Tales from a Young Vet Page 13

  Twinkle had come to the hospital a few days earlier because she kept dribbling and pressing her head against the wall at home. Excessive salivating is an indication of nausea, and judging by Twinkle’s lack of appetite she certainly wasn’t feeling her best.

  Based on all of this, and coupled with the fact that she was very young, there was a presumptive diagnosis that Twinkle had a liver shunt caused by an abnormality that had occurred when she was developing in the womb, which meant that blood was bypassing her liver rather than going through it. This had led to a build-up of ammonia in her blood. The liver filters ammonia and converts it to urea, which isn’t toxic, but if the blood isn’t going through the liver or the liver isn’t working, then ammonia builds up. Excess ammonia can lead to many problems, including nausea, but the worst of all is the effect it has on the brain, causing the compulsive head pressing and progressing to seizures, coma and death if left untreated. The condition is otherwise known as hepatic encephalopathy. Twinkle was on lactulose, which takes the strain off the liver by decreasing the uptake of ammonia from the guts, and it seemed to be working quite well. She also was on antibiotics to alter the good bacteria in her gut and stop them producing so much ammonia from the protein in her diet. The alternative would be surgery on her liver, but we hoped she wouldn’t need that as she was simply too small for such a major operation at this stage.

  My next patient was Bella, an eight-month-old yellow Labrador puppy with chronic, profuse diarrhoea. She was severely dehydrated, so she needed to be on a drip. It isn’t easy having a young dog on a drip, because they want to bounce around and tend to get tangled in the tubing, but Bella was feeling rough and she was flopped in the bottom of her kennel, her nose resting on her paws, her big eyes following every move I made.

  Despite her tender age, Bella had been in the hospital before. Like Twinkle, she’d had a liver shunt, and at just a few months old she’d had surgery for it. Her recovery had been good, and the condition she’d arrived with on this occasion was unconnected. It was just rotten luck that she’d become sick again.

  This time the diarrhoea had not responded to initial treatments by her local vet, so she’d come to us for further investigations, and on my second day in the unit a faecal culture revealed she had Giardia, a protozoan parasite that manifests itself in the gut. This caused a bit of concern, as Giardia can be transmitted to humans, giving them symptoms similar to a severe form of food poisoning.

  Until then I’d been enjoying giving Bella lots of cuddles, but the presence of Giardia meant that we had to barrier nurse her, kitting up from head to toe in protective clothing and wearing rubber gloves, and then wash very thoroughly after each examination. I was a bit worried that I might have caught it already, but there wasn’t much I could do except wait it out.

  Meanwhile, in came Toby, another Labrador puppy, an adorable little chocolate-coloured fellow, just three months old and full of bounce. He had severe diarrhoea, too, so, until we had his tests back, we also had to barrier nurse him. Unlike Bella, Toby was not feeling too bad, and he wanted to play. Like most young dogs he wanted to bite and chew absolutely everything, so despite my protective clothing I was covered with tiny puncture wounds. He would regularly shred my rubber gloves when I was examining him – I got through a couple of pairs each time.

  Tests confirmed that Toby also had Giardia, so he was put on the same strong antibiotics as Bella. Both of them needed to stay for a few days so that we could be sure they were on the mend and fully rehydrated.

  We students were expected to do absolutely everything for the animals whose cases we were allocated, including taking blood for tests, doing physical checks, giving them their drugs and phoning their owners or seeing them when they came in, as they had to be kept informed. And of course we had to regularly report every single thing back to the clinician in charge.

  All three of my patients needed to be checked every couple of hours, so most of my day was spent taking the protective clothing on and off, yelling for Lucy to help me check on Twinkle, trying to avoid Toby’s nips, and clearing up after Bella and Toby, a chore that I shared with the veterinary nurses and any other students who happened to be in the vicinity. Neither puppy was able to control their bowels, so there was a lot of clearing up to do.

  As Bella began to recover she started chewing through her drip tube, at least four times a day. I put a buster collar on her, one of those funnel-shaped plastic contraptions designed to stop a dog chewing at itself or anything else. She chewed through it. She also developed the habit of peeing on my feet. And when, with the agreement of my supervising clinician, I finally discharged her a few days later, she thanked me by flooding the consulting room floor with a final pee that looked as though she’d been holding it all in for about twenty-four hours.

  Next up was a cat called Buttons, a docile tabby with high blood pressure and no appetite. She had to be fed through an oesophageal tube, which took ages as she could only take in two millilitres of liquid food a minute and she had to have fifty-four millilitres per feed – that meant twenty-seven minutes was needed for every feed, several times a day.

  I felt as if I were on a merry-go-round of taking barrier clothing on and off to check Toby, feeding Buttons and then going through the whole parrot routine with Twinkle. By the time I’d seen to all of them it was time to start the whole routine again.

  To add to our woes, we had to use a totally baffling computer system to record all our patients’ results. It was called CRIS and initially we found the name amusing because people would say ‘I hate CRIS’ or ‘I’ve got CRIS to do,’ but that very quickly got boring and the system was still just as confusing.

