“Sorry about that,” Allie said. She pulled Bianca’s head away from my hands. I continued to feel her back and legs without incident until I performed a rectal examination. With my gloved finger, I could feel several areas of crepitus — broken bones — in her pelvis. It felt like crunched-up potato chips. Bianca screamed when I applied pressure. I removed my finger, happy not to see any blood on the glove.
“The car fractured her pelvis,” I told Mark and Stephanie. “I don’t think any of the sharp edges penetrated her colon because I didn’t find blood in her rectum.”
Mark and Stephanie looked at each other, consumed with worry.
“Now I’m going to check to see if she can feel her back legs.” I took Bianca’s left rear paw in my hand and pinched the pad. She jerked her foot away from me. “So far, so good.” I repeated the procedure on her right hind leg, and she jerked that paw as well. Relief enveloped me. “She’s got good anal tone and voluntary movement in both back legs. That means her spinal cord is OK; the car didn’t crush it.”
Stephanie collapsed in her husband’s arms. Tears rolled down both of their faces.
“Her color is much better,” Allie said, holding her lip up. “May she have some pain meds?”
I nodded.
Kim pinched the fluid line with her left hand to stop the fluids while she injected morphine with her right hand.
“How did this happen?” Allie asked, watching the pain medicine flow into Bianca’s catheter. When the syringe was empty, Kim released the fluid line and watched to make sure it resumed flowing.
“She slipped out the door when I went to get the mail,” Stephanie said, dabbing her face with a tissue. “I heard her cry and saw her lying in our neighbor’s driveway. He backed right over her.”
We stood silently, absorbing her words.
“He’s devastated.”
“I would be, too,” I said, not knowing what else to say. Allie released her hold on the injured dog and stroked her head. Bianca took a deep breath, looked at Allie and rested her head on the table.
“The pain meds are kicking in,” Kim observed. “It’s time for her X-ray.” She moved around the treatment table to the opposite side and removed Bianca’s fluid bag from the IV pole. Allie repositioned her arms around Bianca’s body without putting pressure on her rear end. She lifted the injured dog in one fluid motion, keeping her back straight. Bianca started to pant, but her body remained relaxed.
“I think she likes her drugs,” Kim said, giggling softly. Allie carried Bianca into the X-ray suite, Kim trailing behind with the bag of fluids. Allie laid Bianca on the table as gently as possible. For the first X-ray, Bianca was on her right side with her legs straight out to the side. Allie stepped on the foot pedal, and the X-ray rooter began to spin until a soft ding sounded. The next view was more difficult. Allie cradled Bianca’s head and front legs in her arms while Kim held her back legs. Slowly, they rolled Bianca onto her back and pulled her legs into position. Bianca struggled and tried to bite.
“You’re OK,” Allie cooed. “Be a good girl, and it will be over before you know it.” Bianca stopped struggling long enough for Kim to snap the picture. They slowly rolled her back to her side.
“What do you want to do, Allie?” Kim asked. “Develop or hold?”
“I’ll stay with her,” Allie responded. “But give me a towel before you go. The fluids are making her cold.” Kim went to the kennel and pulled two warm towels out of the dryer. She covered Bianca with one and placed the other under her head for a pillow.
Kim headed out the door with two large X-ray cassettes in her hands. While Allie waited, she pulled a nail clipper from the pocket in her scrubs. One by one, she pushed the hair back from around Bianca’s nails and clipped them to the perfect length. Allie did this for all sick or injured animals to bring them good luck. Kim reappeared in the radiology suite just as Allie finished the job.
“Shouldn’t be long now,” she said. Ten minutes later, two films hung on the light box in the treatment room. I stood in front of them, Mark and Stephanie by my side.
“Well, let’s start with the lateral.” I pointed at the X-ray taken with Bianca on her side. “Her spine looks good.” I followed the vertebra to her pelvis. “And most of the pelvis looks good from this view.” I pointed at the large wings of the ilium. “But this area looks a little funky,” I said, studying her pubic bones.
“Is it broken?” Mark asked.
