I watch the faces, I think. The ‘I think’ part is because I’m not really sure what I do all the time, or even some of the time. I watch the faces in the exam room because so much of what happens in the exam room has nothing to do with what the people think they know, or what they want me to know.
I’m looking for the truth, and for those bits of useful stuff that I learn from folks when they don’t know they are telling me these things. This is all a part of that thing somebody once said about veterinarians, that thing about how the animals can’t talk, so the vet just has to know. Well, we don’t just know, but we can often find out.
To do my job I need to know what my patient has been doing. I’m hoping the people have seen what the animals are doing. I ask questions of the people, and they generally answer. Sometimes they tell me what the animal is doing, and sometimes they tell me why they think the animal is doing it. The difference between these two answers is that sometimes they tell me what the animal is doing and I get a useful answer, and sometimes they tell me what they think is the why the animal is doing what it is doing, and that is often wrong. If they fool me, and I accept as fact their why instead of their what, I may make serious mistakes in my diagnosis and treatment. And these mistakes can have grave consequences.
The best example of this dilemma would be an old friend of mine, a retired physician. He has brought his pets to me for the best part of 40 years. I believe he was once a skilled physician. He certainly thought he was a pretty special doctor, but he was only trained on that one species of animal, and not all of his knowledge transfers over to the species I work with.
When I watch his face in the exam room, he puts on his “I’m the real doctor here, so shut up and listen to me and I’ll tell you how to take care of things” face, and I guess I’m supposed to be impressed, and compliant. As a client bringing his pets to me, he was, and is, a trial. Mostly, he is a trial because he will not, or cannot, tell me what his animals are doing, without injecting the why that his doctor brain has already concluded. Now, all this would be fine, except that he generally is wrong. And that makes my job much harder.
I walked out of surgery the other day after amputating this physician’s dog’s tail. All because of that cancer on the tail that he had been treating on his own with the antibiotics because he thought for a while it was just an infection. We had talked about the thing and how it could be a cancer, and he was convinced that the old dog could not survive a surgery to remove said tail, so he simply discarded that notion and did what he thought best, which was wrong. And finally he decided to do what I told him to do, which was to amputate the tail, and I let it be his idea and I did the surgery. And the dog is fine now.
And then later that day I went into the exam room with another man and his young, innocent child and their puppy. He was a nice man, and the boy was bright and asked good questions, and the puppy was a doll. And when I did my examination, and I listened to the puppy’s heart with the stethoscope, and it was OK, and I handed the stethoscope to the boy and he listened to a puppy’s heart for the very first time, I watched his face. His face was quizzical at first, and his eyes moved back and forth, and then he heard the lub-dub…lub-dub of a living heart, and his eyes froze for a second, and the astonishment came, and then the smile, and I saw it in his face, and my heart sang with his. And in that instant I knew that he had learned a precious thing that I could not have taught him any other way.
I will never know what becomes of this child, but I will always know that he knows that a heart beats inside a puppy, and that may change him just a little as he moves on into this harsh world.
The day before, I bent over a friend’s kitty that had had the misfortune of beating up a car, and there was a hole in this kitty’s diaphragm that let his guts slide into his chest, where they certainly didn’t belong, and they made sure he couldn’t breathe right. And I was needed to close that hole. On paper such a surgery is a simple thing. You anesthetize the kitty, and open the abdomen, and pull those things out of the chest and put them back where they belong, and then you find the torn parts of the diaphragm and suture them together, and all will be well with the world.
In reality, such a task is a bit more exciting, and when you contemplate such a task, it feels a bit like Bullwinkle the moose, and “Hey Rocky…watch me pull a rabbit out of my hat.”
You don’t want to know how often, “That trick never works.”
I have this machine that sits in surgery, and its job is to beep every time my patient’s heart beats, and show me numbers that mean the lungs are taking in oxygen and putting it into the blood. It is a useful machine…
But when you are doing the surgery, and you can actually look into the kitty’s chest through that hole in the diaphragm, and you can see the heart beating, and it bumps into your finger as you putz around in there, and the lungs are blowing up and emptying out, it just means so much more to you than a machine can convey. If at that point you could look into my face, you might see the quizzical look, and then my eyes might freeze for a second, and the astonishment might come, even after all those decades of playing this game. You might not be able to see into my future, but you would know that I know that a heart beats inside this kitty… and that is a precious thing.
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