Drinking from the Trough Read online

  Dr. Banks wasn’t our only instructor, of course. Dr. Robertshaw, a well-dressed English gentleman with a ruddy complexion, lectured on the physiology of the digestive system, explaining how the system works in various animals.

  One lecture, presented in his serious, upper-crust British accent, was on deeee-fecation, or solid waste elimination, and how animals accomplish this. You and I call it defecation.

  Okay, it was a lecture about animals taking a crap.

  At first, it just seemed a bit strange, watching this man in a tweed suit, vest, and tie speak in that sophisticated accent about the process of pooping. But the mismatch grew even more pronounced as his discussion continued. This was clearly his favorite subject.

  Feces are pushed out of the body by bearing down on the abdominal muscles in order to release stool, a process called the Valsalva maneuver, named for Antonio Maria Valsalva, a seventeenth-century Italian physician.

  The Valsalva maneuver can vary in intensity. There can be weak pushes or strong pushes. Dr. Robertshaw pointed out that people can actually die sitting on the toilet if they do the Valsalva maneuver too hard and long without breathing. The maneuver can stop the heart. He spoke at great length about constipated Grandma dying on the can. By the time he reached the Grandma example, the lecture hall was filled with quiet snickering, my own included.

  Like most of us, I’d thought of death as dying peacefully in bed, surrounded by loved ones. Here was a distinguished British fellow talking about how Grandma died on the pot trying to alleviate her constipation. Perhaps she’d been taking a stool softener, and she’d settled her creaking bones onto the cool porcelain throne, praying to the Almighty for a pleasantly soft poop while reading a romance novel. But, being constipated, she pushed so hard trying to get her rock-hard stool out of her rectum that she’d died of sudden cardiac arrest.

  By the time we reached the end of the lecture, the snickers had become giggles, then, as we escaped into the hallway, outright laughter. Some of the humor was because we’d never heard of the Valsalva maneuver before and hadn’t thought about what was involved in such a basic biological function. Some was the weird-to-us pronunciation of deeee-fecation and the juxtaposition of proper Dr. Robertshaw and the improper discussion of bathroom activities. Or maybe that’s too much rationalization; maybe it was just that we’d never outgrown potty humor.

  Dr. Robert Kainer was the head anatomy instructor for freshman spring semester. He was a gifted anatomist and an excellent teacher. Later, he became my employer and friend.

  Dr. Kainer had been lecturing for days on the structural anatomy of the equine hoof. Day after day after day, he spoke in exquisite detail about its microscopic layers. We watched a seemingly infinite parade of slides of the same image with different colored stains illustrating the various tissues that were so important for us to learn. Even I eventually began to nod off.

  One day, from the far back of the lecture hall, a student raised a weary hand. “Dr. Kainer,” he said, clearly suffering from a severe case of information overload that had short-circuited his common sense. “Why do we have to learn all this stuff?”

  The lecture hall instantly became as quiet as a tomb. The only sound was the whoosh of the ventilation system.

  Dr. Kainer glared at the offending student for a long moment, then replied in a clipped tone, “Well, young man, I guess all you’ll need is a syringe and a lariat, and you’ll be ready to practice.”

  His response broke the tension, and the entire class cracked up. We understood what Dr. Kainer meant: we’d better get on board with a medical education filled with the accurate details we needed to properly diagnose and treat animals. Learning the normal structures is crucial to the ability to identify the abnormal. Learning what was normal, from the largest overview down to the tiniest detail, was our job and our responsibility, and it was really what freshman year was all about.

  Soon after, exams wrapped up freshman year. I was by no means near the top of the class, but I had a decent enough grade point average, and I was thankful to have it.

  Sophomore year, pathology replaced anatomy as our major morning course. Disease systems courses began after lunch.

  Dr. Patty Olson taught our first disease course, Diseases of the Endocrine System, which entailed the study of all the disorders of the endocrine glands in the body. These are the ductless glands that secrete hormones or other products directly into the blood, and the information about abnormalities applies to all species. The course covered the effects of the over- and under-secreted hormones from those glands.

