Don't Turn Your Back in the Barn (Adventures of a Country Vet)

by Perrin, Dr. Dave

  "Won't that leave a big hole into her stomach?" The tone in Doris's voice left little doubt that she found the thought revolting.

  "Yeah, it'll leave a small draining tract to the outside, but that'll granulate in a few days after the tube's been removed."

  Reading the procedure in the text a third and fourth time, I finally got on with it. As usual, it came down to common sense and observation of where the organ appeared best positioned of its own accord. Making a small stab incision where I wanted the tube to exit the abdomen, I drove a large pair of forceps through the muscle wall and incised over the bump in the overlying skin. Enlarging the tract, I pulled the tube through. With a stab incision in the stomach, the catheter was placed.

  I blew up the cuff on the endotracheal tube and pulled back. The stomach sandwiched tightly against the abdominal wall. I finished suturing around the outside of the tube and congratulated myself on a job well done. I marveled at how complicated the author had made it sound and how simple it had really turned out to be.

  "We're home free now!" Jessie was breathing steadily, she looked stable, and the surgery had gone so well that I could hardly believe it! "All we have to do is close her up and we're done."

  It wasn't until I had placed the first suture through the peritoneum and the rectus abdominus muscle at the end of the flap and the base of the sternum that I realized I was in trouble. Cranking on the Dexon to try and tie a knot, I noted a good three inches of discrepancy.

  "Oh no," I groaned. "Just look at how much those muscles have contracted!"

  Grasping the end of the muscle flap with my gloved hand, I pulled towards Jessie's head with as much pressure as I could muster and still hold on to it. I pulled until my hands were aching from the exertion. Going back to my knot, I tried again to appose the ends of the muscle, only to find that I was still two inches short of joining them.

  "Son of a bitch!" I hollered at the top of my lungs, as a pair of forceps bounced off the surgery wall. I suddenly felt very, very tired. I became conscious of the pain that throbbed in my head and the tightness that had developed in my neck. Standing back, I took a deep breath and let my head hang in an attempt to loosen the tension that had developed in my own muscles during the period of intense concentration.

  "How could the muscle have shortened so much?" Doris broke the uneasy silence.

  "You remember how hard I had to pull on that cat's leg the other day when we were doing the bone pinning? How I had to lever the two ends of the bones together? Well, the same thing's happened here—when the tension's taken off a muscle for any length of time, it shortens. We'll have to see if we can get around it somehow. How about you and Dad untying the hind legs and lifting her back end up? If you flex her forward, I may be able to put her back together."

  Father and Doris flexed Jessie's body in the shape of a U while I reefed on the suture material and apposed the muscle ends.

  "Just a little higher," I muttered. "Just hold her there now while I get a few more sutures in place."

  As Doris and Father grunted with exertion, I managed to place one suture after the other until the ends of the muscles were pulled together.

  "Can we put her down?" Doris's face was a beet red. Her arms were shaking from exertion.

  "Yes, I should be able to finish closing the rest of the incision without your help."

  The remainder of the closure was pretty routine and, when I was finally finished, Jessie had a long row of sutures shaped like a horseshoe over the front of her tummy.

  As Doris was cleaning up the instruments, I called Dr. Walker. He answered on the first ring, and I wondered if he'd ever gone to bed.

  "Hello! Hello!"

  "Yes, Dr. Walker, we've finished surgery, and Jessie's doing as well as can be expected."

  "You were able to get the bleeding under control? It's stopped?"

  "Yes, the bleeding's stopped and she's pretty stable. All in all, I'd say the surgery went well."

  "Can I come and see her? I'd really like to be there for her when she wakes up."

  I was hesitant because of the state of the room. "Give us a few minutes to finish up and it should be all right."

  "Doris! Doris! We'll have to get things cleaned up a bit here—Dr. Walker's coming."

  I had no sooner spit those words out of my mouth and filled the mop bucket, when he whipped around the corner.

  "Oh my!" he croaked. "Is that blood all hers?"

