Читать книгу Tales from a Young Vet: Mad cows, crazy kittens, and all creatures big and small - Jo Hardy, Jo Hardy - Страница 5

‘Can you help her? Please? She means the world to me. I don’t know what I’d do without Misty.’

Tears filled the eyes of the elderly woman on the other side of the consultation table as she looked down at the small white ball of fur in her arms.

I took a deep breath.

‘Pop her on the table and let’s have a quick look.’

Misty was a little terrier, and she was clearly feeling pretty ill. She lay on her side on the table in front of me, whimpering and panting frantically. Terriers can be real rascals, full of energy, always keeping their owners on their toes, but poor Misty was obviously in a bad way.

I was doing my best to sound confident, but inside I was quaking. It was my first twelve-hour shift in Emergency Critical Care – the equivalent of accident and emergency for pets – at the world-famous Queen Mother Hospital for Animals, and it was my job to assess each new case as it came in and to judge whether the animal could wait for attention or needed to be rushed straight to the Emergency Room – or ER – for treatment.

This was crunch time. As a fourth-year vet student I’d done all the theory, attended endless lectures, written papers and taken exams; in fact, just about everything except take charge of real live animals. Now, I, together with the other 250 students in my year at the Royal Veterinary College, was starting the final year of training – a whirlwind of back-to-back work placements known as rotations in which we’d be taking all that we’d learned in the classroom and putting it to the test in practices, farms, zoos and animal hospitals. We’d be covering everything from surgery to radiology to anaesthesia and tackling a whole range of life-saving procedures for the first time. Each of our three dozen or so placements would be assessed – we couldn’t afford to fail a single one.

I’d started out feeling a mixture of excitement and terror, anticipation and blind panic. What if I blew it, made a wrong diagnosis, failed to spot something vital or just froze? Was I really cut out to be a vet, or had I been fooling myself? It was time to find out. So here I was, in Emergency Critical Care, just three weeks into rotations, in at the deep end, dealing with a non-stop queue of very sick animals with very worried owners and having to make the vital first-stage triage assessments on my own.

That morning I’d got my kit ready – the unwritten vet ‘uniform’ of chinos, flat pumps and checked shirt. Over that went the student’s purple scrub top with my name stitched onto the top left side, plus a stethoscope round my neck, thermometer, scissors, notepad and pens (lots) shoved in my pockets. And a fob watch, because as vets we had to keep our arms below the elbow bare of clothing or jewellery.

Knowing that I’d be on the front line of emergency animal care had kept me awake for a good part of the night. So far we’d had a couple of easy weeks, learning how to take diagnostic images and spending time in dermatology. But now, along with the four other trainee vets in my rotation group, I would be facing a continuous stream of animals, all needing a split-second diagnosis. Animals can’t tell you what they’re feeling, so all a vet can do is look at the presenting symptoms, the animal’s condition and its history and put everything together to try to work out what’s going on.

I looked down at Misty, trying to remember my list of vital checks and questions. A three-year-old West Highland terrier, she was clearly in distress. Her temperature was high and her heart was racing. Her face looked swollen and her breathing was becoming ever more laboured.

Her owner, Mrs Stevens, was clearly worried and distressed. I could see that Misty meant the world to her. In a shaky voice she explained that she had taken Misty to the park a few hours earlier.

‘It was such a nice day,’ she said, her voice wobbling with emotion. ‘The sun was out, so we went for a walk and stopped for a bit. I sat on a bench and Misty was chasing around in the flowerbed. Then she yelped. I think she might have been stung by a bee. But surely that wouldn’t make her so ill, would it?’

She had just given me the clue I needed. I was pretty sure it had to be anaphylactic shock – an extreme allergic reaction – and there wasn’t much time to waste. The swelling was now so intense that Misty’s tongue and gums were turning blue from lack of oxygen.

‘I think Misty may have had a bad reaction to that sting,’ I told her. ‘Sometimes it can be very extreme. I’ll need to take her through to see a senior vet. Try not to worry. You have a sit down and I’ll ask someone to bring you a cup of tea.’

‘Please do your best,’ she said, her eyes filling again. ‘I can’t lose her.’

I carried Misty through to the treatment room, where I explained to the clinician in charge what I thought was going on. He agreed, and the team swung into action to administer oxygen via a mask, IV fluids and steroids. The steroids would reduce the inflammation in her mouth and larynx so that she could breathe properly again. A nurse ran to get a fan to bring down her temperature, which was still rising. As the team rushed around Misty I checked her vital signs – heart rate, respiration rate and temperature – so that we had a base line against which we could check, to see whether she was improving or deteriorating.

