Drinking from the Trough

by Mary E. Carlson, DVM

  Knowing that Marcie was there for me, whether I called it rehabilitation or training, was a huge comfort. Marcie was a stable, reliable mount for rehab riding. My rehab team included excellent professionals, from trauma surgeon and physical therapist to Pilates trainer and massage therapist, but Marcie, my lovely old mare, gave me equine therapy, which was the best rehabilitation modality of all.

  I visited school the day before my official return to work and told some staff members hanging out in the lounge that I was going riding that afternoon. They looked at me in surprise. Was I really going to ride horses again?

  I was equally surprised by their question. I asked them, “Have you ever had a car accident?”

  Heads nodded.

  “Do you still drive?”

  “Of course,” someone said.

  “It’s the same,” I said. “What happened was a freak accident. My surgeon said one millimeter’s difference in the way I hit the ground would have avoided disaster.” I shrugged. “I’ve had more car mishaps than equine incidents.”

  I returned to school on Friday, November 5. We were supposed to begin the unit on genetics. Instead, I spent the day debriefing the kids about my summer and fall semester and showed them the X-rays of my fracture with the huge screws holding things together. They listened with rapt attention.

  Despite my dedication to recovery, I was still scared of going through the school hallways packed with students rushing to classes. I didn’t want to be junior high roadkill, so I waited in out-of-the-way pockets until passing period was over before moving from place to place. Other than that, I got around all right, but I was definitely looking forward to welcoming a student teacher during spring semester.

  On the last day of school before winter break, I was scheduled to check into the hospital again so Dr. Lundy, my trauma surgeon, could change the screws to a shorter size. I skipped breakfast, headed to school at my regular time, and taught as usual all morning. Earl picked me up at noon, and we headed to Poudre Valley Hospital.

  The second surgery was a cakewalk compared to the first one: eleven minutes total surgery time, twenty-three hours total hospital time, a little fentanyl for pain (much easier on the system than morphine). Recovery at home was easier too; I didn’t need any pain medication at all, and I was up and walking almost immediately.

  That might have been the end of this particular story, were it not for my adventures with my new student teacher, Leah, and her horse, Dancer, less than two months later, in February.

  Dancer was Leah’s “dream horse,” whom she’d gotten for free. Dancer was being treated for a leg injury, and Leah asked me to take a look at her. I packed my vet bag and took it with me to school on Friday.

  Leah was an enthusiastic horse owner, but the horse hadn’t had much training. I took one look at Dancer as Leah led her into the barn and thought that it was great that Leah could jump three-foot fences with this mare, but if Dancer didn’t get in some solid ground training and learn manners, she had the capacity to seriously injure or kill someone.

  Being aware of the danger, when I changed Dancer’s leg bandage and put on a Furacin sweat (a type of bandage to keep heat on the injured leg), I knelt on the concrete floor of the barn with the knee of my injured leg on the concrete. I kept my left foot flat on the floor, my left knee up, ready to launch myself with my good leg away from Dancer, should she blow up. Most of my body weight was on my bad leg.

  Dancer behaved herself, but by the time we finished, I could feel how big a mistake I’d made by positioning myself bad-leg-down on the concrete. I was in agony.

  The next day, Saturday, Earl and I went for a short ride. Earl was on Marcie; I was on Scooter. Thirty minutes in, I was in so much pain that we had to stop. Earl untacked the horses and loaded them up, and we drove home in silence.

  By Sunday morning, I could barely walk. I called the Orthopaedic Center, and Dr. Lundy happened to be on call. He was getting his kids ready for church. I was near tears from the pain and was panicking. In a gentle voice, he asked me what was wrong. I told him about the pain and that I could barely walk. He said to skip breakfast and go to the hospital for X-rays.

  No breakfast? Did that mean he thought I’d have surgery that day?

  Well, that ship had sailed—I’d already had my oatmeal and apple juice.

