“Are you done with that eye already?” Allie asked from her stool by the anesthesia machine. An EKG beeped methodically in the background.
I nodded and moved to his right eye. Ten minutes later, that was done, too. Kim positioned Radar on his back for the neuter. When I picked up the scalpel, Allie turned off the anesthetic gas but left the oxygen flowing. She knew from experience how long it took for me to do every routine procedure. As my hands moved over his rear end, Kim returned with a warm towel from the dryer.
“I’m done,” I said.
Kim shot me a quizzical glance.
“She said she’s done,” Allie interpreted. “Kris always mumbles with the mask on.”
“I do not,” I objected, stepping back from the table. I pulled off the surgical gloves and tossed them in the garbage can under the surgical table.
“Then what would you call speaking with your head down, focused on the surgical site, wearing a mask?” Allie asked.
“With all the equipment humming in the background,” Kim added.
Radar twitched his left ear and moved his tongue. “He’s almost awake,” Allie said. She untied the gauze holding the trach tube in place. Radar coughed to clear it from his throat. Allie let him cough two more times to make sure he was awake, then pulled the tube. Radar lifted his head, licked his lips and meowed.
“Radar, I’m here,” Kim whispered. She placed her hand in front of his nostrils. He put his head back down and started to purr. Kim rolled him onto his stomach, wrapped him in the towel and carried him back to his cage. She elevated his head with another towel to lessen the swelling. Before closing the door, she kissed him on the forehead. Radar sighed and drifted off to sleep.
“That certainly went well,” I said. The plastic clock hanging over the scrub sink read 12:45. “I wasn’t really sure how long that would take.”
“I know,” Allie said as she coiled an oxygen hose around her arm. “That’s why we blocked you out until 2.”
“Two?” I repeated. “We have nothing to do until 2?”
“Well, you could call Ben and tell him Sugar’s blood results look great,” Kim suggested.
“Or you could call Ben, and I could get lunch for all of us,” I said. “How about some soup and salad? It’s my treat to celebrate Radar’s successful surgery.”
“It’s a deal,” Kim and Allie said in unison.
“Great. But one of you has to call Steve and tell him about Radar.” Kim and Allie froze. “Good luck, ladies!”
Chapter 28
C-section
“Beep, beep, beep,” the pager sounded from the nightstand. I fumbled for the device in the dark. Steve rolled over and pulled a pillow over his face. The alarm clock read 11:36 p.m. I sat up, flipped the switch on the lamp and tried to wake up. I squinted at the pager as I dialed the number.
“Hello, Dr. Nelson,” a concerned voice said. “I think Lilah is having problems.”
“Who is having problems?” Fog blanketed my mind.
“Lilah, the pregnant German shepherd with seven pups on the X-ray, remember?”
According to her breeding dates, Lilah should give birth the second week of March. Kay Beaumont took her temperature several times a day, looking for the drop that occurred 24 hours before whelping. Finally, it dropped on March 13.
“Sorry, Kay, I’m having a tough time waking up. I was up late last night with a sick cat. Now, what’s up with Lilah?”
“She had three pups,” Kay continued. “The first one came at 5. She delivered the last one at 8:30.”
“Were the placentas delivered with the pups?”
“I’m not sure,” Kay said. “Lilah gets right in there to clean them.”
“So her last pup was at 8:30 p.m., and it’s midnight now.” I paused to think through the time frame. “She approaching the limit of four hours between pups rule. You better bring her in.”
“No, Dr. Nelson, 8:30 a.m., not p.m.,” Kay said, correcting me.
“Then she definitely needs to come in right away,” I said, feeling a pit form in my stomach. “Why did you wait so long to call me? I told you the limit is four hours between pups.”
“That’s what I thought you would say,” Kay said, ignoring my question. “See you soon.”
“Bring the pups, too.”
“Will do.”
I shivered as I hung up the phone. Winter emergencies in Minnesota are the worst. I longed to crawl back under the covers and close my eyes for five minutes. If I did, I would never make it to the clinic.
