The lack of manpower can cause a few problems here, too. I well remember a time, a few years into my career, when I visited an elderly woman who lived in a large house in a seaside village to put her great dane to sleep. It was a Sunday afternoon, and that meant that it was just me, no nurses. The procedure went smoothly (the poor dog was very, very ill) but then we were faced with something of a problem - although I am, of course, incredibly manly and strong, I couldn't lift an eighty kilogram dog by myself. The old woman was almost bent in two with back problems, but she didn't seem worried.

'Just a second,' she said, brightly. She opened the front door and hobbled out to a man who was passing by. 'Excuse me,' she said. 'Could we just have a hand lifting something?' The kind stranger agreed, and it was only when he walked into the living room that he realised exactly' what the 'something' was. Poor guy. He took it in his stride, though, only looking aghast for a few seconds before he helped me carry the dog. I often wonder what he told his family and friends about that day.

It was while I was working at the same practice when I received a call from a man asking me to visit him to put his canary to sleep. It was, of course, a Sunday afternoon again, and I was extremely busy, so I asked if there was any way he might be able to bring it in to the practice.

'I can't get near it,' he said, sounding nervous.

'Er...right. Is it somewhere you can't get to?' I asked, thinking it might have flown up into his loft or something.

'No, no, it's outside the front door, tied up, but he won't let me get past him. I can't even get to the car!'

The mental image of a massive bird, all wide-staring eyes and saliva-dripping from its beak viciously pecking anyone who dared to step near it confused me enough that it took me several minutes to understand that the man was actually talking about a presa canary - an enormous mastiff-type dog several rungs higher than the Hound of the Baskervilles on the 'violent bastard' ladder, and about as far from a gentle yellow bird as it is possible to get without watching a horror film. It turned out he'd bought it from his mate down the pub, and now it wouldn't let him leave the house. In the end we had to enlist the services of a vet with a blowgun, who darted it into unconsciousness so that the deed could be done.

I can also sadly remember the many times I have visited people to put their pets to sleep, and taken them back to the practice with me. There's something awful about taking someone's companion away with you, and leaving them alone in the house. I do always ask if someone is coming round to keep them company after I've gone, but the answer isn't always yes.

So, there's a lot of cons about home visits - but there's a few pros, too. It gets you out of the mania of the practice for a little while, and it's always nice to have a breather. Secondly, and principally, it gives you a chance to be nosey - the same kind of nosey as peeking into people's living rooms as you pass them by (I swear that's half the reason my wife rides horses; she gets a much better view from higher up, you see). I think this interest stems from the nagging feeling a lot of us have that we are the weird ones mentioned above; that there's something not quite normal about our own households, and other people do it differently. Well, we're right. After an extensive study of other households over the years, I can reassure you all that you're right; everyone is a bit strange, and weird is actually the normal state of affairs. It's the normal ones you've got to watch out for.

Well, that covers most things I wanted to say on the topic. In conclusion, I'd just like to add... sorry, just getting a message from the practice... what was that? A visit to do? Clip a canary's claws? Er... well, I'd love to, but I've got some impacted anal glands that really can't wait any longer...

The Youth in Asia - part three mark 2. Once more, with feeling!

Okay, here's the thing.

Kerry and I went out for a nice evening's gaming with a a friend last night, and also checked over his jack russell, Max. I've known Max for years. Lovely little dog, he sits under my legs when I'm playing games, and I absently tickle his ear when I'm rolling dice (Yes, yes, I know I'm a nerd! I'm fine with it, so there)

Anyway, Max has been ill for a while, and last night was also a 'check up'. It had been on the cards that he might be needing to be put to sleep, by friend had phoned me last night and told me that Max was doing much better, so Kerry and I took some wine, a nice board game, and looked forward to an evening's gaming.

When we got there, we checked Max over, and sadly, he was much worse. He needed to be put to sleep. And so that's what we did.

Then I came home and wrote the blog below. I was in a funny frame of mind - mentally, I'd been set up for relaxing, fun, gaming, and then suddenly had to shift the gears round in my head and turn into caring vet mode. I was sad, and upset that I'd in some way betrayed Max - all those times I'd been tickling his ear, or his belly, then one night I came round and killed him. Unfortunately, this seemed to warp my fragile little mind, and I'm sorry to say that the blog post that came out of it wasn't very good at all. I deleted it after I'd written it, for a number of reasons.

