Full Circle: A First Responder Invitation

It was about 8:00 pm on a mild December night. I had just steeped a cup of Tension Tamer tea and had serious plans to finally fold the laundry when two Town of Eldorado First Responders began pounding on my door. After corralling my four-legged body guard (an American Bulldog named Guppy), I opened the door unsure what was about to unfold.

Car crash scene near Highway 41, Town of Eldorado. Photo reprinted with permission, Carlos Munoz Jr.

"There's been a car accident over there," the female First Responder rushed, jerking her head in the direction of flashing lights and sirens across Highway 41. She wore a helmet, heavy coat and reflective gear. A rumbling truck with flashing lights waited behind her. "A dog was in one of the trucks and was thrown around the vehicle. We don't know if it's hurt. Could you come and take a look?"

Immediately my mind began running through the possible scenarios of what I might find and how I could help. I looked down at my clothing. I was still wearing a dress and tights from attending a family funeral earlier that day. "Let me throw something else on," I said and ran upstairs to whip on jeans and a sweatshirt, a hat and winter boots.

Both First Responders waited at the truck for me. "Do you want to bring your own car," one asked.

"Actually, I need a lift. I don't have a car tonight," I answered.

Quickly I unlocked my clinic and hurried about gathering the first things that came to mind: stethoscope, otoscope/ophthalmoscope set (it'll serve as a flashlight if nothing else, I thought), a slip leash, towel and several muzzles in different sizes. I had no idea what kind of dog I was going to encounter or in what degree of pain. It would certainly be afraid. My hastily grabbed items felt inadequate, but I reminded myself that my job tonight was to assess a trauma patient and possibly preparing a pet for transport to an emergency facility. In any event, we could bring the dog back to my clinic for a better assessment and stabilization once it was removed from the scene. These doubts and rationalizations flitted through my mind rapid-fire as I clambered into the truck.

As we bumped down Ridge Road and turned onto County Road N, the pair of First Responders chatted easily with each other and tried to prepare me. "The people involved have already been evacuated from the scene," they said. "The dog is in the back of a truck. It began drooling heavily. We just don't know if it's hurt."

In no time, we arrived at the accident. As I opened the door and stepped onto the shoulder, I felt dazzled and disoriented by the red and blue and yellow lights flashing off the reflective gear of half dozen or more emergency personnel. It was an alien scene: diesel fumes and broken car smells, crackling radios and blinding lights, strangers and neighbors, adrenaline and apprehension. I noticed one vehicle disabled a ways off in the farm field facing the road, its front end damaged but headlights on. The First Responders pointed out a pickup truck in the ditch, its air bags deflated, driver's door open.

I cautiously approached the cab, sorting through the items in my pockets for the leash. A wide-eyed, big, blocky-headed white and brown dog sat in the passenger seat.

The use of a dog seat belt not only keeps a pet from interfering with safe driving, but also keeps a pet inside the vehicle in the event of an accident.

"Her name is Roxy," someone shouted to me. "She had been sitting in the front and was thrown into the back seat."

"Hi Roxy," I started crooning. "How are you feeling? Are you hurt? I bet you're scared. Do you want to come out?" As I chatted at the dog, I showed her the slip lead and attempted to place it around her head. The dog was too far away from me, and I worried she might be protective over the vehicle. I didn't want her to feel trapped and take a defensive position. "Does the passenger door open?" I asked a nearby Responder, never taking my eyes from Roxy, examining her from afar. She was breathing without increased effort, mouth closed. No visible blood on her. Sitting squarely on her haunches. Front limbs straight and weight bearing.

"It's locked," they said. I wanted Roxy to come out so I could examine her better.

As if she might understand me, I began reasoning with her. "You don't want to stay in there, do you? Why don't you come out so we can get you somewhere warm and safe." The dog didn't shy away from me as I reached toward her. Her body language indicated interest and confidence. More confident myself, I was able to slip the leash around her neck. With just a little prompting she crawled into the driver's seat.

