Chapter 2, Part 3

The surgery the next morning went very well. Dr. E is a great teacher, informative without hovering. I incise through the skin and superficial muscle layers of the dog’s thigh then separate the muscle bellies of the quadriceps muscles until I locate the fractured ends of the femur. I then place the stainless steel rod through the middle of the femur, passing down along the marrow cavity and screwing the threaded end into the thick bone by the knee joint. The tricky part is to not go all the way through the bone and into the joint itself. After the pin is placed it is a simple matter to close the incision. It takes about 30 minutes from start to finish and is really a lot of fun. The rest of the day passes uneventfully.

That evening, Emily and I drive into Oklahoma City to have dinner with Moose and Amber. After graduation, Moose took a job at a small animal practice close to where he grew up. His employer was excited to add Moose’s extensive exotic animal experience to their range of services. As we drove to the restaurant, Moose and I traded war stories in the front seat.

“I really thought that they would kind of ease me into the on-call schedule,” I say, complaining to Moose. “At least let me get my feet under me and figure out where things are at in the clinic and the pricing, but no. Pretty sure I was there for a week before they put me on call, and then it was Memorial Day Weekend, so it was a three-day weekend to boot!

Moose shakes his head sympathetically, “Dude, that sucks.”

“Being on call really sucks, especially at first,” I say as I navigate the metro traffic. “Half the time I didn’t know what was going on with the patient or I didn’t know what to treat it with, and if I did figure it out, I couldn’t find the medication in the clinic anyway. And then I didn’t have a clue what to charge because they don’t have a set price list for anything! I bet I called the other guys at least five times a night that first weekend. I really looked like a jackass. It’s getting better, but my heart rate still goes through the roof whenever the pager goes off.”

Moose shakes his head and says, “Yeah, I’m really glad that we’re not on call. That’s what the emergency clinics are for.”

“We don’t have any in our area,” I say, “and besides, none of the emergency clinics see large animal cases anyway. So even if we did, I’d still have to pull calves and treat colics.”

“Are they letting you do much surgery,” Moose asks. “The guy I work for is kind of a surgery hog. I’ve only done a couple of spays and neuters since I started.”

“That’s one thing about these guys,” I reply, “they definitely believe in getting your feet wet, even if sometimes it is sink or swim. I do a couple of spays and neuters a day most days. And so far I’ve done a cystotomy on a dog with bladder stones, enucleated an eye on a kitten, and even got to pin a broken leg on a dog that had been hit by a car the other day.”

“Wow, that’s cool they are letting you do all that,” Moose replies. “Are you set up pretty well with diagnostics?”

“Not as good as I would like,” I confess. “We have an ultrasound and a really old radiograph machine, but no in-house blood-work.”

Moose asks, “Where are you sending your blood to?”

“To a lab in Edmond,” I answer. “A courier comes to the clinic every weekday around noon to pick up the samples and they fax us the results by that afternoon. So if I can draw a blood sample in the morning during the week I get same-day results. The problem is if the animal comes in after lunch I have to wait a full day for results and if it is on the weekend you might as well forget it. By the time three days go by, half the cases are better or dead. How about yall?”

“We’ve got in-house blood-work, but it is kind of slow and cumbersome to work with,” Moose replies. “Our x-ray is pretty decent, but we don’t have ultrasound.”

In the backseat, Emily and Amber discuss things other than veterinary medicine. Amber has been attending physician’s assistant school at the University of Oklahoma. It is an intensive program, lasting two-and-a-half years with no breaks. She is discussing her latest test.

“We had a cardio test on Wednesday and I don’t think there is anyway that I could have passed. I felt like I knew nothing on that thing,” she complains.

“Oh, Amber, that’s what you say every time, and you always end up acing them,” Emily says with a smile.

“I’m just sick of school,” Amber groans. “I’m sooo ready to be done.”

At this I have to smile. I know exactly how she feels. I had those exact same thoughts through almost four years of veterinary school.

“Be careful what you wish for, Amber,” I say. “Moose and I said that not that long ago and look how much fun we’re having now.”

