Don't You Even Care?

New blog post - makes a change from me pushing my book on you all, eh? (which you can buy here for £1.99 by the way. Ahem.https://www.amazon.co.uk/Once-Bitten-adventure…/…/B01FIK4KV6






Over at the Vet Times, I have written a blog about emotional blackmail.






http://www.vettimes.co.uk/dont-you-even-care/

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.

Geri

This one is different. It is not a well-thought out blog post, with a coherent argument to make (so, in that respect, it's just like all my other posts). It's a lament for a friend. I'm not writing it for any reason that I need to write about it, so please indulge me, nod and smile. Feel free to back away if I get a little crazy.

Geri died today. It's strange to write it. I've known it has been coming for so long, and I have been on the other side of the table so many, many times, that you'd think I would understand it. But I don't. The sentence at the start of this paragraph makes no sense to me. But still, Geri died today.

It seems to be a cruel trick of the human brain that, on some level, we simply don't get death. We are aware that it happens - we can even take in the knowledge that it will, sort of probably, happen to us some day. But still, we don't get it. It doesn't make any sense. That personality that was such a vivid part of our lives, that was always there - it can't just be gone, can it? I mean, sure, we know they're dead, but... y'know... where are they? It doesn't make sense.

As I write this, it's raining outside. We buried Geri in the orchard. There's a part of my brain that is screaming at me that I've left Geri outside, alone, and it's cold, and she'll be scared. It's very, very hard to silence that part of my brain. This is what I mean. We just don't seem able to process it on some fundamental level. Maybe that's what grieving is. Geri is dead.

How can death have visited our happy little family? Its got no right. Sure, I've killed hundreds, thousands of animals myself. But Geri? It doesn't make any sense.

Geri was found as a stray in Exeter in 1997, and taken to the local RSPCA kennels. Being her naturally charming self (read: tart) she was quickly rescued and rehomed to a family in Totnes. Being far, far too clever for her own good, she quickly established dominance of the household and enjoyed a rule-free life of doggy leisure and luxury matched only by the Emperor Trajan's toy poodle in the first century AD. Her debauched lifestyle led to her being speyed at her local vets a year later, after a brief but eventful dalliance with the dog that lived upstairs. Though neither of them knew it at the time, this is where Geri met one of her future owners - a fresh-faced young vet student by the name of Kerry.

Fast forward a year, and Geri's career as Imperator of Totnes was, unbeknownst to her, drawing to  a close. Her owners, growing tired of Geri's habits of rolling in badger poo, jumping up to lick small children's faces no matter how muddy her paws were, and stealing other dog's property (they had to carry money on their walks to pay anyone whose tennis balls Geri took a fancy to, because once she grabbed it she developed acute selective deafness and galloped home to add it to her growing pile) had deemed her 'unhandleable', and were looking for an unsuspecting home upon which to land this dog with ideas above her station.

Which is where I enter the story. I graduated as a vet in 1999, and as it happened, I had just moved in to my unsuspecting practice home in Bridgwater (yes, I spelled it right; don't ask me why there's no 'e') and, having just taken on possession of the feline equivalent of Hannibal Lecter (you'll get your own blog one day, Vienna, I promise!) I had foolishly voiced the notion that I might one day 'quite like to have a dog too').

One chance encounter with Kerry and Geri's owners in Totnes later, and I soon found a brown and white lurcher being pointedly offered in my direction, complete with cow eyes, a sob story, and a heavilly edited history that skimped over Geri's more megalomaniac traits.

So, Geri moved in with me in the latter months of the second millenium (and don't go on about it not starting until 2001 - it starts whenever we said it does, okay?) and... was wonderful. 

It was a shock to both of us, at first. I didn't really feel ready for a dog, and Geri certainly wasn't pleased about the hassle of having a new subject to have to break in. Unfortunately for her, I was fresh from my animal training classes, and was keen to put the theory into practice. It was a titanic battle of wits. It quickly became apparent that Geri had more wits than I did, but fortunately, I had back up - Kerry, my then girlfriend, was still having her animal training lectures. Between us, we finally managed to iron out the most anti-social of Geri's numerous traits - at least when we were watching.

Geri was also horrified that she had to share her new house with another canid - Kerry's wonderful, but not necessarily bright, greyhound, Beattie - but eventually they settled into a relationship similar to that of Pinky and the Brain. You never did manage to take over the world, Geri, but I suspect you came close - behind my back, of course.

Geri was with me for the first few years of being a vet. Those were hard years; I was depressed, disillusioned and mostly unhappy. Geri was one of the bright spots in my life during those times. It's hard for me to write more about that, today, of all days, but... she helped a lot. She was the first dog I ever owned on my own, and she's been with my my whole career.

Three years ago, we started to notice that Geri was struggling walking up hills, especially on hot days. We realised that she had developed laryngeal paralysis, and when we took her to a referral practice, our surgeon told us that it was part of a larger neuropathy that would also gradually affect her hindlimbs, called geriatric onset laryngeal paralysis polyneuropathy (GOLPP). With this in mind, we opted against surgery to open up her larnyx, because we knew there was nothing that would help her legs. We didn't think that we'd have her for very much longer. Every month seemed a bonus, but she was dextrous, and smart, and she coped with the progressive disease. It started to rob her of her continence, but Geri was always a pikey little bugger, and didn't really mind wetting her bed once in a while. We got her dog pants, banned her from the sofa, and despaired at the occasional (eventually frequent) messes on the carpet. But she was happy.

