Coated With Fur Excerpt

“I’ll be right there.” A combination of training and experience guided me to stay calm.  Yet, I had no sense what could be done under the circumstance.  In an exaggerated fashion, I motioned my father to head for the car.  He pushed a shopping cart full of supplies through potholes in the parking lot.  I ran ahead and opened the trunk.  We unloaded bags of brushes, paint, tape, light bulbs, pipes and garbage bags in record time and sped off. 

            We drove along the Minnesota River.  The car sped towards the clinic without a word from either of us.  Normally, I gaze on the maple and oak trees that line the boulevard or look for waterfowl resting on the banks.  But today, I kept my eyes on the road and tried to ignore the pit forming in my stomach.  I considered the resources; I had fluids, catheters and a few emergency drugs on hand.  Hopefully, it would be enough. 

            When we reached the clinic, I slammed my car to a stop next to a large pickup truck.  The half- ton Chevy dwarfed my Ford Probe.  Through the glass door, I spied a dog surrounded by my family.  His lifeless body lay in the middle of the lobby.  White foam poured from his mouth.  Allie knelt by the dog’s head.  She held an oxygen mask over the dog’s nose and mouth.  The sparkling anesthesia machine towered over her.  A red first aid kit sat on the floor by her side. 

            I rushed inside and knelt by the dog.  A glassy stare covered his face.  I touched the inner corner of his eye with my finger.  He did not blink.  His chest heaved up and down as he fought for air with all his might.  I reached under his hind leg to check the pulse.  I pressed my fingertips against the leg in search of the femoral artery.  Most times, it is easy to find as the large vessel runs along the inner aspect of the femur.  But this dog was in severe shock.  His heart was having a hard time pumping blood through his body.  As a result, the pulse was weak and rapid.  We had to act fast.  I feared the worst.

            “Allie, let me see his gums,” I ordered more than asked.  She removed the mask from the dog’s mouth and pulled back his lip.  It revealed a sick shade of blue.  It should have been pink but the color confirmed my analysis.  This poor dog was starving for oxygen.  Allie was an experienced technician.  She replaced the mask and held up a catheter.  “Is an 18 guage okay?”

            I nodded and took the catheter.  My hands trembled as I removed the plastic guard.  Through many years of school and medical practice I had placed more of these than I could recall.  But today, with a new clinic, few resources and my family standing vigil – afraid for me and the dog, this time was different.  Allie slid her hand around the dog’s elbow.  She used her fingers as a tourniquet to block the flow of blood.  In healthy animals, the vein distends from the backup of blood.  I scanned the leg.  The vein was invisible despite Allie’s clip job.  I pumped the paw a few times and splashed more rubbing alcohol over the prep site.  Gratefully, the ever so faint outline of a vein appeared down the center of the dog’s leg between the wrist and elbow. 

“His pressure is awful,” I mumbled.  I pumped the paw again with my left hand and felt his leg with the fingertips of my right.  “I can barely feel it.” 

            I held the catheter over the vein with the tip hovering above the dog’s leg.  “Lord help me,” I prayed while it penetrated the skin.  I threaded the catheter up the leg and waited.  Allie and I froze in place with our eyes focused on the catheter protruding from the leg.  A moment passed, then blood appeared.  I slid the stylet out and capped it off. 

            “Nice stick Dr. Nelson,” Allie said while handing me a piece of white medical tape.  I could feel my muscles release just a little.  I wrapped the tape around the catheter and then securely around the dog’s leg.  Allie prepared a bag of Lactated Ringers.  She handed the bag to my sister Debbie, with the firm guidance to hold it high to increase the flow rate.  Then she allowed clear fluid to rush from the bag down the tubing and on to the floor.  Once the air bubbles were gone, Allie handed the end of the drip set to me.  I removed the plug from the catheter and replaced it with the fluid line.

“Now,” I said with a tone accentuated by the massive adrenaline coursing through me.  Allie opened the valve and fluid rushed out of the bag into the dog’s leg.  I turned my attention to his respiration.  I had to find out what was making him breath like this.  I asked Steve to find the stethoscope.  The dog fought for every breath.  Each one lifted his feet off the ground.  It seemed like an eternity before the stethoscope appeared.  I placed the bell on the dog’s chest.  The air rushing in and out of the trachea sounded like a wind tunnel, so loud it drowned out all the normal lung sounds.  I looked at the only stranger in the room and said, “This does not sound good.”  What color remained now drained from his face.  He clung to the reception counter for support.  “I’m worried your dog has a pneumothorax.  That means he has air in his chest.” 

