Peter’s Substack: The Comatose Cow

A cow is lying comatose in the back of a pickup truck, and I don’t know where on the vast expanse of its chest I should put my stethoscope.

I have also always been afraid of getting too close to cows.

I am the only doctor for a rural district of 15,000 people in Dominica (pronounced “DominEEca”), a small country in the West Indies. It is 1969, when the island of Dominica is the second-poorest country in the Western Hemisphere, after Haiti. I’m a medical volunteer, a green, inexperienced new grad, and treating diseases that are unheard of in the wealthy world.

But now I’m examining my first cow. Behind me, on the verandah of my simple cottage hospital, the waiting human patients are watching me closely.

The beast’s breathing is shallow. It is dark brown with white nostrils that twitch a little with each breath. It barely fits into the back of the pickup. The old black truck sags with its weight. There is a musty smell. I move out of range of the cow’s hooves, then touch it gingerly. It doesn’t move.

Its owner is watching closely. He is about 60, and frowning. He wears old, shapeless brown pants, and a sleeve of his blue work shirt is torn. He fidgets with the frayed cuff.

He sees my hesitation. But he needs an answer now.

“Would you please just cut out a piece of the liver?” he says.

“I beg your pardon?” I ask.

“Could you cut out a piece of its liver and check it for disease? Just tell me if it’s all right for me to sell its meat.”

The cow is his principal financial asset. His livelihood depends on the sale. But the animal whose liver he wants me to cut into is alive.

I’m only a doctor for humans, and I have no idea what’s causing the cow’s coma. Not a clue. I feel a tightness in my neck and shoulders. There’s no medical history. Did it have a seizure? A stroke? Or could it have a brain tumor? Meningitis?

I need to start somewhere.

“Would you please take its temperature?” I ask, and my assistant produces an elbow-length glove. I watch the thermometer, followed by the man’s hand, wrist, and forearm, all disappear up into the cow’s rectum.

“Thirty-nine degrees,” he reports. 

I feel my throat tightening. What is a cow’s normal temperature?

I have no idea, of course. But the villagers are watching me closely, so I nod wisely.

“Ah, yes, 39,” I declare in a tone that I desperately hope sounds professional.

I think about cutting into the live patient’s liver. The tightness gripping my throat spreads around my neck.

The owner is watching me carefully. I look up at him and shake my head.

“I’m sorry, I honestly don’t know what’s wrong with your cow. There’s no history to go by — it really could be almost anything.”

I am only partway through a day in which I would see 120 patients, and I’m feeling pressed. I can’t linger with comatose cows. The creature’s owner frowns, avoids my eyes. Not only is he clearly unimpressed, but a small crowd has witnessed the fiasco. He drives off with the cow in the back of the truck. The fierce bumps in the rutted road don’t wake it up.

Shoulders slumped, I walk back to the waiting patients. Everybody has seen my veterinary failure. Apparently I’m expected to know everything.

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The next day, they brought me a wounded wild parrot.

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“Communication Failure” – illustration by Sadie Levine

It can be puzzling to care for humans, too, especially when communication confuses. English is Dominica’s official language, but French has left its mark. (The majority of Dominicans are descended from the African slaves of the original French and English planters.) Most of my patients spoke Kwéyòl (Creole) – a French-based dialect, locally called patois. It is far removed from international French, and my French was of little help. Dominican English, too, had branched out from standard English. It kept tripping me up.

In the villages, “okay” meant “goodbye.” If I said “okay,” to agree with people, they thought I was leaving.

“What seems to be the problem?” I asked a heavy, middle-aged woman in the clinic one morning.

“Pain in the waist, Doctor. For two years.” 

I asked about abdominal symptoms; she had none. I ran through gynecological and urinary systems, but everything was fine. I examined her abdomen. It was normal.

“Do you go off okay?” I asked.

“To go off” meant to have a bowel movement. I had just learned that. It felt good to be using local dialect.

“Yes, I go off good.”

“Can you show me exactly where you feel the pain?” I asked.

She stood up and pointed to her lumbar spine. So “pain in the waist” was low back pain. I was learning.

The next patient was in his 70s, thin and frail. “How can I help you?” I asked.

“Pain in the stomach.”

“Can you show me exactly where?”

He pointed to the left side of his chest. When I questioned him further, it was clear his pain was angina, from heart disease. I learned to beware of “stomach” pain.

A month later, language was still catching me off guard. A woman brought her five-year-old boy to see me, along with a handwritten note from his teacher. 

“Doctor, please see Robbie,” said the note, in the teacher’s careful handwriting.

“He bottom falling out.” 

A look at the little fellow’s posterior reassured me. It was still attached to the rest of his body.

Relieved, I willed my tense shoulders to relax. “You’re okay, Robbie,” I said.

I turned to the experienced nurse, and showed her the teacher’s note. “What does ‘He bottom falling out’ mean?”

“It means  rectal prolapse,” she explained. “Plenty of children have it.” She stretched out the first syllable of “plenty,” in a Dominican way I was coming to love.

Rectal prolapse is a slipping down of the rectum such that it partially protrudes externally. It is caused by Trichuris, the whipworm parasite. It sounds more serious than it is.

I gave the little boy a worm medicine. His bottom stayed in place.

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Two months after the Comatose Cow, a human patient asked me, “You remember that sick cow, doctor?”

I’d been wondering what happened after my failure. The patient’s hands were rough, callused from working on a banana plantation.

“Of course. What happened afterwards?”

“The owner killed the cow.”

Of all the possible outcomes for that cow, that was one I hadn’t considered.

“Killed it? Why?”

“He had to sell the meat fast, before the meat inspector find out.”

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That was the end of my mercifully short veterinary career. I remain unimproved. I’m still cowed by cows in coma.

In my next post I’ll look at some recent, spectacular medical flip-flops, and what’s behind them. Is it “flip” to call medical flip-flops, flops? It’s a remarkable story of change in medicine— stay tuned!

Peter

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“The Comatose Cow” and “He Bottom Falling Out” are excerpted from my forthcoming memoir.