Friday, June 28, 2013

Fuji's Problem

A ringing phone in a veterinary hospital opens up all manner of possibilities. You never know what you are going to get. And even when the caller tells you exactly what has happened with a pet so you might know what to expect when they arrive, it pays to see things for yourself. Because sometimes client perception, or client deception, differs from reality.

My receptionist leaned into my office.

“Bin Tappingakeg is on the phone. Says his dog is in the ditch next to the road and it’s being attacked by vultures.”


“Bring it in?”

“Seems reasonable.”

Turns out ole Friskee had been out in that ditch for a few days, just laying there under the hot sun, next to the road, and each day the vultures were coming closer. Bin must have figured those big birds were the culprits onnacounta how often vultures attack sixty pound dogs???

The fractured rear leg was the first thing to catch my eye when Bin carried Friskee in, what with the way it swung to and fro as if not properly attached. Bin “seen that”, but figured the vultures “dun it to his dog”. The immediate proximity of the highway was my first thought, but of course, I was wrong too.

My x-ray of the leg revealed the true nature of the injury. Ole Friskee actually had bone cancer, which had weakened the thigh bone to the point where it fractured under his own weight. And he’d recuperated in that ditch for days, unable to move while Bin contemplated what to do about them vultures. Friskee wasn’t in the best of shape by then, and after a heated discussion, Bin finally accepted my version of reality.

Traveling back in time to the mid-seventies, and yes…we did have telephones back then, but they were fixed to the wall, I recall the phone ringing one morning. Seems a client had dropped his toolbox on the puppy’s tail, and he couldn’t get the bleeding to stop. Well, come on down!!

That seemed a bit weird to me, but I had not yet seen everything, so I waited to see this. Sure enough, the tail had been cut clean off on this four month old puppy, and no…it wouldn’t stop bleeding. Imagine the force involved if a tool box would cut off the tail, clean as a whistle, and right exactly where you’d dock the tail of a Doberman pup if you set out to do just that. Hmmmm…

Ya see, Dobermans were quite popular back then, and one of the things we did in those days was to surgically dock the tails on the two to four day old pups. We didn’t worry then that it wasn’t politically correct. The folks who’ve assigned themselves to improve our behaviors hadn’t yet even invented those words. The pups got over it quickly, and at that tender age they didn’t bleed much.

When you cut off the tail on a four month old puppy however, it bleeds considerably. I figured this guy had used a hatchet, or perhaps an ax. I must have complimented him for sharpening it well, but otherwise it was a poor choice, a choice to which he was initially disinclined to admit. He did eventually realize that the turnip truck I’d fallen off had left some time earlier, and just maybe I’d figured out what he did wrong here.

We first heard about Fuji when the phone rang on Tuesday morning. The lady said that the pup had a “belly button hernia” and it had just “popped” and her guts were hanging outside. Interesting. Let’s have a look.

I’ve seen plenty of umbilical hernias, mine included, and had yet to see one “pop”, but I’m open to new experiences. Fuji stood on my exam table, all five and a half pounds of four month old puppy, with another half a pound of fleas, trying to wag her tail and lick me all while some of her stuff hung down from that hole in her belly.

The lady said her young son had been playing with the puppy the night before, and everything was fine…and then that morning she’d seen this. I took a quick peek and got the sense that something rather sharp had cut the pup’s skin. Otherwise this made no sense, for hernias don’t simply pop open.

The owner of course, asked if we took payments. Her family wouldn’t loan her the money needed to pay for the surgery to repair this oops. Neither would her friends. I figured they knew her better than I did. So nope, I wouldn’t loan her money either.

Meanwhile, we’d had the pup for an hour. She was loaded up with pain meds and the stuff we give them to ease the induction of and recovery from anesthesia. We were ready to do the surgery. And the ladies had been babying her, for that is what they do best.

The owner threatened to take the pup home, and I suggested that the animal control people would be waiting for her when she got there, for I couldn’t let her take home a puppy with her stuff hanging out like that.

Now, nobody likes the corner into which we were backing. Puppy suffering, no one with the wherewithal to help, and our first obligation is the relief of suffering. And we, none of us in this building, were not interested in putting yet another darling puppy to sleep for “humane reasons”. The owner seemed very reluctant to get the animal control people involved. They are a police agency, after all. Somebody needed to bite the bullet, again.

