Lambs’ Tales 2: Balk Beck
My impeccable reputation at Grange Farm did not extend to all the farms looked after by the practice. Alf Wight, better known to the animal-loving world as James Herriot, had a phrase that all enthusiastic veterinary surgeons would be wise to remember: ‘You are only as good as your last job.’
Farmers around Thirsk, and probably everywhere else too, have long memories when things don’t go according to plan, but often quite short memories when it comes to stories of success on their farm. A hard-earned reputation can easily be blown away by a bad decision whilst calving a cow, or the wrong choice of drugs to treat a calf with a severe case of pneumonia.
There is one farm where, if father and son were following Doreen’s ranking system, I would certainly be at or somewhere very close to the bottom.
I had been called to see a heavily pregnant ewe. She had fallen into a stream, swollen by heavy springtime rain. The stream, ‘Balk Beck’, which on this day was more like ‘Balk River’, ran right through the middle of the farmyard and separated the farmhouse from most of the farm buildings, which were reached via a little bridge. In days past, there was a watermill on the farm. It would harness the power of the gently flowing stream to grind grain and turn it into flour. The days of the watermill were long gone, but Balk Beck was still a significant feature of the farm.
This spring, the beck had flooded, which caused problems for the in-lamb sheep grazing in the nearby paddock. It was knee deep in water. Most of the ewes had sensibly manoeuvred themselves to the edge of the field and were safe from the overflowing torrent, but my poor, waterlogged and weary patient was not so fortunate. She had been found bobbing about in an eddy current just downstream from the little bridge.
Sheep have a large rumen, half full of gas, so even though they are not very competent swimmers, they do float very well. Just like Eeyore in the famous Winnie the Pooh story, this sheep had obviously been bobbing around in the water for some time. By the time she had been scooped out of the stream by Mick and his son Andrew, all she could do was lie, flat and moribund, on her side in the soggy paddock. She couldn’t walk and her waterlogged fleece made her too heavy to be carried. When I arrived, Mick and Andrew were standing next to her, in the place from where she had been fished out, with their hands on their hips. Strictly speaking, Mick only had one hand on his hip, since his right hand was occupied with his ever-present cigarette.
‘Bah! She looks badly, Vet’nary,’ he wheezed between puffs.
‘I think she’s abart buggered, Dad!’ offered Andrew, in a typically astute and terse assessment of the situation.
‘I think she is, son,’ confirmed Mick, in a ‘that’s my lad’ kind of way.
It seemed that both my services and my opinions were surplus to requirements, as the three of us stood and stared at the almost drowned ewe. I hadn’t said anything useful so far and I had no specific remedy in my car boot to cure a hypothermic and waterlogged sheep. She was only marginally closer to life than she was to death. Then it occurred to me that we might be able to salvage something from the dire situation.
‘Is she in lamb, Mick?’
‘Aye, she’s due next week by the look of her mark.’
All the sheep were marked with a spot of colourful dye on their backs, which showed when they had been mated by the ram. At tupping time, each ram would carry a raddle – a sort of harness, with a paint cartridge attached on the front. The farmer would change the colour on the raddle every week, so they could tell when the ewe had been mated by the colour on her back. In this way, an approximate lambing date could be calculated.
The poor ewe was fading fast, but I thought there was a possibility we could at least save the lambs, by performing a ‘bush’ caesarian. This is a way of saving the unborn lambs from a terminally ill sheep (or calf from a cow or foal from a mare). A quick and efficient caesarian section is performed before the dam is euthanased on humane grounds. Done correctly and at the right time, this can save the life of an unborn lamb in a situation where otherwise both mother and baby would perish.
I discussed the plan with Andrew and Mick, who seemed to think it was a good idea. They hadn’t seen a caesarian before, and anything that would make an otherwise sad morning better was worth a go. I was somewhat pessimistic about the chance of success – experience had taught me that an emergency caesarian like this, on a sheep that was some way from its natural lambing date, was fraught with problems. The lambs only become mature enough to survive in the last few days of gestation, and by Mick’s calculations, they weren’t due for another week. Nonetheless, it was the only hope of some sort of positive outcome.
