The Gift of Pets: Stories Only a Vet Could Tell (29 page)

When I came in to the hospital on Saturday morning, I found Max’s breathing to be labored again. What worried me just as much was the look of anxiety that had crept back onto his face. I suspected air or fluid was leaking into the chest cavity. But when I aspirated the tube with the syringe, nothing came out. I needed X-rays to evaluate the problem, and I needed help to take them. Fortunately, Susan was willing to come from home to assist me.

When, in less than an hour, I was once again placing Max’s chest X-rays up on the view box, I was shocked to see a pattern almost identical to the films I had taken before surgery. There was the same light density at the bottom of the film, the same intestinal gas pattern where it shouldn’t have been, the same discontinuity to the diaphragmatic shadow.

“Oh no,” I said, letting out a deep sigh. “It looks like the whole incision line in the diaphragm has broken down. We’re going to have to go back in.”

“You’re kidding!” Susan had enough track record with my sense of humor to think I was pulling her leg.

“No, Susan. I wish I was kidding, but I’m not! And what’s worse, I don’t think it should wait till we’re open again on Monday. I think we ought to do it today.”

“Okay. But we will need extra help, won’t we?”

“Yes. We’ll need at least one more person. You can scrub in to assist me. We’ll need someone to ventilate Max and monitor the anesthesia.”

“Lisa’s out of town, you know.”

“Oh shoot,” I responded. The anesthesia for a case like this was especially difficult, and Lisa was the only licensed technician at the hospital at that time. “We’ll have to call in Ginny. We can walk her through the procedure beforehand. You call her and I’ll call Elaine.”

This was not a call I particularly relished. Ms. Farmer was expecting a routine update on Max’s continuing recovery. What she was going to hear instead was that another frightening surgery was necessary. I picked up the phone with a measure of dread. But I needn’t have worried. Elaine was her usual unflappable and controlled self when I told her the news.

“Well, that’s not what I wanted to hear, but I had a feeling things were not going as well as we wanted them to when I was in to visit him yesterday. Even Megan couldn’t spark any enthusiasm. And that’s not like Max at all.” She paused for a moment before continuing. “Say, Dr. Coston. Would you mind if I came in and observed the surgery? I wanted to watch the first one, but I was too busy to get away. I do have time today, though.”

I choked a bit on the phone, and she sensed my hesitation. “That is, if it’s okay with you. I wouldn’t want to go against your better judgment.”

It was indeed against my better judgment to let owners observe surgeries on their pets. There had just been too many times over the years when such a plan had injected unnecessary drama into an otherwise-routine procedure. But this was different. Elaine had quite a bit of clinical experience in her work. She probably would not get queasy. She was also very educated and levelheaded. Nor did I have a great deal of high ground to stand on. This was, after all, the second time I was going to have to do surgery for the same problem. Accommodating her request, I thought, was wise, though there was still trepidation in my heart. Had she not been so magnanimous, I probably would have said no.

“Okay. If you really want to, I’ll let you come. But it can be a pretty tense operation. I don’t want you to be alarmed with the process—no matter what happens, okay?” But I wasn’t really concerned about Elaine. She was just so self-possessed. I expected no problems from her.

Ginny arrived a few minutes later. Ginny was a short, lean woman about thirty-five years old. A no-nonsense, take-charge person, she was extremely capable and committed to doing everything just right. She had been a loyal client before approaching me for a job, timing her query just when I needed someone as an assistant. The vast array of individual tasks and the intensity and quantity of work done in the hospital had surprised her, as it does most new staff members. As she did not always feel proficient enough to perform to the level she expected of herself or at the speed she wished, this frustrated her.

I often recall with a chuckle her response to me one busy day when I added a new task to her already-long list of chores. She fixed me with a look mixed with equal parts humor and irritation and said, “Well, just stick a broom in my behind and I can sweep while I walk!”

