“You see right here? That’s her stomach.” I outlined it for her. “And here, poking into the wall of the stomach, is the needle. I suspect it is wrapped up in a ball of thread. That’s probably how she swallowed it.”
“Oh, Doctor, what can you do? She can’t pass that, can she?”
“Well it’s possible, but it could also perforate the gut someplace along the way, and that would cause really serious problems. The best thing we can do is operate and remove it.”
“Have you done that before?” she asked.
“No, but when I was in vet school, I assisted one of our surgeons on a couple of stomach surgeries on dogs. The surgery is straightforward. I’m certain I can do it.”
She looked at me critically. “How much?”
“How much what?” I asked.
“How much will it cost? And can you save her?”
“Well, I can’t guarantee a good result, but I’m pretty certain she’ll do fine. The surgery will be...,” I tried to calculate quickly in my head. We charge twenty dollars for an ovariohistorectomy. This is trickier than that... “Thirty-five dollars, plus the radiographs, the blood work, drugs, and three or four days of hospitalization. The total bill shouldn’t be more than sixty to seventy dollars.”
“That’s a lot of money, sonny,” she said, “a lot more than the cat cost.”
“Yes, but do you really think you can replace Siam with another cat, Mrs. Neilsen? It wouldn’t be the same, would it?”
“No, I suppose you’re right. The mister and I are quite attached to her. The mister will have a fit about the cost, though. You don’t suppose you can do it for less?”
“No, I don’t think so. You know if you needed this kind of surgery it would cost hundreds, maybe thousands for the same procedure.”
“So you think I’ll be eating sewing needles?”
I looked for but didn’t see any indication of humor. She was serious, as near as I could tell. “No, that’s not what I meant,” I said. “I meant veterinarians perform the same services as medical doctors with equal amounts of training and skill needed and get paid a fraction of what the medical profession receives. We’re a bargain.”
“I suppose you should have gone to medical school then.” She still wasn’t smiling.
“Well,” I decided to meet her bluntness with my own, “we have to do something for her. Siam’s in a great deal of pain, we either have to give her a bulk laxative and hope, without much reason to, that she’ll pass the needle and thread without puncturing something along the way or operate or euthanize her. The choice is yours. Do you want to call and consult your husband?”
“No, that’s not necessary, young man. I can make the decision.” She finally smiled at me. “I like your grit. Most folks back down from me. Go ahead. We do love her, maybe the mister more than I. Is it all right if I wait here until you finish so I know how everything turns out?”
“Yes, of course. You may even be able to convince Dick to make you a cup of coffee while you wait.”
“Do you suppose Dick Mathes could really do that?” she responded. “When I allowed him to graduate from high school, I never thought he’d amount to as much as he has.” She gave Dick a withering stare.
Dick looked at me and shrugged.
“You think she’s tough now, you should have met her before she retired as principal of the high school ten years ago, was it Mrs. Neilsen?”
“Seven,” she responded, “and you still haven’t learned to hold your tongue.”
“Yes’m,” he said. “I’ll go start a fresh pot of coffee. Do you take cream and sugar?”
“Just a teaspoon of sugar, no cream, and in a real cup, please, not one of those paper things.”
“Yes’m.”
I had never seen Dick so cowed.
“I’ll get Siam ready for surgery,” I said. “I’ll let you know when I’m done, and you can see her then.”
Siam was still relaxed from the tranquilizer so I decided to mask her down using the gas anesthesia machine Dr. Schultz had purchased at my insistence. After I anesthetized her, I put in an endotracheal tube and hooked it to the anesthetic machine at a low setting. I placed a needle in her cephalic vein and hooked up an intravenous drip of saline. Next, I clipped all the hair from her abdomen and washed and prepared the skin with antiseptic.
I opened a general surgery pack on the instrument tray and dropped sterile towels, drapes, and gloves onto the tray, along with some chromic catgut and skin suture material. I decided to rescue Dick and called him in to the OR to monitor anesthesia and act as a gofer for any other supplies I might need.
