Tales from a Young Vet Page 12

  Thys decided not to wake the rhino fully until we reached its destination on the other side of the river that ran through the reserve. But when we reached the other side we realised that the trailer the rhino was in was more like a horse-box, and it had no window through which Thys could reach to administer the second half of the reversal drug. So, being Thys, he decided he would get into the trailer with the rhino, while he insisted I carried on filming, although I made sure I stayed at a distance. He nipped in, gave the injection, whipped off the blindfold and sprinted out, leaving the door open for the rhino to leave the box, which it did, hard on his heels.

  The following day we were back on farms, inoculating cattle against heart water, a nasty tick-born parasitic infection that can lay waste to livestock herds. It’s not present in the UK, but it is devastating in Africa. Thys used a primitive vaccine made from the blood of infected animals. It’s injected and then three days later followed up with antibiotics. He kept his vaccine in heavy old metal canisters filled with dry ice. Once he’d used the vaccine he took the lid off my water bottle, stuffed in some dry ice and threw it across the yard, where it exploded like a bomb. He thought this was hilarious and made several more bottle-bombs, roaring with laughter as they exploded across the yard.

  Thys was an extraordinary character; a talented vet, a passionate philosopher, a dare-devil and a schoolboy all rolled into one leather-skinned, white-haired, unconventional old man. Every time I worked with him he made me laugh, shocked me, stretched me to the limit and taught me invaluable lessons.

  After an action-packed month in South Africa it was time to go home again. I arrived back in England on a bleak day in early November. I had a weekend with my family before driving back to college to prepare for my next rotation – equine orthopaedics.

  On my first day the sky was grey and drizzly rain was making everything feel damp and chilly in the way that only a November day can be. In these unappealing conditions we were greeted with the news that we’d be spending most of our week outside, testing horses for lameness.

  The thrill of this had worn thin by the end of the first hour.

  ‘So what do you think about this horse? Is it lame or not?’ The clinician fixed me with an icy glare.

  I rubbed my arms and shivered as I looked at the horse being lunged in a circle in front of me. It looked absolutely fine.

  ‘It’s lame,’ I said. ‘In, er, the left foreleg? No, the right hind. Oh wait, erm, both? Maybe?’

  ‘I think you’ll find its lame in three legs. The left fore, the right hind, and the left hind.’

  Really?

  The horse didn’t look lame; indeed its gait barely looked uneven. But the clinician wasn’t finished.

  ‘To what degree do you think it’s lame? Lucy?’

  ‘Oh, um, two-tenths?’

  ‘Actually, just under one-tenth. Maybe a tiny bit more in that left foreleg. Since there are multiple lame limbs, the best way to start the diagnostic process is to bone-scan the horse. You students really must learn to spot lameness with more accuracy.’

  Lucy and I looked at one another. I was beginning to think we were being played, and I could see she thought so, too. It was honestly impossible to see how the horse could be lame, let alone in three legs. I thought I was pretty good at spotting lameness, but I clearly still had some things to learn.

  Lameness is measured on a scale of ten, with one-tenth being barely visible lameness. Anything under that wouldn’t usually cause any concern; in fact, some people argue that lameness under one-tenth doesn’t even exist, but the clinician clearly wanted to keep us on our toes, hence the ‘Is this horse lame or not?’ routine. We went through this performance at the Equine Centre endless times, watching horses that appeared to be pretty sound, while standing out in the rain – it rained for the entire week – and wishing we could be almost anywhere but there.

  The only bright spot in the week was when we were told a case was coming in the following day for patella ligament surgery and I managed to bag it – anything for a break from the lameness routine. An hour later I went out to the car park to find an enormous lorry waiting there. Judging by its size it contained a very large horse, but as the door opened what emerged was a little skewbald (brown and white) Shetland pony, Otis, with more hair than body. He reminded me of the Thelwell cartoon ponies.

  I introduced myself to his owner, Mrs Harris, and while she closed the lorry I took off Otis’s travel boots, which were much too big for him and made him look like a toddler in grown-up wellies.

