‘Okay.’
A few days later I judged the mood to be good and I briefed the girls. ‘Today’s the day I tell him about the fish tank. Are you ready?’
‘Yep. We’re pumped.’
Geoff appeared from the consult room, all smiles, as he saw his favourite client, Caz Holt, to the front door with her dog. My moment had come. ‘Geoff, you know, I think what would really finish this renovation off perfectly would be a nice fish tank here in the waiting room.’
Watching his face, it was like that thing mimes do when they pass their hand downwards over their face and it goes from a smile to a frown.
But Trish, Marie and Rebecca chipped in perfectly before he could get a word in.
‘That’d be fantastic.’
‘What a ripper idea.’
‘Wouldn’t it look great over there?’
It was all to no avail. I’ve never seen someone go so close to exploding. ‘No, no . . . no, no, no, no . . . no, no, no, no, no.’ He turned and walked out, still muttering. ‘No, no, no, no, no . . . no, no, no, no, no.’
Well that was that, I thought. But half an hour later he returned. ‘Actually, Anthony, I think it’s probably quite a good idea to get that fish tank. I think we should get one.’
As it turned out, James Turk, the mechanic next door, used to own a pet shop. I was chatting to him about it and he said that he’d had a tank in his shop that just seemed to attract people to it. ‘I couldn’t sell it because it was such a great tank,’ James had said. ‘I’ve still got it but I’m not using it. I’ll tell you what, I’ll give it to you in exchange for a big bag of dog food.’
Geoff, needless to say, was stoked with the deal.
IN A TWIST
James
Ronnie and I were growing increasingly fond of each other, enjoying all the excitement of new romance locked up in our little love fortress in Wisbech. Ronnie, however, worked in human resources in the financial services sector and there weren’t many jobs for that sort of thing on the Fens. As winter darkened the countryside and the global financial crisis dimmed employment prospects, she managed to find a job in London. My job was more transportable so I went back to the locum agency and found a spot at a practice in a place called Beckenham, 16 kilometres south of the Tower of London.
It was a practice that largely ran on locums. It was owned by the most eccentric man I’ve ever met. His name was Clinton ‘CJ’ Jefferies. He was in his sixties and had run the practice for a long time without doing too much veterinary work. He basically just employed Australian locums and focused his energies on managing us. It’s amazing how many vets I meet now who worked for CJ. He did still love to operate and he had some quirky techniques. I remember him showing me how he repaired cruciates, using a slice of skin from the animal in question. CJ said that this was how all cruciates were to be done in the practice. So I said that I’d leave that to him, then. Years later, I was discussing different techniques for cruciate repair with my boss back in Sydney and when I mentioned this method he turned around and said, ‘CJ! You must have worked for CJ too!’
CJ looked like a mad professor, bald on top with white hair encircling his bare dome, and a white handlebar moustache drooping down his cheeks. He got around in socks and sandals. You always heard him coming because he had so many keys jangling from his belt in a football-sized cluster.
CJ was also a hoarder. Out the back he had sheds full of stuff. When he finished filling one, he built another. There was a whole office you couldn’t get into because of all the paper in there. Only the clinic cats knew the way in and they’d use it as their personal toilet.
He loved printers. One of his principal shed-fillers was printers long since made redundant by the march of technology, mostly in their unopened boxes. He’d get a good deal on them and buy four. He was always going to the hardware store and buying eight of whatever he didn’t need.
You couldn’t help liking CJ but his practice was as eccentric as he was. We did the on-call work for nineteen other clinics at night. One of us would be on call and you’d do at least four or five jobs per night. It meant that the clinic was overstaffed during the day but very busy at night for whoever was on. Sometimes you’d work right through to dawn and never see your bed.
Ronnie and I moved into a 4-metre by 6-metre flat above the clinic. We decided to renovate it, and when I went looking for tools, I found four 18-volt power drills in their boxes and a couple of electric sanders. I was sorted. CJ was obviously hoarding them for a post-power-tools Armageddon.
