Vet Among the Pigeons (14 page)

After some time, during which I cautiously stabbed at the oedematous fasciae, I noticed Arthur glancing at his watch.

‘So, what’s next?’ he eventually asked.

‘Well, I just have to find the divide between the two muscles, but,’ I added, glancing again at the simple line drawing, ‘the cadavers we operated on in the course didn’t have a half a pound of mince meat in there.’

I couldn’t understand why he laughed as, by now, a cold gush of fear was starting to seep through me.

Eventually, I could swab no more and had to try to
discern
the muscle divide. A few times I picked up the tissue forceps and Metzenbaum scissors and half-heartedly incised in what I thought was the right area. The glistening strip of fasciae that should have acted as my guideline had long since disappeared, lost in a mass of traumatised tissue.

Eventually, the tips of the scissors divided the two
muscles
, although I suspected not exactly at the right place. At an agonising pace, I swabbed and fiddled and eventually opened the divide to match the length of my initial incision, although the distal end did run off at an angle over the last few centimetres or so. Finally, I put the instruments back in the tray and ran my finger deep into the incision until I was able to feel the bony shaft of the femur. With more force than I thought would have been necessary, I was eventually able to break down the tissue attached to the shaft, enough to feel my way to the roughened fracture end. Using a
combination
of gloved fingers, scissors tips and a periosteal
elevator
, I was, with difficulty, able to expose the point of the
fracture at the proximal end, although it obstinately remained deep within the massive limb.

Arthur was, by now, looking like he regretted ever
offering
to help as I ignored any attempts at conversation, so intent was I on trying to figure out how I was ever going to complete the surgery.

In the time between completing the first surgical course and meeting Boris, I had read and reread the lecture notes. I had imprinted on my brain the importance of not
traumatising
the tissue and trying not to strip the muscle from the bone, as the muscle provided the blood supply that was essential for the repair of the fracture. That morning, I had vowed to leave every bit of muscle attached but, by now, my standards had dropped; I was now merely trying to expose the bone any way possible.

Having finally exposed the proximal end as best I could, I drew a few deep breaths and carefully tried to unravel my back and hunched shoulders before turning my
attention
to the other end of the fracture. All the time I had worked on freeing the jagged proximal end, I had been aware of the shaft of the femur running alongside. Now I ran my finger along its length, gradually breaking down the soft tissue attachments, and realised, with dismay, that the two ends of the bone overlapped by what seemed to be at least three centimetres.

I glanced up at the X-ray viewer to see the first
radiograph
which indicated an overlap of maybe half a
centimetre
. In the days in between, the strong musculature of the huge dog had contracted to an extent that the two ends looked like they would never meet again.

After my initial setback in trying to locate the femur, I had finally achieved it and quietly reassured myself that the hardest party was over. Now, with a sense of dread, it dawned on me that my work was only beginning.

Arthur, too, seemed to have noticed my dilemma and had stopped the smalltalk. ‘How are you going to get the two ends together?’ he asked quietly, annoying me with his assumption that I would know.

The surgery in the course had involved dead dogs, with artificial fractures that were in place and ready to repair. Little mention had been made of how to reduce the
fracture
or to realign the two ends of the bone. The surgical atlas neatly skipped from locating the fracture to sewing up the muscle layers afterwards.

It was only later that I realised with shock that it took almost an hour as I pulled and rotated and tried against all odds to get the two ends of the bone together. Arthur,
similarly
scrubbed up, followed my directions as he
manipulated
the end of the leg. With neither of us having any experience of what we were doing, it was agonisingly slow, as millimetre by millimetre we gradually made progress.

In all the time, I drew consolation from the fact that Boris’s anaesthetic was the only part of the case that could be described as textbook. I was reassured by his regular, even breathing as he slept, oblivious to our struggles.