I could see the exasperation on her face as soon as Ginny walked into the treatment room, where Susan and I were going over the materials we would need for the surgery. I knew that it was not from frustration at having to come in on a weekend. Ginny wasn’t like that. It was instead concern that she would not be able to do what I asked of her. There was foreboding on her face as I outlined exactly what she would do. But when I told her that Elaine was going to come in and observe, I thought she might just kick me.

Susan and I had given Max the anesthetics through his catheter and were inserting into his airway the tube through which we would administer the anesthetic gases when Elaine arrived. Ginny escorted her into the treatment room. Quickly I secured the endotracheal tube in place by pulling it to the roof of Max’s mouth and tying it around his nose and upper jaw with a length of gauze.

Susan and Ginny busied themselves scrubbing and sterilizing the surgery site. Max was laid out on his back, his front legs pulled over his head and the surgery table tilted dramatically so his head was lower than his chest. I gave Elaine a quick summary of the task at hand and what she would be seeing. I was careful to explain the process of manual ventilation, which the tear in the diaphragm made necessary. Then I began the ten-minute process of scrubbing my hands, donning a surgical gown, and pulling on a pair of sterile gloves in preparation for surgery.

Since I had completed surgery just three days previously, entering Max’s abdomen again involved simply cutting and removing the sutures that had been placed at that time and separating the already-healing tissues. Once I had entered the abdomen, I was surprised at what I found. I was not surprised that there was a diaphragmatic hernia. The surprise was to find that the liver, part of the spleen, and the intestines were bulging into the chest cavity not on the right side as they had been before, but through a hole that was just as big on the opposite side. This shocked me so much that I double-checked myself by looking for the suture line I had placed previously. There it was, intact and holding strong.

Apparently, the initial injury had resulted in a tear in the diaphragm on not just one side but both. The abdominal organs, however, had fallen through only the tear on the right side, the one I originally found. When I had tested the diaphragm for leaks during the first surgery, the liver must have fallen against the second hole, in effect sealing any leakage through it during the test. The second hole had remained undetected. It was not until the second day after surgery that the liver had once again slipped through this second hole, sending Max back into respiratory distress.

The process of closing the rent in the diaphragm would have to be repeated on the other side. This was going along famously, the four of us idly sharing pleasantries as I stitched, when all of a sudden Max’s heartbeat sped up noticeably and he involuntarily coughed. It is not unusual for a surgical patient’s depth of anesthesia to vary a bit during the course of a procedure. This is easily managed by changing the dose of anesthetic gases administered with a quick twist of a knob on the machine. But because Max’s head was tilted downward and because the gauze tied around his nose had apparently loosened during the forced ventilation, when he coughed, the tube I had inserted into his windpipe shot out like a blow dart, hitting the ground with a thud. The tubes connected to the anesthesia machine, through which passed the anesthetic gases that kept Max asleep, fell with it.

The sound made me jerk my head up from my work, my hands buried almost to the elbows in Max’s deep chest. My eyes went wide, and I was immediately stricken with alarm. I noticed that Susan’s eyes also registered concern. But nothing could match the ashen countenance on Ginny’s panicked face. It was frozen in slack-jawed terror. The three of us knew that it was now only a matter of time before Max started waking up—and not much time at that. If he came to with both his abdomen and chest cavities open, it would be catastrophic. I could envision the scene: Max bouncing around the surgery room, intestines falling through the incision, struggling unsuccessfully for a few frantic seconds to draw air into his lungs before crumpling to the floor.

There was not a moment to lose. Jerking my hands from deep within Max’s insides, I picked the tube up off the floor and ran to the sink in the next room, where I rinsed it quickly under the faucet. Then I raced back into the surgery suite, where Max was beginning to huff a bit. Standing practically on my head, I pulled his mouth open and quickly stabbed with the tube at his airway, the anatomy appearing upside down from its usual appearance because of his position on the table. Fortunately, the tube slipped easily down his trachea. Tying the gauze tightly around the tube and then again around Max’s upper jaw, I secured the tube in place again before reattaching the anesthetic machine to it. The whole episode had taken less than a minute, but I was dripping with sweat and there was a noticeable ringing in my ears by the time I had finished. I could feel the blood rushing to my face, redness sweeping aside the astonishment.

