A Wander in Vetland

by John Hicks

  “We need to get the foal into a bath of hot water.” I continued. I was thinking about a discarded bath, perhaps one now used as a water trough, or what about the old house? But the power was off, the fittings gutted. By a process of elimination, I managed to extract the inevitable from Dave’s very own lips: a bath with lashings of hot water was only available in the new house. We’d have to use the new house.

  “You don’t know what you’re asking, John. Wendy will kill me if she finds out.” It seemed strange coming from Big Dave, looming well over six feet in his stockinged feet, but before long he had entered into the spirit of the occasion. We kicked off our boots at the front door, a token concession to matrimonial harmony. The clean fresh paint and wallpaper was assailed by the smell of honest sweat and horse manure. We hefted our patient – heavy, mud-slimed and slippery – towards the bathroom. Precariously, we paused to re-grip, staggered our way across the light and airy living area, threaded past a cream lounge suite, and round a few tight corners down a narrow hall. With our hands fully occupied it was impossible to prevent the aimless, convulsive paddling of dirt-laden hooves. A trail of mud peppered the oatmeal carpet. Occasional dollops disappeared onto the walls – disguising themselves amongst the rose-strewn wallpaper, awaiting chance discovery on some happy occasion in the future. Dave, the last person I would have taken as house proud, tried to keep track of these, but he was a man distracted. Soon we were both carried away by the surreal absurdity of the situation. “It’s all right for you. You’ll be able to bugger off in a couple of hours when you’ve killed my foal. I’ll be welded to a vacuum cleaner for the rest of the day.”

  “Aw, get away with you! It will be a bit more cottagey with some genuine horse shit on the walls,” I ventured.

  “Go on! Joke about it! You won’t be here when Wendy comes back.” His jocular tone failed to disguise an element of fear. I made a mental note to make sure I wouldn’t be.

  The bathroom was tastefully decorated – clean and bright; but I had no time to admire the subtle, pastel shades. There was a logistical problem to solve.

  Archimedes, wise Greek that he was, must have filled his bath prior to getting into it. This option was not open to us, we had to deposit our burden first. With some relief, we slithered our filthy foal into the pristine white bath. Freed at last, my soiled daubs were soon defiling the gleaming gold mixer tap, and we filled the bath around her.

  At this point, it is pertinent to note that baths designed for the human body are not the right shape to accommodate a foal. We achieved a reasonable fit with the foal laid on its back. Instinctively, she rejected this unnatural position, even in her semi-comatose state. As the water level rose she became more difficult to restrain. Her long limbs, still absently paddling away, refused to fold neatly into place. As I concentrated on supporting her head above water it was becoming increasingly obvious that there were problems at the other end. Big Dave may have been as strong as an ox, but he was proving to be considerably less adroit than an octopus. Liberal sprays of hot, muddy water flicked across plush towelling, dribbled down the delicate dado and strobed across the complicated clutter of shampoos and cosmetics on glass shelves. That gave me an idea.

  “Perhaps we could tidy up with some of Wendy’s exfoliating lotion.”

  My feeble effort was peremptorily dismissed: “I’m more worried about excommunication if Wendy finds out!” “If” seemed an increasingly optimistic qualification, given the circumstances.

  Sometime, during our struggles, there came a “eureka!” moment of near perfect immersion. By some chance of timing we had achieved an almost complete displacement of water. A tide of filth ran along the floor. Archimedes would have been proud of us, but perhaps he didn’t have carpet in the hallway next to his bathroom…

  Mercifully, it took far less than two hours for the foal to expire. One final flurry of flaying limbs, and she was dead. The clean up job promised to take a lot longer.

  Dave seemed to take his loss philosophically, but now the charade had played its course, the time for jokes was past. I helped him carry the body outside. My quick post-mortem was inconclusive. I needed to extract the brain for laboratory tests if I was to find the cause, but Dave, realistically, declined the further expense. Besides, he seemed desperate to get on with the housework. For a fraction of a second I pictured his tall, lean figure in a black-vested frenzy of muscular mopping, driving a damp duster round the Crown Derby, or sponging horse shit off the chintz. Perhaps the wry smile I tried to suppress, as he waved me away, would be my undoing. I scurried back to my car, consigning Dave’s fate to his dubious skills as a house husband.

