Tell Me Where It Hurts: A Day of Humor, Healing, and Hope in My Life as an Animal Surgeon - Hardcover

Trout, Nick

Hardcover

ISBN 10: 0767926439 ISBN 13: 9780767926430

Publisher: Broadway, 2008

Synopsis

It’s 2:47 a.m. when Dr. Nick Trout takes the phone call that starts another hectic day at the Angell Animal Medical Center. Sage, a ten-year old German shepherd, will die without emergency surgery for a serious stomach condition. Over the next twenty-four hours Dr. Trout fights for Sage’s life, battles disease in the operating room, unravels tricky diagnoses, reassures frantic pet parents, and reflects on the humor, heartache, and inspiration in his life as an animal surgeon. And he wants to take you along for the ride.…

From the front lines of modern medicine, Tell Me Where It Hurts is a fascinating insider portrait of a veterinarian, his furry patients, and the blend of old-fashioned instincts and cutting-edge technology that defines pet care in the twenty-first century. For anyone who’s ever wondered what goes on behind the scenes at your veterinarian’s office, Tell Me Where It Hurts offers a vicarious journey through twenty-four intimate, eye-opening, heartrending hours at the premier Angell Animal Medical Center in Boston.

You’ll learn about the amazing progress of modern animal medicine, where organ transplants, joint replacements, and state-of-the-art cancer treatments have become more and more common. With these technological advances come controversies and complexities that Dr. Trout thoughtfully explores, such as how long (and at what cost) treatments should be given, how the Internet has changed pet care, and the rise in cosmetic surgery.

You’ll also be inspired by the heartwarming stories of struggle and survival filling these pages. With a wry and winning tone, Dr. Trout offers up hilarious and delightful anecdotes about cuddly (or not-so-cuddly) pets and their variously zany, desperate, and demanding owners. In total, Tell Me Where It Hurts offers a fascinating portrait of the comedy and drama, complexities and rewards involved with loving and healing animals.

Part ER, part Dog Whisperer, and part House, this heartfelt and candid book shows that while the technology has changed since James Herriot’s day, the humanity and compassion remains unchanged. If you’ve ever had a pet or special place in your heart for furry friends, Dr. Trout’s irresistible book is for you.

About this title

About the Author

Nick Trout is a staff surgeon at the Angell Animal Medical Center and lives near Boston, Massachusetts.

Reviews

This is the perfect gift for anyone considering becoming a veterinarian. Trout, a staff surgeon at Boston's Angell Animal Medical Center, has exactly the traits that any pet owner would wish to find in a vet: he's smart, sensitive, experienced, empathic and has an excellent sense of humor. He also happens to be an excellent writer, and his personality suffuses the many stories sifted from recollections of thousands of animal encounters during his 25 years of practice and compressed in this account into one day. Trout shows how the daily life of a veterinarian requires the ability to be a social worker, a psychologist, a grief counselor, mentor, carpenter, plumber, cosmetologist, athletic coach, magician, grim reaper, and occasionally, guardian angel. And in some of the more heart rending stories, such as that of an older widowed man dealing with the potential loss of his shepherd companion, Sage, Trout shows his sensitivity to the fact that in each case, The rewards and strength of the bonds with the animals in their lives proved irresistible, irrepressible, and more than worth the risk. (Mar. 11)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

Far from the rustic environs of James Herriot’s Yorkshire Dales comes an equally heartwarming, yet high-tech, memoir of a veterinarian. Trout is a staff surgeon at a large veterinary practice in Boston and writes with equal facility of the clinical side of animal surgery and the emotional side of the human bond with animals. Couching his stories as a 24-hour “day in the life of,” the author has squeezed his reminiscences into a single day to capture “the pace, the rush, and the intensity of all that is new in twenty-first-century veterinary medicine.” As he moves from the 2:00 a.m. emergency surgery on a dog with a twisted bowel to an outwardly male boxer with an undescended testicle and an infected uterus, or euthanizes an old Labrador retriever, Trout looks back on earlier cases, muses on such subjects as the ethics of euthanasia and the costs of modern veterinary procedures, and wonders at the different ways the love shared between owner and animal is expressed. This is an addictively readable chronicle of what it means to be a veterinarian today. --Nancy Bent

Excerpt. © Reprinted by permission. All rights reserved.