“I’m afraid it probably is. We’ll know from the other view.” I continued to scan the first film. Bianca’s tail and back legs appeared normal. Next, I focused on her abdomen. I visualized both kidneys resting below the spine, her empty stomach and spleen lying below that. “So far, so good. The intestines appear intact, and so is her bladder. I was worried the impact might have ruptured her bladder, releasing urine into the abdomen.”
With that good news, I smiled at Mark and Stephanie before switching to the film of Bianca on her back — what is known in radiological circles as the VD view. “The car fractured her pelvis in three different spots.” I pointed at each fracture with a pen in my right hand. “See?”
Mark and Stephanie nodded.
“Can they be fixed?” Mark asked.
“Yes, I think all of these will heal with rest.”
The couple continued to stare at the films without showing much emotion. They had a lot to process.
I paused, waiting for a response.
“You mean she won’t need surgery?” Stephanie asked, turning to me.
“Yes, I think these will heal without surgery. As one of my favorite professors’ once said, tincture of time is all that is required.” Tears spilled down Stephanie’s cheeks. Mark’s eyes glistened as well. He put his arm around her shoulders, smiled and sniffled. Stephanie buried her face in his chest and sobbed.
“Are the films OK?” Allie shouted from radiology.
“Yes, no retakes needed.”
Kim retrieved a thick quilt from storage and placed it in the middle cage of the treatment room. A cat in one of the large cages below pawed at her leg. Kim laughed and stepped to the side while holding the stainless steel door open. Allie walked into the treatment room with Bianca in her arms and the bag of fluids in her teeth. Kim grabbed the bag, hung it from a metal clip placed above the cage and set the drip rate.
Mari begged for attention from her cage next to Bianca’s. She leaned her body against the cage door, stuck her snout through the bars and licked Kim’s arm.
After Bianca was nestled inside, Allie motioned for Mark and Stephanie to come and pet their dog.
“What do we do from here?” Mark asked.
“The next three days will be the worst as far as pain goes,” I responded. “She’ll stay with us for at least three days and then go home. Do you have a crate for her?”
“Yes, but she hasn’t used it in months,” Stephanie responded.
“That’s OK. As long as she knows what a crate is all about, she’ll be fine.” I smiled at Stephanie and Mark, trying to display confidence that this would all work out. “The pain medication will make her sleepy. She’ll be fine here in the clinic and at home in the crate.”
Stephanie looked at Mark for confirmation that he thought their baby would be OK. As he opened his mouth to respond, Bianca snored loudly. Each of us visibly relaxed.
“I think Bianca will do fine,” Mark said. “It’s you I worry about.” Stephanie nodded and straightened the bow on Bianca’s head. “Are you going to be all right without her for three days?” Mark asked. He got no response.
“You are welcome to visit anytime,” I said. “But please call first to make sure we don’t have something else going on.”
Allie pointed at her Star Trek watch. We still had to clean up the operating room before afternoon appointments began.
“I think Bianca needs to rest now,” I told the Flemmings. I felt a nudge on the back of my knee. I turned to find Captain wagging his tail. He stood with all four feet splayed wide, like a sa
whorse. I reached down to steady him with both hands.
“If you wish,” I suggested to the couple, “why not come back at 4 for another visit?” I grunted while trying to keep the tranquilized Captain upright. Despite my best efforts, he slumped to the floor, looked up at me with dilated pupils and swept his tail from side to side. He appeared confused why his legs didn’t work. Nonetheless, I was pleased he had forgiven me for the neuter.
“Feel free to bring her favorite toy and something that smells like you to keep her company,” Kim added. She closed the door to Bianca’s cage and repositioned the IV line.
“Be a good girl, Bianca,” Stephanie said to the sleeping dog. “We’ll be back to visit soon.” Tears ran down her cheeks again. “Mommy loves you.” Mark took Stephanie’s hand, pulled her close to him for another hug and kissed her cheek.
“We better go, honey. They have other patients to see,” he told her. The couple thanked us and walked out of the clinic hand-in-hand.