‘Come on, Misty,’ I muttered, looking at her prone form. ‘Stay with us.’

After a tense hour she gradually began to perk up and I felt weak-kneed with relief. Along with a supervising vet I went back to see Mrs Stevens in the waiting room to let her know that Misty was starting to improve. We would keep an eye on her overnight and if all went well she would be on her way home the following morning.

Mrs Stevens clasped my hand, relief etched on her face. ‘Thank you, oh, thank you. I can’t tell you how grateful I am.’

‘We’re here to help and I’m glad we could,’ I said. ‘We’ll be checking on her right through the night, so try not to worry.’

Seeing Mrs Steven’s reaction I was reminded how much this job is about people as well as pets. Every animal belongs to someone who loves and cares for it. A dog or a cat becomes a member of the family, and sometimes they are also a treasured companion to someone living alone.

Back in the ER I took a gulp from the cup of tea I’d been handed half an hour earlier, now stone cold, and slumped into a chair. It looked as if it was going to be a long night.

As I finished my tea and stood up my best friend Lucy shot past, holding a very limp-looking poodle. ‘Nasty V and D,’ she muttered. Numerous cases of vomiting and diarrhoea appeared in the hospital, so the staff all knew it as V and D.

‘You OK?’

‘Yes, you?’

‘Fine. Catch you later.’

It was the longest conversation we’d managed all evening. Lucy was in my rotation group, so we would be doing all our core placements together. Clever, forthright and outgoing, Lucy was a fantastic friend and she was going to be a talented vet. We’d clicked from the moment we met, in the third year, and had been close friends ever since.

The phone rang and I leaped to grab it.

‘It’s reception. We’ve got a lady here with a very poorly cat.’

‘I’m on my way.’

I took a deep breath, rubbed my tired eyes, straightened my scrub top and headed down the corridor to the cat waiting area. The Queen Mother Hospital, known as the QMH, has a bank of reception desks and beyond them there are separate dog and cat waiting areas – for obvious reasons.

The QMH is situated on the campus of the Royal Veterinary College in Hertfordshire. It’s a world-class, state-of-the-art veterinary hospital with superb facilities. Twelve thousand animals go through the door each year to be treated by a team of highly experienced vets. The hospital’s daytime working hours are 7am to 7pm, but it offers a twenty-four-hour service. At night only the emergency department operates, so every animal that needs out-of-hours urgent care arrives there first, and more than any other service in the hospital it relies on students to keep it going. That meant long hours on our part; our shifts were midday to midnight, or four in the afternoon to four in the morning.

We trainee vets did the initial assessments of the endless stream of animals arriving overnight, but we then reported to a senior clinician and a couple of interns, qualified vets completing an advanced version of rotations to further their careers.

While we were the only ones on the spot, staff from other departments were always on call should they be needed, and the sight of a dishevelled surgeon, hair awry, shirt half-buttoned, hurrying through the darkened corridors towards the operating theatre to attend to an emergency was pretty common.

I already knew just how brilliant the emergency vets could be; my family’s lovely springer spaniel Tosca had undergone life-saving surgery at the QMH the previous year, after getting into a sack of dried food and gorging on a large quantity that swelled in her stomach. The first surgery at our local vet practice had gone wrong, causing her abdomen to become septic. While a very ill Tosca was rushed into theatre, a final-year vet student, who had been impressively thorough and calm, had consulted with me and my parents.

It had seemed impossible then that just a year later I would be the one doing the consultations. But here I was, doing my best to appear calm and competent. In the waiting room I looked around. ‘Pepsi?’ A friendly-looking couple and their young son leaped to their feet as I approached.

‘Pepsi isn’t well,’ said the boy, who was about ten. ‘She keeps going to sleep and she won’t eat.’

His mum joined in. ‘She’s been losing weight and now she just seems to have no energy.’

‘And she’s only eighteen months,’ finished the dad.

‘Right, well, let’s go through to the consulting room and take a look at her, shall we?’

I was already beginning to realise that with more than one owner present, all keen to tell me what was going on, I was likely to end up having to untangle the story.

Pepsi was a sorry sight. She was a pretty little tabby, and she flopped on the examining table with no interest in anything going on around her. I took a look at her gums. They were practically white, a sure sign that she was anaemic.