  Otis may have been small, but he was a big personality. He strode into the barn and made himself instantly at home as the rest of the rotation group gathered round to say hello while I went with Tim, the clinician in charge, to take a detailed history from Mrs Harris.

  Otis had a condition in which one of his back legs would lock in an extended position. Known as locking stifles, this happens when one of the ligaments holding the patella (kneecap) in place is slightly too long and sometimes gets caught over the end of the femur. It usually unlocks by itself after thirty seconds or so, but it can be quite distressing for the horse. Exercise to build up hind limb muscles often helps, but as Otis was too small to be ridden it was difficult for Mrs Harris to give him enough extra exercise, so he needed surgery.

  Tim and I waved Mrs Harris off, and he told me to let my rotation group know we would be doing the surgery straight after lunch. I got back to the stable to find Lucy beaming and Otis with a catheter successfully placed in his neck. She had managed to insert it first time, proving that she wasn’t half as bad at horsy stuff as she thought she was.

  I peered over the stable door. Jade and Katy were giving Otis’s voluminous mane a brush, while Grace talked soothingly to him in preparation for his operation. I dragged them all away for a quick lunch before we gathered at the knock-down box next to the surgical theatre where Tim, an equine nurse, a resident equine vet and an anaesthetist joined us. Otis was sedated and then given the ketamine–diazepam combination to knock him out. After a few seconds he fell gracefully to his knees and then onto his side with a small grunt. At least he didn’t have far to fall!

  After scrubbing in Tim located the ligament using an ultrasound machine and, with a very small scalpel, made several stabs along the length of the ligament. The idea was that when these cuts healed they would form scar tissue that would shorten the ligament and stop it catching. It was a simple operation and in minutes we were done. Twenty minutes later Otis was conscious again and attempting to stand. He was going to have a sore leg for a while; he wasn’t going to be allowed pain relief since all equine pain relief is anti-inflammatory, and the whole point of the surgery was to create inflammation and scarring. I felt very sorry for him, but a day or two later he was well enough to go home and was loaded back into the huge lorry he had arrived in. Over the next few weeks it would become apparent whether the surgery had worked.

  Little Otis proved to be our only bright spot that week. After the excitement and adventure of the wildlife work, trying to spot lameness in horses that looked perfectly fit was pretty dull. I was missing Jacques, and the sun, badly. And to make matters worse, the Saturday at the end of that week was my birthday. I would have loved to have been spending it with Jacques, but a Skype call would have to do. I wasn’t even sure I’d manage the day off; we were expected to do weekend shifts, but at the last minute I managed to swap my shift that day and race home.

  As it was just after bonfire night we had a houseful of uncles, aunts, cousins and grandparents, a buffet and fireworks. After the week I’d had I was more than ready to party, so it was nice to catch up with everyone and it made a welcome break.

  The following week we were back at the equine centre for equine soft-tissue surgery, which was a lot more interesting than the orthopaedics. It meant an early start at the stables to do our SOAP – Subjective, Objective, Assessment and Plan – for each horse we’d been assigned to, checking to see if it was bright, alert and responsive, checki
ng its pulses, gum colour, heart-rate, gut sounds, breathing rate and temperature, and generally assessing whether it was improving or deteriorating. After that we had to decide what we thought should be done; more or less drugs, different drugs, diagnostic tests and so on.

  We had to get out of the way by 8.30am, when the clinicians did their rounds, so we’d slope off to have breakfast before meeting the clinicians to go through our findings. This usually involved a grilling along the lines of, ‘Fine, but have you thought of this?’ or ‘Why do you think that would help?’

  My first patient was an event horse called Mackenzie. He hadn’t been performing well, was breathing noisily and wheezing, and we needed to find out why.

  He was a handsome fellow, chestnut with white markings, and he stood at least seventeen hands high, which is five feet eight inches at his withers – the point where his neck meets his back – meaning that the top of my head was just about level with his nose.

