A Country Practice

1
THE SURGEON
1.
On New Year's Eve of Chuck Shaw's first year in Walpole, New Hampshire, a few months after he had bought his veterinary practice, he got a call from a policeman in Bellows Falls, Vermont, across the Connecticut River. A dog had been found in a snowbank after he had been hit by a car--an HBC, as it is called--and the police wanted to bring him in to be euthanized.
They met at the clinic, and Chuck took custody of the dog, but he didn't put him down. Maybe an owner would show up, he said. As a new vet with a small practice, Chuck held his patients dear. He was one to take an animal home and put it in a box in his bedroom at night if he thought it needed watching over. Chuck stabilized the dog, sewed up his cuts, and put him in a cage for the night.
A dog heals quickly, and soon this one was up and walking around. Chuck named him Duffer. He was a mongrel, likely a Lab and setter cross, with a feathered tail and a happy-to-see-youpersonality. With no word coming from Bellows Falls about an owner, Chuck began to search for a home for Duffer. Of course the possibility existed that if no one adopted him within a few months, Chuck might euthanize him. Such was the nature of the business. Until then, Duffer could serve as a blood donor if Chuck needed one. Veterinarians often keep a big dog around for that purpose, or they know of a farm dog who can serve as a candidate.
Duffer soon revealed a special talent--that of an escape artist. Each night when Chuck went home, he locked Duffer in one of the cages, and each morning Duffer was out and waiting. He didn't do any damage, just flipped the latch or undid the cord. Chuck was alternately amused and annoyed. He didn't want animals getting out of his cages.
March came, and Duffer still had not been placed in a home. Then came the fateful day, late that month, when Chuck got a call about another dog who had been hit by a car. The owner was one of Chuck's clients, and it was clear that the animal would need extensive surgery and a lot of blood. Chuck looked at Duffer and said, "Your time has come." He began the surgery, and when he had taken the blood he needed, he gave Duffer the fatal injection. Chuck set Duffer out in the garage and made a mental note to dispose of him later, but with the rush of cases soon forgot Duffer was there. He finished the surgery, made a farm call, and went home for the night.
The next morning at the clinic, Chuck was looking at his appointment schedule when he heard a scratching at the door. He wondered if an animal had gotten out. He opened the door, and in stumbled Duffer. He looked as if he had had a very bad night, as if he was wondering what had happened. He shook himself off, cold and bewildered, but happy to be inthe warm treatment room again, and happy to see Chuck. Chuck was amazed that he could have survived the loss of blood, not to mention the injection. He said, "This dog is going to live. This dog is a survivor." He adopted Duffer then and there, and took him home that night.
Later, Chuck established a policy that no healthy animal would be euthanized at his clinic. In the meantime Duffer became the first in a long line of clinic pets. It was a good idea to have a pet at the clinic. A healthy animal could be a reassuring sight to a worried client, or an anxious pet, or a staff member who had seen a bit too much real life on a particular day.
Chuck brought Duffer to the clinic for four more years, until one day Duffer wandered off. Chuck searched in the brush and the woods around the clinic throughout the day, until he concluded that Duffer had gone off to die. An escape artist to the end.


Two decades later, at Chuck's new clinic on Route 12, a door opened from the treatment area into the reception room and a light shone through, but no person came out. Instead, out walked a cat, stubby-legged and rotund, with short gray hair, a white shirtfront, and little white bootlets. His name was Hobbs, and he was the current clinic pet.
Hobbs was a survivor too. He had once been a feral cat, scarred and infected from fights, living on a diet of whatever he could catch or scavenge. But his feral days were long behind him, and the lean scavenger had become an overweight fourteen-pound pussycat. His obesity was one reason Hobbs was not supposed to be in the reception room; he did not send a good message about nutrition and weight control. Hobbs also got into trouble out front. He walked on the computer keyboard and froze the system. He used the rubber plant as alitter box. And sometimes, being a former feral cat, he could get aggressive.
But Hobbs was a great clinic cat. He could give comfort. One day a client named Chase Romano brought her cat in for treatment. Chase owned a bookstore, and her handsome black cat, Bookcat--or Bookie--had developed a kidney problem. He had become dehydrated and needed daily subcutaneous injections of fluids that Chase was learning to give. She would also soon decide to take him on all of her book-buying trips, outfitting her van with a litter box. While they waited in the reception room, the door opened and a light shone through, but no person came out. Then Hobbs jumped up on the table in front of Chase, startling her. She later said, "I saw the fattest cat I've ever seen in my life. I don't know how he launched himself up on the table. Poor skinny little Bookie, and there was this huge fat gray cat, just looking at him. Staring at him, nose to nose. I had to laugh."