The clock ticked as lunchtime came and went and Arthur’s shift at the local factory approached. My mind was numb with the sheer monotony of attempting to get the ends to meet and it wandered to thoughts of replacing
prolapses
in cows, which, until now, I had found arduous.
Nothing could compare to the numbing of my fingers and the strain over neck and back, or the cramped thumbs that finally led to the two ends of the fracture eventually being hauled, not into a perfect fit, but to some sort of alignment. Arthur was by now anxiously watching the clock and despite my exhaustion, I was aware not only of the fact that I was soon going to lose my assistant, but also of the length of time that Boris had been anaesthetised.

At least the next part of the surgery I had done before on the course, but it took every last ounce of energy to drill the nine-millimetre stainless steel pin from the
fractured
end up the shaft of the fracture, until it protruded out at the top of the leg. I cut a small incision to allow the pin to pass out through the skin and continued drilling it up until the other end was just protruding at the fracture site. Both the sheer size and the amount of swelling of the leg made it impossible for me to assess if my pin
placement
had avoided the sciatic nerve that ran behind the femur, but by now that seemed the least of my worries. With my gleaming new bone clamp holding the two ends of the fracture in rough alignment, I then drilled the pin back down the length of the leg into the second half of the bone. Using an identical pin, I was able to measure how far up the shaft the pin had travelled until it seemed to be in the right place.

Despite the pain deep in my back and shoulders and the fact that I was drenched in sweat, I felt a sneaking sense of triumph through my exhaustion. Cautiously, I moved the part of the pin that was protruding from the top of the leg and noticed how the entire leg now moved as one unit
when I angled the pin. The leg was now, relatively, back in one piece.

‘So. That’s it, then,’ announced Arthur, sounding glad that the ordeal was almost over.

‘Well, now I just have to put the cerclage wire around the oblique edges.’

He couldn’t hide his dismay and shifted awkwardly for a few more minutes until, looking pointedly at his watch, told me that he had to go to his shift in the factory.

‘I didn’t think it would take this long or I would have asked Seamus to swap with me,’ he ended apologetically.

‘Neither did I,’ I replied wearily, wondering as I did if the pin would hold without the three cerclage wires. Reluctantly, I dismissed the thought, knowing that in such a big dog, the repair wasn’t going to be ideal even with the wires.

As I cut the first length of wire, Arthur flushed the
surgical
site with several sixty-millilitre syringes of heated saline. The muscle around the site was beginning to take on a blueish tinge that worried me.

Then, with Arthur gone, a renewed flush of weariness washed over me, dissipating my momentary triumph. By now, I wasn’t surprised to find that it wasn’t as easy as I had thought it would be to angle the wire placer under the fractured shaft of the bone before threading the stainless steel wire through. The weakness that seemed to have taken me over made it difficult to pull the thick wire through the curved instrument. With the wire finally in place, I took up the wire twisters and, remembering the detail in the notes, I twisted the two ends of the wire
around each other, leaving loop after loop, until the loops were down to the level of the bone. I cut the wire, leaving three loops to ensure the knot wouldn’t open. The next wire was slightly easier to place and, as I tightened it, I began to feel that my ordeal might finally be coming to an end. As I readied myself to cut the wire, I gave one last twist to ensure it was tight enough, and watched in dismay as the wire snapped. I didn’t even have the energy to berate myself as I wearily threaded through yet another loop until the second and third wires were finally placed.

The leg was by now unrecognisable and far from the perfect limb it had once been. I flushed the open wound with the syringes that Arthur had left for me and began what should have been the simple task of suturing back in place the layers of muscle and skin. Although it was
technically
easy, my numbed fingers fumbled with the
instruments
as I rejoined the muscle masses. It seemed like the edges of skin would never be sutured. As I placed the last knot, despite my exhaustion, I felt a slight tremor of hope and elation that, despite all, I had succeeded in doing what, on a few occasions, looked like being hopeless.

All that remained, now, was to cut the pin that
protruded
from the top of the limb.

