Her response to this man was no exception.
The little pooch had started to shake and was panting heavily, saliva pouring out of his jowls. The man bent down and scooped him up under his arm.
‘Calm down, Archie,’ reassured the man, ‘no one’s going to hurt you.’ The man glanced at Beryl and smiled wanly. ‘Anyone would think the end of the world was nigh,’ he went on. Whoosh. Was he about to turn into the caped crusader, I wondered? The dog shook his head and a string of saliva arched up and over the desktop to splatter down on Beryl’s keyboard.
‘Archie, for heaven’s sake, you’re embarrassing me,’ said the man, as Beryl pursed her lips, took a tissue from the horde up her sleeve and, with an exaggerated swipe, mopped up the offending dribble and dropped the sodden tissue in her wastepaper basket. ‘You must be Mr Henderson,’ she said brusquely, checking her computer screen. ‘Archie’s coming in for a dental. Am I right?’
Mr Henderson nodded. ‘Dr Sharpe warned me a few teeth might have to come out.’
Ah, there we go, I thought. One of Crystal’s clients. If it had been a ruptured knee ligament or some complicated internal surgery she would have had it booked in to do herself. But rotten teeth. Well, Paul could deal with those. I gritted my own teeth and slipped out ready to start my appointments, having seen two people, both with cat baskets, come in through the front door and who were now queuing behind Superman (Mr Henderson), waiting to be transported to another world (my consulting room).
I was running ten minutes late by the time the double-booked appointment Beryl had mentioned turned up. The poorly Schnauzer I was presented with was of the miniature variety, salt and pepper, with clipped beard and short upright tail. They’re normally alert, sharp little dogs, full of vim and vigour. Not so this female. You didn’t have to be a vet to see we had a very ill dog here. Her owner, a Mrs Little, did little to hide her feelings as she carried the dog in and lowered her onto the consulting table.
‘Thank you for seeing me at such short notice,’ she said, her eyes glistening with tears, the mascara round them smudged. ‘Bo-Bo’s not at all well.’ The Schnauzer just lay there, on her sternum, head down between her extended front paws, eyes glazed, unfocused, pupils dilated.
Since starting at Prospect House, I’d gradually perfected a standard approach to my consultations, usually beginning with a ‘Good morning/afternoon/evening …’ depending on the time of day, directed at the owners with a ‘Come in’ as they entered the room, carrying pets in baskets or cages or – in the case of dogs – in arms, or beside or between legs, or sometimes disappearing rapidly down the corridor, being pulled towards the exit.
Having overcome that initial hurdle, I would follow it up with a friendly ‘Hello, Tibbles … Cindy … Fluffy … Rex … Sabre …’ My cheerful ‘How are you feeling today?’ I had to curtail and use more selectively. It was OK if it were a dog or cat coming in for its annual booster, bright-eyed and bushy-tailed. But for a pet that came in dull-eyed and droopy-tailed, such a phrase was not appropriate as the animal was obviously feeling bloody rotten and would have said as much. For a short spell, I did try ‘What can I do for you?’ But I stopped that after my encounter with Francesca Cavendish, an out-of-work actress, who had swept into the consulting room with Oscar, a Maltese, wrapped in her pashmina. My ‘What can I do for you?’ was countered by a ‘Darling boy, it’s not what you can do for me but what you can do for my darling Oscar.’ I then tried ‘So what seems to be the problem?’ only for Miss Cavendish to retort ‘That’s for you to find out, sweetie.’ After a few months in practice, I acquired a short list of phrases from which I would select one to fit the circumstances of a particular consultation.
My initial observation of Mrs Little’s Bo-Bo made me want to utter ‘Bloody hell, she’s sick!’ But that wasn’t on my list so I had to resort to an ‘Oh dear, we seem to have a poorly little dog here.’ Not quite so dramatic but the sentiment expressed was just as heartfelt. I started to ask the standard questions as I examined Bo-Bo.
‘How long’s she been like this?’
Mrs Little hesitated before she spoke. ‘Er, just the last 24 hours.’
I suspected it was longer. Those tears wetting Mrs Little’s cheek could have been induced by guilt. Especially when she went on, ‘My husband thought it might be a tummy upset. She does get them from time to time.’