Now I was trying to fit a muzzle on her, not sure if she was going to need help exiting the truck and afraid she might bite if my assistance incited pain. The muzzle was ridiculously large. Roxy looked at me disdainfully. "Okay, okay," I laughed. "Let's see if you can get down out of there yourself." I backed up and kept an encouraging amount of forward pressure on the leash. Roxy jumped daintily from the seat onto the gravel, all 80-some-pounds of her. She strained at the leash as I tried to get a better look at her eyes and ears and gums, cold dampness creeping through my denim as I kneeled on the crust of snow. As I ran my hands over her limbs and back, feeling for bumps and scrapes and watching for signs of pain, she leaned with all her might toward a trio of people standing several feet away. Heart and lung sounds good, no drooling, strong and alert. I stood up, handed the leash to a First Responder, and said, "She looks all right. Could use another exam in a better setting, but I think she'll be all right."

The First Responder thanked me and pointed the hand holding Roxy's leash toward the trio of people standing at the front of the truck. "That there is her owner."

Feeling more than a little stupid -- if I'd known that, I would have just had him get the leash on her and entice her from the truck -- I walked Roxy over to him myself. "American Bulldog?" I asked trying to break the ice. "She's beautiful. My own dog is an American Bulldog...don't see many around here." He nodded, distracted as the two officers finished their interview and administered last minute instructions on how to document any latent injuries. The guy looked shell-shocked and I couldn't blame him. I waited my turn for his attention. "Are you local? Do you have a regular vet?" I cringed inwardly; it sounded like soliciting. "I mean, you should have her looked at tomorrow morning," I blurted out. "Even if she seems okay." I gave him a list of things to watch for that would indicate emergency veterinary care should be sought right away.

I wandered back to my ride. My First Responders--my neighbors, my daytime clients--stowed their gear and turned the rumbling old truck toward my home. Feeling calmer I began to enjoy the mild December evening and the camaraderie of being a Local. It occurred to me suddenly that I'd come full circle. "You know," I mused, "over ten years ago I trained to be a First Responder. It's what inspired me to go back to school to become a veterinarian." I never even had had a chance to practice as a First Responder at the time, I thought, and now here I am a veterinarian on my first First Responder call. Ironic, isn't it?

The other irony in this story is that a mound of clean laundry continues to sit unfolded upstairs while I write this post.

Inspiration

Tonight I was asked by my neighbor to remove a kernel of corn from her son's ear canal.

Swallowing chuckles, flanked by his desperate mother aiming a light at the barely protruding foreign body and my incredulous son (his best friend), I try first to suction the kernel out with a baby nasal aspirator. Failing with this approach, I grab a pair of finely pointed forceps from my veterinary cold sterilization tray.

The boy whimpers when he sees the instrument, although it is no more sinister than a pair of tweezers. 

"You must hold still," I warn. "If this doesn't work, you're off to the hospital."

With a steady hand and held breath, I reach into the opening of the ear canal and grasp at the kernel. The offending golden seed glides from the boy's ear. It feels as though I just successfully grabbed the "funny bone" from the Operation man without setting off a buzzer.

Amid cheers and high fives, we part ways for the evening. My arm around my son's shoulders, I have a weird nostalgia feeling as we walk into our house. I'm rather proud of my performance and wonder if my son is similarly impressed. And I'm thinking of my own mom being heroic under extraordinary circumstances in a memory from so long ago it feels more like a dream than reality. In college I commemorated the experience with the following poem later published in UW Eau Claire's 1998 NOTA. In honor of moms everywhere rocking at improvisation in times of crisis (and with its slightly spooky Halloween theme), I present:

Mother

The skinny
scream of the bunny
pierces the adults
to their kitchen
perches—
all except for Mother
who flies to her bare feet
and in a voice I've never
heard—vibrant and
strong—summons
Towels!
Thread!
Needle!
Suddenly the objects
appear, submitted
by leaf-trembling
children sooted with
alfalfa dust and wearing gnome-like
wigs of spiky yellow straw.