Firstly, it was intended to be an exploration of how performing euthanasia affects the person performing it. I wanted to explore the idea of what it might mean for human euthanasia, and how doctors may cope with it. Instead, it turned into a self-pitying 'poor me' polemic on how I don't like putting animals to sleep - fair enough, you might say, but it wasn't really what I was trying to say.

Secondly, it didn't feel very respectful to Max to be whinging about how unhappy -I- was.

Thirdly, I'm a bit of a drama queen. Anyone who follows me on twitter or facebook may be familiar with the intermittent angst-ridden 'waah! this happened' type of post that I like to squeeze in between puns just to throw everyone off track. What can I say? I wear my heart on my sleeve. If I'm miserable, I want everyone in the world to know! Thanks to the magic of the Internet, that is now possible. Ahh, technology :) This behaviour is not something I'm proud of, but it's part of me and there it is.

Fourthly, it made me sounds like a suicidal nut-job. This is not the case, honestly! I was just having a 'black dog' moment, if you'll pardon the pun (there I go again!)

So, I've decided this morning to reinstate the blog, in a slightly more rational, and hopefully light-hearted, frame of mind. I've chosen to do this for several reasons...

(Oh for God's sake! Get on with it!)

Firstly - well, the blog was at least partially successful in that it gives you an insight into the mind who has just put a well-loved dog to sleep. Well, my mind, anyway. Morbid chap that I am, I always find it slightly awkward meeting a friend's pet, because there's a little voice inside me that wonders if I will ultimately be the person who puts them to sleep. Yes, I'm a lot of fun at parties.

Secondly, I thought it might help to comment on some of the things I said in it. I'll add in some further thoughts in italics as we go - the great benefit of arguing with a past self is that they can't answer back. Take that, Nick from last night! Ha ha!

Thirdly, did I mention that I'm a bit of a drama queen? The blog from last night, poorly written and rambling though I feel it was, does reflect a piece of my personality that is, in it's own way, just as valid as the normal, handsome, well-adjusted fella that I am this this morning.

As you read the blog, especially the self-indulgent 'pity me!' parts of it, bear in mind that the guy below has got a pretty good life - a nice house, a lovely wife, great friends. How many people in this world have as much as him? Don't feel too sorry for him, he thrives on that sort of nonsense. Anyway, on with the show!

It's a hell of a thing, killing a man. Take away all he's got, and all he's gonna have. - Will Munny, Unforgiven

I'm not a cowboy. I've never held a gun, and I haven't really got the swaggering gait required. We do seem to have collected a number of horses here, but neither my wife nor myself use them to round up cattle, or escape from Red Indians (or Native Americans if you prefer...calling them that doesn't change what we did to them though...). I have never been part of a posse. But there's a part of my life that resonates with the gravelly-voiced Clint quote above. I've never taken the life of another human being, but by any definition, I am a killer.

This is a selfish post. It's selfish because it's about me - or, at least, about vets. I've talked about the act of putting an animal to sleep several times in this blog, but tonight I'm not thinking about them, for a change. I say for a change because during the process itself, it's all about them. The animal comes first, and rightly so. I feel guilty even writing this, because I am aware that I am alive, and all those many that I have seen, have killed, no longer have a voice for anything.

The more perceptive amongst you may have realised by now that this one isn't going to have many jokes in it. Sorry about that. Scroll down a few, I'm sure you'll find one. If you've all tuned out by now and I'm just talking to myself, well that's just fine too.

Most of these blogs are precipitated by an event in real life. Tonight, my wife and I went round to my friends house to play a board game, and check over his poorly dog, Max. Instead of playing the game, I put Max to sleep.

So tonight, I want to consider the effect this has upon me, upon the vet. Upon the instrument of the animal's destruction. I'm aware that to some of you - those of you who, mistakenly in my opinion, believe that humanity is something special, something quite apart from the rest of the natural world - may feel I am being melodramatic. They're only animals. All I can tell you is that this is how it makes me feel, and that, to me, the difference between humans and animals is not as great as is commonly regarded.

Except, young Nick from last night, it's not quite as simple as that, is it? I stand by my assertion that humans are animals, but, much as it pains me to admit it, a human leaves a much bigger hole behind them than an animal. This is probably because we're humans (well, most of us). What I'm trying to say is - human euthanasia, though I wholeheartedly agree with the idea in principle, would be much...well, messier, than animal. No-one's ever going to conspire to murder a dog in order to gain their inheritance, for instance. Humans leave a lot more clutter behind from their lives, which would makes things much more complicated that I suggest above.