‘So she’s got diarrhoea then?’
‘Well, no. But she has been sick several times. And she’s off her food.’ Mrs Little bent over the Schnauzer and stroked her head. ‘I’ve tried her with all her favourites – tuna … fresh chicken. But she’s not interested.’ Mrs Little shook her head and gave a little sob.
By now, I’d checked Bo-Bo’s temperature – slightly below normal. Checked her eyelids – congested. Felt her pulse – erratic and sluggish. All suggestive of a toxic dog. My list of differential diagnoses began to narrow. The next two questions would narrow it further and probably allow me to reach a definitive diagnosis.
‘Is she drinking more than normal?’
Mrs Little nodded. ‘Why yes, heaps more than normal. Could it be her kidneys then?’
I ignored her question and posed the second of mine. If the answer was going to be ‘No’ I had a pretty shrewd idea of what was going on. ‘Is she spayed?’
‘No. My husband was against the idea. He was hoping to have some puppies from her. But we never did.’
Classic condition. Yes! I suddenly reprimanded myself. No cause for jubilation here just because I reckoned I’d diagnosed Bo-Bo’s problem. A careful feel of her abdomen would give me further evidence that I was on the right track. Or, more appropriately, on her tract. Having gently rolled the Schnauzer on her side without a murmur of protest from her, I had used my fingers each side of her tummy to knead her distended abdomen and, in doing so, felt a large, soft mass yield beneath them. Yes, I was definitely on the right track – her uterus was grossly enlarged and no doubt full of pus. Bo-Bo was suffering from pyometritis – an infection of the womb. Sometimes in such cases, if the cervix remains open, the infection drains out and you see a sticky vulval discharge. But if the cervix remains closed, the infection, unable to escape, builds up in the womb, causing it to grossly dilate, and consequently leads to toxaemia and collapse. Precisely what we were seeing in Bo-Bo. I explained all of this to Mrs Little and ended by saying: ‘We need to operate and remove her infected womb. But I do have to warn you, she’s in a very toxic state so it’s not like a normal hysterectomy. The risks here are much higher.’
Tears welled up once more in Mrs Little’s eyes – this time there was no doubting their sincerity. ‘You mean she might die?’ She leaned over and kissed Bo-Bo’s head. ‘Oh my poor sweet,’ she whispered. In response, there was the merest wag of the Schnauzer’s tail.
‘We’ll, of course, do our best,’ I said with more conviction than I felt. That line wasn’t in my list but I could hardly say ‘You shouldn’t have left it so long before coming in.’ But I surmised that this had been developing for quite a few days and not just suddenly overnight as had been suggested by Mrs Little. Still, now was not the time for recriminations. I had a feeling those would be wrought on a certain Mr Little when she got home.
I took the decision to admit Bo-Bo straight away and lifted the inert little dog off the table and carried her down to the ward while instructing Mrs Little to go back out to reception where Beryl would get her to sign the necessary consent forms.
As I passed the alcove door to reception, Beryl swivelled round in her chair and said, ‘Thought it might be a pyo.’
‘It is,’ I replied and hurried on. Here again, Beryl’s uncanny instincts had proved right, although she’d had the good grace not to prejudge the problem earlier on.
I saw Mandy step out of the preparation room as I came down the corridor, and she stood there watching as I approached with the dog in my arms, her face set in what, over the months, I’d come to think of as ‘Mandy mode’. Under normal circumstances, she h
ad a pleasant enough face, rounded, a little chubby maybe, but Rubenesque, pink cheeks, snub nose, unblemished skin framed by a no-nonsense auburn bob – she had none of this frizzy or straggly long hair which constantly escapes the confines of hair clips or grips to dangle down over operating sites, threatening their sterility, as witnessed on several lady vets in past TV programmes, forcing me to utter the words, ‘Get a grip.’ I can still hear my previous girlfriend, Sarah, moan every time I said it. When things were going Mandy’s way, her face would be all sweetness and light; she could be the apple of your eye. But when things weren’t going her way – ouch! I’m not sure what fruit you could compare her to – a lemon perhaps? Sour grapes? Whatever, her look was guaranteed to give you the pip. And one way in which to get that sucking-on-lemons look was to upset her ops list for the morning. Something I was just about to do.
