It's a hot sunny afternoon and an extroverted and vibrant lady in her late twenties hurries into the hospital with a basket dangling in her left hand. “Doc, it's an emergency!!”, she exclaims. I was looking into another Labrador which was recovering from anesthesia after a routine dental cleaning. I quickly stopped and led her into the cat examination room. I opened the basket from the top and a young-adult ginger cat springs out in a jiffy while flaying my hand. He jolted to the nearest window sill and climbed all the way up even as I pulled his hindlimbs. Not the ‘Emergency’ I was expecting! The kitty found a sweet spot between the window glass and the topmost grills in a cozy corner and was quite content to have an eye out over our impending conversation from the top.
On questioning the enthusiastic lady, she articulated a two-minute story of how she ‘rescued’ this cat. It turned out the kitty was apparently just another neighborhood stray roaming around the lady’s gated community for about a month now. She happened to notice the cat breathing ‘abnormally’ ever since she’d been sighting him. After a couple of failed attempts to capture the poor guy, she called in a couple of her neighbors who managed to finally put him in a big fruit basket that she had gotten into the clinic. That was all the history I could muster. And considering that he was roaming around and evasive for weeks, he had to be otherwise alright.
He was about 10-11 months old. On examining the cat, he was literally gasping for breath. It seemed like one of the simplest involuntary actions of respiring had turned into a grueling ordeal for the little one. But in reality, I felt it wasn’t as bad either considering he was clearly capable of evading potential predators for almost a month. He looked emaciated and almost all abdominal organs barring his urinary bladder were in his thorax after penetrating the thin sheet of muscle separating the two cavities. It was a clear case of Diaphragmatic Hernia, a traumatic condition where the contents of the abdomen end up in the thorax after the diaphragm gets ruptured, mostly due to trauma from a fall from a height or a hit from a vehicle. It was pretty evident without any diagnostics and confirmatory on a radiograph,
I conveyed the same to the rescuer in depth. I let her know about the potential treatments and their prognoses. It was pretty straightforward, he either had to be operated upon to re-establish a border between the two cavities again, which sounds a lot easier than actually performing, or had to be left as he was. Now, being left as he was didn't necessarily mean he had to be left to die; I meant he had to be left to live, live a seemingly handicapped and challenging life but one that was endearing to him and that he had already been living for a while now.
The surgery to correct the same is a fairly straightforward procedure but requires more than just a surgeon. Any invasive surgery of the thorax demands a mechanical ventilator and a skilled anesthetist, all of which raise the cost of the procedure multifold. These are the surgeries that give you a real serotonin boost and you want to perform as a passionate surgeon. However, the chances of the owner opting for surgery understandably seemed distant but I coaxed her to consider it anyway by offering her a complete rebate off our profits. As vets, we can’t suggest euthanasia as an outright treatment modality but it's our responsibility to let the owners know of such an option. I reluctantly let her know of the same in a sullen tone after she threw light on that subject while dreading the possibility of her opting for it.
She was understandably taken aback knowing the cure wasn’t a touch or a prick away. She needed a breather before she took a call, and a long one at that too. We lured the cat back into his fruit basket by vacating the cat room for a while hoping he would want to get in a cozier place. It took more than just that seemingly smart but of thinking to put him in but we managed to get him in his fruit basket ultimately.
The next day, she walked into the hospital at pretty much the same time and bemoaned in a determined tone. “Doc, We’ve decided to put him down. We just can’t watch him struggle”. I was confounded, distraught, and gripped by a fleeting moment of overwhelming sadness. I indisputably denied her request stating I couldn’t see a plausible reason to take the extreme call. The cat was able to hunt mice, keep his heart and soul together and literally give the counterfeit ‘rescuers’ a run before being captured. “You didn’t have to ‘rescue’ the cat if this is the call you’re taking”, I said, which came out as a thinly veiled insult. I might have crossed my line slightly being judgmental and a tad bit rude but it's heart-wrenching to see such an animal being put down for not being pleasing to the onlooker’s eye. By that logic, all differently abled and sick people should be banished, which obviously doesn't make sense either.
I left no stone unturned in convincing the lady. It's hard, very hard to accomplish that. As vets, we very frequently end up handling clients whose emotional brain (the Amygdala) would have overshadowed the reasoning center (the Frontal Cortex) and you can’t talk sense into them. It’s not that they are fools, they just aren’t at their best to take the right decisions. And in that state, it doesn’t take long for their sadness to turn toward the varied spectrum of negative emotions.
I was instructed by the management to go ahead with the procedure and I kick myself even to this day for agreeing to that. I clearly shouldn’t have abandoned my stand. On the contrary though, if it wasn’t me, my senior colleague would have put him down anyway. I don’t intend to wrong anyone here but many vets including my colleague at the workplace use only a shot of succinylcholine, a skeletal muscle relaxant because of its ease of administration. Succinylcholine is a synthetic analog of curare, the poisonous extract first found in poison-dart frogs of the Amazon forest. It paralyzes the respiratory muscles and kills the animal, all while it's completely aware and grappling to take in its potential ‘last breath’. Usage of such drugs is outright cruel, inhumane, and forbidden as per the American Veterinary Medical Association guidelines, 2020. It’s synonymous with suffocating a person using a pillow with his limbs tied. Ideally, the animal has to be unconscious before attempts are made to terminate the heartbeat and breathing. The use of sedatives, anxiolytics, and anesthetics is of paramount importance concerning animal welfare. Without the ideal use of these agents, one might as well stick a knife into the animal and term it ‘mercy killing’.
I was left to choose between a rock and a hard place here. I could have denied performing the procedure stating my reasons which would mean the cat would have a painful and horrific two minutes before it ultimately gave up. Or, I had to get my hands dirty and let my heart ache so that the poor kitty could at least pass away peacefully. As much as I knew that it wasn’t even a consolation to the muddle the cat was forced into, a peaceful death was the bare minimum and the most that I could provide. So, a peaceful death it was. Or, at least, that’s how I convinced myself.
I had an epiphany. Compassion fatigue is underrated, but real and scary. And it's unfortunate because compassion is an inseparable part of our profession and you can’t really execute your roles of being a surgeon and anesthetist without putting your heart into it. Compassion fatigue in vets is a leading cause of burnout, suicides, and attrition in the USA and I can understand why.
While the lady must have indeed felt deep contentment after her humble attempt to end the sufferings of a mute soul, the question remains ‘Does true Altruism really exist?’ And as a vet, there’s only so much you can do. With my qualifications as a small animal surgeon and anesthetist, I felt I had better chances of pulling off the difficult surgery than convincing the owner to opt for it.
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