1
2:47 A.M.
WAKE-UP CALL


This might seem strange, coming from an Englishman, but sometimes emergency surgery in the middle of the night can play out like a synopsis of a perfect season for the Boston Red Sox. The beginning may be predictably crappy, slow, and discombobulated until a rhythm develops and momentum builds leaving you stricken with that familiar glimmer of hope. When it comes to the final stretch, everyone accepts that there may be failure, there may be disappointment, but the struggle is always gritty and memorable, and occasionally, if you are really lucky, something magical will happen.

My beginning came half an hour earlier with a phone call reeling me in from a cozy dreamless void.

"Hello," I said, two disjointed syllables caught in a sticky web at the back of my throat.

"This is Dr. Keene, one of the new surgical residents. We haven't met but I've got a dog, a ten-year-old spayed female German shepherd; she's bloated and . . . like . . . well . . . I need you to come in for the surgery. Sorry."

All I heard was sound, not words I could interpret, my brain dormant on my pillow.

"Hello, are you still there?"

"Yeah, sure, I'm listening," I croaked, wiping a palm across my face. "What time is it?"

She told me and dove into her apology.

"I really hate to disturb you but, like, my backup's not answering his pager and, like, I didn't know what else to do." Her words surfed through me--a Valley Girl inflection--and sluggish gray matter dug out a memory of a recent departmental memo--"Be sure to welcome our first-year surgery resident, Dr. Sarah Keene, from the University of California, Davis."

I came awake, sat up in bed, and told my wife to go back to sleep.

"No problem, Dr. Keene. Tell me about your GDV."

As a new surgery resident, Dr. Keene may know all about GDV, an acronym that stands for gastric dilatation and volvulus, commonly referred to, with a satisfying rustic flavor, as "bloat." But more than likely, at this stage in her training, her understanding is primarily academic, words and phrases in a textbook, disease as bullets of information in shocking fluorescent pink highlights. She will be a year out from veterinary school, a year in which she will probably have diagnosed and managed several cases of GDV. She knows all about this bizarre anatomical aberration and the inevitable, rampant pathology it will incite. She even knows exactly what needs to be done. But, until now, until tonight, she has never been the one who actually picks up a scalpel and makes the cure happen. Tonight, for the first time in her professional career, she is the surgeon on call, and not surprisingly, she is in need of some help.
GDV is a true veterinary surgical emergency. It typically occurs in deep-chested dogs like German shepherds, Great Danes, and standard poodles but, on occasion, I've even seen it in breeds as small as dachshunds. No one is entirely sure why it happens, but oftentimes the animal eats a large meal, gets some exercise, and an hour or so later the problems begin. Fermented gas starts to accumulate in the distended stomach, and for whatever reason the entire organ twists around and flips over on its long axis. The effect is catastrophic. The twist blocks off the esophagus so despite the poor creature's desire to throw up and rid itself of all that food and gas, nothing will budge. The stomach expands unchecked, destroying its own blood supply, driving into the chest and squashing the lungs and the blood flow back to the heart. There is no absolute timetable for how long an animal can survive in this state, but dogs can die in a matter of hours. As soon as the diagnosis is made, the clock is ticking.

"She got into a full bag of kibble around seven. Owner took her for a walk before bed. He could hear the dog trying to vomit unsuccessfully around midnight and drove her all the way up from the Cape. She looks ready to explode. Classic double-bubble on abdominal X-rays."

I had been waiting for this description, the twisted, distended stomach looking like the silhouette of a giant heavyweight's boxing glove on an X-ray. It tells me her diagnosis is correct.

"Is she stable?" I asked.

"Not really," said Dr. Keene. "Her pressures are through the floor and we're having a hell of a time just finding a decent vein, let alone placing a catheter."

My feet were swinging out of the bed and I began to fumble for clean clothes.

"Do your best. Try to pass a stomach tube. I'll be there as fast as I can."


Angell Animal Medical Center, part of the Massachusetts Society for the Prevention of Cruelty to Animals, is located in the eclectic and increasingly gentrified Boston neighborhood of Jamaica Plain. There are no world rankings of veterinary hospital size, but at 185,000 square feet I imagine Angell is one of the larger ones, with over seventy veterinarians serving nearly fifty thousand dogs, cats, and exotic pets every year.
After ten years on staff as a surgeon, I know that those nasty rumors about Boston traffic are all subterfuge because at three in the morning, an easy commute is rewarded with my pick from one of the primo parking spots close to the front door.

