Before proceeding with drastic surgery, I had Lisa dial the Malnottis’ number and hold the phone to my ear. I described what I had found upon entering the abdomen, the worst-case-scenario foreign body in the duodenum, and the surgical techniques required to give Keno even the slightest hope. I warned of the potential outcome, the difficulty of the recovery period, and the likelihood of significant financial investment in this difficult fight. But despite my tale of gloom, I was instructed to spare no expense in Keno’s care.
I proceeded to remove a sizable portion of her duodenum, fishing out of the damaged section of intestine several pieces of the tennis ball that had occluded Keno’s intestines for almost a week. I then sewed the remaining intestinal wall closed, trying my best to salvage the ductwork that drained the gallbladder and pancreas. Then I flushed the abdomen liberally with eight or ten liters of warmed saline solution, until the fluid I removed after each liter ran clear.
Finally, with my shirt soaked with sweat and my back hunched in what felt like a permanent Notre Dame–worthy stance, I placed the final suture in the skin and pushed back from the surgery table. The procedure had taken close to three hours and I was physically and emotionally drained. There is a saying among surgeons: “The solution to pollution is dilution.” But despite being guilty of extreme overkill in the dilution category, I was not confident that the pollution problem had been solved. Nor was I sure that the damaged intestinal wall I had sutured was healthy enough to heal. Time would tell. I was still not betting on Keno.
For the next several days I flooded Keno’s system with many liters of intravenous fluids, thousands of milligrams of powerful antibiotics, and enough pain medications to render her an addict. Her attitude improved daily, though her appetite did not return. By the weekend she was better, although still in need of intensive therapy, so I referred her to the twenty-four-hour veterinary-care facility thirty minutes away. All weekend I could think of little else, rehashing each step of the surgery and her aftercare. Had there been anything else I could have done to help her get better?
On Monday morning Tim Malnotti brought Keno back to my hospital. I went out to his car to help him carry her into the hospital. The moment I saw her, though, I knew her condition had deteriorated.
“Oh, Tim, she doesn’t look good at all! I can just see it in her eyes.”
“Yeah, that’s what I thought when I saw her this morning, too. What should we do?”
“She needs more intensive care than I can provide in my hospital. She may, in fact, need more surgery. And if that’s the case, then I think it should be done by specialists. If you still want to proceed, I think we should refer her to the veterinary school in Blacksburg.”
“Okay, you make the call. I’m going to get on the road.”
“Tim,” I said, “you should know that this might be expensive.”
“I appreciate your concern, but now’s not the time to stop.”
While I made a call to the veterinary school, Tim headed down the road for the three-hour trip to Blacksburg, where the Virginia-Maryland Regional College of Veterinary Medicine was situated on one corner of the Virginia Tech campus. During the ten days she was hospitalized, the doctors there had to go back in and remove even more of her duodenum, reroute the outflow tract of her stomach, and remove her gallbladder. But after the second surgery, her recovery was steady. Though for the rest of her life Keno required supplementation of pancreatic enzymes and vitamins, she was otherwise healthy.
You would think after the mess she had placed herself in, Keno would have learned not to consume recreational equipment. But four or five weeks after she had recovered from this episode, she was back in my hospital, showing similar symptoms. I was forced to do a third surgery, during which I again removed the hemispheres of another tennis ball she had eaten. Since we were able to intervene much earlier the second time, the surgery and Keno’s recovery from it was much less dramatic.
At the time of suture removal from the final surgery, I turned to Tim and Steph. “You guys should be commended for all the care you have given Keno. She really struck the jackpot when you adopted her. Not many families would have been able to give her all the care you have. I know this whole episode has cost you a fortune.”
“You’re right, Doc C.,” Tim replied. “I added up all the bills from this the other night and it totaled a little more than ten thousand dollars.”
“Wow, that’s a lot! Well, I’m glad she’s finally back to normal now. I wouldn’t have bet a nickel on her when I saw her that first morning. Was it worth all that money?”
“We have no regrets at all,” Tim said. Steph nodded her head in agreement. “In fact, I’ve been meaning to ask you. When you called us during surgery that first day to say that it looked bad and gave us the option of putting her down, were you serious?”
“Absolutely. In my business, many, if not most, of my clients would have done just that, given the seriousness of her disease and the costs of treating her. Those choosing to proceed would have made the choice on the next Monday morning or before the surgery down at Tech. You guys are the exception to the rule.”
The Malnottis were quiet for few moments, considering my words. Then Tim turned to me again. “That amazes us, Doc C. Our dogs are our children. We would no more have considered putting Keno to sleep when there was any chance at all for her to recover than we would have euthanized our baby. We are fortunate that we can afford her care. But we still would have done this if we had been forced to mortgage our home.”
“Keno is one lucky dog!”
