Patiopup's personal compost heap

Very strange to me, what I do. And strange how I have to be to do it.

It's not long ago. I stand over a dog -- a Boston Terrier with dry eye and a nearly ruptured left cornea. Formerly, anyway. I've just removed his left eye. After suturing the lids ****, I cut the skin around the lid margins, used scissors to dissect down to the level of the conjuntiva, and dissected back to Tenon's capsule, the curtain that connects the eyeball to the skull. I cut through the capsule around the perimeter of the eye, elevated the extraocular muscles and severed them, and placed a curved mosquito hemostat behind the eye and clamped it down onto the optic nerve, waiting a bit, before cutting through the nerve itself.

In a large dog at this point, I would slip a ligature under the clamp and tie of the stump of the optic nerve. In a small dog or a cat, just the prolonged crushing action of the hemostat is enough to staunch bleeding. The dog is smaller than he is large, so I go with the latter approach.

After about a minute, bleeding starts from the region of the optic nerve. An attempt to isolate the nerve and replace the hemostat results in increased bleeding.

My pulse comes up a bit. My breath probably quickens. It isn't enough of a stressor to bring sweat to my brow.

The dog, being anesthetized, does nothing. His heart continues to beat about nine times every six seconds. He breathes about every twenty beats.

I compress gauze into the socket for five minutes -- the length of one or two songs on the radio.

The radio is almost always playing. The radio is only off when a monitor isn't working, meaning somebody is listening to and counting a heart rate, or when a patient is being resuscitated. During resuscitation, words are hushed, the lowering of the voice creating an expanding circle of calm.

So a song, a set of commercials, and some inane DJ chatter. I remove the gauze. The bleeding starts again. It's a sluggish ooze at first, then a steady stream. The bleeding does not have the characteristic pulsing flow of a large artery, so the situation is not urgent. Only two four-inch-square sponges have been soaked, so the dog has only lost about 30 cc of blood and has been on IV fluids for 45 minutes, meaning volume loss is not a concern.

A private clinic recently had donated some surgical supplies, including three sterile collagen sponges. The sponge is put in a bleeding site, the collagen in the sponge interacts with tissue factor in vessels and with platelets in the blood to form a clot, and bleeding rapidly ceases. Very handy stuff, but not the sort of thing that a shelter clinic normally purchases. So I call for the sponge, it's opened with the casual ceremony of the operating room, and I place it in the socket.

Bleeding stops within three seconds. I wait. The bleeding continues to be stopped.

I elevate some periosteum, suture a scaffold, close Tenon's capsule. I close the subcutaneous tissues around the wound in an inverting pattern. I close the lid margins with black nylon suture.

The dog recovers uneventfully from anesthesia. He exhibits limited pain, less than he has shown when the painful eye was still in place. He stops trying to bite hands near his head. There is never evidence of post-operative bleeding and minimal swelling. The veterinarian who later removes the sutures will remark that the scar looks very good, though she will complain that the sutures, like the surrounding fur, are black.

Nobody's donated any other color of 3-0 nonabsorbable suture.

Anywho, it just suprises me sometimes that my sloppy, boorish self is doing this stuff. And because I expect myself to succeed -- I have to, going in, or I shouldn't be doing it -- it always ends up seeming humdrum. Except for the nerves' elevated hum and the slightly taut drumming of the heart I come out with. The mind knows that calm is important, and, over time, it manages to temper the body's response to stress. The combined sensation of focused and precise control and physiological excitation actually reminds me of the feeling I used to have after 60 or 90 minutes of yoga and body and voice exercises all those years ago. It's an addictive feeling. As a reformed/reforming smoker, it's probably the one routine part of the day that leaves me wanting a cigarette.

My hands have become more intelligent since I've started doing surgery. When one of the (goddamn) shampoo/conditioner/whatever bottles topples off one of the crookes shelves in the shower, my hands catch it. The hands have become better at chopping onions, at loading the dishwasher, at handling tools, at manipulating tiny objects, at intuitively making the most menial tasks more deliberate, more considered, more efficient. And my mind handles pressure a lot better than it used to, particularly if it's anything important. It's better at resisting frustration, at accepting setbacks, at adapting to evolving situations.