While the bunny
cries on the table,
she grasps
the torn flap of hide,
rinses dust and leaves
from the bloody meat beneath—
silent now,
surrounded by silence,
except for the spiraling
shriek of the bunny.
She holds him between
her legs, pressing him still
with solid thighs, as she
calmly weaves black
thread through the eye of the needle.

As easily as she glides
our summer green
cucumbers—
warty legless frogs—
into the boiling cauldron
to pickle,
Mother eases the needle
through one slice of soft
hide into the other,
pulling the torn pieces
taut into the whipstitch.

She needs no
finger-pointing from
the stunned children
to divine the truth.
The evil eye she
levels at the smallest two
boys—the ones whose tug
of war broke the animal—

is not a curse, not hatred
but fear and shock and
sadness.

Still wordless
she knots the thread
as peacefully as tying
off a newly darned
sock, rests the quieting
bunny in a shoe box
and sighs,
breaking the spell.

Feline Urethral Obstruction, a Common Cat Emergency

I'm superstitious and I know it. I holler at my staff when they exclaim what a peaceful day it has been in the clinic. Such statements practically guarantee that a complicated life threatening emergency will walk in the door at 4:55 p.m. I find myself "knocking on wood" to secure little blessings and remarkable recoveries. Also, I am convinced bad things (or just plain weird things) happen in threes.

Within a 24 hour period this week, we had three feline emergencies -- urethral blockage.

Male cats have a narrow urethra, the tubular passage from the urinary bladder to the outside world. Because it is so narrow any number of things can plug it up causing an excruciating and life threatening emergency. Bladder stones, "crystals," mucus and blood clots can get stuck anywhere along the urethra preventing the cat from emptying his bladder.

Signs this is happening include spending an inordinate amount of time in the litter box, licking excessively under the tail (specifically the penis), straining so hard to urinate that stool comes out (or vomit), yowling in pain (especially when touched on the belly), walking funny (because the bladder, located between the hind legs, is distended and painful), decreased appetite or thirst, or hiding.

A male cat crying while repeatedly posturing
to urinate yet producing little or no urine
can signal urethral obstruction, a life
threatening veterinary emergency

By the time most owners notice these signs, the cat has already been blocked for several hours. A "wait and see" attitude in a blocked kitty will result in a dead kitty. If the cat is not seen by a veterinarian for treatment the bladder will continue to stretch (sometimes causing permanent damage to the muscles and nerves involved in contraction) and may rupture, kidney function will be compromised, and vital electrolytes will go haywire. In particular, if the potassium gets high enough the cat can have a heart attack and die.

Any time an owner calls worried about a male cat yowling in pain or straining to "poop or pee" I want to see it immediately. Urethral blockage is usually pretty simple to rule out, so I'd rather be safe than sorry if the cat is acting weird for some other reason!

No two "blocked" kitties are the same. However, I generally follow a certain diagnostic and treatment protocol initially:

Yellow arrow points out numerous large bladder stones in
this cat which will require surgical removal

1. Take x-rays of the abdomen to determine if there are bladder stones that need to be surgically removed after dealing with the immediate problem of "unblocking" the cat. 
2. Perform bloodwork to assess kidney function, electrolyte balance, blood counts, and more. 
3. With the cat under sedation a urinary catheter is passed to relieve the pressure in the bladder.
4. A urine sample is obtained to check for infection, crystals, kidney function, etc. Medications and diet changes may be prescribed based on this information.
5. The kitty is hospitalized for one or more days while we flush the bladder, treat infection, rehydrate the patient, rest the kidneys and balance electrolytes. 
6. After the urinary catheter is removed the cat is closely monitored to make sure he does not re-block.

Most cats who have been treated for urethral blockage require special lifelong management at home. This often includes a prescription diet made to dissolve and prevent crystals from forming. Canned food is recommended to increase water consumption and flush the bladder of crystals and cellular debris. Unfortunately some cats with recurring obstructions require special surgery to open up their urethral opening so they "pee like a girl cat" and are less likely block again.