The Malnottis are still good friends of mine, though Keno and her cohorts are now gone, victims of old age. Tim and Steph are now too busy to have dogs in their home. Three pregnancies later, they are now the proud parents of four children, who occupy every spare second. But I cannot forget the roll of the dice that they took with Keno, for on the wall of my office hangs a plaque that Tim and Steph presented to me after Keno was fully recovered. On it is a picture of Keno with a sloppy grin and bright eyes. In her mouth is clamped a tennis ball, very possibly one of the two tennis balls I removed from her over the course of those two long months. Below her picture are these words:
You are my hero and trusted friend
You have been blessed with the ability to mend
I swallowed my ball and you took it out
You saved my life without a doubt
I came to you broken and sick
And I thanked you with a wag and a lick
My Girlfriend Megan
“Dr. Coston, I think my dog has broken her leg.”
The voice was even and measured, but I could sense the concern lurking just below the surface. Ms. Elaine Farmer had been a client for a year or two, and I knew her and her dogs well. Elaine was educated, levelheaded, and unswervingly devoted to her dogs, Megan and Max. Though she was controlling the fear and panic well, I could tell she was distraught.
“Tell me what happened, Elaine.” Often an owner’s first assessment of the severity of a problem is exaggerated by her own anxiety, so I usually expect the problem to be less serious than is perceived. I was not concerned yet, especially because Elaine’s voice was so calm and controlled.
“Well, the dogs and I were going down to the mailbox this evening. My driveway is almost a mile long, so it’s a great walk for all of us. All of a sudden, a pickup came barreling around the corner and ran right over Megan. Now she won’t put any weight on the leg, and I think I can see the bone. Will you check her out?”
“Of course I will. Bring her right down. I’ll meet you at the office.” I was still not terribly alarmed. It’s not unusual for a client to see subcutaneous tissues in a wound and assume she is seeing bone. Tendons, ligaments, and muscle sheaths can easily be mistaken for bones by the uninitiated. I felt sure that I would find a less serious injury than Ms. Farmer had described.
At that time in my practice, there was not an emergency hospital available, which meant that I saw my patients on an emergency
basis when the situation called for it. Since I didn’t have as far to go as Ms. Farmer, I arrived at the hospital before she and Megan did. With my mind running over the possible wounds I might encounter, I turned on the X-ray machine, retrieved bandage materials, and prepared the drugs I thought I might need.
Within a short time, Ms. Farmer rumbled into the parking lot, the motor of her Ford F-150 pickup truck grumbling quietly, like that of an idling motorboat. She lived in the Fort. Her job as a clinical psychologist required her to leave home in even the most inclement of weather—thus the impressive pickup truck with high clearance, four-wheel drive, and an extra-powerful engine. Chrome running boards helped Elaine scale the heights into the driver’s seat, as her stature was neither tall nor particularly petite. I recognized the vehicle immediately.
I ran out to the truck, threw open the door, and jumped up onto the running board on the passenger side. Megan was sitting on the front seat, her leg wrapped in a towel. Her face was the picture of pain and anxiety, but she greeted me warmly with a wag of her tail and a broad swipe of her tongue on my cheek.
Megan was a lean sixty-pound Labrador-shepherd cross with a long, fringed tail and flopping ears. Her coat was fairly long, brown and highlighted with wisps of lighter hair ringing her face and eyes, raccoonlike. A splotch of white splattered her chest. Megan had always struck me as a docile and totally agreeable dog, but tonight I was cautious because of her injuries. Gingerly, I lifted her in my arms and stepped as lightly as possible from the running board to the ground. Despite my caution, the step was high and the effect was jarring on Megan’s injured leg. She whimpered quietly but otherwise bore her pain without further complaint. I carried her to an examination room and deposited her onto the table.
Quickly I examined her for other injuries. I looked in her mouth, listened to her heart, felt her abdomen, looked in her ears, and manipulated her other limbs carefully, not wanting to focus in too quickly on the obvious problem and miss clues to other internal injuries. Fortunately, everything else seemed to be fine.
Slowly and as gingerly as possible, I unwrapped the towel from the injured leg. As I worked, Megan monitored my every movement, tenderly licking my hands as if to say, “I’m really glad for your help, Doc. But remember, that leg really hurts and I’d appreciate it if you’d go slowly.” I thanked her for her kisses and tried as best I could to reassure her with quiet, soothing dialogue. It was working: She trusted me.
As I pulled away the last of the makeshift bandage, I recoiled at the sight. Just above the right wrist was a large, gaping wound, through which protruded about three inches of glistening white bone. The shattered ends of the radius and the ulna, the two bones in the forearm, were coated with blood and debris from the gravel driveway. Grass, dirt, and small sticks clung to their jagged edges and were scattered throughout the wound. Held by the skin and soft tissue around the fracture, the wrist and foot dangled like a plumb bob on the end of the limb. Since no vessels had been damaged, there was surprisingly little blood. Megan looked up at me gamely, almost apologetically, and licked my hand once again.
I was moved with admiration for this noble and courageous creature and awed by her trust in me. For just a moment, I allowed myself to ponder the privilege and responsibility of meriting such unwavering confidence! My heart went out to the valiant dog and I cradled her head in my hands. Bending over, I laid my cheek on her forehead and whispered in her ear.
“Oh, Megan, I’m so sorry you’re hurting. We’re going to make you feel better, okay? Just work with me and we’ll get through this.”
