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iarrhea?” I repeated. Hiram nodded. Hiram would never come to see me because he had diarrhea. He was as considerate as he was thrifty, and he would not waste my time or his money with such a trivial complaint. No. It was not Hiram. There was only one possible explanation for his visit. “One of the girls?” Hiram nodded. Stoic as he was about his own health, he was a veritable mother hen when it came to his family. “Diarrhea. In a cow?” I said, thinking it was only to myself. Hiram looked pained. Cow was not a word he used. “If I remember correctly,” I said, hurriedly correcting my indiscretion. “Most of the family has left the farm now.” He nodded again. Age and the cost of farming had forced him to reduce the size of his once large and extended family to only a few. “Well, let me see. Who would still be at home?” I ticked off those I could remember. “There’s Annabelle and Betty, Clara and Dorothy, Esther, and Francine. That would make six.” Hiram raised a finger. “Seven?” It was seven. Who would it be . . . “G-gertrude?” Not Gertrude. “Gloria?” It was Gloria. To some, veterinary medicine might seem rather out of my line of work, but not to Hiram Stedrock. When I came to Dumster, Doc Butterfield was the vet in town. He had been there for a long time. Those who remember his arrival say he was still in his cavalry uniform when he came to Dumster just after the war in 1946. He bought one
It’s Probably Nothing
of the six old brick federals on North Main Street, a set of stately buildings that were reminders of a time when Dumster, with its tooland-die factories, was the economic center of the Connecticut River Valley. He set up an office in the back of the house and converted the barn to an examining area for large animals. In front of the house was a signpost, but it was unreadable. There was no need for a sign. Everyone knew who was there. Doc Butterfield was a hefty man, with a great shock of white hair, a broad open forehead, and a set of full lips that always had a smile. It was a smile that inspired trust and the confidence that, however bleak the situation seemed, all would now be okay. His most remarkable feature, however, was not his face, but his hands. Huge almost to the point of acromegaly, they could, with equal ease, pull a reluctant calf out of the womb or sew the ear back on a kitten who had tried to play tag with a neighboring dog. There was not a soul in town who wouldn’t be willing to put his beloved pet’s fate in those hands. Or, should the need arise, their own. On more than a few occasions, when I was out of town, Doc Butterfield capably filled in. I, in turn, on the rare occasion when he took a day off, would dip my toes in the more shallow waters of the veterinary seas. This medical miscegenation seemed only natural to Dumsterians, for whom a plumber could, in a pinch, repair the wiring, and the history teacher, if need be, could teach biology. As always, they expected only that one would do one’s best. One year, at the tender age of eighty-five, Doc Butterfield decided to retire. He sold the house and the practice to a young veterinarian couple from Pennsylvania. Then he packed up his belongings and headed south in the camper with his wife up front and their two horses in the trailer behind. “Someplace I won’t have to wear wool,” he said when I asked him where he was going. Last November I got a card from him postmarked Ocracoke, North Carolina. On the front was a picture of wild horses grazing on grassy dunes with the ocean in the background. On the back he had written two words. Don’t retire. The young couple spent six months fixing up Doc’s place before they moved in. To do the work, they hired a firm from Salem,
Massachusetts, that specialized in historic restoration. When they were done with gutting the interior, sandblasting the exterior, and landscaping the grounds, there was hardly a brick or a beam or a bush that they hadn’t restored. Around the property they built a stone wall. As far as anyone knew, it was the first stone wall within town limits. On the front lawn they put a well. The siding for the well was from an old barn in Pomfret, and the cedar shingles for the roof were handmade in Ferrisburg. It had a crank with a rope, at the end of which was attached a historically correct eighteenth-century oak water bucket that they found on eBay. It came from Santa Monica, California. Thanks to an underground pump connected to the house, you could actually draw water from it. There were a few grumbles about Flatlanders, and Old Sturbridge Village, and who did they think they were anyway. These were mostly from their North Main neighbors, whose property had suddenly acquired a rather tired and dingy look. But even the least gruntled had to admit they had done a nice job. They put new lettering on the sign. It read: Abenaki Ark Holistic Veterinary Services I took our dog, Bonger, to see them shortly after they opened. He was due for his rabies shot, but mainly I wanted to see what they were like. The office was as changed as the rest of the place. The old bare walls had been Sheetrocked over and painted in two shades of orange. The fold-up chairs had been replaced by expensive-looking upholstered couches. In each corner was a collection of brightly colored beanbag-type chairs, one set slightly larger than the other. Over the larger was a sign that read canine quarters, and over the smaller calico corner. The walls were decorated with pictures of happy-looking dogs and cats. There was a large sign advertising a special price on organic vegetarian animal food and a poster showing a smiling dog and cat with their mouths wide open to display a full set of gleaming teeth. Under the picture was a caption that read, dental hygiene isn’t just for people. ask us about our dental cleaning and gum massage. Behind the counter were two sets of diplomas documenting the qualifications of Paul and Melinda Barker-Purris. Both had graduated summa
