Saturday, 17.00
The dog with the throat wound is in a cage in the kennels, with a drip and blankets.
The next hunter has already put his collapsed lung case on the operating table. Is he fed up with missing his turn?
I turn to the dog and give it a quick examination. The heartbeat is impeccable, I can hear the characteristic sound of air between the pleurae, one of the ribs is broken. For the time being, the hole is more or less plugged by the muscles and skin. I take my time getting everything ready. Insert a catheter and drip, choose an endotracheal tube and prepare the anaesthesia circuit. While I do this I explain to a hunter standing beside me how to use an anaesthesia breathing bag on a dog. I hope my wife will be here soon.
Olivier delivers a loud commentary on his X-ray for my benefit: bone fragments all over the place but there doesn’t appear to be any serious damage to the bone, so he sets about stitching it up.
The telephone rings. When Perrine informs me that Monsieur Dupont is waiting for us to take bloods from his ewe I can barely conceal my irritation. I speak very loudly for his benefit.
‘Tell him that we’re very sorry but it’s carnage here today and we can’t come. It’s not urgent, so he’ll just have to make another appointment for next week.’
She nods, then joins in the game, repeating the same thing in a slightly more roundabout way. Then she hangs up.
‘He’s cross.’
‘Too bad, if he’s not happy he can go somewhere else. Anyway, he always gets in a huff when we don’t run around after him.’
The telephone rings again. I heave another sigh. Perrine rolls her eyes.
‘No, we can’t do it, we already have three packs of dogs here.’
Standing there holding the anaesthetic gel for the endotracheal tube, my white coat covered in blood, I have difficulty getting my head around it. Four packs. She hangs up.
‘It’s Roque’s team, they’ve got four injured dogs.’
She hesitates: they weren’t happy.
Too bad, they’ll understand.
I hear my wife’s voice. She’s arrived and is taking in the scale of the disaster. I follow her gaze. The floor is a shambles of blood, shit and mud from the hunters’ boots, with trails of footsteps where we’ve tramped through it all. There are at least seven hunters now, reliving the day together, watching their dogs anxiously, listening to my explanations or keeping an eye on the latest dog to come round. Some have gone outside, sickened by the blood. Others are itching to join in when I palpate a wound and describe the damage.
Blood is sprayed all up the walls from the dog with the collapsed lung on the operating table: as it quietly pants for breath it carries on wagging its bleeding tail. With those war wounds. Dumb dog.
Saturday, 17.45
I anaesthetise the collapsed lung case, placing the dog on its back and intubating it; it’s not fully asleep and I have to wait. My wife has put on a white coat and is attempting to get a handle on this scene of chaos. We insert the endotracheal tube together as I fill her in on the quirks of our anaesthesia circuit. Perrine dashes from room to room, keeping an eye on things, replenishing stocks of compresses, and fetching catheters, transfusion bags and more reels of suture material. ‘She must have covered a few kilometres by now’, quips one of the hunters.
After shaving, cleaning and disinfecting all round the wound to the thorax, I make a broad incision in the skin in order to get a better view of the damage to the thoracic wall. There’s a broken rib, the opening is wide enough. I stitch the intercostal muscles, a continuous suture that I’ll close up at the last minute. Next door, I hear Olivier exclaim:
‘It’s not splinters of bone, it’s bits of wild boar teeth!’
The hunters crowd in to see. Meanwhile, on our side of the wall, I reach the end of my continuous suture and my wife checks the breathing bag. The fateful moment arrives: in order to re-establish the vacuum in the pleural cavity, we’ll have to inflate the dog’s lungs with the breathing bag, compress its abdomen, and close the stitches – all at once.
‘Perrine, I need a hand! Now!’
She’s close by and she knows what to do: my wife compresses the bag, Perrine compresses the abdomen, and I tighten my knot.
Merde! All of a sudden the dog’s skin swells on the side of the thoracic wall, fifteen centimetres from my suture. Two holes!