Now Hobbs squinted his green eyes with pleasure at the hand reaching down, and he walked back into the treatment room through the door I held open for him.
2.
In twenty-one years Chuck had treated thousands of animals. His patients consisted of several thousand cats and dogs, three thousand dairy cows, and, through his associate Roger Osinchuk, several hundred horses. His was a true mixed practice. Scattered around Walpole and other nearby towns were sheep, Ilamas, pigs, donkeys, birds, ferrets, goats, and guinea pigs that came under the umbrella of their care.
Many of his clients had stories about him. The dairy farmer who at first didn't trust the young doctor to work onhis cows but put them under his care after Chuck saved his dog's life. The penniless client whose cat had a fishhook caught in her stomach. The woman who remembered that even though he disapproved, Chuck had put her dog down after her husband died. Over the years she had become grateful for his humane treatment.
Chuck was on call this weekend, which meant handling office appointments, overseeing treatments and feedings of boarders, and responding to emergency calls. Still doing it after all these years, Roger had said of Chuck and his dutiful approach to being on call. Roger meant to praise Chuck, but there was a touch of sarcasm. In this two-vet country practice, the on-call schedule could be brutal, as Roger well knew--and he had thought of leaving because of it. Chuck alternated with Roger, one of them on call every other weekend or every other weeknight. Being on call, with its demands on time and body, was possibly the most contentious issue among veterinarians. It was the issue, Chuck had said, because young vets were increasingly less willing to be on call.
Chuck's weekend had been typically busy. Friday night began with a long session with a client who had a seizuring border collie. After doing some research, Chuck told her that border collies are among the breeds susceptible to neurological problems. He decided to wait to see what developed. Then a call came in from a woman whose elderly dog had spinal problems and couldn't move. She brought the dog to the clinic, and Chuck examined her in the backseat of the woman's car. The dog's spine was making crunching sounds, and Chuck said that it didn't look good. He explained the treatments they could try and the injections he might give. He told her she could take the dog home, leave her for observation, or euthanize her. She decided to have a family discussion and then told Chuck they wanted to put the dog to sleep. Sheasked if he made house calls. He said he did, and followed them home.
He performed the euthanasia in their backyard, and just as he finished, his beeper went off. About a mile away, a Rottweiler had gotten a cross section of bone lodged over his lower jaw. Chuck said he would come right over. He wondered what he had in the car to sedate the dog, and rummaging through the boxes, he found a drug that he thought would work. When the arrived, he gave the Rottie a partial dose, and the dog became unconscious. Chuck tried to pull the bone off, but it was lodged too tightly. The owner said he had a hacksaw in the basement, and left to get it, but Chuck feared they would mangle the Rottie. He ran to his car, found some obstetrical wire, and cut the bone off before the owner came back with his saw.
Home again and preparing for dinner, Chuck got beeped for an HBC--a Lab that had run in front of a pickup truck. He met the owners at the clinic, and from 9:30 to 11:00 p.m. he got the dog stabilized for the corrective surgery he would do on Saturday. Then he went home and had dinner with his wife, Ellie.
On Saturday morning he went to a dairy farm and treated several sick cows, then returned to the clinic for office appointments. He gave an enema, the third, to a twenty-four-pound cat named Crunchy. He spent most of the afternoon mending the broken bones of the HBC Lab, using steel pins and wires.
At seven that night he got a call from someone whose parakeet had a bloody wing. "Wait and observe," Chuck told her. At midnight he got a call from a woman boarding three kittens for the Humane Society because of overcrowding. Two were healthy, but the third was vomiting. Chuck asked how long it had been vomiting, but the call struck him as rude. Hefinally asked the woman why she had waited so long and called him in the middle of the night.
An earlier call had not struck him as rude at all. It came from a woman named Sally Buttermore who lived in Charlestown, just north of Walpole on the Connecticut River. Chuck had known Sally for many years. She and her family lived in a mobile home with a large kennel attached. Sally bred terriers, and even though she didn't have a lot of money, she tried hard to take care of her animals. She said that someone had shot her cat with a .22 rifle and the bullet had gone through a hind leg. The cat was nursing four kittens.
Sally asked what it would cost to amputate the leg. Chuck didn't answer. He wanted to see where she was headed. He said only that he could amputate the leg.