I paused to collect my thoughts.  My mind raced back to veterinary school and through all I learned about pneumothorax.  In normal animals and people, air flows down the trachea into the lungs and back out on exhalation.  The system works because the space around the lungs is a vacuum.  It’s empty, devoid of pressure.  I turned to the owner.  “I think the impact of the car damaged his lungs and air leaked into his chest.  His vacuum is gone and he can’t breathe.”  I pushed the oxygen mask back and lifted the dog’s lip to check on his color.  There was no change.  I had hoped it would improve some from the fluids.  “I need to tap his chest,” I exclaimed as much to myself as to anyone.  Turning to the owner I said; “We need to remove the excess air.  I will stick a needle into his chest and pull the air out.  Is that okay?”  I looked at the man for his response.  He slumped over the counter with his head in his hands.   

            Often the hardest part of veterinary medicine is dealing with people.  Giving owner’s time to make decisions is always hard for me, especially with critical patients.  This patient did not have the luxury of time.  I looked at Steve and wrung my hands.  Debbie and Allie exchanged a concerned glance.  What was he waiting for?

            Finally, the man straightened and faced me.  His eyes glistened with tears under the clinic lights.  “Do what you think is best Doc,” he whispered and looked down at his leather cowboy boots.  “I don’t want to lose Cody.”  He raised his hand to forehead, closed his eyes and made the sign of the cross over his chest.  When he finished, he kissed his fingers and touched the dog’s back.      

            Allie sprang to action.  She clipped a nine by nine inch square patch over his rib cage.  Loose brown hair fell onto the floor.  She disinfected the area with Betadine scrub and then rinsed it with rubbing alcohol.  While I donned a pair of surgical gloves, Steve grabbed a thirty-five milliliter syringe and a butterfly catheter from the first aid kit.  Thank goodness we had that in the kit.  He opened the packages carefully and slid them into my gloved hands.  I connected the syringe to the rubber tubing of the catheter. 

            As Allie finished the sterile prep, the pit returned to my stomach.  If the rent in Cody’s lung was large, this chest tap would not work.  He would need a chest tube with continuous suction.  My suction equipment would not arrive for a week. 

            Allie rubbed her hands on her pants to dry off the slimy scrub.  “Ready,” she said.  I passed the syringe to her and took a deep breath.  I dread the feeling of the needle passing through the muscles of the chest. The professors said I would get over it with time, but in four years of practice I had not.  I always thought about how much it must hurt.  Cody could not wait for me to numb the area with lidocaine.  His gums looked gray. 

            I felt his fifth and sixth rib with my left hand and identified the muscular space between.  I grasped the special catheter by its plastic wings and plunged the needle deep into Cody’s side.  The dog did not flinch.  His chest continued to heave up and down with each breath. 

Allie drew back the plunger on the syringe filling it with air.  When it was full, I kinked off the tubing with my left hand while holding the needle in place with my right.  She disconnected the syringe and flushed the air from the chamber.  “One,” she counted out loud.  When it was reconnected, I unfolded the tubing and Allie pulled more air out of Cody’s chest.  He did not fight the chest tap at all.  We repeated this over and over again.  “Two, three, four.”  The air just kept coming.  “Five, six, seven.”  The dog’s chest continued to rise and fall.  He still fought for each breath.  Worry and doubt crept into my mind.  I quickly calculated how much air we had removed.  Seven times thirty-five is about 250 mls, which isn’t that much for an Australian Cattle dog.  As the amount of excess air decreased, Allie would need to pull harder on the syringe.  Hopefully, she would feel resistance soon.      

“Are you getting any resistance at all?” I asked in a desperate voice.  She frowned. 

“Eight, nine, ten.”  She smiled when the syringe finally became harder to pull.  It dug into her fingers, leaving red marks.  She rubbed them against her leg to remove the numbness and pulled again.  The plunger slid halfway back and stopped.  I removed the needle and reinserted it higher on Cody’s chest.  “Here goes eleven,” she said.  Halfway through the next syringe, I felt a scratching sensation on the tip of the needle.  Even though lung tissue is soft and elastic, it feels rough and abrasive like steel wool during a chest tap. 

“Stop,” I ordered.  Allie took her fingers off the plunger.  I repositioned the needle and asked her to pull again.  Five mls. of air flowed into the syringe before I felt lung again.  I withdrew the needle completely.        