  A day or two later I was surprised and relieved to hear, from the safety of my desk at the back of our clinic, a cheery voice and noisy laughter rattling the walls of the reception area. Dave sounded his usual, vital self. Wendy must have enjoyed an inordinately happy day at work, the day we messed her house up. Or Dave must have resorted to low cunning. A strategic meal out? A bunch of roses? It didn’t seem his style. I listened as he spoke to one of the girls. Was there an edge to his booming request? Perhaps something more than detached irony? “Now, where’s that Hicks fellow? Tell him I want to see him now.”

  It was time to hide.

  ~

  The story of the foal in the bath is a somewhat rueful footnote to my involvement with horses. To set the record straight, Dave is not the sort of person to hold a grudge. I am pleased to report that we were on friendly terms when we last met socially.

  Horses have challenged and pained me totally out of proportion to other species during my veterinary career. In this respect horses are different. They cost a lot to buy and to keep. They are large, strong and can be dangerous. The faster and more valuable they are, the more they live on a physiological knife-edge. They and their owners present the greatest challenge to vets, an observation backed up by the disproportionately large number of professional indemnity insurance claims made by horse owners against vets each year. Horse vets need additional insurance cover. Death and disaster are never far away.

  One common procedure, as much as any other in his repertoire, highlights the drama of a horse vet’s life: general anaesthesia. Horse anaesthesia is always a challenge. Guinea-pig anaesthesia has its attendant risks, but it is equine anaesthesia I am drawn to write about…

  Chapter Twenty-seven

  The Sleep of Life

  Below the thunders of the upper deep;

  Far, far beneath in the abysmal sea,

  His ancient, dreamless, uninvaded sleep

  The Kraken sleepeth.

  - Alfred, Lord Tennyson

  By a quirk of human nature we are always impressed by the latest whizz-bang technology, even if it isn’t the best. It has been claimed that for reliability, rate of fire and overall effectiveness, English longbows, as used at the famous English victory at Agincourt in 1415, were not surpassed by muskets for three hundred years and, in the hands of trained archers, they could still have been effective tactical weapons at the battle of Waterloo four hundred years later. Yet the military, impressed by noise and technology fell, erringly, for the more unreliable musket. It seems that the development of veterinary anaesthetics has sometimes followed a similar path.

  Horses can be awkward animals to anaesthetise. One of the commonest reasons to, in veterinary slang, “knock a horse down” is for the routine operation of castration, though perhaps there is more poetry in the older word: geld. Gelding a horse can be quite a challenge for the vet concerned, since it usually precedes the painstaking process of breaking a horse in – the process that makes horses tractable to the whim of men and wiles of women. Unbroken colts can be decidedly frisky and untrustworthy.

  As vet students, before we qualified, we had one memorable bus trip to a farm in Derbyshire. Awaiting our arrival were about twenty semi-wild ponies. They had been mustered off the moors and corralled into a large stone-walled field. Our task was to castrate them and compare several different anaesthetic te
chniques. The traditional method involved strapping a canvas nosebag (a Cox’s mask) onto the muzzle and then inserting a chloroform soaked sponge through a zippered compartment, close to the nostrils. Another group of horses were knocked out with a dose of barbiturate. This is a very reliable, but highly irritant chemical, and it must be injected into a vein – the jugular in the neck being the most accessible. It is essential not to inject any barbiturate around the vein, which is easier said than done with a prancing horse; any mistake and there is likely to be a severe reaction followed, in a day or two, by sepsis (pus formation). An abscess around the jugular can be fatal. The last method we tested that day was the newly available drug “Immobilon”, a version of the drug used to dart African game animals. It had the great advantage that a vein was not required; it could be injected into a muscle. A large muscle mass, such as in the side of the neck, is a much easier target than a vein.