Which brings us to yesterday, when Kerry first noticed the swelling on the side of her face. By the evening, her face was twice the normal size. I rushed to the practice to get some medication, hoping that it was just a tooth root abscess, and would start to settle by today.

This morning, the swelling was on both sides. I tried to take her for a walk, and Geri - my naughty little Geri, terror of white clothes and cat food hidden 'out of dog's reach' on tables everywhere - collapsed in the field, and looked at me.

We knew. It didn't matter what the cause of the oedema was. We knew it was time. So, after a few brief teary hours at work, we came back home, to found Geri lying in the same place we'd left her. Half an hour later our poor colleagues arrived (thank you so, so much, Emma and Leanne, and we are so sorry what we put you through) to do what needed to be done. Within an hour, we were burying her in the orchard.

We were lucky, so so lucky, to have such a wonderful dog for such a long time. She helped me through a lot, and she... well, she made it easy for us, in the end. We didn't think she would, but we knew it was time. She died with three of us tickling her. Not as many as she would have liked, because there never were enough tickles in the world for her, but I hope, perhaps, enough. It's unfair of me to feel cheated by this, when so many people have endured so many worse things, so much more unfair. Geri had a full life, and she went peacefully. I should be content.

Here's a few of the things that I'll never again experience -

Her strange wookie-like howls of pleasure when she knew it was time to walk

Her complete command of my tickling arm; she got so she only had to twitch one leg and glance in my direction to receive more cuddles

Those perfect little ears, and her grunts on pleasure when I massaged them

Her bouncing through long grass like a canine space hopper

That tiny little wet nose

Her propensity for eating seatbelts - never thought I'd miss that one!

Her swimming (only when she really had to)

Her sunbathing (even to the point of asphyxiation)

Her uncanny ability to push me off the best spot for sunbathing in the garden to steal it for herself

Her rare barks

Her honing ability to find anyone out on a walk that had treats in their pockets, and her charm to always - always - get a treat for herself

I could go on. Well, maybe that should be I should go on, but I can't. I can't piece any useful thoughts together any more. I told you this was just a lament. She was a dog, but the grief feels as real to me as anything I've ever felt. 

It's raining outside. Geri is dead.

It doesn't make any sense.

Mistakes

Regular readers of my blog will probably be aware by now that the tone of my posts tends to vary wildly between flippant and maudlin - sometimes even within the same post. I'm going to be honest; this isn't one of the flippant ones. Consider yourself warned.

'Experience is the name everyone gives to their mistakes' - Oscar Wilde

There's a nice little word that you can use in medical terminology - you may have heard it before. I may even have mentioned it in the blog before. That word is 'iatrogenic'. It's especially useful for those of us in the field because it sounds nice and official, slightly intimidating, and mysterious. Here's what it means - the doctor did it. Your physician ballsed up in some way, and now you're ill because of it. If you've got iatrogenic Cushing's disease, it's because the doc gave you too many steriods. If you've got iatrogenic aural trauma, then it's likely he was a little overenthusiastic with his otoscope. If you're iatrogenically monorchid...well, you get the idea.

There's a reason that this word was created, and that reason, of course, is that doctors (or in the case of this blog, vets) make mistakes. You may be getting an inkling of where you think this blog is going, now, but you may be wrong. I'm afraid this isn't going to be an 'Alright on the Night' style list of amusing veterinary cock-ups, where the poor James-Herriot-alike accidentally drills through their own finger whilst attempting to pin a fracture (though, I must admit, I have known that happen). No, this is really a confessional blog, a penance for me for a mistake I made. I did warn you at the start.

You see, I've been reading through my blog posts recently, and much as I like them, I do rather give the impression that I never make any mistakes myself, and that the hard positions I've found myself in have been due outside influences. This is, I will admit now, not the case. I have - in common with most of humanity, I suspect - made many mistakes, both in and out of my career. It's possible that this blog post is one of them. But I am so weary of politicians and others in the public eye avoiding even talking about, let alone admitting to, errors they have made on the basis that they may - horror of horrors - actually be called to account for them, that I wanted to make my own claim to honesty here.

I've been a vet for a long time now - ten years - and it has been quite some time since I felt that awful 'out of my depth' feeling that lived with me as a new graduate. Considering how much I've learned since then (and see Oscar Wilde's quote above for the true meaning of 'learning'), I'm a little surprised, when I think back on it, how few serious problems I got in to. Most of them were learning how to communicate with clients effectively and fairly, or easily corrected surgical mistakes, but here is something that has stayed with me down through the years :

I was a new graduate - maybe three or four months into the job, and it was one of those evening surgeries - the kind where all your old cases come back to haunt you. Nothing has got better, some things have got worse, and even the vaccinations have got heart murmurs, or sinister-feeling lumps that the owner has never noticed. I've had many, many of them since, and have discovered that really all you can do is take things one at a time, and remain calm. Back then, watching with alarm the list of people waiting grow whilst I was trying to think about a Chinese water dragon that had just been presented to me 'off-colour' (as I recall, it turned out to have been dead for a few days), panic was setting in. It was the first time I had experienced anything like it.