I got what I needed from the car and swiftly clipped away some soggy wool. I numbed the area with local anaesthetic, then got a syringe ready with the solution that I would use to euthanase the sheep after her lambs were out. I knew I had to be quick and time was of the essence. If the ewe were to beat me to it and die before I had delivered the lambs, their chances of survival would be even lower.
Sadly, this is exactly what happened and, only moments after the local had gone in, she took one last breath and promptly expired. Ever the optimist, I quickly whipped out my scalpel and made a swift and bold incision – hoping it might not be too late to save the lambs.
However, my incision was a bit too swift and a bit too bold. The puffy, oedematous skin and muscle were weaker than I expected, and my scalpel, in one sweep, went right through the skin, muscle and uterus. I pulled out the first lamb which I could instantly tell was more than a week premature. It was also very dead.
Mick and Andrew could not tell from their vantage point that the lamb was premature and dead, but they could tell quite quickly that my scalpel had made a long gash into its flesh.
‘Bah! Vet’s slashed lamb!’ exclaimed Andrew at the top of his voice to his father.
I had, indeed, slashed the lamb, although this was entirely irrelevant to the lamb, since it had died several hours previously, presumably as the body systems of its mother were shutting down in the cold water of the river. I tried to explain, but my protestations fell on deaf ears.
Moments later, I felt somewhat redeemed, as I pulled out a second lamb. It was free from any kind of slash mark, but equally dead. Several hours of bobbing around in the cold water had obviously been too much for all concerned.
It seemed, though, that in the eyes of father and son, it was all my fault. As they splashed their away across the flooded paddock, I was certain I would never be allowed back onto the farm.
Poppy or Penny?
It doesn’t always rain in springtime in Thirsk. As spring progresses, the wet and wintery weather eases into lighter nights and longer days. When there are emergency calls to do in the evening, some days are longer than others and one particular April day was longer than most.
It was about half past seven, at the end of a busy evening surgery. I was heading across the car park with the ‘on-call kit’ – a big box containing the calving jack and all the equipment needed for doing a caesarian on a cow (or any other large surgical procedure). I hadn’t even got as far as my car before my beeper went off. Instead of locking up the surgery and heading home for tea, I went back inside to phone the answering service for details of the emergency.
The beeper message said there had been a road traffic accident on the A1 and my attendance was required immediately. These calls are always complicated. Not only is there an injured and terrified animal (or animals) to deal with, but there is the danger inherent with high-speed traffic whizzing past. Usually we have to coordinate with the traffic police to make things safe for everyone concerned.
A dog had been hit, reported the person at the answering service, and people were sitting with it on the hard shoulder. Could I go right away?
The accident was on the southbound carriageway of the A1, not far from Richmond. It was a long way away, some twenty miles outside our normal area. Calls like this are a tricky issue because our foremost responsibility is to
our own clients, within our practice area. If I am tied up for most of the night somewhere miles away, it falls to the vet on second call to deal with all the other work that comes in during the evening. There were at least four other veterinary practices closer to hand than I was, but we did a lot of work for the police so were often their first port of call.
Despite these issues, the moment my beeper chirped into life, I felt I was responsible for the case. I gathered all the things I would need. Dogs that have been hit at high speed by a car are usually badly damaged and they can react in an aggressive way, for no other reason than being frightened and in great pain. One of my patients, a gentle and benign German shepherd dog called Jed, who belonged to Sue, a receptionist at the practice, was in such terrible pain after being hit by a car that when she tried to help him, the poor dog actually bit her finger off. This was not what I wanted tonight so, armed with medicines, bandages, blankets and a selection of muzzles, I clambered into the practice van/animal ambulance and set off.
As usual, there were major roadworks on the A1. As I got close to the site of the incident, I could see the commotion on the opposite side of the road. There was a traffic control vehicle and another car. I could see people sitting on the hard shoulder, but I had to drive further north for another ten minutes before I could get out of the roadworks and back down to the injured dog and its rescuers.
