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

by Perrin, Dr. Dave

  Although Gidgit had never been sick a day in her life, we were constantly seeing her for one thing or another. For a toy poodle, she was a delight to handle and seemed far more practical about life than her adopted mother.

  I peered into the mirror in the back room and decided that my appearance was acceptable. I entered the exam room with my shoes on and my smock neatly tied up.

  "If anyone else talked to me the way Tom talks to me," Doris was saying, "there's no way I'd ever go back." The fact that both women had biweekly hair appointments was a testament to Tom's winning ways.

  "Dr. Perrin." Mrs. Reynolds smiled at Doris then turned to me. "Gidgit seems to be having a major problem with hiccups. She just about drove me crazy with them this morning."

  "Does she seem fine in other respects, Mrs. Reynolds?" I bent down to stroke the immaculately groomed little dog. She sidled over to greet me, the fluffy poof on the end of her tail wagging boisterously.

  "Oh, yes, she's just fine otherwise."

  As Gidgit jumped up to greet me, I lifted her to my chest. It was at that point that I first noticed the expression on Mrs. Reynolds's face. At first, I chalked it up to concern about Gidgit—or was it more?

  I continued my examination while Gidgit licked at my face. I smiled at the pink bow that sat perfectly balanced on the middle of her head. She looked bright, and I had yet to detect anything that resembled a hiccup. Peeling back her lip, I examined her colour and her capillary refill time. They seemed normal enough.

  I pried opened her mouth and pushed her tongue down with the tip of my finger. The tonsils looked normal, and I could detect nothing unusual. I was about to ask Mrs. Reynolds a question, when I noticed again the look on her face. I was so distracted by her baleful expression that I completely forgot what I was going to ask.

  I was dumbfounded. I glanced at Doris. From her vantage point behind Mrs. Reynolds, she crossed her eyes and held up her arm. Then again, in a less-than-subtle fashion, she pointed to her forearm and repeated the procedure of rolling her eyes. I gently put Gidgit down, then raised my arm and rotated it to look.

  A "high water mark" of crusted blood decorated my underarm as though painted for dramatic effect. I looked sheepishly from Mrs. Reynolds to Doris and then back to Gidgit.

  "Oh my, Gidgit, will you look at that! I didn't mean to bring along as much of my last patient as all that!"

  I retreated to wash, while Doris went to great lengths to explain to Mrs. Reynolds just how hectic my day had been and how hard it was for poor Dr. Perrin to juggle large and small animal medicine.

  The remainder of the afternoon flew by in a blur. It was getting on to eight o'clock by the time we had completed the last surgery and were waiting for the dog to recover.

  "So, what do you say to Chinese food, Doris?" I rolled the dog onto his brisket, and he made a feeble effort to stand. "All I could scrounge for lunch was a mouldy cheese sandwich and most of it's still sitting on the counter."

  We had our coats on when the telephone rang. Doris shook her head despondently. Shrugging her shoulders, she picked up the phone.

  "Yes, we are," she responded. "Yes, it's just been one of those days."

  I had lulled myself into believing it was a social call, when Doris turned to me with a glum look. "It's Jeanette Evans on the phone. They're having difficulty with a calving. She says Bob Rogers came over to help but they still can't get it."

  I took a couple of steps in Doris's direction, then resigned myself. "Just tell her I'll leave in a few minutes." Willie Evans was a practical, down-to-earth sort of fellow who had been around cattle most of his life. He had been with Bob Rogers for years helping with calvings and working the farm. If he and Bob weren't able to deliver this calf, there must be a problem.

  "Did you ever get those large-animal instruments autoclaved, Doris?" I cringed at the thought of another surgery tonight.

  "No, I got them washed and packed up, but didn't have time to sterilize them. For that matter, none of the other packs are ready to use either."