‘Double pneumothorax! Drop everything!’
I make an incision in the skin to discover the second wound: a second broken rib, nowhere near the first one. I put the finishing touches to my first suture. When the second one is ready we’ll go through the same process all over again.
Next door, in a low voice, Olivier is explaining to the owner of the dog with the injured paw that he’s repaired the damage but that it will need a lot of physiotherapy. If there’s no nerve damage. In which case it will have to be amputated.
Saturday, 18.00
My second suture is ready, my wife and Perrine are back in position, the dog’s owner is watching.
‘OK, we’ll restore the vacuum. On a count of three!’ Total silence, we all wait for the dog to start breathing on its own again, while keeping an eye open for any small leak from the suture. One. I redo a stitch, then spread the wound in order to start the process of re-establishing the pleural vacuum.
‘One. Two. Three!’ I tighten the knot.
Silence again. No leak this time. We all get back to work. My wife offers to finish the cutaneous suture, and there’s a lot of work to be done. One or two drains, a star-shaped incision. I agree. I’ll be more useful assessing the injuries of the other dogs. Micro-surgery is more her thing.
Olivier has already started on another suture, for a wound to a joint.
The hunter has gone outside for a smoke.
Saturday, 18.15
As I head for the consulting room, I talk to the hunters of the three different parties. I leave it up to them to decide who’ll be seen next. They suggest two different dogs, I choose a wound to the thorax. The hole is small, but it might be deep: another collapsed lung? I notice another dog with the same type of wound: perhaps a third. Luckily the first one doesn’t really need help with breathing any more. We’ll see soon enough.
I wash my hands with antibacterial soap, the Gascon hound is on the operating table, wagging its tail. I tell the hunter that I’m going to examine the wound and warn him that he’ll need to hold the dog. I insert my fingers into the wound, feeling for the passage to the pleural cavity. The dog whines a little and wags its tail harder. There probably isn’t a collapsed lung. I decide to anaesthetise it: it will all need stitching and a drain in any case.
Perrine comes in and asks what I’ve done in each case, keeping a record for the accounts. While I insert the catheter and anaesthetise the dog I tell her, adding the antibiotics, anti-inflammatories and other opioids used on each of them, as well as the follow-up prescriptions they’ll need afterwards.
I’ve lost track of what’s going on at the back of the surgery, in the operating theatre and the prep room, but it hardly matters. I insert a drain, do a muscular continuous suture, a subcutaneous continuous suture, a cutaneous continuous suture. On to the next one. Benoît, one of the youngest of the hunters, comes round with a bag of sweets, unwraps them for us and stuffs them in our mouths while reading out the little printed quotations enclosed in the wrappers, his great boots squelching through the puddles of blood smeared around the floor by the oozing mop.
Saturday, 19.00
Another blue griffon with a wound to the thorax is brought in to me. I dare to hope that my findings will be the same as with the last one. There’s a small wound to the sternum as well. Someone tells me that Olivier has finished the articular suture:
‘He’s stitched the, erm … joint capsule.’
‘If he doesn’t get osteoarthritis or even arthritis your dog will be lucky.’
As I examine the wound and anaesthetise the dog I talk to the hunters. This is definitely not a collapsed lu
ng, but a major cutaneous and subcutaneous tear. Some simple stitching and a drain. With all the dogs, the reek of dogs and blood and wild boar, the hunters chatting with each other and calling their friends and families (‘We’ll be late back’) – with all this activity, at once frenetic and laid-back, the atmosphere in the surgery is extraordinary. All around there are discussions about the weight of the wild boar involved, the length of their tusks, and the different injuries produced by females’ teeth and the males’ snouts.
Saturday, 19.30
I call the friends we’re supposed to be having supper with tonight. We’re going to be late.