With the glimmer of hope that came from completion, I giggled as I recalled my trip to the local hardware store two days previously to purchase the bolt crops that I knew would be necessary to cut the stainless steel pin. Molly, as usual, was familiar with the case in progress having met Boris on her frequent trips to the surgery. She had nodded knowingly as I held her up to the x-ray viewer and showed
her where we would put the pin into the shattered leg and cut off the bit sticking out at the top. In fairness to the man in the hardware shop, I could hardly blame him as he observed a heavily pregnant woman arriving, with toddler in hand, when he asked what my husband needed the heavy-duty bolt crops for. Before I managed to reply, Molly, with her usual enthusiasm for the job, informed him that I needed it ‘to cut the doggie’s leg off’. Somewhere in her two-year-old brain, the story had got jumbled. I’m quite sure that the man thought that I was some psychotic hormonal female who was going off to commit some
heinous
crime. It took two more hardware shops to locate the required instrument that would be strong enough to cut the nine-millimetre stainless steel pin.

Somehow, the bolt crops seemed heavier now as I lifted them up to the level of the table before placing the jaws around the pin as close to the leg as possible. When I was finally happy with the placement, I braced myself to lever together the two jaws to cut the pin. My best efforts only left a scratch and I re-angled them again to get a better grip. Fifteen minutes later, I was still at it, but by now was standing on the operating table, one foot on either side of Boris, having decided that some extra height might give me a better chance. It was at that moment that Seamus chose to appear, irate from a stressful morning of awkward clients. Had I not been so tired, I might have laughed at the look of utter bewilderment as he observed me in full
surgical
garb, standing straddled over the prostrate body of the huge dog, brandishing my bolt crops. He watched and stared, until finally he begrudgingly asked, ‘Do want a
hand or is that the way you usually do it?’ Too exhausted to care, I handed over my weapon and watched, as with one quick heave, he closed the jaws and the end of the pin shot off to the far corner of the room.

Never a man of many words, he watched silently as I undraped the dog and cleaned the site. He busied himself around the office as I waited for Boris to wake up
sufficiently
to remove the endotracheal tube. Only then did he return and, without a word, lift Boris off the table and put him in the kennel that I had readied with thick
bedding
and a heat lamp.

Unceremoniously I dumped my orthopaedic
instruments
into a sterilisation solution and cleared the worst of the mess while waiting for the kettle to boil. Because of the pain relief I had given him, Boris whimpered only slightly and recovered remarkably quickly from his lengthy
anaesthetic
. Wearily, I gulped a cup of tea and instantly felt
nauseous
as the milky liquid hit my stomach. I abandoned the remainder and went to adjust the flow rate on Boris’s fluids.

I could never have imagined that one operation could take quite so much out of me and was relieved that I wasn’t on call that night. Arthur promised faithfully to keep an eye on Boris, so it was the next morning, after a
surprisingly
deep sleep, that I was able to see how Boris was coping with his amateur repair. The first thing I noticed was that he placed his foot, although tenderly, to the ground – so at least I had managed to avoid the sciatic nerve with the pin.

Never having pinned a leg before, I was frustrated that I
didn’t know what to expect and neither did anyone else in the practice. At least I was grateful that I wasn’t having to reassure an anxious owner that everything was going well and the recovery was as expected. Or was it? I really had no idea.

The day of the surgery was my last week at work before going on maternity leave. On the Friday afternoon, with some difficulty I loaded Boris into the well-padded back seat of my car while Slug hauled herself into her customary position in the front seat. She sulked the whole way home, studiously ignoring our passenger. Molly was naturally delighted to have Boris, especially as his post-operative care consisted of several slow lead-walks a day – at just about at the speed of the average toddler. We became a common sight over the days that followed, Molly and Boris and me, pacing up and down the country roads. Despite the fact that Boris was putting some weight on his injured leg, the muscles continued to fade over the next few weeks, but he always enjoyed his walks and suffered no obvious pain.