I asked the family to wait and carried her gently through to the chief clinician, Giacamo, in the ER. Exuberantly Italian, outgoing and laid-back, Giacomo is a brilliant vet. He examined Pepsi and asked me what I thought.

‘Her pale gums indicate severe anaemia.’

‘And what do you think might be causing that in such a young cat?’

I hazarded a guess. ‘Well, it’s either loss of blood, a destruction of blood, or a lack of production of blood. Since there’s no obvious haemorrhage, I think a good starting point would be to rule in or out IMHA – immune mediated haemolytic anaemia.’

‘OK, can you tell me about that?’

‘It happens when the cat’s body is destroying its own red blood cells. But we would need to run blood tests to check.’

‘Good, right, take some blood, get it down to the lab, have a look under the microscope, and come back and tell me what you reckon, fast as possible.’

I leaped into action, filling a small vial with blood from Pepsi’s jugular vein. Many cats would object to this and miaow loudly, but Pepsi was silent and unresponsive.

‘Don’t worry little thing,’ I said, stroking her head. ‘We’ll get you better.’

With no lab assistants there at night I needed to do the blood test myself. I hurried down the hospital’s hushed corridors to the lab, smeared a few drops of blood onto a slide and looked at it through a microscope. Some of the red blood cells looked almost transparent; they’re known as ghost cells. The diagnosis was right; Pepsi’s body was behaving as though her own blood cells were foreign bodies that had to be destroyed.

Giacomo was back at my side. ‘So, how do we treat it?’

‘We could downgrade her immune system, but that would make her vulnerable to other diseases.’

‘Or?’

‘Give her a transfusion?’

‘Yes, we’ll need to ask reception to ring around for a donor. And in the meantime we’ll give her the synthetic substitute. It might take a while to find a donor, and she can’t wait.’

Along with one of the interns I went to explain to Pepsi’s owners that she would need to be with us for a while and that she would need a transfusion.

‘Why has she got it?’ the mother asked.

‘We don’t always know. It can be triggered by something like a vaccination or certain types of drugs, but sometimes it just happens and the cause is unknown.’

I promised we would call with an update first thing in the morning. The little boy smiled and waved to me as they headed for the door.

Back in the ER Pepsi was being given Oxyglobin, a synthetic substance that could be given to cats and dogs needing transfusions as a temporary substitute for donor blood. Within a few hours she was sitting up and looking around and her eyes had turned bright gold, a side-effect of the Oxyglobin that made her look distinctly weird.

Cat blood types are commonly A or B, and occasionally AB. It’s dangerous to give them the wrong type – it would kill them – so we needed to find a match to Pepsi’s A-type blood. The QMH had a long list of willing donors, but finding one meant ringing to ask the owners to bring their pet in to have blood taken. The whole process could take half a day or so, and given that it was now late in the evening, possibly longer.

Pepsi was taken through to the Intensive Care Unit and placed gently into a cage lined with a soft blanket, where the nurses would keep a close eye on her until it was time for her transfusion.

While I was there I nipped over to check on Misty, the Westie with the severe bee-sting reaction. She was fast asleep, her breathing was normal and so was her temperature. She would almost certainly make a full recovery, and I knew just how much that would mean to Mrs Stevens.

The new patients rolled in non-stop that night, and I would discover over the following week that this was the norm. We students would deal with a patient and then run to take the next on the list. It was so busy that after the first few cases I forgot all about my nerves; I just had to get on with it.

Adrenaline-fuelled, I was buzzing, with no time to stop or to eat. Around midnight Stacy, one of the interns, stopped me in the corridor as I headed back to reception for my next case. ‘Take a break after this next one and get some sugar into you or you’re going to collapse,’ she said in a tone that brooked no argument. The interns and clinicians were well aware of how easy it was to forget to eat and end up making yourself ill.

That night I saw a dog with heart failure, another with unexplained bleeding and a cat with seizures. After each assessment I would report back to Giacomo or one of the interns, and we would discuss what might be wrong and what should be done.

More than once I had to hazard a guess under the fierce gaze of an intern waiting to know what my diagnosis was. Thank goodness most of the time I got it right – and each time that happened it boosted my confidence a little more.

Around one in the morning, after I’d wolfed a bar of chocolate and downed most of a cup of tea, the phone shrilled again. Off I went, hurrying back towards the waiting area to collect a dog I’d been told was in a lot of pain.