  We’d studied the normal structure and function of the endocrine glands the previous year, and I’d done fine with it. But the endocrine diseases course was a mixed-up jumble for me. I was confused all the time. My concrete sequential style of learning in an orderly fashion, A-B-C-D-1-2-3-4, failed me.

  Animals don’t have symptoms as humans do. They have clinical signs.

  A human who tells his doctor, “Hey, Doc, I have a bad bellyache and some diarrhea too,” is describing a symptom. An animal who is lethargic and off its feed is displaying clinical signs.

  We learned step-by-step pathways to discover what disease was presenting, but animal patients don’t necessarily follow the algorithms we learned. Animals don’t read their lab work, and they can only tell you what is bothering them by the clinical signs they manifest.

  Clinical signs were the key to diagnosis. Simply memorizing—like learning the name and function of a shoulder muscle or regurgitating Anna’s lessons about the cranial nerves—didn’t work. I had to have the thought patterns to get the knowledge. It’s the biggest difference between book learning and the laying on of hands. It would be another year before I began clinical rotations; for now, I had to focus on the causes, clinical signs, diagnoses, and treatments of abnormal endocrine function and real diseases.

  I was in serious trouble. To succeed, I had to overcome my natural learning style and find a new way to think. I needed to develop a more abstract learning style. There were times when I thought my head was going to explode.

  I would wake up in the wee hours in a cold sweat, convinced that my diabetic patients were going into ketoacidosis. Diabetic ketoacidosis is a life-threatening complication, insanely difficult to treat, and it can quickly kill the patient.

  I soldiered on, despite my starring role in the Walking Dead Vet Student Night Terrors. I wish I’d known at the beginning what Dr. Olson confessed to me just before the final exam: she never graded anyone lower than a C unless the student was truly a dolt, and I was not, she assured me, a dolt.

  I was never happier to get a C in my life.

  Pathology, which met in the mornings, was challenging but not as nerve-racking, at least for me. In anatomy, we’d studied normal structures. In pathology, we learned the consequences of disease, the morphology that told us what made the animal sick and how and why it died.

  Dr. Jaenke, one of our pathology professors, told the story of a dinner party he and his wife had hosted. The main course was roast leg of lamb (a personal favorite of mine). As he sliced into the meat, the carving knife opened up an abscess the size of a tennis ball. Viscous grayish-white pus poured out of the meat and onto the platter.

  Fortunately, none of the guests saw the disgusting river of infection. He quietly disposed of the meat and called for Chinese takeout.

  I’d never eaten liver, and after the class in veterinary pathology, I swore I never would. The huge portal vein that drains the intestines goes directly to the liver, bringing along any disease-causing organisms. The liver tries to remove them. Nasty-looking abnormal livers paraded past us in the lab and on lecture slides. Liver and onions? Not in this lifetime.

  At the beginning of the semester, Dr. Jaenke asked for volunteers to come in early on Fridays to set up lab specimens. These were from cases that went to the necropsy lab during the week for diagnosis, after which they were returned to the Veterinary Teaching Hospital for the afternoon’s one o’clock pathology
rounds. The volunteers set up the specimens so they could be broadcast along with explanations via closed-circuit TV into the lecture hall. Afterward, students could examine the specimens in the lab. I was chosen to be one of the volunteers.

  It was interesting work; I got to see the specimens up close while preparing them for viewing. I felt rather like a funeral director preparing a body for visitation. I also thought there might be potential for a little comic relief with the “organ recital.”

  I discarded my first impulse; decorating specimens with parsley and crackers would be both tacky and disrespectful. But it didn’t take long for a better idea to surface.

  I recorded the theme song to All My Children—my beloved soap opera, which most of my classmates watched too—and made a book cover with the title All My Innards. In the lab, we played the theme song, and as the camera beamed the music and image to the lecture hall, we opened the book cover the same way the soap opera began, and then the professor presented the various organs and case histories.

