Well, okay, in relative terms a goodie.
I was reminded of this at work the other day when we became entangled in an odd series of events involving a dead Portugese Water Dog in a large Coleman cooler, a pathology lab in Utah, and a really wigged out UPS store employee. Understand that the current story really has nothing to do with all of the above, but you’ll see the parallels.
When I was working for Dr. Ratbastard in Olympia I was presented with a largish hound type dog with the complaint of a persistent cough. Largish hound dog was 12 years old and had lived nine of those twelve years in Texas without being on any type of heartworm preventative.
And really that made my diagnosis pretty darned easy. See, if you’re a dog living in Texas without heartworm prevention, the reason you develop a nasty cough is most likely because you’re infested with heartworms and your heart is in the process of failing in a truly spectacular manner.
Which was, indeed, the case. Largish Hound Dog (LHD) had stage 4 heartworm disease and was so classic for progressive heart failure that they could have written the book just by her symptoms.
Persistent and progressive cough worsened by exercise (or, really, any movement).
Profound dependent edema –swollen legs, swollen feet, the works.
Marked abdominal distention secondary to ascites from failure of venous return — we pulled three or four liters of fluid out of her abdomen that afternoon.
And just to add a seriously oogy bit of oomph to the diagnosis, when we pulled blood from LHD the blood in the collection tubes was wiggling because of the huge numbers of microfilariae (baby heartworms) in the circulating blood.
Basically LHD was on her way out. There certainly wasn’t anything practical that I could do. If I’d referred her to a teaching hospital they would have been able to put a tremendous amount of effort into saving her and she’d have died anyway.
And in the gentlest way possible I told the owners that. Fortunately they were able to hear the words “your dog is dying and no one can help her” and make compassionate and rational decisions about her.
And I think part of that capacity was because I was so wound up about seeing a case of heartworm disease.
For those that don’t live in the Pacific Northwest I’ll explain.
Dirofilaria immitis is transmitted from dog to dog (and occasionally to cats) through a mosquito bite. If you live in an area where the proper species of mosquito lives, your dog is at risk as long as the mosquito season lasts (year round in some areas). For whatever reason, D. immitis hasn’t figured out how to use the species of mosquito that are found in the Northwest.
For which I am profoundly grateful. I don’t WANT to have to deal with heartworm, I don’t want to have to argue with people about using the preventative (I have a colleague on the east coast who was told by a client, in all sincerity, that “my dog can’t get bitten by mosquitos because I live in a gated community”), and I certainly don’t want to have to treat the nasty ass things which, up until just recently, involved a medication that was a derivative of arsenic. For the record the treatment has improved somewhat, but treating heartworm is still a bitch.
Veterinarians in the northwest almost never see a case of heartworm. I was a young doctor, I never thought I’d see a case of heartworm and I certainly never thought I’d see so classic a case. As a scientist this is an exciting thing and LHD’s owners picked up on my scientific excitement. Since they couldn’t do anything practical to save their dog they decided that they “wanted her death to mean something”.
Could they, they asked, donate LHD’s body after she was euthanized so that someone could actually learn something from her death?
Well, lemme see what I can do.
I called the pathology department at WSU’s veterinary teaching hospital. I spoke with the head of the pathology department who said that they’d be delighted to have LHD’s thoracic viscera from the larynx to the diaphragm to use as a teaching specimen. Veterinary students in the northwest almost never get to see this sort of thing, especially not as such a classic presentation. Dr. L gave me the department’s FedEx number, told me how to package the specimen, and requested copies of all the diagnostic testing I had done, the chest x-rays, and a case summary.
No problemo! Can do.
I went back to the owners and told them what I’d arranged. They were as happy as could be expected under the circumstances.
They wanted to take LHD home overnight so she could have one last night with the family. It was Thursday evening. I didn’t work the next day, but I got everything worked out that they would drop LHD off mid-morning on Friday, the office manager would give me a call when she was dropped off and I would run out to work, euthanize the dog, do the dissection, package everything up, and run the package to the local FedEx depot so that the package would arrive in the pathology lab in Pullman early Saturday morning.
A tidy arrangement and it would have been very successful except that Dr. Ratbastard’s clinic was owned, run, and staffed by (with a few outstanding exceptions) useless fruit loops.
I sat at home, doing my usual Friday things, waiting for a phone call from the clinic that LHD had been dropped off and was waiting for me to show up and perform a final mercy.
10 a.m. passed.
2 p.m. passed.
I knew that the FedEx depot closed at 5 p.m. and I knew that there was NO way that I was going to be able to pull this off if the dog was euthanized Friday and the viscera waited until Monday to get on their way to the university. So at 3:30 when I had chewed my fingernails down to the wrist I called the clinic and asked whether or not LHD was there.