We fixed the injury, which was in fact a stab wound, from a knife, box cutter or something similar. There had been no hernia. Despite the owner’s inventive story, somebody in that fine family had stabbed this puppy. This no doubt factored into the owner’s willingness to sign the puppy over to us rather than have to deal with a police agency. The pup has a new home already, with a wonderful kind family, where the old dog just loves it and the woman hugs it and talks baby to her, and the man sits quietly lest he disturb the sleeping puppy on his lap. They sent us photos that first night.

And the smiles around this place are back, for a while, because by hook or crook we got to do what we are supposed to do in this place. We cannot do this sort of thing every day, or even very often, but sometimes we simply have to. And that’s just way more fun than some of that other.

Sunday, June 23, 2013

Petting Puppies

Once upon a time, in a land far away…

I approached the Canadian border on a deserted two lane highway. I’d traveled for days up the coast from California, turned inland at the end of Washington, ferried across the water, and then forgoing the interstate highway, found a small road that headed north. I hadn’t considered this to be anything suspicious. It simply seemed more fun to be riding the motorcycle on a winding back road than on a boring crowded interstate.

The border crossing was not crowded. In fact, I had the place to myself. The officer in the kiosk was efficient if not exactly effervescent. I figured he was simply doing his job. But I was a bit surprised when he invited me into the little building over there for a few questions. The gent in there was efficient but not polite.

Where was I from? Where was I going? No surprises here. Straight answers from me. Just hoping to see some Canada, I said. What do you do for a living? Oh, I’m a veterinarian. Ah….so you can get drugs, right?

Excuse me?

Dawned upon me right about then, the why for why I was sitting in a chair across a table from a law enforcement agent in the always welcoming nation of Canada. This guy thought I was smuggling drugs. Apparently, that’s what veterinarians do.

And all this time I’d thought that veterinarians just petted puppies and kittens, and cashed the checks so we could get rich. I had no idea I was supposed to be smuggling drugs, too. All these years I’ve wasted by not scoring drugs for sale. Probably could have retired by now.

Petting puppies is a major plus in the why-do-I-do-this-job column. Puppies are nice. They mostly arrive on my exam table simply real glad to see me. Too young to know any better, a puppy trusts everyone, loves everyone. They march right up, eyes locked on you and mouth spread in perpetual grin, they match their tails with their enthusiasm. Puppy breath. Puppy kisses. 

All of the negatives in this deal, all the disappointments, all the tragedy, all the frustration and pain this job nets us…..melts away with just one puppy lovin’ on you. A good day in this business is puppies, all day long. The more puppies, the better.

Today….The four o’clock….three puppies. Saw this show up on the appointment schedule, and my heart sank. I wanted to cry.

We get to see the puppies often for the simple reality that the best way to keep the devil away, that virus we call Parvo, is to vaccinate the puppies early and often. I won’t bore you with the details, but when we have the opportunity to vaccinate every three weeks or so, most of our puppies won’t catch that disease, and they will live to be the companions we so value in our dogs. And they won’t die lying weak and helpless in the puddle of vomit and bloody diarrhea that that disease inflicts upon them. 

Something went wrong with this litter. The dam was vaccinated, according to the owner, so her immunity should have protected the puppies for weeks more than it did. The puppies had started their vaccine series so they should have been in a pretty safe state. We don’t much see eight week old puppies catch Parvo anymore. Eight week old puppies have never had much of a chance when Parvo showed up.  That’s what we saw back in the day, when we watched so many die in agony.

These days, usually they wait until they are older and they have a semblance of a chance of surviving even if they do catch it. If Mom’s immunity transferred to the pups works like it should, only the older pups will get sick, and our opportunity with proper care, of saving the pups who do catch this disease, hangs in the pretty good chance percentages. 

Of course, when we cannot apply what we can, that damn disease will still kill off most of those precious babies, just like it has for the last thirty years.

Seven pups were born into this litter. The first puppy had been sold, and within a day it was diagnosed with Parvo at another hospital. Not quite eight weeks old. A day later, the first of the rest showed up at our hospital. It tested positive, but wasn’t too badly off, so a few simple things which might help if the gods approved, were tried, and we sent it home. Two days later, we got to kill the first two.

Ya see, the plan was to sell the pups for many hundreds of tax free dollars. No money was set aside for the puppies’ care if anything went wrong. These folks had no money to spare at all. Proper care of a Parvo sick puppy costs many hundreds of dollars at a good hospital, and even at our little place it ain’t cheap. And the puppies’ owners weren’t going there. So rather than watch the puppies die puking and shitting blood, and crying and twitching in agony, somebody gets to “put them out of their misery”. 