It is January in New England. There are a couple of inches of snow on the ground, a miniature version of the Andes has been plowed against the perimeter wall, and today's high will be only ten below. I walk across the salted asphalt like a geriatric with a bad case of hemorrhoids, poised to slip on the black ice. Despite the hour, my sleepiness is starting to burn off like fog on an imaginary sunny morning as I enter this five-story brick building and head toward the nonsterile surgical prep area. The corridors are empty, floors polished, phones silent, and pagers dead. I have entered an antiseptic ghost town and I like the way it feels. It reminds me of being a kid again, of breaking into the neighbor's backyard in order to steal the ripe apples taunting me from their tree. The mission is covert, even risky--all but guaranteeing the rewards will make it worthwhile.

Cutting through the radiology department, I catch a glimpse of my reflection in the glass window outside the MRI unit. The man I see looks unfamiliar. He has piggy eyes, a pillow-crease scar across his left cheek, and a jaunty case of bed head. Thank goodness my patients never judge me on my appearance.

My patient lies splayed across a large gurney, nervous nails clawing for purchase on the stainless steel surface. She is a big girl, obviously not lacking for love in the calorie department. Her darting chocolate eyes scream in fear of her strange situation and the changes taking place in her body, but as I enter the room and approach, her broad and bushy tail offers me a couple of friendly beats. I like German shepherds. I grew up with one as a kid, but this gesture strikes me as both uncharacteristic and, at the same time, utterly endearing. Until this moment I have been dealing with an anonymous and remote animal reduced to a list of diseases, conditions, problems, and deformities. Suddenly everything has changed. This animal has a name and a personality. This animal has become my patient. This is the moment when I begin to care.

I pat her head and run my hand across a soft velvety ear, over her chest and down to the enormous, unyielding abnormality that is her drum-tight abdomen.

"Hi, sweetheart. You hanging in there?"

For me, all my patients are "sweethearts" until proven otherwise, whether they are male or female, cute and cuddly Himalayan kittens or slobbering and stoic 250 pounds of bullmastiff.

Holding a needle and syringe, Dr. Keene, a short, shiny-faced woman with blond hair in a ponytail, turns to me. She can be no more than twenty-five. I wonder if at forty-three I'm getting a little long in the tooth for this game. She glares through sparkly green contacts as though she thought I had been addressing her. I introduce myself, offer my hand, and assure her that I was speaking to our patient.

"This is Sage," she says, trying to apply an oxygen mask to the dog's snout. "I'm Sarah, and this is Dan." She gestures to a technician I have never met before, although this is not surprising given the hour. For most of us working in a busy animal hospital, being on call for surgical emergencies every other night, every other weekend, is simply not sustainable for more than a couple of years. Nocturnal surgical emergencies are a rite of passage, an inherent requisite in any decent residency program, a privilege to be endured and enjoyed. But now, nearly fifteen years after the completion of my training, my midnight forays into the OR are limited to the one week in every month that I am available as backup to the residents.

Dan juts a square chin in my direction and gives me a casual " 'sup." He has a pierced right eyebrow and lower lip with colorful sleeves of tattoos running down his arms in perfect contrast to the sallow vampire skin of his face. In different surroundings he might attract attention, but here, working the overnight, he can relax, setting up the EKG leads, sorting out the pulse oximeter, and adjusting the intravenous fluids with an experienced hand.
There is a small shaved square on Sage's flank where an attempt has been made to release the trapped and expanding gas in the dog's stomach by directly puncturing the organ with a large bore needle. I touch the small red bull's-eye in the center of the bald spot. The skin is impossibly taut. Clearly the attempt failed.
"No luck with a tube?" I ask, although I know the question is redundant. If they had successfully passed a stomach tube, the preferred method of decompression, there would have been no need to try to use a needle.

Dr. Keene shakes her head.

"I'm afraid not," she says. "She's in bad shap...

Edition details

• Publisher: Broadway
• Publication date: 2008
• ISBN 10: 0767926439
• ISBN 13: 9780767926430
• Binding: Hardcover
• Language: English
• Edition number: 1
• Number of pages: 304