Now people start to bring me dogs with very superficial cuts. A few staples and a stitch on the sternum and groin of the first one, a bitch. She doesn’t appreciate it, but the hunters hold her securely. It’s not the first time for her and she doesn’t cry, even though she doesn’t seem very keen on my needles. Perrine tells me that my wife is repairing an eyelid, and Olivier is stitching some masseter muscles in a dog’s jaw.
I move on to the next dog, a simple cutaneous suture and a small drain, with just a few minutes of anaesthetic this time. I’m on automatic pilot. Olivier comes to ask my advice on the next dog. I can tell he’s flagging: under normal circumstances he wouldn’t have asked for my help in such a case. Our brains may be turning to mush, but our hands still know what they’re doing. At least I think they do. I search for my catheter. Where can I have put it?
Saturday, 20.15
My wife is done, and is now checking a dressing on the two-hole case. Olivier is finishing off an awkward wound in the middle of a dog’s neck, before anaesthetising the last one. The last one, really and truly. I take a deep breath. That’s it, it’s over. I stretch my spine, my back’s sore from bending over the tables. Benoît eyes me with a gently mocking look, bag of sweets in hand:
‘There’s one left if you want it?’
A bitch arrives, hopping on three legs.
I lift her on to the table, give her a quick examination, anaesthetise her. The wound is near the knee and it’s deep: my metal probe penetrates over fifteen centimetres between the layers of muscle. It will need a drain.
Cyril, one of the hunters, puts his head round the door of the consulting room, now transformed into the ante-chamber to a horror film:
‘You haven’t told me about treatments for Athos and Uno?’
And I hear a voice ask:
‘Doctor, do we need to wash the drain?’
My wife offers to finish off the knee surgery. I grab my prescription pad and blister packs of antibiotics. For one dog after another, I explain the dressings, post-operative care and check-up visits that will be needed. I write it all down. I reiterate my fears for the dog with the damaged hyoid.
I heave a sigh. It’s nine o’clock.
At half past nine, we set off on the hour-long drive to our friends. It will take Perrine and Olivier another hour at least to do an initial clean-up and keep an eye on the most traumatised dogs as they come round from the anaesthetic.
Time for our out-of-hours service to begin.
Choke
It’s eight in the morning. The calf is nestling in a cowshed in the crook of a valley. I finish inserting a catheter into his ear. The day started too early, but at least this one should make it. A drip for the day, or the morning at least, and with a bit of luck he’ll be out enjoying the sunshine that the forecast has promised us.
My mobile makes a vague bleeping noise. A text message. At this time in the morning it will be someone wanting to make an appointment. Normally I don’t answer calls, I filter them. But this time I couldn’t have answered anyway: any time you get mobile coverage round here it’s strictly only by accident. Occasionally something will go wrong and a text will get through. Orange covers 99 per cent of France; I’m one of the thousands who live in the remaining 1 per cent. I check anyway: ‘You have four new voicemails.’
Damn.
Voicemails aren’t about appointments. Voicemails are about emergencies. I finish inserting the drip, lob out antibiotics and the rest, scribble a prescription and sprint up the nearest hill, where I should get a signal.
Success. The voicemail is from nearly half an hour ago. And it’s a genuine emergency. The message is hysterical, but it’s nothing compared with the ones that follow. A horse with choke, an oesophageal obstruction, from swallowing alfalfa granules too quickly. The horse is calm, she says. She isn’t, though. Not remotely by the time she leaves her fourth message. I don’t even listen to it. Have I got everything I need in the car? Parked half on the verge and half on the country lane, I inspect the contents of the boot. Silicone nasogastric tubes, paraffin oil, red catheters, anti-spasmodics, antibiotics, anti-inflammatories. But I haven’t got the pump, or the anti-tetanus serum.
I’ll have to make a detour via the surgery. In all, it will take me a good half-hour to get there. Meanwhile, the surgery is open now and taking calls so I don’t have to. A quick dash into the supply store to grab the pump, and a serum from the fridge. I take another bottle of analgesics, just in case, and I know I have sedatives. And a bag of bran mash.