  "Yes, I'm afraid so. Her abdomen was just full of blood—we were lucky to be able to save and recycle as much of it as we did."

  Dr. Walker took a long, deliberate look around the surgery as if taking a mental picture for posterity. The room could easily have passed for a poorly designed slaughterhouse. Doris had the instruments soaking in a crimson bath of water. The surgery table was plastered with blood that had run down and accumulated in congealed puddles on the floor. The blood-drenched drapes were piled in a laundry basket at the corner of the room. The floor had been tracked with red from one end to the other, and a set of bloody footprints led across the room into the reception area.

  It took us the better part of an hour to make things presentable. By that time, it was eight-thirty and the first appointments were arriving for the day. Dr. Walker was perched on a chair in front of Jessie's kennel. He held her head in his hand and crooned a constant stream of platitudes in response to the whines she emitted with each and every breath.

  "Does she have a lot of pain? She's usually not one to complain this way."

  I thought about how poor Jessie's abdomen had to be feeling about now. The image of Doris and Father holding the dog's feet in the air and my reefing on the muscles made me hesitant to say no.

  Doris struggled by, dragging a reluctant yellow Lab towards the kennel room. As he heard Jessie's wail of complaint and got a whiff of the surgery room, he planted his feet and tried digging his way back to his owner. Doris looked at me in despair and exhaustion, and I scooped him up in my arms.

  "Lead on, McDuff," I joked. "How 'bout if you open the kennel door for me?"

  Father was loading the last of the dirty laundry into the washing machine. Doris quickly opened the kennel door and I deposited our unhappy visitor inside. He looked around frantically for an avenue of escape, then let out a mournful wail and began scratching at the bottom of the door. We all started laughing at the same time. We would not soon forget this night!

  "Well, Pop, did we have a good time on our day off?"

  Father opened his mouth, then slowly shook his head and went back to loading the washing machine. Doris sighed deeply and retreated to the reception area to sign in and collect another patient. A new day had dawned and there was nothing to do but to dig into it.

  Jessie went on to make a miraculous recovery. After the second day, I discharged her to Dr. Walker with the understanding that when they got home, she be examined by her own doctor. Jessie's veterinarian was an old friend of Dr. Walker's. They had been in constant contact, so the vet was well aware of the dog's progress.

  That afternoon I carried her out to the Lincoln Continental. Dr. Walker had contracted a local carpenter to build an insert so that the entire area behind the front seat could be made into a bed for Jessie. The whole surface, including the seat itself, was covered with pillows that he'd just purchased to make the ride more comfortable for his precious dog.

  Ten days later, I got a call from Jessie's veterinarian.

  "Dr. Perrin, I'm calling to update you on the progress of your recent patient, Jessie Walker. I just removed the endotracheal tube from her abdomen, and I can't believe how well she's looking."

  "Great! We were very impressed with Dr. Walker and Jessie while they were here. I'm certainly glad to hear that they're doing so well."

  "I have to tell you that you make me feel a bit dated."

  "What makes you say that?"

  "I've never heard of the technique you used to tack down the stomach, and I've certainly never seen anyone make an incision quite like that."<
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  "Well, if it makes you feel any better, the surgery was cookbooked from Veterinary Clinics of North America and I'd certainly never use that approach again—I had a devil of a time closing her up!"

  We both had a good laugh, and I was about to hang up when he began again.

  "I don't know exactly how to say this, but do you mind if I ask you about your fees?"

  I flushed and my heart picked up its pace. Fees have always been a touchy subject for me, and I tended to be defensive when someone even hinted that my services may not be worthy of the fee that I charged.

  "Dr. Walker was upset with the fees? Three of us were up all night working on her, and I tried to make the bill as reasonable as possible."

  "This really is none of my business, Dr. Perrin." He was struggling with his words. "If we didn't have a good rapport on the phone I wouldn't mention it, but Ralph's a good friend of mine and he did ask that I bring it up."

  "Okay, fine. What did he have a problem with?" My heart was pounding, and I felt as if I were behind Rayfield's boat being catapulted out of the wake one more time.