I was on my own - my colleague (a keen surgeon - a classic of the breed, very interested in the technicalities of the work. The animals, not so much) had left me to take one of his spinal cases to...well, I remember it as MRI, but I wonder now if, all those years ago, it would have been far more likely to be a C-T scan. Doesn't matter) and no cavalry  was coming to save me. The 'complaints' list on the computer, a brief description of what was wrong with each animal, read like a thesaurus - 'worse','no better','no improvement'','poorly' etc - and I had just run out the back with my immobile water dragon to try and get a better look, when I got the phone call.

I forget the name of the breeder, and I wouldn't put it here even if I could remember, but she had phoned the practice to speak to my boss, and was upset that he wasn't around. She was even more upset to discover that the only vet she could talk to was the new graduate - and if she'd realised my state of mind at the time, she probably wouldn't have spoken to me at all. She had a reputation at the practice for being incredibly demanding - and any vets reading this will have a picture in their minds right away of exactly the sort of client I'm talking about. Flustered, with one eye on the water dragon (about which I was starting to suspect the truth - it's not quite as easy as you might think to immediately diagnose death in a reptile. Well...not if you've never seen one before. Anyway, that's not the mistake. I got that one right, in the end, it just took me a while) and another on the ever-growing waiting room list, I took the receiver from my nurse.

The situation explained to me was this : one of the breeder's bitches has just finished whelping. The births had gone fine, but one of the puppies had been born with a severe umbilical hernia - it's intestines had prolapsed through the large hole and the pup was not looking at all well. The breeder wanted me to go straight out to her and put the puppy to sleep.

This (like most things in those days) was not a situation I had been in before - I had never seen, or even heard of a puppy with such a severe problem. The breeder was adamant that the problem could not be fixed, and it certainly sounded serious enough to me. This is painful to write - but that's the whole point of this blog, isn't it? - but I agreed the puppy needed to be euthanased. 

That's painful to write, because it's wrong. It's a treatable condition with immediate surgery, and I have fixed a number of puppies in a similar situations since. I was wrong, but that wasn't the worst of it.

I couldn't get out on a visit; I knew that. I had a waiting room full of people and no back-up. I asked her to bring the pup in, and she absolutely refused - she couldn't (she said) leave her bitch, and all the other puppies, just to bring this one in.

I wince to think of it. Older now, and wiser, I would have told her to bring the whole lot in right away. I also would have told her the pup could have been saved. I didn't. I merely feebly protested that I couldn't make it out.

'That's okay,' the breeder said. 'I'll deal with it myself.' She wasn't rude, or annoyed. She had really just wanted to check whether I thought the puppy should be put to sleep or not. She put the phone down. I didn't ring her straight back. Instead, I got on with my evening surgery.

Twenty minutes later my boss phoned me. He had a number of missed calls on his mobile phone from the breeder in question. When he got back to her, he found out what had happened. It was here that I discovered that the condition could have been surgically corrected. My boss had also discovered what had happened to the puppy.

She had drowned it.

I cannot tell you, dear reader, the number of times I have played that phone conversation over in my mind, wishing I had handled things differently. I can't count the number of nights I have lain in bed, staring at the ceiling and thinking of the pup, struggling against calloused hands, bubbles escaping from its mouth. That one mistake, based on a lack of veterinary knowledge and poor client handling, has haunted me for years. Its taken me ten years to write it down.

I don't even know, at this stage, how bad that seems to someone else. Its grown to be so large in my mind that I find it hard to think and write about, even now. I've made mistakes since then, of course - some worse that this one. But it was my first one, my first realisation of what can go wrong in just a few seconds of thoughtlessness. The drowning puppy lives in my mind (and only in my mind - it's painful to think that it could still be alive even now, all these days, weeks and years later, if I had acted differently) as a symbol of failure, and mistakes. Whenever things go wrong - which thankfully is not so often, these days - I think of that pup.

So, my confession is done. Don't think for a moment that this is my only error in ten years. As you may have suspected, this blog was prompted by a mistake as well, and of a similar kind. A few moments thoughtlessness, forgetting what really is at stake if I don't try my hardest, may have cost another animal its life. I ignored my instincts and took an easier path, and I was wrong. Likely it would have made no difference - in fact, I'm almost certain that in my recent error of judgement, acting different would have merely meant that the animal ended its struggle in the practice, rather than at home. Almost certain. But I'll never know now.

I suppose the hallmark of a mistake, as opposed to simple bad luck, is that if you think back over the situation - like I have, many times, thought over my phone call to the breeder - and you wish you had done something other than what you did, then you made a mistake. And that's how I feel today about this new mistake. I could have acted differently, and I wish that I had.

I'm not perfect. I wonder, if any vets are reading this, how many of them have their own version of the drowning pup, that swims into their mind when things go wrong? More than a few, I suspect. I'm so sorry that I failed then, and I'm saddened to realise that the lesson, hard and painful though it was, still needs reinforcing to me from time to time. This post is a way of doing that.

Thanks for reading.

Breeds Apart

Imagine, if you will, I go to the doctors. There's nothing particularly wrong with me, I'd just like a check-up to make sure everything's tickety-boo. The doctor (I'm imagining an elderly distinguished chap, something like John Le Mesurier, but hey! It's your imagination, they can look however you like. So can I, now I think about it. Can I be handsome, please? More hair than that. Great, you've got it.) asks me about my family history, and at this point I break into a broad grin.

