Memoirs of a Cotswold Vet

by Ivor Smith

  Jacqui’s son, Lyndon Davies, was for many years involved in the acting profession. His opportunity arose when pupils from Churchdown’s Chosen Hill School were auditioned for a major role in Dennis Potter’s The Singing Detective. Knowing him so well, it came as no surprise to learn that he had been successful. Once, while enjoying a glass of coke at our house, I asked him casually what sort of day he’d had. Twelve-year-old Lyndon stroked his brow and replied, ‘Oh, not so good, Ivor, I’ve been through purgatory today.’ I cannot recall what the dramatic comment referred to, but he must have been having a bad day.

  Little did we know that within a very short time we would be enjoying his Shakespearean roles on stage at the Globe and at Stratford-upon-Avon. While next door one day, I was more than a little surprised when, nearest to the ringing telephone, Tony asked me to answer it and on the other end of the line Dame Judi Dench asked to speak to Lyndon!

  At our house one day Angela rushed to the front door to greet Lyndon, knowing that he had secured another successful role. She opened the door, hugged him, and, before she had the chance to wish him the traditional actor’s ‘break a leg’, they tumbled over and Angela fractured an ankle-bone. Lyndon, as young Perkins, appeared regularly in Sharpe’s Rifles but the opportunity to go to our local for a pint with Sean Bean sadly did not arise.

  Jimmy and her family had taken over both the utility room and the kitchen of our house. We still have the treasured video of the litter that Tony took when the pups were a month old – bounding around the house while their proud mum does her best to keep them in line. How different they were from Jimmy at that age. No excuses, but my tardy surgical oversight resulted in years of happiness for five other families, and incalculable happy memories for ours. Coco stayed with us for the next thirteen years.

  This episode in our lives took up many fascinating hours but I was also responsible for the health and welfare of hundreds of other clients’ four-legged friends. The companion animal side of the practice was growing rapidly, but, disappointingly and frustratingly, the farm side of the practice, in keeping with the national trend, was gradually contracting. In the mid-1980s, probably 40 per cent of practice work revolved around life on the farm. There were still scores of milk-producing farms within a 15-mile radius of Churchdown, and I also spent at least one day of the week involved in the maintenance of the health of numerous large pig farms in the Cotswold area.

  Today, most of those pig farms have disappeared and the dairy farms in the area have reduced to a mere handful. The lack of support that successive governments have given to the farming community has, in my view, been little short of scandalous, but this is not the time to debate politics. Fortunately for my practice the loss of income from agriculture was balanced by the increased number of people bringing their pets to the surgery. Many of our clients lived in the Brockworth and Hucclecote areas of Gloucester and, due to lack of public transport at the time, and in many cases no transport at all, demanded a local surgery. So, in 1983, I bought our second surgery. It was a seventeenth-century cottage and adjacent outbuildings in Green Street which, long ago, had once been Brockworth’s village blacksmith: hence it was appropriate to name the surgery the Old Forge. In creating an up-to-date and hygeinic surgery, I had hoped to retain most of the original building but the architect, by chance an Old Cryptian, Rob Baggot, suggested that to do so would result in treating more of the staff than the animals. Nevertheless most of the four exterior walls were retained and it has seen much action since then.

  A stone monument once stood at this crossroad in Brockworths, but as Ermin Street began to experience more than casual village traffic it was moved from the middle of the road. The heavy circular base lay for years at the foot of one of the forge walls and when we began our renovations the Parish Council asked if it could be moved to a safer and more public place. I agreed and at some point it was moved – and that was the last I saw of it. No doubt it is in a safe place, probably adorning an old councillor’s garden somewhere! The little surgery grew rapidly and became a bustling place with many new clients joining the practice.

  At the time of the Falklands conflict, Pam Profit, the wife of a high-ranking officer at neighbouring RAF Innsworth, was the practice secretary. When she joined the practice she knew that at some time in the future her husband would be moved to another station, but that was unlikely to be for a number of years. It was disappointing when she broke the unexpected news to us that their move to another part of the country, where her husband would be responsible for running his own base, was imminent. I know that Pam truly regretted leaving the practice after just eighteen months, but she was determined to find the best replacement with the minimum of bother to me. She advertised the post, contacted and interviewed the applicants, and made the final choice. She then brought her successful candidate to the surgery for an introduction and official approval.

  Enter Joan Moat, a mature lady with excellent office skills and a polite and friendly manner. She was completely satisfactory for the position and was duly appointed. I suspect that Pam recognised that she possessed other qualities that made her perfect for the job. Joan always offered encouragement and advice, and was often a shoulder for a young nurse to cry on. As principal of the practice my involvement in this important arena of practice management was limited to sorting out the odd problem a male vet assistant might have, and this was usually done over a pint in the local.Joan was the mother of three grown-up children and married to Horace. I rarely, if ever, mentioned my efforts at jumping from a plane to him. Horace had been a true Para and a sergeant major in the regiment. He had parachuted into Normandy on D-Day and spent the remainder of the war battling his way across France. After almost two decades with us, I suspect that Mrs Moat wondered what her position and job description was in the practice. By the time Joan retired she was assumed, among other titles, to be the practice secretary, practice manager, personal assistant, legal and social adviser but, to most members of staff, she was Auntie Joan.

