A wry smile spread over Dan’s face as I talked. When I finished, he placed his hand on the doorknob and cracked the door open. Butch pushed his face into the opening and forced the door wide open. “I’ll see you again in three weeks, Doc,” Dan said as the two left the room. The pair walked past a Miniature schnauzer sitting with a retired woman. The dog barked and then ran under a chair. Dan laughed before he pulled Butch out the front door. I headed to the back to finish writing up his medical record.
“Help, I need help!” a lady screamed from the front lobby. “My dog has been hit by a car.” I recognized Jennifer Thomas’ voice immediately. Dropping my pen, I ran toward the lobby.
“Jennifer, what ...” I froze in place. Jennifer stood in the middle of the lobby holding Captain’s limp body in her arms. Blood poured down her pant leg onto the floor. Captain looked dead. The waiting client clasped both hands to her mouth in horror. Her dog sniffed the air and froze, seeming to sense the gravity of the situation.
“Bring him here,” I ordered. She followed me through the clinic to the treatment room. I held Captain’s head in my hands as Jennifer laid him on the table.
When Jennifer stepped back, I saw the source of the blood. The skin and hair on the outside of Captain’s right front leg were gone, ripped away by the car. I could see bone, muscles and tendons. Blood drops collected on the underside of his leg like icicles on the edge of a roof and dripped into a large puddle on the floor.
“Oh, my God,” Jennifer wailed when she looked at the injury. “Captain, Captain, please don’t die!”
I grabbed a tourniquet from the drawer and slipped it over the bloody front leg. When it rested above the elbow, I cinched it into place. The dripping blood slowed to a trickle. The clock on the wall read 5:35 p.m. The tourniquet could stay in place for 40 minutes before Captain’s leg suffered damage from the lack of blood flow. Time was of the essence.
“Allie, give me a bag of saline and a catheter setup,” I said softly. “I’ll prep for the cath.” I pulled a clipper off the shelf, unwound the cord wrapped around it and plugged it in. As I shaved the dog’s leg, black fur fell to the ground. Captain’s gums were almost white, and his chest heaved up and down with every breath. I splashed alcohol over the vein. Captain did not have time for meticulous sterile prep. Allie plugged an extension set into a bag of clear fluids, hung it from a ceiling hook and evacuated air from the line. She grasped Captain’s left elbow and held off the vein, which failed to swell because of the blood loss. Captain was in hemorrhagic shock. Allie flashed me a worried look.
I took the cap off the catheter, felt the leg one more time and thrust the tip into where I thought the vein should be. We watched the hub, but no flash of blood appeared. I hunched over and waited for it. Two precious seconds ticked by. The worried look on Allie’s face intensified. I continued to watch the hub of the catheter. Since Captain’s blood pressure was negligible, it would take longer for blood to flow into the catheter. If this didn’t work, I would have to cut open his skin for direct visualization. I pumped his paw again. Much to my relief, a small amount of blood flashed into the hub of the catheter.
“You’re in!” Allie exclaimed. I advanced the catheter a little farther into the vein and taped it to his leg in record time. As Allie opened the valve on the drip set all the way, clear fluid shot into his leg. Then she placed an oxygen mask over Captain’s muzzle. In blood, the majority of the oxygen is carried on the red blood cells. A small amount diffuses into the plasma, the liquid part of blood. Giving Captain 100 percent oxygen to breathe would saturate his plasma and the red blood cells he had left.
I needed to check for arrhythmias. We clipped a wire lead from the EKG, which measures electrical impulses that spread through the heart, to each of Captain’s legs. At first, the electronic tracing was hard to read. It bounced all over the screen every time Captain breathed. I fiddled with the position knob until visible waves crossed the screen. Captain’s rate was fast, but so far there were no abnormal rhythms.
With the blood loss stopped and the catheter in, I stepped back to re-evaluate the situation. Jennifer lay over Captain’s chest. Blood covered her face, glasses, shirt and pants. She was a sickly green. Her back heaved up and down in silent sobs.
“It’s my fault. It’s my fault,” she wailed. “We were out walking, and the leash slipped out of my hand. I should have slipped it around my arm. It’s my fault.”