For the first time, Cody closed his mouth and inhaled through his nose.  I sat back on my heels with a sign of relief and watched his chest.  His ribs moved slowly up and down with each breath.  His respiratory rate slowed to normal.  Allie removed the oxygen mask from his face.  She pulled back his lip.  A healthy pink color replaced the deathly gray tone.  Cody stuck his tongue out and licked his lips.  “Whew,” I exclaimed with delight.

The man slumped over the counter but this time washed in relief.  Tears of joy streamed down his face.  He pulled a red handkerchief from his pocket and wiped his eyes.  Smiles spread across my families’ faces.  Cody could breathe again. 

I removed my gloves to tend to the second dog, but did not see it anywhere.  “Weren’t there two dogs?” I asked.  I looked around the room, but no one answered.  I distinctly remember Steve saying there were two dogs. 

Finally, Allie pointed at the truck and whispered, “Cody’s buddy didn’t make it.  He was DOA.”  The joy I felt from seeing Cody improve was immediately squashed by the somber words.  I slowly rose to my feet and stood by the man’s side. 

“I’m sorry about your other dog Mr. uh, Mr. . . . I’m sorry but I don’t even know your name.” He turned to face me with his right hand extended. 

“Tommy, Tommy Munson,” he replied as we shook.  “I thought they was locked-up when I left.”  He cleared his throat and swallowed hard.  “They never seen the car.  Poor Jeb.”  He bit his lip and sniffed loudly.  Through the lobby window, I saw the dead dog’s body lying in the bed of the pickup.  The wind ruffled his beautiful fur coat.  “Cody will be heartbroken without him.”  He slid his thumbs into the pockets of his tightly fitting jeans.  

At the sound of his name, Cody lifted his head off the floor.  I returned to his side and checked his pulse.  It felt strong and regular.  I placed my stethoscope over his heart.  Lub, dub, lub, dub echoed in my ears, its beats crisp and regular.  No signs of a murmur.  I moved the bell of the stethoscope around his chest.  Soft sounds of air moving through his lungs replaced the harsh rattle from before.       

“What happens now?” Tommy asked. 

Because this was our first day and the clinic was not operational, I explained that Cody should go to the emergency clinic for continued care.  He needed radiographs to check for fractured bones and bruised lungs.  My machine was not set-up yet.  I gave Cody an injection of Demoral to control his pain and ran my fingers over his body once it took effect.  I manipulated his head and front legs, palpated the abdomen and back searching for signs of injury.  So far, so good.

When I reached his back left leg, Cody swung his head toward me, teeth exposed. 

“Sorry, boy.”  I released the leg.  Orthopedic injuries are so painful.

Allie took a muzzle out of the first aid kit and slid it over Cody’s nose.  I continued to palpate his leg.  The hip was swollen, probably fractured.  Now it was time to examine the other side.  Allie held Cody’s head, my sister Debbie had his middle and I took the back end.  On the count of three, we rolled him onto his left side on top of a thick wool blanket.  It was the kind of blanket we all have in Minnesota.  Cody let out a loud yelp that made everyone jump.       

After I examined his right side, Allie prepped his chest for a second tap.  This time Cody jumped when the needle penetrated his chest.  Only a few milliliters of air flowed into the syringe.  Gratefully, he would not need a chest tube.  We rolled him back to his right side to take pressure off his injured left hip.  Allie left him muzzled.

As I stood and stretched my back, Tommy asked, “What’s the verdict, doc?”   

“I’ve stabilized him as best I can.  Now you need to get him to the emergency clinic.  I’m worried his chest might fill with air again or he might revert into shock.

Tommy pressed her lips together and nodded.  “He’s a tough dog, he’ll make it.”

We used the blanket as a sling to carry Cody to the cab of Tommy’s truck.  Once he was more or less comfortable, I removed the muzzle and rubbed his nose.  “Good luck Cody.”  He licked my hand and began to pant – it was a good sign. 

Tommy stuck the key in the ignition and promised to call with an update.  As he pulled away, everyone went inside except Steve and me.  We stood together silently watching him depart.  He put his arm around my shoulder.  A thousand thoughts raced through my mind.  Here I was a young veterinarian who now owned her own clinic.  There was so much to do.  Quite unexpectedly, we had treated our first patient.  While it seemed he would make it, I was not at all certain about us.