In dogs, the spleen is a narrow, flat organ that rests behind the stomach. It usually feels like a meaty sponge because of the many blood vessels that course through it. Sugar’s spleen was thick and rounded, so much so that I found it difficult to perform the exploratory. Her huge spleen kept getting in the way.
I pulled the spleen out through the abdominal incision and laid it on the drapes. Allie opened a sterile package of lap sponges and dropped them on the Mayo stand, careful not to touch the sponges or contaminate the stand. I covered the spleen with the pads. Next, I poured saline over them to keep it moist.
Performing a splenectomy is a time-consuming process due to the number of blood vessels entering and exiting the organ. Each one must be ligated to prevent bleeding. One by one, I dissected out each vessel from the surrounding fat, clamping it close to the spleen’s surface and tying it off with 0 PDS. The sturdy suture should prevent any leaks. Over and over, I repeated the process until one last vessel remained.
“Dr. Nelson, she’s getting a little pale.” I looked up from my work. “And her pulses are weaker,” Allie continued. She fidgeted on her stool. Even with her face covered by a cap and mask, I could tell she was nervous. I could see it in her eyes.
“Increase her fluid rate. I’m almost done.”
I separated the fat along the border of the spleen and clamped off the artery with a forceps. The vessel throbbed with each heartbeat. This vessel provides blood to the spleen and a portion of the stomach. I threaded suture around the vessel just above the branch supplying the stomach and tied a strong knot. It’s a delicate procedure and care must be taken to avoid damaging the stomach’s blood supply. The vessel spasmed but did not leak. One snip later, the spleen was free. A large number of silver clamps dangled from its underside as I handed it to Allie. She removed the instruments and slipped it into a plastic bag for histopathology.
“How’s she doing?” I asked.
“Her color is about the same, but her temperature is dropping.”
“It won’t be long now.” I needed to close fast but had to inspect the ligatures once more. A bleeder might do her in. The walls of the arteries swelled with each beat of Sugar’s heart but the ligatures held. Her stomach remained a healthy pink. Normally, I relax at this stage. But we needed to get Sugar off the table fast. Allie turned the vaporizer dial from 2 to 1.5, lowering the concentration of anesthetic. The race was on.
My hands moved swiftly over the incision. The needle poked down through one side and up through the other. Back and forth, back and forth, until I reunited the edges of the linea alba. Allie stood up, surveyed the incision and turned the dial to 1.0. I felt a bead of sweat form under my cap. Just two layers to go. I tied a knot to anchor the next line of sutures and pushed the needle through the subcutaneous tissue with a needle holder. When the tip emerged, I grabbed it again on the other side. As fast as was sensible, I repeated the motion until I found myself tying a knot at the other end.
“I’m turning her off,” Allie said emphatically. She turned the big round dial for the isoflurane until it clicked to zero. Pure oxygen now flowed into Sugar’s lungs. I tied the anchor knot for the last layer. In out, in out, the needle passed just below the skin from side to side. With each stitch, the incision grew smaller.
With about an inch to go, Allie stood for another peek. I closed the rest of the incision and pulled the drapes from Sugar’s body. Her legs felt stiff and cold, like a dog with frostbite. Even with the heating pad, her temperature dropped to 98 degrees during surgery. I wrapped her limp body in a blanket and carried her to the treatment room. Allie trailed behind with the anesthesia machine and fluids. I stood with Sugar in my arms as Allie retrieved the heating pad from the O.R. I placed Sugar on it and wrapped another towel around her as Allie hung a heat lamp over her.
“Keep her on oxygen until she starts to chew on the tube.” I looked into Allie’s eyes. “Wait as long as you can to pull it.” She nodded and positioned a stool by Sugar. “I’m going to call Ben.” I pulled the mask off my face, and it left a red mark over my nose. My skin beneath the mask felt slimy. I pulled off the surgical cap and fluffed my hair. A red line also ran across my forehead from the elastic band.
Five minutes later, Sugar moved her tongue. It flicked from side to side under the tracheal tube. Allie continued to hold the tube in place. A minute later, Sugar coughed and gagged. Allie clamped one hand around Sugar’s mouth and the other on the tube. When Sugar coughed again, she pulled the tube from her mouth. Sugar tried to sit up, but couldn’t even hold her head up; it flopped back onto the blanket. Allie rolled the dog onto her chest and placed a towel under her chin.
