The little creature is now fully out, much to her amazement. Lying in the central passage, she breathes in and out, a bit dazed. Still lying down, her mother is calling her already. A little water behind the ears, a deep breath in, a noisy breath out, lots of mucus. As a precaution, we’ll hang her upside down. She’s spent a long time upside down inside her mother. I knot a rope around her hocks, Monsieur sends Madame to fetch a chair so we can pass the rope over one of the beams. I remove some mucus from the calf ’s mouth with my hand.
Madame positions the chair.
Monsieur stops to take off his boots, then climbs up on to the chair. Brushes away a few spiders, passes the rope over the beam. I lift up the bouncing baby, all 50 kilos or so of her. He gets down, checks his grip and takes a few steps backwards. Mucus pours out of the calf ’s nostrils. She’s breathing well, we lower her again. I guide her as she lands on a mattress of straw. The farmer picks up his pitchfork and scatters some straw over her back to keep her warm.
We get the mother into a standing position, and I pull gloves on again to check that nothing is torn.
It’s all good.
*
‘Would you like a coffee?’
‘Oh yes please, but first I must take some photos. They’re for, erm … for my sister – she just loves pictures of baby animals. Silly really, isn’t it?’
‘Oh, if I’d known I wouldn’t have put the straw over her!’
He smiles.
I click away.
You can be 75 years old and still appreciate a moment like this.
Then afterwards, yes, we’ll have a coffee. But before I climb the two steps up to the kitchen, before I cross the threshold, there’s one thing I must remember to do, above all else, before all else. I must remember to take my boots off. Even if he protests that there’s no need. And I know he will.
Chronic kidney disease
I don’t know if anyone’s ever told you just how vile a thing chronic renal disease is.
I’m not talking about acute, sudden kidney failure that can be brought on by some other illness, which if treated generally means the kidneys can carry on with their essential work of filtering and purifying our blood.
No, I’m thinking of chronic renal failure, the ‘natural death’ that awaits so many cats and dogs, the failure of the most fragile of all their organs, their hope for life. With us it’s our arteries that fail, or our brain. With them it’s their kidneys.
There’s a sort of wear-and-tear threshold, at around 25 to 30 per cent of the initial renal capacity, when the kidneys start to seriously struggle to do their job, although the animal isn’t necessarily really ill. You can detect it by testing the urine, or sometimes the blood. Occasionally you can detect it before it gets a hold. Then often you’re in with a chance.
In many cases it’s diagnosed only because renal failure has really set in: the kidneys aren’t working properly, waste products are building up, and uremic syndrome is beginning, with all its many repercussions. We try doing transfusions to force the kidneys to filter out impurities. This can work, and work well, if the kidneys still have some capacity. If they have been plunged into crisis by an accident of some kind, there’s hope for getting the system working again. And then there are some animals that survive very well and for a long time with creatinine or urea levels that should by rights have killed them. As usual, it’s a case of treating the animals, not the test results.
But when the end comes it’s horrible. An ugly, long-drawn-out death. It’s not the heart that gives out, it’s a slow descent into auto-intoxication. It’s not for nothing that we put so many pets down. We’d all rather they died in their baskets, in their sleep.
Number 2298
Number 2298 is eighteen years old.
Number 2298 is just an ordinary cow.
Number 2298 is generally good-natured, but neither more nor less so than other cows.
Number 2298 is an elderly cow with a vague resemblance to a Blonde d’Aquitaine crossed with who knows what.
Number 2298 is still with her herd, despite her age, because she’s always lived a placid life and has calved every year and fed her calves without any problem. And also because she can still get about. She just happens to have outlived the usual age for being put out to grass by six years.
Number 2298 fell over on her side a few weeks ago. She couldn’t get back up again. The farmer got her up on her sternum, wedged her with a hay bale, gave her some water and called me.
