For months, Nikki had been coughing, at times coughing so hard and for so long that it seemed she would never catch her breath. At 12--even in dog years, not a terribly advanced age--the fluffy, sweet-faced spaniel looked robust enough to give her owner every reason to believe that whatever was wrong with Nikki, it probably wasn't going to kill her.
And so, week after week, they returned to the Vanderhoof Veterinary Hospital in Altadena in search of a diagnosis and, they hoped, a cure.
But after chest X-rays, repeated courses of powerful antibiotics, a tracheal wash and a frightening bout with pneumonia, the cause of Nikki's cough remained a mystery. The only option now was surgery. Did the owner want to go that far, spend that much, to find out what was wrong?
After a period of hand-wringing, the owner decided yes. She was not ready to give up and, she believed, neither was Nikki.
Waiting Room Is Thick With Tension and Fur
There is a belief, particularly among those who practice veterinary medicine, that the way we treat our animals is a reflection of the value we place on human life. At the Vanderhoof hospital, located in a brick-faced strip mall in the foothills of the San Gabriel Mountains, that belief is tested daily.
On a typical weekday morning an hour or so before the hospital opens, passersby are greeted by an orange chow chow dog by the name of Ciao pulling his paralyzed, diaper-clad lower half along the sidewalk on a big-wheeled cart. The silver-spoked wheels are strapped to the dog's ample middle, and, although his tail has not wagged since his back was broken by a hit-and-run driver, Ciao is clearly ebullient.
Although movement to his deadened hind legs could not be restored, veterinarians Daniel Vanderhoof and Scott Sloan gave Ciao his life. The injured dog was brought to the hospital by a passing motorist and taken in by the vets who fixed what they could and kept him at the hospital until they could find him a home. Three days a week, Ciao comes in early for therapy, baths, and to boost staff morale.
By 9 a.m., the sparsely furnished waiting room is already full. There are dogs and cats scheduled for vaccinations, a potbellied pig with an appointment to be neutered, a tiny terrier with tremors, a pug with glaucoma, and half a dozen other patients who need to see the doctor.
There is tension--and fur--in the air, but nothing the staff of 11 can't handle. Hanging on the wall is a roster with the staff's names and titles. At the end of the list is Wobbles, whose job is described only as "security." The brain-damaged tabby (named for his tendency to walk in circles) isn't always nice, but his rude behavior distracts the sick animals from their fears.
The first patient to be called is Calvin, a pug with bulging, cloudy blue eyes.
"We see Calvin quite a bit," says veterinary technician and hospital manager Roberta Tipton. "He punctured his eye on a table running for a golf ball, and that required three or four surgeries. Now, he's here to get a growth removed, a histiocytoma. He is a cool guy. We're always happy to see him."
Kitty Waddell, Vanderhoof's longtime receptionist, comes out from behind her desk to tickle Calvin beneath his flabby chin.
"Such a good little boy," she coos.
The second patient is an outgoing striped tomcat who arrives in the arms of a woman who has been feeding him since he showed up on her doorstep two weeks ago. In the examining room, the stray she calls Tommy nuzzles against Dr. Vanderhoof's gray polyester trousers and purrs.
"He was somebody's pet, that's for sure. He's very friendly," says Vanderhoof, tugging gently on the points of Tommy's triangle ears. "Right off, we recommend doing a leukemia test on any stray because it's a fatal virus and is highly contagious to your other cats."
In examining Room 3, a shy Siamese-calico mix named Samantha is waiting with her head buried in the crook of her owner's arm. She is one of many descendants of some Seal Point interlopers that settled a few years ago in the Altadena hills. She has come directly from the emergency clinic, where she spent the night in an oxygen tent.
Vanderhoof, 45, is a lanky man with a thick mustache and an easy smile. He holds his stethoscope to Samantha's chest and listens.
"We're not as congested today as we were last night, are we? Let's hope our temperature is down. Oh, now, nobody likes the thermometer back there, do they, Samantha? 102.3. Not bad. We consider 100 to 102 normal."
Vanderhoof, known around the office as Dr. V, tries to palpate the cat's abdomen, but Samantha has flattened herself on the examining table.
"It's hard to diagnose cats sometimes," says Vanderhoof, who grew up with dogs but has only a pair of cats at home now. "The problem is cats just don't do a lot, even when they're healthy. Mostly, they lie around and sleep. . . . And when they're sick and they're still just lying around, how do you know? Well, let's give her some antibiotics and see how she does."
A Full Schedule for the Surgeon
Outside the operating room at the end of the hall, Sloan, 49, the unflappable, red-haired surgeon who has worked with Vanderhoof for more than a decade, is reviewing the day's schedule of procedures. He is one of the few vets in California who routinely performs laminectomies (disk surgery) on dogs with bad backs.