  The weather had been miserable throughout the afternoon, and the roadway was covered with a couple of inches of slushy wet snow—terrible to drive through! The going was slow. I passed a vehicle traveling in the opposite direction on the Creston side of the ferry landing, and it sent rooster tails of slush spraying over my windshield. I pulled over to let my wiper blades catch up, then proceeded towards the West Creston hills. The road up the mountain was slippery, but I made it to Willie's driveway without much difficulty. I pulled into the yard and met Jeanette on the way over from the house.

  I followed her to the clapboard structure where Bob and Willie were fussing over a large Holstein heifer. I was relieved when I saw the size of her. I had been dreading the possibility of another surgery. As big as she was, I was certain I could deliver the calf without trouble.

  "Just can't seem to get those legs, Dave," Bob lamented. "Feels like lots of room but there's nothing coming but the tail, and we can't reach the feet to straighten out the hind legs. I think what we need is those long arms of yours."

  "I sure hope you're right. Is the calf still alive?"

  "Yeah, I'm pretty sure it's still alive," replied Willie. "I felt it move the last time I was in her."

  I rolled up my sleeves and lathered my arms with surgical scrub. Soaping the vulva, I slid my hand into the heifer's vagina. She had lots of room in the pelvis, so once I got the legs straightened out, we'd be away. I directed my hand forward to feel the calf's tail and rectum. Bob was right; it was a true breech.

  The trick would be reaching one of the calf's feet. After flexing the stifle and hock, I could bring the foot back and out through the vagina. With thirty-seven-inch arms, I was well suited for veterinary obstetrics. I hadn't run into many situations where I couldn't reach far enough to correct a difficult presentation.

  I was following the calf's leg down from the stifle when I realized we had major problems. I could touch the inside of the heifer's abdominal wall and, further down, feel bowel slip between my fingers. I slowly withdrew my hand; from the look on my face, the boys knew we were in trouble.

  "Can't reach it?" Willie's face was etched with worry.

  "It's not that; the problem is that the uterine wall is split wide open. Unless we go in and sew it up, she hasn't got a hope."

  Willie and Bob looked at each other, neither of them saying a word. Finally, Willie glanced at the cow and sighed.

  "She was shaping up to be such a nice animal." He looked from the heifer to Bob, then back to the heifer again. "She's the easiest critter to catch—we can walk up to her darn near anywhere."

  "What are her chances if you operate?" Bob asked.

  "It'll depend on what we find when we get in there." I was trying to hedge my bet—this was a long way from a sure thing!

  "We have to give it a shot!" Willie had a determined look. "I want to give her a chance."

  "How well did you guys scrub before you went in to work on her?"

  "Well..." Willie hesitated. "I washed myself with a bar of soap before I checked her the first time, and Bob here brought that brown soap that he buys from you. We've bin pretty careful."

  "We'll start her on antibiotics right now. With that tear, bacteria can get directly into her abdominal cavity."

  I went to the car and drew up a syringe full of chloramphenicol. Slapping her hip a few times with the back of my hand, I popped the needle into the muscle, attached the syringe, and injected the syrupy, clear liquid.

  "Do you have a pressure cooker by any chance, Willie?" He gave me a puzzled look as I withdrew the needle from the cow's rump. "My instruments aren't properly sterilized. I'm sorry. We're usually ready to go, but I've been running with surgeries all day, and Doris didn't get a chance to do them up before I left."

  "Just the one that the wife uses for canning."

  "That'll do fine—a half to three-quarters of an hour at steam temperature should do the job."

  Willie took the instruments to the
house and Jeanette fired up her pressure cooker. I'd finished clipping the surgery site and had the nerve block done when he came back with sandwiches and a pot of hot coffee.

  "Boy, that'll sure hit the spot." I looked ravenously at the food. "It's been a long time since lunch!"

  We had demolished the sandwiches and drained the last of the coffee when Jeanette arrived with the instrument pack. They were still steaming, and she had to carry them wrapped in a large towel.

  "They're hot out of the cooker," she warned, "so watch you don't burn yourself."