Genny hopped into the treatment room carrying her stump high in the air. She rubbed her face on the I.V. pole, causing the bag of fluids to wiggle at the top. She sat down in front of the cages and stared at the animals inside. A young schnauzer in one of the lower cages sprang to her feet.
“Woof, woof, woof.” Unimpressed, Genny limped over for closer inspection. She sat down three inches from the cage, just outside of the pup’s reach. “Whoooooooo, whoooooo,” the pup cried again.
“Genny,” Allie scolded. “Quit tormenting the animals.” Glancing at Allie before returning her attention to the puppy, Genny lay on her side and flicked her tail up and down. The puppy pranced inside the cage. Her nails sounded like pennies in a soda can against the stainless steel. Allie bent down to shoo Genny out of the treatment room. The cat moved just out of her reach and lay down again, still with a view of the puppy. She rolled onto her back with her three legs in the air.
“Genny, knock it off,” I ordered upon my return. She jumped up and disappeared under the cages. “How’s Sugar?”
“I pulled the tube two minutes ago.” Allie pulled up Sugar’s lip. “Her color is better and she’s starting to shiver.”
“And her temperature?”
“She’s up to 99 degrees.”
I patted Sugar’s head. Her entire body shook from the cold. She stared at me through dilated pupils. Nothing seemed to be in focus for her. “Ben will be here to visit in a few hours. Until then, I want you to sleep,” I instructed to my marginally conscious patient. “He’s very worried about you.”
“Bang, bang!” The puppy crashed against the side of her cage. The bowl tipped over, and water sloshed on the floor. Genny retreated back under the cage to get away from the water. Allie instinctively reached under the cages and tried to grab the stubborn cat. Genny ran out the side, back into the pharmacy area. How could such a small three-legged cat possess so much attitude?
The next morning, I couldn’t wait for Allie to recheck Sugar’s PCV. I drew the blood myself, filled four PVC tubes and loaded them into the centrifuge. With the turn of a switch, the rotor spun the tubes in a circle separating cells from plasma, the liquid component of blood. Sugar ate a little breakfast while the machine roared in the other room. It reminded me of an airplane revving its engines before takeoff.
“Ding, ding,” the machine sounded as it clicked off. Sugar looked up from the bowl with food stuck to her whiskers. I closed her cage door. By the time I reached the lab, Allie already held the tube against a white plastic card with horizontal lines across it. “Her PVC is 20 percent! The same as last night.” Her smile said it all. For the first time since Sugar’s ordeal began, we had something to celebrate. I couldn’t wait to call Ben.
By afternoon, the PCV increased to 22 percent. Sugar sat contentedly at the front of her cage and watched other animals. Her appetite returned, along with her interest in the outside. She devoured lunch and begged for more. When Allie ignored her, she barked for more.
Ben and Spice arrived at the clinic for their afternoon visit. Sugar pranced in her cage. She knew what was coming. When she saw Ben and Spice, she tried to jump out of Allie’s arms. She wagged her tail and moaned with delight. She felt great, and so did I.
“Looks like the gang’s all here,” I said taking the seat beside Ben. I patted Sugar and then Spice on
the sides of their faces. “Congratulations, Ben, I think she’s ready to go home.” Ben’s eyes glistened. He looked down at his beloved companion. Sugar looked back at him. A pink tongue slipped from her mouth, and she licked his hand. A tear spilled down his cheek, leaving a wet streak on his face.
“Her afternoon PCV is actually higher than this morning by two points,” I told him. Ben wiped his face and cleared his throat.
“I, ah, I wasn’t sure if I would ever take her home again.” He pulled a handkerchief out of his pocket. “She looked so bad ... two transfusions. I thought I was going to lose you, old girl.” He patted her head. Another tear ran down his cheek. “Are you sure?”
“If she has any problems, you can always page me.” I smiled at Ben and touched his arm. “I want to see her tomorrow to recheck a PCV. If it continues to increase over the next three days, I’ll start tapering her medications.”
