It was nearly midnight on a Saturday night during my fourth year of veterinary school when she was presented to me.  As part of my emergency medicine rotation, I was working in the after-hours clinic of the university veterinary teaching hospital along with three other classmates, a technician and an intern supervising us. In walked a couple who had driven to our hospital from their home more than an hour away. They had been referred by their regular veterinarian due to the late hour.  They were country folks.  Nice folks. They fell into the category of pet-owners-who-can-afford-healthy-pets-but-not-sick-ones, the large middle region of the client spectrum between pet-owners-who-do-nothing-to-care-for-their-pets and pet-owners-who-have-lots-of-disposable-income-or-credit-to-pay-for-extreme-measures-of-care-for-their-pets.

The dog was a tiny middle-aged female poodle-ish type, and her problem was obvious. Protruding from the “business end” of her body was a puppy’s head, hopelessly stuck during delivery at the level of the shoulders, with a bloated purple face, clearly lifeless.  The mama-to-be looked to be in agony. She was panting, crying, straining and looking terrified. The owners did not know what type of dog had impregnated their pet, but he was clearly much larger than a miniature poodle mix.

Caesarian section was almost immediately ruled out by the owners. They could not afford it, as it took all of their spare cash just to pay for the emergency visit itself.  Additionally, we were not convinced the puppy could be extracted surgically from its location without breaking the dog’s pelvis, increasing the cost and complexity of surgical intervention. We took a quick X-ray to confirm the normal conformation of her pelvis, the size and formation of this puppy and to look for others still living in the womb. There were two more, one large and one small (Note:  X-rays are commonly used for puppy assessment late in pregnancy in dogs, as it can be hard to find all of them using ultrasound).

We committed to trying manually to pull the puppy out.

“Shouldn’t we give her a sedative?” I asked the intern, who I will call Gary to protect his identity (he was an abysmal veterinarian, at least at that point in his career).

“No,” said Gary, “We want her to help push while we pull.”

“But Gary, she is already straining as hard as she can, and it is making the opening that much smaller,” I pleaded.

“No,” he said again, “We will lubricate the puppy with K-Y jelly and pull.”

He proceeded to infuse K-Y jelly around the puppy and tried to delicately maneuver the puppy while the female dog strained and straining. Nothing.  Totally stuck.

Resigned, Gary went to talk to the owners in the waiting room. They began to cry. They loved the dog but couldn’t afford to do anything more for her. Euthanasia was discussed and chosen. The owners paid their bill and headed out to their car. A fellow student retrieved a syringe of euthanasia solution from the Pyxis machine, an automated pharmacy. I stayed at the examination table with the dog, now virtually collapsed from fatigue and no longer pushing. In a sudden move, I put on some gloves, grabbed behind the protruding puppy’s head and gave it a firm pull. It budged slightly.

“I really think I can get this out,” I whispered excitedly to a fellow student.

I pulled again, firmly and evenly. Crack went the puppy’s neck and shoulder, and he was out. The mama dog literally sighed and went to sleep. The fact that she had given up probably saved her life.

“Stop the owners!!!” I cried.  

The intern ran out to the parking lot to retrieve the bewildered couple, who returned inside to see their dog still alive and now well. We came up with a plan to send them to their regular veterinarian the next morning, where they said they would be able to pay for a C-section at a lower cost and would also have their dog spayed. We administered a drug to slow labor and warned them that one of the remaining puppies was also large and could get stuck, so they needed to watch their dog overnight.  We warned them that the other puppies could die from the delay in treatment.

After they left, I wrapped up and carried the dead puppy through the night to the walk-in cooler next door.  I stepped into the quietly humming cooler and around the giant bull with white foam coming from his nostrils lying on his back in full rigor mortis. I set the puppy on the shelf next to the white cardboard coffins containing the other pets that could not be saved, and for that night, it was enough to me that there had been one animal in this world I could, and did, save.

Remarkably, the mama dog delivered the other two puppies at home that night all by herself. The puppies were born alive. Her owners had her spayed, and she went on to live for years.

Over time, the weight of the animals I couldn’t save, and especially the animals that no one could afford to save, did wear on me. I left clinical veterinary practice to specialize in veterinary pathology and earn a Ph.D. degree in molecular biology. I was always more of an academic, so being positioned behind the microscope fits my personality. Ironically, I chose a specialty where I commonly deal with dead animals (or pieces of live ones).  However, I’m situated beyond the point where the life-or-death decision was made.