  I knew from the outset this surgery would prove to be far from routine. The bovine uterus consists of a body and two horns—as a fetus develops, it usually occupies one of the horns. When doing a caesarian, I always tried to keep my incision towards the end of the horn so that the uterus could be brought out through the incision, where it can be easily worked on. The tear in this cow's uterus extended well back into the pelvic region where nothing could be externalized. Everything would have to be done by feel.

  I laid out the instruments and surgery materials on a bale of straw next to the cow, scrubbed her to my satisfaction, and was on my own final scrub when Willie couldn't stand it any longer.

  "Good grief, man! If you worry away any longer, you may be needing a skin transplant!"

  "I don't think there's much danger of that, Willie. How about your scrubbing up just in case I need some help to pull the calf out."

  He pushed his jacket sleeves up past his wrist, then extended his hands towards Bob for soap.

  "You better strip down more than that! You'll need to take all your loose clothing off. We don't want to expose this poor critter to any more sources of infection than we have already."

  Willie winced as he pulled off his jacket and stripped down to his short-sleeved undershirt. As he scrubbed, I went ahead. Making the incision as far back on the left side as possible, I cut through the skin and underlying muscle tissue. I had just picked up the peritoneal layer and made a stab incision when I turned to grab the scissors. There stood Willie, hands on his hips, watching the surgery unfold before him.

  "Willie! You're supposed to be scrubbed up so that you can help me if I need you."

  "Well, I am!" There was a defiant look on his face. "How many damned times do you want me to wash?"

  "It wouldn't matter how many times you washed; you're only as clean as the last place your hands have been. In this case, they're on your hips."

  "Oh yeah, guess so." He held out his hands for more soap.

  By the time Willie was scrubbed again, I was exploring the uterus to determine the extent of the damage.

  "It's even worse than I expected!" I followed the rent into the pelvis. "The tear goes back as far as I can reach, then gets lost in the fatty area in the pelvic canal."

  I reached into the abdomen and found the calf's head and front feet at the tip of the left horn of the uterus. Pulling up, I lifted the head and feet as close to the incision site as possible, then grabbed the scalpel and cut into the uterine wall.

  Willie looked on in disbelief. "I thought you said she was all tore up inside? Why are you cutting another hole in her if she's already got a big one?"

  "If I tried to bring the calf out through the hole that's way back there, I'd end up tearing the uterus even more. I'd rather make another incision and take the calf out where it's easy to suture."

  Willie was at my elbow, anxious to help with the delivery. His hands clasped together at chest height, he watched as I manipulated the uterine wall over first one foot, then the other. Holding the feet in my left hand, I reached in with my right to guide the nose through the incision. Everything was lined up and coming nicely.

  "Are you ready if I need you, Willie? Why don't you get the calving chains out of the disinfectant just in case?"

  Before I could remind him not to let the chains get contaminated, he dragged them out of the bucket and dried his hands on his pants. Bob chuckled quietly, and I proceeded to extract the calf the best I could without help.

  "You ready for the chains yet?" Willie asked anxiously.

  "I think I should be able to manage without them." I extended the uterine incision another couple of inches. With steady traction, I pulled on the feet. We saw more leg, then the nose, forehead, and ears.

  "Look! He's alive!" Willie was ecstatic, as the calf's eyes suddenly blinked open. I drew more and more of the black, white-faced calf from the womb. Once past the shoulders, all resistance ended, and the calf glided from the uterus to be deposited at Willie's feet.

  "He's all yours." I eased him onto the barn floor.

  Bob handed me the catgut suture material to close the incision, while Willie busied himself with rubbing down the calf. I quickly closed the wound with a single layer of sutures, then followed it with a second layer to fold the uterine wall over on itself and prevent leakage. I applied traction on the horn and rotated it slightly in order to get a better look at the damage to the uterus and cervix.

  The laceration started at the level of the abdominal incision and disappeared in the abdomen as far as the eye could follow. "Have a look, Bob."

  "That's quite a tear." Bob shook his head. "How in the world are you ever going to get that sewn all the way to the other end? Can you even reach that far?"

