by Ivor Smith
The next few weeks were bedlam. Tewkesbury Borough Council had approved our surgery development plans and on our first Sunday morning in Churchdown, Norman and his gang arrived. The lads were ready for a speedy brick-laying session and the walls of our first surgery were erected in five hours flat, in time for them to shoot off to their local for a lunchtime beer. Norman and his wife had been our good neighbours for a couple of years in Cheltenham. He was a skilled bricklayer, but his talents didn’t extend to animal management, although he enjoyed giving a piece of sandwich to Ginny when the opportunity arose.
One summer when his wife went away for a couple of weeks, her last words to him as she left the house were, ‘Don’t forget to feed the budgie, Norman.’ The budgie had been moved to a cool bedroom during her absence. She returned two weeks later and her first words on entering the house were ‘How’s Charlie, Norman?’ For the first time in a fortnight Norman remembered they had a budgie called Charlie. The reality of the situation was that they did have a budgie called Charlie. It was another couple of weeks before Norman was sure he still had a wife.
It took just three weeks for the building to transform into a surgery. Actually, built on a shoestring budget, I thought it was really good. All the essentials were there. I proudly put my plate up on the front of the house. It was not the traditional brass plate. Instead I chose a fashionable brushed stainless steel version adorned by dark oak backing. We were perhaps a little optimistically hoping that we would be far too busy to polish it with Brasso every day. Amazingly this was the limit of our advertising our presence to the village and potential clients. Any step beyond this and I would be appearing before the Royal College of Veterinary Surgeons’ Disciplinary Committee, with more than an evens chance of being struck off the Register. Thirty-odd years down the line the situation seems almost comical but at the time it was a problem always on a vet’s mind. What would I have given then for a full-page entry in the Yellow Pages or a jingle on the local radio?
It was the opinion of the Royal College that word of mouth and recommendation from existing clients should be the only way to achieve professional success. This is a tricky situation when you have no existing clients, but as in most villages there was plenty of word of mouth, whatever was being said. The early weeks were spent building in the surgery and in the house. Most of the work was subcontracted to skilled tradesmen, but there always seemed to be many in-between jobs for which no one claimed responsibility. My student days spent on building sites were once more put to good use.
I accept that my building experience was limited and I had never removed a fireplace before. This became clear one dreadful afternoon. My hammering and chiselling was interrupted when son Ed, who had now reached the crawling stage, managed to find a gap in the roped-off rails of the first floor landing and squeezed through. His 12-foot fall on to a stone tiled floor was, thankfully, broken by his folded pushchair. Angela rushed him directly to the doctor and I returned to my fireplace. I finally succeeded in dismantling the old thing, but at one stage I had ended up underneath it. When it started to move I had no idea how heavy a fireplace could be and the intact structure had a will of its own. Despite my best muscular efforts it settled across one of my legs. During this commotion and while I was cursing and swearing, the doorbell rang.
I hobbled to the door and a concerned elderly lady asked me if I was the owner of a Labrador dog that had just been hit by a car. By her side was an even more worried-looking Ginny. I immediately forgot my own aches and pains and while I checked her over, Angela returned from the doctor’s surgery smiling. Ginny, Ed and I had all managed to escape with just a few cuts and bruises, some more painful than others, but it didn’t stop me thinking to myself, ‘Is somebody somewhere trying to tell me something?’
We had been in Churchdown only a matter of days when our first patient arrived. The news that a vet was in the village had spread quickly. This particular morning Angela answered the doorbell and was more than a little surprised to be confronted by a distraught lady with her injured spaniel. Despite the owner’s attempts to stem the flow of blood from a leg wound, it continued to drip profusely through a combination of dressings, bandages and an old sock. We were unable to offer the benefits of a first-class operating theatre, which had yet to be set up, but with the benefit of Crudwell-style veterinary ingenuity we could sort the problem out. What we needed was an operating table, clean surgical drapes, a nurse and a surgeon. Angela was thrown in at the deep end as usual and her vet nursing duties commenced in the lounge. She suggested an old family wooden chest would make a temporary operating table, which she covered in a clean white sheet.
