I felt strangely relieved with the decision to hire Doris. She had a presence about her that I found reassuring. It would be good to have her on board.
"I have nothing set up in town yet for surgeries, but if you don't mind driving out to West Creston, we can make do there."
"Could you do it here?" Doris offered.
Gordon shot me an I-told-you-so look.
"I don't see why not, if you don't mind. I could do it right over there on the countertop."
"Well, you know, I have the sink and everything set up in the spare room where we used to do Stu's dialysis. How about there?"
"Sounds good to me."
By the time Gordon had given me a ride back to his place and I had returned with Albert, Doris had completely cleared the counter.
"I'm afraid I don't have much of an idea of what to expect. I guess if this were in an old western movie, I'd be boiling water and ripping up bed sheets for bandages."
"To be honest with you, you're not the only one who doesn't know quite what to expect! This is the first leg I've ever amputated, and it'll be the first time I've done a major surgery like this with just an injectable anesthetic. At the vet college, there'd be no way this cat would be done without an endotracheal tube and a gas anesthetic machine."
"Oh dear." Doris gave me a meek smile and wrung her hands. "This is going to be quite the evening, isn't it?"
"If it's any consolation, almost every surgery I do is breaking new ground. It's truly amazing how well things have been turning out!"
"That's reassuring to hear."
Doris grabbed a dishcloth and began scrubbing at a counter that was already sparkling clean, while I rummaged in the car and returned with all my anesthetic and surgical supplies.
"We'll premed Albert first."
"Oh my," Doris groaned, when she saw the wound. "I can see why you have to amputate it—that's plain disgusting!"
Albert was obviously feeling better and, the moment he was on the counter, turned to lick gently at the gash at the base of his tail.
"There's a boy, Albert." I grasped his hind leg and administered the premedication.
"Why, he never even felt that! He kept right on washing himself."
I diluted a bottle of Pentothal with saline. Taking up three millilitres, I diluted it once again and set it on the counter. Placing the pack of instruments on the end of the table, I instructed Doris on how she was to open it without reaching over and possibly contaminating them. I explained that she would have to open the gloves and the drapes in a similar fashion.
"It's not as if this is a sterile surgery site by any means, but the cleaner we are, the less chance we have of ending up with an infection. When we're dealing with bone surgery, we're extremely careful. There aren't many things uglier than working with an infected bone."
Within twenty minutes, Albert was very obviously sedated. His eyes were once again reduced to slits; his head rested fully on his forepaw.
"We'll do everything we can with just sedation before I inject the Pentothal. That way, we'll be able to cut down considerably on how much anesthetic we have to use. It'll be less dangerous for Albert."
I cautiously turned him over so that his mutilated leg was uppermost. This time, he just lay there. Applying surgical scrub to the dried edges of the wound, I gently worked loose some of the debris and smeared more soap over the fur adjacent to the wounds. I flexed the double-edged razor blade to a slightly bowed position, then ran it down both edges of the wound by his tail, shaving the hair cleanly away.
"I've never seen anyone use a razor blade that way," Doris exclaimed.
"I learned this trick from Dr. Croxall, the veterinarian from Nelson. It gives you a cleaner wound edge, and all the hair sticks together so that you can remove it easily. If you try doing this with the clippers, you end up with little hair fragments all over your wound that are almost impossible to pick out."
Within a matter of minutes, the kitten was denuded of hair over the base of his tail and over his right shoulder. I positioned him next to the sink, and with the tap running warm water, kept picking debris from the wound and rinsing it with a gauze.
"Doris, could you squirt on soap whenever I ask for it?"
She was getting into the cleaning of the wound with a great deal of interest.
"There's something sticking out of the hole up there by the end of the bone. Yes, that's it. You've got it."
I pulled a long whitish object from deep beneath the bone and held it up to the light.
"My word, what's that?"
"It's a feather," I replied, after closer scrutiny. "His owner found him under the fan in his chicken barn."
"Imagine that—the poor thing."
"We've done about all we're going to do without the anesthetic." I picked aggressively at some debris that stuck tenaciously to the wound margins. In his tranquilized state, Albert had been tolerant of my endeavours, but I had now reached the point of needing instruments.
"I'm going to give him the first injection, Doris. But after I get scrubbed up, if he needs more anesthetic, you'll have to give it to him. I made this up so it's very dilute—that'll give us a wider margin for error, and we'll be less likely to overdose him. Make sure you inject it gradually and only a little at a time."
I began a slow, deliberate administration of the Pentothal. Albert clenched then slackened his jaw. His body relaxed. I waited a few moments, then firmly squeezed the toes of his hind leg. His reaction was detached, but he had definitely felt discomfort and been able to move.
I forced open his jaw and pulled out his tongue. His mouth was dry and clear of mucous and the colour was much pinker than it had been earlier. His breathing was regular. I injected just a bit more Pentothal. Waiting a moment, I gave his toes another firm squeeze—no reaction.
"Doris, how about your scrubbing the area where I'm going to make the incision? We'll get rid of as much of this contaminated debris as possible, then work towards making it a cleaner environment."