  We suspected that Mackenzie had RLN, or recurrent laryngeal neuropathy, a condition in which the top of the windpipe is partially closed because the nerve that supplies signals from the brain to the larynx, called the recurrent laryngeal nerve, has been damaged in some way. This is easily done, as the nerve takes a tortuous route from the brain, down into the chest, around a blood vessel then back up the neck to the larynx, and because of this there are plenty of opportunities for it to become damaged. The test for this condition is to put a camera up the horse’s nose and down the back of its throat so that you can see the larynx open and close as the horse breathes.

  The clinician in charge, Tom, was a hugely clever, very intense and focused vet, not given to being chatty or wasting time. ‘Right, Jo, you’re doing this,’ he said.

  I’d seen it done several times, of course, but watching someone put an endoscope costing thousands of pounds up the nose of a horse that is tossing its head around, especially given that said nose is full of fine blood vessels that can be easily punctured and will then bleed copiously, is very different to doing it yourself. And to make matters worse, the TV crew were there, taking a lot of interest in this case. So, with a camera focused on my face, I gritted my teeth. ‘Come on, Mackenzie,’ I muttered, ‘we’re going to do this’. I grabbed his nose, stuck my left forefinger and thumb into his nostrils and pushed the endoscope in under my finger, so that it ran along the bottom, next to the septum. And to my amazement it worked. I turned around to grin at Amy, who was holding the sound boom. She gave me a thumbs-up with her spare hand. I was so pleased that my brief moment of success had been caught on camera.

  The endoscope camera confirmed what we suspected; Mackenzie had RLN and would need what’s known as a tie-back surgery. I scrubbed in and Tom opened up the side of the neck so that he could reach the larynx. My job was to hold the incision open with retractors, which I did for two hours, with Tom barking ‘Open it up more’ every few minutes as he stitched open the part of the larynx that kept flopping shut. It was an impressive job, and would mean that Mackenzie could breathe in a significantly larger volume of oxygen and so perform far better. For the next few days I watched Mackenzie closely, doing all his checks and going in regularly to give him a stroke and a few words of encouragement. His progress was excellent; he would be going home before the end of the week and would be back eventing in just a few months’ time.

  We were all a little in awe of Tom, who had achieved, in addition to his basic veterinary qualifications, a PhD and then a residency at Cornell University, which meant he was both a European and an American specialist in equine surgery, all at a ridiculously young age. Tom loved technology; he always had the latest gadgets, and when he wanted to show us something he would send us a QR code to our phones, rather than an email link. All of which meant that when, towards the end of the week, he handed Lucy his brand new iPad to take some pictures of the colic surgery he was doing, she took hold of it with extreme care. Not quite extreme enough, though, because she didn’t realise that the iPad cover was only attached to the iPad by a magnet and as she lifted it for a picture, holding it by the cover, the iPad fell out and smashed on the floor. We all stared at it, speechless with horror.

  Tom was aghast, but he had his hands inside the horse, so there wasn’t much he could do except fume, while Lucy turned pale and ran out of the surgical suite.

  After that it was hard to concentrate on the colic surgery, which I absolutely needed to do, since I’d scrubbed in and had one arm inside the horse feeling around for its intestines, which Tom was in the process of untwisting. I had no idea what to say, so for the rest of the surgery I kept quiet, tried not to catch Tom’s eye and just followed directions when asked to pass a surgical instrument or hold something.

  After the operation was over Lucy and I went for a quick cup of tea in the student tea room. ‘There’s something about horses,’ she groaned. ‘I just seem to have bad luck when I’m on horse rotations. That would never have happened if it had been a cow.’

  I wasn’t too sure about the logic of this, but it was one of those times when the only thing to do was to nod sympathetically and pass her a very large slice of cake.

  ‘It’s so typical it would happen with Tom,’ she groaned, biting into the cake. ‘He’s the one clinician you really want to impress. What do you think I should do? I mean, he can’t honestly expect me to pay for it, can he? I’ve got a £35,000 student loan to pay off already. I just don’t have that sort of cash.’

  ‘Don’t worry. I don’t think he will expect that. Just get him something to say sorry. I mean, he was the one that asked you take the photos. He took the risk with your butter fingers.’