I wish I could remember the name of that dog, but Spaniel patient number 1 was soon heavily sedated with an injection of acetyl promazine, the area surrounding his deep lacerated wound was anaesthetised with local anaesthetic, and the traumatised area washed and cleansed with saline and the iodine-based pevidene. The surgery was straightforward; tie off the exuding blood vessels, remove tissues that were no longer viable and close the wound using only healthy tissues. Not bad for front-room surgery. The sutures were removed ten days later and all was well once more.
We hoped the successful treatment of our first patient, albeit in unconventional surroundings, would provide a little of the word-of-mouth advertising that was acceptable to our governing body. It later became permissible to have an illuminated sign fixed to the surgery wall displaying the words ‘veterinary surgeon’. The purpose of the sign was, of course, to assist people who had been there before in identifying the practice on a dark winter evening, and not to advertise it to anyone that had not. The size of the letters could be no larger than one inch tall and lit by a background bulb no more than 25 Watts.
It was a mixed blessing. The relaxation of the rules was a start and most practices took advantage of it, although it was soon considered a waste of time. In reality anyone with good eyesight would still require a telescope to find it. One practitioner wrote to the Veterinary Record pointing out that in his area the small sign was causing confusion to the general public and after a few weeks they had taken it down. The staff of his practice had become fed up with explaining to people with bursting bladders that their waiting room was not a public convenience.
For us nothing could have been worse than the ‘Churchdown Widow’ saga. Elderly Mrs Gough and her family of cats had become a regular client of the practice in a very short space of time. She did not live far from the surgery and often called in for a chat about her cats. This informality was welcomed and never considered a waste of anyone’s professional time. However, with the worst of bad luck Mrs Gough did not really have to struggle for reasons to visit the surgery. In one short spell she had lost two of her cats due to serious terminal illnesses. Sadly I had put to sleep one suffering from chronic renal failure and another with incurable feline leukaemia. To add to her woes, Mrs Gough was met one morning by a third cat dragging himself up her garden path. One of his front legs was so severely traumatised that surgical treatment and amputation of the leg was necessary. Mrs Gough feared the worst and believed she was about to lose another member of her family. The seriousness of the situation was explained to her. ‘If you can save him, Mr Smith, please do whatever you have to.’
At that time I felt one of those ‘special occasion’ operations was required, not one that required exceptional surgical skills, but where success and a full recovery was essential. I operated that day. The surgery went well and I believed he would make a good recovery. Cats are remarkable animals at adapting quickly to life on three legs. Shortly after we received a telephone call from a reporter at a local newspaper who had heard of the unfortunate fate of Mrs Gough’s three cats. He telephoned during a busy Saturday morning surgery and apologised for bothering me. We chatted for a couple of minutes and as usual from the outset I stressed to him that if I was to be quoted at all then there must be no possibility that I could be personally identified from my comments. He of course gave me that assurance, before asking m
e,
‘Can you confirm that Mrs Gough has lost two of her cats in as many weeks and a third one has received grotesque injuries?’
‘Yes, very sadly she has’, I replied sympathetically. ‘She has had a dreadful run of unbelievable misfortune.’
‘A bit of a coincidence, isn’t it?’ Our reporter asked. ‘Do you think someone could have a vendetta against Mrs Gough?’ He was so eager for a story his imagination was running riot. ‘Thank you so much for your time, Mr Smith.’ The line went dead.
I carried on with morning surgery and thought no more of the telephone conversation until Monday evening. I went home at the end of surgery. It wasn’t far to go as I lived next door of course, but usually by the time I got in at 7.30, and often much later, the children were in bed and it had been left to Angela to read their bedtime stories. On this particular evening I was greeted by a worried-looking wife and, ‘Ive, I think you may have a big problem.’