Number 2298 was four months pregnant and crippled with arthritis. I gave her an anti-inflammatory injection and advised the farmer to use straps or a crowbar to get her back on her feet so as not to leave her lying down for too long, and to make sure she ate, especially hay, and drank.
Number 2298 was up on her feet within a few hours, and went back to her daily routine.
Number 2298 fell on her side again a few days ago. She couldn’t get back up again. The farmer got her up on her sternum, wedged her with a hay bale, gave her some water and called me.
Number 2298 is a bit thin, but only a bit. She’s still in fine fettle, she has no detectable neurological deficit, she still ruminates, but her temperature is slowly going down. She’s weary. Weary of carrying her calf, which hasn’t yet begun the rapid growth phase of the last months of gestation. Weary of clambering up on to her feet every morning, weary of her haunches that won’t do what she wants any more. I give her an anti-inflammatory injection, but there’s not much advice I can give to the farmer. He’s already done it all, even clearing out the stall, leaving just a thin layer of manure to help her get a grip on the beaten earth below. Number 2298 just can’t really support her own weight any more.
Number 2298 didn’t get back up again, despite the farmer’s efforts. Two days later, he called me out again.
Number 2298 was lying on her side. She’d pushed away the bales of hay that were keeping her lying upright. She still looked in reasonable shape, she was still eating and drinking. The farmer came with me, a fixed expression on his face. His father chose to stay behind in the farmhouse.
Number 2298 is dead. I put her down.
Number 2298 lived eighteen good years, with no major incidents. She gave birth to sixteen calves, some of which have bred further generations in their turn. Three, four, five generations? Others have gone to the slaughterhouse.
Number 2298 was born when the farmer was a small boy. He saw her being born and helped her give birth to all her calves, guided their first steps, sometimes helped them on to the udder. He took them to their mother to suckle, morning and evening. He looked after them, watched them grow, watched them go.
Number 2298. The farmer was her lifelong companion, from birth to death. In her last days he devoted himself to her care. He got her back up on her feet, turned her over to avoid pressure sores, fed her, took the time to give her water, spread out her mattress of straw, cleaned up after her. He asked me to do what I could for her and he didn’t quibble over the cost of the anti-inflammatories, even though he knew that her last pregnancy would never reach full term.
‘I owed her that much at least’, he said.
Number 2298 was a nondescript old cow, one of those old cows that have been bred out now. The pride of the meadows. She died in about 30 seconds, with no pain.
Number 2298 was just an ordinary cow. I killed her.
Number 2298 was eighteen years old.
Putrefaction
A WORD OF CAUTION: This chapter contains a scene that some readers may find upsetting. My editor wanted me to take it out but I insisted on keeping it in. Firstly because anyone who knows anything about what a vet does would be surprised not to read about scenes such as this. And secondly because I don’t want to endorse any misconceived idea that vets spend all their time cuddling adorable puppies. Happily this type of event doesn’t happen very often, but to be a vet you have to have a strong stomach. Those of a sensitive disposition might be advised to skip this chapter and turn to page 112.
It’s half past eight in the evening, an injured labrador has just arrived at the surgery, and the phone’s ringing again.
‘I’ve just got back to the farm and found one of my ewes can’t get up. She had a lamb yesterday morning. Do you think there might be another one left inside her?’
Not likely. But not impossible either. I hesitate as I tell him to come and pick up some antibiotics, anti-inflammatories and a little sugar and calcium, because … well, he might just as well bring the ewe in with him, didn’t he think?
Whatever happens, I’ve still got work to do on my labrador. The drip’s in place, the anaesthetic’s done, the dog’s stabilised, the X-rays are ready. A shattered tibia. I finish off a dressing to support the wound in preparation for transferring him tomorrow to colleagues who can operate on him. It only takes about ten minutes in the end, but I still have to look in on my in-patients, check the till, prepare the handover notes and send in the order. And while I’m at it I might as well expand some over-succinct consultation notes.
I’ve got nothing else to do while I wait for my ewe to arrive, anyway.