Still, personally, and as an aside, I would be happier having the occasional person bumped off deliberately before their time than the current situation, where every single one of us is dragged on and on until our bodies litter ally stop working. Ugh. Anyway...

Early on in our career, vets learn (much as in many other professions with unpleasant tasks, I suspect) to suppress it, not to think about it, to joke about it, and to reassure ourselves that we are doing the right thing, that we are relieving suffering. Most of the time we are. Some of the time we aren't. We do it regardless, because we know the alternatives are not good.

Here is how the act of killing another animal makes me feel - a little sad. That's it. If it made me feel any worse, I wouldn't be able to function on a day to day basis. So, I feel sad, and usually professionally proud that it went well, that no more suffering was caused than was necessary.

At least, that's how it makes me feel most of the time. In my darker moments - moments like now, for instance, it makes me feel...well, it's a hell of a thing, to kill an animal. Taking away all those moments, for ever. In my very dark moments my mind conjures up a special hell for people who killed, who are confronted with all the lives that they have taken, and all the person can say is that they were doing their job, that they were relieving suffering. It's crazy, I know, because I'm pretty sure that there is nothing after death just as there was nothing before birth. Pretty sure. I think of the times when I haven't been entirely sure of the decision, and I have allowed the owner to influence the outcome. I think about the times when I knew it was the wrong thing, and I did it anyway, because there was 'no choice'. (Here I'm skirting around the issue that I sometimes do it because it is the easiest, and not the right, thing to do.) I think about the times when it was the right thing.

This may sound like I don't believe in euthanasia, but that's not true. I passionately believe that quantity of life is nothing if there is no quality. What is the point of continued existence, if all of that existence is pain? My wife once was peripherally involved with the case of a dog, rushed into emergency surgery, that was found to have a bleeding inoperable tumour on its liver. The vet in charge informed the owner, and sadly recommended euthanasia. The owner absolutely refused, and made the vet stitch the dog back up. He came and collected his dog, and took it home. It died overnight. That single case tells you all I rationally believe about the continuation of life. It is a concern to me that most of the patients I treat will have better deaths than my own.

No, this post is nothing more than a single, selfish lament. A long drawn out 'why me?', railing against the choices which have lead me to be the one responsible for the deaths of so many. I want to say that it isn't good for the soul, but I don't believe that such a thing exists so I'm stuck with simply saying that it doesn't feel good.

I'm running out of steam, (I think I mean 'wine' - I certainly found an empty bottle next to the laptop when I came down this morning!) and I think I'm glad for it. Other concepts flit through my mind - the idea of death as simply a loss of time. The process of dying. The culpability of the killer. But I find myself unwilling or unable to explore them as I thought I would.

I'm not sure I'll even publish this post - it seems very out of my normal writing style. Perhaps I'll re-read it in the morning. If I do, and if you're reading it, then rest assured, normal service will be restored soon.

I -did- mention that I was a drama queen, didn't I?

In the meantime, I can think of no better way to end this morose rambling than with the save words of Mr Eastwood, who says more with six words than I can manage with this whole blog. After the opening quote, his sidekick, the Schofield kid says 'Yeah, well, I guess they had it coming.

Clint looks into the middle distance.

We've all got it coming, kid.

The Youth in Asia Pt 2 - Christmas Clearout

The dust from the house move is slowly settling (like nuclear fallout, only slightly worse for my health), Christmas is fading away into the ether and the New Year looms menacingly in the darkness ahead, like a drunken thug with a sock full of stones.

All of which cheery preamble means that my life is starting to approach something of a routine once more, and the quiet but insistent voice that's been whispering in the back of my brain that I promised I'd do a blog in December has started shouting and poking me in the backs of my eyes as January approaches. So here it is! My Christmas blog, only slightly late.

I love Christmas. I'm aware that it's pretty much a made-up holiday, having very little to do with the birth of anyone any more, a holiday that was pinched off the Romans by the Christians (and almost cetainly stolen off someone else by the Romans before that) - fine by me! I have less religious conviction that Richard Dawkins.

I am also not blind to the fact that it is a tacky, tawdry, consumerist behemoth of a holdiay, all-consuming, all-devouring. But, it's so ubiquitous, that if you try and fight against it you'll go insane. Christmas is, and always has been (whatever it's been called down the centuries) a celebration that we've made it this far through life, and basically a party to cheer ourselves up that we've still got a very long winter left ahead of us.

And it works. Christmas is a bright spot in the dead of winter, a time for family and friends to get together, and forget about our otherwise boring lives. Yay for Christmas!