“You’re coming home, old girl, you’re coming home,” he told his dog. Ben held Sugar’s head in both hands. She closed her eyes and panted. Spice jumped up and down in Ben’s lap, sensing his excitement. Ben released Sugar and looked directly into Spice’s little face. “Sugar is coming home, Spice. Your buddy is finally coming home.” Spice jumped and licked the bridge of Ben’s nose. We both laughed.
“Well, I see Spice agrees with me.” I petted her rear end. “It will take us 10 minutes to get all of Sugar’s stuff together. Allie will review the medications with you. Call me if you have any questions.”
I stood to leave. Halfway to the counter, I stopped and returned to Ben, placing my hand on his shoulder. “Congratulations, Ben. She really had me worried.” My voice cracked on the last word. I blinked a few times to clear the tears forming in my eyes.
“Me too.” He buried his face in Sugar’s fluffy coat, fresh tears flowing down his cheeks. “Me too.”
Chapter 23
Elvira the Snake
I looked at the snake’s head in my hand and wondered how this happened. Desperation set in. The day had started off routinely. I saw appointments, ate lunch, returned phone calls and wrote records.
At 3 p.m., Captain arrived for his last checkup after the car accident. He had healed beautifully. Pink skin completely covered the injured leg, and tufts of hair grew along the margins. He pranced out the front door without a leg bandage for the first time in weeks. It was a moment that makes veterinary medicine worthwhile.
Everything was great ... until Elvira the snake upset her owner, Cheryl. Now here I was sitting cross-legged on the waiting room floor, holding a grumpy snake. I had no idea how to proceed. I waited for inspiration to strike. Professors do not address escaped snakes in veterinary college. Minutes before, people and pets had filled the waiting room. Now empty chairs lined the block walls.
“Dr. Nelson, where are you?” asked a voice from behind the counter.
“I’m over here, Allie.” She soon appeared around the corner of the bookshelves. Her purple scrubs looked stunning with her brown hair.
“I heard screaming and ... what are you doing down there?”
“Well, I’m trying to figure out a way to dislodge Elvira from under the door without hurting her.”
The boa constrictor had decided she did not like my veterinary clinic. As soon as I finished the antibiotic injection to treat her pneumonia, she made a slither for it. Being an intelligent snake, she headed for the door to the waiting room and poked her head into the space between the door and the threshold. Her plan worked well until she reached yesterday’s dinner. The mouse bulging from her midsection stopped the escape about halfway through the door. She wiggled back and forth to free herself but only succeeded in wedging her body tighter.
As the front half of Elvira appeared in the waiting room, women unleashed terrified screams. Society Ladies with fluffy pets, the women wanted no part of an angry boa constrictor. Dogs barked while sinking further into their owner’s laps. A cat hissed from his carrier. Two of the ladies ran out the front door, dogs in tow, slamming it behind them. The third took refuge in the kids’ area. We heard the Persian cat meow but could see neither him nor his owner.
On the other side of the door, Elvira’s owner went into hysterics. She stayed in the exam room with the back half of her snake.
“My plan is to restrain Elvira,” I told Allie. “Then the clients will think everything is under control and come back into the building.” We both turned to look at the front door. Anxious faces peered through the glass, hands cupped around their eyes. With each breath, the glass fogged beneath their noses. At their feet, a bichon frisé and miniature schnauzer paced, leaving nose prints all over the bottom of the glass. Sunlight danced off the crystals on their fancy leather collars, casting beams of light around their heads.
“I don’t think your plan is working.” Allie giggled. “You look pretty silly sitting on the floor holding that snake.”
This image was not the picture of professionalism advertised by the American Veterinary Medical Association. But what else could I do? I felt my heart race. Never in my wildest dreams did I envision trying to “un-stick” an angry snake. My face turned bright red. I felt stupid.
I looked at the door pinning Elvira in place and considered various options. We could take the door off the hinges. The problem was, each clinic door was made of solid wood and weighed a great deal. If we tried that maneuver, the snake might be crushed in the process. Scratch plan A.
