Client Conversations #14

 Hello, I was wondering if I could get an appointment tonight for you to microwave my cat?

Microchip. She meant microchip.

What stress?

 It was a chaotic and stressful day. An op turned up that was booked as just an appointment on the diary, meaning that we hadn’t allocated the time properly and would be pushed to get everything done by evening surgery. An emergency had called in and needed seen right away - fortunately it didn’t need anything extensive and was quickly resolved, but that was another 20mins taken out of the day. Every dog had managed to poo in its kennel, then dance around in it a bit. The feral cat was so frightened and aggressive that when we approached the wire basket he was in, he pee’d himself whilst scrabbling around, spraying the nurse liberally. So it shouldn’t have been a surprise when the last procedure started to go wrong. After a little sedation to take the edge off I had scooped him up and carried him to the theatre, which was when I noticed his abdomen was tight like a drum. Immediately I went into emergency mode, called in an off duty nurse to help, informed the owner and got him knocked fully out. When dogs begin to bloat up, it kinks the pipe into the stomach so they become unable to burp, exacerbating the problem. If the stomach twists, it becomes really serious very quickly as it both cuts off the blood supply to the stomach wall, but also the grossly distended organ puts pressure on the main vein returning blood from the back half of the body, causing circulatory collapse and death. 

I started a general anaesthetic, placed the biggest endotracheal tube I could into his windpipe, measured out what length of stomach tube I would need and fed the thick walled pipe down his throat. I knew I had hit the jackpot when a huge hiss of stinking gas hosed out of the tube, and he deflated in seconds. I stood back and smoothed my forehead, sharply aware of how close he had come to disaster. 

We got on with his scheduled investigation, removed the tubes and lifted him to a padded area on the floor to recover. Looking down at my hands, I realised that there were streaks of blood up my hands and arms. 

“Where’s he bleeding from!?” I squeaked, having visions of having torn his oesophagus with the stomach tube. “I lubed it up, I was so careful! Where is it?!” His mouth was clean. His fur was clean. His IV cannula was clean and dry. I rocked back onto my haunches, and Angela looked up at me. 

“It’s you” she said. 

“What?”

“It’s you. Your nose is bleeding”

Client Conversations #13

 “He’s got ain o’ they Isis.”

“Eh? What, like the Taliban?”

“No! Well, yes, but in ‘is eye!”

“Wait, what? Ohhhhhh - do you mean an eye cyst?”

“Yes! Isis!”

Foalings, Fears and Flunixin

     "It’s an awkward one Heather, I’m so sorry to bother you with this on a Sunday and all, and it’s not even my horse, but you know the field that faces onto my Grandma’s house? Where the trotter ponies get tethered? Well there’s this mare in there, she’s foaled but she’s still down, nobody is looking at her, and it looks really bad. Can you come?"

     I logged the call with Bill – every time I went out I let my boss know where I was going, then phoned in when I got back. It made it easier to trace me if I disappeared, and a tiny bit safer as a lone female driving a car full of drugs around remote locations. “£140” he said. “Cash”. I then called one of the local travellers to find out who’s horse it was. He promised to “send a lad up, hinny”, and I set off with some trepidation.

    I got to the field gate at the same time as a pick-up truck with two burly travellers inside and the lad Johnnie had promised in the back, a quiet skinny 17 year old with a wispy moustache who would never look at me but always at the ground to the left of my boots, whilst almost whispering the answers to any questions sent his way. They said he was a demon for the drink.

     We bumped across the grass in convoy and pulled up alongside her prostrate body. The turf was roughed up into furrows where she had been kicking out, struggling to give birth to the foal which lay behind her in a tangle of limbs. He was alive, but a bit cold and slow. The young lad set to work with the foal, coaxing it and rubbing it with his coat which he had taken off to dry it and get it going. The other two stood nearby and stared at me.

“Reet naa, whit ye ganna dae wi thissun then?”

     I tried to look confident, and started talking through the exam as I was performing it. The mare was soaked with foamy sweat, her eyes rolling with fear and exhaustion. She had passed the placenta and it looked intact as far as I could see, so that was a good start. I couldn’t see any signs of bleeding. There were no vaginal tears on exam. But she was pretty done, unable to lift her head, gums darker than they should be, a very sickly animal. Her heart rate was much faster than normal. She didn’t respond to our attempts to get her up.