However...I hate being a vet at Christmas, and not because I usually have to be on duty for some of it - at least people tend to feel a little guilty if they call you in on Christmas Day, and you get less of the 'My cat can't sleep'-type call in the small hours of the night.

No, the reason I hate my particular job at Christmas is the phenomenon of the 'Christmas Clearout'. Christmas may be a time for family, friends and fun, but for various reasons it also seems to be a time when people finally decide to bump off their animals.

In the week leading up the Christmas (a three-day week), I personally performed seven euthanasias. Three of them were in a row, all lined up in reception waiting for me to call them in for their last ever appointment. As to why this happens around the festive season - well, I think it's a time when people stop and reassess their lives. The family is coming round, and suddenly that old doddery cat looks - well, very old, and very doddery. Suddenly that incontinent dog doesn't seem very easy to deal with. Suddenly the fact that your German Shepherd has nipped a few people in it's time looks a lot more worrying when the grandchildren are coming round.

Finances play into it too, of course. It's okay to keep the arthritis tablets going until you have to buy a Wii for the kids, and that thyroid operation looks a hell of a lot more expensive with the presents piled up under the tree.

Frustratingly, another reason - almost unbelievable to me now but sadly I see it every year - is to make room for the new pet that is being bought for someone as a present. Seriously - it's not big, it's not clever, and it's definitely not funny - please don't buy a pet, particularily and especially a puppy, as a present. I'm sure I don't need to tell you this, but it still happens every year.

This year has been especially bad because the practice has had several 'out of the blue' cases - nothing to do with Christmas, cases which suddenly get ill with no warning, but which turn out to have extremly serious problems such as liver cancer or kidney failure, and so need to be euthanased with little or no warning. These sad cases happen all year round, of course, but seem particularily poignant and sad just before the holidays, especially on top of the marked increase in euthanasia in general.

My thoughts at this time of year always turn towards the act of killing itself, and the effect it has upon me. I'm the kind of person who will always catch a spider and set it free rather than squash it - moving into this new house we found ourselves infested with flies, and the fact that I still feel guilty several weeks after the fact for losing my temper and swatting three or four of them in the middle of the night tells you something about my temperament. Nothing to do with high moral standards, of course, and everything to do with cowardice. I hate to feel responsible for the cutting off of another life.

Which might lead you to suspect that I have picked the wrong career. It certainly crossed my mind on Christmas Eve as I was injecting the third cat in a row with barbiturates, and watched it take its very last breath ever. It was made especially hard by an owner distressed almost to the point of hysteria in this last case, something I found rather annoying as once more I knew the cat could have been stabilised and had a normal life for several more years with tablets or a simple operation. Both of these had been refused by the owner who 'didn't want her to go through anything', as if taking a tablet a day was the equivalent of being subjected to what George Bush might politely call 'intensive interrogation'.

As the woman retched and cried and gurgled, heading for my sink, I tried to find it in my heart to feel some sympathy for her, but hten a looked at her dead cat and thought of what she had just made me do to make her Christmas a little easier. During the procedure, all I care about is the animal, making sure everything goes smoothly, and that there is as little fear and distress as possible. Afterwards, though, I wonder about myself, and what kind of effect this constant execution has on me.

You remain detached, of course, because you have to, but I find that as I get older, starting to worry about the loss of those dear to me, both humans and animals, it becomes harder to immunise yourself to it.

The actual process of killing has a demystifying effect upon death to those who deal it out daily - there is nothing taboo about it, nothing strange. It happens easily, sometimes quickly, sometimes slowly, but it is an inevitable, irrevocable end for us all. There is no 'special time', no warning, no clues that your story is about to come to an end. It just happens, without reason or purpose, just like your iPod fails to switch on one day or your car won't start in the morning. Life is fleeting, precious, and not at all sacred.

Okay, I'm laying it on a little thick here - It's not like I've just spent Christmas on the Somme. And I am far from the first person in the world to understand that death is no respecter of...well, of anything. But, as I sit here and reflect on the role of a vet during the Christmas holidays, knowing that there will be, more than likely, a large pile of black bags waiting in our freezer when I return to work tomorrow, it makes me wonder, just for a moment, what the suicide rates of doctors would be if human euthanasia were legal.

And, on that bombshell, I draw a close to my blogs for 2009. See you all in the new year with more cheerful news from the front line!

Eat, drink, and be merry, for tomorrow we go back to work :)

The Youth in Asia - part one

There I was, writing my last blog about drug reps - bit dull, wasn't it? I even bored myself, writing it. But a small part of it stuck with me.

