“She’s motion sick. When we moved her, we made her nauseous. Let’s hope she doesn’t vomit.”
“Well, she’s going to vomit after the pain medicine, so she might as well do it now,” Allie reminded me.
Before every anesthesia, I always examine the patient for any changes in their physical condition. Dolly passed her physical with ease. Her heart sounded great, her lungs clear, her pulses strong. I listened to her chest; I also heard lots of gurgling, so I knew Jenna and Thomas fasted her for today. The only thing I couldn’t check was her ears. Every time I tried to insert the otoscope into her ear, she whined. That would have to wait until she was under.
While Allie held her, I placed the IV catheter and attached a bag of fluids. Next, I shut off the line for a moment to inject her pain medicine. Allie placed a newspaper under her head. Ten minutes later, Dolly vomited a frothy yellow material onto the paper. She immediately tried to lick the vomitus. Allie pulled her head up right before her tongue hit the paper. I rolled it up and threw it in the trash before she could try it again.
“Why do dogs do that?” Allie asked with a wrinkled nose.
“No idea. I understand the cat box thing because cat feces are high in protein, but I’ve never understood why they would want to eat what they just vomited.”
I rinsed Dolly’s mouth with water and wiped her lips with a paper towel. I wadded the towel into a ball and threw it at the wastebasket. The wad hit the rim and bounced off to the side.
“I hope you’re a better surgeon than a basketball player,” Allie quipped.
I laughed and cleaned up the paper towel.
“OK, Miss Dolly.” I picked up another syringe filled with a thick white liquid. “It’s time for you to go to sleep.” Allie hugged her while I injected the short-acting barbiturate. Dolly yawned, blinked her eyes and slumped into Allie’s arms.
Ten minutes later, the dog slept peacefully on the table in the radiology suite, her neck relaxed. For the first time in months, no furrows wrinkled her forehead. The black rubber bag on the anesthetic machine inflated and deflated each time she breathed. A monitor beeped in the background. Allie and I hovered over her, wearing royal blue lead aprons complete with gloves and thyroid protectors.
While Allie monitored Dolly, I positioned her for the first skull film. I rolled Dolly on her back and stuffed pillows around her body to keep her from moving. In this position, her nose was off the table too far for the film. I stuck a piece of medical tape to the table, ran it over her lower jaw and then stuck it down to the table again until her nose was level. I placed a lead R on the right side of the cassette, signaled Allie and stepped on the pedal. The machine whirred, then dinged.
“I’ll be right back,” I said as I took the film cassette out of the bucky tray in the radiology table.
“I’ll develop it, Dr. Nelson,” Kim offered from the doorway. “Here’s your next film.” She handed me another cassette while taking the exposed one.
“Thanks, Kim.”
With the ventral-dorsal view complete, I needed to visualize Dolly’s ears from the side. We rolled the dog onto her right side, the left ear toward the ceiling. I placed a foam wedge beneath her head to tilt it slightly. Without the tilt, the bullae would end up superimposed on each other on the film. The X-rays needed to penetrate from a slightly oblique angle to let me see both. I taped her head into position, took the film and flipped her over to do the other side.
As we waited for the films to develop, I examined Dolly’s ears. Her right one looked good, but the left was a mess. A dark brown material filled her entire ear canal, making it impossible to visualize her eardrum. I flushed sterile saline into the ear with a blue bulb syringe purchased from the drug store down the road. Chunks of wax floated onto the table. When the saline ran clean, I looked again. Dolly’s tympanic membrane, or eardrum as it is commonly referred to, was opaque instead of translucent. The mucosa of her ear bled wherever I touched it with the otoscope cone.
“Why is her muzzle gray?” Allie asked. “She’s only 4 years old. She shouldn’t be that gray for a couple more years.”
“She’s been in constant pain for the last year,” I said while cleaning her ears with gauze. “I think the stress has caused her to age prematurely.”
Allie recorded Dolly’s heart rate and respirations on her chart.
“Dr. Nelson, the films are ready,” Kim called from darkroom. I met her at the light box in the treatment room. My eyes focused on the left tympanic bulla. Then I compared it to the right. Dolly had the worst radiographic signs of middle ear infection I had ever seen. I marveled at the bony changes to her left ear.