Chapter 4
Slumber Party
“There she goes again,” Allie said to Kim as she watched me walk to the fax machine. She shook her head back and forth. “I told you, Snowflake’s lab results aren’t back yet.”
“I know; I was just making sure,” I said after checking the fax machine for the fourth time in the last 30 minutes. “I wonder what’s taking the lab so long. It’s been well over an hour.”
“Would you like me to call them to see what’s going on?” Kim asked, always eager to please.
“Please do,” Allie answered before I could. She looked at me and said, “You’re driving me crazy.”
I retreated to my office to write up the surgical reports on Captain and Goliath. Genny laid on the office chair in the same position. I bent down and rubbed the fur on her belly. She stretched her front and back legs fully while keeping her eyes closed. Then she curled up for a few more winks.
I closed the office door and changed out of the scrubs into my normal clinic attire, cotton twill pants with a button-down shirt. I reopened the door to find Kim standing with white papers in one hand and the other poised to knock.
“The lab had to dilute Snowflake’s blood because some of his values were so high,” she reported as she handed me the papers. “That’s why it took so long.”
I scanned the results, ticking off values in my head. Unfortunately, there was a lot to keep track of because almost everything was abnormal. On the complete blood count (CBC), he had a high white count suggestive of infection, anemia and low numbers of platelets to clot the blood. His chemistries were as distressing as the CBC. His liver enzymes were the highest values I had ever seen reported by this lab. The bilirubin was also sky high, causing his yellow appearance. His electrolytes were a mess as well.
“So what do you think?” Kim asked. I was so focused on Snowflake’s reports that I forgot she was standing there. She fidgeted nervously, waiting for my response.
“He’s a really sick cat. There are so many abnormalities that I’m not sure what to address first.” I rubbed my forehead with my hand. “Before we do anything, I need to talk to the Olsons’ and see what they want to do. Frankly, I couldn’t blame them if they chose humane euthanasia.”
Kim lowered her head and went back to the treatment room to update Allie. I dialed the Olsons’ home number. Margaret picked up on the first ring.
“Is that you, Dr. Nelson?”
“Yes, Margaret.” I could feel the tension on the other end of the phone. “I’m afraid I have bad news.”
Margaret gasped.
“The lab work came back, and Snowflake is a very sick boy. In fact, I have to say I’m surprised he’s still alive with blood work like this.”
Margaret gasped again.
I took a deep breath before launching into the medical details. By the time I finished, I could hear Margaret crying on the other end of the line.
“I am always willing to try, but even with aggressive, round-the-clock treatment, I’m not sure he will make it,” I told her. “Because his prognosis is so poor, I’m terribly sorry to have to say this, but humane euthanasia should also be considered.” I paused again. “I am so sorry, Margaret. I know you and Scott love Snowflake very much.”
“Is he suffering?” Margaret asked.
“The liver disease makes him extremely nauseated. Although he’s not drooling like most cats do when they’re nauseated.”
“Then I want to do everything possible to save him. If he’s not suffering with extreme pain, I want to give him a chance,” she stated. “He’s been a great cat.”
“All right, then I’ll put in the feeding tube right away.”
“Please call me if anything changes. Scott and I can’t visit him today, but I’ll be there first thing in the morning. Please take good care of him, Dr. Nelson.”
“I will, Margaret. He’s a special boy, and we’ll all smother him with affection.” I hung up and headed back to the treatment room. A red rubber tube in a sterile wrapper laid on the treatment table with instruments, suture material and a pack of sterile gloves. I shot a quizzical glance at Kim and Allie.
“How did you know they would choose treatment?”
“As you always say, Dr. Nelson,” Allie began. “Assume the best until the worst happens. Besides, I clipped his nails for good luck while you were talking to Bianca’s owners.”
Kim opened the glass top of the old incubator. I bought it from a hospital liquidator on the north side of town. The heating element was on the right side of the unit, separated from the patient compartment by a metal screen. Snowflake laid on the other side, wrapped in blankets with only his head showing. Kim stroked him with her finger a few times before picking him up and placing him on the treatment table.