We recarpeted the flat and painted it, installing a new kitchen and buying new furniture, all for a grand cost of £1200. One of the features that Ronnie and I didn’t like was that the shower cubicle was covered in lino. CJ had a love of lino that bordered on obsession. Everything was lino-ed, including the lowest metre and a half of all the clinic walls. So when the tray at the bottom of the shower was changed years previously and there was a gap between the tray and the tiles, it was no problem for CJ; he simply lino-ed the shower cubicle – no more leaks. I pulled that lino off along with thirty years of muck and vet DNA and re-tiled it at the bottom.
CJ followed a unique business model (not one that has taken off, for some reason), and communication was a common problem exacerbated by the transient workforce. CJ’s answer for this was signs. He loved signs and lamination and fonts more than he loved printers. I once did a count of the signs in the darkroom where we developed X-rays. This is a room without any light. You couldn’t read anything in there, but there were eleven signs. In the waiting room, where there was plenty of illumination, there were forty-eight. In the operating theatre there was one: ‘Do not pull this lever too hard or the window will SHATTER’, and ‘shatter’ was in a font like broken glass.
Every sign was on slightly different coloured paper. He’d put tags on things saying ‘Do Not Lose’ or ‘Do Not Drop’ on an expensive phone. He’d put signs on the back of tubes: ‘You must label your tubes.’ ‘You must label your labels.’ It was overwhelming. No one read the signs. There were too many. You mightn’t see CJ all week, but some problem would bring him back with a new sign. ‘Make sure you do NOT leave the CATS here!’
Any problem that arose would be greeted with, ‘Well I don’t know what more I can do. I’ve already made a sign about it, but I’ll have to make a bigger one.’ He would then disappear for three or four hours before emerging with a new sign to get some feedback on the font choice.
There was so much sign saturation that one staff member began removing a sign a day, yet after a month there was no discernible difference.
I worked there for quite some time and ended up taking on some of the day-to-day management of the business for him. It was great experience and I learnt a lot about how to run a practice, as well as how not to. I tried negotiating better deals on how he bought his drugs and how he managed the staff and the pricing structure. I wanted to do it because I liked living there but found myself so frustrated by how it all worked. I thought that if I fixed a few things I might be less frustrated.
Beckenham was like Sydney’s Upper North Shore with big houses and leafy gardens. The cricket club where I played and made some lifelong friends was right over the road. But council housing is spread evenly across London so there was quite a melting pot out there too. Next to Beckenham was Catford, one of the rougher bits of London, famous for being a bus depot. We always said that in London you never had to travel too far to get stabbed – or get a good curry.
The leafy suburban side of things was interesting. Cats were much more prevalent in the UK than in Australia. Once again I saw a lot of pocket pets and kept my trusty exotics manual handy. There were still a lot of Staffies, but mixed in with some different breeds: flat-coated retrievers, a British breed of hunting dog; Labrador retrievers; giant Leonbergers; and French bulldogs. But from a veterinary point of view what stood out was the nights. Because we covered for nineteen clinics, we were getting most of the emergency work for South-East London.
Dogs hit by cars, busses hit by Rottweilers, blocked cats, poisoned rabbits.
All the clinics had their phones forwarded to us and the nurse downstairs would take the call. She’d phone up to me: ‘There’s a dog coming in in twenty minutes. It’s been hit by a car.’
‘Okay, can you get the oxygen ready? Get the X-ray ready and a drip set up.’
I’d get out of bed and dress myself then lie down on the bed and go back to sleep because often people wouldn’t turn up. Maybe the dog died already or they just decided the dog didn’t need treatment any more. So I’d close my eyes until the nurse rang again to say they’d arrived. It was only a ten-second run down the stairs to the clinic.