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cum laude from the University of Pennsylvania School of Veterinary Medicine, and both had completed with distinction a residency in small-animal medicine from Cornell. In addition, Paul had a fellowship in animal behavior, and Melinda in comprehensive dentistry. They both came in to see Bonger. “We practice as a team,” they explained. They were friendly and cheerful and certainly seemed to know their business. They looked in his ears, and listened to his heart, and prodded around his stomach. They took his blood pressure and stuck his paw for blood sugar. I think they may even have checked his prostate, but I didn’t ask what they were doing with that part of the examination. They were very thorough. And when they were done, they gave me a three-page printed sheet on their findings, the sum and substance of which was that it was remarkable Bonger had survived as long as he had, given our utter neglect of his well-being. There were blood tests to be done, and vaccines to be given, and drops for his ears and pills for his bones. They even gave me a prescription for his blood pressure. I was impressed. I still bring Bonger in occasionally, although not as regularly as they recommend. They are always very friendly, but every time I leave, it is with the vaguely uncomfortable feeling that I have been a bad owner. I don’t think Hiram has ever been to see them. Doc Butterfield used to say, on the occasions of our mutual consultations, “The way I see it, Beach, you can divide animal and human troubles into two types: those that cross over and those that can’t.” And he was right. If somebody called him up with, say, a pain in his chest or told me that he had a horse gone lame, we would each have to say, “Gee, that’s too bad.” And leave it at that. But a boil, on the other hand, is a boil. Diarrhea is at least enough of a crossover trouble that I was willing to take a shot at it. Doctor or vet or plumber, when a customer presents with a problem, before one starts merrily down one’s path, what one has to do first is answer a single important question. Is it A Big Deal, or is it No Big Deal? If the answer is A Big Deal, like a belly that’s about to burst, or a foot of water in the kitchen, then right off the bat you know you have to take the situation very seriously. If, on the other hand, the
determination is No Big Deal, say a drippy nose or a drippy faucet, you can be pretty sure things will turn out fine no matter what you do. The problem arises when you find yourself faced with a problem that by itself is no big deal, but that may be a sign of a very much bigger deal somewhere else. Diarrhea is like that. Except in the very young or the very old, diarrhea is one of those things best left alone, being sure always, naturally, to recommend some innocuous intervention so that when it does finally disappear of its own accord, you can get the credit. Not always, though. Some diarrheas can poison your bloodstream, infect your heart, and shut down your kidneys. But that is pretty uncommon. The big-deal question is where the diarrhea is coming from. Until 1854, nobody thought much about this question. The flux, as they called it, was spread by miasma, which, as any good physician knew, wasn’t something you could do much about, except maybe a little judicious bloodletting and a dollop of castor oil to flush it out. That year, however, saw the outbreak of a horrific cholera epidemic in the Soho district of London. The rest of the city, except for an isolated case occurring randomly here and there, was pretty much spared. “Divine intervention,” declared the Reverend Henry Whitehead, a leading vicar in the area. He said it was the Lord’s retribution for the evil and slothful ways of the parishioners of that notorious district. Whitehead’s view was not surprising. He generally attributed all natural disasters, even the unnatural ones—Jack the Ripper for one—as part of the Almighty’s plan for sin control. Of course, that was a long time ago. There was a surgeon in Soho named John Snow. Dr. Snow was as God-fearing a soul as any man, but he was skeptical that the Almighty would go to so much trouble for such a small spot of sin. He suspected that the cause was more likely in the here and now rather than the hereafter. So he started asking around. He went around from door to door, stopping at each house to find out if anyone inside had gotten the flux. Then he made a map of where all the victims lived. He discovered that almost everyone who got cholera lived within a few blocks of the corner of Broad and Cambridge Streets. On this corner was located a well from which the neighborhood drew its water. Water for bathing