  For most of this financially demanding decade by hook and by crook we stayed on even keel. The practice grew, expanded and thrived. The hours were long and tiring, but nearly always happy and rewarding and there was usually something to smile about. However, towards the end of the 1980s we went through a particularly sticky patch that I shall remember all my days. We could easily have gone bust. We were to some extent victims of our own success. I am sure that this is an over-used phrase in the business world but it was related, if not the cause, of our problems and we needed the support of the bank.

  The small animal side of the practice was growingly rapidly and becoming ever more sophisticated. The need to invest in new equipment, employ more staff and provide bigger premises in which to house them had become paramount. The bank, as usual, was happy to finance the project and we could not foresee any problems. The architect drew up the plans, the builder extended the surgery, and we bought our new equipment, but we were close to the limit of our loan arrangements.

  What we could not have predicted was that bank interest rates were about to go through the roof, and suddenly everyone wanted to be paid at once. After we had settled our account with the architect, the planners, the builders and the solicitors, it was time once more to pay the Inland Revenue and the VAT man. There were, of course, the electricity and gas bills, drug bills and a seemingly endless bundle of other demands to pay, but, most important of all, the staff had to be paid.

  There were two factors aggravating our problems. The tightening of the economy meant that a large number of our own fees were not being paid. Our difficulties came to light when Joan discovered, to our embarrassment, that one of our cheques had bounced. Having reached the limit of our overdraft arrangement and marginally exceeded it, the bank decided to apply their new rules and their interest rates shot up from 18 per cent to 32.4 per cent.

  I thought it was financial extortion verging on the criminal. Joan spent most of the next few weeks on the telephone negotiating with the latest bu
siness banking manager. Each week there seemed to be another unfamiliar face who claimed to be our new bank manager, but they all spoke the same impersonal language. It was thanks to Joan’s coolness and negotiating skills that we kept afloat despite every new £1,000 loan costing us a £100 arrangement fee. If ever there was money for old rope! I had one option to escape from the bank’s clutches, and reluctantly cashed in all my life insurance policies and then started them all over again.

  I was sad in some respects to part with the bank that I had been with since my student days, but clearly loyalty now meant nothing. The days of Mr Mainwaring and the customer/local bank manager relationship were almost over, but I was pleased to move the practice account to the little branch of the Yorkshire Bank in Gloucester where we still felt that local customers had some relevance. In a very short time I had learnt that:

  Turn over is vanity

  Profit is reality

  Cash flow is sanity

  I’ll never need reminding of that. I needed no reminding either that I would soon be fifty.

  CHAPTER EIGHT

  M99: THE ANAESTHETIC FROM HELL

  In the early 1960s, while I was beavering away at veterinary science in Liverpool, two research chemists concocted a drug which was labelled M99. It was chemically related to morphine but was 80,000 times more powerful. They called the substance etorphine hydrochloride. Combined with the powerful sedative acepromazine it was, and still is, marketed under the name of Immobilon. It is a very potent anaesthetic.

  Its use today in the UK is restricted for use in dart guns for capturing and restraining large wild animals like deer and zoo animals. The procedures for emergency medical treatment should anyone be unfortunate enough to be scratched with a contaminated needle or receive a small eye splash are rigorously enforced today. The consequences of accidently injecting yourself are too scary to think about. The tiniest amount of the drug injected will very quickly cause dizziness, a drop in blood pressure, respiratory depression, cyanosis, loss of consciousness and death; quite an unpleasant way to go.

  On a brighter note, by 1968 it was being advertised and promoted as the state-of-the-art convenience anaesthetic for use in horses and donkeys. A different and less potent version was available for use in dogs, but this was used on a much smaller scale. At the time it was launched by the pharmaceutical company, none of us vets realised just how serious self-injection of a small amount could be, and I do mean a small amount; the liquid film adhering to a used needle was enough to cause a life-threatening emergency. The attraction was that it was so convenient to use. A small volume of intravenous Immobilon was all that was required to put a horse of any size to the ground and allow quite extensive surgical procedures to be carried out. At the end of the operation, when you wanted the horse back on its feet, a similar volume of the antidote marketed under the name of Revivon was given by the same route and within minutes the horse would be standing, and amazingly often looking for food. It was not a perfect anaesthetic by any means and the much preferred technique of delivering anaesthetic gases directly to the patient via an endotracheal tube were vastly superior. The problem for most practices which were not essentially equine practices was that they did not carry out a sufficient number of general anaesthetics to justify the large financial expense of the more elaborate equipment. For the average practitioner involved in the welfare of a range of large animals, Immobilon seemed to be an injection too good to be true. It was certainly an improvement on some of the techniques still being used at the time.