"About 90% of the time we get dogs walking again," he says. "I've got a nice dog here--Willie Clark--who cries out whenever he walks, has to be lifted in and out of the car. From the X-rays it looks like he has an ulcerated disk in the lumbar region, and we're going to try to fix him up."
Also on the list are two feline castrations, a spay for a Shih Tzu, excision of Calvin's histiocytoma, removal of an infected surgical screw from the shattered leg of a dog he treated two years ago, and a rare thoracotomy and removal of a lung.
Sloan, who taught surgery at UC Davis' famed School of Veterinary Medicine, has only "cracked a chest" three times in his career. The patient this time is "a 12-year-old, 27-pound female dog."
The patient is Nikki, the wheezing spaniel.
The decision to operate wasn't an easy one, Tipton says.
"Nikki's mom had a hard time deciding," Tipton says. "We told her, 'Well, you either do nothing and she keeps going down, or you do something and maybe it's bad or maybe it's not . . . you hope it's not.' "
While vet assistants are shaving and swabbing Nikki's chest with Betadine, Sloan pulls on a turquoise scrub cap decorated with orange and yellow tropical fish. A sign in the shape of a dog bone that hangs near the sink where he scrubs up reads: "Laminectomy! I thought you said lamb 'n' rice!"
Birds and Snakes Are Off-Limits
Back in Room 3, Vanderhoof finds an old friend with a new patient.
"This is Sarah--with an 'h,' " says Kate Spark, who works with Little Angels Pug Rescue to save dogs like this homely orphan. Sarah's breathing is loud and labored, and she seems to have an upset stomach.
As Spark details Sarah's symptoms, the pug suddenly poops on the stainless steel examining table. "Well, I don't think she's constipated," observes the vet straight-faced.
The Vanderhoof hospital sees "companion animals" and what Tipton calls "pocket pets"--rabbits, guinea pigs and hamsters. They refer avian patients to other doctors because Sloan is allergic to feathers. And they send snakes and their kind elsewhere because Vanderhoof does not like snakes.
The hospital does treat tortoises and recently was the site of an unusual tortoise birth announcement. As Waddell, the receptionist, tells it, it all began with Max and Lilly, who were patients until Max was run over by a truck and Lilly ran away.
Months later, Waddell recalls, she received a jubilant call from the grieving family. After years of infertility, Max and Lilly had apparently mated successfully and left six eggs in the family's backyard. This spring, the eggs hatched, yielding half a dozen little Max and Lilly look-alikes. "Of course, we were thrilled," Waddell says.
The last patient of the morning is a sleek 50-pound whippet with a turban of white gauze around its head. The owner, a young woman from Orange County, explains what happened in a breathless rush.
"My dog was attacked by a squirrel. I saw a squirrel. He saw the squirrel, and next thing I knew I heard a, a sound I'd never heard before. I don't know if it was him or the squirrel. He must have caught the squirrel by the tail, and it flipped around and grabbed his head. He was bleeding all over. I bought him a toy when he was little--a life-size squirrel toy. Maybe that was the wrong thing to do . . . do you think?"
A Tearful Owner, a Dog in Pain
It's the lunch hour at the video store, the nail salon and the other stores in the minimall, but at the animal hospital, the noon hour is the same as any other hour. Sloan is still in surgery. Vanderhoof is on the phone with specialists, and out in front, Laura Hilton-Jacobson is on the phone with a woman crying on Line 1.
The caller is a longtime client, a Pasadena retiree with three beautiful dogs. Her golden retriever, Jake, is down. He's in the backyard, yelping in pain, but he can't move and the woman is not strong enough to lift him.
Tipton dispatches two assistants, Ethan Bearman and Vanderhoof's son, Sam Vaquera. In 20 minutes they are back with the dog and his owner. Jake, his graying muzzle caked with mud, his bold head trembling, is obviously in trouble.
Vanderhoof looks at the dog and shakes his head. "Right off the bat, it's not good," Dr. V says. "He's very shaky, and I think he's bleeding internally, probably has already lost a lot of blood. His pulses are very weak. I . . . I . . ."
"I think he should be put to sleep," Jake's owner, a petite older woman in gardening clothes, finishes the sentence.
The dog struggles to lift himself off the stretcher and falls back.
"Yes," says Vanderhoof, who by now is convinced that Jake is suffering massive internal bleeding. "That may be the kindest thing. He's been a good dog for you."
Tipton enters with a 12-cc syringe more than half-filled with a thick liquid the color of cotton candy. As Tipton pushes the pink viscous liquid into a vein in Jake's foreleg, his owner pats and rubs his big bronze head.
"I've taken four adults through [death], but this . . . is hard. There's a darling. There's a sweetheart," Tipton says.
Tipton, her face wet with tears, withdraws the syringe and strokes the dog's matted fur. "It's all right. You're all right now."
Jake falls limp.
"His expression is changed," says the woman.