“Oh yes!” came the bright and brainless reply “Her owners dropped her off about 10:30 this morning, we’ve been waiting for you.” (and so NONE of the FIVE people that had been there the evening before who were also there that day remembered my instructions, that when the dog was dropped off they were to CALL ME?!)
Sour grapes. I have no doubt that all of the useless fruit loops have gone on to bigger and fruitier things.
I grabbed my new pair of hedge trimmers and bolted.
Got to the clinic, euthanized the dog. I’m sure she was grateful.
Got a rather delicate dissection done in what must have been record time and left with a squishy, triple bagged package on ice in a styrofoam cooler inside a cardboard box, leaving a horrendous mess for one of the few competent and sane people employed there to clean up (sorry about that).
I didn’t have time to prepare the case history, to make copies of the lab results, or properly package the radiographs that I had taken the day before, but I figured there wasn’t going to be any problem. I would get the perishable stuff to the path lab at WSU ASAP and then arrange with Dr. L to fax and courier the rest of the case across the state come Monday. My repulsive box and I sped through downtown Olympia, out to the freeway, and at top speed (at least the top speed allowed by my aged Toyota Corolla) to the FedEx depot in Yelm.
I screeched into the FedEx depot at 4:55 p.m., skidded into the building with a squishy box full of dog viscera and waited my turn.
I got to the counter got the thing addressed, put my name and the clinic address (this will be important later) as the return address and asked the weary FedEx drone if there were any stickers that I could add that would make it obvious that the package needed to be opened immediately.
“See, it’s kind of perishable and I don’t want it to sit around all weekend. I know it’ll be delivered on Saturday, but if no one opens it until Monday it’ll be ruined. Something like “BIOLOGIC SPECIMEN OPEN IMMEDIATELY” or something like that?”
I swear you could hear the FedEx drone’s eyelids snap to full open and alert from three blocks away.
“WHAT is in that box?”
“Um, well, it’s kind of gross. It’s a specimen for a laboratory at WSU.”
“WHAT. IS. IT?!” (clenched teeth and all, I swear!)
“Well, it’s nothing infectious or anything. At least, not unless you’re a dog.”
“I’ve gotta go get my manager. Don’t go anywhere.”
A little confused, but yet unwilling to let her know that she was going to be dealing with a box full of dog guts — that sort of thing being a little disturbing for those of a delicate constitution — I waited for the manager.
Manager shows up.
“Ma’am, what is in the box? We can’t ship unless we know that it’s not a biohazard.”
Throwing caution to the wind, I explained what was in the box and I got exactly the results you’d expect.
To his credit the FedEx manager dealt with it pretty well, even going so far as to slap about two dozen “PERISHABLE OPEN IMMEDIATELY” stickers all over the box once he’d stopped gagging.
With a sense of triumph I turned around and went back home, thinking the job was done, LHD’s owners would have their wishes fulfilled, and some second year DVM students would get a decent look at something that is pretty darn rare in this state. All’s right with the world.
Except that Dr. L, who of course didn’t work Saturdays, didn’t ever talk to his residents.
The package arrived at the path lab at the WSU VMTH early Saturday morning. A package of dog viscera sans explanation, sans any sort of lab submission form, sans case history, lab reports, or radiographs. A package slapped with two dozen or so bright orange “PERISHABLE OPEN IMMEDIATELY” stickers. A package whose only identifier is my name with my clinic address on it.
Andrew and I like to sleep late on Saturday mornings. That particular Saturday we slept until 10 or so, got up, made pancakes, and went back to bed to eat them.
So when the phone rang I was sitting in bed with a plate of pancakes in my lap and I was unwilling to leap up and answer the phone. Answering machine came on, from across the house we heard a male voice talking to the tape. We figured it was my brother and that there wasn’t any urgency in calling him back so we settled back into our pancakes.
And our books.
And our cats.
Around noon or so we finally got out of bed and went into the kitchen to see what the answering machine had to say.
At that point in time our answering machine message was:
“You have reached (the incorrect phone number) which is odd because you dialed (the correct phone number). Perhaps there is something wrong with your phone.”
On the tape was a hopelessly confused second year pathology resident from WSU who was trying to get ahold of me to find out what the box full of dog guts was all about.
I still have to laugh. The poor man. Early Saturday morning he’s delivered a large package marked “OPEN IMMEDIATELY” which he opens only to find an anonymous dog’s innards. Looking to the return address he figures if he calls the clinic from which the innards originated he’ll get some sort of explanation, but he doesn’t because I’m not there and the place is run and staffed by incompetent fruit loops. The fruit loops give him my home phone number which he promptly calls only to be told by the answering machine that he’s reached a different number than he’s dialed.
If I knew who he was I’d call up and apologize, but even almost 15 years later it’s still danged funny.