We arrive at the restaurant and our evening passes eating good food in the company of our good friends. It is some years later that I learn that during the car ride to the restaurant, while Moose and I griped about the pitfalls of our new jobs, I had accidentally made a call on the cell phone in my pocket. It had dialed Dr. E, who heard every word of our conversation. I would have been mortified if I had known that he had heard me complaining about the job, but he didn’t say a word about it until some two years later. When he did, he didn’t give me a hard time about it as I deserved, but was actually sympathetic. He seemed to remember having a similar conversation thirty years ago with one of his classmates.

Chapter 2, Part 2

I pull into the parking lot of the vet clinic at a quarter ‘til eight the next morning. The clinic consists of a plain brick building with a flat roof and a tin metal barn off to the side. The interior consists of a single exam room, a small surgery room that doubles as a second exam room when needed, a lab area, a small pharmacy, the receptionist office, a waiting room and a kennel. The barn houses a set of equine stocks and a hydraulic squeeze chute for working cattle. Behind the barn are a set of working pens and a small loafing shed for hospitalized livestock. When Dr. E built the clinic in 1980, he was a solo practitioner new to the area and designed the clinic for the needs of one veterinarian. The barn was an old Hostess bread warehouse. Dr. L joined the practice a few years later. Now that I have arrived on the scene, the clinic is definitely a small shell for three busy veterinarians. Point in fact, there are four cars waiting in the parking lot as I pull in to park.

I get out and unlock the front door and prepare to meet the rush. Two of the clients are dropping off animals for elective surgery, a dog to spay and a cat to neuter. Another has a puppy that had been vomiting the night before and the last is an ADR dog. ADR stands for “Ain’t Doing Right” and is a universally understood abbreviation in the veterinary industry originating with a pet owner’s description of their animal’s ailment - “She just ain’t doing right, doc.” Our more grammatically correct colleagues to the north sometimes say IDR, or isn’t doing right, but the meaning is the same.

I take the surgery animals back to the kennel to await their procedures as the rest of the staff arrive for work. Dr. L administers a pre-operative injection to the dog and prepares his surgical pack to perform the spay while Dr. E works up the vomiting puppy in the exam room. When he finishes, I take the ADR dog back to the exam room. The patient is a nine-year old Chihuahua with elderly owners that are complaining of a three-day history of anorexia and lethargy. I take a thorough history of the animal, discussing vaccination history, diet, and past medical problems. The dog is not on heartworm prevention, hasn’t been vaccinated in five years, and is fed a diet consisting primarily of table scraps. Off to a good start so far, I think to myself. My physical exam reveals severe periodontal disease with rotten, tartar covered teeth, a severe heart murmur, and congested lungs. I explain these findings to the owners, telling them that their dog is in congestive heart failure and that the dog’s dental condition could very well be contributing to the problem. I recommend testing for heartworms and performing chest x-rays and bloodwork to fully evaluate the degree of heart failure.

“How much is all that gonna cost,” the grizzled old man asks skeptically.

Doing a quick tally on the ticket, I reply, “Counting the physical exam that I just performed, the total would be around $300 for further diagnostics.”

The owner actually snorts as he exclaims, “Hell, it’s just a dog! Can’t you just give him a shot or something and fix him?”

“Unfortunately sir, they don’t make a shot that will just fix a failing heart,” I answer. “Especially when we don’t know for sure why it is failing in the first place.”

“Well, we just can’t spend that much money on a dog,” says the man’s wife. “I’ve got about $100 of my social security check left. What can we get done for that much?”

I consider my answer. “I tell you what. We’ll start him on a diuretic to help draw some of the fluid off of his lungs and an antibiotic to help treat the infection that he has in that mouth. Bring him back in a week and we will recheck his lungs and see where we want to go from there.”

As the couple leaves with their dog, Dr. E walks up and asks, “What was going on with that one?”

“Heart failure and periodontal disease for sure, probably has heartworms too, but they couldn’t afford much of a workup,” I say. “It sure is a lot different than vet school, Bob.”

“How do you mean?,” he asks.