I suspected she knew that since her expression changed from rosy-appled to bitter-lemoned in the time it took me to get down that corridor; in fact, when I drew level with her, such was the look of her pinched-in lips and the narrowness of her eyes, she could have just finished sucking on a whole basketful of lemons.
‘It’s a pyo,’ I said, rather weakly. Where was my manly voice when I needed it?
‘Right,’ said Mandy, briskly. ‘We’ll get that sorted once we’ve finished the morning’s ops.’
I knew that, on the rare occasions when additional ops came in from morning appointments, they would be tagged onto the end of the list, often meaning they wouldn’t get done until the afternoon, especially if they involved re-sterilising some of the instrument packs. It wasn’t usually a problem. But I felt uneasy about leaving Bo-Bo those few extra hours, hours in which her toxicity would only get worse, making the operation even more risky. No – I wanted to get her spayed as soon as I finished seeing my few remaining clients and ahead of the routine spays and castrates and – I suddenly remembered – Superman’s dog’s dental. Well, that could certainly wait until the afternoon, and even be postponed if necessary.
‘No,’ I said, my voice much more manly. ‘We’ll do her ahead of the list.’
‘But …’ faltered Mandy, going bright red.
‘I’ll be right down when I’ve seen my last client,’ I growled deeply, interrupting her as I handed over the Schnauzer. Gosh, I sounded positively Neolithic. I adjusted my loincloth (lab coat), swung my cudgel (stethoscope) over my shoulder and pounded back up to my cave (consulting room).
Once I’d finished my appointments and snatched a quick cup of coffee, I was ready to start. Mandy had Lucy fetch the Schnauzer up from the ward kennels, instructing her to continue with their cleaning and to come up and assist should she be required. The abrupt schoolmarm tone of voice didn’t escape my notice and, from the look that Lucy gave Mandy, it didn’t escape hers, either.
But Mandy, as ever, swung into action and, in her typically efficient manner, ably assisted in the induction, intubation and preparation of Bo-Bo for her hysterectomy; and it only seemed minutes before I was in the operating theatre, peering into the Schnauzer’s open abdomen, beginning to panic when I saw the size of her uterus, as one horn of it bulged out of the incision I’d made.
Knowing the womb, in this dilated state, would be highly susceptible to rupture, I had to be extremely cautious as to how I handled it for fear of tearing open the uterine wall. I gingerly slid my hand in and under the one horn, levering it out; I then stretched my fingers back in and upwards to locate the left ovary and, clasping it between finger and thumb, gradually pulled it towards me, keeping the pressure up until the fat and ligament holding it in place parted, and I was able to access the arterial supply, buried in the fatty tissue, and clamp it. I then ligated the artery.
It was always an anxious moment when you released the forceps and watched the ligated artery sink back into the abdomen, praying that you weren’t then going to see a pool of blood well up, which would indicate a slipped ligature – since relocating the bleeding artery, especially in dogs with deep abdominal cavities, was a momentous task and fraught with difficulties.
And I should know; I’d had just such a slipped ligature during one of my early attempts at spaying a dog. The dog in question had been a large, adult Alsatian bitch. I knew from the outset it was going to be difficult. She was deep-chested and overweight so I predicted the ovaries would be buried in a huge wodge of fat way down inside her abdomen, difficult to find, difficult to extract, and difficult to tie off their supply of blood. I was right.
In the struggle to pull the first ovary out, my constant heaving and squeezing of the surrounding fat reduced it to the consistency of semi-liquid blancmange; greasy, slippery, almost impossible to grip, constantly slithering out of my fingers, so that by the time I’d secured what I hoped was a tight enough ligature round the ovarian artery, my fingers were feeling numb with fatigue. I tested the knot with artery forceps, pulling at its end. It seemed secure enough. I let go of the forceps clamped below the knot and watched the ligature in its liquid yellow mass of fat sink out of sight between loops of gut. There was a little blood in the abdominal cavity – inevitable as some had oozed in from the initial incision – and I reached over for a swab and dabbed it over the loops of intestines, mopping up the remnants of that blood. Only, as I did so, more blood seemed to seep up through the bowels. I tossed the first swab – now soaked – onto the instrument trolley and snatched up another, pushing it into the abdominal cavity, withdrawing it in less than a minute, bright red and sodden.
