Oh, life.

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.

That stupid, stupid corn on the cob.

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.

The owners have no idea how she got this piece of corn.

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?

Luna.

Some troubles are shallow, while others are deep. Just try to stay focused and stand on your feet.

It doesn’t stop.

Even at work. In the middle of a consultation – Charlie pops into my head. Gosh he has been coughing for over a week now. I wonder if he ate at nursery today, or if he got bitten by a kid again, or if he sat on any of them. “Sorry, how long did you say your dog has been vomiting for…?” My mind is all over the place.

Then I sit for approximately 4 minutes to eat lunch (If I’m lucky – most days there’s no sitting involved), open LinkedIn and see that it’s “World pneumonia day” on the WHO’s account which says that almost 1 million children under 5 died in 2015 from pneumonia, and my stomach sinks. Jesus, does Charlie have pneumonia? But the doctor said once he’s getting better, which he is, that he should be fine. And I reassure myself that all is ok…after I call the nursery to ask whether he ate and whether he’s still alive. You never stop worrying.

Yet the day goes on. Some fly by and others seem never-ending…until a case comes in that shakes and wakes you right back up. An owner comes in with a dog who has been chopped with a cutlass, by accident. The owner was hunting and the dog jumped in front of the cutlass at the last second directly in the line of fire…right along her face. Her eyeball was dangling, jaw broken, sliced all the way from the top of her head to the tip of her nose. The first thing you usually feel in brutal cases like this is of course, anger. I was angry, upset, horrified, sad. Up until I sat down and spoke to the owners and realized that they are truly genuine, kind people who actually really adore their pets and brought her all the way from the other side of the country to get help for her. I still get a shiver when I look at the ‘before’ photo – which I will not post because it is just a bit too much.

And because I know certain people who would buff me cause their tummy’s can’t handle it.

You see, when you decide to become a vet it’s usually because you love animals more than people, you feel like you were strategically placed on this planet to help them, you feel an inexplicable level of anger that channels your inner virago when people mistreat them, and you cannot explain its depth. Because they are innocent and pure and amazing. Why can’t we be more like them? Things change though, when you actually start working because you realize that it’s just as much about helping the animals as it is about helping the people who own and love them. Your job is about the human and the animal as a whole…one unit, it’s a cycle. By helping one you help the other and vice versa- a unique symbiosis. It’s more responsibility than you ever thought it would be and not something you were fully prepared for, but theres no escaping now.

Anyway – The whole situation was totally depressing until I had an epiphany. Of course, the owner must be devastated. Of course the owner is feeling a guilt that we cannot imagine. What is wrong with me, why am I so angry? I quickly realized that they were in a much worse position than I was and snapped myself back into professional mode. No judging. They were humble and kind and didn’t complain about the cost of the surgery and after care, which is a rarity. I felt guilty but thankful to be reminded that you should give people the benefit of the doubt in certain circumstances. Like this one.

We were in surgery for about 4 hours. I enucleated her almost already fully detached eyeball and we wired her jaw back together. Her soft palate and nasal cavity were torn apart, as was her gum from her jaw, and we sutured her face back together from the frontalis muscle to the orbicularis oculi to the levator nasolabialis. When she woke up I felt relief and shock. How on earth did she survive this? It had happened the night before and she hadn’t even tried to bite, snap, she didn’t even cry…she just sat there, helplessly waiting for us to fix it. She woke up all stitched up in dreamland and I imagined that she felt like I did after my c-section…high as a happy kite. I didn’t expect her to recover that quickly from surgery and sure as hell didn’t expect her to heal that well. I sent her home with a few different medications which were color coded so that the owner wouldn’t be too overwhelmed- various antibiotics and pain medications. A few weeks later the owner sent us pictures on WhatsApp and my stomach sank, fully expecting her to say that her wound dehisced, or she had an infection, or she didn’t pull through… but nope. She was totally back to normal, back to hunting, her good old self. I sat for a second, reminded of why I chose this profession. Medicine is truly incredible. Oh how I love it.

*Of course, the owner gave me full permission to post a picture of her lovely pet-child, and tell her story 🙂 *

Then the day which was initially taking decades to pass has suddenly turned into night and I fly home at inappropriate speeds to get Charlie from my mum. Hug, feed, bathe, play, sleep. Exhaustion. Netflix, wind-down and eat. Then bedtime – the time I’ve been waiting for all day. So tired I excitedly think that tonight I will knock out in a millisecond, yes. Then I toss and turn for hours on end contemplating life, Charlie wakes up for a beppm, Skye cries to go weewee outside, I run to weewee after that, then sneak back to bed wondering how many hours I can get in before it’s time to start another day and force myself not to check the phone. I lie down, heart racing, trying to work out what time it could possibly be then sorely give in, click my phone and it’s 4am. I lie back down distracted by all of the things to remember to do tomorrow, check that Charlie is still breathing 1,000 times using my phone light and swear to myself that one day things will get easier…then I must have fallen asleep because I wake up to “MummaMummaMummaMUMMA” at 6am. Here we go again! Another day.

Here she is, the super trooper, right after surgery. Girl power.

And this is her a few weeks ago.

“When you think things are bad,
when you feel sour and blue,
when you start to get mad…
you should do what I do!
Just tell yourself, Duckie,
you’re really quite lucky!
Some people are much more…
oh, ever so much more…
oh, muchly much-much more
unlucky than you!”

-“Did I Ever Tell You How Lucky You Are?” Dr. Seuss