“Prep her for surgery,” I announced. “I’m going to call Thomas and Jenna.”
“What do you see, Dr. Nelson?” Kim asked.
I pointed at her right ear. “Follow the canal from the flap toward the skull.” I traced it with my finger. “See this round structure with a very thin bony wall that looks like an egg shell?”
Kim nodded.
“That’s the bulla. Now compare that to the left side.” Kim’s eyes widened as she focused on the left bulla.
“The bone is much thicker than the right side,” she observed. “And the middle is gray instead of black.”
“Yes, her right one is full of air, which looks black on the X-ray. The left is full of fluid, probably pus,” I guessed. “Be sure to put a culturette on the Mayo stand for me.” I took off the heavy apron and handed it to her. “Prep her from the top of her head on the left side all the way down to her chin. I want plenty of room to work.”
While I spoke with Jenna, Kim shaved Dolly’s head as directed. She flushed her ear again with saline to make it as clean as possible. Kim and Allie teamed up to carry her into the operating room, pushing the anesthetic machine in front of them. They positioned her on her right side before reconnecting her to all the monitors. Kim attached a clamp to the ear flap, ran a strip of medical tape through it and connected it to a metal bar hanging from the ceiling. She scrubbed the area for 10 minutes with a strong antiseptic.
In my experience, bulla osteotomies may go great if there isn’t too much scar tissue, or horrible if there is. I ate a granola bar and drank a glass of water before scrubbing just in case it was the latter. A surgical textbook open to the ear section was on the counter for reference. The facial nerve runs close to the opening to the bulla. I hoped the scar tissue did not surround it.
The first step in every surgery is to establish a sterile field. One by one, I placed sterile blue hand towels around Dolly’s ear and clamped them in place. While I held the bottom on the flap, Kim removed the clamp suspending the ear. I threaded the flap through a small opening in a large paper drape and spread out the drape over Dolly’s body. Kim turned on my head-lamp, and Allie made an “X” on the anesthesia form.
For the next hour, I carefully peeled away the cartilage of the ear canal from the underlying tissues. With one clean slice of the scalpel, the canal separated from the eardrum.
“I’m going to rupture the eardrum,” I mumbled through my mask. Kim and Allie stood on the opposite side of the table, trying to get a glimpse. I poked the tips of a pair of forceps through the eardrum, releasing thick green pus. I pulled the swab out of the culturette, rubbed the tip in the pus and replaced the plastic cap.
“Oh, that’s nasty,” Allie exclaimed when she saw the sample.
“OK, now for the tricky part,” I took a deep breath before going back to work. I carefully retracted the soft tissues around the eardrum, exposing the bone. To clean out the middle ear, I needed to enlarge the opening. I placed the tips of a small rongeur (forceps) on the bone and squeezed. Snap! A piece of bone broke off, and I collected it in a sponge. Slowly, I worked my way around the entire area until the opening was twice the original size.
With the bright light from my headlamp, I could see the inside of the bulla. I peeled off the lining, being careful to avoid the major structures within. If I left any behind, the entire surgery wo
uld fail. I checked and checked and checked. When I was certain that the bulla was clean, I inserted a drain that exited several inches below the ear and closed the incision.
“Kim, hold her head up so I can bandage her,” I ordered. I rolled the large blue drape into a ball and threw it in the garbage. Kim removed the towel clamps and small drapes exposing Dolly’s head. I packed the surgical site with gauze pads to provide some padding, then wrapped them in place with cast padding.
Kim lifted Dolly’s head off the table for each wrap. Next, I applied a layer of gauze for support before covering it with a sticky wrap called Elastikon. Dolly looked like something out of a Halloween fun house by the time we finished, with one ear hidden under the wrap and a rubber drain sticking out of her head.
“Her body temperature dropped to 98.0 degrees during the surgery,” Allie informed us. “I want to recover her in the treatment room so I can keep a close eye on her.”
