2. And the drugs come out
It's always a Saturday when the most entertaining cases visit. It's a day when I'm working sole charge in a busy small animal practice, where I'm fully booked in consults from 9am- 4pm. I've got my coffee and am attending the first walk in emergency – it's not even 8:45am!
"He's eaten some marijuana butter", the owner says, she is sheepish, and about 18 years of age. In her arms she is cradling a small black dog who has no intentions of moving. Her father is with her, bemused and embarrassed as her. I go through the usual drill of trying to work out how much he has eaten, when he had access to it, and sorting through a convoluted history of "if's" and "maybes" and "it wasn't theirs". The patient is stoned, but his symptoms do not match the story that the owners are giving me. I ask them again if there is something else that he could have got into, but they assure me it was only the butter.
I take him to the back of the clinic, and set him up on fluids. He is hypothermic, and my nurses quickly start active warming. As it appears- the dog ingested the butter 12 hours earlier, and the owners had left him in a stupefied state outside for the night.
The rest of the consults start off easily – a couple of vaccinations and post-operation checks, and my marijuana dog is doing well. I'm halfway through explaining the importance of socialisation to the owners of a Chihuahua, when a hysterical women runs into the clinic. I excuse myself and pull her into the next consult room.
"Thomas has been hit by a car!" she wails, holding a cardboard box infront of her with a towel over the top. A stiff back leg hangs out over the top.
"And…. This is Thomas?" I ask – lifting the towel off the top of the box.
"I just want to know if he is dead" she asks, tears pouring down her face. The cat is a large tabby, and rigour mortis has well and truly set in.
"I'm sorry" I say, placing the towel back over him, but she cuts me off in sobs "It's just- he's a good pretender – is he just pretending to be dead?" To say I was taken aback would be an understatement.
"I'm sorry" I repeat again, shaking my head, "he's not pretending Mrs Southerland". Walking into the other consult room, I look at the already full consult room: 9:30am, and my coffee is now cold.
In the surgery out the back, the senior vet is doing a tricky bone plating on a dog, and our experienced nurse is being pulled through the dredges as she tires trying to please him. "Hold the packet up for me to see" he orders, and she obligingly holds up the suture material, he ignores her, fumbling through the rest of the instruments on the table, only to look up several minutes later and tell her she can now open it. Her face says it all as I walk back from consulting, the grimace of trying to endure another demanding surgery. She has only been here two weeks…. But it's already telling her to quit.
Its mid February and we have attained yet another new nurse, the staff-turn over is relentless at this practice. Her name is Navada, a girl from Canada who is not formally trained as a vet nurse. She has done enough practice with other vet clinics over the years, that she is competent with basic vet nursing duties. I'm working alone at the single vet clinic today, a partial relief from the onslaught of the other clinics. I can work at my own pace here, and look after my patients better, rather than trying to get through a dozen surgeries like a production line.
As I walk in, and place down my bag, Navada is standing out the back in hysterics. It is one of my first encounters with her, and I'm not expecting hysteria at 8am on a Tuesday morning. Through giant sobs she tells me her boyfriend and her split up, and how having moved from Canada she now doesn't know where to go or what to do. I feel for her, what an awful predicament to be placed into. Her mascara has run down her face, and her long knotty blonde hair is crumpled uncaringly ontop of her head. I listen patiently, but the duties of hospital patient care removes me from the situation. It's better that I don't get involved, I tell myself.
The rest of the day goes smoothly, easy consults that don't require big workups, and two routine surgeries. It's a good day today, especially as the suture needles are sharp and the haemostats work. The last consult for the morning arrives ten minutes late for his consult. Fortunately he is the last consult, as when patients are late, it makes our whole day fall behind.
Mr Tegan enters the consult room with his dog Amber. She's an American Bull Mastiff, black and white spotted and sits beautifully on the consult table. She's a big girl, and is in beautiful condition.
"What's been going on with Amber?" I ask, as I watch the man pull out a small container.
"There are little bugs all over her" he says, opening the lid of the container and pointing out 4 small black things in it. "Every time I part her fur, they run off the black spots!"
"Is she up to date with flea treatment?" I ask, suspecting a flea outbreak.
"No" he replies "but these aren't fleas". He begins frantically parting the hair over Amber's black spots, and exclaims "See! There it is". I part the fur as well, but nothing moves over my parting.
"Did you see it?" he asks, feverently brushing the fur again. "It's only on the black spots though – they're camouflaged. I think they know I will find them if they go on her white skin". He explains that this has been going of for three days now, he noticed it when he was sitting by the fire, and was stroking her fur. These bugs move under the hair whenever he parted it over the black spots. He continues to part the hair yelling "See? See? Can you see them!" I try my best too, but nothing moves on the hair follicles for me. I do some tests, looking under the microscope for any evidence of bugs, and I examine the four insects in the container. They are only scabs. I try my best to see what he is looking at again – but there is nothing. I give her a flea treatment, explain that it will kill off any mites or fleas, and if no improvement to come back.
"You must think I'm crazy" he says, a bit deflated "I think I'm going to go get my eyes checked out".
