A week in the Animal ER
BY Charles Hirshberg "SHE'S GONNA GO AGAIN!" A doctor sprints into the ICU. There, on the examining table, lies a 12-year-old in cardiac arrest. Listening through her stethoscope, the doctor asks for a half cc of epinephrine and then studies an EKG. "Hmm, strange rhythm," she says. "I'll need three milli-equivalents of sodium bicarb. And can someone whip me up a Bretylium dose? I may have to shock her." Nurses in scrubs dash back and forth. "She's a severe diabetic," says the doctor. "There's major damage to her pancreas and liver. I'm going to try some lidocaine. It'll either make her much better--or much worse." The patient, a cat named Little Tiger, revives briefly but dies before morning. The cost of her treatment at Boston's Angell Memorial Animal Hospital: $ 1,695. Americans spend $ 2.8 billion on veterinary care each year, and the services now available to animals rival those provided to humans. Pet owners can obtain kidney transplants for their cats, CAT scans for their dogs and chemotherapy for their ferrets. A recent survey (done for Pfizer pharmaceuticals to promote a new canine arthritis medication) revealed that the typical dog owner spends $ 275 a year on vet care, and that one in five would be willing to pay much more--over $ 5,000 or "whatever it took"--to extend their pet's life. That's good news for pets. But for humans it raises a tough question: How much is an animal's life really worth? Angell is one of the finest veterinary hospitals in the world. Some 125 animals are treated there each day, and the round-the-clock drama at Angell is as compelling as any television E.R.--complete with blood, agony, panic, sadness, relief, gratitude. From the outside, the hospital looks like an asylum--a gloomy three-story brick building surrounded by a high brick wall. Inside, it looks...well, loopy. There is a non-stop parade of fur, fangs and feathers, for like any full-service hospital, Angell is always open, and open to all. Its waiting room has the ambience of a bus station. People and their pets sit, sometimes for hours, staring curiously, or suspiciously, at other people and their pets. These include dogs with what look like lampshades on their heads; cats with bald patches shaved into their coats; and dozens of animals spaced out, or wired up, on medications. The majority of Angell's emergency cases are treated by one of the hospital's 14 interns, but all are the responsibility of doctors Ann Marie Manning and Lisa Moses, co-directors of emergency services. Both are star graduates of prestigious veterinary colleges (Tufts and the University of Pennsylvania, respectively) who work 60-plus-hour weeks and frequently joke about how much they hate being single. ("Will you put that in LIFE magazine, please?") Their days, and especially their nights, are spent treating, most commonly, bursting tumors, plugged urethras, malfunctioning bellies, every manner of bite or car-crash victim, plus a catalogue of the unexpected--from dreadful abuse (dogs tied up so long their collars have become embedded in their flesh) to silly false alarms. ("Sometimes people rush a cat in because she's yowling and sticking her butt up in the air," says Moses. "We have to explain that she's in heat.") The place is like a human hospital, with this difference: "Every day, we deal with two issues that don't normally enter into human medicine," says Moses. "Money and euthanasia." Veterinary care today can be so complicated and expensive that even owners willing to pay "whatever it takes" are advised to consider their options carefully. "We treat animals and not people," says Moses, "so we don't try to save lives at all costs. Our clients want to consider not just the sanctity of their pets' lives, but the quality of those lives too. As a result, people who come in here wind up facing very difficult decisions." Max, a black Labrador, merrily wiggles his nose at each cat or dog who wanders in or out of Angell's waiting room. It is only when Dr. Joseph Fedorich calls his name that anything appears wrong. As Max ambles into an examination room with his owners, David and Carol Campagna, he puts scarcely any weight on his right rear leg. Dr. Fedorich quickly diagnoses the problem: "Same knee injury Joe Namath had," he says. "We see it a lot in this breed. He'll have to have surgery." But which surgery? The Campagnas have two choices. The first, Fedorich likens to a Volkswagen--the procedure will do a minimal job for a minimal time. The second, he likens to a Mercedes--it'll fix the problem for good. The Campagnas are