Anguilla

Granted, sometimes it feels that way. When my left thumb joint aches from holding pots and pans while my right hand scrubs them. When the first few steps out of bed in the morning are on shuffling, surprisingly stiff feet. When I can’t avoid a glimpse of my sadly lax skin. However cliché it is to say it, though, my age is just a number. It is certainly not a diagnosis.

Medically speaking, age is part of what we call the patient’s signalment. It is a descriptive term. In people that means the patient’s age, sex and race. In veterinary medicine: age, sex, breed and species. We start with the signalment because right away that begins to narrow our focus. For instance, once you know you are dealing with a female, prostate cancer is off the table. No reason to even entertain the possibility. A Doberman isn’t going to have Feline Leukemia but probably has some degree of heart muscle disease. A 12-year old dog with vomiting and a palpable mass in his abdomen is more likely to have cancer while a puppy with those same symptoms and findings is more likely to have eaten a rock.

To illustrate: I will always remember a case in my early years of practice. I was called up to the lobby to triage an emergency because all of the examination rooms were already occupied. The owner was frantically cradling a cat all wrapped up in a towel. What seems to be the problem? All of a sudden he can’t move his back legs. OK, I said. Trauma it is. Let me take him to the treatment area. He was probably hit by a car. The owner protested. Absolutely not, he is 14 years old and never goes outside. Ok, then. Heart disease and a blood clot to his legs. A quick 180 degree turn and I was off and running again. That is why medical professionals are encouraged to obtain the signalment and medical history BEFORE making their diagnosis. Not my finest professional moment, but I think you see my point.

And getting back to that point, age is a starting place. It should not be the final conclusion. Yet I find people using age that way here in the islands. From other medical professionals asking me, “Do you really want to put an old dog through that?” (whether ‘that’ is surgery or a simple blood test) To owners debating, “Is it really worth doing – fill in the blank – at her age?” To the casual conversation with someone on the street discussing their sick pet and concluding with “Well, my wife says he’s just old.” (And here pets can be considered old at the ripe age of 7.) I honestly don’t remember this being the case in my previous practice life in the States. Of course, in all fairness that was 15 years ago. I am older myself now so it might be that (1) I am more sensitive to the inherent gravity (pun intended) of aging and/or (b) I am losing my memory. Nevertheless it bears repeating.

Age is not a disease.

Furthermore, age is absolutely not a death sentence. Contrary to popular opinion, nobody ever actually dies of old age. Something else happens. At the very least, their heart stops beating. Even dying of natural causes is the manner of death (as in not a homicide, for instance), but there still has to be a cause. Aging simply shifts the diagnostic focus. Again, it makes certain diseases less likely and makes others more likely; and, as ridiculously frustrating as it may be, as we age there are more diagnoses that don’t have ‘cures’ but only the hope of management and mitigation.

Let’s face it, as the years go by most everything gets harder…. scrubbing my pots and simply living another day included. But age is not, in and of itself, reason not to look or to treat or to try. One might find plenty of other such reasons, but age is not one of them. And as I am lucky enough to get older and older and hopefully older, I personally take comfort in that. Consider that I have been with Michael through lots of doctors’ visits and even two weeks of serious illness in a hospital in New York. Doctors recommended myriad numbers of tests, a few surgeries and prescribed beaucoup different medications, and never once did I take one of those physicians aside and not-so-subtly suggest, “yeah, well, but he is pretty old……..” I’m just saying.

So far our small, house call, veterinary practice here on the island has been only a bit different than we envisioned. We thought we would be busy doing primarily routine wellness exams, etc. In reality, however, we have been involved in a disproportionate number of complicated medical cases: unusual cancers, involved metabolic diseases, and major surgeries (performed in the local clinic or across the channel in St. Martin). It is all more of a logistical challenge given the limitations of our mobile, business model. But it is still the standard companion animal medicine we are familiar with so we’ve successfully worked things out on a case by case basis. The other night, though, the call came in that really tested our limits.

At 7PM the phone rang. It was hard for me to understand the caller, but it became apparent that he was calling because he had a goat that was having trouble delivering her kid. He tried to contact other people before us (I have no idea whom), and someone ( I have NO IDEA who) had suggested he contact Pelican Mobile PetCare. I tried to explain to him that I was a city vet. I have exactly ZERO experience with barnyard animals. So he put a woman on the phone to implore me to at least come to see if there was something I could do to help the poor animal. How do you say no to that?

Michael wasn’t home, but I managed to reach him and told him where to meet me by the side of the road….literally by the side of the road. After traipsing through the bush in the dark using my cell phone as a flashlight, we were led to the poor, pathetic, bleating, distressed goat. It turns out she had quite possibly been in labor for nearly 24 hours with the front feet of the kid visible since early that morning. After that many hours, that baby was not coming out in the normal and natural fashion in spite of our noble attempts to the contrary. The kid was likely already dead. (I could feel his teeth and he wasn’t trying to bite me.) And the mother would die too without intervention. She needed a caesarian section, but we are not equipped for that level of surgery. I have instruments and suture materials, but what I have is only really suitable for lacerations, biopsies, small lump removals, that sort of thing. Not sterile, major, abdominal surgery. We tried to explain this to the owner. Who would normally do this for him? Who would have done it two years ago when we were not available? It seemed that nobody else could help.

That’s how we found ourselves doing a goat c-section on a small table on the guy’s back porch under flashlights. We could have given a lecture on how NOT to do things. Local anesthetic only. Intestines spread out on disposable medical pads. Neighbors coming to watch and trying to video tape something that we most certainly did not want documented for posterity sake. It was a circus. When Michael finally pulled out the baby it sounded like a wine cork popping, but damn if he wasn’t still alive. And huge. The minute he was delivered it was impossible to imagine how he could have possibly ever been inside his mother in the first place. But that was only half of the process. We needed to get finished and close up. Unfortunately, the sutures we had were the equivalent of using 4-pound test fishing line to catch a marlin. We could only hope for the best. We rinsed everything with sterile fluids and bathed it all with intravenous antibiotics and put it all back into place. At one point, the mother became weak and barely responsive, so I instructed someone to mix some sugar and water and pour it into her mouth to treat likely hypoglycemia. Damn if she didn’t come around, too.

We tried to impress upon the owner that the mother and the baby needed to be strictly confined….a clearly foreign concept for a free range goat herder. We tried to set him up for the very real possibility that one or both of them would not survive the night. But at least they were alive when we left them. And they were alive the next morning when this picture was taken. (Seriously, I do not know farm animals, but doesn’t he look proportionally large compared to his full grown mother? Yes that is the porch were we performed the surgery, but at least mom was “confined” – i.e. tied to that little chair.)

We go to take mom’s stitches out today. We’ll see if someone is grateful enough to pay us something for our hard work and dedication or if this time saving lives has to be its own and only reward.