Why is it that just when you think you’re getting your life back into some sort of order… when you’ve made a plan that may actually stick (moving to England) and not explode into a million pieces…some event comes along and throws you totally off track? This event may be a person. And this person may actually throw you off your current track and get you onto an even better one, which you will realize after a bit of denial. And as usual… impeccable timing, life.
It started with a dog. A very beautiful doggie as a matter of fact.
I got an emergency call that she was vomiting masses of green fluid constantly, suddenly not eating and drinking, lethargic – just totally not herself – definitely an emergency case that needed stabilizing – so I met the owners at the clinic. Not like the ones who call you just to have a chat about their pet at 11 pm. We took her into the clinic that evening and put her onto fluids, antibiotics and pain relief until the next morning when I did radiography and ultrasound. The owner was convinced that she had eaten a piece of carpet. But this definitely looked like a cob of corn on the x-ray and on ultrasound I saw the swirling fluids rolling back and forth in the intestine, blocked from flowing through by this stupid piece of corn.
We performed a full hematology and biochemistry blood test to ensure no concurrent issues and took her straight into surgery. Foreign bodies can be fun to operate on because usually it’s just a small incision into the intestine and you remove the silly thing they ate, put it into a bag to excitedly show the owner, close them up and that’s that. I’ve seen mango seeds, toothbrushes, metal cloths, my friend got a rubber duckie recently… But this case wasn’t that simple. Because it was an entire cob lodged in there, her intestine was compromised (it looked an unhealthy purple colour) which meant that we would have to perform a resection and anastomosis. Remove a portion of the intestine and close back the two healthy ends. This was after much debate and even trying laser therapy to bring the unhealthy tissue back to life – to no avail. We ligated the vessels that fed that portion of intestine, removed it, sutured the healthy ends together, leak tested it and made a beautiful omental wrap. We then moved on to the stomach which was dilated at least 3 times its normal size, made a tiny incision about 3cm long and suctioned over 1000ml of green foul smelling watery fluid out of it. We sutured it closed, double checked all of her abdominal organs and went through (again) the entire length of intestine from stomach to colon to make triple sure that we got everything out and to check the integrity of the sutures, all of which were A-okay. I closed her up and that was that. Or so I thought.
She recovered from surgery really well, started eating little by little and seemed to be doing fine. The first 48 hours are the most critical and I’m a paranoid freak so I kept her in for four days before sending her home. Because the surgery was a biggie, I asked the owner to keep a really close eye on her as there are many potential complications, and they updated me constantly Some complications included shock, leakage, ileus, dehiscence, peritonitis, adhesions, stenosis, recurrence, intussusception, and ultimately death. Gosh it sounded like those adds on TV for drugs that are supposed to help you but actually you’ll die from some other random complication. “Take this pill to lower your cholesterol, but watch out as it may actually make your cholesterol higher and give you a heart attack, cause severe depression and kill you from a blood clot.” And they say it in the happiest voices too, it confuses me every time. The owner said she pooped at home which was like music to my ears, and although she wasn’t back to her normal self as yet, clinically was doing fine. I wasn’t worried. Until the next morning when I got a frantic call that fluid was aggressively leaking out of her incision and she looked like she was dying.
It was Sunday. I flung Charlie into my mum’s arms and flew to the clinic to meet the owners – my stomach sank when I saw her condition. She was very obviously in shock with bloody fluid flowing out of her incision which seemed to have opened up a little bit cranially. Her mucous membranes were pale, she was tachycardic and almost totally unresponsive. I felt sick and I felt my eyes tear up. Get it together Steffi.
At this point there wasn’t much stabilization that could have been done so the vet-on-call and I made a clinical decision to get straight back into surgery. Differentials were now post operative peritonitis from wound dehiscence, DIC secondary to sepsis… We thought that going back into surgery and finding it would at least give her a chance of survival. We couldn’t find a source of bleeding, the intestinal and gastric tissue didn’t look necrotic or dehisced, the abdomen just kept filling up with blood. We removed over 1 litre of bloody abdominal fluid that had no clotting and under the microscope all we saw were red blood cells and the occasional white blood cell. During the surgical exploration her heart stopped and we administered epinephrine and dopram to try to get her back up and running but just couldn’t. My stomach twisted and I was in total shock myself. I stayed for ages looking, searching for a cause of the bleeding to at least have an answer for the owner but I just couldn’t find anything. The vet-on-call spoke to them as I wasn’t in any condition to do it at that moment, and I was so grateful. I spoke to them after a little while of sitting down and trying to figure out what the hell just happened. We took biopsies of every organ and sent samples of fluid from her abdomen to the lab but they were all inconclusive.
You always feel extremely upset when you lose a patient but this was different. I felt a deep sadness and couldn’t figure out whether it was because it was the first case that I had personally lost post-surgery so I felt totally responsible and like a terrible vet. Or if it was because she was just such a lovely sweet beautiful dog or if it was because I’ve known the owner for most of my life. We weren’t ‘friends’, but we knew each other. Probably a combination of all three. I found myself randomly crying about losing her and was feeling waves of guilt intermittently for a few weeks after it all happened. I took the sympathy card along with a photo of her for the owner. It was tragic seeing someone lose a pet that they cherished so much and I kept imagining the mess I’d be in if it was happening to me. I also felt responsible for her death because she was my case and thought, God he must hate me. I hugged him tight.
…and that’s how we started getting to know each other.
Who on earth would have thought that a beautiful relationship would come out of such a heart-breaking situation?
Some troubles are shallow, while others are deep. Just try to stay focused and stand on your feet.