silent. Then Carol asks how much this "Mercedes" will cost. "About $ 1,800," says Dr. Fedorich. And Max's other rear knee will likely need the same operation within a year. The Campagnas look stunned, like cartoon characters clonked with frying pans. Then Carol gasps. Max's ears jump and his head whirls around, as though he's wondering what's wrong. Money is tight; the couple has a mortgage, they want to start a family. Dr. Fedorich advises them to go home and think about what to do. Angell offers a Mercedes-style treatment for almost every animal ailment. The hospital employs 29 specialists: surgeons (including a plastic surgeon), cardiologists, a dermatologist, an ophthalmologist, a dentist and a pair of oncologists who ply their trade in a newly constructed cancer care unit. But such medical care is increasingly expensive. Each new year brings new technologies--most of them handed down from human medicine, a few not yet available to humans. As a result, more and more pet owners face wrenching dilemmas. Dr. Manning is not surprised that many pet owners say they would be willing to pay thousands to save their animals' lives. "I'm sure they mean it," she says, "but I see the same thing every day: People come in and say, 'I'll do anything and everything to save my pet.' Then when they find out how much anything and everything costs, they say, 'Oh, my God, I can't afford that!'" But Moses adds this caveat: "Sometimes just the opposite happens," she says. "When people face the prospect of euthanizing a pet, they discover the animal is worth more to them than they ever realized." Before long, the Campagnas are back at Angell. "Putting Max down did cross our minds," says David. "For about two seconds. We're going with the Mercedes." The couple has decided to postpone a few things--even parenthood, if necessary--to extend the life of their dog. "Max is a lot like a son, really," says Carol. She spent a sleepless night worrying over what to do. What tipped the scales was Duffy. "He was a cocker spaniel I grew up with, and I remember what it was like when we had to put him down, even though he'd had a good life. Max is only a year old. But I worry: We can put things off or do without a vacation. What would someone do if they really didn't have the money but really loved their pet?" Paris, an orange-striped cat, lies prone in a cardboard box, mewing as Keith Murrell, his wife, Annette, and their daughter, Anita, 12, huddle over her. The Murrells tell Dr. Manning that the cat stopped eating after having a litter of kittens. "I thought she was going through what we women go through," says Annette. "You know, a postpartum depression." Dr. Manning is gently massaging Paris behind her ribs. "I think there's a stillborn fetus inside her," she says. "We need to put her into intensive care right away." As the Murrells head to Angell's financial office to find out the cost of Paris's care, Dr. Manning rushes Paris to the ICU, where two nurses work frantically to insert an I.V. in the emaciated cat. Her skin clings tightly to her bones, her veins are fragile. But the nurses keep at it, talking to Paris as they might to a frightened child. Finally, the I.V. goes in. But at this triumphant moment, Carmen Branch of the hospital's financial office pushes through the door. "Cease!" she calls out. "Cease and desist!" The nurses look at one another glumly. They know what it means. Carmen Branch has been working in Angell's financial office for 10 years, during which time she has been yelled at, threatened, lectured and, once, cornered in her office by an angry biker. That's what comes of explaining Angell's financial policy, which works like this: The hospital presents the pet owner with an estimate; the owner must pay half up front. Credit can be arranged for the remainder (no interest is charged), and for the very poor, financial assistance is available. The majority of Angell's clients pay their bills without complaint, but a few go ballistic, accusing the hospital of everything from profiteering to racism. Some indignant pet owners march out of Angell with bleeding, broken animals dying in their arms. Angell's estimate of $ 1,200 to treat Paris shocks the Murrells. "The rent is due," says Annette, "the car payment is due, everything is due." They don't qualify for aid, and even if they did, it's doubtful it would be provided for a cat as sick as Paris. If she survives, Paris will need more treatment, and for the Murrells, this is the crushing blow. Branch watches these dramas day after day. She has seen homeless people scrape together