One of the scariest but most memorable rotations for me in veterinary school was small animal neurology. Scary because the subject– neurology– was difficult in itself. Scary because Dr. S, the neurology professor, had a reputation for being a pretty tough cookie. Students for the most part feared him. He yelled curse words a lot, especially in surgery, until I thought the paint would come peeling right off the walls. I think that in itself made a lot of people uncomfortable around him. At the same time, he was highly revered for his knowledge and skills in the world of veterinary neurology. Neurology had the reputation for being one of THE hardest subjects in veterinary school. I had heard all the horror stories– all the students had– about how neurology flunked out a vet student or two every year. We had rounds daily in Dr. S’s office, usually right after lunch, where he would project slides or a film strip (this was the 80s) up on the wall of some poor wretched animal suffering some neurological disease. There in his small office, where it felt like there was no escaping, we’d be quizzed for hours. I’ll never forget him pointing randomly at any student in the room with his pointer and saying loudly, “LOCALIZE THE LESION!” And trust me, you better be able to localize the lesion to the correct place in the nervous system or you’d wish you’d never been born. I’d usually exit that tiny office sweating and shaking. No lie.
In the mornings we would usually have rounds where we would walk through the neurology ward where the patients were housed, and discuss the various cases. Among these patients were epileptics, animals with brain tumors, animals with intervertebral disc disease, spinal cord injuries, head and brain injuries, post surgical neuro cases, etc. Any case pertaining to the nervous system was found here. And there was always Joey, the beloved gray and white tabby cat who lived at the veterinary college in the neuro ward. Joey’s mother had contracted feline panleukopenia (also called feline distemper) while pregnant with Joey and his littermates, leaving Joey with a condition called cerebellar hypoplasia. This is a type of brain damage where there is a lack of development of the cerebellum, which is the coordination center of the brain. The cerebellum coordinates voluntary movements, posture, and balance. Joey had a lack of coordination and had intention tremors. He could stand and walk but was very ataxic (incoordinated) and would fall and roll around a lot. I guess you could say Joey always appeared drunk. Yes, Joey was there in the neurology ward as a teaching case, but after a few days of close observations, it didn’t take me long to see that old Dr. S dearly loved this cat. I can’t tell you how many times I walked into the neurology ward where Joey was housed to find Dr. S standing at Joey’s cage talking to him and giving him a rub down or a scratch behind the ears.
I remember the day during rounds that a student asked Dr. S why someone didn’t just put poor ole Joey out of his misery. I could almost see Dr. S’s hackles rise at the thought. He told the student to go over and pick Joey up. The student did. Dr. S then asked, “What do you hear?” The student replied that he heard loud purring to which Dr. S replied, “Ah…. the sounds of a happy kitty!” Then Dr. S told the student to go get Joey some food. When the food was put in the cage, Joey devoured it, intention tremors and all. Joey could eat. Joey could drink. Joey could get into his litter box where he could urinate and defecate. He could climb out of his litter box. Joey could sleep and Joey could love. Joey certainly wasn’t lacking in attention and he got A LOT of it from both students and technicians, AND Dr. S. The technicians often brought Joey a fresh sprig of catnip to put in his cage from the many catnip plants they grew. Joey always looked like he was under the influence of catnip anyway, but he loved the stuff. Sometimes a technician or student would take him outside to roll around in the grass and to get some sunshine. He loved that too. Dr. S felt that Joey, despite his nonconformities, had a good quality of life, was happy, and enjoyed his days. Joey knew no other way of life. He was not in pain. He was born with incoordination and intention tremors and this was life as he knew it. And you had to admit, Joey was one heck of a great teaching case who provided valuable information to any veterinary student who took the time to observe him. No student ever mentioned Joey and euthanasia in the same sentence to Dr. S again.
I remember one particular slow day in the rotation. The other students were down in the student lounge reading up on cases. I decided I would go visit and play with Joey a while. I found him with dried cat food around his face from the hearty breakfast he had just enjoyed (he often needed help in cleaning himself due to his lack of coordination). I removed Joey from his cage and decided to give him a bath. I placed him in the tub and gently wet him down with warm water and soaped him up with the shampoo. Unlike most cats who despise baths, Joey seemed to love his. I was standing there and rubbing the soap suds all over his little body, when Dr. S walked in the ward. He approached the bathtub and stared down at little Joey, who at this point looked like a drowned rat. I never knew how to read Dr. S and I was thinking that perhaps he was going to reprimand me for bathing Joey. I was wrong. Instead, he commended me. He told me that in all the many years that he had taught at the veterinary college, that he had never once seen a student take the time to give Joey a bath. He smiled, gave Joey a rub under the chin, told him to enjoy his bath, and started to walk away. After a few steps, he turned around and said, “Thank you Gail, for taking care of Joey and taking the time to show him some love.” I thought I even saw a tear glimmering in one of his eyes. My neurology professor taught me something valuable about compassion that day and I think I started seeing Dr. S in a whole new light from that day forward. In his own strange way, he taught this budding veterinarian that we must show compassion to all of God’s creatures, even those who “are different.”
I remember early on in the neurology rotation that Dr. S told the students that it was in this rotation that we were most likely to witness “pain in the eyes.” And I also remember him telling us that once we saw it, we would never EVER forget it. To be honest, I didn’t really comprehend what he was saying that day but asked no questions and didn’t give it much more thought after that. That is, until the day it happened and I witnessed EXACTLY what he had tried to get across to us– seeing pain through the eyes. And he was right. I never EVER forgot what that looked like. And I never saw it again after veterinary school. I don’t think I can even describe it verbally, but I knew it when I saw it. Suddenly, I understood everything Dr. S had tried to tell us. And I’m 100% sure that if I ever see that look again, I’ll know it. There are different kinds of pain that people and animals experience, but I think there’s something about neuropathic pain that tops all other pain. I can say that from experience after my bout with trigeminal neuralgia many years ago. On a scale of 1-10, that pain was definitely a 10. The patient I witnessed this “pain in the eyes”in was a very sweet black and tan miniature dachshund who had taken a flying leap off the owner’s sofa and who presented paralyzed in the rear and dragging its rear legs. Deep pain response was absent. A herniated disc was suspected (dachshunds are probably the number one canine breed predisposed to this). After radiographs and myelography (where a contrast dye is injected into the spinal canal to be able to tell exactly where the herniated disc is), the dog was immediately taken to surgery. Early spinal cord decompression is imperative in these cases. The prognosis was guarded in this particular dog since it had no deep pain response. The owners and referring veterinarian had done everything right in getting the dog to the veterinary school within a few hours of the event so that surgery could be performed before too much time had passed. Thankfully, the case had a very happy ending, and the next morning when I walked into the ICU ward, I found the little dog already bearing some weight in the hind legs and wagging its tail. It stayed at the veterinary college for a while and received IV dexamethasone to reduce the inflammation and edema of the spinal cord, pain medications, and later physical therapy. It was one of my most memorable cases while in school.
I often find it ironic that the rotation that I dreaded the most in small animal clinics, and the one where I abhorred the subject matter the most, was the rotation I learned the most in. I think I learned a lot during that two weeks– not only about small animal neurology, but about people, animals, and the importance of compassion.