It’s the humane thing to do.

And guess who gets to do it.

The puppy at the other hospital had already died. The one I’d seen two days earlier died at their home. These two had the zombie look that Parvo gives us, but they still tried to wag their tails and smile at us as we killed them. My poor tech was crying, and pleading, “I’m sorry baby, I’m sorry, I’m sorry….”

I kept it together, because somebody had to hit a tiny vein in a tiny leg so these pups could die in peace, and tears get in the way of that.

So today we got the last three. They weren’t eating and they could not play. They were vomiting and barely moved. The drool seeped from their mouths and horrid stuff leaked from the other end. The first two died quietly, just like it’s supposed to be when I do my job right. My tech was more stoic this time, as the job here had killed a little bit more of her.

The last puppy sensed something. Perhaps he wasn’t ready to die at only eight weeks of age. Nobody should be ready to die at eight weeks of age. This puppy railed and cried, and struggled, and then I killed him too. My tech left to go scream in the bathroom.

The owner turned to face me, after all this.

And he asked me for a discount on the bill, for this had involved so many pups, and the cost was more than he had hoped.

Saturday, June 22, 2013


My alarm turns on the radio at the same time, six days each week. Waking up only to go to work is no particular pleasure, but at least it happens in the morning. I like morning, the beginning of a day, when the air seems fresher, cooler and a little damp as it flows in through the window. The colors in the eastern sky highlight the fog hanging around the mountain and I wish I were an artist who could paint and thus preserve this scene.

Usually, I step slowly into the day, lingering in my bed, listening while the morning guy on the radio tries to be funny while reading the news. I see nothing to be gained by leaping out of bed and startling the day. It may be no more ready for me than I am for it.

Yesterday was different. I had someplace to be very early in the day, so I rolled out quickly and left the house before my wife had a chance to twitch; this was no business for her anyway.

The dogs go to work with me every day. They knew it wasn't the usual time to leave and they hadn't had their coffee yet, but they piled into the truck with me. They know their job and would follow me into the gates of Hades.

I motored off into the rising sun, reminding myself again that I need to wash that darn windshield. No time to enjoy this morning as I worked my way upstream against the morning commute, to the next town where a friend needed me.

My friend lived with a dog that was poetry in motion for a decade and a half, a dog that ran like the wind with her blonde hair flying and nothing but joy reflected in her eyes. For this dog, time had passed and taken its toll. Her body was irrevocably damaged, frail and weak, and she could no longer carry the weight of that thing growing in her belly. Her eyes said she was tired.

I needed to go to my friend's house early this morning to do what I do to end this pain. I administered my injection, a quick almost mechanical task, so the suffering could finish and the grieving begin. For even grieving must begin before it too, can end.

Then I joined the tide of cars slowing flowing west; I was late for my morning appointments at the clinic, but nothing would speed up that parade. When I finally arrived the kitten problem was waiting for me there.

The kitten was about seven weeks old, colored like a Boston Terrier in black and white, and, of course, terminally cute. And my wife wanted her.

Number two son had just graduated from college and moved far away to begin his adult life. However, because of this something important was ending for my wife. The nest was emptying and she felt a kitten would be the cure.

I opposed adding another member to the menagerie at home, but I relented, reluctantly. At the end of the day, Cassie was in the truck with the dogs and me as we followed the sun back home.

I had my reservations. I figured another cat would just add to the chaos at home, more work, more conflict between the animals, and more problems to solve. Then I watched that silly kitten and my silly wife play and giggle and pounce and hide and seek for the next four hours. I watched Cassie snuggle under my wife's chin and start to plug that big hole in her heart. And, of course, the little con artist fell asleep in my lap, purring.

OK, I was wrong.

Our house is a little brighter, now. Cassie brings more joy to my wife than any diamond I might go into hock to buy for her. The dogs already like the little tyke and the other cats will get over it, eventually. We experienced a resurrection of sorts in our little home, with a new soul to love, a beginning. For a day that had started with sadness, such happiness didn't feel bad at all.

Thursday, June 20, 2013

Obesity, Obstinance, and Obfuscation

Unless you've been living under a rock, you know that obesity has become one of the biggest public health problems in the United States over the past couple of decades. Interestingly, it isn't only a problem for homo sapiens - it's affecting our household pets, too. Any of you who treat pets here in the USA are probably nodding your heads right now. Dogs whose ligaments rupture under the strain of an extra 75 lbs on a skeleton that should only be carrying 70 lbs to start with... cats who can't muster the strength to drag their flabby butts over the lip of the litter pan... and they are almost invariably accompanied to my office by owners who state "but I hardly feed him ANYTHING! how can he be fat?" It's a common story, and a sad one.