  The transmission was only one-way, so my fellow volunteers and I couldn’t hear the reaction of our classmates. But later, friends told me that the entire class had erupted in laughter, not just at the comedy but because they knew exactly who had perpetrated the joke. I think it helped everyone relax a little bit. I know it helped me; I slept better that night than I had all semester.

  During spring semester, we had eight classes. The veterinary ethics course had an option: instead of attending class, you could write a paper. Juggling the studying for seven classes would be tough enough; I opted for the paper, wrote “Understanding Grief and Pet Loss” during the winter break between the semesters, and attended only two of the actual class sessions. I got an A on the paper and thus in the class.

  To my surprise, the professor suggested that I submit my paper for publication. Not only did Intervet, the national veterinary school publication, accept it but it awarded me a hundred dollars for the best article in that issue.

  I dove into the rest of spring semester’s classes, reveling in the fascinating topics our professors presented.

  Well, most of them.

  Dr. Kessel, with her wild and windblown hair, long peasant skirts, and Birkenstocks, looked like a refugee from a 1960s hippie commune. She was a researcher, working with laboratory animals in a secured building next to the pathology building. Her primary area of research had something to do with rabbit diseases.

  I’d come down with a nasty case of bronchitis and was doing my best to pay attention, despite what was (to me, anyway) a stultifying lecture on rabbit research.

  My surgery partner, Steffan the Obnoxious, was sitting beside me. When Dr. Kessel said something about having to slice up dead rabbit tissue so she could study her results on slides, Steffan leaned over and whispered that she chopped them up using a new machine called a “Rabbomatic.”

  I pressed my hand against my mouth, trying to keep my giggles from escaping. Steffan stepped it up a notch and kept going on and on about the Rabbomatic, just to make me laugh harder. My shoulders shook and tears ran down my face; I could barely breathe. Then my bronchitis kicked in, and I started to cough too, that deep hacking cough typical of bronchitis. I fled the room before I could cause any more disruption and sat in the hall outside the door so I could hear the rest of the lesson. I was glad to have escaped without Dr. Kessel realizing that it wasn’t just coughing that had caused me to rush out.

  As the end of sophomore year wound down, another pathology professor said, “It goes fast from here.” He was right. It was time to get our hands on some patients. It was time to move to the hospital.

  7

  Sick Pets and Summer Olympics

  Summer Olympics, 1984—and the women’s gymnastics finals!

  I’ve been an avid fan of the Olympics my whole life. You might think it’s because I’m an ex-gymnast myself, not to mention a former physical education teacher, or because my cousin Dave competed in the Olympic steeplechase trials, though he didn’t make the final cut for the 1984 Olympic team.

  But my fascination began with my mother’s friend Elizabeth “Betty” Robinson Schwartz.

  Betty won the one-hundred-meter dash at the 1928 Olympics in Amsterdam. It was the first time female track-and-field athletes were permitted to compete in the Olympics, and Betty had won the gold. She’d added a silver medal as a member of the American relay team that year too.

  She’d been only sixteen years old, and even more amazing to me, she hadn’t even trained as an athlete. Charles Price, her high school biology teacher and the assistant track-and-field coach, saw her sprinting for the commuter train—she was late but made it to the train—and was amazed at her speed. The rest, as they say, is history.

  She’d been slated to compete in the 1932 Los Angeles games, but in June 1931, she and her cousin had almost died in a plane crash near Chicago. In 1936, after rehab and surgery that left one leg half an inch shorter than the other and unable to bend enough to kneel in the classic starting position, she returned to the Olympics, winning gold again, this time as a member of the American relay team—in front of Hitler—beating out the much-favored German team.

