To Wallow or Not to Wallow

In my final year of vet school, I was on rotation in the food animal barn when I was assigned a pig patient. The Production Animal Service handled species traditionally raised for food and fiber: cattle, sheep, goats, and pigs. The departments were segregated by species, not owner's emotional attachment, so even pet pigs got hospitalized in the food animal barn. If your mini pig was getting an MRI, you might find yourself sharing the lobby with a mud-spattered, dip-chewing farmer from the valley who had no more than $400 to spend on his prized heifer.

The easiest way to distinguish one animal from another was by their name—or their number, if they happened to be a real production animal. I didn’t care much about the animals’ socioeconomic backgrounds; I just wanted to learn good medicine. "What’s in a name?" Shakespeare might have quipped.

But names sure mattered there. Numbered animals could only expect as much veterinary care as was slightly less than their own economic value. Harsh, cruel, or simply realistic, the equation was simple and reliable. It was never done maliciously, but I saw a lot of production animals put down when their cases got too complex.

Not so much for the pets.  

My pig patient had a cute, pun-based name, so he was obviously someone's pet. He was a mini, about the size of a cocker spaniel. And every morning I'd do his treatments before rounds: rustled him up from his straw bed to scoop up “eliminations”, shoved pills down his throat, gave him injections, stuff like that. I’d never really gotten to know a pig before, but we sure spent a lot of time together in his stall. I wish I could say I enjoyed it more. 

It started off fine. He had some rare neurological condition and ended up at the vet school hospital because his owners wanted the best possible care. As a student, these seem like fun cases, because lots of people get excited and want to be involved. He was a patient at no fewer than three specialty departments during his stay. But most of my job was the administration of these (frankly) unpleasant treatments. Scrubbing dried feces off of a squealing seizure patient day after day isn’t enjoyable for anyone.

He was (reportedly) the first pig that the Neurology department had ever successfully performed some technically challenging sampling maneuver on. I can’t remember the details, sorry (it’s probably published somewhere). But with all the interest, nobody had a definitive diagnosis, and as the weeks went on he didn’t get better. Other patients came and went (or were put to sleep), but the pig lingered. 

A long stay in a specialty department is usually a poor prognostic indicator, but no one was giving up yet. His owners (a youngish city couple), the supervising clinicians, colleagues recruited from across campus to help solve the mystery, all of them were determined to get him through. But honestly? I didn’t want to keep going in that pen every morning. I didn’t want him to keep feeling like–despite my best efforts–he was being tortured. Who ever wanted to be in a hospital that long?

I guess we tried to inform his owners. We explained carefully all the relevant information: differential diagnoses, risk of adverse effects for each medication and treatment, and of course the cost. We even gave a guarded prognosis, but assured them we had plenty of options left. They always wanted to try. A new med would get added to his chart, and I’d go give it to him. Nothing made a difference. He got worse. 

Look, this pig was loved. His owners would have done anything to save him. The genuine Ag kids might have rolled their eyes, but I just wanted to know how to fix pigs. I wanted to be a cog in the wheel of this advanced medical institution. What else was I there for? Why wouldn’t I try to save him?

At some point, the owners must have felt like time was running out. They began visiting every day. I’d set up a blanket on the south side of the lawn, and bring the pig out to them for some quality time. They didn't dress like farmers, but laid down comfortably in the grass with their animal. He couldn't settle though. He jilted and twitched and let out little squeals of discomfort as they tried to help him relax. We'd add a new pharmaceutical, with little effect. Sometimes they’d spend hours together.  

I might exchange a few polite words with them as I shuttled the pig out. One day, one of the owners asked me if there was something they were missing. Meaning some diagnostic test, procedure, or medical treatment that we had been holding in our back pockets but had decided (in our paternalistic sagacity) not to try just yet (for some wise reason). 

I thought for a moment about what was needed. The pig paced restlessly and squealed, and they looked pained and confused.

I couldn’t come up with anything. There were so many smart people involved already. Who was I, Dr. Gregory House? I just thought of the other animals I had seen suffer. Their owners–farmers–knew about the endless hardships. They didn't take up arms against a sea of medical troubles, they couldn't afford to. They also didn't hesitate to end suffering, and I wasn’t sure that was such a bad thing. 

So I answered, “Have you ever thought about euthanasia?”

Silence, for an existentially terrifying two or three seconds. I was a student, and not supposed to give medical advice. Especially not for complicated cases, doubly especially not for “high value” clients. I didn't know the Dean very well, and I wondered if he knew who I was. 

The expressions on their faces were unreadable–really hard to read! Could I pay off my student loans on a teacher’s salary? But after a moment of excruciatingly blank looks, one of them turned to me.

“No one has ever brought that up”, he said. 

I bet that’s true. This was a place of promise, a wonderful university veterinary hospital with powerful and extraordinary possibilities! In weeks of meetings with smart, impressive, and highly experienced people, I doubt anyone had suggested that option. Certainly not so bluntly!   

I don’t know, maybe somebody should have been supervising me better. But I was struggling with what I felt the pig deserved. I was sick of these pharmaceutical slings and arrows I kept having to stab him with. It wasn’t my unpleasantness of cleaning his crap and performing his care–it was his existence, he was miserable. 

I don’t think he read Shakespeare, but there’s a good chance his owners had read it aloud to him at some point. Maybe I did see them with a book out during one of their final visits. One bright sunny day, they laid down in the grass with him one last time. They had decided to let him go. The resident performed his euthanasia, if I remember correctly. His body relaxed as he shed his mortal coil.

His story is a genuine tragedy. So much of his suffering could have been avoided by paying attention not to the complexities of his medical condition, but by addressing the heartache of the people involved. I have no criticism for anyone involved with his care, I just feel my own sadness that we couldn't have helped him escape his pain earlier.

The choice to live or to die, to be or not to be, was agonizing only for the people involved, because he never would or could consider such questions. I spent so much time with him, I knew him well. And I don't think it's a transgression of confidentiality to share his name. He had the full authority of character, to me.

His name was Hamlet.