  "It's going to be a challenge. I suspect I'll end up with a few holes in my fingers before all's said and done."

  I tied the first knot, then began the tedious task of pulling together the wound margins. The first six inches was a breeze, but very soon the combination of pulling the uterus back, holding the wound margins in apposition, and suturing, became onerous.

  "I'm going to need help here. One of you'll have to hold the uterus while I suture."

  "I'll give it a try." Willie pulled the calf out of the way and covered him with the towel. Daubing on a few drops of surgical scrub, he gave his hands a cursory rinse, then stepped up as if to grab the uterus.

  "Whoa there, Willie! You need to wash up a lot better than that if you plan on helping."

  "What do you mean? I'm clean! Look at these hands—if I wash 'em any more they're gonna melt."

  "Back to the bucket, Willie! Scrub them for three or four minutes more at least."

  Willie grumbled continuously as he lathered his hands and arms. When finished, he glumly stepped up to grasp the uterus.

  "Just keep a slow, steady pull towards her head while I suture."

  Traction on the uterus made a tremendous difference initially, and I closed the next bit easily. Time after time, I reached in, felt for the location of the next suture, then drove the needle through the wound margins.

  Bob and Willie traded off as we struggled with the remainder of the tear. The more progress I made, the more difficult it became to place the sutures in the proper location. The needle found its way into the end of my finger as often as into the opposite side of the tear. My hands were raw and bleeding. Bob and Willie were impatient for the ordeal to end. Each time I reached again, they couldn't hide their disappointment.

  Several times during the arduous process, Willie squirmed and twitched. He'd glance furtively in my direction, but invariably broke down and scratched madly at a different portion of his anatomy. Each time, he dutifully returned to scrub. By the time I no longer needed his services, he swore that he'd never wash again.

  No matter how far I stretched or how hard I tried to finalize the closure, nothing was good enough! Left as it was, the suture line would leak fluid into the abdominal cavity, and the cow would almost certainly die from peritonitis. In desperation, I closed her abdomen, hoping that I would be able to suture the remainder of the wound through the vagina. If not, the whole effort would be in vain. Bob and Willie dressed themselves and watched in silence as I closed the cow up. They had been part of the struggle for the last three hours, and they were aware that I was less than happy with the outcome.

  I was cold and miserable by the time I placed the final sutures. This was the moment I always looked f
orward to with great relish. The placement of the final skin stitches signaled completion! It was the time I got to put on my clothes and warm up; the time I threw my instruments into the box for Doris to worry about. Today, I had been robbed of that sense of completion; I was left with the feeling that this surgery would never end.

  The next hour passed slowly as I struggled to suture within the confined space of the heifer's vagina. Countless times, I found the point of the needle by burying it within the flesh of my finger or thumb. By the time I called it quits, I was so fatigued that it was difficult to grip the needle well enough to drive it through the tissue of the womb.

  "I think we finally have it closed off." I sighed and threw my instruments in a heap.

  This procedure had ended with a whimper. Before going into veterinary medicine, I had thought of heroic surgeries as dramatic second-by-second battles where a life was saved or lost by one decisive act. And there are heroics in veterinary medicine; it's just that they are often lost in the mundane plodding that's necessary to achieve the glory. Looking back on this surgery, I'd say that it had all of the attributes of a heroic case. We started with a massive defect that would have meant certain death and ended with a cow that lived to be healthy and productive.

  I later found it easy to be critical of my performance that day. Many of the tasks I was called upon to perform were difficult and rarely could I choose to deal with them when I was in top form. With this cow, I could have spent hours more fiddling here and tucking there, but I still wouldn't have been satisfied with the job.

  When I finally got back to the clinic, I glanced at the clock in the waiting room—quarter to three. No wonder I felt so bagged! I threw the surgery box on the counter, plunked myself against the gas heater, and turned up the thermostat. There was a faint "whoof" as the heater ignited. Within a few seconds, the fan cut in, and I was bathed in a flow of hot air.