BY G. WAYNE MILLER
Journal Staff Writer

EAST GREENWICH -- Pam Scripps arrives at the animal hospital at 7:25 a.m. with her dog, Reggie, a 12-year-old cocker spaniel. Pam, 53, has two grown sons and is married. She calls Reggie her baby. She dresses him in antlers for Christmas and lets him sleep on her bed. She talks to him. Sometimes, she speaks for him, as she does this morning:

"Reggie says: 'I know something's up.' "

Pam sits in the lobby of Ocean State Veterinary Specialists, Rhode Island's largest and most sophisticated animal hospital. Reggie hides under her seat.

"He says: 'I don't want any part of what's going on.' "

Reggie is not well.

A marble-size mass has grown out of the corner of his right eye, and a fleshy red tumor is eating into his lower jaw, having already engulfed a tooth. Reggie has recently become a patient of veterinary surgeon George S. Coronado Jr. Today, Coronado will try to save the dog, a cuddly, laid-back, floppy-earred animal who entered Pam's life when he was a puppy.

A woman at the front desk calls "Reggie Scripps" and Pam gets up to fill out paperwork and make financial arrangements. Sophisticated veterinary care is not cheap: today's surgery could cost $2,000 or more.

If Coronado operates, that is.

Reggie's eye tumor is prepped for surgery by Dr. George S. Coronado Jr., of Ocean State Veterinary Specialists, in East Greenwich. Journal photo / Bob Thayer

Should pre-operative testing disclose that cancer riddles Reggie's body, Coronado will call Pam and she will have to decide what, if any, treatment the dog will receive. She hates thinking about this. She ignores the boxes of tissues left around the lobby for owners who receive the worst news. But euthanasia is a part of veterinary medicine, too. It's one of the few major differences today between animal and people medicine.

Scripps completes the paperwork and technician Jose Cruz Jr. appears at a door.

"Reggie, you ready to go?" Pam says.

" 'No, I want to go back home with you.' "

Cruz greets Reggie with a pat.

Pam says goodbye.

"I swear to God I used to feel less sad leaving my kids with the babysitter." Pam will return to her home in Pawcatuck, Conn., to await Coronado's call.

Cruz brings Reggie through the door, past the laboratory and pharmacy and into the main treatment area, the hospital's hub. Pet owners are not allowed in.

This is not the snug place depicted in Norman Rockwell's 1961 painting "The Veterinarian," in which the doctor examines a dog with only his hands.

This 20,000-square-foot center offers x-ray, CT scan, ultrasound and MRI services. Specialists in dermatology, neurosurgery, internal medicine, ophthalmology and oncology are on staff. Emergency care is available around the clock. For behavioral issues, there's an animal psychiatrist.

Ocean State has 21 intensive-care cages; five surgery cages; 23 treatment cages; five surgery cages; an isolation ward; four oxygen chambers; a cat ward, soundproofed so that the barking of dogs won't disturb; five large dog runs, including two that are soundproofed; and an "exotics" ward, for birds, ferrets, hamsters, snakes, iguanas, alligators and other such pets. "There was a penguin here at one point," says manager Cheryl Rizzo.

This is the world of modern animal medicine, where pets can receive health care almost as advanced as that for humans.

Dr. George S. Coronado Jr., far right, and fellow staff members operate on Reggie. From left are Jose Cruz Jr., Norm Davis and Dr. Karen Stern, a surgical intern. Journal photo / Bob Thayer

SHORTLY AFTER Cruz places Reggie in a cage, Coronado arrives.

A handsome, soft-spoken man, Coronado is 36 but looks younger. Coronado graduated from Texas A & M College of Veterinary Medicine, then served a year-long internship at Purdue University and three years of residency at Michigan State University College of Veterinary Medicine, where he also earned a master's degree. He is qualified in most types of small animal surgery, including neurosurgery.

"Hi, Reggie," says Coronado. He takes the dog out of his cage, examines the mass and tumor, and listens to Reggie's lungs and heart with a stethoscope.

"He looks good for now."

Not long before 9 a.m., a technician brings Reggie into the x-ray room, and Amy Cardwell positions the dog on the table. She uses small sandbags and tape to hold Reggie in place. Reggie complies uncomplainingly. "The majority of patients I can do without sedation," Cardwell says.

Ocean State has a digital x-ray machine and images can be called up on a monitor virtually instantly. Cardwell displays Reggie's for Coronado. This is the first hurdle for the dog: a screening that will help determine if cancer has invaded his body. This could prompt the call that Pam Scripps fears.