"How much will it cost me to put her to sleep?" she asked.
"Two thousand dollars," Chuck said. Then, "You're not going to put that cat to sleep." One injustice had already been committed against the cat. He wasn't going to kill her for getting shot.
"How much can you pay for an amputation?" he asked.
After a moment Sally said, "We can pay a hundred dollars." That was about half of what Chuck would normally charge, but he knew a hundred dollars didn't come easily to this client. He made a deal with her. He would do the surgery on Sunday morning, and she would take the cat home on Sunday night. There would be no boarding.
Now the little cat was laid out on the table in the surgery. She was a calico, brown and gold and black, small and slender, her tiny nipples raised on her belly. She had a bloody crater on her rear leg.
Chuck bent over her, examining the leg. He was tall and lean, though he could easily turn gaunt and thin after long stretches of being on call. He had brown hair, gray above theears, soft blue eyes, and thick eyebrows. He had been a navy pilot during the Vietnam War, flying an attack plane from a carrier. At times his rugged singularity seemed to suggest this experience. Though he could be charming and friendly--as he put it, a real schmoozer when he wanted to be--Chuck was a thoughtful sort of person who tended toward quietness, especially when puzzling over cases.
Chuck usually had several high school kids working at the clinic. They fed the animals, took the dogs into the runs, and did various other jobs as needed. Two girls were with him now. One was a senior named Andrea, who had been accepted into a marine biology program at a good college and was working at the clinic to gain experience. Tony, a sophomore, stood next to Chuck and held the gas mask over the cat's nose while Chuck made the first incision. She was exceptionally slender and wore a lot of makeup, but she was wiry and tough. Tony had worked at a dairy farm for three years, helping out after school and on weekends, when her mother got her out of bed and drove her to the farm for the 3 a.m. milking.
While Chuck peeled back the layers of muscle on the cat's leg, he talked to the girls about what had happened the night before. When he told them about the woman who called at midnight about the vomiting cat, he tapped his bloody scalpel at them for emphasis, saying, "Don't you ever do that to a vet. You got that? Don't ever do that to a vet." Tony smirked and popped her gum. Andrea was looking a little pale.
Chuck pulled another strand of leg muscle out of the way and pointed to a white strand running through it. "The sciatic nerve," he said. "This is the one where if you stress it, you can have sciatica and get all laid up." Then he cut through the nerve.
Andrea had seen enough. She told Chuck she was feeling light-headed and had to kneel down.
"Good," Chuck said. "Good that you said so. Kneel down before you fall down." He laid bare the bone while Andrea crouched down and put her arms around her knees. A minute later she said she needed a drink of water and left the surgery.
"One time three eighth-graders from Charlestown came to visit the clinic," Chuck recalled. "I was doing an autopsy on a cat that day, and I gave them an anatomy lesson. The three of them were standing side by side, two girls and a boy. I was naming the organs when all of a sudden the girl in the middle passed out and went straight backwards. The two other kids just watched her, so I yelled, 'Catch her!' but they were too late, and down she went. I thought she'd be hurt by the way she landed, but she wasn't."
Andrea came in and said she thought she'd go home if Chuck didn't mind. He told her he hoped she felt better soon.
The femur on the little cat was so small that Chuck decided not to saw through it, but to use the razor-sharp obstetrical wire. He pulled the wire back and forth a few times and then pulled away the leg and held it up. It was good that Andrea didn't have to see this part.
"I would have been a great Civil War surgeon," Chuck said. "Civil War surgeon and a World War II bomber pilot."
He finished up by folding muscle over muscle, skin over skin, just like a napkin, and tied a neat line of sutures. Chuck placed great importance in sutures. He said they were the first thing the client saw, and all they had to judge the work by.
"She'll be fine on three legs," Chuck said, pulling off the latex gloves. He carried the little cat to a cage and set her on a heating pad. After lunch he went on a call to a dairy farm, performed surgery on a cow, and returned to the clinic at five-thirty for the second round of feedings and treatments of the boarding animals. Sally Buttermore picked up her cat, and by the next morning that cat was nursing her kittens again.
It was the kind of case that meant something--service for a long-term client, a fair exchange, a life saved, an injustice indirectly addressed.
3.
Chuck--Dr. Charles Park Shaw--made the decision to become a veterinarian before going to Vietnam. He was attending flight school in Virginia Beach. By the end of 1969 he would be one of a squadron of twenty pilots based on the aircraft carrier Constellation--at twenty-three, the youngest member.