She grasped the kitten's foot and began scrubbing as if she'd been at it all her life. "How aggressive do you want me to get with the stuff that's really caked on?"
"He can't feel what you're doing. Everything you're holding on to is going to be gone after the amputation, so just do the best you can to get down to bare flesh—even if you have to scrape it off with a fingernail."
Without a moment's hesitation, Doris continued her task, alternately squirting the reddish-brown soap over the leg and working at the debris. Watching her progress out of the corner of my eye, I carefully opened the surgery pack.
"Make sure you remember not to touch the instruments, Doris. It's amazing how often you'll feel like reaching over and handing me something. In most surgeries, we try to avoid even bending over them. For routine procedures where we're not dealing with contaminated wounds, I use a mask and a cap as well. But when you pick feathers from your wound, you can forget the possibility of sterile surgery."
"How does this look?"
"That's probably as good as you're going to get it. How about lifting the leg up just a little more and scrubbing it better underneath? I'll have to cut through the skin under there as well."
While Doris finished her scrub, I opened a pair of gloves and a package of cotton corner drapes. I laid them on the counter next to a spool of gut and a spool of synthetic suture.
I gave Albert's foot one final squeeze. Donning my gloves, I spread out my instruments so that I could see them at a glance. Drapes were applied so that the haired portion of Albert's upper body was covered. I wrapped the mangled remains of the lower leg to prevent further contact with it and flexed the leg towards the inside to expose the fractured end of the humerus. On closer inspection, I could see the bone was fractured lengthwise for a considerable distance up the leg. Although the fragments were still attached, they were quite unstable.
"We'll amputate the bone up here." I wiggled the end of the humerus to show Doris the line of the fracture.
S
he moved in closer to get a better view. "Are you going to cut the whole leg off up there?" she asked, obviously not the least distressed by the sight of the exposed tissues.
"No, we'll want the muscles to be quite a bit longer so we can fold them down over the end of the bone to act as a cushion for the stump."
I flexed the fragment, and it easily broke away from the remaining bone leaving a sharp, jagged end. With a pair of forceps, I continually broke off small pieces until the bone stump was blunted.
"Do you see the vessel that's pulsating down there? That's the brachial artery. And that's the vein and this little white string over here's the radial nerve."
"That's pretty neat."
"I'm going to need a package of that 3 0 gut, Doris...That's the one in the gold package," I prompted. "Just slip your fingers between the two layers and fold back until I can grab the inner package."
I pulled the suture material free and ran it through my fingers to straighten the kinks. Guesstimating the length of the muscle tissue that I would require to cover the bone fragment, I passed the needle under the artery and vein and through a portion of muscle and carefully tied them off. Repeating the procedure, I placed another ligature about a half-inch lower and cut the vessels between them. With a pair of curved scissors, I isolated and severed one muscle at a time.
"Why isn't there more bleeding? I was expecting to see blood spurting all over."
"It's surprising how little the muscle tissue actually bleeds when it's cut. Usually, it doesn't do much more than ooze unless you tackle a major vessel."
"Amazing."
"There's one that would bleed." I pointed out a vein and tied it off.
Soon, all that kept the end of the leg attached was the skin on the under part. Leaving it as long as possible, I trimmed through the attached portion and tossed the amputated limb aside. I folded the muscles beneath the end of the bone and sutured them in place.
"I need some of the other suture now, Doris, if you don't mind." I pointed to the spool of Vetafil on the counter. "Pop off the lid, then grab the suture material and pull it straight up."
Doris did as she was instructed and when she had pulled a couple of inches from the spool I grabbed it and cut it below her fingertips. Pulling out another few feet, I cut it off and threaded it through a needle. I draped the skin over the exposed muscle tissue, trimmed the excess away, and tacked it together.
"He just twitched his ear," Doris volunteered. "Should I give him some more anesthetic?"
"No, I'll be just a couple of minutes. That's almost perfect timing."
As I finished suturing the stump wound, Albert was indeed starting to recover. He made a few feeble attempts to move first his front, then his hind legs. I could feel a smile coming on as I pulled off my gloves.
Albert was going to be just fine. And better still, so was Doris!
"Oh dear," moaned Doris, as she surveyed the dingy little room. "Talk about your fixer-upper!"
"Pretty depressing, isn't it? Do you think there's any hope?"
Doris didn't say a thing. We walked to the centre of the room and paused under a lonely, flickering fluorescent light fixture. The walls and ceiling had been tastefully covered with rolled roofing and painted an institutional green. Its surface rippled and bulged in waves depending on where the glue had been applied. The indooroutdoor carpeting, a reddish-brown colour reminiscent of bargain brand catsup, was covered with debris and stained by a filthy traffic pattern.
"You know," Doris started, "I came into this building dozens of times when it was Gunnar Larsen's Photo Studio, and I never got the impression it was such a dump. It's amazing how much different I feel now that I'm faced with the prospect of spending a lot of time here. I never gave it a thought when I dropped off a roll of film."
"Any brilliant ideas?"
"Well, when Stu and I moved into our first house in Erickson, the walls were covered with this same stuff, and we just plastered it all with wallpaper—it hides a multitude of sins." Doris's eyes sparkled as she shifted her gaze from one corner of the room to the other. She had the look of a woman about to head on a shopping spree, and I could almost hear the wheels turning.