“Steve,” I nudged his shoulder. “Steve, we have to go to the clinic for a dystocia.” He mumbled something and sat up. When I returned from the bathroom, he was asleep again. “Steve, come on. You’ve got to get up and get dressed.” I pulled the covers off of his body.
“Okay, I’m coming,” he relented.
We spoke little during the ride to the clinic. I drove since Steve seemed so tired. He sat in the passenger seat with the hood of his thick winter jacket hiding his face. Poor Steve, I must have caught him in the wrong part of the sleep cycle. When we arrived at the clinic, I turned on lights and prepared for Lilah. He headed straight for a Mountain Dew.
By the time Kay arrived, Steve was awake and ready to go, thanks to the power of caffeine. Lilah snuggled into his arms while I examined her.
“Her cervix is wide open, but I don’t feel any more puppies.” I pulled the rubber glove off my hand and sat back on my haunches. Steve released his grip on Lilah. She acted like she was done giving birth. “Have you seen any contractions, Kay?”
“None since the last pup was born,” she replied. A sigh escaped from Steve before he could control it. He knew from experience that we were in for a long night.
“Well, I think we should give her some pharmacological help,” I said. I walked over to the treatment table. “We’re going to start Lilah on some IV fluids with calcium and dextrose. The dextrose will give her energy, and the calcium will help with the contractions.” I put a catheter on the table next to bandages and a clipper. “Once we get that going, I’ll give her a little oxytocin to make her contract.”
“What if this doesn’t work?” Kay asked as she stroked Lilah’s head.
“Then we’ll do a C-section.”
Kay looked away and frowned.
With Steve’s help, I placed a catheter in Lilah’s front leg and started the treatments. Ten minutes after giving the oxytocin, a beautiful black and tan pup emerged. I peeled the placenta off of the little girl, cleared her airways and placed my mouth over her snout. After a puff of air, her gums pinked up as oxygen-rich blood circulated around her body. Ten seconds later, she took her first breath on her own. I nestled her into the incubator with the other puppies. She wiggled to the bottom of the pile right away. I popped the cap off a bottle of root beer before returning to Lilah. Puppies taste really bad!
At 12:55 a.m., clear fluid drained from Lilah’s vulva. I inserted my gloved finger into her vagina, expecting to feel another puppy after the placenta ruptured. Instead, I felt the mucosa and pelvic bones of the empty birth canal.
“What’s wrong?” Steve asked, reading the concerned look on my face.
“There’s no puppy in the birth canal.”
Steve frowned and petted Lilah.
“What does that mean?” Kay asked.
“It means that there’s a puppy inside Lilah without an oxygen supply. We must get this pup out right away, or it will die.” I reinserted my finger into Lilah’s vagina. In school, I watched one of my professors stroke the floor of the vagina to stimulate contractions. I ran my gloved finger along the canal until it fell over the pelvic brim. With gentle pressure, I pulled on the cervix and vaginal mucosa. A second later, I felt Lilah contract on my hand. She squeezed the blood out of my hand for three agonizing seconds, then relaxed. I let her rest for 20 seconds before stimulating her again.
For the next four minutes, I continued to repeat the process…stimulate, let her rest and stimulate again. During the
rest break, Lilah panted. With each contraction, she squinted her eyes and moaned.
“Sorry, Lilah,” I told the tired dog. “It’s time for another.” Lilah grunted as her muscles strained. “I feel a foot and a tail,” I announced with a huge smile on my face. “Come on, Lilah, push. Let’s get this baby out.” I pushed my hand into the vagina as far as possible. Unfortunately, the pup was just out of reach. With the next contraction, the pup moved a little closer. I strained to secure the foot.
“I just need another inch, and I can deliver this pup,” I grunted. Lilah seemed to hear my request. She contracted so hard that her back legs left the ground. “I’ve got it.” With steady traction, I delivered the pup. It looked awful. The gums were gray-blue. I could not feel its heartbeat.
I cleared fluid from the pup’s lungs, breathed into its snout and compressed its chest. After 30 seconds, I paused to see if it was responding…nothing. I injected epinephrine into the pup and continued with CPR. After 10 minutes, I knew it was hopeless. Steve wrapped the lifeless body in a towel and placed it in another room. There were more pups to deliver.