  At the end of each day, as in many of the other rotations, we had rounds with the clinicians in which we’d sit around a table and work through cases as a group. And, true to form, the clinicians had a tendency to put one of us on the spot to see how much we really knew. The fear of being singled out kept us on edge for the whole hour of rounds. It’s not easy being singled out, as I’d already discovered in the anaesthesia rotation, and by that time in the day we were so tired it was impossible to think straight.

  One evening, the ten of us gathered round the table in the teaching room. The clinician in charge had written ‘Hypercalcaemia’ on the board, which basically means increased calcium levels in the blood. They started with one person and worked around the group, asking each of us to give a reason why an animal might develop this condition. By the end we’d managed to come up with ten different reasons. Cue a sigh of relief all round, but no, the clinician wanted to go round again – twice. That meant coming up with thirty different potential causes for one condition. Towards the end we really struggled, but the clinician pushed us. They were never nasty, just very, very persistent and in absolutely no hurry to let us go until we’d come up with what they wanted.

  Lucy and I did our best to help one another. We had a fair number of muttered confabs in the corridors about how to handle our cases and how to survive the endless days, and we did plenty of grumbling over tepid cups of tea that we never had time to finish. We couldn’t imagine how the resident vets stood the long hours and lack of daylight. Some of them were there until eleven at night and back in again at six the next morning. It wasn’t a question of shortage of staff – there were plenty of vets and plenty of nurses. It was about dedication. This was a specialist unit in a specialist hospital and the vets stayed with their cases all the way through. I really admired their commitment.

  Our days were supposed to end at 6.30pm, but every couple of days we had to do evening checks, which meant that we didn’t finish until nine. When that happened I would get home at 9.30pm, eat anything I could lay my hands on that didn’t need cooking and fall into bed, utterly wiped out.

  At the end of my first week I went back to Kent for a much-needed weekend with my family and friends. It was a chance for a long-overdue get-together with Abi. We went riding together and it felt like old times, chatting and laughing as we c
antered over the fields.

  That evening we went out for drinks with a couple of friends and I poured out my woes. It felt good to have a break from the cameras, the clinicians and the endless (diarrhoea-filled) corridors of the QMH.

  I started the second week feeling a bit better and I took on the case of Biscuit, a Yorkie that had come in a couple of weeks earlier with tracheal collapse, which is when the cartilage rings holding open the windpipe are weak and can’t hold their shape when air passes by. The signs include an awful honking cough, being too weak to exercise and shortness of breath. It’s a congenital condition common in small-breed dogs, particularly Yorkshire terriers.

  Biscuit was a sweetie, a little black and brown dog with a round face, and he looked just like a teddy bear. When I met his very chatty and friendly owner for the consultation we sat and swapped stories about Yorkies and how lovely they are. This was a follow-up consultation to see how Biscuit was doing, and how he had responded to treatment and advice. He had been given cough suppressants and anti-inflammatories for his airways, but the most vital thing of all was to get him to lose some weight, because as he hadn’t been able to exercise he’d got rather chunky. He was a real success story, already looking much slimmer, much stronger and barely coughing. His delighted owner said he was almost back to his old self.

  Halfway through the last week I had a brief reprieve. David Bolt, my research supervisor, asked me if I wanted to go with him to a local zoo to rasp donkeys’ teeth. He’d been asked to do it by a friend there. I know I’ve had more bizarre offers, I just can’t remember when, but I leaped at the chance of a break and off we went. I was allowed the time off, providing I got friends to cover my cases, so Lucy volunteered to do it in exchange for me covering Wednesday afternoon for her, so that she could slip away for a tennis match.

  David told me he hadn’t rasped donkeys’ teeth for years, which made us about the same standard and we had a lot of fun. Rasping the teeth of donkeys involves holding their surprisingly small mouths open with something called a Hausmann gag and then filing the teeth with a large rasp. Unfortunately when I was mid-rasp the gag slipped and the donkey’s teeth clamped shut on my hand. I yelped. It felt as though my whole hand had been crushed and I was convinced it was broken. I hate making a fuss so I gritted my teeth and carried on, although much more slowly, while constantly checking that the gag wasn’t slipping again. The next day my whole hand was black and blue, and there was a large swelling on the back of it, but at least I could still move it. Despite this I really enjoyed my day out; it was a nice change and it felt wonderful to be outdoors for a few hours.

  Back at the QMH, over the next few days I had a couple of very sad cases. The first was Riley, a sweet-tempered, chunky old golden retriever of about ten or eleven, grey around the muzzle and slowing down. He came in with yellow gums and eyes. He was severely jaundiced and clearly felt awful. So much so that he didn’t need any sedation for an ultrasound or a needle biopsy of his liver. He just lay quietly and let us get on with the tests.

  It was clear that Riley was very ill, and I knew that his was not going to be a case with a happy outcome, so to stop myself from breaking down I tried to stay upbeat. I was being filmed at this point and one of the cameramen, a new member of the crew, took me aside to say that my cheery attitude might come across badly to the general public, since Riley was very ill.

  I felt ridiculously upset. He wasn’t being unkind, just pointing out a bit of an incongruity, but I was finding the whole week hard, I was tired and, of course, I always worried about how I’d come across on camera anyway. The thought of millions of people watching me felt quite overwhelming at times.