You could almost set your watch to the arrival of dogs with twisted stomachs. It usually happened a bit after 10 p.m. The dog had been fed its dinner, maybe it had eaten too much or drunk too much on top of dried food. Then it had a romp before bed while its stomach was blowing up with gas. The stomach dilates then twists itself in a knot, shutting off the blood supply. And once it’s stretched and twisted far enough, the blood from the rear two-thirds of the dog can’t get back to the heart. So they go into shock and cardiac failure. About 30 per cent of dogs that get it will die. It used to be 50 per cent. It is a serious emergency that comes out of nowhere.
If you were a vet who didn’t do on-call work, you could have an entire career without seeing a single one of these cases, but covering half of South London on the graveyard shift produced plenty. My first one was when an old woman with short hair and big glasses brought in her bull terrier.
‘He’s dry retching and look at ’is belly. ’E’s bloa’ing,’ she said.
She was rough around the edges but devoted to her dog and she’d brought him in at the very first sign of trouble. Benny was his name and he was nine years old. She told me he’d got sick a few hours after she’d given him a big feed of dry food.
‘Looks like it’s a twisted stomach,’ I said. ‘We can do an X-ray but I think that’s just going to confirm what I already suspect. Your dog is very sick. We can save him, but the operation only has a 70 per cent survival rate. So three dogs in ten won’t survive it. It’s going to cost you about £1200 and we need to make that decision right now. Speed is of the essence.’
This woman, with her short brown curly hair and faded brown coat, clearly did not have a lot of money, but she did not hesitate. ‘I love me dog. Let’s do i’.’
I sent her home, so it was just Benny, the nurse and I. I got the IV fluids into him to counteract the shock that dogs go into owing to the blood from the back of the body not being able to get back to the heart. I took an X-ray to confirm my diagnosis and then tried to get a stomach tube into his gut to try to get some of the gasses out.
I couldn’t work it in there so I proceeded straight to surgery. I made a very large cut along Benny’s abdomen, revealing a stomach that was enormously bloated, purple and confused. It was hard to make out exactly which way it had twisted. It felt like it had gone clockwise and statistically I knew that about 75 per cent of them twisted that way. So I grabbed hold of this flaring wine-coloured blob and tried to rotate it gently back counter-clockwise. It was hard to grasp and I wasn’t entirely sure I was going in the right direction. Nothing moved at first and I kept doubting myself, fearful that I was making things worse, when all of a sudden the stomach started to move, and then it kept going; the kinetic energy of the twist wound it back into place in the most satisfying of motions. There was an almost instantaneous colour change as the blood started to flow and the whole purple mess subsided to a gentle pink.
I got a tube into the stomach and waited for the gasses and food to come streaming out, but nothing happened. Things were now back in the right spot but the stomach was still hugely bloated. There was no option but to reach for the scalpel again. I opened up the stomach with and found a congealed slurry of grainy rehydrated food that stank of digestive juices.
I cleaned it all out, then set about attaching the stomach to the body by making a small cut in the wall, not all the way through, and a small cut in the body wall, then stitching the two together at the point where the cuts had been made. When the two small cuts healed, the scar tissue would weld them together permanently so the stomach would never twist again. With that done I had to clean up the abdomen and make sure I’d removed all contamination – rushing all the while, because it’s been shown that with this operation, the longer you take, the poorer the chance of survival. Animals often die in the aftermath from heart abnormalities that arise out of the huge derangement of their systems that has just taken place. I stitched Benny up as quickly as I could. It was 1 a.m. by now. I let out a huge sigh. What a ride. I woke the dog and he looked great. He went on to be one of the 70 per cent that survive. It’s a high-stakes, adrenalin-fuelled procedure that you’re doing by yourself in the still of the night. This one was helped by how quickly the owner had brought Benny to us.
I went on to do plenty more. I had a good run there where most of mine were surviving and I allowed myself to think I was becoming a bit of a hot-shot, but unfortunately things have a habit of evening themselves out.
A FIERY REDHEAD
Anthony
Poppy Perkins had her big ginger cat, Willy, out in the waiting room. Willy appeared on edge and probably in pain, but he snuggled in against Poppy as she fondly caressed his chin. ‘He’s been off his food,’ she said, ‘and he’s been going to the litter box a lot and just squatting there with nothing coming out.’