  "Ralph practised dentistry for over thirty years himself, and I've been at it for twenty-five. When the bill for Jessie's pillows came to thirty-eight dollars more than what you charged him for your services, he thought you ought to know!"

  "I don't follow you." My jaw flopped open in disbelief. "You mean he didn't think I charged enough?"

  "Let's just say that he would have paid three or four times that amount if I had done the procedure here. Ralph was shocked at how little you charged but didn't want to insult you by saying so!"

  There was a long period of silence, as neither of us knew what to add. Finally, he closed by saying, "Thank you very much for taking such good care of my patient and my client—they're both more than happy with your services."

  I listened to the dial tone for several moments after he hung up. I've since learned that, at such times, the only solution is to have a good laugh. Somehow, I couldn't even manage a smile.

  My belly was sore from leaning over the false front. The fascia board was rotten; nail heads poked out in an irregular fashion. Several times, I recoiled as one drove into my ribs. My shirt was filthy and riddled with puncture holes.

  I reached anxiously over the edge to scrape at the last of the huge scrolls of peeling grey paint. I was sick of this job. Soon I could start smearing on the white latex. Doris kept telling me that new paint and wallpaper hid a multitude of sins, and I couldn't wait to cover this ugly building. I had been here for two months and still didn't have the courage to hang out a sign.

  "Can you help me, mister?" I looked down with a start. I had been so engrossed in attacking that final square of stucco that I hadn't noticed what was going on in the street below. The boy was plastered with blood; the dog in his arms looked more dead than alive.

  "I'll be right there! Just give me enough time to get down the ladder." I tossed the scraper onto the irregular surface of the tarred roof and squeezed my frame through the hole that offered access to the apartment below. I quickly descended the ladder and ran down the stairs to the office.

  "Boots got hit by a car! We were up by the Dairy Queen and a guy ran right over him. He never even stopped!" I looked at the innocent face, at the limp body that he held in his arms, and rushed them into the clinic. I slipped my arms under the dog, and the boy reluctantly relinquished his burden.

  "They told me at the Dairy Queen that you were a vet...Is he going to die?" Intense blue eyes burned into me as I ran my hands over the pup's body. Open wounds gaped everywhere; his right ear was half torn from his head. The upper thigh of his right leg was shortened, and his leg dangled at a grotesque angle. His tail was hanging by a shard of skin. Blood dripped steadily from the stump and from his nostrils. The dog's chest rattled with each breath he drew.

  "I don't know, son. We'll do what we can." I quickly assembled an intravenous administration set and shaved the dog's foreleg. I plunged a catheter into the cephalic vein; as a slow reflux of blood appeared, I connected the fluids. Turning on the oxygen, I slipped a mask over Boots's nose.

  "I don't have any money, mister." The boy's wet-eyed gaze was intense; he spoke with a maturity beyond his years. "I have no way to pay for what you're doing."

  "We'll work something out."

  "We have no money. Mom never did like Boots—she'll be furious." Tears trickled down his cheeks. He stood silently looking at the lifeless body of his friend. He shivered, then looked away and lifted an arm to wipe at his tears.

  Boots's gums were white. I grabbed a penlight and examined his eyes. His right pupil was the size of a pinpoint, the left one ten times its size.

  "What does that mean? Why is one so much bigger than the other?"

  "He's been hit on the head, and his brain is swelling. When the pupils are like that, it means one side of the brain has more pressure than the other."

  I grabbed a vial of a potent steroid called Soludelta Cortef and pushed down on the rubber stopper that mixed sterile water with the white powder in a lower chamber. I drew the solution into a syringe and slowly injected it through the port of the intravenous set.

  "Is that sort of like a concussion?"

  "Yes, Boots has a concussion, and he's in shock."

  The dog lay unresponsive as I cleaned up the lacerations on his head and shaved away the hair on the wound margins. I had the muscle layer closed and was suturing the skin when he shivered and started whining.