“Did you get her situated OK?” I asked.
“Yeah, what a tough old bitch she still is. Always did bust my balls. You see how stiff and straight her back is. She’s got to be at least seventy-five years old and still made of steel.”
“If you talk a little louder, she’ll probably hear you. That should make her smile,” I said. Behind the surgical mask, I smiled at his discomfort.
After a surgical scrub of hands and arms, I put on a surgical gown and gloves. Dick tied the gown in back, and I placed the towels and drapes and then made the skin incision. When I opened the cat’s abdomen, there was a most unwelcome smell. I manipulated the stomach into view and saw the sewing needle sticking out through the wall along with an accumulation of greenish fluid oozing from the puncture.
I packed off the stomach with gauze sponges and made an incision adjacent to the needle. I removed the needle entwined in a ball of black thread and closed the stomach incision with catgut.
“Dick, I need you to empty a five hundred ml bottle of saline into this stainless bowl and then add twenty cc of benzathine penicillin to it. I need to flush and clean up her abdominal cavity. She’s getting a case of peritonitis started. Also, add two cc of aqueous penicillin from the bottle of potassium penicillin in the fridge into the IV. Thanks.”
I poured some of the penicillin-laced saline into her abdomen and then sucked it out with the sterile turkey baster I had propitiously dumped on the instrument tray as an afterthought. After repeating that procedure three times, I instructed Dick to shoot two more cc of the long-acting penicillin directly into the abdominal cavity. I closed the incision in three separate layers of catgut and then closed the skin.
“Let’s turn off the anesthetic and let her wake up,” I instructed, peeling off the surgical gloves.
I removed the mask and cap as I walked into the waiting room. Mrs. Neilsen looked up from an issue of Life magazine she was reading.
“It went pretty well.” I held out a stainless bowl with the needle and thread for her to see.
“This is what we removed. Unfortunately, the needle pierced the wall of her stomach, and she has some peritonitis, which we are treating. The antibiotic we’re using should take care of the infection, but we’ll have to wait and see. We may have to switch to another antibiotic if the penicillin doesn’t work.”
“Peritonitis is serious business,” she said. “My father died of peritonitis after a hunting accident.”
“Yes, but that was probably before the advent of antibiotics. There’s a lot more we can do now.”
“How will you monitor her condition and make certain the antibiotic you use is having a beneficial effect?”
This was one sharp retired school principal.
“Well,” I said, “we’ll keep a close watch on her rectal temperature looking for persistent fever. I expect her temperature to spike after the surgery, but it should go down again by tomorrow morning. I’ll also follow her white blood cell count. We’ll keep close tabs on her.”
“Good.” She finally favored me with another smile. “You sound as if you know what you are doing, young man. May I see Siam now?”
“Certainly. You can help me put her in a cage and stay with her as long as you like.”
“Thank you, Dr. Gross. I appreciate everything you have done for her. As I told you before, she is dear to us.”
***
The next morning, Siam’s temperature was three degrees above normal, and she was not eating or drinking. Her white blood cell count had almost doubled from the day before. I decided to switch antibiotics and loaded her up with intramuscular injections of gentamicin every six hours.
Gentamicin is no longer used extensively, too many adverse side effects, but in those days, it was considered a very effective broad-spectrum antibiotic. It worked exceedingly well in this case.
Mrs. Neilsen visited every morning promptly at nine, always dressed in a different suit, clean and pressed, hemline well below her knees. She returned each afternoon at four, still immaculately turned out. On the fourth postoperative day, Siam accepted the teaspoonful of canned tuna Mrs. Neilsen offered. She reported the event to me beaming with pleasure.
“That’s great, Mrs. Neilsen. Her temperature was back to normal last evening, and her white count was also normal, but I wasn’t able to get her to eat anything. She has been drinking water since yesterday, though, and as you saw, we don’t have to give her fluids under the skin any more. Please come back to the ward with me. I want to see for myself how she’s eating.”