Kim took a warm blanket out of the dryer and placed it below the X-ray light box. Together, Kim and I carried Dolly to the makeshift bed. Allie reconnected her trach tube to the anesthetic machine but kept the anesthetic valve closed. Oxygen flowed down the tube into Dolly’s lungs.
“She’s certainly taking her time waking up,” Allie observed. She touched the corner of Dolly’s eyelids hoping for a blink, but nothing happened.
“Well, she’s been out for two-and-a-half hours,” I said. “I expect her to wake up slowly because her metabolism has slowed with the drop in body temperature. Put the water heating blanket over the top of her abdomen.”
“And I’ll make up some hot water bottles for her legs,” Kim said. “She’ll be toasty in no time!”
“Just be sure to put a towel between her skin and the thermal device,” I cautioned. “I don’t want her getting burned.” I pulled off the green surgical gown and threw it in a pile of dirty drapes. “I’ll be back in a minute.”
“Where are you going?” Allied asked with a frown.
“To the rest room, Miss Nosey,” I answered with a smile. “It was a long procedure.”
Normally, I wait until a patient is fully recovered from anesthesia to call its owner. But with the afternoon appointments starting in 15 minutes, I decided to call Jenna and Thomas even though Dolly was still asleep. I dialed their number while fluffing my hair. The surgical cap plastered it against my head in a most unflattering way. Jenna picked up on the first ring.
“Dr. Nelson, I’ve been so worried. How’s our girl?” she asked.
“She’s in recovery right now, sleeping it off,” I replied. “The surgery took a little longer than I thought it would because of all the scar tissue. I had to proceed slowly.”
“But Dolly’s OK, right? I mean,” Jenna fumbled for words. “I mean she needed surgery.”
“Absolutely. The infection was really bad. She had green pus in her middle ear.”
“Oh my,” Jenna gasped.
“I sent off a sample to the lab so they can tell us what kind of bacteria caused the infection and which antibiotic we should use to treat it. The results should be back in about a week. I flushed her middle ear and removed the entire lining to make sure this doesn’t happen again.”
“But you think she will be OK?” Jenna asked. “I mean, you think the surgery went well.”
“Yes, I think the surgery went as well as we could have hoped for, given all the scar tissue and inflammation.”
“When can I see her?” she asked without acknowledging my prior comments.
“Tomorrow morning or afternoon, depending upon how she’s doing.”
“Tomorrow!” she squealed. “I can’t wait until tomorrow to see my baby.”
“She’ll be pretty dopey for the next 24 to 48 hours because of the anesthesia and pain meds. I doubt she’ll even recognize you, let alone remember if you visited or not.”
“I’ve cared for her since she was a pup. She loves me,” Jenna replied quickly.
“I’m sorry, Jenna, I did not mean to imply anything about your relationship with Dolly. I can tell by the way Dolly looks at you that she loves you very much. I know you have a special relationship with her. But right now I want Dolly to rest without any interruptions.”
“I’m her mother. I’m not an interruption,” Jenna countered. “Thomas and I will come as soon as he gets off of work.”
“Well, I’m not going to argue with you, but I really do not recommend it. Remember, she just had a major operation. Her head is bandaged, and she has a drain.”
“Tell Dolly her family will be there soon,” she said, ignoring my comments and hung up.
I hung up the phone with a sense of apprehension building inside me.
A second later, it rang again.
“Minnesota Veterinary Center,” I said without identifying myself.
“Hello, Dr. Nelson. I didn’t expect you to answer the phone,” Frank Culbertson said.
“Hello, Frank. Is Trudy OK?” I asked, hoping she wasn’t poisoned again.
“She’s fine, Dr. Nelson,” he replied. I’m calling to tell you that the FBI has closed the investigation. Thank you so much for all the help.”
“What did they find?” I asked. “Was the kennel attendant involved?”
“They didn’t say,” he answered.
“And the other dogs that were killed on the border?”
“The final results are classified,” Frank said. “But I think you can fill in the blanks on your own.” Instantly, I realized I hadn’t seen Sherry walking dogs since she asked about Trudy. “Thanks again, Dr. Nelson,” he said. “I’ll see you in June for Trudy’s vaccinations.”