  I struggled on, as the crew followed me while I gently led Riley from the ultrasound suite back to the ward. Just outside the doors of the ward Riley produced a profuse amount of diarrhoea all over the corridor, which I had to clean up. As I mopped, Riley stood next to me and produced more. This happened over and over again. Poor Riley just couldn’t help it, but trying to clear it all up was a nightmare, and through it all the film crew just kept filming. I felt hopeless and tired and annoyed, and I just wanted them to stop. That evening I went home and cried. The whole fortnight had been hard, and Riley’s case was the hardest of all.

  The next day his biopsy results came back, and they weren’t good. He had a large tumour infiltrating his liver. Despite a poor prognosis, his owners wanted to give him every chance, so he was transferred to the oncology department to start chemotherapy. This might at least allow him an extra few months with his owners, but we all knew that he probably didn’t have long to live and the atmosphere in the department was subdued.

  Next up was Oscar, a seven-year-old collie-greyhound crossbreed. He was huge, not far off the size of a wolfhound, grey and white, with a face like an Old English sheepdog. Poor Oscar had been having sneezing fits for months. This could have been due to something benign and fixable, like a grass seed that had got stuck up his nose, or something life-threatening like a tumour. It was a very uncertain time for his worried owners as there was no way to tell how serious it was until we investigated.

  The choice we had was either to put a camera up his nose or to take a CT scan. You can see more with a CT scan as it’s three-dimensional, but to be sure, in the end we opted for both. While he was under the anaesthetic we did a rhinoscopy (camera up his nose), but we couldn’t find anything. However, the CT scan revealed a tumour at the top of his nose that had worked its way through the bone between his brain and his nostrils. It had penetrated his brain, which meant there was nothing we could do.

  In the few days that he was with us I had a lot of cuddles with Oscar and I spent a lot of time with him. Once the diagnosis was made, his heartbroken owners were informed and he went home to spend some time with them. When they were ready, and when they felt that Oscar no longer had quality of life, they would bring him back for the final time and we would put him to sleep.

  By now we needed a bit of light relief, and Charlie provided it. He had decided to grow a moustache for Movember – an annual event held to raise money for prostate cancer – and by our second week it had sprouted fulsomely and was a truly hideous handlebar affair that Charlie twirled with gruesome pleasure. However, the producers of Young Vets were not happy; they needed continuity in the films and they certainly didn’t want Charlie suddenly appearing with a horrendous moustache. There was an impasse; despite their pleas Charlie refused to remove it and in the end they had no choice but to film him with it.

  He did shave it off a few days early, though. He and I were due to do what they called a ‘master interview’ along with Grace. The idea was to sit around talking about being vets, sharing experiences and funny short anecdotes, and the producer, Isobel, put her foot down. The moustache had to go. She gave Charlie a £50 donation to the Movember charity and his pride was satisfied. The moustache went.

  When he eventually saw himself in the programme, as we all watched a preview, he blushed crimson at the point when the moustache made its unexplained appearance.

  ‘Why didn’t they say something to explain it,’ he spluttered. ‘I thought they’d say what it was about.’ We had no sympathy, Charlie became the clown of the show and his moustache caused endless hilarity. ‘At least you didn’t have it for the master interview,’ Grace teased him. ‘It could have been so, so much worse.’

  The other highlight of the second week was Thanksgiving, which fell on the day before we finished the rotation. It had become a tradition in our house, with two American students living there, for all five of us to get together for a Thanksgiving dinner. The college sold its own home-reared and humanely slaughtered turkeys and we pooled our resources to buy one, which John then cooked with the full trimmings, including pumpkin pie for dessert. It was a feast we all looked forward to every year, and Kevin and James travelled back for it from the far-flung locations where they were involved with, respectively, sheep and zoo animals.

  By our final day I couldn’t wait to f
inish this rotation. I just wanted to pass and go home for a quiet weekend to catch up on sleep. We were graded in three areas at the end of each rotation: professionalism, knowledge and application of skills. On the last day we had a one-to-one feedback session, which the film crew decided it would be fun to include. I was dreading being given poor results on camera, but to my immense surprise I was awarded pass, pass and distinction. I came out of the room, to where Charlie was waiting his turn to get feedback and gave him a high-five. The cameras left me and joined him for his moment in the hot seat, and all I could think as I walked down the corridor towards the exit was, wow, how on earth did that happen?

  CHAPTER TWELVE

  Mad Cows and Doris the Goat

  It was the middle of December, early on a freezing cold, foggy day and the last thing I needed was a face-off with some very grumpy cows. One of them looked as though it was about to head-butt me and a couple of others were straining against the decidedly flimsy-looking gate that separated them from the yard where I was standing.

  I looked round for Niall, the vet I was assisting, and the farmer who owned the cows. He’d asked us to come and test the whole herd for pregnancy, which would mean getting up close and personal with every single one of them.

  ‘They look a bit excitable.’ I tried not to sound worried.

  ‘They’re not used to being handled,’ the farmer said cheerfully. ‘Beef heifers, you see, not dairy cows these. So they get a bit frisky.’