Tales from a Young Vet Page 19

  The surgeon in this operation was one of the more intimidating ones. As he called out the name of the instrument he wanted, I would take a wild guess. Most of the time he’d then snap ‘nope’ and I’d try again until I got it right. After a couple of rounds like this I was so on edge that I dreaded his next demand. When it came I stared wildly at the tray trying to guess what Adson’s was, until Lucy edged into sight and pointed, from behind her notepad, towards a pair of forceps, which I grabbed and handed over, handle first, while signalling ‘Thank you’ to Lucy with my eyes from behind my mask.

  The surgery went smoothly, and once I got past the instrument panic, watching was fascinating, as the surgeon deftly changed the shape of Hermes’ stomach exit without adding or removing anything.

  By the end of the operation, several hours later, all had gone well and I was so hot I thought I might melt if it went on for a single minute longer. Hermes woke up feeling pretty groggy and I felt so sorry for him. He had been through things like this so many times. But the next morning everything had been forgiven, he was back to his normal waggy self and happy to see everyone. I know if I was taken away from my home and operated on without my consent and without understanding why, I would be terrified and hate the people who had done that to me. It always amazes me how trusting, forgiving and loving dogs can be. I guess that’s why I’m a dog person at heart.

  Over the next few days Hermes made good progress. He was a valiant old dog, and despite his age he was full of life. By the end of the week he went home, with plenty of pain medication and on a very delicate diet, but with the potential for a few good years ahead of him. Before he left he did the rounds of the staff, giving each of us a final lick and a wag goodbye.

  At the end of each day Lucy and I did the evening checks together. The students often worked in pairs, as it made everything a bit easier and a bit more fun. The checks would take at least an hour, usually longer. Every dog had to be taken out into the sludgy patch, medicines had to be administered, and vital signs – temperature, heart-rate, gums, breathing – had to be checked. You can tell a great deal from a dog’s gums – you can pick up signs of anaemia, jaundice, dehydration and lowered blood pressure. You press the gum with your finger and a healthy gum will go from white to pink within a second or so after release. And finally, when we had done all the checks we had to fill in the kennel sheets for each dog, detailing everything that had been done.

  I was just coming to one of the last dogs, one that both Lucy and I had been avoiding. I sighed. ‘Luce, can you come and help me with Bruno?’

  ‘Urgh, fine. I thought I had got away with avoiding him!’

  Bruno was a very large, young, bouncy German Shepherd. Every time his kennel door was opened he would barge out, sending everyone flying. To top it off, if you did manage to lasso him with your slip lead as he came shooting out, it wouldn’t stop him. He was so strong that he would just drag you wherever he wanted to go. Taking him out was becoming a two-person job.

  Lucy blocked the kennel door as I squeezed in and got a lead on him. Then she put her lead around his neck, and we walked him outside together, just about managing to keep hold of him between the two of us. He’d come in as an emergency a few nights earlier, and he’d needed surgery after swallowing a Batman toy, but he was clearly not feeling unwell anymore and we were hoping he was going to be discharged any day.

  In the end Bruno went home on our last day in small animal soft tissue, and after the long hours and endless checks on multiple animals I was glad to be moving on. In orthopaedics we wouldn’t have to do the same checks, and that alone made the following week look extremely attractive. In fact, I was home by six most evenings, which was an unheard-of treat, and gave me time to talk to Jacques, whom I was missing like crazy, and to put my CV together and start sending it out to recruitment agencies. Like all the other student vets I was keenly aware that once we graduated we would need to find jobs. I still didn’t know what I wanted to do long-term, but as I was planning to spend some time working for World in Need in Africa I decided the best thing would be to start by looking for locum work.

  In locum work I would hire myself out, on a short-term basis, to vet practices that were short of staff or needed to cover holidays. It meant I would have plenty of flexibility, which was just what I needed, although I was feeling quite daunted by the idea of having to hit the ground running.

  By this time most of my housemates had a pretty good idea of what they wanted to do.