As I leave, the first nurse arrives. I ask her to call Madame Dussans to let her know I’m on my way. No point in leaving her to stress unnecessarily.
*
I’m coming, but it’s a long way. I detest choke. A horse that’s a bit greedy and a big dose of bad luck, and a blockage of granules can form in the oesophagus, often at the entrance to the thorax. The horse coughs and coughs, and there’s a high risk of food ‘going down the wrong way’ and being aspirated into the trachea, and of lesions to the oesophagus. My last two cases of choke ended very badly. So it goes without saying that I was already pretty tense, especially as the owner of this horse is a long way from being the easiest of customers. I always have a problem working with people who are under stress, hard to please and – because it goes with the territory – aggressive in their attitude. If everything goes according to plan, they simply take it for granted. If it doesn’t, it’s an absolute scandal. So I do my best to batten down the hatches and just focus on the animal, which has as much right as any other to the best possible care. But I know I’m not as good. I don’t have the temperament of some of my louder colleagues, who have the knack of shutting up clients when they seem to be trying to win some kind of prize for being thoroughly disagreeable.
*
I park near the loose box. The woman is with her horse, her dogs and her husband. She is calm and smiling. So is he. Has the horse managed to void the obstruction?
Sadly not.
I guess I should stop making mountains out of molehills.
The horse appears calm too. No straining to cough, no obvious nasal discharge.
I load all my paraphernalia into the toolbox. A quick auscultation: I’m listening above all to the breathing in the trachea and as it leaves the nostrils. The chestnut gelding’s warm breath caresses my ears. There’s moisture and a little bubbling, but nothing serious. The trachea is dry, but you can hear the pain in the arytenoid cartilages. I disinfect around the jugular, shave, insert the catheter. I’ve got the time to do the job properly. An injection of anti-inflammatories to deal with the pain. I test the nostrils with my finger. Korn (seriously, who’d call their horse Korn?) doesn’t like it, any more than most horses like having a vet’s finger stuck up their nose. Sedation. I’ve got a catheter in place, so I might as well make the most of it.
Two minutes later the sedatives have done their job, and Korn’s muzzle is stretched out flat on the floor. I start to investigate his nostrils with my largest nasogastric tube. I’m taking a bit of a chance, as he’s not that big, but if I can manage to insert this one the lavage, or flushing out, will be easier. My first attempt fails, and I’m in the trachea. It was bound to happen, as his head was really stretched too far back. But we’re not here to practise neck extensions with Koko, so I ask Madame Dussans and her husband to draw his head in behind the vertical. As he’s under se
dation the horse allows them to move his head, and between them they struggle to hold it in the position I need. This time I get stuck. A good sign. I ask them to move the head to the left a little, to the right, down a bit, and at last I can get past and into the oesophagus. I’m making progress. They can let go of the head.
The horse coughs once, and evacuates a great stream of saliva through his nose.
I stop straight away. The marks I made on the tube have rubbed off already. Too bad. I must be there, just at the entrance to the thorax. Nothing comes out spontaneously.
I pump in a little warm water. The horse doesn’t complain and keeps his head low – my preferred configuration in this type of situation. If liquid rises back up the oesophagus, as it nearly always does, it won’t go down the trachea.
A little more water, I withdraw the tube by five centimetres, then push it back in again. Still nothing. I wait a little, to allow the water to loosen the obstruction. Back down goes the tube, another two or three centimetres. A little more water again. This time, green liquid starts to seep down the tube. With difficulty. It’s very thick. I draw the tube back and launch another attack, send in a little more water. This time it overflows, and alfalfa trickles out of Korn’s nostrils. Not much of it, and he doesn’t move. That’s OK. I carry on chipping away, slowly, gently, forwards, backwards, never forcing, never injecting too much water. I suck on it but it doesn’t help, and a mouthful of horse saliva and alfalfa isn’t that tempting a prospect …
Monsieur le Vet Page 6