'Oh, no problems there, doc,' I say, reaching into my man bag (what? They're fashionable now, aren't they? Or was that the nineties?) and retrieving a document. 'Take a look at this!'

I then proceed, proudly, to show the doctor my family tree. 'All great specimens, doc! Champions, the lot of 'em.'

Doctor Le Mesurier, at this point, can't help but notice that three of my great-grandparents appear to be the same person. Not on that, it looks (to his increasingly concerned eyes) as if my grandfather also produced several other children from my own mum, and my dad has likewise done the nasty with with maternal grandmother. At this point, he could be forgiven for thinking that this particular family tree would not be out of place adorning the wall of a backwater redneck banjo-playing (and if you're reading this, Jon, I do apologise. I don't mean to drag the good name of banjos into the mud, but it's an easy stereotype, and I'm sticking with it) web-toed buck-toothed cannabalistic clan, and he's starting to wonder if it might be a good idea to page the nurse.

'What do you reckon, doc?' I say, proudly. 'Impressive stuff, eh?'

Now lets talk about dogs, and the concept of a 'pedigree'.

Canis lupus familiaris is a remarkable species - genetically speaking. Think of the smallest adult human in the world. What are they? Let's say two feet tall for the sake of argument and unnecessary googling. That'd be about twenty kilos in my money. Now think of the tallest. Shall we go crazy and say ten feet tall? Tiny bit of googling suggests this would give you a weight of about two hundred and fifty kilos. (I won't get into obesity, because I'm really thinking of body frame rather than fat, plus that's a far too depressing subject to get into this close to Christmas). So, quite a difference - the tallest human weighs about 12 x more than the tiniest.

Back to the dog. The smallest breed that springs immediately to mind (and there's probably smaller out there) can weigh in, as an adult, at as little as 1 kilo. (Sorry about metric weights, but I'm sorry to tell you it makes a hell of a lot more sense than pounds, and a lot easier to do in your head). Now, the largest dog that springs to mind that I see regularly is a great dane - and squashes the scales in our practice to the tune of 80 kilos. It doesn't take Stephen Hawking to work out there's an 80 fold difference between the teeny tiny yorkie and the great dane - and there's definitely bigger dogs than her out there.

The point of that slightly tedious maths exercise was to illustrate the amazing genetic variation that exists within the doggy gene pool. Remember, this is the same species. Tiny tim the yorkie could (with some mechanical aids probably best left only to the imagination) in theory mate and produced fertile offspring with Gerta the great dane (their names have been changed to protect them so don't go ringing the Daily Mail in disgust). I picked on body mass as it's the easiest to visualise, but just about any characteristic in dogs shows the same variation - tail length, hair thickness, nose size, ear shape - they're all incredibly variable. Astonishing, and fascinating, and unlike most other species on the planet.

Which is why it's upsetting to me, and to many vets, that this variation has been turned into a torture implement.

Now, I'm aware torture is an emotive word (certainly our governments seem to think so. Good job they don't do it, then, and thank heavens for these new-fangled advanced interrogation techniques that I'm hearing so much about. They sound terribly effective) but I use it quite seriously. The wondrous genetic variation within dogs has, in the hands of humanity, caused more profound suffering to this beautiful, loyal and trusting species than anything I can think of (and trust me, I can think of some pretty horrible diseases).

Y'see, the concept of breeding like animals together to get offspring that were similar to their parents has been around for a long time - long before Darwin (and Wallace) developed the elegant theory of evolution, people knew it happened. They just didn't know why. (The difference in evolution, of course, being -natural- rather than -artificial- selection, but let's not get into that now). Farm animals have long been interbred to produce more meat, more milk, more honey, more pencils (okay, not the last one). Even this form of breeding has it's problems - you select for one trait, and often get weaknesses in others - but at least you're trying to get something useful out of it (well, useful to you, anyway. Quite what the cows get out of it is another matter, for another blog). That is...you're breeding for a function. It's when you stop needing your animal to do anything, and you just want it to look a particular way (breeding for a form) that the problems really start.

Enter the dog.

Poor Canis lupus familiaris may be man's best friend, but I must say if any of my friends treated me like we have them, they'd be off my Christmas card list before you could say 'inbreeding'. Dogs, who are unlucky enough to have a very wide gene pool, have been moulded over the years into the craziest shapes since the invention of silly putty. The difference is, silly putty can't suffer. Dogs can. And 'pedigree' dogs most of all.

Roughly 50% of my canine consultations for ill animals (i.e. not vaccinations, neutering or check-ups) are to try and deal with pain and disease caused by inbreeding. In the practice right at this moment we have a bulldog on a drip because it can't stop projectile vomiting (due to a hiatal hernia - guess what? An inbred trait), a spaniel recovering from surgery to repair a condylar fracture (inbred weakness), and a labrador that can barely walk because of it's chronic severe hip arthritis (caused by hip dysplasia - you get the idea). This is not an unusual day for us.