‘Christ,’ I muttered, a surge of panic welling up in me in much the same way blood was now surging up through the guts and lapping at the edges of the abdominal incision.
Mandy, sitting on a stool, monitoring the anaesthetic machine, looked across and stated the obvious. ‘You’ve got a bleed, Paul,’ adding, ‘I’ll get you some more swabs.’
Of course, that wasn’t the answer. I realised I now had a slipped ligature on my hands, the fact verified when the ligature itself floated out on a sea of blood. I think I actually squealed when I saw it, knowing that deep inside the Alsatian, a large artery was pumping out blood at high pressure, and unless I could track that artery down, isolate it and clamp it off, the dog would bleed to death. My hands started to tremble, my heart race. Sheer despair gripped me as I extended the abdominal incision forward in an attempt to access the point of bleeding more easily. I watched as blood poured over the edge and ran down onto the drapes, instantly soaking them.
‘I think I’d better get Crystal in,’ said Mandy quietly, and ran from the room.
Moments later, Crystal was there, a gown hastily donned, me stepping to one side, splattered in blood, as she snapped on some surgical gloves and plunged in, Mandy next to her, mopping up the constant stream of blood, some of which had trickled under the drapes and was now dripping onto the floor, being smeared into red, slippery puddles by our boots.
‘Paul, hold these back,’ said Crystal tersely, indicating the coils of intestine she’d heaved out of the wound to give her more space. ‘And use those tissue forceps to hold the wound open for me.’ She nodded at the trolley. I did as instructed. Crystal was now immersed up to her forearms inside the dog’s abdominal cavity. ‘Mandy, swab please.’
Mandy had already anticipated her request, having put surgical gloves on to pick up a swab, ready for Crystal’s need. It was snatched from her, and another requested almost immediately as Crystal peered up and under the Alsatian’s liver.
‘Right … forceps, Mandy.’ Crystal held out a hand and the forceps were placed in it. They disappeared into the wound. ‘Now let’s have some curved artery forceps, please.’ Crystal’s other hand extended out to one side and the forceps slid onto it without hesitation on Mandy’s part. These two clearly worked as a good team. There was the click of the forceps as they were clamped. Another two swabs offered by Mandy were used. The surge of blood stopped.
‘Right,’ declared Crystal, easing herself up. ‘Seems I’ve got the blighter. Just need to make sure i
t’s tied off more tightly next time, eh, Paul?’
I felt myself go crimson.
She noticed, adding a little more gently, ‘It happens to us all at some stage or other,’ and proceeded to ligate and release the artery with the skill and ease that comes with practice.
Thank God, no such problems occurred with Bo-Bo – at least with her left ovarian extraction; and so I turned my attention to the right horn of her womb, pulling it out as far as I could and ligating the ovarian artery on that side, breaking the ligaments and fat that were holding the ovary in place so that I could haul the distended two horns of the uterus out onto the drapes where they laid steaming and glistening. The body of the uterus now had to be tracked down to the cervix, and where, on each side, there were prominent arteries, which were engorged and throbbing. I first clamped the whole of the womb just at the entrance to the cervix and then I threaded a curved needle with catgut and carefully slipped a stitch round each artery, anchoring it with a small portion of the uterine wall. Clamping a second set of artery forceps above the others, I cut between the two, severing the whole of the womb to enable me to drag it out and lift it across to the stainless steel dish Mandy was holding out for me. Boy, was it heavy. I checked the interior of the abdominal cavity. There was a little bit of free blood. I dabbed it away with some swabs … none reappeared. Seems my sutures were secure. Breathing a sigh of relief, I rapidly stitched up the wound, two layers – inner connective tissue and skin. A few drops of blood oozed from the wound. Nothing significant. I stood back, feeling exhausted.
Mandy picked up a dry swab, ran it along my row of sutures then dusted them with antibiotic powder and covered them with a strip of gauze.
She looked across at me and actually smiled. ‘Well done, Paul,’ she murmured. Wow. Praise indeed.
Although not actually Superman, I was still flying high when, later, I had to turn my attention to Archie’s teeth. But tackling that canine grounded me in one fell swoop, as I was to find out after lunch.
Pets on Parade (Prospect House 2) Page 9