Hugh Cran - Promises to Keep: A British Vet in Africa

PROMISES TO KEEP

A British Vet in Africa

MERLIN UNWIN BOOKS

But I have promises to keep, And miles to go before I sleep

STOPPING BY WOODS ON A SNOWY EVENING
Robert Frost

To our peerless daughters Kim, Sophie and Rona

Time to hit the sack, I said to my Berna, my lovely and long-suffering bed-mate, Ive got 140 cattle to pregnancy test at Beaumont-Botts place on the other side of Eldoret at eight tomorrow morning. Im going to have to get up at 5.30 in order get away by six.

Eldoret was 100 miles away on the road to Uganda.

As I shuffled off to the bathroom, the phone rang. Berna lifted the receiver. Its the police, she said. My heart skipped a beat. The Dixon of Dock Green type did not figure in the ranks of the Kenyan constabulary. Most of the ones I had met were narrow eyed, overweight and open palmed. Had they finally run me to earth for that time I had failed to stop at a road block on the way to Naivasha? Had the cops hand been raised to stop me or was he just scratching his head? Naturally I had assumed the latter. Its the Dog Section, said Berna. Major relief.

Inspector Macharia here, an authoritarian voice declared. One of our German Shepherds is sick. Less relief. She ate all right at six, but now her stomach is swollen and she is trying to vomit and having difficulty in breathing. She doesnt look good. Shes twelve years old but shes one of our best dogs. They always are, I thought. I looked at my watch 10pm.

Right, I replied. Youd better bring her to the surgery right away. This sounds serious.

Berna came along to help me and we got to the surgery in short order. We arrived before the police. I opened the door, put on the lights and started getting things ready. This is probably torsion of the stomach, I said to Berna. Happens in big dogs after a meal and a bit of exercise. Fatal unless treated very early.

So what do you have to do?

Probably open her up ah, here they are.

The police van screeched to a halt, headlights shining through the open door of the surgery. A posse of gendarmes marched in, leading a large German Shepherd bitch. She staggered slightly, stopped, salivated, lowered her head and made an ineffectual attempt to vomit. I palpated her abdomen. It was grossly distended, as tense as a drum and so hard that I feared to exert pressure lest I precipitate a terminal collapse.

I addressed the uniformed front rank. From what I can feel shes got a twisted stomach, which is now distended with gas. Weve got to act fast, or shell die very soon, so I want two men to stay to help. The rest can go. A spokesman barked a command and Berna and I were left with the bloated patient and two cops.

Right, I said, first of all we have to give her fluids i/v.

How much? asked Berna.

Well, shes about 35 kilos, so up to three litres. But well give her a litre and see how we go. The policemen lifted the bitch onto the surgery table. I clipped the hair from her right foreleg below the elbow, and fed a catheter into her cephalic vein, attached it to a bottle of Hartmanns solution, held by Berna, and ran in the fluid. After fifteen minutes the litre was finished and the bitch looked no better. If anything she was worse, gasping and groaning.

Lets give her another half litre and then try to get rid of some of the gas, I said. I ran in the fluid.

Right, lift her off the table and stand her on the floor. Lets see if we can pass a stomach tube.

A stomach tube for dogs? asked Berna. I didnt know you had one.

I havent, but I do have several sizes for horses. Well try the yearling model.

I placed a bandage roll in the bitchs mouth and asked one of the policemen to hold the mouth shut while I fed the tube through the middle of the roll. But try as I might it was impossible to pass the tube. I gave her an injection of Valium and tried again. No go. Right, well have to decompress the stomach with a large bore needle and then try again. I rummaged in my surgical bag and located a 14 gauge cattle needle. I sterilised this, clipped an area over the bitchs right side, just behind the ribs, where the distension and tympany was at its maximum, sterilised that and pushed the needle through the skin and into the stomach. There was a rush of gas and a satisfactory deflation, before the needle became blocked with stomach contents.

OK, I said. Shall we try the stomach tube again? This time the tube slid down and more gas was released.

Right, a little more i/v fluid, and were ready to open her up. Are we all ready? Berna was. The two gendarmes looked less sure. Another litre together with i/v antibiotics, then the pre-med. The instruments were ready, the anaesthetic, ketamine, was not ideal, but I was strapped for choice. This was Africa, not Bognor or Brighton. The patient was now unconscious. We lifted her onto the table and I shaved her abdomen and clipped drapes over the incisional area.

OK, here we go. Very carefully I made an incision through the midline from sternum to umbilicus carefully as the last thing I wanted to do was to puncture a distended stomach and contaminate the abdominal cavity. As I cut, the distended stomach came into view, protruding through my incision, still distended, despite gas being removed by needle and stomach tube, as it was still rotated and still producing gas. The now visualised stomach was covered with the greater omentum, the lacy part of the mesentery which covers and protects this part of the abdominal cavity. Seeing this I knew that the stomach was rotated in a clockwise direction, as viewed from the dogs rear.

Something made me look up. One of the policemen had gone a strange grey-green colour. He was swallowing convulsively, which I knew was the horrid precursor to a burst of vomiting, the very last thing I wanted mid-operation. Out! Out! I bellowed. He fled.

And then there were three, I said. On we go. Now I have to try and turn the stomach back to its correct position. But first Id better deflate her a bit more. Berna, is she still breathing at your end?

Yes, looks fine to me.

Good, can you give me that cattle needle again. Thanks. There was a welcome high-pitched hiss as I pushed the needle into the stomach and the mounded balloon sank until it was no longer under internal pressure. Great, here we go. By pushing down on the right side of the stomach and pulling on the left, the organ slowly swivelled anti-clockwise, followed by its attendant spleen. Looks good, I said, no sign of damage. The last thing I want to do is to resect a chunk of necrotic stomach wall. Then the outcome can be poor to hopeless. But I can feel big pieces of meat in here so well have to open the stomach, empty it, stitch it up and then stitch the stomach to the abdominal wall to prevent a recurrence of the problem.

Oh yes, and how do you do that? asked Berna.

You make a careful incision in the wall of the stomach, without going the whole way through, and then make another in the muscle of the nearest abdominal wall and stitch them together. They form a strong adhesion which prevents the stomach from twisting again. Simple! Simple indeed, but it took me another hour to empty the stomach, close it up, perform the so-called incisional gastropexy and then close the abdomen. During this time I had to top up the anaesthesia. The bitch was coming round, I was pleased to see. When they dont come round, is when you worry.