Thursday, March 16, 2017

Spunky Swings Low

Pity poor Spunky, the captive sugar glider. Pity his adorable big black eyes. Pity his cuddly soft grey fur. Pity his delightful cupped-handful size. Pity him because these features make him irresistible as a pet - a little plush toy come to vigorous life - and pity him because he does not want to be a pet. Ok, "want" is a tricky concept in a creature with the brain the size of a chickpea. He is unlikely to be conscious of the fact that his kind lives in the forests of Australia, not the apartments of Canada, and he is unlikely to be conscious of the fact that his kind lives in large family groups of other sugar gliders, not in a household of enormous loud and smelly primates and possibly one or two four-legged predators. He is also unlikely to give much real thought to the problems inherent in wanting to be busy and noisy at night when the primates are sleeping, and then trying to sleep in the day when the primates are themselves busy and noisy. Even though he does not think about these things, there is no doubt that he would be far happier if he were ugly and were left alone to glide from eucalyptus tree to eucalyptus tree, with his family, at night.  

Further pity poor Spunky, for I have been asked to castrate him. As with many cute and fluffy creatures, Spunky does not know that "cute and fluffy" also means "passive and gentle" to his primate captors. In his mind he is fierce and he is tough and he has had it with you and all your b.s.. Tiny cuddly creatures with big baby eyes can still bite hard. And these ones in particular can swoop down on you from above. His owners were members of the online sugar glider community and had tried all the recommended behavioural and environmental modifications, but at the end of the day Spunky was still too... "spunky".

The medical care of captive non-domesticated species can present the veterinarian with an ethical and moral quandary. My approach is to strongly discourage ownership of such animals but also to recognize that an animal like Spunky is now stuck with this situation as he cannot be released into the wild, so I have an obligation to do what I can to help make his life as pleasant as possible, under the circumstances. And on balance, in this case, it meant trying surgery.

So Spunky was presented on the appointed day and the nurses handled him gently, gave him pain medication and then carefully induced general anesthesia, at which point I was called into the o.r. for the procedure. While I had given the ethical  and moral dimensions of this some considerable thought, I hadn't really done the same for the technical aspects. Neuters are, after all, really pretty similar from species to species.

Pretty similar, except in sugar gliders as it happens. They are marsupials and marsupials are strange. And before I get hate mail from Australia, I don't mean strange in the pejorative sense. I mean it in the strict traditional sense of the word - "unusual or surprising" - as seen from the perspective of someone whose practice includes no marsupials at all. Except Spunky.

So what was strange? His scrotum. Spunky's scrotum was strange. It dangled down between his hind legs on a long thread-like stalk like a teensy weensy little tetherball.

Now consider this carefully for a moment. Here is a creature that glides from tree to tree in the dark, presumably dodging twigs and branches, his scrotum dangling free beneath him all the while. Doesn't it strike you as problematic from an evolutionary perspective? Men reading this are feeling a little queasy now as they picture what must be a common mishap...

In any case, there he was, deep asleep, and there I was, scalpel in hand. I glanced at my nurse. She shrugged. I looked back at Spunky's scrotum and it's breathtakingly long and narrow attachment. I will spare you the technical details, but ultimately I had to abandon the normal approach which involves a lot of careful dissection, transection and ligation and instead... just lopped it off. I snipped the stalk, sewed it up and that was that. Ten minutes of pondering and ten seconds of actual surgery.

Somehow simultaneously both the easiest and the hardest neuter I have ever performed.

Thursday, March 2, 2017

Black Coat

Some days I feel like I should be wearing a black coat instead of a white one. Some days I feel like I am ending more lives than I am saving. Some days I really understand the people who tell me that they wanted to be a veterinarian until they learned that you have to euthanize pets.

After 26 years in practice, euthanasia is still the hardest thing I routinely do. I've gotten used to all manner of grim fluids and funky smells and chaotic days and wacky clients and freaked-out pets and hopeless cases, but I have not fully gotten used to euthanasia. Watching the light go out of an animal's eyes as their human companions dissolve into grief is not something that anyone should ever get used to, so it being hard will be a necessary and integral aspect of my job until I retire.

And it is a frequent part of my job as well. I think most of us average maybe two or three euthanasias a week. They tend to cluster so sometimes I can end up performing three or four on a single day. Those are the black coat days. Most pets, probably 80 - 90%, die of euthanasia rather than of "natural causes" at home. If you think about it it makes sense. How many people get to die in their beds at home? The majority of us will die in hospital or by slow degrees in palliative or chronic care facilities. There is no such place for a dog or cat to go once their quality of life is poor at home, and there is no longer any hope of it improving. There is no ward for demented pets to live out their last days, wearing a diaper, unable to walk, unable to feed themselves. There is only a reasonably good life at home, or death.

Seen this way euthanasia is of course, perhaps ironically, one of the best things we do as veterinarians. It allows us to fully focus on quality of life. No animal needs to suffer pointlessly the way some people do. It gives us a powerful tool many on the human side wish they had, if only they could find a clear path through the ethical minefield. We are still far more comfortable wielding the power of life and death over animals, but with that power comes responsibility, and with responsibility inevitably comes stress. It's just the way it is, and the way it must be.

It is interesting to note that I get far more thank you cards after a euthanasia than after any other procedure. Far far more. Some of this is thanks for service over the life of the pet, but some of it is also gratitude for the way the end of the pet's life was handled. It's funny, but veterinarians themselves are always most impressed by their colleague's diagnostic and surgical skills, by the cool cases they figured out and by the new treatments they mastered. Clients never are. They just assume we know how to do all that stuff. What they are most impressed by is our compassion and caring, especially in those terrible emotionally fraught moments at the end of the pet's life.

But all that said, my heart still sinks every time I see a euthanasia booked for me.