She was still reading the headlines of the local newspapers. The most dramatic referred to the butchering of a local widow’s cat. A touching picture of Mrs Gough and one of her cats had made front-page news. The first short paragraph related to her distress and the tragedies of the three cats, which the story suggested must be connected. The following paragraphs and almost the rest of the front page appeared to relate to my ‘belief’ that the three cases were related to the reporter’s vendetta theory. It was of course ‘just too much to be coincidence, wasn’t it?’ No it blooming well wasn’t. But the seeds of doubt had been sown.
The reporter didn’t go quite so far as to suggest that there was a maniac on the loose with a hatchet, but he had gone too far for the likes of the Royal College. Suddenly we were involved with solicitors to get our version of events in quickly before I was hauled up before the disciplinarians. Letters of explanation and apology were sent to the various divisions of the British Veterinary Society, and, more importantly, to local practitioners. Explanations to the latter were probably unnecessary. My relationship with the neighbouring practices was always sound. We were a small profession who enjoyed the occasional dig at each other, but faced with a serious problem we were united.
‘There but for the grace of God go I.’ We were all too familiar with this philosophical quip for a multitude of reasons. One cheeky prominent local veterinary practitioner did ring up to remind me that I had forgotten to give the reporter my telephone number. We are still very good friends. It sounds ridiculous now that something so frivolous should have caused so much worry and stress at the time.
It was a wonderful feeling having your own practice and knowing that you were running your own business, whichever way round you put it, even if you were not earning enough to make a living, but it was also a very stressful time. There were occasions when the enormity of what I had set out to do struck home. Among the considerations there was a huge mortgage, a wife, a child and another on the way to support. I tried not to think about it too often.
In order to succeed I needed patients, the trust of my clients and clinical results. In other words the people who brought their animals to me wanted to see them get better quickly. Putting up one’s plate can be a lonely world without other colleagues in the practice to discuss your cases with. Even now I reflect on some early cases that perhaps did not go terribly wrong, but which did not go terribly well either. I am probably being a little paranoid but I still remember a couple of cases I wish had turned out differently.
To have got our diagnosis right most of the time without modern aids required considerable skill and experience, and it was quite an achievement, even if we say it ourselves. Many vet practices at that time did not even have basic X-ray facilities, or if they had, the poor quality radiographs they produced were often of no diagnostic value. The thorough basic clinical examination of the pet was essential. More often than not the thermometer, stethoscope and your own senses were the only available diagnostic tools.
I do not think this would have influenced the outcome of the young Labrador that was presented in surgery one morning. His vomiting had worsened over several days and after I had examined him one thing was certain: a rapid exploratory laparotomy of his abdomen was a priority. Everywhere the abdomen was palpated the digestive tract felt abnormal. Every inch of gut seemed to be in a contracted spasm. An X-ray would not have influenced the treatment, but it would have been a great help in convincing the owners from the start of the seriousness of the situation. The puppy did not survive the operation.
In different circumstances and with a successful outcome this particular case would still be talked about today, probably with some hilarity. On this occasion I did not want to talk about it. Several days earlier the pup had obviously rummaged through one of his owner’s bedrooms and, of all the things he had found to eat, he had chosen a pair of ladies’ elastic tights. The result was a surgical nightmare. The main body of the tights had remained in the stomach while, over the next few days, the leg parts gradually extended through the intestinal tract beyond. The vomiting, dehydration, pain and shock caused by the garment were overwhelming.
I had not really recovered from the disappointment of this case and could not believe things could get worse for a young vet trying to impress. But, good or bad, things do seem to run in twos and threes, and it was not long before Jasper became ill. This Jack Russell terrier also had an obsession for eating anything he could get his mouth around and there seemed to be no limit to his voracious appetite. It was simply a matter of time before he met with serious trouble, probably surgical. One day he was brought to morning surgery vomiting and bloated from a mainly bone-impacted bowel and showing the usual signs of dehydration and weakness that so frequently complicate these situations. Enemas had little effect on his impaction and clearly, if he was to be relieved of this very serious condition, surgery was required. I carried out the preliminary laparotomy but, to my horror and dismay, within a short time Jasper gave up the fight and died on the operating table.