The minute some idiot (sorry, did I say idiot? I meant the kennel club) that they'd like this particular breed's nose to be shorter than a certain length, or it's spine to be yea long, or even something relatively innocuous, like thinner, shorter hair, you're asking for trouble. Two dogs that look very similar on the outside are likely to share genes that affect more than their looks. Genes for a slight propensity to have malformed hips, for instance. You'll be fine the first time you do it. Probably the third. Possibly the tenth. But sooner or later, along with those genes for lovely silky coats, you'll have a whole load of crappy genes that you really didn't want.

All this is pretty basic genetics, and apologies if I'm patronizing my readership, but this fairly simple point seems lost on a large proportion of dog breeders, not to mention the Idiots (oh, oops, I did it again, sorry, I mean the Kennel Club). Of course, this happens when you're breeding for a function, too, but there comes a point where you have to breed out with a different stock, so your animal can still do what it was supposed to do in the first place. The problem with breeding for a form instead is that your animal doesn't need to be very healthy to do what you want it to do, which is just to sit there looking (according to Idiots) pretty.

This is a problem when the form you're breeding for is relatively sensible - you still get poor genes when you're inbreeding, hence my little doctor scenario above. It's a major problem when the form you are breeding for is actively, and obviously, deleterious to an animal's welfare - and it still blows my mind that there are so many breeds like this out there. Daschunds bred with legs so short and spines to elongated that you can almost hear their discs slip as they walk in the door (and it takes a deal of self control on my part to try and make that sound funny, considering the number of cases I have seen with dogs in absolute agony because of it. Thanks, Idiots), bulldogs bred with such short tails that they grow in upon themselves (and that's only one of many many anatomy problems I could suggest about a bulldog. More than 50% (in our practice, probably 75% of bulldogs are brought into this world via caesarian, because they can't give birth unaided. Doesn't that set any alarm bells ringing with the Idiots?), pugs bred with noses so short they can barely breathe (and if Hal or Lindsay are reading this - please don't take offence, Ruby is clearly one of the sweetest loveliest there ever was. But given the choice, she'd like to be able to breathe a bit easier, trust me).

The Idiots, when discussing Basset Hounds, like to talk about 'furniture' - which basically means the amount of skin folds they have on their stumpy legs. This is, apparently, a good thing. The fact that the majority of bassets suffer from chronic pain due to their malformed elbows seems not to matter very much to them (which makes me want to drop large pieces of furniture on them. Maybe that's where the term comes from?).

In bassets, as in other breeds where the genetic problems have reached crisis point (like West Highland White Terriers with skin disease, or Labrador Retrievers with hip dysplasia) the Idiots have instituted 'screening programs' to 'breed out' the unwanted traits. I have a very simple breeding program - stop breeding mother with grandparent, and your problems will go away.

All of which means, to me, that a 'pedigree' is simply a history of how inbred your dog is. The longer your pedigree, the less healthy you are likely to be, no matter how many bloody times your ancestors won at Crufts. These dogs cost hundreds, if not thousands, of pounds, are going to cost you a great deal of money in veterinary fees, and also, (and this is my key point, which is why I keep returning to it) they will suffer.

Things are changing a little. A few years ago all this information was news to my clients, but no more often than not they are well aware of the problems. I can't tell you how many westie puppies I've seen with the first hints of atopy which will likely mean they will be on steroids for the rest of their life, only for the owner to tell me 'Oh, I know they suffer from that, our last one did.' It depresses me and upsets me that they can't see that perhaps going out and purchasing another one will, ultimately, lead to more animals spending their whole lives in pain.

I'm aware my tone has shifted from flippant to angry, and that's the very reason I've avoided writing this blog for some time. The unfairness of life aside, it was probably the main reason I wanted to start a veterinary blog at all. Because I'm tired. I'm tired of seeing wonderful dogs in pain and chronic misery because some shithead decided his legs needed to be -this- short, or his eyes should bulge out just so. I'm sick and tired because our profession, the 'champions of animal welfare' have let this misery go on for far too long. It took a BBC documentary on the subject to bring it to peoples attention, and finally have the horror show that is Crufts taken off air.

Okay, I'm going to stop ranting. For those gluttons for punishment who want more of the same, here is a letter Kerry and I had published in the veterinary times several years ago. For everyone else - please reconsider buying that puppy with the long pedigree. I know it's nice to know exactly how big it will get, and you can buy a nice bumper sticker that looks like them - but remember Dr Le Mesurier, and try to consider what that means for the dog, and not you.

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 other side of the table

I don't like mechanics.

Okay, that's not entirely true. I'm sure there are lots of mechanics who I'd really like if I met them socially. (Well, okay, even this is stretching the truth - being a socially-inept geek I don't really have a lot in common with the average grease monkey) What I'm trying to say is - I don't like taking my car to mechanics.

Part of the problem is that I'm a man (please don't take that quote out of context) and so it seems to be assumed that I was born with some deep underlying insight into how a carburettor works (or even what it does) and so the fact that I don't have the slightest clue already marks me out as a failure the second I step out of my car.

But how do they know you don't really understand the secrets of the internal combustion engine, I hear you cry? Don't try that with me. They know all right. They know the second they lay eyes on me, that I'm not the kind of man who takes pleasure in reading What Car magazine. They can tell just by looking that I used to get picked last in PE lessons. The bastards.