I’ve even got the syringes prepared. When she gets here I’ll bung in a thermometer, find out if there’s an infection, give her the injections, and we can all go home.
*
The guy has parked his C15 van outside the entrance, its rear doors facing the surgery door to take advantage of the light. It’s only a couple of hours since the place was cleaned: no way is the sheep coming inside.
The ewe is lying on her side. She can lift her head and she looks alert.
‘She can’t stand up. I had a real job getting her into the van.’
Yeah, very sorry, but I had to look after a dog that had been run over, it would have taken too long for me to get to you, and in any case this has saved you paying the price of a call-out. Agreed?
A solid 80 kilos of sheep, I can well believe she wasn’t easy to carry. She’s had lambs four times, twins every time, and this time it was a singleton. Not surprising that he should think there might be a second one left behind. Temperature of 39.2, heart beating faster than normal, but then after that journey … Mucous membranes OK.
In any case, there’s nothing like a good feel along the birth canal with your arm. Even into the uterus. There, at the far end, is a sac, almost a perfect sphere. Through the membrane I can feel bones – there’s a lamb in there all right. I try to grasp a bone – a shoulder blade? – through the membrane, but it doesn’t respond. Dead, clearly. The sac is strange, granular. Chronic placentitis, an inflammation of the placenta? I’m surprised she’s still alive. I’m even more surprised that I can’t puncture the sac. Anyway, with my gloves on it’s hard to know what I’m feeling. I think I can make out the spine. The lamb must have presented curled up with its back first and got stuck like that. There’s no question of taking my gloves off, though.
I’ve switched to mouth breathing – an automatic survival mechanism for vets.
The ewe puts up pretty well with my investigations and manipulations. She strains without any effect, but she doesn’t struggle too much. I slide my hand and arm over the dorsal face of the uterus, to feel all around the lamb and work out its exact position. Oh look, the membrane’s thinner here. I try to puncture it.
And I’m not disappointed: out flows a flood of foul-smelling gases and blood-streaked matter with a stench of well-hung game, all streaming out of the back of the van and into the surgery doorway.
A hoof.
The farmer is standing ten or so metres off, looking nauseous.
The lamb is putrefied, its body swollen with gases, and what I took for a malformed foetal sac was in fact its skin, blown out from its body by the gases of putrefaction. The thinner area was the skin of the abdomen, under the stifle joint in the hind leg. Now I can feel the skeleton and muscles better. Its head is facing down towards the ewe’s udder, with a leg to each side probably. That’s where I’ll have to set to work.
But first, antibiotics, anti-inflammatories, intravenous drip.
This time I slide my arm over the ventral face of the uterus. It’s much less easy because of the curve. I’ve got my gloves on, naturally, but I know they won’t be enough and my hands will stink of decaying flesh for at least 24 hours. As for my jumper, the less said the better. As I crouch on my knees at the back of the van at nine o’clock at night, in the dark and the rain, I conjure up mental visions of midwives in hospitals, with state-of-the-art delivery suites, birthing pools and childish decorations in pastel palettes. In my dreams.
Locating the nape of the neck, I slide my fingers to either side of the lamb’s head. It’s all slithery, I can’t get a hold. The jaw slides away. I try to grasp the front leg from above, and manage to do so without too much difficulty. I draw it into the pelvic passage, then I turn the head. This will mean I can raise the lamb up a little, which will make me feel I’m making headway.
The next stage goes on for another ten minutes or so. Try to get a grip on the head, straighten it and pass it through the pelvis. No way. It catches on something every time and slips out of my grip. Even though I’ve found some fingerholds. There’s the jaw: too fragile and also dislocated. Or the eye sockets: not bad, but you’d need to have bloody strong fingers to use them to pull the head up. And just imagine the stomach-churning sensation of the eyeballs as they explode between your fingers. Or the neck: yeah well, OK, but the angle’s never quite right.
The ewe, meanwhile, has given up. She’s not moving any more, but her breathing’s good. She’s in pain. In shock.
