The Patient Was…

The patient was a Great Dane, an honest-to-goodness canine, and one of a pair residing in a historic castle in the countryside some distance from the nation’s capital.

The owner of the castle and the dogs was a woman whom I had cared for in New York and who was now at her permanent home in another country. Her health problems were serious, and I had traveled abroad to see her and to consult with the physicians who would thereafter be managing her care.

She divided her time between a large house in the capital city and the rural countryside, and had permanent staff in both locations. Her personal chauffeur had met me at the airport on my arrival from the United States and had driven me directly to the castle where she was staying.

The castle itself had been a royal one for most of its existence, but had eventually come into private hands. The first, and relatively simple, structure on the site was built over one thousand years ago but over time the magnificent structure now there was created.

The Great Danes stayed in the countryside and were not brought into the city. They were pampered, treated extremely well, and bounded about the interior and the grounds of the castle more or less at will, even leaping through large French windows into the dining room where they often startled guests.

When the limousine in which I was driven from the airport arrived, crossing the drawbridge over the moat and entering the castle grounds proper, the two dogs were lying in the sun in front of the massive castle doors. As the car stopped and I got out, the two dogs rose and started across the grass. One was running easily and gracefully, while the other was lagging and breathing with difficulty.

I pointed at the dog that was clearly laboring, and jokingly said to the chauffeur,   “Looks like that one has heart failure.”

There was no response, and soon a member of the staff came and rounded up the dogs. I was escorted in and taken to my quarters in one wing of the castle.

Early the next morning, the phone in my bedchamber rang. When I answered it, a disembodied voice at the other end said that there was a local veterinarian at the castle entrance who wished to speak with me.

I dressed quickly and went down to meet a young man with a serious and unhappy demeanor.

Without even a perfunctory greeting or an introduction, he said, ”I understand you made a diagnosis of heart failure in one of the dogs.”

“I didn’t make a diagnosis,” I answered. “I just made a simple joke.”

“There is no joking about the dogs at the castle. Which of them was it?” he asked, pointing toward the two dogs lolling in the early morning sun.

“I don’t know,” I said, “but I have an idea how to find out.”

I picked up a stick lying near us and waved it to get the dogs’ attention. Then I threw it as far as I could. They started after it and, once again, one of them was running effortlessly while the other was breathing hard and trailing.

Pointing at the laggard, I said, “That’s the one.”

One of the castle staff brought the dog in question over to us.

“Will you examine the dog?” the vet asked.

“The last time I examined a dog was in physiology lab in medical school,” I said. “The only thing I think I remember is that dogs often have rapid heart beats and heart murmurs.”

The vet looked very unhappy.

“Look,” I said, “you’re the vet. What do you do if you think a dog has heart failure?”

“Well, if I were in the city I would send the dog to hospital, and do a cardiac catheterization, and confirm the diagnosis,” he said.

“Well,” I said, “you’re not in the city. So what do you do here in the country if you suspect a dog has heart failure?”

“I give the dog digitalis,” he said. (Digitalis is an old medicine used to treat heart failure in humans and animals.)

“Then what?” I asked.

“Well, if I’m right the dog gets better,” the vet said. And then he stood there silently.

“Suppose you’re wrong?” I finally asked.

He looked at me as if dumbfounded that I didn’t grasp the obvious.

“If I’m wrong,” he said, “they get another dog!”