How do you comfort a pet owner in a situation like this? Telling them it was an accident rings hollow when the pet is fighting for its life. “Is your son OK?” I asked. She nodded.
“Blake is with his Dad this week.” Jennifer’s tears mixed with the blood on her face and left streaks down her cheeks. “It was my fault.”
“Jennifer, he’s getting better. See, he’s not breathing so hard.” I motioned toward Captain’s chest. “Now, I want you to go with Allie and clean up.” Allie took Jennifer by the arm and pulled her off Captain. More tears flowed down Jennifer’s cheeks. Allie half escorted and half dragged her to the bathroom.
The clock on the wall read 5:45 p.m. when Allie returned to the treatment room. She caressed Captain’s head and looked at the horrible wound on his leg. While she was away, the dog’s color had improved from white to pale pink. His breaths came easier. Then Captain looked over the oxygen mask at Allie and thumped his tail twice. She caressed him again. “Can you save the leg?” she asked.
“I don’t know. I need to clean this up and get a better look.” Before we started to clip the leg, I gave Captain a dose of meperidine to ease the pain. Allie folded a towel and placed it under Captain’s head. The poor dog closed his eyes and relaxed.
“Let’s get going on this leg,” I said. Allie hung another bag of fluids to flush the leg. While I donned a pair of surgical gloves, she threw a towel on the floor under Captain’s leg. She rolled up another one and placed it between the dog’s front legs to separate them. Next, she squeezed a large amount of sterile lube into the wound. This would keep the hair from sticking to the area.
Allie pushed the clipper through the hair. Large hunks fell onto the towel. The clipper groaned each time it hit a clump of dried blood. The blood gummed up the blade and made it stick to the fur and skin. Allie cleaned it out with a brush and sprayed the blade with clipper lube.
With the hair removed, we could see the full extent of Captain’s wound. The skin on the right side of his leg was missing from the elbow down past the wrist, almost to his paw. The wound gapped open from the front of his leg all the way around to the back side. The edges were smooth, as if cut by a knife. Chunks of muscle were missing on the outside of the leg. Toward the wrist, I could see clear down to the bone. Pebbles, sand and road grit littered the wound.
Allie loosened the tourniquet a little and blood started to ooze from the damaged leg. One by one, I traced the leaks to damaged vessels, isolated them with a hemostat and tied them off. Five packs of suture later, all of the bleeders were under control. At 6:10 p.m., Allie released all the pressure from the tourniquet. We made it! She left it loose around Captain’s elbow in case I dislodged a ligature while flushing the wound. At first, large pieces of road dirt dropped to the floor. By the third liter, no visible debris remained.
The clean wound now needed a wet-to-dry bandage for protection. I put on a fresh pair of gloves, and Allie dropped several sterile gauze pads into my hands. I placed them over the entire wound and dripped sterile fluid over them, forming the “wet” part of the bandage. Next, I covered the gauze with pads containing a waterproof barrier on the outer surface. All these layers were held in place by cast padding, roll gauze and a final layer of vet wrap. Only the tips of Captain’s toes protruded from the bottom of the wrap by the time I finished. Bright red wrap covered the rest of his leg. I secured the end of the vet wrap with a piece of medical tape.
“Can I get Jennifer now?” Allie asked. She turned off the EKG machine and removed the leads, which left clamp marks in Captain’s skin. When she removed the
oxygen mask, Captain opened his eyes and yawned. He arched his back as he stretched his entire body. He even lifted his bandaged leg off the table!
“Let’s clean this mess up first. Jennifer looked like she was going to pass out before,” I replied. Blood, fur and debris covered the towel on the floor. I folded up the towel, trapping the dirt inside. With my gloves still in place, I picked it up and ran for the bathtub. A trail of bloody fluid followed my footsteps. Allie mopped up the mess. She surveyed the room one last time before leaving.
“Everything looks good so I’ll go get her,” Allie said as she turned to leave.
“Better clean off your arm first.” I pointed at her right arm where a streak of blood extended from her elbow down her arm. She raised it to examine the bloodstain.