Of course, Big Pharma would love to find the Magic Anti-Fat Pill, and I'm sure that they've been working night and day to come up with it because along the way, they've found Slentrol. Slentrol is a Magic Anti-Fat Pill for dogs.* Dogs who take Slentrol as instructed DO LOSE WEIGHT! They feel full, because the drug works on the intestinal level to stimulate a feeling of satiety. They eat less. The pounds come off. A dog taking Slentrol as instructed will generally reach his target weight within 6-12 months, depending of course on individual factors.

Discussing obesity with the owners of fat dogs is kinda touchy. In particular if the owner is also obese, the vet might feel really awkward raising the subject. Also if the veterinarian is obese, it can be difficult to bring it up. But I find that most of my own clients, when I simply state that their dog is clinically 20% or more over his ideal weight, are genuinely interested in trying to address it - or at least they CLAIM to be. Sometimes, they go ahead and start Slentrol right away, and I think everything will be great....until their first recheck. Then, the owners bring them in, full of concern. "He's not eating!" they say. Well, yes, he is eating. He is eating a *normal* amount of food. "But it's only 1/2 cup! He usually eats 4 cups a day, now just 1/2 cup!" they cry. But, see -- the dog was packing on excess pounds eating 4 cups a day. Four cups a day was KILLING the dog. Now the dog is losing weight, looking great, and becoming more energetic, able to run and play instead of lying on the floor 23 hours a day. Which brings up the other complaint - "my dog is hyper on this drug!" *sigh* Anyone who, like me, has had the personal experience of losing a few of those extra pounds will understand immediately that those extra pounds can really sap your strength and energy levels, and that once they're gone, you feel a lot more energetic. This is also true of our furry friends!

Once a dog has reached his target weight, the Slentrol program requires a 3-month maintenance phase. Zoetis originally wanted to call this the "Owner Retraining Phase," but apparently that was deemed inappropriate by the Political Correctness in Big Pharma task force. Still, it's a period of time in which the owner learns by direct observation exactly how much food is appropriate for the dog to eat, to maintain the ideal body weight. After the 3 months is over, the Slentrol is withdrawn - and the dog will be hungry again! But hopefully the owner will be able to stay strong and just keep feeding the right amount of food.

We sometimes see situations where a dog taking Slentrol will start defending his food from his canine housemates who come to scope out his leftovers. "Slentrol made my dog food-aggressive" is the presenting complaint. Well, no it didn't! Your dog was always food-aggressive, there just never was any leftover food to defend because he always scarfed it down in five seconds!!! Address the food aggression with behavioral modification techniques or by separating the dogs when food is out, but don't let your dog get dangerously obese again just because Slentrol has unmasked his previously occult food aggression.

What's most interesting to me & my fellow VBB is the large number of people who seem truly distressed at seeing their dog's appetite decrease. Food is clearly equated with love, and a big canine appetite is equated with acceptance and return of that love. The majority of Slentrol failures happen when people stop giving the drug because of this "side effect," which is of course not a "side effect" at all but rather the DESIRED effect of the drug!

I wish more people could recognize this in themselves, get over it, and allow their dogs to free themselves from the prison of obesity.

*NB: Slentrol is not actually magic. It is a drug that works pretty much as advertised, though. Please note that I do not now nor have I ever worked for Zoetis or any other pharmaceutical company. I don't get kickbacks from any drug company. I'm not on some secret "viral marketing" social media payroll, either. As far as the possibility of pro-Big-Pharma bias from li'l ol doc VBB here goes.... well, it's about as likely as it is that I will make a house call to cut the nails of your dangerously aggressive and untrained 198 lb Fila Brasiliero. In other words: I have no vested interest in promoting any Zoetis product. Thank you for your time.

Saturday, June 15, 2013

Signatures and Support Needed

Seems someone else in the profession feels the way many of us do and has taken it upon himself to spread the word and try to make the changes necessary to save the profession in general.  He's taking on the AVMA and asking for help on so that we can force their hand with enough signatures.

He needs our support.  Please visit the page and join him in the fight to do SOMEthing instead of sitting on our hands bitching and moaning and accomplishing nothing, as we've been doing for the last 20 years.

Save the Veterinary Profession

Tuesday, June 4, 2013

Another from the Mailbag

A really great entry sent in from a reader who experiences the same types of scenarios as the rest of us.  More proof that those of us at the VBB are not alone in our jaded views!