My gaze made its way around the room. Ginny’s eyes were wide above her surgical mask, the light blue of which contrasted sharply with the pearly white pallor of her glistening forehead. She pressed her back up against the wall, her palms gripping the vertical surface like a spider, her legs spread, knees bent and tense as if she was, at any moment, either going to take flight and run screaming from the room or slide unconscious down the wall. Susan was little better. Her hands, swathed in surgical gloves and bloody, trembled as she continued to hold a liver lobe aside at the spot where I had been working. Her eyes, too, were wide and rimmed with surprise.

I was afraid to look at Elaine. Throughout the ordeal, there had not been a sound from the corner where she stood. I wasn’t sure whether that was good news or bad. When I finally summoned the courage to look at her face, I was stunned to find there a serene and untroubled expression of complete calm. Her eyes were soft and steady as they returned my gaze, and though I could not see her mouth under the surgical mask, I was sure she was smiling sweetly. Her hands were clasped comfortably in front of her and she leaned nonchalantly against the wall. I could find not a trace of alarm or concern on her face or in her demeanor.

Her steadiness snapped me quickly back to the task at hand. I had to go through the entire process of scrubbing, gowning, and gloving again before I could proceed with the surgery, but the rest of the procedure was anticlimactic. In short order, I had repaired the hole in the diaphragm, tested for leaks, placed another chest tube, and closed the abdominal wall and skin. In no time at all, we were carrying Max back to his cage and pulling off our masks, gowns, caps, and gloves. Max’s recovery after that was rapid and complete. He was ready to go home within two days and was almost back to normal by the time we released him.

It was not until suture-removal time two weeks later that I dared to bring up the incident to Elaine. I asked her if she had been afraid or worried when things started to go wrong, and how she had remained so calm.

“I did notice that the three of you were pretty stressed. But there was nothing whatsoever I could do to help. I was sure you would soon have everything under control. And I figured that the last thing you needed was for me to flip out on you. And I was right to be so confident, wasn’t I? Look at him. Max is one hundred percent back to normal. You did a great job!”

I could have hugged her on the spot. How in the world it was that she had witnessed such unadulterated panic in the face of unexpected crisis without losing every shred of confidence in my skills amazes me still as I think about it. I had dodged a bullet!

There was, however, fallout from Max’s surgery. Ginny’s career as a veterinary assistant did not survive it. From that day on, she vehemently refused to be the anesthetist for surgical patients. Within just a few short weeks, in fact, she left my employment, choosing instead to go to grooming school to master that less stressful aspect of pet care. To this day, Ginny blames Max’s surgery for her career change. The terror of it was just too much for her. When she completed her training, she opened a pet-grooming parlor in a nearby community, where she is still a groomer today.

But there were no consequences with Elaine. Now, some ten or twelve years later, she is still a loyal client of mine. Sadly, Megan and Max are now both gone. But Elaine has two new dogs, young, exuberant, and wonderful chocolate Labs. Their pictures are pinned to the message board above my desk. In fact, as I look at the appointment book, I am pleased to see that Elaine has an appointment for both of her new dogs in the morning. I will remain forever grateful to her for her continued friendship and the confidence she still places in me, despite Max’s exciting surgery.

Fighting the Good Fight

There lies within some people an unseen and unseeable reserve of strength and energy, unbelievable optimism in the face of improbable odds, overflowing wells of goodwill, and constantly optimistic attitudes. Some of us are endowed with limitless stores of these qualities, stores which can be requisitioned in times of need—our own or the needs of others—despite the emergence of the burgeoning forces arrayed against us. Others, faced with similar circumstances, or even those not nearly approximating the same harshness, grovel and feign, wrap themselves in layers of excuses and complaints, thereby making their own lives piteous and unbearable, and casting the lot of those around them into deep shadow. Tragedy does not create in a person good character; tragedy only reveals the courage, the integrity, the forbearance, and the inner wellspring of strength that lie quiescent within those whose inner selves are constructed of these raw materials.