“Yikes!” She washed it off at the scrub sink. “See any other spots, Dr. Nelson?” She twirled in place.
“No, you look good.” I looked at myself. “How about me?” I spun around.
“You’re clothes look fine but you have quite a bit of splatter on your shoes.” I looked down. Tiny spots of blood covered the tops. I moistened a paper towel with disinfectant and wiped the tops of my shoes.
When Jennifer entered the treatment room, Captain rolled from his side onto his chest. He knocked the folded towel off the table as he extended his legs. Jennifer ran to Captain’s side, threw her arms around his neck and hugged him. The dog wagged his tail. When Jennifer relaxed her grip, he turned his head toward her, studying her face for a few seconds. His nose twitched from side to side, and his tail froze in place as he drank in Jennifer’s scent. After three more sniffs, Captain leaned into Jennifer and licked her face.
Her eyes filled with tears, she buried her face in Captain’s thick fur. “I’m so sorry,” she whispered over and over again.
“As you can see, Jennifer, Captain is doing much better.” I removed a box of tissues from the shelf above the treatment table and placed them on the table. “He’s out of shock and feeling better after the pain medicine.” Jennifer straightened up and blew her nose. “Now the big problem is the leg.” I pointed at the thick bandage. It concealed a horrible injury.
“Is he going to lose it?” Jennifer asked with trepidation.
I shook my head and smiled. I explained that Captain could move his toes, which indicated the nerves to his paw were intact. His paw also felt warm to the touch, so the blood supply was still functioning. The biggest problem facing him now was infection. It wasn’t a question of if the wound was infected but what it was infected with. Jennifer nodded and tried to comprehend despite her shock and emotion.
“For the next few days, we’ll flush Captain’s leg twice per day,” I told her. “When the wound stops weeping, I’ll evaluate it for closure.” I warned her that the wound might require a skin graft.
“When can I bring him home?”
“Let’s see, today is Friday.” I thought for a moment. “The first three days are the worst for these kinds of injuries. Captain will need frequent bandage changes and lots of medicine to control his pain. If everything goes according to plan, you’ll be able to take him home sometime next week.”
“Blake is going to be so upset,” Jennifer said, placing her hand on her forehead. “Captain sleeps in bed with him at night.”
“Bring him in for a visit,” Allie responded. “We’re open on Saturday from 8 till noon.”
“What do you mean, we’re open?” I asked Allie. “Steve and I will be slaving away in the clinic while you’re sleeping in.”
“And what’s wrong with that?” Allie winked at me and grinned.
“Seriously, Jennifer, we want people to visit their pets while they’re in the hospital.” I petted Captain’s head. “It seems to make them feel better. They heal faster.”
“Blake and I will be here tomorrow as soon as I pick him up from his father’s house,” Jennifer said. She took Captain’s head in both of her hands and stared into his brown eyes. “Rest well, little teddy bear. I’ll see you tomorrow.” With that, Captain planted another sloppy kiss on his owner’s chin.
Chapter 18
Emily the Guinea Pig
Overnight temperatures plummeted to the low teens. Slush froze into bizarre, uneven shapes. Hunks of gray ice littered the roads. Snowplows dumped their loads of salt and sand on icy patches. Sand accumulated in the center of traffic lanes. Most cars sported long black icicles behind each tire. If the driver made a sharp turn, the back edge of the tire ground into the icicle.
Steve and I parked as usual toward the highway and away from the building. We always left the close spaces open for clients. When I got out of the car, I noticed an especially long clump of ice stuck behind the tire well. I kicked it with the toe of my boot. Sharp pain radiated through my toes. The clump did not move.
A thin sheet of ice covered the surface of the parking lot. Steve slid his hand around my arm as we made our way to the front door. White pellets of salt lay on the building sidewalk. I took off a mitten and inserted a gold-colored key into the lock. My fingers tingled from the cold metal. The key refused to turn in the lock. I jiggled the door handle with my other hand and tried again.
“What’s wrong?” Steve asked. The edges of his ears beneath his hat were bright pink.
“I think the lock is frozen.” I dangled the keychain in front of him. “Do you want to give it a try?”