"Everything looks good," Coronado says. "We don't see any tumors in here. His heart looks fine and his lungs look pretty clear." A blood test has revealed no barriers to surgery. Coronado prepares for his first operation of the day, on another dog.

IT'S ALMOST noon. Cruz opens the door to Reggie's cage. Cruz will administer a muscle relaxant, morphine and a sedative, all to prepare Pam Scripps' dog for full anesthesia.

"Hi, Reggie. Ready for your pre-meds, baby?" Cruz says.

He delivers the drugs through an intravenous line in Reggie's right front leg, where technicians found success after three failed attempts on his left. Reggie scratches around some and curls up in a corner, still. This is a preservation instinct: in the wild, an old, groggy, sick animal would be vulnerable to predators. Ancient instinct drives a modern dog to hide.

A technician carries Reggie to a table outside the operating rooms and the dog is put under, with another sedative and finally the anesthetic gas, which flows into his lungs through a tube inserted into his trachea. A pulse probe is clipped to Reggie's tongue. Except for the tube and probe, Reggie resembles a 52-pound rag doll, black and fluffy and impossibly cute.

As Cardwell takes a second set of x-rays, Coronado finishes with his first operation. He emerges from the OR and looks at the x-rays. This second set includes closeups of Reggie's lower jaw. Coronado studies one of the left side. The bulk of the tumor -- the visible part -- appears as a whitish mass. But a black line penetrates inward to a point about halfway down the interior of the jaw.

Daisy, a toy poodle, center, gets attention from technician Christine Carvalho. Journal photo / Bob Thayer

"It actually is eating into part of his bone," Coronado says. "It looks like it's going kind of far back."

The surgeon ponders his strategy and decides to remove a substantial portion of Reggie's lower jaw: from just past right of the midline, or middle, to roughly halfway down the left side. Bone and teeth will all come out. And while it is possible to graft new bone or even use metal as replacement, Coronado decides Reggie will be fine taking a less complicated route. Soft tissue and ligaments will still connect the two sides of remaining jaw, which will be enough for nearly normal function.

"At first he might have a little bit of instability when he's trying to chew on the bottom jaw," Coronado says, "but eventually it kind of scars and they tend to do pretty well."

The surgeon telephones Scripps with an update: he will remove the eye mass first; turn Reggie on his right side and, as a precaution, remove a lymph node in the neck, into which cancer cells unseen on x-ray could have metasticized; and, finally, remove the piece of bad jaw.

"It's probably going to take us a good hour and a half plus recovery time, so you probably won't hear from us for at least a good two or three hours," he says. "I'll give you a call at this number when I'm done."

Coronado anticipates no problems: removing jaw bone is not neurosurgery.

What he can't predict is the findings from an outside lab after a pathologist studies the eye mass, lymph node, and jaw -- a report that takes a week or so to come back. A report of metastatic cancer, which can spread throughout the body, would be devastating.

Regardless of today's outome, Reggie remains in peril.

TWO DAYS before Reggie's surgery, Pam, a nurse, was home with her dog; her husband, Steve, an engineer, was at work. It was a muggy afternoon, with barely a whisper of breeze off the Pawcatuck River, which is across the street from the Scripps' house.

In the living room, Reggie dozed at Pam's feet, getting up only when Pam did.

"He follows me around incessantly. And he's worse now that he's older -- it's like when my kids were little and wouldn't let me go to the bathroom." Pam is not complaining; after all, she calls Reggie baby.

Named by Pam's older son for the late Celtics player Reggie Lewis, the dog was born on April 1, 1993, and purchased from a private breeder. The family had owned a cocker spaniel before and been charmed.

Part of a technician's job is keeping animals calm before inserting IVs. Chris D'Ambrosio calms a golden retriever before hip surgery. Journal photo / Bob Thayer

"A good family dog," Pam says.

He was tranquil. "He had to be, huh Reggie? My kids drove me crazy. I thought: Dear Lord, I at least deserve a nice calm dog!"

When he was younger, Reggie used to enjoy walks, but at 12, walks have lost their appeal. He still occasionally chases squirrels and rabbits, but he sleeps more than ever now. He likes climbing up with Pam on the couch when she's watching TV. He likes having his belly rubbed.

"Hey, give mommy a kiss!" Reggie complies. "He's a big smacker. With his bad breath I'm not that thrilled with it!"

When the masses emerged, Pam's local veterinarian at first advised a careful watch; when they kept growing, the vet referred her to Coronado.

"He said dogs are amazingly resilient -- they can lose part of their jaw and they're still raring to eat. Hopefully he'll make it through OK. Hopefully, we'll get a little more out of him."