I gazed around the room, fighting a tremendous urge to pack up and run. After all, no one was keeping score. If I disappeared right now, no more than a couple dozen people would even know...
Doris interrupted my train of thought. "Maybe we should go down to Creston Hardware and look at the wallpaper. I was in there just the other day and noticed they had a new selection in. I looked at some to put up in my bedroom, but decided against it."
Creston Hardware was a hallmark family business run by Jack Barnes and his two sons, Morley and Bob. It occupied an old concrete building that had been poured in the late twenties and had a selection of everything from brass screws to living room sofas. It was only half a block from the office, and I was beginning to envision wear patterns in the sidewalk from our location to theirs.
Within the hour, Doris and I returned so laden with provisions that Bob Barnes trailed along behind us carrying a mop, a bucket, and a myriad of cleaning supplies.
"Watch your step," I warned Bob as he approached the threshold. "My landlord has a few boards to replace."
Bob stood back, drinking in the glory of the ratty old building. "We just happen to have a sale on paint coming up," he mused, looking up at the huge scrolls of grey paint that were peeling from the false front. "It looks as if you're going to need a few gallons."
"I'll keep that in mind." I relieved him of his burden and threw it in the corner.
"Well Doris, I'm going to have to leave you with this for a while. I have an appointment at the bank in five minutes."
Doris looked at me helplessly. It was truly difficult to know where to start!
I stood outside the bank building for several moments gathering my thoughts. Up until now, I hadn't really made much of a financial commitment to the establishment of my practice. Other than the few supplies that I'd been able to pay for with cash, the only other thing I was out was my time. At this point in my career, I still had great difficulty putting a lot of value on that—after all, it wasn't long ago that I had been a lowly student, and everyone knows what they're worth! Borrowing money was going to change things in a big way.
I felt conspicuous as I walked into the cavernous room where tellers worked diligently along the right side and long lines of customers waited. I was certain that everyone was staring at the tall, lanky newcomer approaching the reception desk. I was grateful when the manager's secretary acknowledged my presence and showed me to an oak door with a frosted glass panel in the centre of it. Across the width was stenciled T. M. Hall Manager. She knocked and immediately opened the door for me.
The manager was on the phone when I entered. He was a slight, white-haired, balding man with hawkish features that for all the world suited the role he was playing. I stood there a few moments, feeling very much like I was back in high school standing before the principal. He looked up for a moment, plucked off his wire-rimmed glasses, and by extending them, pointed me to a chair. He carried on with his conversation as if I weren't there.
My mind was whirling as I rehearsed my pitch. It hadn't occurred to me to put my plans down on paper, to actually have numbers beside the things that I wanted to buy. I certainly could have, because over the past few days I had ordered most of the things I would require to open my office doors.
"So what can I do for you, young man?" he asked, hanging up the phone.
Pushing his short legs out from the desk, he leaned back into a large swivel chair that engulfed his slight frame. He plunked his glasses onto the end of his nose and peered over them at me. The tone of his voice and the way he emphasized the words young man made me uneasy.
"My name is Dave Perrin," I began hesitantly. "I'm starting a veterinary practice in town, and I'm interested in borrowing enough money to get things off the ground. My plans aren't elaborate but I need a new car, some equipment, and some
basic instruments."
"And what, Mr. Perrin, do you plan on offering the bank for collateral?" He was making no attempt whatsoever to put me at ease. I was surprised that he hadn't even bothered to introduce himself.
"The majority of the loan would be for the car, and I assume you would have a lien on that," I started, "and the remainder would be for equipment that the bank could market if necessary. I've just spent the last seven years as a student, so you can appreciate that I don't have a lot of assets to put up for collateral."
"I assumed that might be the case, Mr. Perrin," he replied matter-of-factly.
"Look, I could see that if I came in here with an airy-fairy proposal for thousands of dollars' worth of equipment, you could question my chances of success, but I'm talking about starting small. I'm a professional person who has already invested a lot of time and money in my future, and I have every intention of being successful. I have more than enough cash flow to cover the amount that I need to borrow, and I'm certainly not one to live extravagantly."
"I'm sorry, Mr. Perrin," he said, with a self-congratulatory smile. "But I'm not prepared to offer you any hope of a loan with our bank. I'm afraid that I personally don't put a lot of value on university degrees."
"Well, that was short and sweet!" I vaulted to my feet. "And I have to say from what I've seen of you, that if you were the last banker on earth, I wouldn't deal here."
I was through the door when he calmly added, "It has been a pleasure dealing with you, Mr. Perrin."
I wheeled around to catch his smug smile. His insolent eyes peered over the same silly glasses.
"Look, Mr. Hall," I snarled, "to you it's Dr. Perrin!"
I slammed the door. I'd taken half a step toward the exit when I heard the crash. Turning with a start, I could see that the oak door no longer had a frosted glass panel, and although Mr. Hall still peered from behind the wire-rimmed glasses, he was no longer smiling.
Don't Turn Your Back in the Barn (Adventures of a Country Vet) Page 8