Tuesday, September 04, 2007
Looking back on med school, one thing crests the long list of second thoughts: dog labs. Growing up, I always had a dog. Having left home, when I returned to visit, a dog was always there. (From sublime to ridiculous: Buttons, my confidant, my purveyor of love when I felt otherwise, smarter than any; to Fred the disagreeable.) We recently returned from dog-sitting our grand-dog, a Chocolate Lab, the sweetest guy in the dog parks, Dutch the dog who has never known anger, doesn't even have it in his vocabulary, the luggiest of the big lugs. I love dogs. I approached my first dog lab with trepidation and discomfort.
Smelling musty and slightly feculent, the room held around twenty lab tables of the old-fashioned kind: little sinks, taps, gas outlets suggesting that at some time they supported bunsen burners. On a dozen or more of the tables were dogs, lying on their sides, already anesthetized, looking peaceful and vulnerable. One or two had evacuated their bowels. (We'd been spared the sight of the technicians accessing veins and injecting the pentothal. And the dogs had been spared having us doing it: we'd have made a mess of it.) I don't remember the goal of the work. I do remember that when my partners and I began to reposition our dog, he awoke with frightened cries. Without another thought I turned heel and vacated, waiting in the hall until I heard silence, after the techs responded and re-dosed. With persisting uncertainty, I re-approached the table and helped tie the dog onto his back, shaved his belly. I think I was the one to make the initial incision. If there'd been any further evidence of response by the dog, I'd have remembered it.
It's probably significant that I have no recollection of what it was we were to learn that day: some physiological truth or another. What I do remember is that at some point I got swept into the thrill of handling living tissues, seeing vessels pulsate; touching, smelling, holding. Using surgical instruments. If memory serves, it was my first clue where I was headed. But at the end, as we unceremoniously dumped the dogs into black bags and left, I felt it again: it seemed a waste. They'd told us these were strays from the local pound, doomed to destruction one way or the other. Still, I felt a sadness as I walked away. We'd done, for our own purposes, something not entirely honorable. Whatever it was that we studied that day, our education wouldn't have been less without it.
During the summer after that first year, I got a fellowship to work in the lab of a world-famous heart surgeon. There, we implanted prototype valves into dogs (I assisted some -- never did the actual surgery, of course.) We also worked on a membrane oxygenator: an artificial lung, of sorts. This was important work, and I had then nor have now any reservations about its rightness. But these were my kind of dogs: big mutts, bred there for their size and broad chests. Each morning when I'd arrive at the lab I'd head to the cage containing our latest patient, and he'd whimper and drag himself toward me for a pat on the nose, having no clue what had happened but happy to get a little love. Despite the certainty that it was proper, that there really was no alternative way to test these life-saving devices, it always brought tears to my eyes as I scratched behind his ears, the way my dogs had always liked it.
Dogs don't have differing blood types: a donor provides for any recipient. Our "donors" were greyhounds from the racetrack; the losers. By now, I'd learned to find and access their veins myself, which I did as I tried to calm their high-strung anxiety. After a dose of pentothal they went down, and I made a neck incision to get to a main artery to the brain -- the carotid -- into which I inserted a large catheter and let the dog bleed to death into blood bags. I knew what I was doing, they didn't, as I petted them and mishandled their trust. Dogs willingly jump into a fray to rescue their people, yet this seemed unfair.
Those particular heart valves have saved countless lives. (The oxygenator didn't work out.) It was an important project, and I was proud to have worked there. On return to school, my learned skills allowed me to help other students with some of the surgical aspects of the next dog labs, making the surgery cleaner and the labs therefore more meaningful. It's a little part of who and what I became. Later on, in training, I skipped over a potential research year where I'd be operating on monkeys. I didn't like the way they had to be kept in little high-chairs after, to keep them from pulling on their tubes.
I'm a pragmatist. I don't claim human superiority over animals in some sort of moral sense, but I can rationalize that we do research using them. I'd like to think that it's done humanely everywhere, but I know it's not. Ever more realistic, computer simulations and modeling are becoming widespread; surgical trainees can acquire a significant portion of the skills they need in such a lab. Boeing produces planes that fly just as predicted, and fit together without ever having been pre-tested, using only super-computers. If the day arrives when med students never play with dogs the way I did, I'll be delighted; and perhaps it'll also happen that mankind will figure itself out at a desk, with silicon chips instead of in a lab, with animals.