"Yes," says Vanderhoof, "Jake says, 'I'm at peace now.' "
Vocation Handed From Father to Son
When Daniel Vanderhoof's father opened his veterinary practice in Utah nearly half a century ago, medicine was a different sort of art.
"It's always been as much about emotions as it has about science," says the younger Vanderhoof, "but now there's so much that can be done. The question is, should it be done?
"Today, people can say, 'How about a kidney transplant for my cat? How about a heart transplant? As in human medicine, we have the technology to do many of these things, but financially you just can't.
"And then there's the other side. I had a couple come in with a dog with a serious but operable tumor. I said it will cost $400 to take this out. The husband said, 'No way.' The wife looked at him and said, 'You just spent $800 on new rims for your truck.' And he looked at me and said, 'When would be a good time to schedule the surgery?' "
Like many animal hospitals, Vanderhoof's has a fund to help people who have sick or injured pets they can't afford to treat. And occasionally, someone on the staff will take an abandoned pet home. (This does not include Vanderhoof whose wife, Ofelia, "laid down the law early on--no pets come home.") The vets say there are many cases in which economics dictates care--and, sometimes, death.
Although their training is almost as lengthy and intense as that of medical doctors, few veterinarians can expect to be even half as financially successful, according to the American Animal Hospital Assn., the national certifying organization based in Lakewood, Colo. It is not unusual for veterinarians such as Vanderhoof and Sloan to work six days and 60 to 70 hours a week for years, and still not make the six-figure salaries most physicians earn. According to the hospital association, many vets start with salaries of less than $30,000 a year.
Sloan, an accomplished surgeon and former instructor in small-animal medicine at UC Davis, says he has no regrets about forsaking a possible career as a neurosurgeon.
"I help dogs and cats, and I think people appreciate it. I grew up with a lot of pets. I was born hard of hearing," says Sloan, who is still hearing-impaired. "A dog or a cat won't make fun of you if you're hard of hearing, if you have a handicap. You give them love and affection, and they give you love and affection back.
"But I think with pets, sometimes people need to let go. For example, I just refuse to do chemotherapy on some dogs and cats . . . even if it was free, which it's not," Sloan says. "Sometimes there comes a time, you have to treat them with what some people call benign neglect--what I call love."
Music to Soothe the Ailing Pet
Nikki is out of surgery and a five-pound tumor in her right lung is out as well. The music in the surgical suite has been switched by Tipton from heavy metal to the triumphant strains of a Brandenburg concerto.
As the hospital's most skilled anesthetist, Tipton was assigned the job of breathing for the dog, mechanically inflating her lungs by squeezing oxygen from a black-rubber bellows bag into her mouth. With exquisite precision, Tipton times the breaths to complement but not interfere with the surgeon's opening of the sternum, separation of the ribs and, finally, cutting away of the dusky diseased lobes.
At the end of the surgery, she bends down over the groggy spaniel.
"Miss Nikki? How about some pain medication? No need to suffer now, is there?"
Sloan, still in his scrubs and the Nikes he wears for long days in the OR, whistles softly as he gently lifts the four layers of blue surgical draping off his patient. It has been almost five hours since he walked into the operating room.
As he examines the rigid yellowish mass taken from Nikki's chest, Sloan turns suddenly toward a noise from the recovery room.
"Did Nikki cry?" he asks. "I thought I heard a cry. She may need more pain meds. She's hurting. I know what it feels like."
In 1994, Sloan had his own chest cracked open for heart surgery to correct a chronic arrhythmia.
Despite the vets' guarded optimism about Nikki's prognosis, several days later she suffered a fatal cardiac arrest.
"Is it fair? No, it's not," Tipton says. "We gave Nikki every chance, every extra breath we could get for her. Sometimes, sadly, what humans can do is simply not enough."
The Day Isn't Over Yet
Before the after-school / after-work rush begins at 4, the vets will see a puppy with a sprained tail, a spunky calico named Callita with sinusitis, a blue-eyed cat named Frank with gum disease and, the most serious case of the afternoon, a sable Burmese cat who vomited blood on her owner's white carpet.
"I didn't even wait to clean it up--that's how worried I am!" says the owner.
There is also Simon, a 125-pound Great Dane with skin problems, which has nothing to do with the fact that he recently ate the family sofa, three cushions and the ottoman.
The woman who brought in the stray Tommy is also back with her pet carrier, eager to take the cat home.
"Dr. V is going to have to tell her," says vet assistant Leann Skaggs, shaking her head. The news is not good. According to the chart Leann is holding, Tommy has tested positive for feline leukemia.
Vanderhoof comforts the woman.
"Leukemia is a misnomer," he says. "It's not like cancer in people. It's more like the AIDS virus."
"He's such a nice cat. This is terrible," sobs the woman.
"Yes," says Vanderhoof, "it is."