“In school, we performed every diagnostic option at our disposal and worked up every single problem before we decided on a treatment option,” I say. “Here either they can’t afford or are unwilling to do all that and I end up having to do a lot of treatments based on guesswork.”

“Yeah, welcome to the real world, son,” Dr. E says with a wry grin. “These people don’t care if you know with absolute certainty what all is going on with their animals, they just want you to make them better. And most of the time if you can make an educated guess, you’ll get it right. Don’t worry, you’ll get used to it.”

Dr. E is in his mid fifties, a tall man with huge hands and feet. In his younger days he played baseball and basketball at Oklahoma State before attending vet school. He is loud and boisterous with a joke for every occasion. He and Dr. L are the ultimate odd couple. Dr. L is quiet and reserved, more methodical in his actions. Although they don’t see eye-to-eye on every issue, they have established a great practice and are well respected in the community. Both are excellent teachers and willing mentors.

The next patient that I see is an 8-month old boxer puppy that had been hit by a car early that morning. He is able to walk but is not putting any weight on his left rear leg, which is dangling unnaturally limp. Fearing the worst, I runs my hands over the leg, feeling the grating of bone against bone that signifies a fracture.

“I’m afraid the femur is broken, Mr. Edwards,” I tell the concerned owner, who is a teacher at the local high school. “I’ll need to take an x-ray of it to see how we can best repair the leg.”

“Do whatever you need to do,” the man replies. “The little guy is a member of the family, and we want to do whatever we can to make him better”

I pick the dog up and ask Cole to help me with the radiographs. We walk out the clinic back door to the barn, where the x-ray unit is located. The machine is a hulking monstrosity, six feet tall, unimaginably old and painted olive green. It looks like it came out of the engine room of a submarine. Due to it’s age and appearance I have started referring to it as Sergeant Surplus. It is a contrary and temperamental piece of equipment to work with.

“Cole, why don’t you put on the lead apron while I see if I can get this old soldier to report for duty,” I say as I flip the on switch and the unit sputters to life.

As he shrugs into the lead apron that will shield his body from the radiation of the x-rays, Cole asks, “How old do you think this piece of crap is anyway?”

“Ancient,” I reply. “This thing was probably radiographing shrapnel in dudes back in WWII. Dr. E must have gotten it from an Army surplus store or something. You should probably salute it in honor to its service to this great nation.”

Cole laughs, “That’s great. Did you learn how to work with this kind of stuff in school?”

“No, man,” I reply. “In school everything was digital, on computers. This is all OJT - On the Job Training.”

Cole holds the dog still while I click off a couple of films of the leg. I then take the films into the small dark room in the corner of the barn. The interior of the room is pitch black. The red light bulb that once provided illumination burned out sometime shortly after my birth and was never replaced. Interesting things lurk in the dark corners. Spiders, scorpions, Jimmy Hoffa’s body...that sort of thing. I hang the undeveloped films on metal hangers and suspend them within the developer chemicals of the dip tanks for processing. Five minutes later, I switch the films over to a different dip tank to fix the image to the film. Five minutes after that the films are developed and ready to be read. Holding the first film up to a light box, I study the fractured bone. Simple transverse fracture to the left femoral diaphysis. Should be easily repaired with an imtramedullary pin. Of course I’ve never seen that surgery, much less performed one. I take the films back into the clinic and seek out one of my colleagues for advice.

“Hey Bob,” I call, “can you take a look at these films with me?”

“Yeah, that should be a snap to fix,” he says after looking at the films. “Schedule it for in the morning and I’ll help you through it.”

I go over the radiographs with Mr. Edwards back in the exam room and explain the treatment plan. He agree to leave the dog with us for surgery the next day. I place a temporary splint over the broken leg to keep it stabilized and start the dog on pain meds and antibiotics before taking it back to the kennels.