As he is leaving the consult, a young couple rush their cat in. They explain they found her in the garden at home and think she has been hit by a car. I take her out the back and examine her, she can't use her back legs and has no anal tone. She is very stoic and is purring throughout the whole examination, but it is not a very good prognosis. The nerves to her back legs have been damaged, and the ones innervating her bladder and anus are not working either. She can feel pain and does try to stand, but a cat that can't urinate or defecate cannot survive. She is otherwise stable. I explain to the owners that need to do some xrays and get her onto some intravenous fluids and that I will call shortly with some answers.
Navada is still crying, despite sitting at reception, it is making the day a challenge as nothing is moving exceptionally smoothly. She is explaining to Mr Tegan about her situation, and he is telling her about the bugs. I start some xrays on the cat – Missy, and find that she has fractures her pelvis in 3 parts, and her lower spine. It is displaced and matches the semi-paralysis in her back end. I explain to the sobbing clients that it is a very poor prognosis, but that its difficult to tell wether her paralysis is because of spinal shock or irreversible damage to the nerves. We give her a chance for a few days to see if she can urinate on her own. Her owners are students at the university, but want to do absolutely everything for her.
The afternoon is fortunately a bit easier – I am able to grab a cup of coffee and a couple of crackers that I leave in my car for busier days. Navada is still teary by the evening, and as I settle Missy in for the night with her pain relief, give her an extra chin scratch I try the last few corny words of wisdom to try and cheer her up.
It's 8pm and I finally walk in the door, my dog is levitating as he hasn't had a walk for the last two days due to my late finishes. My partner is overseas still, and the house is empty. The cat has managed to lose her collar again, and her face looks sightly swollen. She seems pretty happy demanding food, so I make a mental note to look at her properly in the morning as I jump into bed.
I forget to examine the cat properly as I walk out the door, but she is still happy. I promise the dog I will take him for a walk when I get home, and pray silently that today is smoother. I'm at the busier clinic today – it's going to be a tough day.
The senior vet is already stressing the staff out – he is ranting about the floors and why they aren't clean enough. The nurses are up in arms as they have cleaned the floors already and don't have time to be constantly wiping it with the number of patients in the hospital. I keep my head down, say a cheery "hello" and start trying to work out the order for the day, and what is wrong with the 10 patients already in hospital. I've just started trying to read through the 4 page case summary of Gizmo, who has been vomiting for the last two days, and has had every test run under the sun performed. Two preceding vets have no idea, and the after hours clinic couldn't shed any further light on the case.
"There's a dog whose been attacked by another dog who's just walked in", the nurse announces. I ask her to do an initial triage whilst I try and work out what medications Gizmo has or has not received. "There's a lot of blood" she says. Gizmo is relatively stable, so I leave him for the moment and go and see the new walk in client. 8:38am. Miss Kaye is crouching on the floor, covered in blood, her hand is clamped on a pad which is attached to the belly of her dog. Asha is a friendly little dog, and is well behaved and I assess the degree of bleeding and the depth of the punctures. Unfortunately she's definitely going to need a stitch up. I get her some pain relief, place a more effective bandage over her belly and admit her onto our already growing surgical list for the day. I'm just about to go back to Gizmo, when Navada walks in – still crying.
"No better?" I ask, but she is already sobbing to another nurse. The senior vet who is still angry about the condition of the clinic, asks her is she is ok, and then returns back to his ranting. As much as I hate seeing staff upset, I do not have the time to try and resolve her life problems. Its unfortunately a survival environment at this clinic – put your head down, work your hardest and give your patient the best care possible.
The bleeding dog has severed a big vein, and whilst she's under anaesthetic, I work to ligate the vessels. Navada has become more subdued, and her eyes are now more blood shot than I remember. She is vacant, and I ask her multiple times to get things for me, which she keeps forgetting. Meanwhile, Gizmo is still relatively stupefied- and his owners still adamant that it was only "hash butter", for their "sick granny"- which they had added last minute. It's 3pm, and I haven't had a chance to get to the toilet yet, I've got 2 minutes, and have to go to a home euthanasia. Ned is a 16 year old border collie, who has been on deaths doorstep for a while. Her favourite vet is away, and unfortunately Ned cannot wait another day for her to return.
My nurse and I jump into my car, and travel the 30 odd kilometres to her small townhouse. Neither of us have met Miss Theilise, but she seemed very sweet on the phone. As we walk up to the front door, our kit in our hands, Miss Theilise "Megan!" she insists, opens the door in her nighty. Her modest attire shows off almost everything underneath. We step through the door and there is a mattress in the corridor, with Ned lying in the middle of it. We are joined by 3 dogs and 2 cats, who are all hovering around. Megan sprawls herself over the top of the sedentary animal, spooning him. We go through the usual routine, me, trying not to see the saggy breasts that pop out the top of the night dress, and trying to console a hysterical lady who is recounting his puppyhood with graphic details. All goes smoothly, and Megan requests that we leave the body with her, she wants to lie with him for the day, ad will take him to the crematorium two days later. My nurse and I oblige, wish her well and our condolences, and jump into the car. Neither of us dare mention that the weather forecast is in the 40s for the next three days.
By the time I get back to the clinic, Navada is causing a scene out the back. There are hysterical screams and one of the nurses is closing all the doors to the clinic to stop the sound spreading to the waiting customers. I sag into the one chair in the clinic, find a glass of water, type up my notes, and walk in the first consult of the evening. If all goes to plan – I may be home before dinner.