  ‘Too soon for jokes, Jo,’ Lucy replied, although there was the flicker of a smile on her face.

  The next day she brought in a bottle of wine with a picture of a sheep on it, and a card saying ‘I’m feeling sheepish’ on the front, which made Tom smile. He forgave her, and even gave her a good grade for the rotation.

  CHAPTER ELEVEN

  The Kitten who Thought She Was a Parrot

  By late November I had reached a real low. We were in the middle of our two weeks in small animal medicine and it was, to put it mildly, challenging.

  To be honest I had dreaded this placement, and it was turning out to be even worse than I had feared.

  The problem with this rotation wasn’t the patients, which were mostly cuddly and uncomplaining, it was the non-stop pressure of hectic twelve- to fifteen-hour days on which I arrived at and left the almost windowless confines of the Queen Mother Hospital without ever seeing daylight.

  I’m a very outdoorsy person. I need to ride, jog, walk or just get outside, or I start to get cabin fever. But on the treadmill that was small animal medicine there was no time even to stick your head out of the door and check that daylight still existed. Breaks were snatched and barely lasted long enough to grab a cup of tea or a biscuit. And inevitably tiredness set in, tempers frayed and grumbling became the order of the day.

  Lucy, Grace, Jade, Katy and I were on this rotation with our sister group. So there were ten of us students, each being assigned multiple cases for which we were expected to take charge, and the strain set in pretty much straight away. Even cheerful Charlie looked a bit white-faced by the end of each long, long day.

  Each morning I woke at 5.30am to a freezing cold house, threw on my clothes, gulped down half a bowl of cereal and huddled into my coat before venturing out into the cold and dark to de-ice my car.

  I had to get to the hospital by 6.30am to start animal checks. On day one we were each assigned multiple cases and from then on we took charge of them. As new animals were admitted to the QMH we were allocated their cases, which happened as frequently or sometimes more frequently than our current cases being discharged or transferred to other departments. So we continually had at least three or four cases on the go, and that meant morning SOAP checks on all of them. In addition to checking their medical state, we also had to clean out kennels and cat cages and take any dogs that wer
e in our care outside so that they could go to the toilet on the square of grass reserved for this purpose. Everyone was supposed to pick up after the dogs, but a lot of them had diarrhoea, so we’d be out there in our dolly shoes tip-toeing through a minefield of dog mess and mud in the dark, thinking ‘Please go quickly so we can go back inside’ while the dog whose lead you were holding would be sniffing around, taking its time and enjoying the aroma. At least the cats had litter trays.

  At around 8am we’d go to the tea room for a welcome cup of tea and to be allocated the new cases that were to come in that day. Each one would have an entry on a consult list for the day that would have the animal’s name, breed and a one-line summary of its condition. We’d all fight for the easy cases, which basically meant conditions we understood or ones that looked a little bit more straightforward. That didn’t mean we got them, though! It was a first-come, first-serve situation and we were all ruthless, snatching cases from under each other’s noses and ticking them off the list.

  Once all our animals were sorted out and assessed, we met the clinicians and had to explain to them what was happening with each animal and what the plan was for its care. And, of course, the clinicians did not accept any plan without asking a dozen challenging questions that made you doubt whether you’d made the right diagnosis after all.

  My first case was a kitten called Twinkle. I’d cheated a bit, because my housemate Andrew had been on small animal medicine the week before I started, so I asked him if there were any nice cases he’d worked on that I could take over. He told me Twinkle was cute, so when her case came up I volunteered. But what he hadn’t told me was that Twinkle seemed to think she was a parrot.

  I laughed when someone first said this, but it was true! Twinkle was a beautiful little blue kitten and her condition had initially been a bit of a mystery. She needed regular examinations, but as soon as you picked her up to have a look at her she would clamber onto your shoulder. And if you tried to stop her, she would just scramble and scratch your neck until she got her way. It was funny, but very frustrating, too. In the end, every time I needed to check her over I had to ask Lucy to come and help so that she could sit on Lucy’s shoulder and I could check her there.