February 2004
Simba, a large orange boy cat, just over a year old, sat hunched on the exam room floor. His eyes were squinted, ears flattened, internally absorbed in his misery, so dramatically different from his usual loving greeting. Shannon, his pet-mum, had called five minutes before closing time. Neither Shannon nor Pete could face their Valentine’s dinner worrying over Simba, who had been vomiting copious amounts of light green watery fluid since noon. They clutched hands, faces etched in concern, as I sat down next to the cat. Dehydrated and going into shock, he squeaked pain when I palpated his abdomen.
The days surrounding Valentine’s Day can be heartbreaking for a veterinarian. That’s when we are typically dealing with the fall-out of love – dogs that shared the chocolate, candies or cannabis edibles; cats investigating the flowers; candle burns and the unwanted kitten or puppy gift. This last week had been no exception to that, even in a new and not very busy veterinary clinic.
“I will need to get some x-rays, bloodwork to figure out what is going on.” Thinking of the thousands of reasons why a young cat vomits – acute kidney failure, pancreatitis, salmonellosis and GI foreign body uppermost in my mind.
Simba crawled under a chair, threw up a small pond the color of old hospital walls.
“And get him onto an IV as quickly as possible.”
“Anything. Yes.”
Those were the days – no estimates to prepare, go over, get signed permissions – a procedure that can generate so much distrust and hostility, misunderstood as if money is everything and the staff uncaring. It was still ok to give a verbal estimate – “It will be at least a thousand for the first day, are you ok with that?” – and eventually we would get the legal paperwork done.
X-rays are not always diagnostic, but Simba’s did give us the clue – a classic picture of small intestines bunched into loops, an air bubble in each fold, and a suspicious shadow in his otherwise empty stomach.
Cats have backward facing barbs on their tongues, perfect for that rasping licking action on your eyelid that wakes you up in the morning. But if something long and stringy gets into their mouths, they cannot spit it out. Caught on the tongue barbs, they are forced to keep swallowing it until it is all down. Sometimes it will get stuck around the tongue. Often it will form a knot in the stomach or small intestine, catching in place. The rest will continue to pass through the small intestines, which keep doing their wavelike peristalsis movements that move food through. But now the string is in one place, and the intestines start moving up the string, threading it until they are accordioned so tight, one end of the string ready to pass out the bum, the other stuck in front, the linear foreign body now a taut tightrope that will cut through the traumatized gut. These are not visible on x-rays, casting the same grey shadow as the rest of the abdominal organs, but in many (not all!) cases, we can see the effect – the gathering of the small intestines into folded loops, fluid and air entrapment, shadows that should not be there.
Simba needed immediate surgery to remove this linear foreign body if he was to survive.
“We have some options. I can send you to the ER. Or I can do this.”
Turned out the animal ER down the road was already too busy, with no surgeon available until possibly the next day. They faxed up the referral forms and an estimate for the night.
“You. We trust you.” Gulp. But.
“I have not done this before. Just thousands of spays and neuters.” Of course, I want to do this! This is exciting, adrenalin-pushing, nerve-wracking. I trained for this, expect to be able to do this, am dying to do this. An emergency surgery I have never seen other than pictures in a textbook. Will you forgive me if something goes wrong?
Right when the rest of Vancouver was packing the restaurants, pouring the champagne and lighting the romantic candles, my partner and I prepped the OR. We forgot the tiredness of the already long day. It probably took an hour to get every detail right where I wanted it, sneak a peek at the surgery textbook and brief my novice OR assistant.
Simba, IV already running and sedated for GA, sat in Shannon’s lap in the exam room whilst I bustled around. Finally, I declared us ready, and we gathered around the prep table. A lingering stroke, a whispered “love you”, and Simba was left in my partner’s arms. Shannon and Pete retreated to the exam room. From there, they would have a view of the surgery, bravely peering from the large curtained window of the exam room, staying close by just in case.
“Don’t die!” I whispered as I injected the milky propofol, watching him slip into the state of forgetfulness. There is always a little flurry as we get our patient intubated and prepped.
“BP 40!”
“Give a bolus, ISO to 1”
“BP 50!”
“Give another bolus!”
Fur flew as I shaved, scrubbed him up as fast as I could, all the while he struggled with ridiculously low blood pressures. At least he kept breathing. We managed the tube-trailing transfer to the surgery table, positioning him, doing the final scrub.
“BP 60!”
“Give the Pentaspan! Keep ISO at 1! Come tie my gown!” Waving scrubbed up hands helplessly in the air, unable to touch anything now.
And then I was spun around, the bows tied behind my back, sterile gloved hands held in the surgeon’s prayer position. The routine of opening the packs and draping the patient, irritatingly time-consuming, is a surgeon’s mantra into the calmness that you need, to be able to take a deep breath, scalpel poised, and make that cut without haste, without shaking, knowing that the harm you are doing is to heal.
“BP 100”
“Surgical stimulus. ISO to 2. Hold it right there Simba!”
He did. My assistant became absorbed in taking videos of the surgery, especially of the thrilling moment when over a meter of thin pink ribbon slid out from angry and traumatized small intestines.
Closing took what seemed like forever, Simba steady now. Like he was already healing, intestinal color fading to normal as I sutured. Many times now I have closed a foreign body surgery, loving that thrill and the almost instant bring back from death.
As soon as could be arranged, Simba transferred to the ER for the rest of the night, still requiring close observation post-operatively, and we staggered off to get four hours sleep.
Six hours later, Simba returned. He strolled out of his carrier as if nothing had happened, purring loudly, greeting me with hugs and demanding food. Watching him wolf down breakfast, all of us grinning and making euphoric jokes about that very expensive pink giftwrap ribbon, Simba made Valentine magic that year.
For more information on Valentine’s Day pet hazards, visit https://www.aspca.org/pet-care/general-pet-care/valentines-day-safety-tips
Characters are fictional in all my veterinary stories, although they are based on common events that happen in veterinary medicine. It could be that you have experienced similar events or had a similar situation turn out differently.
Joosting 