Once, taking my car in for a routine service, the guy behind the counter (with deep, ingrained oil around his fingernails - the kind that looks like it could never wash off even if he had his hands flayed0 asked me the mileage of my car. I had no idea. He looked quizzically at me like the cop in the Terminator when Kyle Reese grabs him by the lapels and demands to know what year it is. How could anyone not know what their mileage on their car is? I felt such a deep sense of masculine failure, I wanted to jump up on the desk and cry out 'I changed a tyre! I changed a tyre once, and it was raining, so there!'.

I didn't, of course. I was too humiliated, because his first question was 'What is your registration?' and I hadn't known that one, either. I had to go outside and check. Once, I was standing in a queue to pay for my fuel at a petrol station, and a woman in the shop was looking for oil for her car. She wasn't sure which one it needed, so she glanced around. It suddenly dawned on me that I was the only man in the whole building. The fact did not escape her either, for rather than ask at the counter she approached me, waving a tub of Castrol something-or-other, and asked me 'Is this the right one for my Peugeot?'

Everyone in the shop turned to look at me. I was so caught between umbrage at her sexist assumption and embarrassment that I didn't know the answer (of course!) that I just mumbled 'Don't know.' I couldn't leave the shop then, which would have been my preferred option, because I still had a car full of unpaid-for petrol, so I had to slowly wend my way up the queue of shame to pay, everyone there knowing that I had failed at some unwritten man-test.

You may get the impression from the above that I have something of a man-chip on my shoulder when it comes to mechanics, and you may well be right. You may also be wondering by now what the hell this has got to do with being a vet. Well, be patient (heh. Little medical joke there, see. Patient? No? Please yourselves.) Here is the tenuous link...

What I really don't like about going to the mechanics is that, basically, if something is wrong with my car, I don't have a clue what to do about it. I'm going to have to take it to someone else, who is going to look at it, tell me what's wrong with it, and then, hopefully, fix it. I will wait anxiously for the bill, really not having the slightest idea what it will be, and hoping that I haven't picked some cowboy who instead of fixing my car has just hastily Sellotaped in back together. I have no way of telling a good mechanic from a bad one, and all I can do is pick someone who seems vaguely nice and hope for the best - though whether being vaguely nice has anything to do with some one's skills in engine repair, I have no idea.

Sound familiar?

What I'm saying is - it is very easy to forget, as a Veterinary surgeon, what a depressing, stressful, expensive and scary experience it can be to take what is essential a family member, and leave them with a stranger for a day whilst they do unpleasant things to them, and charge you for the privilege. Now (and I cringe at saying this because I'm a thoroughly middle-class English person, and any hint of self-praise is usually enough to send me almost into a coma of embarrassment) I am, as it happens, fairly popular with clients, and they seem to quite like me. Part of the reason for this is that I'm a dreadful toady, and am almost unbearably nice to people because I don't like to cause a scene, but a lot of it is because that I do understand that it's not fun to take your animal to see a man in a green coat, and the more you can relax people, and explain as clearly as you can what you think, why you think things happening, and why you would like to stick sharp things into their beloved friend, the more they will trust you.

I do keep that in mind, but even so, a number of things have rather reminded me what it is like to be on the other side of the consulting room table. The first is that my own dog is not very well herself. Being vets, we thought that anything that happened to her we would probably sort out ourselves, but being the stubborn little so-and-so that she is, she decided to develop a condition that needs surgery, the success of which greatly depends on the experience of the surgeon with that particular op. And the experience we have with the op is zero, so we have had to refer her.

Which basically means we have had to ring round vets, getting appointments, getting (dare I say it) quotes for the operation, and generally worrying. Then we've had to sit in vets waiting rooms, trying to make small talk with other people whilst worrying about leaving our dog, and the bill, and whether the anaesthetic would go okay, and whether the vet would be nice to us, and so on. Karmically, it was probably some form of cosmic payback for the stress and misery I have unwittingly caused to other clients in a similar situation. Doctors, apparently, make the worst patients, but it's a fair bet that vets make the worst pet owners, because I was a blubbering mess the night before she went it.

(By the way, the operation has been delayed for the moment, because the condition - laryngeal paralysis - isn't quite bad enough for the surgery (a laryngeal tie-back) yet - some more stress ahead! Yay!)

The second thing that reminded me was talking to some friends a few weeks ago - they had taken their cats to see their local vet to get them vaccinated prior to a house move - and ended up feeling cheated and a little annoyed because the vet responsible gave a vaccine that they didn't feel was necessary without telling them, and generally not really explaining what they were doing. To use my mechanic analogy - it's like me being told that my flange nuts needed tightening, and it would cost me eighty quid. I've no idea whether they do or not, but if the mechanic doesn't take the time to tell me what a flange nut is, why its come loose and why it needs tightening again, I'm going to feel a bit ripped off even if my car would have exploded in a shower of oil and surprised vet had he not done so. It's not so much what they did, as how they did it, and this kind of thing contributes to the feeling amongst people that vets are money-grabbing bastards. We really don't do ourselves any favours on this front.