I could hear his howls and whimpers from the other end of the corridor. I arrived to find a young yellow Labrador lying on the floor yelping. His owner, wrapped in a huge parka, looked exhausted. He introduced himself as Doug.

‘Barney’s nine months old, he’s normally the life and soul, but he’s not been himself today,’ Doug said, raising his voice to make himself heard over Barney’s cries. ‘Tonight I got home from a night out to find him like this. I can’t think what’s happened.’

I had a pretty good idea, but I needed to be sure. I knelt beside him in the waiting room to give him a quick check. His abdomen was bloated and tight, and he yelped when I touched it.

‘He’s very bloated. I’m afraid this could be quite serious. Would you mind waiting? I’ll take him straight through to the senior vets, then come back to get a fuller history from you while they start working on him.’

I ran to get a trolley to wheel Barney through to the ER. Doug helped me to lift him gently onto it and then patted him on the head. I wheeled him through the double doors and Stacy rushed over. ‘He’s really bloated. I think it’s a twisted stomach,’ I said. She checked him over, put the ultrasound probe on him to confirm the diagnosis and nodded.

‘OK, he’ll need surgery, but first we need to deflate his stomach; the build-up of gas is what’s hurting him. Jo, you can do this.’

We clipped a small patch of fur from Barney’s abdomen and applied antiseptic, then Stacy handed me a two-inch-long needle. Clenching my teeth, I plunged it straight through the clipped area and into Barney’s stomach.

The whoosh of gas escaping sounded a bit like a balloon when you blow it up and then let go. Almost immediately Barney calmed down and stopped howling. I knelt and stroked his head. ‘You’ve had a tough time, haven’t you, young chap?’ Barney raised his head, licked my hand and managed two thumps of his tail.

A few minutes later he was taken to a kennel in the Intensive Care Unit to be prepped for surgery while I went back, with Stacy, to talk to Doug and to take Barney’s history.

‘What is a twisted stomach?’ he asked. ‘How did it happen?’

‘It’s not uncommon in deep-chested breeds of dog,’ I told him. ‘It’s a condition called gastric dilation volvulus or GDV, in which the stomach twists and dilates when it can’t expel food or gas. The blood supply can also be cut off. GDV sometimes happens after a big meal followed by exercise, but frequently there isn’t an obvious reason.’

‘Barney always seems to be hungry,’ Doug said. ‘He steals anything he can get hold of; we have to keep all our food out of reach. The only things he doesn’t seem to like are carrots. Yesterday he ate my son’s headphones, a plate of biscuits and the insole of a boot.’

I laughed. ‘That’s a Lab for you. Happy dogs, but big eaters. What happened to Barney wasn’t necessarily anything he ate; we still don’t know all the reasons why dogs get twisted stomachs.’

I explained that we’d relieved the pressure of the build-up of gas, which could eventually have ruptured the stomach wall, and that Barney would need immediate surgery to return his stomach to the right position and to check for any other internal damage. ‘He’s sleeping now, we’ve given him pain relief and we’ll give you a call as soon as he’s out of surgery.’

‘Thanks.’ Doug smiled. ‘I’ll be off then. Got to get up for work at six.’

I looked at my watch. It was ten past two. Ten hours into my shift and there were still new patients coming through every few minutes.

By three things were quieter and at half-past Stacy told me I could go.

‘Have you had fun?’ she grinned. ‘ECC can be a bit of a baptism of fire.’

‘I’ve loved it,’ I said. ‘I felt like a real vet tonight.’

As I headed out to the car park the hospital’s hushed corridors felt peaceful. For a brief hour or two, until the day staff began to arrive, everything was calm.

I climbed into my little Volvo C30 and drove back to the house I shared with four other vet students in the village of Welham Green, five minutes from the campus. It just so happened (honest) that the other four were boys, despite the fact that eighty per cent of students in my year were girls. But despite the teasing I’d had from some of my friends, there was strictly no romance with any of them – we all just got on really well.

The house was in darkness as I crept in through the front door and made my way into the kitchen. Even Buddy, the sixth member of our household, a funny little mutt that one of my housemates had inherited from his grandparents, barely stirred in his basket.

Despite the late – or was it early? – hour, I was still buzzing with all that I’d learned and done over the past twelve hours. I made myself a cup of tea and a piece of toast – standard post-night-out fare – and sat at the kitchen table.

Fifteen minutes later the exhaustion hit me. I crawled upstairs and was asleep within seconds.