He figured he should decide what he was going to do when he returned home. He knew he didn't want to become a commercial pilot. He had been a math major in college, at the University of Kansas, and he tended to be methodical. He wrote a list of priorities for the job he wanted.
Number one, he wanted to work outdoors. Two, he wanted to be in a profession. Being an officer in the navy had shown him the value of being a professional, with its prospects for achievement. Third, he wanted some kind of profession with physical activity. He knew that he wasn't someone who would stick to a disciplined exercise program. Fourth, he wanted to work with people and help others if he could, as that seemed important for the well-lived life. Fifth, but perhaps most important, he wanted to be independent, to be self-employed and have his own business.
It was a list with narrow options. Forestry perhaps, but that lacked the people component. Doctor, lawyer, and teacher were all indoor jobs without the physical component. The only profession he could come up with that covered all the categories was veterinarian. Later, when he applied to vetschool, he was asked whether he loved animals. He said he did but wasn't actually sure. He didn't have much experience with animals other than family pets. It wasn't until many years later that he thought about it again and realized that the answer had become yes.
If the making of the list was methodical, the purpose was also emotional. This was the kind of decision often made before going to war, the kind of decision that states, I will be this certain something, and therefore I will be--I will have survived.
Chuck flew eighty-eight missions in Vietnam, bombing passes and supply routes in Laos. He had wanted to fly since he was a boy, from the time his older cousin attended Annapolis. Flying symbolized independence to Chuck. But as he put it, there happened to be a war there. After his first bombing run, his navigator had said to him, "Congratulations, you've just made a little girl fatherless," and Chuck hadn't forgotten it. He had thought about his role in the war a thousand times, but he also thought he had done the right thing by taking part when others less privileged had no choice to do otherwise. He had loved flying in formation and landing and taking off from the carrier. Nothing since had been so exciting. But he had also seen antiaircraft fire fly up by the wingtips. His homecoming had been typical for that time. When the Constellation arrived in San Diego harbor in the spring of 1970, no one had been there to greet them. "No one at all," Chuck said. "I'm not talking about a parade. There was no one."
Chuck had grown up in Cheshire, Connecticut, but his father had grown up in Kansas, and Chuck decided to attend veterinary school at Kansas State University. He was married then, another thing he had done before going off to war. KSU had a strong agricultural component to its curriculum,and eventually Chuck began to think he would enjoy working with dairy animals. Farm work would provide variety to a practice, he figured. It had the people component, and the treatment of a dairy herd could be a steady income. After receiving his D.V.M. degree, he stayed at Kansas State for another year and got a master's degree in veterinary pathology while his wife finished her doctorate in toxicology.
They returned to Cheshire, Connecticut, and for a few months Chuck worked in a high-volume small-animal clinic, spending most of his time in appointments, minor surgeries, and on call, making $250 a week. It wasn't quite what he wanted, so when his wife was accepted to law school, they moved with their two sons to a town near Concord, New Hampshire. Chuck had a brief tenure at a mixed animal practice, mostly pets and horses, and another at a strictly small-animal practice. They weren't quite right either. He had set a goal in veterinary school of owning his own practice within two years. When Chuck asked the state veterinarian if he knew of any practices for sale, he was directed to Walpole, a small town on the Connecticut River, which is the western border of New Hampshire.
There were more than twenty dairy farms in and around Walpole when Chuck arrived in 1979. When he drove down the main street of Walpole and saw the stately columned houses, he wondered where the wealth came from. It wasn't what he expected of the rural practice that had been described to him. Chuck stopped at what he thought might be the right place, an ornate colonial with a carriage barn in the back that might be the vet hospital, but he was told to keep going. Farther down the road he came to a small building made of cinder blocks--not much more than a two-car garage with an adjoining room. A sign read WALPOLE VETERINARY HOSPITAL,and Chuck thought, Okay, I can deal with this. I'll be out of here in three years. He was there for sixteen.
The practice had been started in 1954 by a veterinarian named Tucker Burr. Burr had built up a large-animal practice along with a healthy clientele of small-animal owners, most of whom Chuck inherited. In those days he would return from a farm call or dinner and see the cars lined up along the road, sometimes a dozen or more, and people sitting on the stone wall, waiting. Hardly anyone had complained about having to wait too long back then.
In those first years, sometimes working with an associate and sometimes going solo, Chuck routinely worked eighty to a hundred hours a week. He held office hours five days a week, every day except Wednesday and Sunday, and had night hours on Monday and Friday. He made farm calls and house calls on Saturday and was available for on-call duty around the clock.