It was the bit where I mentioned that people often say to me 'It must be the worst part of your job, putting things to sleep' - I followed this with a facetious comment about how seeing drug reps was really the worst part of my job.

That's a lie, of course. Never let the facts get in the way of a good blog, I say! (Or a crappy blog, in the case of my last entry). In fact, that isn't really the case.

I genuinely used to feel this. When people hear you're a vet, the first thing they tend to say (well, second thing - the first is 'Oh yeah, had your hand up a cow's arse, recently?' Look, if that's your first response, I would respectfully suggest that it's you that have got the bovine anus fetish, not me, okay? I just do it for a living, all right? Not for fun) is 'Oh, I couldn't do that. I couldn't put things to sleep.' And I used to think they were wrong. I used to feel that it wasn't that bad. Why? Because I was relieving suffering. Because there was nothing but misery left for the animal, and because it was probably the kindest thing I would do for that animal.

Now, ten years down the line, I'm not so sure. Not that I was wrong about it being kind, I still think that's true. In fact, I believe it's the greatest gift I have, to ease an animal's final moments. But nothing is ever quite as simple as it first appears, is it?

There are a number of problems associated with the act of killing. The first is this - the inappropriate euthanasia.

The most obvious case of this is - the healthy animal. The animal that would otherwise get better, but because the owner can't pay/won't pay/doesn't want the animal 'to suffer', they make you put their pet to sleep anyway.

The most blatant example of this that comes to mind is a cat that I saw with a fractured hip. The hip really needed an operation to heal properly. The owner couldn't afford the operation. I suggested that the owner telephone the RSPCA and the PDSA, two organisations that will readily help with financial problems. The owner didn't want to do this. Not having hearts entirely made of stone, we then offered to treat the cat at a cut price. The owner still couldn't afford to it.

Getting a sinking feeling of where this was going, I next offered to treat the cat for free. No. The owner didn't want the cat to go for surgery - it would be 'too much for it'. Okay. Deep breath. Y'know what, even without surgery, the cat would probably walk again. He would need 6 weeks rest in a cage, but he would be able to get back to a relatively normal life afterwards.

No. The owner didn't want the cat to 'go through' 6 weeks of cage rest. It wouldn't be fair. (This was, I may have neglected to mention, a two year old cat. It had, in all probability, ten to fourteen years of life left to it. Maybe it might have been prepared to spend 6 weeks in a cage.)

Would they consider rehoming the cat? No. It 'wouldn't be fair' on the cat. What they wanted was to have their cat put to sleep.

It was me that ended up doing it. I ended up with it because my colleague was hoping against hope that having someone else suggest to them they were doing the wrong thing might change their mind. It didn't. They were adamant. The owners, a young couple with two children, came in to speak to me one final time. Towards the end of the consultation I gave up any pretense of being polite and asked them if they wanted me to 'kill their cat.' They said that they did. I said that I would, hoping, secretly, and very illegally, that I would just be able to rehome the cat. They wanted to stay with it whilst I put the cat to sleep. So, my next plan was that I would sedate the cat whilst they were there, revive it and rehome it when it awoke. The owners wanted to take the cat home and bury it.

So, I did it. I killed a cat with a broken bone that would have healed in three weeks with surgery, and six weeks without. After I listened to the cat's heart beat its last with my stethoscope, the lady's daughter started crying over the dead body. The lady asked me 'Do you think we did the right thing?'

I could not speak, and I left the room.

The memory of that moment is with me strongly now as I write these words. I was the instrument of that cat's destruction. What good would it have done me to refuse? Vets have been struck off by the Royal College for refusing to perform euthanasia. I had no power to seize the cat - this would have been technically theft, and I could have gone to prison.

So I killed the cat.

I'm sure many vets have similar stories to this. Obviously hyperthyroid cats that the owner doesn't want to 'go through' being given tablets. Arthritic dogs that, instead of being given painkillers, the owner would rather that they 'didn't suffer'. Problem behaviour dogs that the owner has never given a thought to dog training, and that they are now scared of.

It always surprises me that people are arrogant enough to assume that they look after their pet so well, that rehoming can not be thought of even for a second - no one else could possibly look after this pet at all! Death is preferable than life without me!

Well, ask yourself - who are telling this lie to? And who is really going to come out worse because of it?

Okay, that's the first problem with euthanasia, and I have many more things to say on this subject. Part two in a few weeks. Stay happy!