  Kevin had gone off the idea of being a vet, but still wanted to work in the veterinary industry. He was missing the sun of South Carolina and would be going back to the USA after graduation, so he was veering towards finding a job as a veterinary pathologist, which would essentially be doing post-mortems all day long and taking samples to look at under the microscope to determine causes of death. It wouldn’t be everyone’s cup of tea, but Kevin had a very forensic mind and it would suit him. As for John, he always knew he wanted to work with small animals in general practice and his heart now belonged to Britain, so he was in the process of sorting out his visa so that he would be able to stay. James also was pretty sure that small animal practice was the direction he was heading, but as for location, that was going to be largely influenced by his girlfriend, Hannah. He kept telling her ‘anywhere but Wales’, but she was ignoring that and had been investigating small animal and mixed practices in several locations, including Wales. Andrew, though, was hugely undecided about where he wanted to be and what he wanted to do long term. But, like me, he hoped that as we progressed towards the end of our university days things would become clearer.

  In my last couple of days on orthopaedics I was assigned one of my saddest cases. When I went to collect the file containing Shadow’s history I could see that the dog had been slightly lame in her left front leg for the last six months, and there had been a mysterious swelling appearing and disappearing around her elbow. So far the diagnosis was unclear, so Shadow had been referred to us for tests.

  I went to collect Shadow and her owner, Mr Jeffreys, from the waiting room to take a more thorough history. Shadow was an unusual-looking dog: almost orange in colour with the body and face of a Staffordshire bull terrier, but with slightly shorter legs and pointy ears.

  While Shadow wasn’t the most glamorous of dogs, it was impossible not to warm to her because she was so nervous that her entire body was shaking from head to toe. She clearly didn’t like coming to the vet one bit, and she needed a lot of reassurance and gentle handling.

  Her owner, a man who gave the impression that on any other day he might have been quite tough, held her in his arms, giving her cuddles and comfort. He wasn’t able to add a great deal of new information to what we already knew, so I went to talk to Vincent, the clinician in charge of the case. After coming to look at Shadow, Vincent decided that she should be admitted for a CT scan so that we could have a clear look at what was going on in her elbow.

  Mr Jeffreys, who clearly adored his dog, was upset at having to leave her with us. There were tears in his eyes as he hugged her goodbye. I knew that without him Shadow was likely to be even more nervous, and as I led her down the corridor to the surgery ward she shook more than ever, and kept straining to turn and follow her owner. I hoped that, given a little time, she would feel calmer and would be able to trust us, but it was going to be an uphill task.

  I found her a large kennel and went to get her several pillows and teddy bears to keep her comfortable until her CT scan later that afternoon. Whenever I had a spare moment during the day I went and sat with her and comforted her as I could see she was still terrified.

  Finally, towards the end of the day, she went for her scan. She was put under anaesthetic for it so at least she had a break from her fear for an hour.

  I was never good at reading CT scans, which are in 3D rather than the usual 2D X-ray pictures, but even I could see that there was a soft mass behind her elbow. A needle was inserted into it to take some cells for the lab to analy
se, but as it was the end of the day it would mean an overnight wait for the results.

  The next morning we looked at the cell analysis; Shadow had a mast cell tumour and, due to its position on her elbow, it was inoperable. I had seen a diagnosis like this before and I knew it had been a possibility in her case, but I felt so distressed when I saw it that I became tearful. Shadow was such a lovely little dog, and with her nerves, all I wanted was to try to make everything better for her. It was heartbreaking to discover that she had cancer.

  Vincent let Mr Jeffreys know over the telephone, and understandably he was very upset, but he was able to offer him some hope. Although the tumour couldn’t be removed, Shadow would be transferred to the RVC’s oncology unit immediately to start chemotherapy to shrink it, and if she responded well she might go into remission for weeks or even months.

