I lifted her eyelids one at a time; both pupils, though equal, were constricted. I ran my hands down her spine. Muscle tone appeared normal, and she responded with an increased pitch to her whine when I squeezed the tip of her tail.
Her front legs seemed fine, and gentle manipulation produced no evidence of discomfort. Her abdomen was relaxed; there was no distention. I clutched the toes of her left hind foot and flexed her tarsus; it moved freely without pain. Moving up the leg, I poked and prodded. I lifted it gently near the knee. There was a clunk deep in the hip; the dog screamed, then whirled to bite me. The side of her teeth grazed my hand, covering it with drool.
Paul buried his head in his father's back. He sobbed quietly, his shoulders rising and falling.
"There's either a fracture or dislocation in her hip. We'll have to treat her for shock and get an X-ray of that back end."
I carried her in and deposited her on the surgery table. Within a few minutes, the intravenous was running; steroids and Demerol had been administered. Cindy's breathing became more regular, her whines more infrequent. After fifteen minutes, her circulation had improved—her gums had a pinkish hue. Paul had quit crying, but there was foreboding in his eyes. He stood glued to his father, clinging desperately to his hand.
I turned on the X-ray machine and measured the Lab's pelvis for thickness. I put on a lead apron, then slowly worked a large plate under her body. I had the Misslers leave the room, extended her legs as best I could, and exposed the first shot.
"I'm going to need help with this next one if you don't mind, Ron. Just slip into this gown and gloves and we'll roll her over."
I supported the hind legs while Ron rolled her on her back and held her in place with her front legs. We tottered back and forth as Cindy squirmed in discomfort. She lay still for a matter of seconds, and I pushed the button. The clunk of the X-ray machine was a welcome sound!
I left Ron and Paul to watch Cindy and retreated to the darkroom. I opened the cassettes and fumbled until I had them impaled by four corners on the racks. Lowering them into the developer, I plunked on the lid and set the timer. Three minutes to dig out new film and reload the cassettes.
The bell rang. After a few quick dips in the water bath to remove excess developer, I lowered them into the fixer and set the timer for six minutes. I squinted as I walked back into the lights of the surgery. The boy and his father looked expectantly in my direction. "The X-rays'll be ready in five minutes."
I checked Cindy's colour and winked at Paul. "She's looking much better." He managed a halfhearted smile but didn't look convinced.
The bell rang on the timer, and I retrieved the X-rays. As soon as I lifted the films from the tank, I could see why Cindy was in such pain. Her hip was dislocated.
I pointed to the head of the femur, then moved my finger to the empty socket. "See how it's way out of joint?"
"How serious is that?"
"It's difficult to know at this point. I can't see any fractures. Most dislocations come along fairly well, but a lot depends on how much the surrounding structures were traumatized. It's all soft tissue, of course, and damage doesn't show up on an X-ray."
We all stood quietly before the view box looking at the bones and the wide displacement of the head of the femur. Cindy squirmed on the table and groaned in agony. Paul looked at her and then at his father. "I want to go home, Daddy. I hate seeing Cindy in so much pain. I'm so sorry. I know you told me to keep her on the leash." He threw his head on his dad's chest and sobbed. "She was on the other side of the road. Why did she run out in front of that car?"
Tears were pooling in Ron's eyes. He ran his fingers through his son's hair and pulled him to his breast. "We'll never know, Paul. What's happened has happened. We can't change that now. Dr. Perrin will do the best he can do for her."
Paul gave Cindy a last hug. Ron wrapped his arm around his son's shoulders. "You have my number if there are any problems."
I could hear Paul's sobs as they retreated. Several times he repeated, "I didn't think she would run out in front of that car." The doors slammed, the engine started, and I was alone with Cindy.
Here I was again! Eleven o'clock on Saturday night—what to do? There was no way I could call Doris in—not tonight—not in the shape she was in. I could call Gordon, but I hadn't seen him all week. Damned if I wanted to call him at this hour.
I pulled up a chair and sat next to Cindy. A little voice told me to put her in the kennel overnight and watch her, to do the surgery when I was fresh and Doris was here to help. Tomorrow was Sunday. Doris had been lamenting about not getting to church in the last three weeks. I was bound and determined she would make it this time!
I got out my Canine Surgery and browsed through the index. I had done several dislocated hips in the last few months, but was always in search of that "secret trick"—the maneuver that pops the femur back in, first time, every time. It had taken me almost ten minutes of sweating and grinding and pulling to reduce the last one. It had finally gone in with a resounding pop, but I couldn't recall that I had done anything special to bring that event about.
The text claimed: "Reduction is accomplished by a coordinated series of manipulations designed to relax the thigh muscles, break down adhesions, slide the femoral head onto the brim of the acetabulum, and finally drop it over the edge into the socket." Sort of similar to my experience—sweat, grind, and pull until it pops into place.