I just found myself at my desk here at VBB Animal Hospital with my formulary open, phone in my hand and six internet windows open. I was researching treatment options for a patient with allergies. I wasn’t researching drugs or treatment options - I already have those down pretty well. What I was researching was a cost effective option for clients who love their dog and want her to stop itching, but for whom money is a concern. So, there I was, still sitting at my desk an hour after closing time, calling pharmacies, googling on line compounding pharmacies and calculating dosages for multiple drugs - all to find the cheapest option for treating this itchy dog.

And you know what? This isn’t uncommon. At all. We vets hear again and again owners accusing us of only being in it for the money and charging outrageous prices for care. Who among us hasn’t heard, “If you really loved animals, you’d treat him for free.” But I had an epiphany this week when I realized how much time my staff and I dedicate to trying to make care affordable. And I don’t think I am alone here.

My staff frequently finds me staring at a shelf in the pharmacy. Fluffy needs antibiotics, or pain medications or some other expensive treatment. I usually have a few options for treating. So I stand there, appearing to be in a trance, but the cogs of my brain are turning, performing a series of calculations to determine how I can dose with half a pill at a time, or use once daily dosing, or which drugs are available as a generic, or use a liquid formulation, other mathematical manipulations to determine what the cheapest option is. And when I’m done with my calculations, there is a fair chance I’ll then refer to the Big Box Store $4 prescription list and then write a script for something cheaper than what I can offer.

Here are some other examples from just this week of what happened at my hospital. I had my staff call every referral hospital in a 100 mile radius to compare prices for a procedure I don’t perform so we could help the client find the most affordable option. We special ordered medications twice this week for clients because those drugs were going to be the cheapest treatment option for the patient. Every sick pet is provided an estimate for treatment. We always offer the best first. But when that isn’t an option, we spend as much time as it takes working with the owner to come up with a treatment plan that works with in his budget. I don’t answer the phone unless I absolutely have to, but I listen to my staff do it. And I hear them answers questions all day long. Sure, sometimes the answer is, “Let’s schedule an exam so Dr. VBB can examine Fido,” - because that is the right thing to do. But lots of times we can get you the information you need - and it’s free. If you have a question for me in the exam room, and I don’t know the answer, I’m going to find that answer for you. It might take me an hour of sifting through text books (yup, I still have some of those), consulting with other veterinarians or online veterinary groups. And then I’ll call you back and let you know what I learned. And unlike a lawyer, I won’t charge you for a minute of that time. It all gets covered in your bargain basement physical exam fee. We also treated a post dental complication this week in a cat - the owner wasn’t able to medicate her at home, so she brought her to the hospital daily for treatment, including weekends when we are not normally open. Charge for that? Free. And finally this week, I have brought into my home an obese little dog. Her owner struggles to get weight off of her. So I am converting her to a diet of actual dog food and getting her little body waddling along several times a day. I hope that if I can start a diet change and some exercise and her owner will see it is possible, he will be able to keep it up and make the dog he loves so much healthier. The charge to the client for this service? Zero.

So, I know veterinary care is expensive. I am well aware since I pay the bills for all that stuff that keeps my hospital running. But I do have your financial concerns on my mind. Always. Even when you don’t see what happens, I am working hard for you and your pet and often not charging for my time (and sometimes supplies) and often working (sometimes behind the scenes) to find the most cost effective treatment plan for your pet. I thought you should know what happens at VBB Animal Hospital - I bet you’d find it happens at your veterinarian, too.

Saturday, June 1, 2013

Myrna and her Lady

Myrna first brought in Lady back in 04 when the pup was 6 months old. She had some itchy eyes from allergies or from the oppressive wind that blows its brains out every day in the summer around here, or both. That one was easy, and the drops helped. Two weeks later, I spayed the young Lady, and then I didn’t see her again until summer of 09.

Sometimes when the females have been spayed they begin leaking a bit of urine in their sleep. They tell me this happens often in the physicians’ patients, and we certainly see this in some of ours. It’s more common in the larger breeds, and it shows up more often as these girls age a bit. Lady was a German shepherd, and now she was 5 years old, so she fit the profile. We have meds that usually stop the leak, but most often this is a life long deal, so the meds go on forever. They are not resoundingly expensive, these meds, but one person’s pocket change can be another’s small fortune.