  The traditional tried and trusted chloroform worked very well. These ponies were walked slowly round in a big circle and soon relaxed and slid to the ground as the drug took effect. The Immobilon worked, but the ponies seemed stressed under its influence. They were tense, and shook and trembled – sometimes making the operation difficult to perform. Fortunately there was an antagonist, “Revivon”, which quickly reversed the Immobilon and the ponies were on their feet in a jiffy. The Immobilon/Revivon combination gave by far the quickest recovery time, a definite advantage not only for the horse, but also the vet who has to wait around to supervise the risky recovery period when a half-doped horse can run into fences or other obstacles and injure itself. The barbiturate was all right as long as the pony was under control at the time of the injection. The vein had to be punctured competently first time; our ponies, much as their human counterparts would be, were reluctant about repeated stabbings. Unfortunately, there is no effective reversal agent for barbiturate anaesthesia and the ponies injected with it took a long time to recover and needed careful supervision while they came round.

  To the casual observer, chloroform would have appeared the best option. Unfortunately, its use was becoming unacceptable. Vets were becoming aware of its toxicity to the liver and the fatal risk this carried, especially if the horse was not a fit young animal.

  Each method had its drawbacks. By the time I started working in New Zealand a couple of years later, the use of chloroform was proscribed and Immobilon was not available for the very good reason that it was a risky drug for the humans using it. A small dose could prove fatal and the risk of accidental self-injection while dealing with a bouncy horse was too great. Purposeful self-injection was another matter. There had been several Immobilon suicides by vets and vet nurses in Britain, where the drug was readily available.

  There was a further option for the brave horse vet. This was standing castration: sneaking up boldly – a valid paradox when considering a puny human weighing perhaps one tenth of the half-tonne kicking machine he was setting himself against – and using local anaesthetic alone. In New Zealand the most commonly used general anaesthetic technique was to inject a barbiturate drug, such as thiopentone, directly into the jugular vein.

  So it was that one fine Canterbury morning my friend Kit asked me to accompany him to geld a Clydesdale. Clydesdales were the commonest work horses on New Zealand farms. A few remain, mostly in the hands of hobbyists. Normally gelding is a job for one vet but, with such a large and valuable animal, it seemed better for two of us to attend. Even though he was only a yearling, he towered above us. Fortunately, he was a pleasure to work with: placid-natured – as are most animals bred for work rather than for sport.

  Everyone was relaxed as we injected the sedative. While this was working we prepared our instruments and equipment – rope, cotton wool, scalpel, triple crush emasculators, tetanus antiserum, penicillin injection, and antiseptic powder. We dissolved up a couple of five gram bottles of thiopentone, each in fifty millilitres of sterile water. A bleb of local anaesthetic was injected into the skin over the colt’s jugular vein with a fine needle. He never flinched. The worst part was done. Now he shouldn’t feel the wide bore needle, through which we would carefully inject the large volume of thio necessary to drop him. Confidently, we instructed the owner what to expect next. “It will take eight to ten seconds after Kit has injected him for the drug to take effect. That’s when you have to concentrate, because he’ll pull back hard.” We prepared for this and, given the size of our patient, two men were put on the rope attached to his head collar. I was one of them. “There is always a danger that he will pull so hard that he will topple over backwards and bang his head. We must keep the tension on the rope and try to keep his head off the ground until he has relaxed into the anaesthetic.” We eased the colt into an open position. All was clear behind him.

  Kit inserted a large eighteen-gauge needle into the jugular. The dark red splash on his hand indicated a clean strike. Deftly, he connected the first syringe and emptied it, discarded it, and repeated with the next one. “Fifty mils, John. Anytime now!” We braced ourselves. Seconds passed. The colt reared on his hind legs, front feet waving way, way above our heads. We were jerked off our feet. For all the tension we could put on that rope we may as well have been lice on a strand of hair. Unusual! We scattered as, unexpectedly, he ran forwards, did a complete somersault and came to rest twenty metres behind us, under a hedge. He lay there relaxed, breathing deeply and appeared to be unharmed. More to the point, so were we! It took a while for four of us to drag him into a more convenient place for his operation, which proceeded without any further hitches. Any vet in the field learns to anticipate the unexpected.