The third thing is the elephant in the room. Not literally (at least I don't think so - I'll go and check, Hang on....nope, no elephants) - but this week a programme was shown on BBC called 'It shouldn't happen -in- a vets' (very clever, see what they did there? I would never stoop so low to use a pun of a James Herriot title for my blog). Now, I have my fair share of issues with this programme, and I don't want them to turn into a rant, but I'll mention a few here. Panorama (which I think the program was - it wasn't clear from the opening credits. I do wonder if it was supposed to be a Panorama but was extended into it's own show? Anyhoo...), which used to be a paragon of impartial reporting, seems to have stooped to the lowest brand of journalistic mischief making. It always starts with the worry-maker-in-chief, Jeremy Vine, standing outside (see! This is an important issue, far too important to sit around behind a desk and tell you about), suddenly telling you that something you previously had no worries about at all may actually kill you/spend all your money/give you cancer. The programme then goes on to tell you, in no uncertain terms, exactly what you should think about this particular issue (which is always WORRY WORRY WORRY WHY AREN'T YOU WORRIED THIS PERSON/THESE PEOPLE IS/ARE OUT TO KILL YOU/STEAL YOUR MONEY/WORRY YOUR LIVESTOCK) - and the vet episode was no exception, right down to the freeze-framing the bad vets in black and white vaguely mugshot poses whilst apparently throttling cats, whereas depicting the nice vets in their living rooms, or in a lovely green field surrounded by nice cows.

I could write a whole blog on the show (which seemed to suggest you'd be far better taking your animal to a vet who has worked on his own for twenty years, than a large, well-supported practice with state of the art facilities. I don't work for one of the large franchise practices that seemed to be taking the brunt of the flak from this programme, but take it from me, I would rather have my own dog operated in one of them than in a single-vet practice.) but that isn't really what I want to waffle about. The thing that upset most of my clients, watching the show, was a brief image of the EVIL vet swinging a cat around the room holding it by the scruff of it's neck. Well, it may be a surprise, but this is a recognised restraint technique for cats if you're on your own - watch the video again and you may well notice that the cat itself doesn't look stressed or upset, and neither vet or cat were at risk from harm during the procedure. It's a technique I have used myself on many occasions (including on my own cat!) and in front of clients too - the point being, I have explained to the clients first what I am about to do, and why. Everything looks bad taken out of context (like my comment above, about it being a problem that I'm a man)

(Incidentally, don't get me wrong - there were a several rather upsetting things shown, like the dog which had it's leg amputated being -very forcibly- restrained post operatively, and a senior vet squeezing used blood back into a bag so it could be re-used on another dog, as well as a pretty depressing laissez-faire attitude amongst student nurses towards animals)

The point, for the purposes of this blog, was that scenes of animal restraint that look fairly routine to me, can be extremely shocking for people unused to such a thing - especially in the animal being restrained is their beloved pet. I'm sure those clients, with horrified looks on their faces, would understand a lot more if they weren't shown the footage of such by the pantomime Jeremy Vine, which accompanying operatic music, but were talked through the procedure by someone who actually knew what they were talking about.

Well, the torrent of words is slowly so I feel I need to creep towards a conclusion, which I suppose is this. If you're a vet, try and remember how horrible it is taking your pet in when you've been worrying about that cough he had all week. If you're not a vet (and really, why would you want to be?) - shop around! Find a vet that explains things to the level you want them explained. If they don't, you'll feel ripped-off whatever the bill, and it's a recipe for misunderstanding and all manner of Royal-college nastiness.

We're all human, you know. Well, except for mechanics, that is.

One of those days...

It's been, as the cliche says, one of those days. It was one of those days, in fact, that made me start this blog in the first place. I don't know where those days come from, but wherever it is they can piss off back there, as far as I'm concerned.

It was the kind of day, in fact, that reminds me that we are, all of us (except for our mighty Robot Overlords, of course) basically fleshy machines, and that when something goes wrong with a bit of the machine that happens to house you, well, it's not great news.

Not a revelation to rival the Buddha's, perhaps - but it is a very obvious fact, the more you work in any kind of medicine. We're machines. Very complicated, self-repairing, self-aware and quite amazing machines, but machines. And machines break. And there's no reason behind this any more than there was a reason behind my Xbox breaking (THREE TIMES you bastards Microsoft! Ahem. Sorry.)

And that's the point of this blog. In fact, it's a bit of a cheat of a blog because it's really just an introduction to my very first blog, which I had to delete from my site (you'll find out later why. Just keep reading, you inpatient bugger. Or skip to the end. I'll put a joke there, I promise.)

So, the reason I'm in that kind of mood today - I came in this morning to find one of my inpatients, a very sweet cat called Humphrey (it really shouldn't matter whether he was sweet or not, should it? He didn't deserve what happened. But I'm getting ahead of myself, hang on...) feeling very poorly indeed. He'd been on intravenous fluids since Wednesday, and this morning his blood results were waiting for me from the lab. And they were not good news. Humphrey was very severely uraemic - that is, his blood urea and creatinine were something in the order of fifteen times the normal upper limit - that is, Humphrey's kidneys were buggered. He hadn't passed urine since he came in, despite all the fluids we were pouring into him, which meant his kidneys had pretty much shut down. Maybe better medics than me could save a cat like Humphrey, but I've never managed to get a cat in this state any better.

So, with a heavy heart, I phoned the owner (who must have seen the number calling, because she answered the phone with a hearty 'Hello! How are you?', which made me feel great). Humphrey was five years old, and I had no idea his kidneys would be in anything like the state they were. Fortunately, being the cautious chap I am, I had admitted him straight away for fluids, which was the right thing to do in such a situation. Unfortunately, for Humphrey especially, it hadn't made a blind bit of difference.