  As I cuddled her goodbye I promised myself that I would check back to see what happened to her. We were changing locations and medical rotations every week or two, and that made it very hard to follow the longer-term cases we handled. All too often I would work intensively with an animal and then have to leave, not knowing the final outcome of the story. I wasn’t due back at the QMH until my neurology placement, six weeks later, but in Shadow’s case I did manage to pop in before that to find out how she had done. I was delighted to hear that she had responded well to chemotherapy and the tumour had shrunk. She was back home with Mr Jeffreys, to enjoy some precious time together.

  CHAPTER SEVENTEEN

  Horse Sense

  By mid-February, a year into rotations, I was finally beginning to feel like a proper vet. I didn’t have to ask how to do things any more, my confidence was growing day by day and I was itching for more responsibility. And during my two weeks’ work experience at a big equine veterinary practice and hospital, I got it. The cases came thick and fast, and I was given the chance to get really involved in the treatment and surgery.

  First up was a cute little cob foal called Murphy. Only six months old, he had a gentle nature and was more hair than pony, his glorious thick mane flowing down his neck and over his eyes. He’d been put in the isolation block over concerns he might have strangles, a horribly infectious respiratory condition. He was really struggling to breathe well and he had an awful cough.

  The mystery was solved when we discovered ugly white ascarid worms in his faeces. Ascarids are a species of roundworm picked up by horses when they are grazing. They’re huge – we picked out worms the size of a ballpoint pen – and they can migrate from the intestines to the lungs and cause serious damage and respiratory problems. The horse coughs up the worms, which causes scar tissue in the lungs and permanent irritation. Most owners de-worm young horses and ponies to protect them, but Murphy had been abandoned and taken in by the rescue charity that sent him to us, so he hadn’t had all the usual precautions.

  The problem was easily sorted with treatment to kill the worms, and Murphy, who had been a bit glum when he came in, soon began to cheer up as his lungs healed and he felt more comfortable. Sam and Amy were with me filming on this placement, and when they found out about the worms they insisted we do a very staged bit of filming where we placed a worm on top of a pile of droppings, and I had to act surprised and say, ‘Oh my word, look at that worm,’ then pick it up and show it to the camera.

  I made a face at Sam. ‘Really? You think it will look convincing?’

  ‘It’ll be great, really funny,’ he insisted. ‘Just look as surprised as you can.’

  We placed the worm on the droppings, I stepped forward to pick it up and Sam zoomed in with the camera. I was about to go into my routine when the two stable girls decided it would be hilarious to attack me with it. They grabbed the worm and came after me with it and, to Sam and Amy’s delight, I shrieked long and loud.

  ‘Lovely, that’s even better,’ Sam said, grinning. ‘But it’s in your hair now, Jo, in case you hadn’t noticed.’

  There are some truly disgusting moments in a vet’s life, and this was one of them. With what I felt was impressive control, especially in view of the laughter all around me, I got the worm out of my hair, dropped it on the ground and headed for the loo to wash my hands and redo my hair.

  When I got back Sam had composed himself. ‘Shall we try that again, Jo? Perhaps you can pick it up with gloves this time. And we’ll keep those two,’ he indicated the still-giggling stable girls, ‘out of the way.’

  Also in the isolation block that first week were an emaciated mare and her foal. They had been sent to us by a rescue centre, whose staff had collected the pair from a field where they were found alone and abandoned and in a very poor condition after being reported by a member of the public. The mare had profuse watery diarrhoea, which could have been caused by a number of things, but they were in the isolation block because of the risk that it could be salmonella. We were more concerned over cyathostomins, though, as it was the time of year when they tend to appear. Cyathostomins are parasites of the gut that stop food from being absorbed and consequently cause horses to starve to death – which would explain their thin condition. We had to worm both mare and foal and give them biosponge, an anti-diarrhoea treatment, by mouth several times a day. However, the mare really knew how to kick. Before we could grab her headcollar, she would swing her rear end around and double barrel with both back legs. Her foal was learning pretty quickly, too, so trying to treat either of them was a perilous business.