Myrna has a fortune in good spirit, but she’s not what ya might call wealthy in the traditional sense. She did find a way to pay for continuous meds, for Lady was an indoor dog, and that was just that. But it clearly wasn’t easy for her. Myrna lives alone, having been widowed some time ago. She has adult children, and some young adult grandchildren, but it is mostly a few friends who help her out. Myrna doesn’t like to talk about it, but it seems that her children and grandchildren steal from her from time to time, which is the kind of help she doesn’t need.

So a year later, when Lady began having trouble with her anus, well that’s when things got real tough.

The condition is called perianal fistulas. These are rather large holes that erupt in the tender skin around the anus. Deep under the skin a problem arises, an inflammation that becomes a pocket of yuck and this eventually burrows out to the surface, breaks open, and then you have a hole you can stick a finger in, which discharges mung and fungu and various bloody pussy stinky sticky substances. Forever.

Perianal fistulas hurt. They hurt when you poop. They hurt when you sit. They hurt when you lick yourself, if you are the dog. For the owner, they stink, they leave stuff all over everything, and they make you hurt for your dog. They often accompany chronic diarrhea, for reasons we don’t really need to consider here. They happen mostly to German shepherds. And of course it was happening to Lady.

So for the owner there is cleaning that must be done, to the dog and to the house. Cleaning of awful stuff. This presents a problem to any owner. It provided an even more difficult problem for Myrna.

Oh, did I mention that Myrna is blind? Yeah, totally blind. Myrna needed to clean Lady’s painful bloody stinky pussy shit covered anus without being able to see it. And she would smell the diarrhea, and she would go find it in her house, on her hands and knees, and she’d call to tell my just how bad it was that day after doing a digital appraisal. And no, her family was not helping.

The doctors know that perianal fistulas show up due to some crazy hiccup in a dog’s immune system, for when we are successful using the drugs that suppress the immune system, some of these dogs get better. But this condition has expensive tastes, preferring only the most costly immunosuppressive drugs. The best choice is an oral med that costs multiple hundreds of dollars a month to maintain a shepherd size dog. We also do better when we can restrict the dog’s diet, since food sensitivities also may be a trigger for the disease, and thus we need to try the expensive foods, too.

Myrna vowed to find a way to pay for all this. We shopped around for the best prices, and since I’m the boss, I cheated myself by letting Myrna buy these things from me at just about my cost. I don’t even want to know what Myrna cut out of her spartan lifestyle to support her beloved dog. Sometimes I’m a sucker that way.

Lady couldn’t tolerate the oral meds. She vomited, and even when we gave it the time you need to try before you finally give up on that med, she still threw it up.

So drug choice number two was ordered, an expensive cream made from a different but similar drug that is rubbed into the skin around the anus twice a day. This one we got through a pharmacy, so I had no way to subsidize the cost. This did work, and eventually Myrna started getting it through some Canadian pharmacy, and this brought down the cost to merely backbreaking. And Lady did much better. The sores never completely healed, but much of the stench and yuck went away, and this little blind lady was able to keep things tolerable for three years.

One morning a couple of months ago, Myrna called asking about arthritis drugs, for Lady was having trouble getting up. Myrna needed to borrow friends and cars and other people’s time to bring Lady in, so we decided to try something simple, a drug that wouldn’t conflict with the ones that were keeping Lady’s anus tolerable, and I postponed that chance to examine her. And the drug seemed to help, although at least one of the grandchildren was stealing them for his own use. Apparently, it’s easy to steal from a trusting little old blind lady if you are truly scum.

The second phone call came some weeks later. A leg was swollen and Lady couldn’t use it at all, and the big sinking feeling settled into my gut. This time we needed to take a look.

The tumor was almost softball size, tucked in behind the knee, hidden under the hair, hard to spot when you are blind and you mostly concentrated on the anus. All those parasitic offspring folks who should have seen this, never noticed.

I tried a few things to help Lady stay comfortable, but not long later Myrna and I came to the wall where we knew we had to stop. She wanted to remain with Lady when I did the last part of my job. The injection went smoothly, and Lady slipped into sleep and out of life. And since Myrna couldn’t see what was happening, I needed to tell her when this all happened. And then all that was left was the grieving.

Perhaps Myrna had more pent up inside that just the loss of her precious Lady. Certainly, from outside looking in it seemed to me she had that right. After Lady breathed her last, Myrna let some of it go, and it filled my hospital and took with it all of us here. Myrna’s heart was truly broken. There was nothing we could do save to hug her and try to convey our own sadness.

So no, I couldn’t fix that, either.