Last week on Tuesday I was on call for large animals until 10 pm, on call for large and small after 10 pm. I was using the internet at the Douglas County Library when my cell phone vibrated. The area code was out-of-state, but I was still somewhat worried when I answered the call and the caller inquired whether I was on call that night.
"Yes," I replied. "I'm in the library -- let me leave before I make people mad."
As I exited the building, the caller asked whether I could go see their cow.
Now, I thought this was a joke... not only was the number out of state, but when I get calls, the answering service contacts me, not the client. However, in case this was a client... I had to be polite -- no sassy responses.
So... "How do I get there?" said I, this being a reasonable question for a legitimate client and a good way to identify the caller.
"Oh, I'm in Kansas," was the answer.
Situation solved, and I was relieved that there was no emergency.
***Later that evening, I was fractions of a minute into my shower when the phone rang once more. Probably just Dad or Mom, but nonetheless I hopped out and answered, hand dripping.
The number was that of the answering service (AS).
"Hi, this is so'n'so from the answering service."
"Hello," I tried to sound cheerful.
"Thus'n'such of your clients has a mare that had a foal and hasn't passed her afterbirth yet," says the AS.
Thus'n'such client breeds dogs... I've never seen any of her horses... called seemed strange but...
"Okay, I'll talk to her," says I.
The AS connected me to the client and hung up.
Client: "Are we the only ones on the phone?"
Me: "I think so."
Client: "Actually, my horses are fine but I have a dog that's been in labor a few hours. Can you do a C-section on her?"
Another client had advised her to make up a large animal case in order to get through to me... since I wasn't really on small animal duty.
I hemmed and hawed a bit... I had no technician on call that night... I hadn't done a dog C-section by myself before (This didn't worry me much -- I've done sheep C-sections, helped with a dog C-section, and have seen numerous others performed. The main part that concerned me was the anesthesia.) etc.
Well, they really didn't want to take the dog to Bailey Vet or the other clinic on-call for small animal work. I believed that I could accomplish the task. And the client assured me that they have helped with C-sections before. I agreed to do the surgery.
I wondered at my sanity -- I wasn't even on call for sm. animal and here I was spending my evening doing surgery -- I had no technician to run anesthesia while I was sterile and scrubbed in -- the risk of surgery was therefore somewhat greater and I told the client so. They had accepted this risk before and all had been well. They had no qualms.
This is one of those cases where you tell yourself: "I know how to do this -- I can do it -- I just need to keep my head about me and it will be fine -- in three hours it will all be done and I will [hopefully] look back at success." But you still have to still your heart. Eat some carbs before going in to surgery to keep from shaking and increase your endorphins.
And run through everything you are going to need in a chronological order. Anesthetic protocol (check) -- sterile scrub for dog (check) -- sterile scrub for doctor (check) -- major surgery pack (check) -- possible extra hemostats for umbilical cords (check) -- epinephrine and dopram for puppies (check) -- suture to close uterus and abdominal wall (check). This process is not so important if you have a tech on hand who knows where stuff is. But in this case, it was crucial.
My client asked me if I was nervous for my first C-section. I responded "Not really"... which was largely true. My first C-section had been on a sheep. Sheep are much easier -- the anesthesia is much less problematic (sedation and local block and you're good). I had been mostly worried about being fast enough. I then commented that I hadn't done a dog before, but relayed my confidence that I could do it. And, yes, I was nervous for my first dog C-section, which she could probably tell.
We got everything together and went for it. As I was making my ventral midline incision, the pulse oximeter began to indicate that the dog's heart rate was dropping. Shoot. I had no tech to make sure the pulse ox was reading correctly. Turn the anesthetic rate down. Check dog gums. Color pale. Shoot. Breathing seemed erratic. (My mind was hyped up suspecting the worst.) I gave directions to my helpers as I continued surgery as quickly as was possible. Inject epinephrine into tongue. Wait a bit. Heart rate begins to raise. Phew. Keep cutting. Heart parameters are stabilized. Proceed with surgery as fast as possible but still do a good job. Lavage uterus surface. Pull off external gloves before closing the abdomen. Helpers report that all puppies are doing well. Surgery finished and observe mother.
She wakes up excellently, faster than normal according to her owners. Her temperature is within normal limits and she is drinking water prior to discharge. A couple days later all were still doing well.
Big sigh.
As it turns out, I think the pulse oximeter was on one of its occasional fritzes. These are no problem if you have someone there to mess with it, check the heart rate with a stethoscope, ensure that all is well. Which is all to say -- it's nice to have a tech. Sometimes you don't get one late at night, and you do the best surgery you possibly can -- but it's still nice to have a tech.