At noon Dr. E, Cole, and I go to the Bullet Cafe for lunch. This small-town cafe is the social hub of the community, popular more for the conversation than the quality of their specials. The crowd at our table is quite the slice of local flavor: a few farmers, a couple of small town lawyers, a local factory owner, a city administrator, and a couple of veterinarians round out the dinner table most days. All are armchair philosophers and self-proclaimed experts on issues various and sundry. The table itself is one of those long tables where people sit down and eat and when they are finished somebody else takes their place. The faces change without so much as a lull in the conversation. It stays full all morning with coffee drinkers and then from 11 to 2 with the lunch crowd. They even hung a sign over it that reads, "World's Problems Solved Here." The lunch crowd is such a diverse mix of ages, backgrounds, and educations that you really get a lot of unique perspectives and quite the mix of topics. Today for instance, the discussions include the tribal customs of pacific islanders (tribes who wear gourds on their privates), suicide cults past and present, and Caribbean scuba diving hot spots. Eclectic and mundane topics alike get equal billing and all due attention.

After lunch I go out on a call to a farm a few miles away from the clinic to vaccinate three horses for rabies, west nile virus, and tetanus. While I am there, the owner asks if I will examine the teeth on one of the horses.

“That gelding keeps dropping grain when he eats,” says Mrs. Kelly, a matronly woman in her early fifties. “I was wondering if he needs his teeth floated.”

Taking a pen light from the chest pocket of my coveralls, I open the horses mouth and grasp his large pink tongue with one hand, pulling it gently to the side of his mouth as I shine the light to the back of his mouth with my other hand.

“Yes, ma’am, he has some pretty sharp points on those lower teeth,” I tell Mrs. Kelly. “Would you like for me to float his teeth while I’m here?”

“Oh could you?” she asks. “That would sure save me from having to haul him in to the clinic or having you come back out just for that.”

I get the dental floats out of my truck. These tools are basically long handles with small pieces of metal file welded to the ends that are used to grind the sharp points from the edges of horse’s teeth. These points are formed by the side-to-side motion that horses make when they chew and interfere with eating causing the animal to drop grain from it’s mouth. I sedate the gelding with an injection of Xylazine and wait a few minutes for it to relax the animal. Then I proceed to grind the points off of the teeth with the floats.

When I am finished, I reach in with my right hand to feel the now smooth edges of the teeth, checking my work. As I am withdrawing my hand I feel a sharp sensation of pain and hear distinct crunching sound. It turn out that this sound is the metacarpal bones in my right hand being crunched by the front teeth of the horse who decided it would be a good idea to bite down hard at just that moment. Choking back a curse, I manage to extract my mangled hand from the horses teeth. I tentatively flex a few times and discover that nothing is in fact broken, but it is beginning to swell and the back of the hand is rapidly turning a lovely shade of purple.

“Oh, he didn’t get you did he?” Mrs. Kelly asks.

“Yeah, just a bit,” I answer through gritted teeth.

“You ornery devil,” she says as she swats the horse playfully on the rump. “Why did you do that for?”

I write Mrs. Kelly out a bill, pack up my equipment, and head back to the clinic. Later that night I am sitting in front of my computer at home sending an email to my vet school classmates, typing a description of the day’s events titled Sergeant Surplus and the Purple Hand. After graduation we all dispersed to various jobs and internships across the country and we now communicate primarily through email, recounting our victories and disappointments to those most sympathetic to our plight. This connection serves to keep me sane and not feeling like an incompetent nincompoop. Most of the time, anyway. I sign off and pick up my copy of the veterinary surgery book to read up on the surgical techniques required to place an intramedullary pin to repair a femoral fracture. Nothing like a little light reading to unwind after a long day at work.

Chapter 2, Part 1

It is 11:30pm. I have just gotten out of the shower and am getting ready to go to bed when the pager begins shrieking loudly from the nightstand. Horse with colic. Needs a vet to come out, is the message on the text display. With a groan I pick up the phone and make the call.

“This is Dr. Carpenter from the T-Town Veterinary Clinic. Do you have a horse that is colicking?” I ask.

A woman’s voice answers in a slow drawl with a pronounced accent, “Yeah, Doc. This is Jenny Jones. We take all our animals to yall. We have this mare that’s been colicking. She won’t eat and she’s been down rollin’ and stuff.”