Cats are famously good actors. They hide discomfort and serious illness until the last possible moment. Routine veterinary care including periodic blood and urine tests is very important for keeping cats healthy especially as they age. Subtle changes in your cat's weight, appetite, thirst and litter box habits, socialization and behavior can signal important changes in health. Trust your instincts and get him to the veterinarian!

There are emergencies, and then there are Emergencies...

I've been telling it on the mountain to anyone who would listen for weeks now. Many veterinary emergencies are best handled at a tertiary care veterinary hospital. In our neck of the woods, that means an after hours emergency and referral center.

Love 'em or hate 'em -- I've heard both sides of the story. Yes, it's expensive. Emergencies are expensive. When is the last time you walked out of a human ER with less than $1,000 invoice for treatment of a trauma or unrelenting pain? What amazes me is that for every client who swears she won't go to the after hours emergency veterinary hospital because of the cost, there is another client who hustles in at midnight to have her dog's itchy ears treated.

Now most ear infections can wait until morning for treatment by the regular veterinarian (there are exceptions to every rule). And many so-called emergencies are chronic problems that have been ignored or avoided for so long they just magically turn into urgent issues at five minutes past 5 o'clock on Friday evening. Procrastination may be human nature, but it unfortunately makes medical problems more difficult and expensive to address.

Merriam-Webster dictionary defines emergency as "an unforeseen combination of circumstances ... that calls for immediate action." True veterinary emergencies are unexpected and do require immediate attention: hit-by-car accidents, heat stroke, unrelenting seizures and sudden collapse are just a few examples (more scenarios are listed on my clinic website).

Most of the emergencies that befall pet animals are readily handled by your regular veterinarian, especially during regular business hours when the clinic is appropriately staffed and the "machinery of medicine" is up and running. At the very least, the pet's injuries or condition can be assessed, he or she can be stabilized, and specialized care at a referral hospital can be arranged if necessary.

The terrible events of March 20, 2011, in Fond du Lac, Wisconsin, reinforced in me the belief that there are times when nothing other than a veterinary facility dedicated to emergency veterinary care will suffice. I believe Fond du Lac Police K9 Officer Grendel would not have survived gun shot wounds received in the line of duty on that day if it were not for the local after hours emergency facility.

I have heard complaints that our local after hours emergency center is too far away, especially in an emergency. To this I have two responses. First, having driven through North Dakota where for some rural residents the nearest tiny human hospital is over an hour or two away I'm thrilled to have so many choices for pets within an hour's driving distance! Second, due to the circumstances, Grendel's medically-disastrous gun shot wounds were several hours old by the time he reached the veterinary hospital (and believe me, his trip north on Highway 41 was considerably shorter than most with squad car lights and sirens blazing!)

Had his emergency happened on a Tuesday morning instead of a Sunday, Grendel could have received an excellent diagnostic workup, immediate stabilization and compassionate care from any number of general practitioners in the area. Fortunately for Grendel, he was transported to a hospital that also could provide advanced imaging, expert abdominal and thoracic exploratory surgery, around-the-clock critical care, and numerous treatments to support blood pressure, clotting and more. The medicines used for Grendel are so specialized and costly no general practitioner I know could justify keeping them on the shelf in case of a rare emergency of this magnitude.

News clip on Grendel's recovery

After just eight days of intensive surgical and medical care at the veterinary emergency hospital, Grendel joined his human police partner at home in a joint recovery. Both returned to the line of duty on May 9th. From a veterinary medical standpoint, Grendel's full recovery is stunning.

In cases of life threatening injury, a patient's best chance for survival rests in the hands of exceptional doctors and staff, available life support technologies, inner strength and good fortune. Grendel had all of these on March 20th and the days that followed. For that, as a veterinarian and as a citizen of Fond du Lac County, I am grateful.