  We felt very sorry for them both; they’d probably been mistreated and had no trust in humans. But we had to find a way to treat them, so, with some of the stable girls, I developed a strategy; we went in with a wheelbarrow as a shield so that when the mare kicked she would strike the wheelbarrow. Once we’d calmed her and got hold of her headcollar we could approach the foal. We kept the headcollar on her all the time as otherwise we knew we would never get hold of her again without it.

  There was a security camera in the corner of the stables, and whenever it came to treatment time everyone in the office would place bets on how long it would take us to get hold of the two of them: two minutes, five minutes, ten minutes? Most of the time even twenty minutes was optimistic and, as we skirted round the extremely nimble mare, cowering behind our wheelbarrow like a couple of Michelin men in our full isolation kit of overalls, gloves and foot-covers, the staff in the office sat around the camera enjoying the entertainment.

  It was worth all the effort, though; mother and foal grew healthier, they put on weight and they did begin to calm down, just a fraction. By the time I finished my two weeks they were due to go back to the rescue centre, from which they would hopefully find kinder owners.

  The staff at the hospital included Paul, the head clinician, who threw me in at the deep end. He encouraged me to scrub in, and even to do some surgery, give anaesthetics and take a consult or two. One of these was a pedal osteitis case (infection of the bone in the hoof), and Paul quizzed me in front of the owners about what I wanted to do about it. When he agreed with everything I said, I was on fire!

  Another vet I worked closely with was a resident called Evan. We’d met before, when he came to do a rotation at the RVC in pathology as part of his residency. This happened to be at the time I was doing my pathology rotation, so I had spent a week getting to know him over some post-mortems. I liked Evan. Tall and blond, he was young and energetic, and he always had a big smile on his face.

  About halfway through my placement I was sent to shadow Evan for the day. Sam and Amy had tagged along, too, with the cameras. I’d forgiven Sam for the worms incident and I was glad to have them along. They’d seen so much by this time that Amy was starting to joke that she could be a vet student, and every now and then there would be an outburst along the lines of ‘Yes! I actually understand what that is!’ or ‘Do you mean he has tachycardia? Yes, that’s right, I used a vet word!’

  Evan said he had an event horse coming in. It was performing poorly, slowing down and generally seeming out of sorts, and the owners wanted to know
why.

  When he arrived I was in awe. Rocky was magnificent; a huge, proud horse with a glossy, dark brown coat and black mane and tail. His head was the size of my upper torso and he strode in so powerfully that you could hear him coming from the other side of the hospital. Evan had suspicions that he might have gastric ulcers, which are common in high-performance horses and horses that are quite highly strung. The plan was to put an endoscope down into his stomach to have a look, and Evan was going to let me do this. I was a little worried as I had only passed a scope down a horse’s throat once before, and I had never steered one once it was inside, but I was keen to have a go.

  Before we could sedate Rocky for the procedure, Evan listened to his heart – standard practice to ensure that it’s safe to administer sedation. This normally takes a few seconds, but Evan continued listening far longer than that, and as he listened his ever-present smile faded. I’d never seen him look that worried before.

  Eventually he looked up and spoke to Rocky’s rider. ‘I’m not too happy about the rhythm of his heart. Let’s trot him up to see if it changes.’ The rider, a tall man in his thirties, who was clearly very fond of Rocky, led him into a trot outside.

  Sometimes horses’ hearts sound abnormal at rest, but arrhythmias can go away with exercise, particularly in large, fit horses with slow heart rates. That was what Evan was hoping would happen. But after trotting up and down for a few minutes, Rocky’s heart rhythm hadn’t changed.

  Evan decided to wire Rocky up for an electrocardiograph (better known as an ECG) to check exactly what was going on with his heart. The ECG would record the patterns of his heartbeat on a graph. While everything was being set up I listened to Rocky’s heart. It sounded like wobbly jelly – all the beats were completely out of sync. I tried to explain this in front of the camera, but in the end the easiest thing was to sound it out: ‘boom, boom,’ long pause, ‘boom boom boom,’ short pause, ‘boom.’ Amy, chuckling away, tried to hide behind Sam so as to not distract me while I was going through my routine.