I made up my mind. I'd put her under quickly and try and reduce the hip. Leaving her overnight was a cop-out; by morning all the muscles would be stretched, and the hip would be far less likely to stay in place. I had to quit sniveling and get on with it!
I laid out all the bandage material that I'd need and turned on the gas to the anesthetic machine. The nitrous oxide tank was up to pressure and the oxygen was half full—we were in great shape for a short procedure like this. I shut off the half tank of oxygen and tried the backup tank. The gauge zipped to the top—it was full. Switching back to the partial tank, I turned the dial of the Halothane vapourizer to full open, and slipped the cone over Cindy's nose.
After an initial spate of whining and a bit of struggling, Cindy relaxed and drifted off to sleep. Her breathing was slow and regular. By the time I decided to intubate her, her jaw was completely relaxed. I opened her mouth and slid the tube down her airway. Lowering the level of Halothane and nitrous oxide, I connected the tube to the machine, blew up the sealing cuff on the endotracheal tube, and tied it in place.
Rolling her onto her right side, I put gentle traction on the leg, rotated the lower portion of the leg inward, and pulled. There was a grinding sensation then a bit of a thump. I flexed the leg back and forth gently a few times—surely it couldn't have been that simple! The leg moved smoothly; there was no grinding.
I smiled—this was too easy. Rolling Cindy onto her chest, I extended her legs behind her. Sure enough, they were the same length! I gently shifted her back onto her side and grabbed a roll of tape. I had two wraps of Elastoplast around her abdomen. It was when I lifted her leg out from her body and flexed it that I felt it shift. It was just a fleeting sensation, the slightest bit of grinding when I moved the leg.
I manipulated the leg again; there was a terrible grating sensation. Damn! It sure wasn't in now. It must have just been sitting on top of the pelvis somehow! I extended the legs again. There was now a good inch and a half difference in their length. With a big sigh, I pulled her leg down and pressed on the head of the femur with my thumbs. Again, I got a half-hearted thump, and the leg flexed normally.
I didn't like the feel of this. Other similar cases had gone back with a resounding thump, and I had no doubt they were in. Was I not really getting it in place? Was the joint so badly traumatized that there was no musculature left to hold it? I placed my left hand firmly over the head of the femur and rotated the leg back and forth. It glided freely, had full range of motion. I was sure it was in!
I rolled her with the greatest of care, making sure to ke
ep pressure on the hip the whole time. Sliding a plate under her, I exposed an X-ray and gently rolled her back on her side. I pondered taping her and developing the film later. But what if it really wasn't in? What if I woke her up to find it just sitting above the joint somehow?
I took a step towards the darkroom. I hated to leave her unmonitored. I turned and checked the machine. Everything looked fine. I flexed the leg a few more times, trying to make up my mind what to do.
Dashing to the darkroom, I opened the cassette, mounted the film onto the holder, and submersed it in the developer. Setting the timer, I covered the vat and bolted for the surgery. Cindy was fine and I rushed back to reload the cassette before the alarm went off. I rinsed the film and slipped it into the fixer then headed back to Cindy. She was breathing regularly, looking so relaxed. I began to wish that I could just lie down beside her and sleep.
The alarm went off, and I retrieved the film. The hip was reduced, but the head of the femur didn't appear to be seated full depth in the socket. I leaned heavily on top of the head of the femur and rotated the leg back and forth. If there was a clot or some soft tissue in the bottom of the socket, surely that would drive it out!
I flexed the leg and winged it out slightly from the body. The text claimed that such positioning helped seat the femur more firmly in the socket. I had wound my way through the better part of a fourinch roll of Elastoplast when I felt it pop out again.
"Lord, help me!" Why did the tough cases always happen in the middle of the night?
This was the beginning of a struggle for reduction. Soon all the developing racks were in use; films dangled on strings in the water bath. Every time I reduced the hip, I X-rayed Cindy again. Invariably, I discovered it had popped out once more. Each time, I replaced it and tried again.
Finally, I had the hip reduced and taped in place. If it came out this time, I'd wake her up and go in at a later date to do an open repair. I was dragging my feet on my final trip to the darkroom. I pulled the last film from the rack and fired it into the garbage. I already had a half-dozen just like it dangling in the water bath. I stifled a yawn and waited for the bell to ring, then shifted the film to the fixer and headed back to Cindy.
I knew instinctively that I was in trouble! I had taken several steps towards her and not seen movement. I broke into a run and reached her in seconds. Her tongue was blue, her sides no longer moving. I looked desperately for signs of a heartbeat, then squeezed the chest over her heart. Nothing! There was no sign of life!