The hands and mind want exercise, too. Any workday without at least a couple of hours of surgery feels like an incomplete work day, like my days behind a desk used to feel.

And still, most success is expected, any personal or systemic failure is to be scrutinized, in case things could have been done better (and they always can be).

No more surgery until Tuesday, when it's back to the salt mines. Was supposed to be in New York for the holiday weekend, but airlines were offering free itinerary changes in anticipation of hurricane, so still here at home. Dinner, beer, campfire with friends tomorrow, though, which is good. And nobody knows what Monday holds, which could be fantastic. And Tuesday I go back to act the doctor again, with all of mild, intermittent excitement and persistent, soul-crushing boredom that reprising the same performance day after day entails.

(But, in the words of Mr. Allen, it still beats waitressin'.)

Rambling ruminations on this, the first day of 2011 -- the year in which, I was informed last night, down is the new up, and bullshit is the new truth.

When I was growing up, there was no such thing as a strictly indoor cat. Our cats always went in and out more or less as they pleased, and they knew to meow at the door to go in or out, and they learned that if they abused that privelege they would be ignored.

Our first cat was named Amethyst at the vet and Jezebel at home. In retrospect, I wonder if the Biblical appelation may have been due to a terminated pregnancy. There were never kittens around, but certainly I did get the hint that there was something salacious about the name.

Jezebel died in the driveway of my aunt-and-uncle's house, where we were living at the time. My uncle ran her over. There was never any acknowledgement or even overt suggestion that this was anything other than an accident, but as it's become apparent what a vile piece of **** my uncle is, I wonder if there wasn't some intention there. It was, after all, around that time that he broke Bandit's leg.

The household, which was together in 1982-83, then consisted of my uncle -- my father's brother -- his wife, their son J (4 years older than myself), their daughter S (2 years younger than J), my parents, my half-sister L (9 years my senior), and myself. Children's ages , give or take birthdays, were 17 (L), 12 (J), 10 (S), and 8 (myself). Bandit was J's puppy. I don't remember what kind of mutt he was exactly, but he was a medium-sized-terrier with a medium-length liver-and-white coat. Something like a smallish Brittany, maybe. Our dog was an Old English Sheepdog we'd got as a pup when I was 3, and she was a mostly-quiet yard fixture.

At any rate, uncle never showed any sort of affection for animals. Tired of Bandit's barking one day, he casually tossed him off the deck -- which jutted off the second story of the hillside home, about a 25-foot drop to the ground. Bandit was in a cast for a while. He was still around when we moved out, but I don't have any memory of him after that. I'm not sure what ever happened to him.

The reason our nuclear family was living in my aunt and uncle's house was that my mother was pregnant again. This was an accident, and we apparently were not financially prepared for it. My parents were just starting to get their business going, strugging to make rent on the office and the house and to pay their secretary, and new babies eat up both time and money.

(I'd been an accident, too, and when I was a baby and a toddler we lived in a one of the poorest cities in the San Francicsco Bay Area. We were the only white family in the neighborhood, and my poor sister had to walk in her homemade clothes and wire-rimmed glasses and blond pigtails to school, where she was a very easy target. We were on food stamps then, too, and I rode the city buses with my father as he went to law school and worked odd jobs with me in tow. For a while, I was looked after for a pittance by an old neighborhood woman who didn't speak any English, but, as I understand it, that arrangement ended when my parents found out she'd been taking me to the racetrack. As I was too young to place bets, I'm not entirely sure why this should have been a deal-breaker.)

So when my mother realized she was pregnant again sometime around the new year of 1982, my parents looked at their business and personal expenses and decided that house rent could be cut out if we moved in with the aunt and uncle, who lived in a giant, half-finished house. In exchange for that, my parents would work on finishing the house, building a kitchen in the downstairs, building terraced decks from the high back deck down to the ground, putting a soft-bottom pool in the lowest level of the deck, painting the house, and so forth. So financially it was a expedient for everybody.