     “It’s a bad do guys, I can give her a couple of jabs to see if we can rouse her, but I’m really concerned she’s going toxic.”

“Dunno lass, if you give her a jab I’m paying for a jab, then she doesn’t mekk it and it’s a reet waste o a jab an my bloody money like. Mebbes we should just pit ‘er doon. Ah wish ah’d brought us gun wi us.”

At that, another 4x4 appeared at the gate and trundled down towards us. I looked over at the guys in askance.

“Me mates”

     They parked behind my car and another three men got out of the vehicle, one carrying a rifle. I tried not to show any fear – now there were six guys and one gun surrounding me, blocking in my car. They started to discuss whether they should let me give the horse an injection or just kill it. I struggled to keep up with the debate, whether on purpose or not I’m not sure, but I wasn’t able to follow much of the heavy dialect and cant. Eventually they turned back to me.

“Give er a chance, pet. But if it doesn’t work….”

     I went back to my truck and selected three bottles with very little idea of whether they would help or not. I opted to give her some heavy pain relief, some non-steroidal anti-inflammatory and a hormone to help her along. I raised her jugular vein, sank the needle through her skin until I hit the flash of red, then gently pushed the drugs into the vein. Sliding the needle back out, I put a little pressure on the site and gave it a rub to stop the bruising. I leaned forward to whisper in her ear. “Come on, old girl”.

     I had turned back towards the car to dispose of the needle when a yell went up behind me. She was thrashing her hooves in the air, nostrils flared. Two of the men ran downhill of her on the steel slope, pushed their shoulders into her side and dug their heels into the ground, tipping her feet back to the soil. She dipped her head and with an almighty heave, leapt to her feet.

“Bloody hell, Vitnery! What’s in them jab? Can I has one?”

     The mare stood for a few seconds, catching her balance, then tossed her head, shaking out her mane. She shivered all over a couple of times, then stepped over to her foal. She nuzzled the newborn and gave a soft deep whinny.

“Get her a drink please, guys.” I said. Johhnie’s lad produced a bucket from the back of the pick up and tripped off to the water trough.

“Ah’ve never seen owt like that! You’ve done us a bloody good job there, hinny. What’ll y’be wanting fer that then?”

“Cash?”

“Wey aye, man”

I pretended to tot up the drugs in my head, counting on my fingers for a second before confidently stating “£150”

He went into his jeans pocket and pulled out a doorstop roll of cash, peeled off two £50 notes, two £20’s and a £10.

The water bucket came back, and the mare took a long slow drink.

I checked her again, and her heart rate was down a bit, her colour ever so slightly pinker. It was time to go see the boss and hand over the cash.

“Watch her tonight lads, any bother just give me a shout alright? Now then, I’d better get on, can you shift the truck and let me out please?” They looked at each other slyly with a question in their eyes for a second and I felt the deep spike of fear, but they broke into smiles and one stepped forward and moved the 4x4.

     I pitched up at Bill’s proudly producing the £150, and he was so pleased that he handed the extra tenner back saying “Danger money” with a sideways grin.

Merlin

     I was standing in the prep room washing my hands when a chunky Springer Spaniel pushed his way through the door and against my knees, stuck his nose in the air and looked up adoringly at me, his whole neck pressed against my leg. I dropped my hand to tickle his ears and he nearly knocked himself over by wagging his tail furiously. Merlin had arrived. Having completed his rounds of saying hello to everybody he ran away back through to his owner in the waiting room. I followed him and we all went into the consult room, Merlin first. It was a pattern we followed every visit.

     As I leaned over to have a look at him I saw that he had blood all over his feet. His owner saw me start and said
“When we went in to his kennel just now there was a big pool of blood with big clots in it. I took him out for a pee and it was just straight blood.”
     Right enough when I looked at him the source of the blood was his penis – he had pee’d so much blood he was splashing about in it. I checked his prostate but couldn’t feel any problems there, and his gums were still nice and pink with a slightly slow return to normal when I pressed my thumb against them to make them blanche. He certainly didn’t seem ill, he was full of beans. I lifted him up on to the examination table and felt his belly. His secret was revealed – a tumour the size of a large orange at his bladder. It must have burst into the bladder itself, and now he was slowly bleeding to death through it.