A bewildered, confused and seriously injured pointer bitch was swaddled in a fleece jacket belonging to the lady who was comforting her. Both of them, as well as the fleece, were covered in dark, congealed blood.
‘Oh, thank goodness you’re here!’ said the lady, who introduced herself as Sheila. She was in almost as much of a state of shock as the poor dog.
‘We were just driving along and right in front of us this dog ran out and straight under a lorry. It didn’t even stop – it just carried on. We swerved and then stopped to pick her up, and stop her running into the road again. I wrapped her in this jumper and then I called you. I’m heading back to Rotherham and I’m really late already. We’ve been here for over an hour!’
Sheila had done a great job in catching and comforting the dog. I felt sure that, had she not stopped her car to help, the dog would have been hit a second time and would not have survived. Not only that – there could have been a serious accident. The dog wasn’t wearing a collar so Sheila was keeping hold of her in an awkward hug. No collar meant no obvious owner to contact, and no indication of her name. It is always nice to be able to call a dog by its name.
I slipped a lead over the dog’s head to make sure she didn’t escape and then, mindful of the aforementioned finger incident, put a muzzle on – just in case – as she was, no doubt, very frightened and in a great deal of pain. Then I examined her as best I could. She was concussed and there was bruising around her face and head. Her lungs sounded noisy, which was suggestive of bruising to this delicate part of the body, and could be serious. There was a large and painful swelling around the upper part of her left front leg. The telltale floppiness of the limb was a sure sign that there was something seriously wrong. It was either a broken humerus or a dislocated shoulder, both equally bad and equally painful. I needed to do some x-rays to establish the full extent of her injuries.
Without delay, I injected a dose of morphine into the muscle of her back leg. This would act quickly and effectively to take away much of the pain. It would also act as a sedative, so the journey to the surgery would be less stressful for her. I wrapped her in a blanket and gently lifted her out of Sheila’s arms. There was no doubt that this dog would not have been alive had it not been for Sheila’s help. Before she left with her bloodstained fleece, her face and clothes also all smeared with blood, she wrote down her telephone number so I could keep her updated on the dog’s progress.
And with that, I headed back to the practice to work out what needed to be done. I stopped every so often to check on my patient. She was having a peaceful journey as the morphine took effect. In the absence of an actual name, I decided to call her Poppy, mainly because she was a pointer and I thought that a name beginning with the letter ‘P’ would be easy to remember. Poppy Pointer was the first thing I could think of and it seemed better to call her something rather than nothing. Even if it didn’t bother the dog (being called by her correct name seemed the least of her worries), it made it easier for me.
Having returned to the surgery, my first job was to check for a microchip. With baited breath I pressed the ‘on’ button and the transceiver flickered into life. The single, jubilant ‘BEEP’ gave me the news that I wanted. The dog had a chip, which meant she had an owner and also a name!
I phoned up the database to get all the details. It seemed that the dog was actually called Penny, so I hadn’t been too far out with my pseudonym of Poppy. I was anxious to speak to the owners as soon as possible. They must surely have been distraught with worry, and I wanted to let them know that although she was badly injured, she was safe and alive. However, worse news was to follow – the only telephone number recorded on the database did not work. It had too few digits. Optimistically, I typed the name into the practice system, but there were no pointers called Penny. After all, I had picked her up quite a long way from Thirsk, so she was unlikely to be a patient of ours. I wondered if I should telephone the veterinary surgeries in that area to ask them to check their records, but by now it was half past eleven at night. I could imagine exactly how unpopular I would be if I woke up at least four on-duty veterinary surgeons and demanded that they go back into work to check their computer systems. I would not be able to trace Penny’s owners until morning.
Now, though, I needed to turn my attention to Penny’s leg. I had already managed to get an intravenous catheter into the vein in her good leg, through which I was running a saline drip to treat the inevitable shock from which she was suffering. She was quiet and relaxed, still under sedation, so I set about taking some x-rays to see whether the leg was fractured or the shoulder dislocated or both. It is vital to replace a dislocation as soon as possible, otherwise it becomes very hard to do, and much more likely to pop out again. Quick replacement is also the very best form of analgesia, as every rugby player who has experienced a dislocated shoulder will know.