Chuck thought he had practiced a lot of good medicine in that concrete building. "We worked hard to keep the place somewhat decent," he said. An X-ray machine hung from a broomstick laid across the rafters in the garage, and they laid the animals on a sheet on the concrete floor to take the X-rays. The exam room doubled as the surgery, and with the office close by, the receptionist could lean in and see what was going on. The anesthesia unit had a peanut butter jar on top as a replacement for the original vaporizer, and the unit was rolled behind a door during office appointments. There was no toilet in the place, though Tucker Burr had made his available, a short walk up the pathway to his house. Chuck put a portable toilet in the unheated garage after a female associate said she wouldn't join the practice if he didn't provide proper accommodations.
Chuck bought the practice when he was only eighteen months out of vet school. Now, as he looked back, he thought he probably should have waited, and worked longer as an associate under a more experienced veterinarian. But he said, "I was like most of my classmates in vet school. There were a lot of Vietnam veterans, and we just wanted to go out and get into it. Compared to the war, running a practice didn't seem all that intimidating. I learned a lot of stuff the hard way. I'm sort of stubbornly independent and feel I have to learn things on my own."
There wasn't much of a life outside of the practice. To make matters worse, Chuck got divorced soon after moving to Walpole, and his sons remained in Concord. Chuck saw them on weekends, leaving to get them after Friday office hours. He hired sitters to stay overnight in the event of emergency calls, and took his boys with him during the day. His schedule was often wearing, and he had to hide his edginess and exhaustion from his clients. "I thought it could have been a case of posttraumatic stress syndrome from the war, but that didn't hold up. I was just under a lot of stress at that time." Still, he remembers with fondness those days when the boys played with barn kittens while he treated dairy cows.
After a couple of years in Walpole, Chuck started dating Ellie Ewaskio, who was also divorced and also from Cheshire, Connecticut, and now living in Vermont. They had dated briefly in college, and their fathers, who were in the same church choir, had discovered that the two were living close by. On their first date, just before Christmas, Chuck cleaned the veterinary tools and supply boxes out of the back of his station wagon and tossed in a wreath to mask the smell.
Soon he took to leaving Duffer with Ellie and her two girls--a promise of things to come, a bonding dog. They married two summers later and had their first family gathering thefollowing Christmas, the first time in seven years that Chuck hadn't been on call on the holidays. They had just sat down to dinner when a knock came at the door. A farmer had tried to call Chuck's associate at the clinic, but the telephones were out. One of his cows was having a difficult calving--could Chuck come? He went and pulled the biggest bull calf he had ever seen, and the cow was so good, standing the whole time. Then he returned home, and they had a family dinner after all.
By the time he bought land for a new clinic in 1995, Chuck knew exactly what he wanted. The land was on Route 12 below Walpole village, part of a pasture on the bank overlooking the Connecticut River. The new building was large, 5,500 square feet, shaped somewhat like a barn, but the architect had broken the rooflines and added telescoping dormers that suggested a house as well as a clinic. There was even a reference to Walpole's classic architecture in the columns at each door. At one end of the building were the dog runs, and at another end was a garage entryway with a stock pen for large animals. The building was painted beige, but the doors were pink--a dash of color that also made it easier to give directions. Chuck planted the flower gardens and did most of the landscaping. He had found gardening the ideal hobby for a veterinarian, because it could be easily interrupted when a call came in.
Chuck and the architect took the flow of people and animals into consideration. There would be two doors--one for entering and another for leaving--on opposing sides of the reception room. There was an office just off the reception area, and down that hallway were the grooming room and a bathing room. The exam rooms would form a buffer zone between the reception room and the treatment area--where only the vets and the animals were allowed. The treatment area wasthe most spacious room of all, off of which were a surgery, an X-ray room, hospital rooms (one each for cats and dogs), boarding areas, and a laundry room. The surgery had a picture window that faced the Connecticut River, with views to the Vermont side. The X-ray room had a modern machine instead of one hanging from the rafters. There were good-quality blood analyzers, microscopes, centrifuges, and ultrasound, plenty of tables and sinks, a full stock of drugs and antibiotics, reference books, refrigerators, and lots of light. In the center of the building was the staff room.
Chuck gave prime consideration to airflow. At the old clinic, moisture had condensed on the concrete walls, making the air thick with the smell of animals. After years of working in that environment, Chuck claimed that his sense of smell had become distorted. He said he could smell dog shit a mile away and pick up the scent of a tomcat the moment he walked in the door. At the new clinic, air would move from the reception area through the treatment rooms to the boarding areas, and then be shunted outdoors. There would be no animal smells lingering in the reception area or exam rooms.