Now, there's not many things that can balls up a young cat's kidneys so severely and so quickly. A blocked bladder would do it, but Humphey had been peeing fine before this happened. Which leaves a rather short list, top of which would be poisonings. And top of that list would be antifreeze.

(which reminds me - please please don't use antifreeze in your nice water features in the garden. Cat's love running water. Antifreeze kills cat's kidneys, followed fairly quickly by the cat. Learn to love your frozen over water feature!)

But, talking it through with the owner, it wasn't antifreeze. Here comes the heartwarming part of the tale (I'm using a sarcastic voice here, if you wan't to read it to yourself like that. Ta.). The other poison that destroys cat's kidneys very quickly and irreperably is lilly pollen.

And as it turns out, Humphrey's owner's house had a lot of lillies in last week. On account of her father dying suddenly and unexpectedly the week before.

I put Humphrey to sleep today, because he licked a lilly plant last week. Because his owner's father died the week before.

I guess what I'm trying to say here is - there's no blame, there's no malice or hatred, or anything, behind any of these events. They just happened. Just like one day, they'll happen to us. I don't know why we seem to have this inate feeling, this need that life should be fair. To the point where if it isn't we tell each other its our fault that it isn't, because of what we like to do in the bedroom, or because we eat fish on the wrong day, or pray pointing in the wrong direction, or some other crap like that. I see, every day of my life, that life isn't fair, it isn't anything other than life, and it still surprises and upsets me when it isn't.

My wife has had a bad day too. A Staffordshire Bull Terrier that she operated on today, and removed an enormous tumour from it's spleen, died suddenly a few hours after it woke up, likely from a pulmonary embolism. It was less of a shock, because we already knew that the tumour had spread to the dog's liver (and possibly heart), and it almost cetainly wouldn't have lived more than a few months. They would have been comfortable and mostly normal months, though, at home with his owner, and he had them all snatched away in the space of a few seconds.

So, in the spirit of that, I'm re-instating my old first blog post, which was inspired by much the same sort of thing, and it expresses it better than I'm managing here. It might be grim, but keep reading! I promised that joke at the end, didn't I?

* * *

Life, death, and blogging.

As I walked into work today, I was immediately rushed downstairs by Chris, to help one of my vets. On the operating tablet was Maisie, an eighteen-month old Dogue du Bordeaux (if you don't know this breed, think of a slightly more canine version of Bungle from Rainbow and you won't be far wrong. Man, Bungle used to scare the crap out of me when I was a kid)

As I rushed into the theatre, wrestling the stethoscope from around my neck, Maisie gave a great shuddering cry, and vomited copious stinking bloody fluid all over the floor, and all over Jenny, one of our junior vets.

Several minutes later, despite much ER-alike injection, pumping, tubing and thumping, Maisie was dead. Not one of us could do a damn thing about it. When we opened up her abdomen, her guts were purple, and stinking. She had an intussuseption - where the intestines telescope into themselves, effectively causing a blockage - but this was likely secondary to the inflammation in the bowels.

Two hours earlier, Chris had walked Maisie out from the practice to go to the toilet - Jenny had admitted her the night before to keep in for observation for her vomiting - and she had wagged her tail, and walked (if slowly) out to the grass verge opposite the hospital, sniffing around in the way that dogs do to show they know more about the world than you do.

Jenny and I have both spent the rest of the day feeling miserable and useless. Partially because it's one of those cases where we feel there are no lessons to be learned - if we saw a case like Maisie's again tomorrow, we wouldn't have treated her case any differently. There was never any indication to operate before - Maisie's abdomen felt normal, her temperature was normal, she was bright and wanting to eat - but mostly because it was just so damn unfair. What did Maisie do to the world to deserve to die in such a terrible way? She wasn't even two years old.

Is there a point to this blog? I'm not sure. Nobody ever said the world was meant to be fair. I deal with death and suffering ever day of my life, but there's still some part of me that's hard-wired to think that there should be some justice in the world. Today I had yet another reminder that life is fleeting, and precious.

So I'm starting this blog - to remind you all of this simple fact, possibly the hardest one for any human to digest. The blog is primarily about my work life. I'm hoping to show you what it's like being a vet in a world like this. Hey, it's a living.

Also to vent my spleen. Trust me, I'm a vet, spleens need to vented regularily or damage will ensue.

More tales from the front line to come.

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Okay, you've made it to the end! Well done! Hopefully you don't need counselling at this point. The reason I deleted that post originally was because the case concerned, and both myself and Jenny, became the subject of a Royal College investigation at the request of the owners. This was sad, but not surprising - you've just read how I felt about the case, imagine how the owners felt. It was a senseless death, very depressing and very unexpected.

I can post it again because the investigation concluded that we had done nothing wrong, and there was no case for us to answer. The owners don't believe that of course, and without understanding, neither would I. The simple fact is, we did our best to save her, and she died anyway. It's a hard thing for our society to accept.

Right, you've made it through all the depressing stuff, now here's the joke....

There isn't one! It was a cruel literary subterfuge all along to further illustrate the point of life's unfairness. Except in this case it was a quite deliberate unfairness orchestrated by me. So it doesn't really make the point at all. Sorry.

Ah, never mind. I'm getting a drink. Anyone want one?

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!