But the x-ray did not show a dislocation. Rather there was, as I had feared, a nasty fracture to the humerus (the long bone between the shoulder and the elbow). The middle part of the bone was completely smashed. This led me to my next dilemma. Stabilising a fracture is always the first priority, as it is the best form of pain relief and stops further tissue damage. The bone clearly needed to be repaired. Fractures can either be repaired immediately, before much of the bruising and swelling has had time to set in, or a day or two later after the swelling has subsided. There are arguments either way as to which is best, but in this case the injury was so high up the leg that I was going to struggle to stabilize it properly in any way other than by just getting on and fixing it. However, as I hadn’t managed to find an owner, I couldn’t get their consent for surgery. Should I just carry on anyway? There was always a possibility they would not want surgery but prefer to go for amputation or even euthanasia. What to do?
Fixing a fracture is usually a two-man job. I did have a second on-call vet on the other end of the phone, who I knew I should really contact to come in and help. But I also knew he had been on call the previous night and had the weekend ahead to cover. Penny was nicely sedated so it would be fairly easy to administer an anaesthetic injection via the catheter that was already in place. I decided I could press on alone. That way I would save him another disturbed night’s sleep.
I thought I could manage singlehandedly, if I was careful with my planning and efficient with my surgery. Once Penny’s anaesthetic was stable, I could clip and scrub the leg, open my equipment then scrub my hands and arms and don surgical gloves. I would open up every single bit of equipment I thought I might need – plenty of pre-sterilised packs of plates, screws, pins and orthopaedic wire – so that
I wouldn’t need a nurse or an assistant to pass them to me. Whilst this would be very much frowned upon by the purists, I reasoned that even under my sole charge, things were still a million times better for Penny than they had been three hours ago.
So I made a decision and made a start.
The anaesthetic was stable and smooth as I made my first incision. The skin was bruised purple by the impact of the lorry and the roughness of the tarmac. The muscle under the skin and around the smashed bone had undergone a colour change that went beyond purple. There were black blood clots all around the smashed-up humerus. I removed the smaller shattered fragments, but carefully retained the bigger pieces so I could fix them back to the intact upper and lower ends of the bone.
My plan was to place an intramedullary pin (a type of metal rod) up the middle of the smashed bone, threading all the pieces back into alignment. It fitted in quite easily and, after about an hour, the two main fragments were more or less together. I used special wire called cerclage wire to keep the other fragments firmly in place. The leg was looking an awful lot better. There was a certain calmness that came over me in the middle of the night, working alone, just Penny and me, the silence only broken by the ticking of the theatre clock and the gentle hiss of the oxygen flowing through the anaesthetic machine. I can recall every moment of that surgery. By the time I had finished, Penny was in an immeasurably better place than she had been at the start of the evening.
After she had woken up from her operation, I plied her with yet more morphine and other painkilling medication and carried her to her new kennel so that she could recover slowly from her operation. Then I headed for home. It was three o’clock in the morning and I had missed my tea, and hadn’t seen my kids or my wife. It had been a busy day and a long night and I was exhausted. I fell into bed and was instantly asleep.
Morning came all too quickly. I rushed in to work to check on Penny, before my beeper could go off again and take me in a different direction. In her kennel at the practice she was sitting up and looking around. She seemed like a new dog altogether. I looped a lead over her head for a second time in twelve hours and took her outside for a walk and a wee. This would be the first test of her leg and of my surgery. Penny was hesitant but walked out gingerly, sniffing the air as if trying to work out where on earth she was. I imagine the morphine haze had left her confused and bewildered. The last thing she would have remembered must have been seeing the radiator grille of the lorry on the A1, and now she was here, at my clinic and very sore. Outside in the spring air, I could see her spirits lift. Three of her legs worked well (this was good news, for I had not examined them in great detail the previous night) and the left fore was bruised and battered but taking a little of her weight.
A Yorkshire Vet Through the Seasons Page 7