During this time, my uncle started molesting my cousin S. Not that any of the other kids knew it at the time. I suppose if I'd been a sharper 8-year-old, I'd have recognized this as the root of the secret naked games S would try to get me to play when nobody else was around, but I didn't connect the dots. Or when uncle bought S a waterbed, which even in the 80s seems a strange thing to get for a kid, but I suppose it was meant to buy silence. At least I choose to believe it was to buy silence. Otherwise his motivation is just too creepy to think about.

This ordeal wasn't frankly acknowledged within the family until a few years ago, when at around the same time S started talking to people in the family about it and cousin J's daughter leveled the accusation that the old man had molested her, too. The aunt, an accomplished enabler, apologist, and flatterer as well as a bitter backstabber, confirmed that uncle had molested S when she was a kid, but maintained that the more recent events were fabricated and, moreover, uncle is not a sexual threat because he is impotent.

Charming, really.

But I didn't know about any of this then. I knew that Jezebel had been run over, as sometimes happens to cats. Bandit had a leg in a cast, but still tried to mount the neighbor dog ("Pumpernickel" was her nickname) whenever she wandered into the yard. My aunt and uncle creeped me out and I avoided being alone with either of them whenever possible. It was a reaction to them that I'd had for as long as I can remember, the same reaction I had to my grandmother on that side of the family -- the three of them were stern, judgmental taskmasters, but since uncle has implicated his own mother as having molested him as a child, my instincts may have been better-founded than I realized. In July of 1982 I had a new baby brother, which was pretty cool. After a couple of weeks of combined family labor, there was a pool to play in. I found a stray cat in my grandpa's yard and brought it home, where it did not get run over in spite of being stone deaf. There was a solar eclipse that fall, and my dad let me stay home from school so we could watch, using a projection screen set up behind the eyepiece of the telescope.

On Christmas morning of that year, my sister found my baby brother dead in his crib. Crib-death, sudden-infant-death-syndrome. Sleep apnea in extremis. I didn't cry then, and I still don't cry when people die. Seeing people and animals suffer troubles me, sometimes profoundly, but somehow death doesn't move me much.

On New Year's eve of that year, my parents got married in a small civil ceremony, after which we all had dinner at an old local Mexican restaurant. It's a curious reaction, but I suppose on some level it must have been a tacit acknowledgement of the fact that families tend to come apart after the death of a child, and a reaction against that knowledge. Nevertheless, nothing was quite the same after the end of 1982.

Sometime in the spring of 1983 we moved into a rental house next door to the house we'd rented when my mom had got pregnant again, the first house I remembered living in. My parents both worked long hours, my sister was graduating high school shortly, and I was pretty much on my own. I started fixing most of my own meals, I walked to school after my mom had left for work and while my dad was still asleep, I came back home to an empty house and let myself in with my own key. I had friends within biking distance, and I spent a lot of dinners and nights at their houses, where there were brothers and sisters, laughter over the dinner table, games, warmth.

It was different at home. Except for formalized activities and outings -- baseball, Cub Scouts, backpacking, canoeing -- life at home was a meditative affair. Sometimes we'd have a quiet family dinner, sometimes it was catch-as-catch-can. I got pretty adept with the skillet. On the weekends I'd stay up very late, watching TV until it went off the air, then reading or listening to the old stereo my sister gave me with big plastic headphones on. My parents went to bed early and read until they fell asleep. The cat got fat, and never strayed out of the yard. I taught our sheepdog how to shake hands, the first trick she'd ever learned. I also started letting her into the house when my parents weren't home or were asleep, and she'd gratefully sleep on the rug in front of the fireplace in the winter or the screen door in the summer.