  The X-rays were unspectacular, but my leg steadily declined. I dug out my crutches and started using them again. Soon, it hurt when I got out of a chair, and the pain continued for the first few steps after getting up. Not too bad after that, which is not a good sign.

  The symptoms were classic for avascular necrosis, or death of the bone from lack of blood supply. My hip was dead.

  I called Dr. Lundy’s office and made an appointment. Strongly suspecting what we’d find, I also called the office of Dr. Kirk Kindsfater, the total hip replacement surgeon, and scheduled an office appointment with him for hip replacement surgery for the Tuesday of spring break. I knew how busy Dr. Kindsfater’s schedule was, and if I had to have another surgery, I wanted it to be when school wasn’t in session.

  Dr. Lundy’s voice was soft when he broke the news to me. “Mary, this is the first time I’m thinking this won’t work out for you.” He showed me the new set of radiographs, and I knew I would be keeping my appointment for the total hip replacement.

  Even though I’d expected this and understood what I had to do, I began to cry. I’d followed all the rules, spent my required eight weeks on crutches, done all the therapy, behaved myself during my long-term sick leave from school, and had the screws swapped out. And yet my fracture repair had failed.

  Although kneeling on the concrete floor to work with Dancer had triggered this latest crisis, I suspect it wasn’t the actual cause. I think it was probably game over when I hit the ground after coming off Hannah. The impact had smashed and trashed my blood supply to the injury site, causing more damage than just the severe bruising that turned my leg and backside black for weeks afterward.

  I was originally scheduled for surgery late Tuesday afternoon, but thanks to a cancellation, they moved me up to seven in the morning, which meant a five thirty check-in time at the hospital. There was a short delay because I had specified that an MD anesthesiologist perform the spinal anesthesia and monitor me during surgery. The staff hadn’t planned for that and had to wake up the doctor, who rushed over.

  The spinal anesthesia was cool. I had to sit over the side of the bed so that the doctor could access my back. I had to grasp a nurse’s arm for balance. First, the doctor injected a local anesthetic so the spinal wouldn’t hurt. Then she began the spinal itself.

  It was a fascinating experience. First, my feet became paralyzed. The paralysis moved upward until it reached my waist. I couldn’t help but think about Socrates drinking hemlock and being forced to walk around; he would have experienced the same sensations.

  In the OR, I was catheterized, then rolled onto my left side, with my right hip up. My arms were tied to splints, one of top of the other, so I could be given continuous sedation.

  It took Dr. Kindsfater fifty-five minutes to replace my dead hip with a new stainless-steel model.

  I don’t remember a thing about the actual surgery. I learned later that during the surgery, Dr. Kindsfater discovered my hip had a non-union fracture—that is, the break had never healed. He could actually toggle the pieces of my femur back and forth. I wonder what Newton would have said about that.

  Dr. Kindsfater retrieved the screws that had done their best to hold my hip together. I added them to my original set; they had cost $500 apiece, bringing the grand total value of my six-screw set to $3,000. Alas, he refused to let me have my bone as a souvenir.

  When I awoke in the post-anesthetic care unit (PACU), my legs were spread-eagled, with a pillow between my feet. That’s how I had to sleep for the next six weeks.

  I was wheeled to my room, where Earl met me. I kept asking him, “When are they going to put me into a bed?”

  “You are in a
bed,” Earl said.

  “No, I’m on the transfer gurney,” I insisted. “Call the nurses to put me into a bed.”

  “Look around.”

  My “gurney” was where beds were placed in the room; I was indeed in a bed, not on a transfer gurney. The OR staff had placed me in the bed, positioned with a pillow between my feet, so I wouldn’t have to be transferred while awake.

  I still felt disoriented, but I finally accepted the fact that, yes, this was a bed, and I was in it.

  A spinal takes effect from the feet up; it wears off from the abdomen down. Nurses came in regularly to draw a line with their fingers on my abdomen, asking me, “Can you feel this?”

  The answer for most of the day was “nope,” but as the day wore on, I could say “yes” to higher points on my abdomen. By the next morning, I was back to normal, my abdomen covered with ink timelines.

