Dr. Whiteley.com "My First Case"

My First Case

Fresh out of school and fearful of failure, each veterinarian encounters a first serious case. Mine occurred 12 years ago, and the lesson it taught me has served me many times since.
My first job as a practicing veterinarian was with Dr. Cashion, the owner of an enormous small animal complex in Dallas. Two other young veterinarians practiced at two outpatient clinics, while I assisted Cashion at the central hospital. Cashion was a small, dynamic man with more stamina than any individual I've ever met before or since. His working day started at 7 a.m. and continued to 9 p.m., seven days a week. Dr. Cashion knew all his clients by name, and never appeared to be hurried.

    It was a rule at the hospital that Dr. Cashion was not to be disturbed when he was with a patient. Even though the waiting room was full, everyone was willing to wait his or her turn rather than take a chance on a new female veterinarian. During my first two days at the hospital, I administered one nail trim and two rabies vaccinations to animals belonging to a few brave souls willing to risk me rather than waiting two hours for Dr. Cashion.
     Then, on Wednesday, while Cashion was at lunch, an emergency case came in. When I entered the exam room, I saw a large, elderly woman clutching a tiny bundle wrapped in a towel. A small girl wiping tears from her eyes stood beside her. The woman gently placed the bundle on the table. She turned to me. "Oh, Doctor, I hope you can do something for our kitten." She explained that while the kitten was playing in the kitchen she had slipped and fallen on her.
     I felt a moment of panic as I looked at the kitten, a plump, two-month-old calico. She lay on the table with her neck stretched back and all four legs extended rigidly. She was cold, obviously in shock. Cradling the kitten in my hands, I rushed into the treatment room where I gave her an injection that I hoped would help raise her blood pressure, and started her on intravenous fluids.
     I turned to the woman and girl who had followed me into the treatment room and said, "She is in bad shape. We'll first try to determine if she has permanent nerve damage."
     The woman replied, "I'm Mrs. Murphy and this is my granddaughter Ruth. The kitten belongs to her; I just feel awful about stepping on her. Please do whatever you can."
      As they turned to leave, the girl said, "Her name is Pumpkin." She was crying, and I wished that I could say something comforting to her, but I didn't have much hope for Pumpkin.
       I made an oxygen tent by placing the kitten in a plastic bag with the hose from the oxygen bottle inserted into it. Cashion returned and peered in the door. "That kitten is hopeless, you ought to put it to sleep,"
he said. I continued to work with Pumpkin during the afternoon. She was my only patient, and Dr. Cashion was too busy to think of things for me to do. As I left for home that evening, I feared the kitten would be dead the next day.   Later that night in bed, I worried that Cashion was right--Pumpkin would remain paralyzed and should have been put to sleep.
     Over the next two days the kitten seemed to slowly improve. Friday, I was encouraged to see her look at me alertly; her legs were no longer stretched stiffly in front of her. Cashion entered the ward. "Mrs. Murphy called to ask about the kitten, so I told her that it has permanent brain damage and should be put out of its misery. She agreed but wants to talk to you first."
     I knew Dr. Cashion wasn't heartless. After years of observing similar cases, he felt the kitten had no chance of recovery. As I looked at the kitten, I began a debate with myself. I could go along with Dr. Cashion, or I could dismiss Dr. Cashion's advice and ask Mrs. Murphy to give me a little more time. Would I build up Mrs. Murphy's hopes and a high veterinary bill and ultimately, return a permanently damaged kitten to her?
     Reluctantly, I moved toward the telephone, uncertain what I would say. Ruth answered the phone.
     "This is Dr. Whiteley. May I please speak with your grandmother."
     "It's about Pumpkin, isn't it?" she asked. Dr. Cashion said that she would have to be put to sleep." The sound of a soft sniff came over the telephone.
      "Your grandmother and I will try to decide what is best," I said with a lump in my throat.
      Mrs. Murphy came to the telephone. "What do you think? You've been Pumpkin's doctor from the first, and we'd like to know what you think we should do?"
     I felt a warm glow. Someone had faith in me; they thought I was a real doctor. "Mrs. Murphy, Pumpkin's a long way from being fully recovered, but I feel we still have a chance. She has improved slightly with each day.   She doesn't appear to be in pain, so if it's all right with you, let's give her a few more days."
     "Oh, I'm glad you feel that way," she said. "If there's any hope, I want to keep trying."
     During the weekend, Pumpkin started eating baby food without assistance, so I released her to Mrs. Murphy on Monday. I talked with Mrs. Murphy at the end of that week, and she told me that Pumpkin was doing well; although the kitten could not walk or stand unaided.
     Phil, a young veterinarian employed at one of the oupatient clinics, quit to start his own practice, and I took his place at that clinic. I began seeing more patients, and busy with the routine of examinations and surgery, I forgot about Pumpkin. About six months later, a woman entered the clinic with a beautiful calico cat.
     "You don't recognize us, do you," the woman said. "This is Pumpkin."
     I was astonished. The cat was perfect in every way. She showed no signs of her accident.
      As I think about that case now, I know that the medical explanation for Pumpkin's recovery is that her brain and spinal cord had no permanent damage, allowing for a complete recovery once the damaged tissues healed. However, that first case impressed upon me that every patient is an individual, and each case is different. God is the healer, and we are merely token instruments of that healing. Perhaps, He heard a little girl's prayer for Pumpkin.
My first case took place in 1970, and I am now amazed that I thought Dr. Cashion's hospital complex was enormous. It would certainly be modest by today's standards. Specialty veterinary hospitals offering experts such as veterinary neurologists and advanced diagnostic equipment like MRIs would be able to determine accurately Pumpkin's neurological prognosis. Still, medicine is not an exact science, and I believe that the lesson is applicable today--every patient is an individual and each case is different. And, God is the healer.