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When grandmother crushed the kitten.

My first job as a veterinarian was with Dr. Cashion, the owner of an enormous small-animal complex in Dalls. While I assisted Dr. Cashion at the central hospital, two other young veterinarians practiced at his outpatient clinics.

A short but dynamic man, Dr. Cashion had more stamina than any individual I'd ever met. His working day started at 7 A.M. and continued to 9 P.M., seven days a week. He knew all his clients by name and never appeared hurried. Each client received his undivided attention, and even if the waiting room was crowded, everyone was willing to wait his turn for Dr. Cashion rather than take a chance with that new female veterinarian.

In the first two days I was called upon to give just one nail trim and two vaccinations. Then, on Wednesday, while Dr. 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 with a tattered Kleenex, stood beside her. The woman gently placed the bundle on the table and turned to me. "Oh, Doctor, I hope you can do something for our kitten," she said. "I tripped and stepped on her while she was playing in the kitchen."

I felt a moment of panic as I looked at the kitten, a plump, two-month-old calico. It lay prone on the table with its neck stretched back and all four legs rigidly extended. The kitten was cold, obviously in shock. Cradling it in my hands, I rushed into the treatment room where I gave it an injection I hoped would help raise its blood pressure and then started it on intravenous fluids.

I turned to the woman and the girl who had followed me into the treatment room. "She's in bad shape," I said. "We'll first try to treat her for shock, and if she makes it through that, we'll try to determine whether she has permanent nerve damage."

Placing a hand on the girl's shoulder, the woman replied, "I'm Mrs. Murphy and this is my granddaugher Ruth. The kitten belongs to her, and I feel just awful about stepping on it. Please do whatever you can."

As they turned to leave, the girl said, "Her name is Pumpkin," and began crying. I wished that I could say something comforting, but I didn't have much hope for little Pumpkin.

I inserted an oxygen hose into a plastic bag to make a small oxygen tent and placed the kitten into it. When Dr. Cashion returned, he peered in the door with the comment, "That kitten is hopeless; you ought to put it to sleep." But I continued to work with Pumpkin during the afternoon. She was my only patient, and Dr. Cashion was too busy to find other 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 I hadn't done everything possible for Pumpkin. I worried that Dr. Cashion was right--Pumpkin would remain paralyzed and should have been put to sleep. But the next morning she was still alive and for two days seemed to slowly improve.

Friday, I was encouraged to see her looking alert, her legs no longer stretched out stiffly in front of her. That day Dr. Cashion entered the ward and said, "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 was shocked and disappointed. I knew Dr. Cashion wasn't heartless; after years of observing similar cases, he simply felt the kitten would never fully recover. As I looked down at Pumpkin, I began a debate with myself. If I were no dismiss Dr. Cashion's advice and ask Mrs. Murphy to give us a little more time, would I be building up her hopes and her veterinary bill only to return to her a permanently damaged kitten?

Reluctantly, I moved toward the telephone. I was uncertain what I would say. Ruth answered the telephone.

"This is Dr. White," I said. "May I please speak with your grandmother?"

"It's about Pumpkin, isn't it?" she asked. "Dr. Cashion said that she should be put to sleep." The sound of soft sniffling 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?" she asked. "You've been Pumpkin's doctor from the beginning, and we'd like to know what you think we should do."

I felt a warm glow. Someone had faith in me--regarded me as a real doctor. "Mrs. Murphy, Pumpkin's a long way from being fully recovered," I said, "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 improved even more. She started eating baby food without assistance, so on Monday I was able to release her to the care of Mrs. Murphy. At the end of the week, she called me to say that Pumpkin was doing very well, although the kitchen could still not walk or stand unaided.

That was the last time I heard from Mrs. Murphy. In the meantime things were changing for me. Phil, a young veterinarian employed at one of the outpatient clinics, eventually quit to start his own practice, and I took his place. I began seeing more patients, and, busy with the routine of examinations and surgery, I forgot all about Pumpkin and her trauma.

Then about six months later, a woman entered the clinic. In her arms she carried a beautiful, sleek calico cat.

"You don't recognize us, do you," she said. "This is Pumpkin."

I was astonished. The cat was perfect in every way. She showed no signs of the accident.

All this happened 13 years ago, but the lesson it taught me has served me many times in the years since. As I think about the case now, I realize that Pumpkin recovered because her nervous system had not sustained permanent damage. Today, treatments for such cases are certainly much more advanced, and there is even greater likelihoood of recovery. However, doctors see so many cases that we begin to feel confident in our ability to make a prognosis. We know what technology can do and what it can't. Pumpkin's case continues to impress upon me that every patient is an individual and each case is different. God is the healer, and we are mere token instruments of that healing. Perhaps He heard a little girl's prayer for Pumpkin.

Questions for the Vet Dear Dr. White:

Our toy poddle Brigitte loves chocolate and ate five chocolate-covered cherries that were left under the Christmas tree. Now Valentine's Day is approaching; can chocolate be harmful?

Mrs. J. Bushell

Baker, California

Chocolate contains theobromine, a cafeine-related stimulant. This compound can cause urinary incontinence, seizures and death in dogs. Because chocolate is slowly absorbed from the bowel, it can persist in a dog's blood for longer than a day. Therefore, induced vomiting might be indicated in the case of a dog showing the nervous signs of toxicity. In other words, chocolate can be dangerous as well as fattening for your poodle. Dear Dr. White:

I recently saw the Movie Cujo, taken from Stephen King's book. In the movie, Cujo, the St. Bernard suffering from rabies, seemed to undergo physical changes in response to noises such as the ringing of the telephone. Was this an accurate picture of a dog with rabies?

Susan Lopez

El Paso, Texas

Although I have not seen the movie, I read the book. The plot was certainly a dramatization; however, I found Stephen King's portrayal to be accurate for the most part.

Cujo developed rabies after a bite from a rabid bat. Bats are major carriers of rabies in the United States. The incubation period (that period of time from exposure or bite until clinical signs of rabies) is ten days to six months (average three to eight weeks).

A rabid animla exhibit signs of rabies one to seven days before death. In the furious form of the disease, the dog becomes irritable, restless and nervous. The dog shows an exaggerated response to sudden stimuli of sight or sound (reaction of Cujo to the ringing telephone). The animal may experience photophobia, an intolerance to light. At this state, the dog is dangerous because of its tendency to bite anything encountered. Paralysis of pharyngeal muscles causes the dog to drool saliva. Convulsions, muscular incoordination and paralysis can precede death.

Not only is a rabid animal such as Cujo dangerous from the standpoint of the physical injuries that it can inflict, but the rabies virus is also shed in the saliva of a rabid dog up to ten days before death.

Our best protection against rabies is to vaccinate all dogs and cats against rabies, avoid wild animals such as skunks, bats, raccoons and foxes and immediately wash all bite wounds with soap and water, alcohol and disinfectant. Contact your physician and public-health officials if there is a question about the need for human rabies prophylaxis following a bite or other exposure.
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Author:White, H. Ellen
Publication:Saturday Evening Post
Date:Mar 1, 1984
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