  "Does he feel that?" The question was matter-of-fact, the boy's handsome face impassive.

  "He doesn't know where he is right now. I can't tell you for sure, but I don't think he feels any pain yet."

  I continued shaving, scraping, and washing Boots's wounds. As the hours passed, his gums began to pinken up; his whines became more constant and, occasionally, he made a move that suggested a conscious effort. The remainder of that afternoon was spent huddled over the surgery table with Boots. Another Sunday was fading into the record books.

  "I'm going to be in big trouble with Mom. She hates Boots—keeps telling me to get rid of him. But he's my friend. I can't let anything happen to him."

  "We'll do the best we can for him, but I want you to know there's no guarantee that he'll be normal. We'll have to keep him here as he recovers, and if all goes well with his head, he'll need surgery to repair that broken leg."

  "You won't tell Mom, will you?"

  "How can you keep her from knowing? She'll notice that he doesn't come home with you."

  "No, she won't—not if you don't tell her! Mom doesn't notice much of anything. It'll be fine if I just stay away from her."

  I wanted to question him further, but the look in his eyes brought me up short. An uncomfortable silence ensued.

  "Have you lived in town for long?"

  "We just got here last week. Mom and Andy were talking to a guy in a bar back in Calgary, and they found out that they could make lots of money picking fruit here in the orchards."

  "So has it been hard work?"

  "Haven't tried it yet. Mom went to Welfare, and they gave her money for the place we're in. She keeps saying we're going to try it soon, though."

  The pup paddled slightly with his right front foot. The boy's eyes met mine as we both searched for a way to continue.

  "My name's Dave Perrin."

  "Mine's Brian Gallagher." He hesitantly reached out and shook my hand, then smiled and returned his gaze to Boots.

  The boy stayed with me throughout the afternoon and into the early evening. By the time Brian reluctantly said goodbye, Boots was looking more stable, and his pupils were almost equal in size. It had been a long day. I bedded the dog down in the kennel and went upstairs for something to eat. I was totally preoccupied with Brian. He seemed like such a nice young lad—how sad that things were so rough for him at home.

  It was after midnight when I checked Boots for the last time. His IV was running fine. I changed the bag and gave him an additional injection
of steroids. I'd hoped that he would be conscious by now but, other than his sporadic whining and an occasional paddle, he was still gone to the world. I was hoping for a miracle.

  My mind was whirling when I finally got to bed. I lay staring into the darkness listening to the sounds of my new residence. There was the characteristic intermittent hum of the directional sign for the City Centre Motel, as the arrow blinked on and off. Engines raced and tires squealed as a steady stream of cars roared up and down the street. A semi hit the pothole in front of the clinic and responded with the usual metallic clatter. A boisterous crowd of drinkers chattered their way from the front steps of the Creston Hotel to the parking lot behind.

  I had moved to town two weeks before. The two fellows who had occupied the apartment before me had been evicted after a raucous party left the place in a shambles. I missed the solitude of West Creston, but I knew moving here was the practical thing to do. I would soon be occupying the entire building. Anthony had decided to close his barber shop and devote all of his time to teaching music. He was going to work from his home and was already hauling away the contents of his side of the building. I couldn't wait to have the additional room; I didn't know how we had been making do until now.

  The phone woke me at five-fifteen. It was Herb Hurford—Tsolum Farms had a cow down with milk fever. I threw on my jeans and rushed downstairs. I could see Brian in my mind's eye—his long blond hair, his brilliant blue eyes, his look of gentle innocence. Was his dog alive? Was he conscious?

  I hadn't bothered turning on the lights. Flinging open the kennel door, I peered into the gloom. Boots was sitting on his sternum, his head hanging dejectedly.

  The dog was in the land of the living. I was elated! Running to the waiting room, I flicked on the lights and rushed back for a closer look at my patient. His eyes were almost swollen shut and what I could see of the whites was blood red.

  I clapped my hands. "Boots! Boots! Over here, Boots!" Was he aware of me? Was he able to see? I couldn't tell.