payments in nickels and dimes, and she has seen people with plenty demand free treatment, often on the grounds that they are "taxpayers," although Angell receives no government funds. Last year the hospital gave out $ 396,000 in financial aid, wrote off $ 735,000 in bad debt and ran a deficit of a half million dollars. (Angell's nonprofit owner, the Massachusetts Society for Prevention of Cruelty to Animals, pays for the shortfalls from its endowment.) Dr. Manning trudges out to the waiting room to console the Murrells. "Paris is a very sick kitty," she says. "I don't think you're making the wrong decision." She then asks if they want to be present as Paris is put to sleep. Anita, to the astonishment of her parents, nods emphatically. "I want to say goodbye to my cat," she says. Keith holds Paris and struggles not to cry while large pearl-shaped tears fall down Anita's cheeks. She tells Paris that she'll miss her and strokes the cat as Dr. Manning injects the blue solution that brings Paris's death. It is over quickly. The Murrells bury Paris in their backyard beneath a peach tree that she loved. Keith finds one consolation: Anita's courage. "I guess God made things happen this way to prepare her for life," the father sighs. "And she held her own." Humans pay all the bills in the person-pet relationship, but both sides profit. Studies have shown that pet owners have lower blood pressure, lower cholesterol, lower triglycerides and, consequently, a lower risk of heart disease than petless people. Indeed, Purdue University veterinarians Andrew Rowan and Alan Beck have written that if pet ownership could be "patented and sold as a drug," it would be the subject of "enormous research" by pharmaceutical companies. But people don't keep pets to prevent heart attacks, and that's certainly not why they spend heaps of money on veterinary care. They do these things out of affection, devotion. And when a pet becomes ill, the distressed owner often has a terrible time explaining to other humans why he or she is so upset. "It can be a source of great anxiety, frustration and even shame," says Dr. Moses. "Often there's someone in their lives--a companion, a family member, a boss--who doesn't understand the bond they have with their pet and thinks it's crazy." No one at Angell thinks it's crazy. But some of the things that happen at the hospital can look pretty bizarre. Donna Snow is holding a turtle up to her face and making loud smooching noises. "Mmm, come on, Tutor. Gib mama a kiss goo-bye!" Donna's 12-year-old daughter, Madeline, rolls her eyes as only a 12-year-old can. "My mother's always talking to the turtle, kissing the turtle," she says. But then she adds, "I do it too. Sometimes." Madeline is moody tonight--a little angry, a little guilty. Earlier, as she was showing Tutor to a friend, the turtle got spooked and bit Madeline. She let go, and Tutor hit the floor with a thud. "His shell cracked and he was bleeding," says Donna. "We were screaming, 'He's dying! He's dying!'" Now, however, the turtle's head is emerging, with his nose pointing toward Donna's pooched-out lips. Donna administers a few maternal kisses to his head and neck and, satisfied, surrenders him to Dr. Manning. "Do whatever you have to do," she says. "That's my baby." Dr. Manning is all smiles as she carries Tutor back to Angell's isolation unit for infirm reptiles. "People really shouldn't kiss these guys--they carry salmonella," she says. "But what can I do? She's been kissing him for four years." The menagerie that passes through Angell is 97 percent cats and dogs. The remainder are so-called exotic pets (anything from gerbils to pythons). A typical week's worth of exotics includes a constipated rabbit, a pair of hedgehogs with dandruff and a ferret with a urinary tract infection. Tutor spends a rejuvenating night in a tank carefully heated to a balmy 80(degrees). The next day he is introduced to intern Bridget Dunnigan, one of the hospital's two exotic-animal doctors. She flips Tutor on his back, applies a coat of Duro Five Minute Epoxy and then dries him with a hair dryer. Next she goes over her work with a detail sander, applies a layer of polypropylene mesh and adds another coat of epoxy. "One tube does two turtles," she says, applying a third coat just to play it safe. Tutor's underbelly now has a glossy sheen. "Better than new, huh?" says Dr. Dunnigan. "They'll probably want the other side done just for looks." Not likely. Tutor's repairs cost $ 329. But when the Snows return home, help arrives from an unexpected source: Madeline. "Here, Mom," she