The stench is atrocious. It’s the stench of the knacker’s yard, of a dog that’s rolled in rotting flesh, of clots of black blood and gobs of putrescence, splattered all over the ground and all over the van. As I manoeuvre the lamb I do my best not to get it all over my trousers. In that respect I don’t do too badly.
I don’t know what I’ve done right, but eventually the head appears. In a tragic state, but in the right position. All I have to do now is to jam my fingers in one more time to straighten the other front leg, and the final extraction will be a mere formality. I pull out the lamb’s body, and the farmer begins to realise just how hellish it was inside. The body ends up in a dustbin bag, with a trail of putrid blood polluting everything as it passes.
I still have to fix up a drip for the mother, otherwise all this will have been for nothing. Corticosteroids and analgesics. The farmer asks if she’ll pull through. I’ve no idea, but I think so, if the uterus is intact. Every twist and movement, every attempt to lever up the limbs, skull and body of the lamb had to be done without putting any pressure on a uterus that has inevitably been weakened by infection. If it’s been punctured, the ewe is done for. If not … we’ll see tomorrow. I don’t give him any medication: he can come back and get the drugs tomorrow, if there’s any point.
As for me, if I don’t want my clients passing out when they arrive in the morning I’ve got to swab down the surgery doorway. And the hose isn’t working. So I fetch the bucket, the long-handled scrubbing brush and the bleach. It’s not even raining hard enough to help.
It’s a quarter to ten, just about time to go home.
Sexplousse
There he was, sitting on the other side of the desk. Olivier was in his chair, I was leaning in the doorway. He hadn’t touched his cup of tea yet, and he seemed a little awkward, with his little laptop displaying great Excel spreadsheets and his neat piles of papers, carefully arranged and rearranged.
He couldn’t leave them alone: he kept picking them up, tapping them up and down to straighten them, then with immense care putting them back in their piles in front of him. He was wearing a three-piece suit and tie, he didn’t have a hair out of place, and his watch was a good one. Not the usual look for the drug company reps sent to beguile us with the latest products or tempt us with miraculous (they were always miraculous) business contracts.
Olivier had greeted him with a cheery ‘Hello, Monsieur De Mesmaeker!’, a witty reference to the
popular French comic-strip character of a wealthy businessman who’s forever on the verge of gaining a lucrative contract but never quite does so.
The reference went over his head, as it had with all the others. He corrected Olivier politely:
‘Oh no, I’m Benoît Laroche, you must be confusing me with my predecessor, I’m the Sexplousse rep for this area.’
As usual, we welcomed him politely, and after a bit Olivier stopped making remarks along the lines of ‘So have you got the contracts, Monsieur De Mesmaeker?’
Anyway.
The Sexplousse drug company sells one product and one only, a treatment for arthritis. It’s been selling this product for some twenty years. Maybe thirty. Maybe longer. No one’s ever really understood how it worked, nor indeed if it worked, but as you can’t ever be sure, and occasionally it has appeared to work, many vets have continued to use it. It can’t do any harm, in any case.
As usual, the rep was about to present us with a new study offering infallible proof of how effective this product was, and as usual we weren’t going to buy any of it.
As usual, we were wondering how we were going to say ‘no’ without being rude. He wouldn’t last long in the job, just as his predecessors hadn’t. For lack of results, I imagine.
*
Now he was off. He looked as if he was revving up, ready to launch into his spiel, and we’d been making idiotic jokes so as to give him a chance.
‘The cell membrane is an ocean of lipids with icebergs of proteins floating in it —’
We couldn’t help it. We didn’t actually burst out laughing, but we couldn’t stop ourselves from gawping at him in disbelief. You see, that sentence is the ultimate tired old cliché in any description of the cell membrane, the one that all our teachers and professors at school and vet school would invariably trot out sooner or later. And there were pages of the stuff to go!
Monsieur le Vet Page 8