We walked back to the ward, and Siam came immediately to the cage door, purring and rubbing against the bars. I opened the door, and she immediately leaped into Mrs. Neilsen’s arms, snuggling. Her purring was almost a roar.
Mrs. Neilsen’s laugh filled the room with joy and hope. The two dogs in cages below joined in, barking their good wishes.
“Let’s take her out to the treatment room,” I said. “We’ll put some of that tuna in a bowl for her and see how she does.”
Mrs. Neilsen put Siam gently on the table, petting her to keep her in place. I put the remainder from the opened can of tuna into a bowl and set it in front of the cat. She immediately wolfed it down. After she emptied the bowl, she meticulously cleaned her face, alternating front paws after licking them.
“Well, I think we can send her home. She will do much better with you taking care of her than she will here in the hospital. Bring her back in six days, and I’ll remove the skin sutures. Call if she stops eating, gets depressed, or acts sick in any way.”
Chapter 14: Penelope
Rebecca Smythe, Dick informed me, taught the fourth grade. One of the two turtles she kept in her classroom was acting strange. She was bringing it in after school.
She arrived with three girls and two boys in tow. Placing a hand on each child’s head in turn, she introduced them. “Dr. Gross, this is Carly... Jennifer... Susan... Tom... and Jack. Children, Dr. Gross is a recent graduate of the veterinary school at Colorado State University. He’s going to diagnose what is wrong with Penelope.”
She turned to me. “We have divided the class into groups of five. We have twenty-five students, and each group is responsible for the care of the turtles for a week. This group is responsible this week. Can one of you tell Dr. Gross what kind of turtle Penelope is and how we take care of her?”
All five raised their hands.
“Good. Carly, why don’t you tell us what kind of turtle she is,” Miss Smythe said.
Carly was a very bright-looking girl, the tallest child in the group. Her weight hadn’t yet caught up with a recent growth spurt, judging by how short her pants were. Her dark hair was in a ponytail that reached just above her shoulders. Her brown eyes, magnified by round, metal-rimmed eyeglasses, stared at me without blinking.
“She’s a water turtle, Clemmys species. We keep her and her mate in a small stock tank in our classroom.”
“Her mate?” I asked.
“Yeah, he’s bigger than her and has a bigger head; that’s how we know.”
“So, how did you get them, and how do you take care of them?” I asked.
The other four children raised their hands.
I looked to Miss Smythe, a petite, young woman who couldn’t have been teaching for more than a couple of years. She was wearing gray slacks and a royal-blue blouse, her almost jet-black hair falling loose below her shoulders.
“Jack, you found them and brought them in,” she said. “Why don’t you tell Dr. Gross where you found them, how we take care of them, and what we plan to do with them at the end of the school year,” Miss Smythe instructed.
Jack was dressed in worn but clean Wrangler jeans, scuffed cowboy boots, a T-shirt, and a flannel-lined Levi jacket. He had pushed back the cowboy hat on his head exposing a shock of thick dark-brown hair.
“My family has a ranch on the Missouri about five miles upstream of where the Yellowstone joins it,” said Jack. “Before school started, I was helping my dad move some cattle to another pasture, and we found two turtles on the riverbank, sunning. Dad said I could take them and see if Miss Smythe might want to keep them in our classroom for a science project. She thought it was a good idea. The whole class did research to learn how to take care of them properly. At the end of the school year, we are going to put them back where we found them.”
“That sounds like a great science project,” I said smiling at Miss Smythe. “It also sounds to me as if you have a very good teacher. What did you find out about taking care of turtles?”
I looked at Jennifer, a slightly overweight blond girl with the promise of real beauty. “Jennifer, isn’t it?”