says, handing her mother $ 60. "I was saving for some new Air Jordans. But I'm the one who dropped him, so I'm responsible." "I've been blessed," says Donna Snow. "I've got an intelligent turtle and an outstanding child." It's 11:30 a.m., and the ICU visiting hour is about to begin. A hospital employee leads a dozen pet owners to a locker filled with sterile booties. The visitors slip these over their shoes and shuffle inside an expansive room, lined floor to ceiling with 63 cages. A stay in the ICU costs $ 200 a night. Scott and Cheryl Glaser hug a tiny pug-nosed creature with preposterously oversize ears. Petunia, a French bulldog, is like a child to them, they say. Scott has been so distraught since she began having seizures that he showed up for a meeting wearing a suit jacket and jeans. ("I forgot my pants!") After nine days in the ICU, Petunia's going home, along with a total of $ 1,800 in bills. Nearby, Mimi Wolfort-Fried caresses Lili, a bichon frise with bows in her hair and more than 20 puncture wounds in her belly, where a coyote tried to snack on her. She, too, is going home, with an $ 800 tab. Across the room, a weeping Jeanna Petrucelli rocks Oliver, a gray Himalayan, as if he were a baby. Dr. Manning has told Jeanna and her husband, Rob, that the cat is suffering from an immune disorder and its chances of survival are no better than 50 percent. Rob leans against a wall and shuts his eyes. "My God," he says, "if we're like this with a cat, what will we be like over a sick child?" Jeanna agrees. "We're going to be the worst parents," she says. "We're so weak." During the next few days, as Dr. Manning tries a battery of medications to save Oliver, the Petrucellis agonize over both their cat and their own reactions to his illness. But after five days in the ICU, Oliver begins to perk up, thanks to transfusions, steroids and cyclosporine, a drug used for chemotherapy in humans. When the Petrucellis return to collect him, they thank the doctors with a cake. For the next six months, Oliver will have to come back for biweekly checkups, and his medication will cost at least $ 300. It's a price the couple is willing and able to pay. "Before we got married, I told Jeanna, 'No cats!'" says Rob. "And I still don't have any great affection for pets in general." (Jeanna rolls her eyes.) "But," he admits, clearing his throat, "I do love my own." Scenes like this are common at Angell. Says Dr. Manning: "We don't often hear people say, 'Oh, come on, it's just an animal.'" This makes the doctors' jobs much harder--and that's just the way they want it. Paddie rides into Angell on a gurney, with sad eyes and a pleading look. He's an old golden retriever who can no longer stand. Dr. Moses matches the symptoms with the breed and comes to a quick conclusion: a tumor in the spleen. Probably cancer. Probably fatal. Even five years ago, when Kate Cotter adopted him, Paddie seemed old. Since then, the dog has never willingly left her side and waits for her each night with a toy ducky in his mouth. Cotter is a nurse, and she's not surprised when Moses gives her the news. But she is nonetheless stricken. Paddie goes to surgery to have his spleen removed and his liver biopsied. "My biggest hope in a case like Paddie's," says Dr. Moses, "is to buy him a few months' time--which can be very meaningful when you consider that a dog's life lasts only about a decade." But two days later the biopsy results come back: It's hemangiosarcoma, a fast-spreading cancer. With treatment, Paddie might live another six weeks. Cotter sits in his pen in the ICU, wondering what to do. "He's been the most consistent thing in my life," she says. "I've changed my job, my apartment, broken up with my boyfriend. Paddie's always been there for me. But I've seen what cancer can do." Dr. Moses would like to treat Paddie, but never says so. Her job now is to help Cotter make a decision. Cotter wants to know how much her pet will suffer. Unfortunately, says Dr. Moses, it's hard to measure how much an animal suffers, and harder still to say how much suffering is "too much." She urges Cotter to think instead about the things that make her dog happy and to ask herself: Will he be able to do those things? The answer comes when Cotter gets up to leave. Paddie tries to follow her--that's what makes him happy--but collapses in a heap. Cotter returns to Angell the next day and hugs Paddie goodbye, slipping his ducky under his leg. She doesn't intend to stay for the euthanasia--"I don't want to see him with the life draining out of him," she sobs--but Dr. Moses