He pulled off his green leather gloves and tried it. “It’s frozen stiff,” he said. “I’m afraid to put too much pressure on the key; it might break off in the lock.” He raised his hands up to his mouth and blew into them. “We need some lock deicer.”
I opened the black nylon work bag that hung from my shoulder. The month before, one of our vendors had given me a purse-size lock deicer. Now if I could only find it among the scrubs, protein bars, toothbrush, toothpaste, brush, lip gloss and other junk. I pushed the contents from one side to the other.
“I’m afraid your bag is a like a black hole, dear,” Steve observed. “Maybe we should ...”
“Found it.” I pulled a little metal can out of a pocket, snapped a delivery straw into the nozzle and handed it to Steve. He sprayed two blasts into the lock and inserted the key again. The deadbolt slid back into the door.
“After you, my dear,” Steve said as he held the door open for me. “I can’t believe I married a woman who carries lock deicer in her purse.”
“And kitty litter in her trunk,” I added. “Just in case the Probe needs traction.”
“You’ve come a long way from breaking off the shift handle of the old farm truck,” he said with a smile.
By 8 a.m., Steve and I finished our morning duties. Captain sported a new fluorescent green bandage on his leg. The birds dined on fresh vegetables for breakfast. Genny nibbled on her cat food and then set out to explore the clinic. Every morning, she conducted “rounds.” She rubbed her face on door-jambs, cabinets and walls to let the rest of the world know this was her clinic and drew wicked delight being outside the cages. This three-legged cat was the envy of the hospitalized patients locked behind bars.
Our first appointment was a hamster who chewed off his fur, a condition called barbering. The owner said his backside look liked the haircut their 3-year-old daughter gave the cat. Clumps of hair were missing here and there. I hoped this was a nice hamster –̶ the last one I treated sunk her teeth into my thumb when I tried to pick her up.
For the next hour, the phone rang nonstop with cancellations. The first call came from the hamster’s owner. Their car would not start. Another client slipped on the ice and was on the way to the emergency room with a broken wrist. An hour ticked by without any appointments. With each phone call, Steve became concerned. He was tired of helping each Saturday. But to hire another technician, I needed more revenue. I hated to burden him, but there was no other way.
At 9:30 a.m., our first visitor arrived, the mail lady. She wore thick wool pants tucked in heavy-duty boats, a thick winter jacket and suede mittens. A very unstylish b
lue-grey babushka perched on her head, the flaps covering her ears completely. It was not a look destined to appear in Vogue. When she entered the clinic, her glasses fogged over from the warmth, but she looked over the tops of them to survey my plants.
“The plants are looking much better,” she observed.
“Yes, we followed your advice, and it made a big difference,” I replied. “Thanks for the help.” She smiled as the door opened behind her. In walked a woman with a chocolate Lab and a poodle dressed in a leather jacket. The black bomber jacket stood out against her curly white hair. The Lab bounded toward the mail lady with a silly grin on her face, sniffing the mailbag until her owner pulled her away.
“I’m glad you braved the weather to come and see us this morning,” Steve said.
“Oh, it’s not that bad if you dress for it,” the woman replied. She removed her mittens, unbuttoned her coat and walked over to the counter. “We are the Davenports. I’m Stacy; that’s Lady.” She pointed to the lab. “And this is Cleopatra.” She held the tiny poodle up to Steve.
“What are the girls here for today?” Steve asked.
“I found a lump on Cleo’s breast that I want checked out. Lady is just here for moral support,” she answered.
“Good for you, Lady,” Steve responded. While Stacy filled out the information sheet, I watched Lady walk around the lobby. She threw her front legs out to the side in a big circle without bending her elbows. She also carried more weight than normal on her back legs.
“Does Lady have elbow dysplasia?” I asked.
Stacy nodded. “The condition was diagnosed when she was 6 months old. The vet told me to put her to sleep and get another dog.” She reached down and patted Lady’s head. “But I couldn’t do that to Lady. She’s part of the family.”
“I’m glad you didn’t listen. She can live a relatively pain-free life if you limit her exercise to low-impact activities and keep her weight down,” I offered. Stacy nodded.
Coated With Fur: A Vet's Life Page 14