With two pups to go, I gave Lilah more oxytocin, hoping to avoid surgery. After the previous dose, she had started to contract right away. This time she did nothing, too exhausted to continue. She had nothing more to give. Kay kissed her head before Steve carried her into the operating room. A few minutes later, she slept on the operating table covered with blue drapes. Steve stood by her head, monitoring her vital signs. Kay peered through the window in the door.
“I’m going in,” I announced as I incised the skin down the middle of her abdomen, between her swollen mammary glands. When I reached the interior of her abdomen, her uterus bulged out of the incision. The left horn and body of Lilah’s uterus was empty, but the right horn still contained puppies. I packed off the right horn and made an incision over a large lump on the base. Fluid poured out of the incision, down the drapes and the front of my surgical gown, onto the floor. I widened my stance to keep my shoes dry.
“Here’s the problem, Steve.” I pulled a large white pup from the uterus. “This bruiser was blocking the right horn.”
Steve held out his cupped hands covered with a towel.
I placed the fluid-filled placenta with the puppy inside into his hands. While he broke it open and worked on the pup, I removed another from the uterus. This pup was much smaller, even smaller than the pup who didn’t make it. I broke open the placenta before handing another white pup to Steve.
Steve placed the second pup on the counter next to its littermate. He cleared their airways and started rubbing them. After 10 seconds, he placed his fingertips on their chests, feeling for a heartbeat.
“How are they doing, Sweets?” I asked.
He continued to work on the two lifeless bodies in his hands without answering.
“Steve, do you have heartbeats?”
“Yes, but they’re weak,” he finally answered. He continued to work on them. “They’re not breathing.”
I packed off the uterus and covered the abdominal incision with moist lap sponges. Without speaking, Steve handed me the large white pup. Through my gloves, I felt the heart beating. After clearing fluid from its lungs, I pulled down my mask and placed my mouth on its snout. A minute later, a healthy pink color spread over the pup’s gums. The heartbeat felt stronger.
“This one’s doing better. How is yours?” I asked.
“Not good.” The little female’s gums were blue gray like the slate I saw at the home improvement store. “Its heart is still beating, but the color is awful.”
“Let’s switch,” I suggested.
Steve gave me the runt in exchange for the bruiser.
I lifted the pup to my ear and heard fluid gurgle in its lungs. White foam oozed from its nostrils. I secured the pup in both of my hands and swung it hard. Fluid sprayed onto the floor, creating a pattern of dots around my feet. More fluid oozed from the nostrils and mouth, but the lungs sounded better.
“My pup just took a breath,” Steve announced. “How’s yours doing?”
“It must have swallowed a ton of fluid,” I replied before swinging the pup again. “I’m still getting more.” I held the pup to my lips, blew two puffs of air into its lungs, then swung it again.
Steve held his pup up to the window for Kay to see. She frowned and looked away.
For five minutes I worked on my pup. The little girl’s color looked much better, but she still hadn’t taken a breath on her own. A feeling a dread spread over me. The little body in my hands seemed so lifeless. I placed my lips on the pup’s muzzle for another puff of air when I felt its mouth move. The puppy took its first breath.
“She’s breathing, Steve.” I wiped my mouth with a towel. The pup opened its mouth and breathed again. “It just did it again.”
“Way to go, Krissy.”
Steve placed a hand on my shoulder. “I’m so glad the pup made it.”
“Me too!” I handed Steve the pup. “I need to get back to Lilah. Would you mind setting out a new gown and gloves while I go scrub?”
He nodded while cuddling the two pups close to his chest. He monitored them for another five minutes before tying off their umbilical cords and introducing them to the rest of the litter.
Since this was Lilah’s last litter, I removed her ovaries and uterus before flushing her abdomen with warm saline. I stitched together the abdominal layers in record time, happy she could never be bred again. When I finished, all that remained of her ordeal was a red line down the center of her abdomen. The scarring should be minimal.
“Nice work, Sweets,” Steve said as he carried Lilah from the operating room to a bed of blankets in the treatment room. He covered her with a blanket and placed a water heating pad over the top.