When operating on an animal today − be it Joe Bloggs’ old cat or the Queen’s corgies − the owner would make no difference to me at all in the way that I made my clinical decisions. But at that time how I wished that Jasper had not been owned by Fred Stevens. In the short time we had been in Churchdown I was familiar with few names, but Mr Stevens was one of them. He seemed to be involved in everything in the Churchdown community, knew everyone, owned an awful lot of property, and was clearly a very able businessman. I rang Mr Stevens and said I would like to come round and speak with him. There has never been any doubt in my mind that he knew exactly the reason for my call.
I rang the door bell and immediately the front door opened. We sat facing each other in the lounge. I did not really know what to expect. Naturally I feared the worst – that he would suggest I leave Churchdown as soon as possible. I shall remember the next few minutes of conversation all my life. It was unexpected. Of course he was saddened that I had not been able to save his beloved dog, but he did not blame me in any way for that and accepted without hesitation that I had done my best for Jasper. Among other complimentary comments, he was impressed that, despite the lack of expectation, I had made an effort to meet and talk to him, knowing full well that it would have been easier to have quickly explained away the sad events in a telephone call. Some good things do arise from adversity and I left his house with a feeling of renewed confidence.
Today we, or at least the Health and Safety Executive, would no doubt be more concerned with the way we were running our veterinary practice than the routines of those early days. They would probably be having convulsions now, but despite our shortcomings we survived.
On a very limited budget there was no opportunity for the installation of expensive safeguards, even if they had been available. Initially, Mrs Farlow’s kitchen was ideally placed to become the maid of all work, perhaps described today as a multi-functional room. It was equipped with a sturdy examination table complete with a heavy lead-surface mat just in case you ever wanted to use
it for an X-ray of a patient – which we soon would – as well as the essential anaesthetic machine. It was amazing what could be fitted into such a small space. After morning surgery the consulting room rapidly transormed into the operating theatre.
For most of that first year a typical morning would find me standing by the operating table dressed in the traditional green surgeon’s robes. My wife raised the sedated cat or dog’s prominent cephalic leg vein, I steadily injected the induction dose of thiopentone and the animal relaxed and obligingly went to sleep. The mouth was opened wide. In went the endotracheal tube and the patient was connected to the gaseous halothane anaesthetic machine.
Angela had already sterilised the surgical instruments in the reliable ‘fish kettle’ for twenty minutes. This was an elongated stainless steel receptacle with a lid and a removable perforated tray. It was suitable and efficient for sterilising most of the instruments and soft materials such as swabs but it had one big disadvantage: for an infuriating length of time the instruments were too hot to handle! The pet had been clipped, the operation site cleaned, sterilised and draped. The operation could began.
Operations during those early years of the practice were certainly family affairs. Somehow we managed to fit in the requirements of a one-year-old son who had a ringside seat to observe veterinary surgery from his highchair. We developed a satisfactory routine and as usual when you are enjoying yourself time seems to go much more quickly. The months passed by too fast and my pregnant wife/nurse was standing increasingly further away from the operating table. When it became clear that Angela’s arms were no longer able to reach the patient comfortably we placed an advertisement in the local press for our first nurse/receptionist employee.
We were overwhelmed with replies, but I knew that with just one vacancy, many local applicants would be disappointed, and some would be really disgruntled. It was the sort of feeling that I had when asked to judge a dog show or an exhibit at a WI meeting. I felt that when the winner was announced I was about to meet one person who appreciated my brilliance in these matters and fifty more who believed I was stupid anyway. I am sure I was just being unnecessarily paranoid.