"LET THE party begin," Cruz says as he and technician Norm Davis settle the unconscious Reggie on the operating table.

It's 12:25 p.m.

The technicians cover Reggie with bubble wrap and lambswool, to retain warmth, then drape all but the dog's head in sterile cloth. Davis adjusts the anesthesia machine while Cruz washes around Reggie's eye with germ-killing soap. Freshly gowned and scrubbed, Coronado enters.

"You know this is going to be a little bloody," he says.

His assistant, Leah Stern, a fourth-year student at Cummings School of Veterinary Medicine at Tufts University, New England's only such school, nods.

"No fainting!" says Cruz. An intern recently watching surgery nearly did. She managed to escape the OR, only to sit woozy on the floor outside.

Dr. Krista Regan examines one of her charges at Ocean State Veterinary Specialists, in East Greenwich. The facility has staff specializing in dermatology, neurosurgery, internal medicine, ophthalmology and oncology. Journal photo / Bob Thayer

"Cautery set up yet?" Coronado says. "Need the skin retractor."

As Stern retracts the skin near the eye mass, Coronado uses scissors and a scalpel to dig the mass out. It is not connected to Reggie's eyeball, a good thing. Nor has it invaded Reggie's face. It has simply bloated, like a grape hanging off a vine.

"I'm working on the base to kind of shell it out, basically."

With a last snip, the mass is out.

Coronado sews up the skin and except for the top layer of stitches -- purple, to stand out from black fur -- there is little evidence the mass was ever there.

"I can do this all day," Coronado says, "but watching humans having surgery makes me feel ill." The surgeon can't explain quite why, but it's not an uncommon sentiment in veterinary medicine. And even if the law permitted it, Coronado would never operate on a person. "I wouldn't feel comfortable."

DAVIS AND Cruz turn Reggie onto his right side, exposing the jaw tumor and the animal's neck. Coronado swiftly removes a lymph node, destined for the pathologist, and sews up the incision. It's 1:30 p.m. The last job is the jaw.

Coronado makes small incisions in Reggie's lips to mark the section he will remove. He studies the skin. He begins cutting.

"Is he doing OK, Norm?" Coronado says.

"Looks like he's got a little bit of an arrhythmia, George."

Dr. George Coronado and Dr. Susan Newell discuss Reggie's x-rays before the operation. Journal photo / Bob Thayer

But Coronado concludes that interference or the cautery is throwing off the monitor. "If his pressures are fine, that's the main thing."

Blood pressure and pulse are within acceptable ranges.

Coronado continues to separate jawbone from tissue.

At 2:15 p.m., he asks for the saw. He tests it and says: "OK, here we go."

Coronado needs only about a minute to saw through the back end of the jaw. The severed bone showers blood and Coronado packs the cavity with bone wax -- sterile beeswax -- to stop the flow. He packs and packs. "I had one dog that did fine but later on in the day started bleeding out through the mouth," he says. "So now I really pack a lot in there."

The other cut goes more slowly.

"Tough bone," Coronado says. "Dang."

More than 10 minutes pass.

"We're almost there."

The section pops free. It's a fiendish-looking thing: a tangle of muscle, skin, tumor and teeth, painted in blood.

After packing the other end of jaw, Coronado examines it. Just to be sure, he has taken a few extra millimeters on either side of the tumor. "From what I can see, it looks pretty clean."

But only the pathologist can confirm that he got it all.

CRANSTON veterinarian Dr. Henry E. Childers, 75, is president of the American Veterinary Medicine Association, which represents more than 72,000 veterinarians. He has practiced for 51 years, the last 48 in Rhode Island.

"Fifty-one years ago, we didn't have formal specialties," Childers says. "We had to do everything -- we had to be the cardiologist, we had to be the ophthalmologist. If a dog had a broken leg and it had to be operated on and a pin put in, we did it or it wasn't done."

Animal medicine has followed people medicine not only in the creation of specialties, but in the development of technologies and pharmaceuticals. "Back in those days, we only had a few drugs," he says. "Now we have millions of drugs. It's amazing, really."

The increasing sophistication of veterinary medicine has accompanied social and economic change. As America has moved from an agricultural to an urban and suburban society, small animals, which contributed to the running of a farm -- cats kept mice away, dogs herded cattle -- have found new roles in the cities and towns. They have become companions. Their value now is emotional.

"Their utilitarian value is not their ability to do something for the household but their family membership," says Angie Warner, associate dean for academic affairs at Tufts, and a veterinarian for 25 years.