“Yeah, that sure sounds like she could be colicking,” I say. “Do you need me to come out and take a look at her?”

“Yeah, I think you should,” she says. “We done give her some Banamine a couple of times, and she seems to be a little better, but we’d sure feel better if you took a look at her.”

“How much Banamine have you given her?” I ask.

“About 40cc. We just give it to her in the muscle,” is the answer.

I’m a bit taken aback as this is close to 3 times the recommended dosage for this particular painkiller. “Well that should be plenty. If you would, don’t give her anymore before I get there, okay? How do I get to your place?”

“Do you know where Banner Hill’s at?” she asks.

I grew up and have lived in this area my entire life and I am amazed at how many landmarks and locations people use that I have never heard of. “I’m afraid not, can you give me directions?”

The lady proceeds to give me directions for a trip that is at least a 45 minute drive from my house. I tell her that I will need to stop by the clinic on the way and pick up a few supplies, but that I can probably be there in a little over an hour. I hang up the phone and begin to get dressed.

Emily is already in bed when I walk into the bedroom. “Are you going to have to go in?” she asks.

“Yeah,” I say. “I’ve got to go look at a horse that is colicking out in the country.”

“Do you think I could help if I went with you,” she asks, sitting up in bed. “At least I could talk to you and keep you awake as you drive.”

“I’d love the company,” I reply as I pull on my boots. “But I need to leave pretty quickly. Can you be ready soon?”

She dresses hurriedly and we load up in the truck and head out on the call. It is a relatively cool night for early June and we roll down the county roads with the windows down, listening to red dirt country on the stereo. I’m a bit apprehensive as this is the first colic case that I have ever seen on my own. In vet school while I was on the equine surgery rotation, we were allowed to do the initial physical examination on colic cases that were referred to the teaching hospital, but as most of these cases ended up going to surgery, they were quickly out of our hands.

As we pull into the client’s driveway, my head lights illuminate a small crowd of at least ten people lounging around the front yard. A woman in a stained tank top holds the lead rope of a geriatric bay mare that is standing three-legged, dirt and mud caked to its back and sides. Half of the bystanders are shirtless and most are holding beer cans. I will soon find out that this is a common scenario that I will encounter time and time again on farm calls. Veterinary emergencies constitute a legitimate form of entertainment in rural Oklahoma, bringing family members and neighbors alike crawling out of the woodwork for a good look to see what the vet will do. As with most spectator sports, drinking just makes the show that much more enjoyable. I warily take in the crowd as I park the truck. Okay we’re about five seconds away from hearing Dueling Banjos out here. What the hell have I gotten into this time? Great call to bring the wife along on Colby!

I park the truck and Emily and I make our way across the yard towards the crowd, carrying my medical trays and equipment.

I walk over to the woman holding the horse and stick out my hand, “I’m Dr. Carpenter. I assume from all the mud that this is the mare that’s been colicking.”

“Yeah Doc,” says Mrs. Jones, “She was really rolling and carrying on a while ago, but she seems to have calmed down a lot since we gave her the Banamine, but we just wanted someone to take a look at her to be sure.”

I’d hope so after 40 cc of the stuff! Hope her kidneys don’t burn out. “Yeah, I really wouldn’t recommend giving more than 15 cc of Banamine, but let me take a look at her and we’ll see how she’s getting along,” I say, getting out my stethoscope.

I commence with my physical exam, listening to her heart rate and respirations, then moving farther back to listen to the rumblings of the horse’s guts or a lack thereof that would indicate a colic. Colic is a generic term that incorporates any condition that can cause abdominal pain in a horse, ranging in severity from simple gas and indigestion to a ruptured intestine. Equine medicine, more so than most other aspects of the industry, still holds on to many such old-school terminology, and it is essential that one know and use them in order to be taken seriously by horse owners “in the know.” Talking the talk is as important in how competent one is perceived as a “horse vet” as being able to walk the walk. I conclude my examination by taking the mare’s temperature with a rectal thermometer and checking the color of her gums by flashlight.