Without moving her head, she turned her eyes up to me and, with an amazing clarity of cognizance, gently licked my hands again in an unmistakable reply, never taking her gaze from my eyes. They were just little things really—that lick, those eyes, the expression on her face. But there was in them a universe of meaning. They spoke of pain and confusion. They apologized for inconveniencing me. There was even, perhaps, anger at the careless driver of that pickup. But they mainly told of gratitude and confidence and acceptance, of satisfaction that her care would be in my hands, and of submission to my judgment. And in that moment of connection, I resolved to warrant her confidence. This dog would walk again if it was the last thing I did!
Our reverie lasted only a moment or two before I turned my attention again to the job at hand, almost embarrassed by the display to which Elaine had been privy. I gave Megan a sedative, an antibiotic, medication to fight shock, and a shot for pain. After placing an intravenous catheter and administering fluids and anesthetics, I proceeded to clean the debris off the bone ends. I then manipulated the bones through the wounds and returned them to approximately their normal locations. The fracture was a bad one and would require surgery to align the bones properly and stabilize them with pins and wires. But the middle of the night was not the right time to undertake such an involved procedure. I covered the wound with a temporary bandage, settled Megan into a cage, and continued the flow of intravenous fluids into her system. Then I turned to Ms. Farmer.
“Okay, so tomorrow I’ll take her to surgery and see what we can do about fixing that fracture. For tonight, she needs rest and fluids. The pain medications will keep her as comfortable as possible till then. I’ll stay with her tonight till she is fully awake.”
“So she’s gonna be okay?”
“I don’t think her life is in danger. That’s the good news. But the fracture is a bad one. I don’t need X-rays to tell me it’s a fracture. But they will tell me how badly mangled the bones are on the other side of the fracture, where I can’t see. Once I get those, I’ll have a better idea what will be required. Certainly it’s going to be a surgical fix. But she’s young and a fighter, so I’m hopeful!”
The next day, with the help of my staff, I anesthetized Megan again and took X-rays of her leg. I was pleased to see that the bones beyond the fracture line that joined the wrist were not shattered. Still, with only about an inch or two of bone between the fracture site and the wrist bones, I didn’t have much to work with for the surgical repair. During surgery, I fashioned a pair of curving metal pins, which I introduced at the wrists. These entered the hollow center of the bone, crossed the fracture site inside the bone, and bounced off the opposite inner wall, curving and gaining purchase on the inner wall of the side they had entered. With one pin placed on each side, the bones were stabilized and the fracture site was protected. Though the repair had been a difficult one, I was confident the bones would heal.
The surgery had been stressful, and I was tired and wringing with sweat as I placed the last sutures. A metal plate would have been a better fix, no doubt, but I did not have that capability in my hospital, and Elaine had ruled out a referral to a specialist. The repair would have to be augmented with a bandage and splint for a few weeks, but I had kept my promise to Megan.
As she recovered from the effects of the anesthetics, I placed a sturdy plastic splint on the injured leg, then secured it in place with layers of cotton gauze and a stretchable bandage. Covered with a final layer of brightly colored moisture-resistant material over the cotton and sprayed with a mist of bitter-tasting liquid to dissuade her from chewing at it, the bandage was finished. It was bulky and heavy, to be sure. I knew it would take a few days for Megan to become accustomed to it, but I felt certain it would do the job. The rest was up to Megan. She needed rest now and weeks of quiet recuperation.
As I waited for Megan to come around completely from the anesthetics, I called Elaine and explained to her how important it would be for her to curtail Megan’s habitually vivacious approach to life. I heard her laugh apologetically into the phone, knowing how difficult a task I had assigned her. Megan was only a year and a half old at the time—still a puppy with a devil-may-care attitude. About that time, Megan, still heavily medicated for pain, lifted her head and wagged her tail. As the clinging fog of the analgesics wore off, I saw relief and the lifting of anxiety in her eyes.
During the next two days, while Megan recov
ered in the hospital, I noticed a special intensity in her eyes whenever I entered the room. She would attentively follow my motions and perk her ears up at the sound of my voice. Like few other patients in my career, Megan fell for me with a fervency that bordered on fanaticism. It was not just that she liked me. It was more than that. The inescapable fact was that she had a crush on me—like a teenager’s infatuation with an attractive teacher. And I was not the only one to notice. Lisa and the rest of the staff were greatly amused and teased me about having a “thing” going on with a patient. I brushed off their humor, flattered by Megan’s obvious devotion.
On the third day after surgery, I discharged Megan to Elaine’s capable care. I prescribed oral antibiotics and pain medication to ease the postoperative discomfort, and issued stern warnings to keep Megan’s activity level strictly curtailed. She was to go outside only on a leash and under careful supervision. Elaine was to keep the bandage dry and clean; this point I stressed at length. Because the bandage was constructed largely of cotton batting under the exterior wrap, any moisture at the toes would wick up the cotton, leaving the inside of the bandage wet. Since the outer layers were moisture-resistant, this wetness would be retained against the skin, increasing the discomfort, causing nasty dermatitis, and dramatically increasing the risk of infection at the surgical site. Then I sent Elaine and Megan home, flush with feelings of accomplishment.
The Gift of Pets: Stories Only a Vet Could Tell Page 18
