Paging Dr. Jasny
Although I was on emergency call that Saturday, I figured it wouldn't be busy so early in April. Surely I could risk taking my kids to a play. I put my cell phone on vibrate as we entered the theater. Too late to get an aisle seat, I sat at the far end of the third row, where I could make a quick exit by climbing over a railing, jumping down a few feet, and exiting a side door to the fire escape.
The house lights dimmed. With impeccable timing, my phone buzzed. Being a bit of a Luddite, I don't know exactly how it works. Thinking I was turning it off, I pushed a button. "Heellloo?" a voice echoed through the hushed theater. I had inadvertently turned on the speakerphone. Catapulting myself and my squawking phone over the railing, the voice got more strident as I swung awkwardly over the bar. "Hellooooo? Anyone there?" I raced from the theater, vowing to read the phone's instruction manual.
"A dog has been hit by a car. Can you meet the Animal Control Officer at your office?" "Any owner?" I asked. "Not yet," they replied. I sighed. The last time this happened it took three days for an owner to show. The town covered the base emergency fee, but other than that, I never got paid. Nor did we ultimately save the patient. Maybe this time would be different.
The ACO arrived with a big shepherd cross cowering, loose, in the back of her truck. Unable to use his hind legs, he nonetheless was able to haul himself around, baring his teeth and growling. "He was very aggressive toward the police, but he likes this gentleman," she said pointing to a slender man talking soothingly to the dog.
"The owner?" I asked hopefully. No, a Good Samaritan who lived nearby. Since the dog had taken a shine to him, and was snapping at everyone else, the gentleman had graciously accompanied the ACO and was now attempting to cajole the dog out of the back.
"Let's get him safely under control." I reached for the rabies pole - a wire noose on a long metal rod that you can operate from the end in your hand. Looping the noose around the dog's neck, I tightened it gently, then pulled him toward us. The Good Samaritan calmed him as I slipped a muzzle on, and we moved him inside.
The dog had a collar but no identification tags. He could not stand but sat in an odd position, his hind legs poking straight out in front of him. He had feeling in his legs, a good sign, but was unable to voluntarily move them. There were multiple abrasions, contusions, and lacerations of his groin and thighs. His left hip was painful. I suspected a pelvic fracture, an injured hip, possibly spinal cord damage. Internal trauma, such as a ruptured bladder, was also a concern.
While I started treatment for shock and pain, the phone rang twice more. A cat with an enormous gash. A dog who drank antifreeze from a toilet. "Antifreeze can be lethal, even in small amounts, " I said, instructing those owners to induce vomiting then get to my office ASAP. The cat, too, would come right in.
"Hey, Molly," I phoned my assistant, "I've got a biting Hit By Car John Doe that needs X-rays, a wounded cat, and an antifreeze poisoning on its way. Can you come help?"
Molly arrived. John Doe got a urinary catheter. We admitted the cat, and prepared for the antifreeze slurper. When he arrived, he had not vomited, so we gave him medication to make him throw up. In the old days, we treated antifreeze ingestion with intravenous ethanol, actually vodka diluted in saline, keeping our patients inebriated for three days. This prevented the antifreeze from being metabolized into the form that causes irreversible kidney failure. Nowadays there is an antidote that is easier to use, one injection every 12 hours for four doses. It is, however, quite expensive.
A phone call to the plumber confirmed that it was indeed ethylene glycol in that toilet. No surprise. We see too many of these - dogs drinking out of toilets in houses being opened for the season. There are pet-safe brands of antifreeze. I wish everyone would use them, especially the plumbers. At the very least, put the lid down and tape it shut with a big sign that says "Antifreeze."
After our patient vomited, we gave activated charcoal to bind any poison left in his stomach and prevent it from being absorbed into his blood. "It might not be a lethal dose," I said, "but I wouldn't take any chances. If it were my dog, I would definitely give the antidote." We gave the first injection. The owners opted to cut their vacation short and bring their dog to the Foster Small Animal Hospital at Tufts for the rest of his injections. I sent them on their way and prepared to suture the cat. It was a long wound, but superficial, and should heal well.
Evening came. We still had not heard from any owners of John Doe. Now what? "Let's get some basic radiographs, while I still have you," I told Molly. Our skewed views revealed a dislocated hip, a possible slipped disc, but no obvious pelvic fractures. It was evident that John Doe was too painful, and aggressive, to get all the films we needed without anesthesia. I tucked him in for the night. Someone would surely call in the morning.
Sunday morning, no one called. If I was going to get that hip back in the socket, the sooner the better. That would require anesthesia, as well as a greater certainty that the pelvis was not broken. The leg wounds also needed attention. Molly came back. We anesthetized John, took films, sutured wounds, and tried unsuccessfully to pop that hip back in. John needed an orthopedic specialist - someone who pops hips in daily, maybe even surgery to get the hip in place. But no owner appeared.
What to do?
Sunday night, I opened John's cage to give his evening medications. He growled and bared his teeth. I tried again. He threatened more. I was alone. My family was asleep. I decided not to risk it, and instead put pills in a bowl of food and slid it cautiously into the cage. Maybe he would eat it. All night I tossed and turned. Partially paralyzed. Unpredictably aggressive. Guarded prognosis. No owner. In need of expensive care from a specialist. What should I do? Legally after 24 hours I am entitled to "dispose" of him. If no owners show up, do I euthanize him? Look for funding and someone to take him to the specialist? Keep him here?
Luckily the next morning his owners called. It seems John Doe has a penchant for wandering so, at first, they were not worried. Now that they found him, they agreed to take him off-Island. The next day, the specialist was able to get the hip back in, but it remains to be seen whether it will stay in the socket without further surgery, and whether his spinal cord injury will resolve. In the meantime, he will stay hospitalized at a 24-hour care facility for a few weeks. We earnestly hope he makes a full recovery.
The morals: Obey the leash law. Put identification on your dog. Contact the Animal Control Officer as soon as your pet is missing, even if he's a wanderer. Be grateful for Good Samaritans. Use pet-safe antifreeze. Close the toilet lid.
My other patients are fine. The cat went home. Tufts called to say the antifreeze dog was doing great. My kids said the play was wonderful..., and I still don't know how to work my cell phone.