It wasn’t hard to guess what the problem was. When male cats get stressed, they can develop a urinary tract complication that leads to crystals or plugs of mucus forming in their urine. The bladder wall also becomes thickened and inflamed and the damaged cells flake away. A cat’s penis is extremely narrow at the tip, so the mucus and flaking cells often block it up. If you don’t do something about it, the bladder can fill up till it bursts like a balloon.
‘All right, Poppy,’ I said, ‘I think we’re going to have to perform a little operation to unblock this. It’s a relatively straightforward procedure. We need to pass a urinary catheter beyond the obstruction and into his bladder to allow him to pass urine freely. We will have to keep him for several nights on a drip with the catheter in place to allow his bladder to settle down and return to normal function.’
Willy was a lovely big gentle fur-ball, but there’s something about ginger cats: they seem to have a correlation to fiery redheads. Another thing about cats generally is that when they’re in the consult room with their owners, they’re gracious and accommodating. They rub on you and purr. It’s a pleasure to deal with them. But once you take them through the swinging door to the back of the practice where the operating theatre is, they can turn into balls of pure, unadulterated hatred. Then when you bring them back through those doors to their owner, they revert to normal cats, purring like 1972 Ford Falcons.
Willy was no exception to any of these generalisations. As he went through those doors he arched his back, bristled his fur and frizzed his tail. The slits of his eyes dilated into black circles. When I reached in to pick him up, he showed me the white daggers in his mouth and the talons on his left paw.
He looked so aggressive away from Poppy that there appeared to be no chance of giving him a nice calm intravenous anaesthetic. In such cases, the best practice is to put the cat into a clear plastic box and run anaesthetic through it. Unfortunately, we didn’t possess such a box, so we had no choice but to go for a vein.
The nurse, Marie, was really good at it. She reached into the cage and, before Willy knew what had hit him, she had an iron grip on the scruff of his neck and was pulling him out. It’s a great skill to be able to do that, then hold the cat’s head up and its leg out so it can’t readily attack the vet with its back claws. I was able to find a vein and we got Willy knocked out quickly.
Once he was anaesthetised we were able to put a catheter in his penis so he could urinate freely, and we got another one into a vein to provide hyd
rating fluids and give him painkillers. We kept him in hospital for several days to allow the treatment – antibiotics and anti-inflammatories – a chance to settle things down, before it was time to remove the urinary catheter and send him home. The urinary catheter is only held in place by a single stitch, so it just needs to be nicked and you can pull the catheter out.
As we now know, the underlying cause of this problem is stress, so our treatment regime was somewhat ineffective. Being in a vet clinic with a cone on his head and a catheter in his bladder had done nothing to alleviate the stress that Willy was suffering. Today a lot more drugs are available to relieve anxiety, but ten years ago we were still trying to convince ourselves that the problem was an infection.
Marie and I stood looking at the snarling ball of jagged-toothed ginger wondering what to do. ‘Look, I think you’re going to have to do the same as last time,’ I said. ‘There’s no way I can get that stitch out without anaesthetising him. He’s way too aggressive. You did well last time. Let’s see if you can pull it off again today.’
So Marie opened the cage and the moment she put her hand in he went totally berserk. Willy had lost the plot and we had just lost the element of surprise. Marie continued gamely nevertheless, opting for a full-frontal assault. Willy replied with all weapons blazing. Marie got her hands on his neck and scruffed him, but he was a writhing ball of furious elastic and his back feet inflicted a lot of damage on her arms. I came in with a towel to wrap him. Cat wrapping is an expert skill because cats are universally good at unwrapping themselves, generally by shredding the towel – and then you – with their back legs. And that’s exactly what Willy did here. He tore that towel to strips. Ditto my arm. And then he started to really go at Marie with his back legs. I went in to help. ‘You let go. I’ll take it,’ I said. I figured we’d get him back in the cage, slam the door shut and rethink our strategy from there.
Village Vets Page 23