encourages her to reconsider. She does, and will be forever grateful: When she sees Paddie go peacefully out of the world, she knows she was right to end his life. Paddie is just one of the hundreds of pets Moses and Manning euthanize each year, but it's never easy, even when they know it's the right thing to do. "A lot of people, including some in this hospital, wonder how we can sleep at night," says Dr. Moses. "And the answer is: We don't. We wake up and think about every one of them." "And that's not all," says Dr. Manning. "We also wake up thinking about, say, a particular dog in the ICU who gives us really sad eyes as we're walking out the door. All of this makes us want to get to work earlier, and stay longer, the next day. Angell is an addiction." It is a wonderful addiction. It is wonderful to cure Maggie the cat, who almost killed herself by drinking bleach, and return her to the four delighted nuns who dote on her. It is wonderful to watch a young man, learning that his dog, Aqainas, is all right after being hit by a car, ecstatically throw his arms around the animal's neck and exclaim: "This is my son." It is wonderful to be greeted by a chipper dog named Coco, and then to hear his chipper owner say: "He doesn't look like he just had cancer, does he?" And each night, after leaving Angell, there is one more thing that is wonderful for the doctors. Waiting at home for Ann Marie Manning are a husky named Knishka, and Dracula, a one-eyed cat; waiting for Lisa Moses are Jamie, a cat, and Dora, a pit bull abandoned by a street gang. "Tonight, and every night," says Dr. Manning, "it will be wonderful to hug our own animals and to thank God that they are healthy." BOX STORY: "THERE OUGHT TO BE HEALTH INSURANCE FOR PETS," said a tearful Annette Murrell after learning the cost of treating her critically ill cat, Paris (see page 107). Increasingly, there is: Veterinary Pet Insurance (VPI), by far America's largest provider, now covers some 750,000 households in 47 states and the District of Columbia. Basic coverage, not including vaccinations or other routine care, starts at $ 101 per year for puppies and kittens but rises sharply as pets age; a more comprehensive policy (providing $ 12,000 coverage per annum) costs $ 251 for dogs and cats five to eight years old, and more for senior citizens (rates vary). VPI President Dr. Jack L. Stephens notes that the company has even covered a few kidney transplants (the most expensive procedure offered at Angell), which cost about $ 8,000. But buyer beware: Insurance won't cover conditions present at birth. Nor will it cover hereditary problems that develop later, such as the debilitating hip diseases that commonly afflict German shepherds, golden retrievers and other large-breed dogs. "That's been our biggest complaint," says Stephens. As a result, the company will soon begin offering coverage "at considerably higher cost" for some of these ailments--provided that owners also spay or neuter their pets. Says Stephens: "We don't want to cause more problems for these breeds by propagating the sick ones." BOX STORY: "I COULDN'T BEAR TO HEAL HIM UP JUST TO WATCH HIM DIE," said Kate Cotter after deciding to euthanize her terminally ill dog, Paddie (below). Each year, countless owners of sick pets grapple with the same excruciating question: "Should I end my pet's life?" The answer seldom comes easily, even when an animal is immobile or incontinent or shows signs of pain. "Scientists are only beginning to research pain in animals," says Carol Moulton of the American Humane Association. So while veterinarians say symptoms of suffering may include heavy breathing, increased heart rate and loss of appetite or energy, they also warn that animals are individuals, and some endure pain with remarkable stoicism. Most often, pet owners are forced to make an intuitive decision, and many find it helpful to consult a pet loss counselor. (The Delta Society, which promotes pet ownership as a way to improve people's lives, provides free referrals: 800-869-6898.) Psychologist Lorri Greene, who specializes in the field, stresses that owners should consider "the quality of two lives, theirs and their pet's." Caring for a terminally ill animal not only requires time and money, but it can be emotionally draining, "especially if your pet comes to see you as the person who is always giving a shot or a pill." When the time for euthanasia arrives, she says, "animals usually give owners a sign. Their expressions can become dull and they grow lethargic, like depressed people. You can see it in their eyes."