  This time, there was no physical therapy. Nurses, doctors, and everyone else hammered the message into my brain that I was to stay off the leg and sleep on my back with a pillow between my feet. There would be no PT at home either; rehab for total hip replacement would involve taking it easy for six weeks and using crutches to move from one spot to the next. After that, it would involve walking and other ordinary day to day activities.

  I was supposed to stay home for six weeks.

  Hip replacement surgery wasn’t nearly as painful as fracture surgery. By three weeks post-op, I no longer needed any pain meds. I was also bored.

  I found I could drive pretty soon after surgery. After the accident, I hadn’t been allowed to drive for five weeks, but I didn’t have any restrictions this time around, beyond the “no weight bearing” and “pillow between feet while sleeping” commands. I was also under strict orders to not flex my new hip past ninety degrees, to guard against dislocating it.

  Dr. Lundy renewed my handicapped parking hangtag, upgrading it from a temporary tag to a permanent one. Because of the way I had to position my hip, I couldn’t reach down to adjust the seat of my Subaru, so I used my little Mercedes as my rehab car. It was lower to the ground but had electric seat adjustments.

  Being able to get myself where I needed to go and feeling the need for something more interesting than sitting at home, I decided to return to school. Leah, my student teacher, was still teaching by herself, supervised by others; I only had to be there to oversee her activities. I spent most of my time in the office, planning lessons for the end of the school year.

  Leah’s time with me was ramping down just before the practical exam for the fetal pig unit. Exam setup was my last day on crutches, and I had a doctor’s appointment after school, so I fudged a little and walked carefully around the classroom without crutches. I did keep them close by, and I used them to get from station to station, but that didn’t prevent Nikki, one of my students, from scolding me. “Now, Doctor C., you have to use your crutches!” I wasn’t surprised to learn that Nikki grew up to be a nurse.

  After missing almost half the school year, I suppose I shouldn’t have been surprised that I was missing from the yearbook too. But on the last day of school—a half-day, when the kids spend pretty much all the class time outside signing their yearbooks—I was battling the beginnings of what would turn out to be a killer three-day migraine. I thumbed through the yearbook and discovered that I hadn’t been included. Sure, I’d missed photo day, but they could have run the one from the previous year, couldn’t they? They didn’t even mention my name as “not pictured.” I felt invisible, as if I’d never existed at the school. The headache made the omission feel even worse, so when the kids were released to wait for the buses, I told an office staff member I was leaving and crawled home to take my migraine medication and go to sleep.

  The migraine didn’t let up. I missed the staff lunch, missed the surprise announcement that our principal was retiring, missed everything. Thursday was more of the same agony. On Friday, feeling a little better, I emerged long enough to attend an end-of-year party at a teacher’s house, but I paid for it the next day. I was back in bed again, writhing in pain: an awful end to a miserable year.

  When the migraine finally released me, I noticed that summer was truly here. It had been almost a year since my accident. I wasn’t allowed to ride yet, but I’d been walking, feeding the horses, and giving Marcie her acupuncture treatments.

  The earliest I was allowed to ride was June 15, two weeks after Marcie’s birthday. I hated waiting! I needed to be on my horse. A few days before the fifteenth, we put the saddle and hackamore on Marcie, and I climbed up.

  It was tough getting up on Marcie. The stretch felt weird, although my hip didn’t hurt.

  But I was up! I was sitting on my beloved Marcie. It was my first time on horseback since that painful day on Scooter, the day after I’d helped Leah with Dancer. And I didn’t ride; I just sat.

  I raised my hands in triumph, and Earl took my photo to send to Dr. Kindsfater. (I’m not riding! I’m just sitting!)

  It was a perfect day, with perfect weather: sunny, warm, clear, everything green and beautiful. And I was sitting on my horse.

  With a small regretful sigh, I slid down after a few minutes. It wasn’t enough, but it would have to do.

  Looking back on that year of orthopedic misery and the year that followed, I realize Marcie launched me too—not high into the air the way Hannah did but back into a lifetime of horseback riding.