A cold shiver ran up my spine as I looked at the anesthetic machine. The blue gauge indicating the flow of nitrous oxide had not changed, but the green one for the oxygen read zero.
"Oh, my God...Noooo!"
I ripped off the connection to the anesthetic machine and breathed into the tube. Struggling with the valves, I turned on the reserve tank of oxygen and reconnected the machine. I closed the valves and started bagging pure oxygen. A minute had passed and there was no improvement in her colour. Her tongue was still the colour of clay. I felt over her chest—still no heartbeat! I put a hand on either side of her heart and started CPR.
Alternating the compression of her chest and the compression of the bag on the anesthetic machine, I struggled to regain some sign of life. Fifteen minutes later, I admitted defeat. I had killed Cindy!
I staggered to the waiting room in a state of shock. All I could see were Paul's sad brown eyes staring accusingly at me. I could see them filled with anguish, brimming with tears. I had killed his best friend! I had betrayed his trust.
"Oh, God! Why have you done this to me? When so many people don't care a damn about their animals, why would it be this one to die?"
I fell heavily on the bench. Tears flowed as if released from a huge reservoir. All the failures of the past week were heaped upon me. My shoulders convulsed, as sob after sob wracked my body. I was the biggest screw-up of a veterinarian that had ever lived! Why had I thought I could handle this on my own? Why had I thought I could be a veterinarian at all? I belonged at the smelter throwing bags of fertilizer into railway cars.
It was almost one a.m. when I phoned Doris. Her voice was husky; she was still half asleep. "Don't bother coming to work on Monday, Doris. I'm closing the practice. I'm leaving town." My voice was flat. I had made my decision. I was a failure—a complete waste of skin!
"What on earth are you talking about? Are you drunk?"
"I just killed Ron Missler's dog! The oxygen ran out on the machine, and I killed her."
"Oh, Dave...Why didn't you call me?"
There was a minute of complete silence.
"I'll be there in a few minutes."
"There's nothing for you to do. Go back to sleep."
"I'm coming right in!"
I stood with the phone in my hand staring at Cindy's motionless body. I felt numb. There were no more tears. There was nothing but a feeling of complete emptiness. I had to phone the Misslers. I picked up the phone, then hesitated. How do you tell a man that you just killed a member of his family? The dial tone gave way to an annoying bleating sound, and I hung up the receiver.
My mind was whirling. There was always a risk when anesthetizing an animal—especially one that has just been run over by a car. I didn't have to tell him that the oxygen ran out. He'd probably feel better not knowing the truth.
I dialed the number and waited in anticipation as the telephone rang. I always hated to give people the news of a pet's death, but this was different—never had I felt more complicity.
The phone rang a half-dozen times, and I fought the urge to hang up. "Hello." It was Ron. I could tell he was anticipating bad news.
My mind was whirling. "Ron, I'm so sorry...Cindy's dead." I hesitated before struggling to go on. "It's my fault. I was working alone. I shouldn't have been...I had difficulties getting the hip to stay in...The oxygen ran out on the anesthetic machine while I was developing an X-ray. I tried to bring her back, but I was too late. I..."
"I understand, Dave. You did your best."
"I didn't do my best, Ron—Cindy shouldn't have died. I failed you and I failed Paul. I'm so sorry." "I know this doesn't make sense, Dave, but Paul knew. He kept telling me that Cindy was going to die. I tried to reassure him. But somehow, he knew."
Doris came through the door moments after I hung up the phone. "What the..."
She stopped short of the surgery. The place was in shambles. Shelves had been whipped clean of instrument packs, the anesthetic machine lay on its side. With a look of amazement, she wandered about the clinic.
"How could you do this? You've worked so hard."
"It's over, Doris. I just can't take it anymore. I killed that dog as sure as if I took a gun and shot her. Every time I close my eyes, all I can see is that little boy and his big, forlorn eyes full of tears."
"You're not God, Dave!" Doris's voice quivered with emotion. "You're human and humans make mistakes!"
"I'm through with practice."
"Where'll you go? What'll you do? All your friends are here!"
I plunked on the bench in the waiting room with my head in my hands. Doris knelt down on the reception room floor and began piecing together the day book. The binding was in one corner, the cover in another. Receipts lay scattered about the floor.
The phone rang. Doris tiptoed through the rubble to answer it.
She spoke in a muted tone. Hesitantly, she turned to face me. "It's Alex Shopa. He has problems with a cow calving. He tried himself, but says he can't get it."
I didn't answer. I was seeing aborted calves, cows lying like toads, mangled dogs...
"Dave, what should I tell him?"
I took a deep breath. "Tell him I'll get there as soon as I can."
Watch for Dave Perrin's second book of veterinary adventures, to be released in electronic format.
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Don't Turn Your Back in the Barn (Adventures of a Country Vet) Page 30