  Sometime later I saw a master demonstrate yet another approach to dealing with horse castrations. Gordon Burr first sedated his horses and then resorted to ropes: a combination of new and old technologies. He placed a thick leather collar round the horse’s neck, and hobbles round the fetlocks (ankles) of each hind foot. One hind leg was drawn up and tied to the collar. Then, as the horse was walked back the rope on the other back leg was shortened. The horse, quite naturally, sank to the ground, and lay on its side. The second hind leg was also trussed tightly to the collar. It was like watching a ballet – a combination of timing and balance. With unhurried grace all four legs were neatly folded and roped. His horses hardly fought; they knew they were helpless. In a matter of moments they were parcelled as neatly as a fly by a spider. It was then a simple matter for Gordon to inject the local anaesthetic around the scrotum and conduct the surgery safely and humanely. Of all the techniques I have seen this was the most impressive. It was safe for horse and operator, used a minimum of drugs, and was entirely humane. However, it required a certain physicality and consummate skill on the part of the operator. Gordon was the longbow man of the anaesthetic world. The rest of us preferred muskets.

  ~

  I still ponder about that Clydesdale anaesthetic, but when dealing with drugs, in either man or beast, there is always the possibility of individual reactions.

  I found it very interesting to experience intravenous anaesthetics at first hand, as I used to undergo regular three-monthly checks and operations for recurrent bladder cancers. When I met Joe, one of my anaesthetists on a social occasion, I was able to inform him that he and his colleagues had knocked me out at least forty times in the previous twelve years. His riposte was that they had brought me round forty times… “It’s only when the two figures differ that we become really concerned.”

  My early experiences in this series were with barbiturate anaesthetics, as used on the horse. I am truly grateful that I avoided the roping down, strong assistants’ era, the years when speed was merciful and lion-of-a-man Liston’s ability to amputate a limb in half the time of other surgeons enabled him to inflict half the pain.

  Each of Joe’s anaesthetics followed the same pattern. I lie on the table. “All right John, slight scratch. Try to relax.” Some slight scratch! The back of the hand is a sensitive area. He tapes the cannula in place as he chats about other things. No
w he has a line into my vein. “OK, we’re away. Breathe into this mask, John”. An icy cold, intense ache snakes up the vein in my arm and a metallic, garlic taste fills my mouth. Very briefly, I appreciate why some dogs lick their lips just before they “go under” with a dose of barbiturate. That ache is intensifying, but the edge is falling off it… and I am falling off the edge. The chattering is fading... Oh welcome oblivion! Nothing…

  The awakening is somewhat less comfortable depending on what the scalpel wielding inheritors of Liston’s crown have inflicted on my body. But undergoing anaesthesia and experiencing that drift into unconsciousness first hand gave me an insight into what I had been inflicting on my own long-suffering patients all these years. And surely it is not inconceivable that an icy ache searing your jugular vein could – if you were large and powerful, and just before the point when its effects claimed you – occasionally trigger a violent reaction; perhaps even impel you to rear up and brush aside your anaesthetist and surgeon, before sweet oblivion overwhelmed you and you fell asleep.

  Chapter Twenty-eight

  Cancer – a Catalyst for Change

  The future ain't what it used to be. – Yogi Berra

  For much of my life, I wanted nothing more than to be a practising vet. Eventually I had succeeded in reaching the next rung, a shareholding in my own veterinary practice. The partnership was going well. Business, with all the new dairy farms setting up on Southland’s rich soil, was booming. However, as with any expansion, cracks were starting to appear. Veterinary business was becoming a game of promotion and marketing enterprise and, with the enormous herds, some up to two thousand cows, it was increasingly a game of numbers. The work became less varied and more physically demanding. You could be pinned down for hours on one farm doing nothing but lame cows or pregnancy testing, or fertility checks. We had had such jobs on the large sheep farms, but they were carried out in a more convivial manner, at a gentler pace, with shepherds and other workers we had come to know well over the years. Even on the large sheep stations we were invited to the cookhouse for morning tea or lunch and treated royally.