  One popular method was to force the horse to breathe chloroform vapour by putting a head-collar on the patient containing a sponge that fitted close to the nostrils. The liquid chloroform vaporised and the patient inhaled it. When sufficient had been taken in the horse fell over and remained anaesthetised, aided by an assistant who juggled with the sponge on or off the nostrils throughout the operation. At the end of the procedure the horse breathed clean air once more and gradually rose to its feet. Chloroform is an anaesthetic with a very small safety margin and not infrequently the patient did not get back on its feet. I recall seeing this procedure used on a regular routine basis as a young vet. Immobilon was at least an improvement on this. The patient was generally safe even though for the vet the procedure was fraught with danger. We simply were not aware of how dangerous the substance was until the first tragedy involving a veterinary surgeon occurred.

  At the time of the incident, in the ’70s, it was still customary to start the day on the farm wearing a clean brown freshly pressed smock-coat, the same style as the ones we had worn at Vet School. This particular young vet had gone along to a farm to carry out a routine castration of a colt. He drew up the calculated dose of Immobilon from his kit in the boot of his car and slipped the syringe and unprotected needle into the top pocket of his smock-coat. He approached the frisky young horse and as he did so the colt reared.

  It was a situation that most vets involved with horses have experienced on one occasion or another. The natural response is to lift your arms to protect your face, which is what he did, and on bringing his arms down again his wrist was pierced by the needle and some Immobilon was injected. He was quickly incapacitated by the drug and tried desperately to reach his car in the hope of administering the antidote, Revivon. Had he succeeded his life may have been saved, but he died before he could reach the car.

  The tragedy resulted in a huge amount of publicity in the veterinary press and started the alarm bells ringing. In hindsight it could have been argued that the vet had been careless in failing to apply the protective plastic cover to the needle of a loaded hypodermic syringe, and this omission led to the accidental injection. Quite right too, but I doubt if there is a single vet who works regularly with animals who has never accidentally pricked him or herself with a hypodermic needle. During the following weeks the veterinary press was full of alarming related reports of everyday experiences from vet practitioners. Several described the effect of an accidental needle puncture as they scrambled over a stile. The rapid onset of dizziness was a frequent reminder that the plastic cap of the needle was in the other pocket.

  The one positive thing that resulted from this sad fatality was that it was instantly clear how dangerous it was to use this anaesthetic at all. The moral conclusion was that if you continued to use it, now being aware of the dangers, on your own head be it. The problem was that it was so useful, particularly in emergency situations, that most vets did continue to use it. The safety precautions leading up to the actual injection of the drug and the care given to the disposal of any needle that had come near it was like nothing we had ever experienced before. But regardless of all these precautions the result of accidental injection was still a possibility, and strict ground rules were laid down. The recommended antidote to etorphine in people is a drug called naloxone and it is marketed in phials as Narcan.

  It was customary (and today essential) to take an assistant, preferably a trusted, experienced veterinary nurse, with you to any operation where Immobilon was to be used. At the commencement of the proceedings she was reminded once more of the emergency procedures if, heaven forbid, it became necessary. If instructed, it was essential for the nurse to inject without hesitation at least one phial containing 2ml of Narcan deeply into a muscle. The vet’s backside was the site of choice, and although vets generally do have a wonderful sense of humour, you can appreciate that for various reasons practical rehearsals were out of the question. I often wondered, as I approached a horse’s jugular vein with the Immobilon in hand, whether if things suddenly went pear-shaped the nurse would actually muster the courage to pull the boss’ jeans down and ram the naloxone needle into my posterior. No doubt the odd nurse would have relished the opportunity! I continued to use the drug throughout the 1970s and ’80s, usually for well-planned routine procedures in the horse, such as castrations and dental operations, and of course I did use it during unexpected emergencies. It is strange how so many of these occur at night. When the telephone ran
g late one evening I was surprised to hear Richard Pullen, a local dairy farmer whose wife, Judy, was the current Master of the Cotswold Hunt, on the other end of the line asking me not to attend a cow going down with mile fever but something far more dramatic. Richard spoke in a despondent tone.

  ‘There’s been a bit of a disaster, Ivor. Judy’s mare has been hit by a car or something and I don’t think there is much you can do. Come and have a look and see what you think – but I expect you’ll be putting her down.’

  I reached the farm a few minutes later. The beautiful black mare, Moffet, was still standing and they had managed to walk her the short distance from the Badgeworth road, where she had been hit, to a small paddock nearer Reddings Farm. She stood motionless in the darkness, a dark mare lit from behind by a very bright moon. I approached her quietly and spoke her name, then moved to the front of her and gulped as I looked at the gaping wound to her chest for the first time. I stepped back, aghast at the enormity of the cavity that I was looking into. It was astonishing that she was still on her feet, but it made my examination of her that much easier. Richard stood next to me. His manner was uncustomarily sharp and abrupt.

  ‘I don’t want any messin’ about, Ivor, if you think you can save her have a go, otherwise put her down now.’ Quite a challenge from one of your best clients, but at least I knew where I stood. I decided to have a go. The wound was huge but I could find no evidence that the thoracic cavity itself had been entered. Through my stethoscope I could hear every abnormal respiratory sound that had ever been described in one of my university text books ringing in my ear. She had suffered immense pulmonary contusion, and the tearing of lung tissue was probably present everywhere in her deep chest. In view of what had happened, this was both inevitable and expected. It might take a long time, but, eventually, I thought she could recover from the damage that she had sustained.