In The House of God, an acclaimed account of  life and death in a Manhattan hospital, Samuel Shem used a phrase that would eventually enter the veterinary lexicon: train wreck. It was such an appropriate description of how some [usually geriatric] patients present (end-stage, multi-system disasters) that it easily jumped the tracks from human medicine to vet medicine.

Red is a train wreck. He came in yesterday because, according to his owner, he had been suffering from rectal bleeding for several days. When I spoke with him over the telephone (before his visit) he had failed to mention that Red had also not eaten for as many days and could not stand up on his own.

Red is a large shepherd mix with a well-recognized aggressive streak. Although he’s twelve-years-old now, the attitude hasn’t softened a bit. Examining him, even in his deteriorated state, required a muzzle.

Our findings? Red has bleeding sores around his anus—perianal fistulas, best described as hemorrhoids on steroids. But these painful, infected wounds are the least of his problems. Red has a prostate gland as big as a honeydew melon. His belly hurts like hell even with strong pain medication so it’s hard to feel what’s happening in there. My X-rays suggest an abdominal mass just in front of the giant prostate so I drain his bladder with a catheter to get a better look. Yep. Looks like it’s there.

As if an abdominal mass (suggesting cancer at Red’s age) isn’t bad enough, exploring the matted fur around the infected, bleeding sores revealed something truly disgusting: maggots. Apparently, Red had been living outside most of the time. Flies had decided his rotting flesh was a great place to lay their eggs. Tiny white worms were making their way in and out of sores hidden by the wet, matted fur. This week’s heavy rains were not kind to Red.

I discussed my findings with Red’s owner, assuming incorrectly that anyone who leaves a sick dog outside in the rain might choose to euthanize him at this point. No dice. My description of his various maladies is met with: Forge on. Let’s get to the bottom of this. Do everything you have to do for him, doc.

Sometimes I think the term train wreck, when used in veterinary medicine, achieves an expanded definition. In this case it extends to the owner, as well.

I’ll keep you posted.