“Yes sir. The man that owns Livestock Supply gave us a small, galvanized water tank for them. We learned they need to have about six or seven inches of water to swim in. Sometimes they just walk on the bottom or stay still on the bottom. We have some pieces of wood floating in the water that they climb up on, but sometimes they hide under the wood. We blocked off one end of the tank and filled that end with rocks and sand. They get out of the water and just lie out and get dry. That’s called basking.
“We have both a regular light and a fluorescent light over the tank and keep a thermometer in the water. We have to keep the water temperature about eighty degrees. We do that by adding hot water and stirring it around when we need to. We learned that the most important thing is to keep the tank clean. Each week we empty it with a pump, scrub it out, and disinfect it with chlorine bleach. Then we rinse out the chlorine and refill the water. We have a pump and filter in the water and have to change the filter every other week.”
“That sounds like a lot of work,” I said. “Do you make sure you wash your hands thoroughly every time you do anything with the turtles or their tank?”
“Oh yes,” they answered in unison. “Miss Smythe told us they can have bacteria in their digestive tract that can make humans sick.”
“Do you know the name of the bacteria?” I asked.
Jack answered, “Sal something... salmonica?”
“That’s very close. How about salmonella?” I suggested.
“Yeah, salmonella,” they all agreed.
“OK, that all sounds pretty good,” I responded. “What do you feed these creatures... Susan?”
“Oh, they eat lots of different stuff. Mr. Mathes gets us some special turtle food that has all the vitamins and stuff they need. It comes as small pellets and floats in their water. Then we give them lettuce leaves to chew, and sometimes we thaw out some frozen pieces of fish or beef. They like beef heart the best. Sometimes we put a couple of earthworms in the water, and they’ll eat those.”
“Well, it sounds to me that you guys are taking very good care of your turtles, but it’s a lot of work, isn’t it? What makes you think Penelope is ill?”
“Well, Doctor,” it was Carly again, “about two days ago, Penelope made a nest in the sand, right under the light, where it’s warmest. She laid two eggs and covered them up. Since then we’ve seen her kind of squatting and digging in the nest with her hind feet, but no more eggs. She won’t eat and acts kind of depressed, we think.” She looked at her classmates and Miss Smythe, who all nodded their agreement.
“Well, OK,” I said. “Let’s have a look at Penelope and see what we can find.”
The turtle was about ten and a half inches long. Her eyes were not sunken, so I a
ssumed she was not dehydrated. She seemed to be breathing a little abnormally, but I hadn’t consciously observed turtles breathing, so I couldn’t be certain. I turned her over to examine the cloaca. I thought it appeared swollen. I washed my hands carefully, trying to set a good example for the children. I put on a pair of surgical gloves and some K-Y jelly on the little finger of my right hand. I lubricated the cloaca and then advanced the finger until I encountered an egg. I pushed against the soft shell, but the egg did not move. After lubricating the cloaca again and placing a small amount of the K-Y jelly as far around the egg as I could reach I removed the gloves.
“OK,” I said, “I think Penelope is egg-bound. She has at least one more egg in her, and it seems to be stuck. I’m going to take an X-ray and see how many more eggs she has. Then I’m going to give her a shot. We’ll see if that allows the egg to come out. After I’m done, you can take her back and put her in her nest. If she hasn’t laid the eggs by tomorrow morning, you’ll have to bring her back, and we’ll see what else we can try.”
I took the X-ray and then showed the group three eggs in Penelope’s reproductive tract.
“Can you all see the three eggs? This one at the end of the line is larger than the others, and that’s probably the reason it got stuck. I can also see that she’s not constipated and doesn’t seem to have any stones in her urinary bladder, a couple of other things that could cause the same symptoms. So, I’m pretty certain the correct diagnosis is that Penelope is egg-bound. Anybody have any questions?”
They all shook their heads that they did not.
“OK then, this shot is oxytocin. It’s a hormone that should help her push out the rest of the eggs. Mammals are animals that give birth to live babies and nurse their young. Mammals produce this particular hormone. You’ve studied about mammals, haven’t you?”
Animals Don't Blush Page 14