Plan B involved copious amounts of lubrication. With Elvira nice and slippery, she might slide out from under the door. A snake’s scales overlap one another in a washboard pattern from head to tail, so if we tried to push her backwards, the scales might be damaged. Because the first rule of medicine is to do no harm, backwards was out of the question.
Besides, the owner would have a fit if anything happened to her snake. She took notable pride in Elvira’s perfect scale pattern, showing it off whenever possible.
Backwards was out, but maybe sideways would work. If Allie pulled up on the handle, there might be enough room to wedge her out. I did not have a Plan C.
As I waited for Allie to return with lube, the clinic’s front door opened a crack. A black nose surrounded by fluffy white fur poked through the small opening. The nostrils flared several times. Soon another black nose surrounded by grey hair poked through the opening just above the bichon. Both dogs wanted to come inside and investigate this curious smell.
“Is it safe to come in?” the bichon owner asked, still alarmed.
I nodded. “Elvira is a nice snake. She’s just upset right now.”
“I didn’t know there was such a thing as a nice snake,” the lady quipped. The door opened and the dogs trotted inside, followed by their owners. The cat owner poked her head out of the children’s room but remained in place, content to view the situation from the other side of the front counter. She was not taking any chances.
“Why in the world do you treat snakes?” the schnauzer owner asked. Her face contorted as she spoke. “They give me the creeps.”
Although I would not admit to it, I used to have the same reaction. I like lizards and geckos much better. Give me anything with legs. Snakes, especially the big ones, make me uncomfortable until I have control of them. I looked down at the helpless little creature in my hand. Elvira was only three feet long. Over time, I began to feel sorry for snakes. They need medical help, and few veterinarians treat them. That’s why I forced myself to overcome my fear and work with them.
“My husband agrees with you,” I replied. “He hates snakes. Even a picture of a snake makes him uncomfortable.”
Whenever a snake is hospitalized, we cover the incubator with a towel to hide it from view and place a heavy weight on top of the lid to make sure no one escapes. But one heavy bottle is never enough for Steve. When Allie arrived some mornings, she often found the entire top of the incubator covered with gallon jugs, sure proof that Steve did the evening treatments. Poor Steve – I wonder if he would have proposed if he’d known that reptile
s were part of the deal. Sometimes it’s better to ask for forgiveness than to ask for permission in marriage.
Allie returned with the tube of lubricating jelly. She squeezed a large amount into her hand, knelt down and coated Elvira’s body with the clear gel. The ladies watched with a mixture of fear and curiosity. All but the cat owner inched closer for a better view.
“What are you doing?” one of them asked.
“We’re putting lube on Elvira, and then we’re going to slide her out,” I responded. I was not sure if our plan would work, but there was no reason to share that with the ladies. “Allie is going to pull up on the door handle while I slide Elvira out sideways.” The ladies frowned. My mother wore the same expression when I told her I wanted to be a veterinarian.
Allie squeezed several more inches of lube onto her finger and painted it on Elvira’s scales. The striking browns in her scales stood out like polished stone. Once Allie coated Elvira’s entire circumference, she disappeared into the exam room to lube the other side. The back door into the dog exam room squeaked as she entered.
“I can’t imagine why anyone would want a snake as a pet,” the lady with the bichon reiterated.
“They just lie there in the corner of the cage staring off into space,” the schnauzer owner added, adjusting her diamond tennis bracelet. “They even look evil.”
“Reptiles and fish are the only pet option for people with allergies,” I noted, smiling at the ladies. “And believe it or not, each animal possesses a unique personality.” The bichon owner gave me a quizzical glance. “They have likes and dislikes, just like people.”
“Oh please, Dr. Nelson,” the schnauzer owner disagreed. “Reptiles don’t have personalities.”
“Sure they do. I know an old iguana named Peaches. She’s a big love sponge until she sees a cat. Then, look out. I learned that the hard way.” I laughed to myself, picturing Peaches in my mind. I had been carrying her into the back when Genny ran by. Peaches whipped her tail back and forth as she struggled to chase the cat. Her tail wrapped all the way around my body. I had red marks on my skin for two days; it felt like I had been whipped. You can’t imagine how much it hurts to shower in that condition.
Coated With Fur: A Vet's Life Page 18