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and washing—and for drinking. He speculated that maybe the water was the source of the cholera. Everybody, from the board of health to the Vauxhall Water Company, laughed at him for such an absurd idea. The Reverend Whitehead declared it heretical. Dr. Snow was undeterred by the ridicule. He decided to find out for himself if what he suspected was true. So he went to the intersection and removed the handle from the Broad Street pump, thereby forcing people to get their water elsewhere. At first there was a lot of complaining about the nuisance of having to travel to get water, but when nobody else got sick, that stopped as quickly as the diarrhea. “It was the water,” said Dr. Snow. “It was the hand of God,” said the Reverend Whitehead. “I’m honored,” said Dr. Snow. Nowadays we know how important it is to have safe water to drink, and around here at least, water is clean and pure. Well, there was that business of the tritium in the wells down in Pownal, but nobody paid much attention to that except the politicians. At any rate, the likelihood of picking up an infection from what we drink is pretty slim. What we eat, however, is another matter altogether. When it comes to ingestible infections, we now have a wider selection than ever. Most are imported. Depending on one’s inclination one can find at one’s local market New Zealand Campylobacter Chicken, Guatemala Cyclospora Raspberries, Mexican Salmonella Jalapeños, or, for those with more expensive tastes, the French E. Coli Camembert. But if you prefer to buy American, there is still plenty to choose from. Tomatoes from Florida, spinach from California, and peanut butter from Georgia are among the most popular brands this year. From time to time there are more exotic offerings. During the time I was an epidemiologist at the CDC, we had an outbreak of more than one hundred cases of a strain of salmonella called Salmonella eastbourne. Most years this bug would cause only two or three cases. Ten would be a lot. The cases came from all over the country: Maine, Florida, California, even one in Vermont. At that time foodborne illnesses were usually local, because that’s where people got their food from. Unless they happened to acquire it from an airline meal. Although the cases were not clustered geographically,
they were in time, and all of them occurred just after Christmas. We had a devil of a time trying to find out where it came from. By the time we received the reports in Atlanta, the cases were several weeks old, so it was hard to pin down the culprit. Imagine someone calls you up and asks you what you had to eat two weeks ago. We were stumped. Then we found out they were having the same problem in Canada, especially the Eastern Provinces. So we called back again. Did you eat anything you bought from Canada? we asked. This time we hit the jackpot. Turned out there was a candy factory in Quebec that was importing the bacteria on cocoa beans from Ghana. They used the beans to make a chocolate syrup, which they then poured over cherries. After cooling, the whole toxic bundle was wrapped up in bright red and green foil for an extra-special Christmas treat. It just goes to show. You never can tell with food. None of this, of course, was of any concern to Hiram. But as we both knew full well, should one of his cows have something that could be transmitted to the others, or to the dozen or so families in Steddsville who relied on Hiram for their raw milk, that would be a disaster. Therefore, Gloria’s diarrhea might be A Big Deal, or it might not. I had to know. Fortunately, the answers to a few simple questions would tell me which it was. As I would with any anxious parent, I approached the subject cautiously: “Anyone else in the family sick?” He shook his head. That was a good sign. “Just Gloria?” Hiram nodded. “For how long—er—never mind. Would you say she has been sick— let’s say, at least a week?” He would. “Two perhaps?” Two was a possibility. “As long as a month?” Not, apparently, that long. “And there’s no blood in her stool?” None.
It’s Probably Nothing
“Nor any fever?” Another negative. “Is she milking okay?” She was. “And she’s not off her feed?” Hiram shook his head vigorously. Cows or people, that was a good sign. I was encouraged that things might be better than I had feared. The cow was not really sick, and as there were no secondary cases after two weeks of illness, there was no evidence the illness was transmissible. I wanted to say that it was most likely Just One of Those Things. But diarrhea has to come from something. Hiram’s herd was all grassfed in one pasture, and being the last farm in Steddsville didn’t have much opportunity for bovine socialization. Only one cow. It just didn’t make sense. Unless— “Gloria is your youngest, I believe?” She was. It had been a very wet summer, and the first haying was yet to occur. So hay stores were pretty low. Hiram would be supplementing the hay with more grain than usual. “Feeding them mostly corn these days, I’d venture?” He was. “With some soybeans thrown in to complete the protein?” Some. “I’m not a vet, of course.” Hiram shrugged. “But I can tell you this much. With two weeks of diarrhea and only one of them sick, it’s not contagious. And without a fever or blood in the stool or being off her feed, it doesn’t involve any damage to her bowels. In a person, particularly a child, that would mean a food allergy. If it were one of my kids, I wouldn’t worry about it. But I would take her off the soybeans and let her feed on her mother’s milk until she can pasture. It’s something to do at least. And it might even take care of the problem.” Hiram nodded. He rose to go. “Of course,” I added as he got to the door. “She could be lactoseintolerant.”
Hiram smiled. “Thanks, Doc,” he said. “My pleasure,” I said. And it was. Whether they meant it or not, most everybody thanked me when they left. Coming from Hiram, however, those two words were quite a compliment. Those two unnecessary words.