“Mrs. Jones, everything is checking out pretty normally so far.” I say. “She has good gut sounds all the way around, and she has a normal heart rate, which usually indicates that they are not in any discomfort. The color of her gums is good and pink, so I’m not seeing any evidence of dehydration or shock, and her temperature is normal. I would like to pass a tube on her to see if she has any gas on her stomach, just to be sure.”

I walk back to my truck to get my twitch, which is an ax handle with a short loop of rope tied to one end. I place the loop around the mare’s upper lip and begin to twist the ax handle, tightening the loop around the lip. This serves to focus the horse’s attention and releases endorphins which aid in restraint, kind of like holding a cat by the scruff of its neck. This is necessary as I begin to pass a ten foot long rubber tube up the mare’s nostril, through her nasal sinuses to her throat, where I must be careful to allow her to swallow the end of the tube before passing it down her esophagus and into her stomach. It is important to ensure that the tube is down the esophagus and not the trachea for what is to follow. Despite the twitch around its lip, the horse tries to throw her head up in the air and paws the ground in agitation at the invasiveness of the procedure. It takes several attempts before the mare finally swallows and I can finish passing the tube. As these events take place, the crowd of spectators begin to drift closer.

“Have you ever done this before?” asks a middle-aged man with skinny legs and a prominent beer gut, making him reminiscent of a pregnant pelican.

“Quite a few times, actually,” I reply grimly. “You just have to wait for the horse to swallow the end of the tube. If they don’t swallow it, you can’t go any farther. Ahh, there she goes. See, you can see the end of the tube moving down that groove on the left side of her neck there. If you can see it there, you know you are in the right spot.”

As the tube passes into the stomach, a small amount of gas escapes from the end of the tube I hold in my hand. I sniff it gingerly, assessing the faintly sweet aroma of fermented grass. I then place the end of the tube in my mouth and apply suction, attempting to siphon any liquid that may be on the stomach. Some years later I was to perform this particular procedure out on the farm by truck headlight and would fail to see the stomach contents coming back down the tube and was rudely surprised by a mouthful of the acidic fluid. The examination was then temporarily halted while I dry-heaved in the bushes. This night, however I am more fortunate as no fluid is obtained.

“Whatcha doin’ that fer?” asks a rather unkept looking woman in the crowd wearing a tube top.

“Horses are unable to vomit,” I explain. “So I am checking to see if there is any reflux on the stomach, which could indicate a blockage. I’m not finding anything, though. A little bit of gas, nothing else. I’m going to go ahead and give her a gallon of mineral oil through the tube. That should act as a laxative and coat her GI tract to help relieve any indigestion.”

This is the reason that I was so careful to make sure that the tube was down her esophagus and not her trachea. Putting a gallon of mineral oil down the trachea and into the lungs tends to do bad things to a horse. Like make them dead. The owners tend to frown on that sort of thing, so I try to avoid that if at all possible. Emily opens the bottle of mineral oil and hands me a half liter dose syringe that I use to pump the oil down the tube and into the horse’s stomach. Afterwards I withdraw the tube and take the twitch off the mare’s lip. She snorts in appreciation and starts grazing in the yard.

“Well guys,” I say, gathering my equipment. “I think she will be fine. I’d keep an eye on her for the next hour or so and definitely check her in the morning. I wouldn’t give her any feed tonight, just hay and water, and start her back on a half ration tomorrow. And I’d probably keep an eye on where you gave her all that Banamine. Sometimes that can cause abscesses if given in the muscle.”

Emily helps me load the gear back in the truck and I make out Mrs. Jones’ bill. She pays and thanks me for coming, apologizing for disturbing my evening.

“Glad to help ma’am. That’s what they pay me for,” I say as I start the truck.

As we are heading back towards the house, Emily laughs about the crowd of onlookers. “You’d think they would have something better to do than stand around gawking at a sick horse,” she says.

“I guess there just wasn’t that much going on at Banner Hill tonight,” I say ruefully. “I’m just glad to get that out of the way. I’d been dreading seeing a colic because of the whole passing the tube thing. Glad it went well. Man am I ready for bed.”