I don't mean to lay blame -- life's hard, hindsight isn't 20-20 but it's better than the blind way we generally step from the present into the future -- but I do wonder how life would have been different if my parents had split up then, instead of soldiering on, presumably for my benefit but perhaps just because objects at rest tend to remain at rest, living together in their complete lack of any common interest beyond their children's welfare. Certainly when the finally split up a few years ago, they both immediately became more relaxed, open, interesting, engaged people. Last time I saw my father -- 2 years ago? 3? -- he looked as happy as I ever remember seeing him. And my mother, who'd harbored a frustrated travel bug from childhood (whereas my father seems to consider any trip that requires a plane or a boat to be the height of self-indulgence) has since flitted to Mexico, Europe, the Caribbean, and China. I can't but think it would have been better for them and me if this had all started when I was still a kid and they were both young enough to make a fresh start with some real forward momentum instead of feeling, as I think they both do, that they're playing catch up.

But I may be projecting. It's taken my wife and I a few years to come to grips with the fact that we've grown apart, that as much as we share a past and a profound connection, the fire is gone and staying together just makes us both flatter, colder, deader. That we're not the same people at 35 than we were or thought we'd be at 22, and that we don't owe it to our youinger selves to pretend that we are. Quite the opposite, in fact.

Neither of us has a cat. Almost everybody I know now who has a cat keeps it indoors only. Which I know is safest for the cat, but I also think is kind of sad.

My oh my.

Quite a read!

You and your wife have come to this conclusion before, no? And at that time you stayed together.

Man, you are a good writer.

Hmmm. Interesting party last night. A different crowd of people. End of a tough year. And a very cold, windy start to the new year with, apparently, some self-indulgent navel-gazing and stock-taking. And thanks to proper pacing and a bit of luck, hangover-free.

Happy new year.

Nappy Yew Hear to you, too. I read your latest installment with an avid interest, and a sinking heart. I am surprised that you are so forthcoming here, but glad to you took the time and the trouble.

What to say. I am fond of a2kers including those I tend to disagree with. I've met some and they were there, as real life.

Pat dog, he blows my mind.
I plan not to post my enthusiasm more, as this was not at all why dawg started the thread. So, don't take my future silence as neg.

This is the kind of thing that I read and then think about and then compose a reply that attempts to show that thought -- but I only have a minute and so this will be quick and feckless.

Very good writing. Very good framing. I was so worried about that dog in the first installment, and you saved the day. And you're not falsely modest about it either, while also managing to keep things a bit acerbic -- damn sponges. (Makes me want to donate some. How much do they cost? If it's under $50 or so I'm actually serious.)

Seems like a moment to make a spongeworthy joke but I'll pass.

And speaking of moments, mine is done, gotta go. Good writing, though.

If I'm in the galley, I'd rather be pulling an oar than swinging the whip.

So it goes, beloved Pup. You're a damn fine dog.

Of course, you always take comfort that the bastard with the whip is on the same stinking boat.

Offered the most cordial and helpful letter of resignation ever on Monday, which was well received. Things looking up.

Bravo..

Whoa!!!

Oh my!

Any plans for what's next or are you just savoring the escape for now?

Offered to stay on for one month -- longer at mutual discretion -- while they conduct a national search for a replacement. I strongly advised national search and they agreed -- this is a multi-million dollar organization, they have to stop playing penny-ante with their veterinary staff. I have offered to stay on in a part-time capacity -- continue with my mobile clinics and pitch in a couple of days of surgery during the week -- provided I can retain my benefits. We're advertising that position right now, but sans benefits, and we've had **** all for applicants (in large part because of inept advertising; I also advised them on this front, and they seem to have taken note). No political bullshit with the part-time, just show up, cut, and leave at an appointed hour.

When I hear whether I'm staying on in the part-time position (and I'd better hear by Monday) I start planning the next move. I'd love love love to pick up some emergency/critical care work, which is where my other professional passion is. I hope to avoid vaccines and nail trims.

But this is decidedly non-ruminative, this chatter.

It's interesting, though.

Back to the ruminations...