It was the kind of setup a young veterinarian dreamed of. Chuck said that because of the new clinic, he had been able to hire someone of Roger's caliber. Possibly the same would be true for the next associate, yet to come.
4.
After he had amputated the leg of the Buttermores' cat, Chuck went to Windyhurst, a dairy farm in Westmoreland.
Chuck played a variety of roles at the dairies. The most important was that of reproduction specialist, which consisted primarily of uterine palpation during regularly scheduled herdchecks. The vet reached inside the cow's rectum and, by feeling the uterus through the rectal wall, determined whether the cow was pregnant and, if not, what condition her ovaries and uterus were in. The purpose of his gynecological work was to get the cows pregnant as soon as possible after calving, to minimize the period of no milk production between calvings.
Chuck also played obstetrician when calvings were not proceeding smoothly. The method of pulling calves depended on the reason for the problem. In one method he reached into the cow, repositioned the calf, got hold of the hoofs, and drew the calf out. In a more difficult calving, he put chains on the hoofs, fastened a light winch to the chains, and cranked the calf out; the mother usually made it through this procedure, but not the calf. As a last resort, he might do a cesarean section, but that was to be avoided if possible because it posed greater risk to the cow's health and milk production, and was more expensive. Chuck had long arms, and he had developed his delivery skills as highly as his palpation techniques. When the calves did survive, he served as pediatrician for the heifers, giving them vaccinations and treating them if they became ill. He didn't treat the male calves, usually. They were sold into the veal market.
He served as bovine podiatrist too, since a cow lasts only as long as her feet do. And he served as general practitioner, treating such problems as cut milk veins caused by slivers in the cow's bedding or by one cow stepping on another's udder. He treated for milk fever, a condition that came as a result of a cow giving up her calcium to milk and then collapsing from exhaustion. The cure for this usually was a boost from a concentrated infusion of bottled calcium. Chuck treated for pneumonia and other lung ailments brought on by the stuffy conditions inside barns; to prevent this, farmers sometimes tore off parts of the walls of their barns and put up screens tolet the air flow through, even in winter. He treated for various infections, pulled retained placentas, and did procedures to correct a "windsucker." This happened when a cow tore her vulva at birth and then--to beat the boredom, Chuck claimed--somehow sucked in air and made a sound like a tuba. Or maybe it was a trombone.
Chuck attended conferences and meetings to learn more about dairy farming and herd medicine, and he talked to farmers about nutrition, cow comfort, bedding space, and breeding practices and genetics. Though he wasn't actually on the staff at any of the dairy farms he serviced, he came close to it. One dairyman had calculated that for the $14 per hundredweight he was getting for his milk (milk prices are determined by pounds), he was paying Chuck 60 cents in veterinary services.
Today Chuck was doing a DA, an operation to correct a displaced abomasum. The abomasum is the "fourth stomach" of the cow, though cows actually have only one stomach, called the rumen, and three modified esophagi. The abomasum can become problematic after a cow gives birth. It can twist, fill up with gas, and move into the vacated space left by the calf. There were lots of reasons why this happened, and it had always happened on dairy farms, but modern feeding practices had resulted in a higher incidence of DAs. Chuck and Roger did about 120 of them a year, as many as cat spays.
Before the surgery had been developed and had become more commonly practiced, farmers tried to correct the condition by rolling the cow over on her back, running her around in a field, or taking her on a bumpy ride in a truck. One of Chuck's clients, a farmer named Peter Barrett, remembered that during his father's time, when a cow got a DA and her milk production crashed, they would simply "ship her," or send her to market for beef. They didn't really know what a DA was then, he said. The Barretts had hired Chuck to dotheir DAs because he was the only vet in the area who would do them on the farms rather than in the clinic.
DAs had been less frequent in the past, because farmers put their cows out to pasture between milkings. Most of the dairy cows Chuck treated nowadays never saw a pasture or ate green grass. They stayed in the barn and ate a mixture of silage (chopped and fermented corn or grass), grain, and additives such as brewer's grain, a by-product of the beer industry. One farmer even added stale candy bars, discount priced, to give them more calories. This high-energy, high-fat diet, or "hot feed," as Chuck called it, resulted in higher milk production, but it could also put cows into a state of metabolic upset, which complicated their health conditions after calving and made them susceptible to DAs.