  Betty and my mother had worked together in Wienecke’s, the Glencoe hardware store, where I’d worked during my undergraduate summers. I’d loved hearing her stories, loved the fact that most of those North Shore matrons imperiously barking out demands had no idea that their salesperson was a famous athlete who’d won gold medals not once but twice. I’ve never forgotten the feel of holding her Amsterdam gold medal, as if I were sharing the glory of being the fastest woman on the planet.

  Of course, I didn’t have the luxury of spending the entire day watching the Olympics on television. I had chores to do, beginning with feeding the horses, and then there was Keli’s “respay” appointment. But my plan was in place, and I was confident that I’d be done in time for my favorite Olympic events.

  When Keli, our first Siberian husky, had been spayed as a puppy, a tiny bit of ovary had been left behind. It’s a relatively common problem; the ovaries can be hard to see in their entirety. The left-behind piece secretes hormones, which cause the dog to go into heat (also called estrus). She can’t get pregnant, but dogs don’t know that, of course!

  And humans don’t know that the bit of ovary has been left behind until the dog goes into heat despite being spayed. Estrus only happens twice a year, so it can be a while before the problem is discovered.

  During estrus, the ovarian tissue enlarges and is easier to see, so as soon as you realize your dog’s in heat, you want to respay as quickly as you can get an appointment with your veterinarian. Otherwise, you wait another six months for the animal to go into heat again, to find and remove the offending tissue.

  I’d suspected that Keli had been in heat once before because she’d been acting “bitchy” (pun intended!), but it wasn’t until one lovely August morning about a year and a half after she’d been spayed that we confirmed her diagnosis.

  I awoke, rolled out of bed, and opened the curtains. There was Keli down in the dog pen, locked into the distinctive canine mating position with a stray dog. She was facing north; her sex partner was facing south—the position is called a “tie” and can’t be broken until ejaculation—and I swear Keli had a satisfied grin on her face that no amount of her beautiful cloverleaf mask could disguise.

  I, however, was not amused that my virgin husky had been deflowered. I stomped downstairs to find my five-iron, nearly breaking my toe in the process when I slammed it against the wicker couch. By the time I’d recovered and stormed outside, the evil cur had run off. Game over for Keli! And time for me to schedule an appointment with the veterinary surgeon who had spayed her the first time. She’d need to do an exploratory laparotomy and, once she found the recalcitrant bit of ovary, remove it.

  “Respay day” ended up being the same day as the women’s gymnastics finals. I scheduled Keli’s surgery for first thing in the morning. We’d all be home by midafternoon,
and soon after, Earl and I would be cheering for our favorite Olympians.

  But first, there were horses to feed.

  Earl and I lived on the family “farm”—a large house with a yard, a corral, and a few outbuildings in what was now the middle of town. Earl’s grandfather had sold the rest of the original farmland to a developer long before I’d met Earl. What remained was a little piece of the rural West hidden away behind student housing and older suburban homes.

  I walked to the barn and measured out the grain for each horse. I dispensed enough flakes of grass hay to last them until suppertime.

  Horses live to eat, but this morning, Marcie wasn’t eating her breakfast. She had a look in her eye that I’d learned meant trouble. Something was definitely wrong.

  I examined her carefully and discovered an inch of a nail sticking out of the very center of her abdomen.

  “How did you get a nail there?” I asked her, shaking my head in disbelief. Most likely, she’d rolled onto it in the corral, but even that scenario didn’t completely explain such bad luck.

  I couldn’t tell how long the nail was, and I certainly wasn’t going to remove it. I was only a rising second-year vet student, not an expert nail puller.

  So much for my neatly planned morning.

  Earl and I hitched up the trailer to the pickup truck and loaded Marcie into the trailer. Earl drove Keli to the surgeon for her respaying, and I drove Marcie to the Veterinary Teaching Hospital, where she was admitted as an emergency patient.

  The equine medicine resident pulled out the nail, yelling “Ouch!” for dramatic effect. The nail was six inches long, rusty and corroded, clearly an antique from times long past. Why it had surfaced now, no one could say.