Perhaps I was expecting a form of lung infection when I x-rayed his chest, but what I found took me totally by surprise. He had a relatively rare condition. “Thoracic empyema” was the presence of a purulent material, caused by infection in his chest, loose around his lungs. A fluid line could clearly be seen in his chest. He had little room to breathe. I had only read about this in books. There was no respiratory specialist in my area, and both Jim and Larry were reluctant to take this on, but I had fallen in love with the stoic dog, and to me, euthanasia was not an option. After reading about the treatments, I decided to give it a try myself rather than send the case to a larger clinic in the city.
Tux had to be clipped on both sides of his chest in order to insert chest drains. With minimal sedation and restraint, he stood patiently on the treatment table while we scrubbed him and put local anaesthetic into the area we planned to drain. First a tube had to be tunnelled under the skin and popped through into the chest cavity and then a one-way valve had to be installed that would let fluid be drawn out but not let air be drawn back into the space around the lungs, which is ordinarily a vacuum. A sample of the smelly, beige fluid was taken to be cultured for bacteria growth. I drained as much fluid as I could from the chest, then flushed warm saline into the tubes and rinsed the cavity, withdrawing the lavage fluid as well. The whole process had to be repeated on the other side and then the chest carefully bandaged so the one-way valves remained secure. Tux endured our ministrations for five days while this painful procedure was repeated, thankfully with less fluid each time. By the time our test results came back and his antibiotic treatment began to take effect, he was eating and happy. He still stood stock-still while we worked on him. It was extraordinary, one of those times when a vet wonders if the animal knows we are trying to help him. Thus started a lifelong admiration I have for this breed. They have seldom let me down. He went home at week’s end and recovered uneventfully. Only later did I realize how lucky I was to have succeeded.
My weekends were filled with farm auctions and antiquing as I discovered the world of Canadiana. My parents’ home had been filled with Victorian furniture, dark and stately, most of it handed down, and I grew up with a love of old things. But somehow they didn’t fit with my rustic log cabin. There were farm auctions held every weekend, in fact many to choose from each Saturday, and countless bargains could still be found. Primitive pine furniture, some of it built by original family members a hundred years ago, could be found leaving these homes for the first time. It was a time when originals could be had for relatively little, and city dwellers had not yet started attending farm auctions in large numbers. I would stand for hours, often in the rain, a steaming coffee in hand, waiting for an odd little table or trinket. Tools and rakes, music and books, chairs and trunks — it was worth waiting all day for that special bottle or picture frame, that unexpected treasure. During the week, there was often time to strip or repair these finds and fit them into my household. It was a really fun and eclectic way to furnish my home. I grew to know the dealers and pickers and saw them again and again at the auctions. Learning from them what things were valuable and what was rubbish, I was on the leading edge of a wave of buying that was just gaining momentum.
I regularly did appointments on Tuesday afternoons, and most of these were routine. Usually I didn’t have a laboratory or surgical helper in place as I finished up my evening appointments. One night, the last patient was a small shepherd cross, a female dog about twelve years old, who came in flat out.
“She started to vomit yesterday,” the owner said, “but she hasn’t been feeling well all week.”
“Is she spayed?” I asked, as I noted an obvious nasty discharge from her reproductive tract.
“Nope, don’t believe in that, changes their personality.”
“When did she last have a heat, then?” I asked.
He replied, “Two or three weeks ago, I think. They’re not like they once were.”
Immediately as I looked at her greyish mucous membranes and felt her tense abdomen, I realized the poor dog had a case of the dreaded pyometra, which was causing toxemia. She was dehydrated and would soon be in shock. In fact, she was barely responding. She needed fluids and antibiotics fast, and ideally blood work, but no technician was at hand.
“She needs an emergency spay,” I said, “and even then she may not make it.”
“What can you do for her?” asked the owner.
“I’ll start treating her for dehydration and shock, and we’ll do surgery in the morning when we have a full team — that’s if she makes it through the night.”
He left, despondent.
I started the iv fluids as our receptionist, Sue, closed down the lights and locked the doors. I tried to gather my thoughts. What could the two of us do? The fellow had refused to take the little dog to the city.
As I stood looking at the little animal in such a tenuous state, my mind played with an idea. A technique called “marsupialization,” which I had heard about for gastric torsion and bloat, might work in this case. The bitch was so sick she could barely move, so I might be able to do this tonight if Sue could stay to help. She could.
The idea crystallized as I clipped and prepared her abdomen for surgery, inserting local anaesthetic into the skin and muscle of her midline. I would pull her uterus just enough through the incision, then insert stay sutures in it and make a stab incision into it, draining it tonight. As I opened the midline of the little dog, Sue held her on her side. I hoped I hadn’t bitten off more than I could chew. The uterus was readily visible, as it was so enlarged with fluid, but it was an awful purple colour. Should I proceed? The first stay suture seemed to slip a little bit through the fragile tissue, but I managed to keep a small sac outside of the body wall and get another suture in about one inch from the first. A small stab and a fountain of brownish-red pus started to flow out into the little stainless steel bowl, which had to be repeatedly emptied. The uterus threatened to slip out of my grasp, and Sue was trying to hold one stay suture and the dog while I held one suture and the bowl. Was I doing the right thing?