  24

  Snow Day!

  Several months after my hip replacement, a monster blizzard descended on Fort Collins.

  Snow day!

  No school, no work, no necessary errands to run; nothing but staying snug at home.

  Tipper was more of a house dog than Keli had been. Keli preferred to be outside, even in extreme cold; we had to insist that she sleep inside when the temperature dropped too low. Tipper preferred inside, and during the Great Blizzard of 2006, she wanted to be in the house. That was fine, but before settling down for the night, she needed to go outside to do her usual business. That meant getting her from the house to her pen and back again.

  Three feet of snow covered the ground, with a higher pile of it along the walk where Earl had shoveled a path to the dog pen. A nice walled walkway; no need for a leash. I could just walk with her to the pen and back.

  We stepped outside.

  Tipper vanished into the snow.

  Had I learned nothing in all those years of Keli’s adventures or from Tipper’s escape from Nancy’s yard?

  I couldn’t follow her; I could barely walk, let alone run high-stepping through the drifts.

  I didn’t see her anywhere. I finally climbed into the pickup truck and drove slowly around the block, hoping she’d surface. I looped the neighborhood just once; the roads were in terrible shape and unsafe. No one else was out, which was a small comfort; it was unlikely she’d get hit by a car.

  Mortified by my carelessness and stupidity, I called Animal Control and told them that my dog was on the loose. They reassured me that because of the blizzard, they weren’t ticketing anyone. I was halfway through giving them Tipper’s description when I glanced out the kitchen window and saw a dog speeding by the house.

  It was Tipper! Holy crap!

  I dropped the phone and opened the back door to yell for her, but I didn’t have to: she was sitting right there, like the obedient dog I’m sure she thought she was, waiting for the door to open. She was covered in snow and panting like a champion sled dog who’d just won the Iditarod.

  What to do?

  The only thing to do was compliment her profusely for being a good dog. As far as she was concerned, she was a good doggie; she had come home and was sitting on the stoop, and I’d opened the door within the three seconds her memory could track the action—returning to the back door—with my praise. Her running off in the first place was well beyond the three-second limit; she’d long since forgotten that action. Scolding her now wouldn’t help prevent a future escape.

  I welcomed her home and promised mysel
f that I’d never again forget that huskies are born and bred to race through the snow.

  25

  A Life Well-Lived

  It is never easy to make the ultimate decision about animal family members. Being a veterinarian doesn’t change that.

  On Monday, Marcie’s last day, Earl and I stood with her in her stall at the vet hospital. That long day of medical exams and tests had confirmed what we’d already suspected: it was time.

  Earl preferred not to watch the euthanasia, so he stood outside the padded anesthesia induction stall. I couldn’t not watch; I realized that this was something I had to do myself, for my best girl.

  The equine staff of the CSU hospital inserted the catheter into Marcie’s jugular vein. They administered the anesthetic, and Marcie sank down into slumber.

  A tech handed me the first of two syringes filled with the euthanasia solution. I inserted the syringe into the catheter and quickly depressed the plunger into the thick liquid, then swapped out the empty syringe for the second one and administered the last of the solution.

  I knelt beside Marcie, speaking softly to her and stroking her head and neck, and watched our beautiful friend drift peacefully out of this life and into the next.

  The next morning, halfway through my bowl of Rice Krispies, I said to Earl, “Let’s go watch the necropsy.”

  I don’t know that being a veterinarian makes it easier to watch the necropsy of an animal you’ve treasured. I do know that, to me, the physical body left behind wasn’t Marcie. Even so, I was a little worried that my breakfast cereal wouldn’t sit well during the procedure. I hadn’t originally planned on observing Marcie’s necropsy, but now, this morning, I was determined to attend.

  Earl and I sat in the viewing area. Marcie’s body lay on its side on the concrete floor of the necropsy room. It took me a moment to get used to seeing my dead horse on the floor, but my Rice Krispies stayed put.