If you love animals and have an interest in veterinary medicine, you have probably read James Herriott's books (All Creatures Great and Small, etc.). [ If you haven't read them, you will enjoy them, so go read them. Then you can finish reading this some other time.]
In many ways, my first year in practice was much like his. We both went to work for a picturesque older veterinarian in a beautiful but foreign (to us) countryside. We both were full of scientific knowledge, but woefully short on experience in practice and in dealing with our clients, particularly since our clients came from a different cultural background than we did. While there had certainly been many advances in medicine and technology between his first year in the 1930s and mine in 1978, some things never change. Animals still get sick and people still care about them. Veterinarians and clients still have occasional disagreements over differing expectations and failures to communicate. You laugh, you cry.
Herriott's books are autobiographical, but they are written as novels, rather than historical records. This means that he leaves out a lot of dull stuff and does a great job of presenting things in a humorous or dramatic fashion, as the case demands. Not that he is making anything up, as heaven knows truth is stranger than fiction, and there is no need to embellish it. On the other hand, there are a lot of what I call "James Herriott Moments" where just as he is about to drive away from the farm, or just as the patient is about to die, or just as the mystery seems unsolvable, Dr. Herriott has a flash of intuition that saves the day.
When I was a kid, my father (who was an attorney) would often comment that one of Perry Mason's dramatic tactics was actually not something that could really happen, such as presenting a "surprise witness". I asked why they would put something so inaccurate in the program and he replied, "Because it makes a better story that way."
I have no doubt that James Herriott saved the day many times, and dramatically, too. I do have some doubts that his flash of intuition was always so dramatic and just in the nick of time. However, I don't begrudge his telling of the story that way, because it does make a better story that way. Also, if you filled the book with anecdotes about how you figured things out a week later when it was too late, it would never have made the best-seller list.
I must admit that some of my James Herriott Moments have definitely come too late. Most cases are not solved by flashes of intuition, however, but by systematic detective work. You take a careful history that includes everything about the pet's lifestyle and what he's been doing lately. You cross-reference the problems with known breed-related problems. A thorough physical examination and laboratory tests (if needed) round out your collection of facts. These get processed to give you a list of the most likely causes, and then you work through those. If you're hitting the wall, you consult with a specialist, or send the case to the specialist if the people can go.
Sometimes, though, you DO have a James Herriott Moment, and it's pretty cool. This apparently obscure and difficult problem presents itself and somehow you just know what's going on and what to do about it. You still need to confirm with testing or response to treatment (because your intuition might be wrong; it has been before, sometimes), but it's pretty sweet when this happens, especially if it's a long-standing problem that's been seeing three other doctors. Of course, a little luck doesn't hurt, either. That luck factor is why you never bad-mouth the other doctors. You don't know what things looked like when they saw it.
I had a James Herriott moment just the other day. This ninety-eight pound German Shepherd came in with a history of an ear infection going on for five months. His ears were rather sore and swollen. The owner had never been able to put any medication in the ears at home, due to the dog's pain, size, and generally uncooperative disposition. This is bad, as one is very unlikely to treat an ear infection successfully without touching the ear. The previous veterinarian had been periodically anesthetizing the dog to clean and treat the ear. Of course, it would quite an ordeal to do that every day for a week or two, which is the kind of treatment ear infections usually need. So, they'd treat him, and then the owner would take him home and do nothing until he couldn't stand it any longer, and they'd do it again.
Even though the ears were horrible and the dog went nuts if you got close to them, I did manage to get a diagnostic swab. They were too swollen to get a scope into, even if I had anesthetized him, so we didn't bother with that. Under the microscope, the swab showed mostly yeast (which need to be dealt with , but are ALWAYS secondary to something else), and (here's the lucky part) half an ear mite. The ear mite is lucky for two reasons: the first is that I found it when the other guy missed it, and I am sure he was looking; the second is that ear mites are SO treatable, as opposed to some underlying allergic condition that would have to be managed for life.
The James Herriott Moment thing is that my plan to treat an ear infection without touching the ears worked (which was by no means a sure thing). We put him on prednisone orally to relieve the inflammation, shrink the swelling and reduce the pain. Ketoconazole orally to kill the yeast from the inside out as he grows a new layer of skin. Revolution goes systemically to begin killing the ear mites by oozing out with the new ear wax he makes.
In seven days, we rechecked him, and he was ninety percent improved without ever touching his ear. Then we put a muzzle on and I just put my finger in his ear for a few minutes. He finally quit going nuts because he realized that his ear didn't hurt any more. After that, I was able to look into his ear canals, flush them out and medicate them, although he was still pretty wacky about it. He's continuing his other treatment, too, and he is going to get well (after FIVE months, Whoo-Hoo!)
It's a James Herriott Moment, folks.