Six puppies rested in the incubator in a big pile. The small white one sucked on a corner of a towel, kneading with her feet rhythmically. A black-and-tan pup crawled over the rest, grunting as he went. The big white pup slept in the middle. When the explorer tried to crawl over him, he raised his head and shifted onto his side. The pup slid off and rolled over another sibling.
“Congratulations, Kay,” I said as I watched the pups. “When I heard how long it had been since the last pup, I didn’t expect any more to make it.” I smiled at her. “But we only lost one, not bad. Why did you wait so long?”
“Because the breeder told us it was normal for her,” she said in a monotone voice. “When are you going to euthanize the white ones?”
“Excuse me?” I stuttered, thinking I had heard wrong.
“I asked when you were going to get rid of the white ones,” she repeated. “They’re against the German shepherd breed standards.”
“I don’t care what the breed standards are, I’m not euthanizing any pup based on the color of its fur,” I answered, staring at her. “If you don’t want to propagate the white color, neuter them.” I looked back into the incubator. The big white pup opened his mouth and yawned. “I am not going to euthanize them.”
Kay pressed her lips together and returned her gaze to the incubator.
Anger welled inside me. We stood together in silence.
After two minutes, Kay turned to face me.
“But it’s against the breed standards,” she argued. “I don’t want to get a bad reputation.”
“A bad reputation with whom?” I countered. “The breeder who has given you bad advice or the veterinarian who saved the dog you love?”
Kay turned away without answering.
“Listen, I’ll help you find homes for the white ones. Let them stay with Lilah until they can eat on their own.”
Kay contemplated my offer. Finally, she nodded slowly.
Suddenly, I felt something brush my leg. I looked down to find Lilah staring up at me with her beautiful brown eyes. She licked my hand, then stared at the incubator with an expectant look. “Looks like Lilah is ready to meet her puppies. Let me check them. Then they’re all hers.”
I removed th
e little white girl from the pile of pups and placed her in Steve’s hands. She nosed around, searching for something to eat. I opened her mouth, listened to her heart and palpated her abdomen. When I inspected her rear end, she let out a loud squeak. Lilah sat by Steve’s side and pawed his leg. He lowered his hands until the pup was even with Lilah’s nose. She sniffed it once and placed her teeth around it.
“No, Lilah,” Steve commanded. “We’re not done yet.” Lilah froze and looked at him. “No,” he repeated. She reluctantly let go.
Next, I slid a tube connected to a syringe full of puppy milk down the pup’s throat. The pup protested at first, but stopped when the warm milk flowed into her stomach. After I pulled the tube, she opened her mouth as wide as she could in an adorable puppy yawn. “OK, now you can have her.”
Steve walked over to the pile of blankets. “Down,” he ordered while pointing at the makeshift dog bed. Lilah eased onto the blankets. Steve placed the puppy next to her abdomen. Lilah gave the pup its first bath while we worked on the next one. Each time a new pup arrived, Lilah inspected it from head to toe before cleaning it. Her pear-shaped tongue engulfed the small pups, knocking them off their shaky feet.
“Well, that’s the last one,” I said, placing the sixth pup, a black-and-tan male, by Lilah’s side. “Steve, please fill water bottles with hot water. I’m going to remove Lilah’s catheter.”
Five minutes later, Steve and I watched Kay drive off with Lilah riding in the backseat next to the puppies. With great relief, we turned off the lights and locked the front door. If we hurried, we could sleep for two hours.
Chapter 29
Missing Pups
Growing up in Minnesota, I learned that winter isn’t over until the Boys State Basketball Championships. In early March, the weather warms to above freezing. Snow melts along the roadways, covering cars with salt spray and sand. The long, majestic icicles that cover most homes shrink into stubble. Minnesotans leave their scarves, hats and mittens at home. The residents hope March will go out like a lamb. Then the skies turn gray as another Alberta clipper blows in. The last storm arrives just in time to make travel hazardous for the tournament. Maybe this year would be different.
Coated With Fur: A Blind Cat's Love Page 30