"It was when farmers started feeding grain that production went up," Chuck said. "The problem is, they can burn a cow out. If you push a cow nutritionally, you can cross over a line." Experienced farmers got close to the line but didn't cross over. If they did it successfully, the results in milk production could be astounding. Some of the highest-producing cows among Chuck's patients were making 160 pounds--almost 18 gallons--of milk a day, or, in Chuck's words, "ten percent of their body weight in milk, every day." The dairy cows of old, eating grass, would make, as Peter Barrett said, "thirty-five to forty pounds a day if they were lucky." A farmer now aimed to get 30,000 pounds of milk, nearly 3,500 gallons, during a cow's entire lactation period, from calving to calving.
Chuck's rate for a DA surgery was about $200, so it took a cow, depending on her productivity, about ten to twenty days to pay off the cost of it. He thought the cow was less stressed and had a better chance of surviving if she stayed on the farm. Chuck claimed that he had a 90 percent success rate with his DAs, that nine out of ten cows survived and were back in themilk parlor soon after the surgery--or, often, the very same day of the surgery.


Windyhurst was run by Roger Adams, who was close to sixty, and his son Stuart, who was in his thirties. Stuart had taken the farm further into the commercial realm, but it still looked about as idyllic as any New England farm. If you were traveling north along Route 12 from Keene, you came to a point where the woods were left behind and the Connecticut River valley opened up with long views into Vermont--the true farm country of New Hampshire, you might think. There was Windyhurst, sitting on a rise--the usual white colonial farmhouse, the foursquare chimneys, and a capacious barn painted red--with that grandeur and the river as a backdrop. If you had to be a dairy cow, this would be the place to be one. Chuck would agree. Roger Adams, he said, was willing to take the treatment further than anyone, in a system that would only go so far with treatment of dairy cows.
It was a windy and bright March day, with ice floes drifting on the Connecticut. Chuck parked his Volvo wagon by the barn. He grabbed his surgery kit, a battered metal picnic cooler, and made his way through the office, past the bulk milk storage tank, and through the milking parlor, which was clean and silent now. He kicked open a swinging door and walked into the barn. Beyond a row of pens were the open areas where the Holsteins milled about. In the pens were two cows. One had just calved, and her calf was sitting near her. The other was the DA cow, and she was standing listlessly, with glazed eyes and sunken ribs.
Stuart Adams, a peaceable-looking man with the freshfaced air of gentleness and determination that dairy farmers often seem to have, came up to greet Chuck. As Chuck got to work, they had a conversation that seemed to illustrate the differencebetween Stuart and his dad, as well as between older generation and new. Chuck said he had read that if a farmer couldn't get a cow bred for 250 days after calving, he should give up and ship her for beef. Stuart said he agreed, but that his dad liked to go further than 250 days, often well beyond a year. "He remembers the days when farmers had just thirty-five cows." Stuart had built the herd to 150 milking cows, but Roger still made most of the decisions.
Stuart put a halter on the DA cow and tied her by the head into the corner of the pen. Chuck gave her an injection of sedative, enough to calm her but not enough to make her lie down. She had to remain standing throughout the surgery. He plugged in his barber's clippers and shaved a patch along her side, behind her ribs. He doused the shaved area with Betadine, scrubbed it with a brush, doused, and scrubbed again. When a puff of air blew through an open doorway, Chuck asked Stuart to close the door to keep out the dust that could infect the cow. "Time is trauma," Chuck said. "In this environment we've got to get in and out as quickly as possible."
Before Stuart could close the door, Roger Adams walked in. He and Stuart were certainly apples from the same tree, though Roger was the bigger apple, with his generous belly and greater blush to his cheeks. Roger rested his arms on the stall and looked at the cow Chuck was preparing for surgery. "You can tell she's a DA by looking in her eyes," he said. "You can tell a lot by a cow's eyes. They should be bright and shiny. With older farmers, looking at cows, used to be wet eyes. That's what they looked for. It was eyes with them."
Chuck took an oversized syringe and needle from his box and used its cutting edge to trace a line through the patch he'd shaved. The cow didn't like this, and tried to kick Chuck with her back leg, but Stuart lifted her tail, which got her to lower the leg, as if a crank had been turned. Chuck made several injectionsof lidocaine, a local anesthetic, along the line he'd scribed in her side.