As I donned sterile gloves, Allie opened the wrapper of the feeding tube, exposing the end. I grabbed it without contaminating my gloves on the wrapper. Next, she squeezed some sterile lube onto the small end to facilitate placement. Kim held Snowflake’s head and front feet to keep him from scratching me. I put the small end of the feeding tube into his left nostril and fed it down his throat into his abdomen without a struggle. Snowflake sneezed a few times, but that was it. Three sutures later, the procedure was over. An X-ray confirmed that the tube had settled in the right place — the esophagus as opposed to the trachea and lungs.
“He was really good for that,” Kim noted.
“Yes, he’s too sick to fight,” I replied. “Imagine trying that on Genny.”
“Good luck with that one,” Allie said. “Remember how she woke up with Steve?”
Kim asked for the story.
“Steve tried to hold Genny when she was waking up from her spay. She was going for Steve’s face when Dr. Nelson grabbed her,” Allie said. Kim’s eyes opened wide as she drew a mental image of that scene.
“OK, what’s the treatment plan for Snowflake?” Kim asked, still holding the cat in her arms.
“It will take me a minute to calculate all his meds. But I want you to give him a dose of metoclopramide right away to help with the nausea. I hope that will prevent vomiting.” I pulled a clipboard out of the treatment table drawer with a hospitalization form attached. “How much does he weigh?”
“6.5 pounds,” Kim replied. “Not nearly enough for a cat of his size.”
I nodded in agreement.
Over the top of the treatment sheet, I wrote “Snowflake” and filled the lines with all of his treatments — antibiotics, anti-nausea medicine, IV fluids with a host of additives and his feeding instructions. We would start with small amounts of an electrolyte solution for the first 24 hours, then switch to a liquid diet with more calories. I finished the orders with instructions to turn Snowflake over every two hours. Since Snowflake was too weak to move on his own, this should prevent lung congestion and muscle damage to the down side.
Thirty minutes later, Kim warmed Snowflake’s first meal by placing the syringe containing the electrolyte solution in a bowl of hot water. She tested it on the back
of her hand as she would with infant formula. When the temperature was perfect, she attached the syringe to the feeding tube and gently pushed the plunger. As the solution filled his stomach, Snowflake purred. The gentle noise echoed inside the incubator, doubling the sound’s intensity.
After the electrolyte solution, she attached a new syringe filled with water to flush the tube. She repositioned the towels around him before closing the lid on the incubator. Snowflake continued to purr for another five minutes before falling asleep.
At precisely 4 o’clock, Stephanie and Mark entered the clinic loaded down with blankets and toys for Bianca. Kim escorted them to the treatment room.
“How’s she doing?” Stephanie asked. She looked at Kim with red eyes.
“Good. She’s been resting in her cage all afternoon,” Kim answered. She opened the door to Bianca’s cage, placed two stools and invited Scott and Stephanie to sit down. They took their places, but seemed unsure as to what to do next. “You can pet her as long as you avoid her rear end,” Kim instructed.
Stephanie and Mark sat frozen in place, staring at their sleeping dog. Mari begged from the cage next door. She pressed her body against the bars, flattened her ears against her head and grinned. When that didn’t work, she stood on her hind feet and banged her splint against the stainless steel cage wall. The loud noise startled Bianca. She opened her eyes, blinked a few times and struggled to focus on the two humans in front of her cage. She sniffed the air for a clue. When Stephanie’s perfume hit her nostrils, she cried and crawled toward them.
“Whoa,” Mark said. He placed his hand on Bianca’s shoulder to keep her in place. She turned her head to lick him. “Sorry Bianca, you have to stay inside.” He smiled at Stephanie, who still sat with both hands in her lap. With one hand on Bianca, Mark squeezed Stephanie’s shoulder with the other and slid his hand down her arm until he reached her hand. After another squeeze, he placed Stephanie’s hand on Bianca’s head. The pup yipped in delight.
Coated With Fur: A Blind Cat's Love Page 4