“Well?” Allie encouraged me. “What did he say?”
“Not much. The report is classified.”
“Bummer,” Allie muttered. “Now we’ll never know what happened.”
“I think we know, Allie,” I winked at her with a smile.
She looked at me for two seconds, then her eyes widened.
At 5:30 p.m., Jenna and Thomas walked into the clinic with their children in tow. Five kids, ages 3 to 15 filled the lobby chairs. Genny abandoned her perch on the front windowsill when the 6-year-old twins surrounded her. She preferred the safety of the office closet.
Allie pulled me out of an exam room to discuss the situation, something she never does. “Dr. Nelson, Jenna and Thomas brought the entire family to visit Dolly,” she whispered with a frantic expression on her face. “They have five kids!”
I stood staring at her in disbelief.
“What do you want me to do?” she asked.
I remembered my phone conversation with Jenna and how she wouldn’t take no for an answer. “Tell her that I am concerned about the children having nightmares because of Dolly’s appearance. To be safe, I want Jenna and Thomas to visit her alone first to make sure it will be OK for the kids,” I replied. “That should take care of it.” I winked at Allie and went back into the room.
After Allie explained my concerns, Jenna and Thomas relented for the moment. They accompanied her in back while Kim supervised the children.
Dolly rested in her run on a bed of blankets, her head on a folded towel. Her fancy bed leaned against the kennel wall outside her run to keep it clean. Blood oozed from her drain, creating a large red spot around her head on the towel. Blood also stained the flesh-colored bandage over her ear. A bag of fluids hung from a metal rod positioned over the walls of the run. Lactated Ringers solution dripped down the tube into the catheter on Dolly’s leg.
“Dolly, you have visitors,” Allie announced. The sedated dog did not respond. “Dolly, come on, wake up girl.” Allie opened the gate and walked inside. She ran her hand along Dolly’s back to wake her up. When Dolly lifted her head, bloody fluid shot from the drain. It dripped down the kennel wall, leaving a red streak behind. All the color in Jenna’s face drained when she saw the blood. She immediately put one hand over her mouth and the other over her stomach.
“Do you need the restroom?” Allie asked. Jenna nodded. All
ie led her by the arm around the corner to the restroom. She flicked on the light switch and closed the door behind Jenna. When she returned to the kennel, she found Thomas bent over with his hands on his knees, hyperventilating. He looked like he was going to faint. Allie pulled him into the treatment room, backed him against a wall and told him to sit down. She held both of his arms while he slid down the wall.
“Bring your knees up to your chest,” she instructed. Thomas complied immediately. “Good, now bend over and rest your chest against your legs.” She sat with Thomas to make sure he didn’t pass out and hit his head on the floor. After three minutes, his respirations returned to normal, and a pink glow returned to his face. He leaned back against the wall, feeling much better.
“I don’t know what happened back there,” he said. “I was fine, and then the room started to spin. I felt dizzy and lightheaded.”
“You almost fainted,” Allie told him. “If you’re not used to being around surgical patients, the shock of seeing them can make you faint. I’m going to check on your wife. Don’t move until I get back.” Allie closed the door between the kennel and the treatment room before she left.
She knocked on the restroom door. “Are you OK, Jenna?” Jenna opened the door holding a paper towel to her lips.
“Much better now,” she managed to say. “I can’t believe this happened. I’m used to seeing blood. I gave birth to five kids, after all.”
“All I can tell you is that it’s different when it’s your pet,” Allie replied. “That’s why Dr. Nelson discouraged you from visiting today.”
Jenna nodded but remained silent. Allie escorted the couple back to the lobby. While they sipped on 7-Up, Kim kept the kids busy making get well cards for Dolly. The twins made their card together — a black stick dog surrounded by turkeys. Inside, their older brother helped them write, “We woof you!”
At 6:30, Kim collected the cards and sent the family on their way. When they were gone, I sent Allie home since she had the early shift. Kim stayed with me to clean up the clinic and take care of our only patient, Dolly. After a trip outside, she needed her bandage changed and another dose of pain medicine. Her last one was wearing off.
Coated With Fur: A Blind Cat's Love Page 16