He took a scalpel from his kit and began cutting into the layers of skin and fascia. The cow didn't like this either, though she probably couldn't feel much by then. When the incision was about eight inches long, Chuck set the scalpel down and lathered his arms with Betadine. He put a plastic sleeve over his left arm and pulled it to his shoulder. He had cut the fingertips off the sleeve so that his fingers would have a better grip.
Chuck put both hands into the incision, and as if he were opening a curtain, he tore the muscle wall and enlarged the incision to twice its length. Tearing, he said, resulted in less bleeding. Then he reached in with his gloved hand, right across the cow's body, until he found the displaced abomasum, which felt like a warm and slippery basketball, he said. Using a needle he had cupped in his hand, he punctured the inflated stomach. He stood there, shoulder-deep in the cow and leaning into her side, while the gas slowly leaked out. She tried to kick again, but Stuart pushed up on her tail and she put her hoof down.
There was time for conversation while the abomasum slowly shrunk to size. They talked about maple syrup--Roger said he would be making pancakes on "Sah-day" at the restaurant they ran in conjunction with the farm. They talked about fishing on the Connecticut and the trout fishing opening soon elsewhere. Chuck said he hadn't done any trout fishing in a while, though he'd like to.
Roger Adams said he had been to church that morning. Chuck hadn't. He was an every-other-week churchgoer, depending on the call schedule. Something spurred Roger to say, "We see evidence of God, we all do, every day in the barn. It's impossible to be around here and not believe in God. Thesepeople who believe in evolution are missing the point. Isn't that true, Stuart?"
"Yeah," Stuart said, but not with much enthusiasm.
Chuck smiled. It was possible to see it both ways. You could see evidence of God or the miracles of nature in these mysterious, even majestic animals, with their striking coats, their wet and curious eyes, their astounding abilities. If you looked back through history, many others had seen it--bovine worship had been prevalent throughout the world's great cultures, among the Sumerians, the Egyptians, the Romans, the Hindus, the Masai, and countless others. Some have said that early Christians counteracted the influence of bovine worship by converting the divine cow into the horned devil. Yet why wouldn't these animals be seen as aspects of God, with the sustenance they give, the peace about them, and the power in their counterpart, the bull?
As for evolution, how could you ignore its workings in this queen of mammals, whose lineage had passed through the great wild cattle that roamed Europe and western Asia and extended to the first Holsteins brought to America from Holland in the 1850s. These cows had made commercial dairying a viable and profitable pursuit. Their genes were now available by way of the Internet. The hand of man was now pushing the edges, touching the womb, making them super-mammary in the effort to extract fifteen to twenty gallons of milk per day from each of them. Here, in this barn, was the course of evolution as well as the presence of God, if Roger Adams had it right.
And this had to be one of the strangest surgeries in the world.
Chuck repositioned the now shrunken abomasum and tacked it to a lobe of fat called the omentum. When the tacking was done, he let go, like a fisherman tossing a sinker andline into the water, and the organs dropped back into the cow.
Milking time had come, and the herdsman began leading the cows into the milking parlor. Small groups stopped by the pen on their way. They wanted a close look, and they raised their big wet noses as if they were feelers. One cow reached her head through the bars and examined Chuck's clippers with her nose. Chuck had hoped to finish before the cows came by and stirred up more dust, and he sutured quickly as they nosed about. Soon the milk-room vacuum pump began making a sucking beat that pulsed through the barn.
The DA cow was not yet done. Chuck stabbed an IV needle into the vein in her neck and fed in a liter of dextrose solution to give her some energy. Stuart held the bottle up while the sugar drained in. Finally, in a last assault, Stuart held the cow's head while Chuck pushed a tube down her throat and siphoned in ten gallons of water mixed with powdered feed, to fill the rumen and hold the abomasum in place.
Wonder of wonders--when Chuck gathered up his tools and carried them out through the parlor, Stuart Adams threw some fresh hay into the stall, and the DA cow, curious now, nosed at it and started eating.
"We'll milk her at the end of this cycle," Stuart said.
It was important to remember that as gruesome as the DA surgery could seem, the cow's life had been saved. She would have become beef otherwise.
Chuck wasn't impervious to the wonder or the demands. On the way back to the clinic he said, "It's amazing what we ask of the cow. We ask so much of them. We ask that they give us a hundred and twenty pounds of milk a day. The farmer knows how much he expects of the cow. And he knows that if he takes care of the animal, it all works out in the end. The farmer who doesn't take care of his animals doesn't make it. That's why when people say cows are mistreated, they don't understand."

Copyright © 2004 by Douglas Whynott