     Here was a tough decision. The chances of successfully removing the cancerous tissue and saving him were small and he was getting on a bit; it was a big op for an old guy. I would desperately have loved to be able to pull off a miracle for this most beloved of patients, but we had to be realistic – Merlin wasn’t going to make it. His owner didn’t want to put him through the invasive surgery. They couldn’t face the prospect of taking him home overnight and so we all agreed that the only way forward was to put him to sleep today, now. His owner was devastated, fat tears slipping off her nose and chin, dripping to the floor.

     I tried to get IV access, but as his blood pressure was dropping, his peripheral blood vessels were constricting to keep the blood flow to his core tissues preserved. On top of that the wriggling and waggling didn’t give us a stationary target. I made the decision to sedate him so he wouldn’t know what was going on and wouldn’t be distressed in any way. A mid range dose and ten minutes wait had him floppy and snoring on the floor. “Come on, son” I said, “let’s get you up on the table”. Despite his sedation, his tail started wagging at the sound of my voice. He was otherwise unresponsive, but every time I spoke to him, his tail thumped against the tabletop.

     Talking to him all the way I slipped the needle in, and delivered the fatal dose. His tail wagged and wagged and wag… and stopped. His owner howled in pain. She hugged him, then threw her arms around me, quivering with grief. And then she turned on her heel and burst out the room, out of the practice and out into the dark.

     I bent and kissed him on top of his head, pressed my face into his neck, and allowed the silent heaving sobs that I had been holding back to be released.

A Swift Exit

     There is a short season every year where we get birds handed in that people have found on the ground. For most fledglings it’s normal to leave the nest a couple of days before they can actually fly, but not swallows, swifts or house martins. They will sometimes accidentally find themselves on the ground and not be able to get airborne again, particularly the swifts. These amazing feathered arrowheads nest in the eaves of houses mostly, so to start flying they use a bit of gravity from two stories up. That option isn’t available when you find yourself on somebody’s driveway. 

     I particularly enjoy getting a chance to see them up close rather than overhead at nearly 70mph. Not only that, I can fix most of them by dropping them out of an upstairs window- now that’s my kind of medicine!

     One day I was checking over a swift that a client had brought down, stretching out its wings to look for breaks or scuffs, checking the flight feathers were intact, when suddenly I saw a massive spider like insect dart across the skin under the feathers.

     Now I’m not notably jumpy, but it was everything I could do not to slam dunk the bird on the floor and run away screaming. This was the stuff of horror films. A large, very fast biting beastie millimeters from my fingers.

     I returned the swift to a quiet kennel, trying all the time not to scratch, and went to look up what this could be. 

     I discovered that swifts have a type of flat fly that is similar to a louse, but bigger and faster. It doesn’t touch humans, so I had nothing to fear, although when it is running at you it’s pretty scary. Crataerina pallida does not have many friends. Birds are usually infected in their parents nest, and will then carry the parasites for life; they are too quick to be caught and killed. They can literally suck a young swift to death, which may be the reason our bird had ended up on the ground in the first place. I steeled myself – it had to be done.

Crataerina pallida - very fast, very horrible. Tiny wings. 

     I got a pair of curved artery forceps and a latex glove. Wearing the glove on my left hand and brandishing my weapon in my right, I picked up the wee bird and started the hunt. I caught sight of the beastie but it shimmied away at lightening speed and hid under the wing. But I was determined – the bugs had to go. I managed to swoop in just as it was away to climb round onto the swift’s back, and caught it by one leg. It was enough to dislodge it and dispatch the parasite. I went back in for more. I took three in total off this tiny sleek bird, and felt quite triumphant. It was window time.

     One of the nurses stood in the car park with a washing basket, ready to receive in case it still wasn’t able to fly. They were not very convinced by my assertion that all we had to do now was chuck it out the window. Nevertheless, they trusted me enough to let my try it. Or maybe they just trusted their own catching skills.
     With a shout of one, two….three! I launched the wee guy out of the second story window. For a sickening moment he tumbled towards the tarmac, then righted himself, swooped low to the ground, built up some speed and lifted himself, disappearing over the roof of the neighbour’s house like a pocket rocket. The nurse gave an audible “ooh!”. 

Satisfied with a happy resolution, we wandered off towards the kettle, another case cured.

House Martin just before curing by window.

    

"Helping"

It's very important to me that the nurses don't get all the crappy jobs whilst the vets swan off to do something less grotty, so I've always tried to muck in with the floor cleaning, pee mopping and assorted stinky jobs. 

Unfortunately I'm just not that good at it.... 

...here's a message I was sent by one of the nurses