And American families are not what they were a half century ago.

The x-ray for a cat named Oreo, who has undergone successful surgery with Dr. Coronado. Journal photo / Bob Thayer

"People feel more attached to their pets," says Childers. "Sometimes it's the only family member they have. Some people don't have any spouse, or any children."

Add that to the nation's relative prosperity and the result is a multibillion-dollar industry. Pet health-care insurance can be purchased, but most small animal owners pay costs out of pocket. Some care requires deep pockets. Coronado recalls a case, in another state, where the owners spent $15,000 to save a dog with an immune disorder -- despite the man being laid off from his job. "It was a hardship for them," the surgeon says, "but they were really optimistic about the whole thing so they kept going for it."

Childers remembers a time when pet owners would feel embarrassed if friends or neighbors learned they'd bought health care for a pet; the old thinking was if an animal got too sick, put it down.

Now, owners tell Childers that "this pet means everything to me. I'd rather spend the money on the pet than take a trip to Europe. And they don't feel embarrassed because they're taking care of a family member."

Even in hopeless cases, some owners are willing to struggle on -- to approve what, in human terms, is called extraordinary care.

" 'Every day is precious,' " they tell Childers. "Just keep him alive."

BY 3 P.M., Coronado is nearly done resectioning Reggie's lower lip and mouth. "I just have a little patchwork to do here, close this tissue here, and that will be it," he says.

"That looks pretty dang good, George," Cruz says.

"Think so?"

"Yeah, it's not so bad. It looks like a dog that had a dental that went really wrong!" Coronado laughs.

The surgeon cleans Reggie's face and scrutinizes the dog's right eye.

"This doesn't look too bad, either," he says.

"Looks good, man."

"Yeah, I think it went OK. It was a little bloody there for a while."

"Hey, buddy," Cruz says as he starts to unwrap Reggie.

Cruz and Davis wheel Reggie back to his cage and Cruz settles him in, laying his head on a fresh folded towel. Cruz covers him with a blanket.

After writing orders, Coronado comes by. He is satisfied. He goes to a phone and calls Pam.

"He did really well through everything. The anesthesia was nice and smooth and right now he's sleeping quiet in his cage. Looks like he's pretty comfortable overall right now. We'll talk in the morning. If he seems comfortable enough, we'll send him home."

Pam thanks Coronado. "I'm glad he did so well," she says.

Coronado moves on to his next case, a large dog with a large mass on his spleen. The dog is receiving a transfusion of blood, and Coronado will attempt to remove the mass.

By day's end, 64 animals have come to Ocean State, according to manager Rizzo. Ten had appointments with internal medicine, six with dermatology, eight with surgery, five with ophthalmology, and eight with radiology.

Katherine Clark, 9, left, helps Oreo back into his carrier. Her brother, Brandon, 12, and mother, Norma, all of Billerica, Mass., are also there to help the cat. The extensive surgery cost almost $5,000. Journal photo / Bob Thayer

Twenty-seven animals received emergency care: two pets with fractures, a dog with seizures, two pets hit by cars, three pets who ingested toxins, two dogs with lameness, a pet with liver disease, two pets with kidney disease, a pet experiencing difficulty swallowing, a pet with a nasal tumor, one with ear disease, two with trouble breathing, two cats with urinary obstructions, a cat with a severe skin irritation, and two pets with pancreatitis.

For Ocean State, it was more or less a typical day.

PAM TAKES Reggie home the day after his surgery. He sleeps a lot initially, and Pam hand-feeds him a bit of soft food. By the third day, his appetite returns. A pain-killing skin patch helps him stay comfortable.

A week after the operation, Pam brings Reggie into the back yard, where the dog lies in the cool of a shadetree. Reggie is supposed to wear a plastic cone around his head to keep him from getting at his stitches, but he hates it and when she is there to watch, Pam takes it off.

Unless one looks closely, it's impossible to see what Coronado has achieved.

Pam recalls waiting for Coronado's call before the surgery.

"I was sitting around the phone kind of waiting for him to call me and say, 'you know, his lungs are full, do you want me to give him a shot?' "

Pam would have declined.

"I would have kept him home for a little while and when I felt it was time, brought him to my local vet. I'm glad it's over, I tell you."

Pam starts back into the house.

"Well, Reggie, what do you want to do for the rest of the afternoon?"

The next day, the pathology lab faxes Reggie's results to Coronado. Both the eye mass and jaw tumor were benign. Reggie's care cost a total of $2,245.

Reach G. Wayne Miller at gwmiller [at] projo.com