I could either sew up the small tear I had made and tuck it all in or try the marsupialization I had envisioned. I decided to do the latter, which involved pulling the edges out and sewing them to the dog’s skin, then closing the muscle and skin around this and bandaging her up with a prayer. I left her late that night with the uterus still emptying its contents and her fluids dripping and went home to get a few hours’ sleep.
The next morning, she was on her feet and considerably better. Her gums were moist and pink. Once the bandage was removed, we could see the drainage needed to continue and after cleaning the wound and flushing the uterus with saline, left her until later that day to spay. She never looked back. Proud of myself, I decided to write a short article describing this technique and put it into the “clinical notes and tips” section of our veterinary journal. As a young vet, never involved with research, I didn’t realize that a literature search to see what had previously been written should have been carried out first. My paragraph was published and it turned out to be a relatively novel idea and one of interest to quite a few colleagues, some of whom called me. Unfortunately, I never knew if anyone else ever tried it. Likewise, if it had originally been someone else’s idea, I never found out.
This is how young veterinarians gain knowledge, far more than from any class or book. We learn through working and reacting to the incredible variety of people, cases, and animals that come though our doors every day. We often have no idea in the morning exactly what will take place that day. We are constantly forced to stretch ourselves, playing our various roles as scientists, counsellors, and inventors.
Things had been running smoothly for some time. We’d been busy, but not too much so. Then a tragic experience every doctor dreads brought heartbreak to our clinic and to a wonderful family.
The MacPhersons bro
ught in their beloved three-year-old black lab, who had been limping badly on her left hind leg. She was radiographed, and it was obvious that her hip joint was severely arthritic as a result of hip dysplasia. There was almost no socket left to the joint, calcium had built up in and around the acetabulum, and the femur was pushed almost out of the shallow joint. It was surprising she could use her leg at all. She must have been in a lot of pain.
Hip replacements had not been perfected for dogs, and the long-term use of painkillers was not common then. There were a few options, and I described them to the family. An excision arthroplasty was a common surgery to treat hip dysplasia. It essentially removed the ball and smoothed off the bone at the end of the femur so that there was no longer a joint, thus no bone-on-bone pain. The animal would develop a callus or “fibrous joint” in the muscle when using the leg, which now floated. It was not a surgery recommended for overweight dogs, but Sadie was a small, slim lab and should do well. We decided to go ahead with the surgery to try to alleviate her pain. I had never done the surgery, but on reading about it, I felt sure I was up to the task.
After Sadie was induced (anaesthetized) and her entire leg shaved, we wheeled her into surgery and began the process of dissecting through the tough scar tissue overlaying her diseased joint. Having never seen anyone perform this surgery before, I had no idea how tough it would be to get enough exposure and to identify the normal structures. I finally got a rather poor look at the joint capsule and incised it over where I needed to in order to expose and remove the femoral head. I had chosen Gigli wire to encircle and cut off the femoral head rather than a chisel, and it was not long before the round piece of bone came off in my hand.
It took a few seconds for me to realize that the surgical site, which looked like a raggedy hole, was filling with blood. I applied pressure several times, but there wasn’t anything obvious to tie off. I tried again to pack the site with gauze and to my dismay it still kept filling, perhaps even faster. I was panicking. Trying to sound calm, I said to my assistant, “We must get an iv set up right away,” realizing she should have been on one already.
We needed fluid replacement fast, something I had naïvely not anticipated with this particular surgery. Should I open it up more to see if there was one major bleeding artery that could be tied off? Should I turn her over and try to tie off a branch of the femoral artery? It seems almost unbelievable to me now, as I have done many more of these procedures with no bleeding complications at all. Events seemed to be taking place in slow motion. I clearly remember the frozen, yet burning hot, feeling I had when Sadie’s heart stopped beating. We tried to resuscitate her for several moments, but could not restart her heart. How could this be happening? I hadn’t had time to decide what to do — there didn’t seem to be that much blood — but it had happened nonetheless. It was over, and my first healthy surgical patient had died.
I sat in my office with my head in my hands. My face was deep red and my heart beating wildly. It took half an hour for me to be able to call them. Even then, I felt like I was observing myself from above, as though in some strange out-of-body experience. I tried to compose myself and picked up the phone.
I can’t remember exactly how the conversation went, but I think I started with something like, “I have terribly bad news: Sadie died under anaesthetic.” I was in a fog, but I remember the owner, though extremely upset, was kind to me despite her shock and distress. I tried to explain as best I could. I also remember the feeling of a sense of deep responsibility that came over me that day. Perhaps it was the first time I truly understood the phrase “the buck stops here.” I would have to be able to accept that kind of responsibility and live with it comfortably and even to fail occasionally with devastating results, and still find a way to carry on. Words cannot describe how everyone in the hospital felt that day. It was a sobering reminder of the emotional weight we carried.
The next day, I had to do several more surgeries. It was hard to get started, but everything went well. Gradually we all felt better, and things returned to normal in the clinic. Sadie’s owner came back in within weeks with two black lab pups.
“We want you to be their doctor,” she said.
I was so pleased to see her come through the clinic doors. We both had a few tears before admiring the beautiful pups, a male and a female.
“We’ll be neutering them at about six or seven months,” I said.
“That’s fine, whatever you advise,” she replied, “and we are calling the girl Sadie.”
I nodded in acknowledgment of both the tribute and the trust.
EIGHT
in the Muck
I WAS NOW SEEING horses all over Lanark and developing my own specialties within the practice. Some of our city-type clients owned show horses, but others were still very much the old-fashioned rural horsemen. I started to gain the trust of the heavy horse people over time and did more and more work on these gentle giants. They had common problems like bog spavins (swollen, fluid-filled hock joints) and hernias that I could help them with, but it was actually more general health issues I most wanted to help the owners with. One dealer of heavy horses went to an auction and came back with four yearling colts, all intact male Clydes. He drove his large, rickety, livestock truck up to the clinic one day when I was already fully booked. He refused to make appointments and always walked right into the clinic with his cigar despite the no smoking signs posted everywhere.
“Can you cut these colts today?” he asked.
“I don’t know, Roy — I already had my day planned,” I said stubbornly, digging in my heels, rebelling at his presumption.
“Oh, I’ll just wait with them; thought we could do it here.”
There was a mowed area beside the clinic, and I realized it would actually be most convenient, since it was not a busy day, to get it over with and save a drive to his stable later. I changed my schedule around and met him out back with two buckets of hot water. His son was there as well, so we had the three people we needed to drop the colts.
Gelding colts is a very common procedure for a horse vet, and these days it is done most commonly with the animal lying down. General anaesthetic in horses is challenging and unpredictable. First the animal is examined to ensure it is healthy enough to anaesthetize, and a weight estimated before the doses are calculated. A two-step procedure is the most common way to give the anaesthetic. First, an intravenous sedative is given and in a few moments it is followed by a second injection, this time a general anaesthetic, which causes the horse to buckle and drop to the ground. Then the veterinarian has fifteen or twenty minutes to complete the surgery. The only problem is that different horses react very differently to the anaesthetics, depending on their breed, state of agitation, and factors such as anemia or pre-existing disease. The skill of the anaesthetist is in predicting the response of each animal.
One of the first anaesthetics I had administered to a horse when I started at Brentwood scared me. The owner had talked me into giving the horse the anaesthetic in a box stall against my better judgment, because it was raining. The horse was difficult to manage, and the sedative did not relax him very much. I should have given more before I gave the second drug — but I was too cautious about overdosing the young horse. The second injection did not seem to have any effect for at least a moment — far too long — then the horse somersaulted forward with straight front legs with such force we had to run out of its stall. We could not risk getting hurt and couldn’t get back to the horse’s head. He ended up in the corner with his head down and twisted and his backbone and tail vertically up in the corner as if he was standing on his head. We did get him pulled down and gelded, but I vowed never to do an anaesthetic on a horse in a box stall again — it was far too dangerous for the handlers and the horses.
Years later, I found myself perfectly comfortable contemplating giving four anaesthetics in a row, outside on a lawn. Experience had finally brough
t me to a place where I didn’t feel nervous about it at all. Besides, these colts were Clydes — a quiet breed — and seemed a bit down on their luck and would be easy to get down. One after the other, we brought them down the truck ramp and induced them. Things went so smoothly that when the surgery was over, we let each of them lie sleeping and went on to the next, until we had four geldings asleep on the lawn. Passing motorists gawked and one even drove around to see if everything was okay. One after another, they likewise stood, as if on cue, shook themselves off, and walked compliantly back up the ramp.
“Oh, give me a Clydesdale to work with any day!” I thought as I carried everything back into the clinic.
That summer, two third-year students came to work with us. Jim was keen on hosting international students, and we often had Swedish or German veterinary students visit while they were travelling in Canada. This year, we had a combination of students who could not have been more culturally different if we had planned it that way. Ron, our vet student from Canada, was a short, dark Israeli who had come to OVC after finishing his military conscription and working on a kibbutz. He was quiet and intense and his interest lay in small animals. The second man was invited by Jim after some written correspondence and was a student from a well-off family in Germany. Gerhard was tall, fair, and ebullient, with a good grasp of English, and he wanted to experience life in Canada. They found a place together and often showed up at work deep in conversation. I wondered when I watched them if the shadows of their parents’ generation or the past would affect them in any way but it seemed not to. Time does heal, and there was truly nothing left of mistrust or anger or prejudice in these two special, openhearted young men. It gave me faith in humanity.
William's Gift Page 8