Moving Mountains

So today I get in a patient who had been in a dog fight the night before. The owner had stopped the ear from bleeding with some quick-stop (not its intended purpose, but in this situation it worked just great) and had wrapped up the bleeding wrist. The wife (who had brought in the dog) had only seen a puncture but she said her husband was sure there was an inch-long cut.

My patient, an absolutely enormous Newfie named (rather appropriately), Foraker, after the mountain, sits smiling benignly at me from the other side of the exam table. Usually this is not possible - either they smile at me from UNDER the table, or they have to stand up and put their front paws on the table - but Foraker has the approximate dimensions of a small and extremely cheerful black bear. Unlike many of his brethren, he has no eyelid abnormalities, and his eyes are a soft light brown, glowing with delight to be here in the hospital with a laceration on his wrist, meeting new people and making friends.

I take my history and then go around the table to examine Foraker, who wags his tail happily and snuggles up for a cuddle while I listen to his heart. I inspect his ear - which has a scrape and a small puncture, neither serious - and then we get around to taking his bandage off. Foraker, faced with the prospect of me handling his sore wrist, slowly subsides onto the floor and lays his enormous head between his paws. I cut his bandage away and inspect his wrist. There is indeed a puncture there, but I can't see a laceration. However, I can feel something, all right, under the thick woolly coat.

"D'you mind if I clip this?" I ask the owner.
"Nope, but if there's a big cut there I don't want to see it," she says. "I'm not good with anything past a puncture."
"Okay," I smile. "You can shut your eyes when we get to that part."

I fetch our portable clippers and begin bushwhacking through the thickets of Foraker's heavy coat. He looks away, as many polite dogs will do when you're doing something uncomfortable or anxiety-provoking, but which they're too well-mannered to object to. Every so often he rolls his toast-and-honey eyes in my direction, forehead wrinkled with worry; but he looks away again quickly, as if he can't bear to see what I'm doing, but he trusts me to do it right.

"Aww," I tell him. "You're a sweetie, aren't you?" Foraker thumps his tail and allows me to rotate his wrist to a rather awkward angle, trying to visualize the injury. Helpfully, he leans away from me, which allows better angulation. "Good dog," I tell him, giving him a pat, and he thumps some more and slumps gradually over onto his side, slow and graceful as a falling tree. Ah. Now I can see it.

"Yep, there's a laceration here," I say, and the owner, rubbing Foraker's belly, turns her head away and shudders slightly, with a comical expression of distaste. The lac is a little over an inch in length, and does need sutures. It's currently glued together by a fibrin seal, but that will fall promptly apart as soon as it's scrubbed (and would fall apart within 5 days if we don't stitch it, and most likely sooner.)

"Do you want to admit him so I can stitch it up?" I ask.
"Please," says the client, emphatically. "I don't have to see it, do I?"
"No," I tell her, smiling, and glance up as SS magically appears with a release form without my asking or even poking my head out the door (how does she DO that? She's like the ninja receptionist.) "Do you want an estimate of cost?" I ask the client.
"I don't care what it costs, I just want it closed up," says the owner, with another little shiver of distaste. Okay, then. We can do that.

I get up from the floor and coax Foraker up with me. I arrange for the owners to pick him up later, and he happily accompanies me out to be weighed. He barely fits on the scale. He's 161 pounds. Oh, goody. I get to lift him up onto a table. Then I get to lift him down again and carry his mountainous sleeping bulk to a run.

Or, I think... Or, I can do the surgery on the floor. Hmm. This idea has some appeal. It's a simple lac, and won't require a lot of fancy positioning. I can use an injectable and reversible anesthetic, prep him on the floor, drape off his arm.... Hmm.

When Foraker's turn in the surgery lineup comes, Dr. G (who is young and strong) tells me he'll lift Foraker up if I want. (I'm willing to bet Foraker outweighs Dr. G, but Dr. G spends a lot of time at the gym.) The techs unanimously vote to do him on the floor. Dr. G seems almost disappointed not to have to hoik this giant dog onto the table, but the techs win. They clean the floor where we will be doing surgery, and we induce Foraker. This requires four people, not because he struggles or objects in any way, but because he's inclined to bump his head affectionately against anyone within 6 inches of him, and his leg is as big around as the business end of a baseball bat. One person cradles his head, square and heavy as a gallon jug of milk. Another applies the tourniquet and braces his huge forearm. The third encourages him to tilt his massive chest to the side to properly position the leg vein-side up. The fourth injects the medication. This procedure is helped along considerably by Foraker's willingness to lay over half on his side for a belly-rub, thus exposing his vein to the best advantage.

Foraker is asleep within minutes, and one of the nurses huddles over him on her knees, clipping and scrubbing. The laceration opens up. There is a moderate amount of hair in the wound (by which I mean approximately enough to knit yourself a small hamster). My nurse carefully picks this out, places a drape under Foraker's leg, and brings me a tray of instruments. I sit cross-legged on the floor, with Foraker's draped leg balanced on my knee, and begin to stitch. Foraker twitches once, but for the most part lays somnolent as I suture him quickly up.

When we have a neat little incision line in place of our formerly yawning wound, we set a wrap and reverse his anesthetic. Foraker, apparently enjoying his medication, snoozes on. After a while he starts to lift his head, and then he rolls up onto his sternum, looking around, evidently surprised to find himself napping on the floor with two girls sitting by his head. This seems to strike him as a waste of good girl-time, and he thumps his tail sheepishly, as if apologizing for being so foolish as to have fallen asleep while they were petting him. One abortive attempt later, he makes it to his feet and proceeds back to his run under his own steam, his habitual smile back in place.

It's a good thing that Foraker is such a cheerful, willing, good-natured dog; if he wasn't, handling him would be difficult, if not dangerous (or even impossible). It's a bonus that his owners are as good-natured as he is, and apparently as devoted to him as he is to them. Dogs (and clients) like this remind you of why it is you do what you do, going in to work every day, making your own small contributions to the world. Little bits that add up, a piece at a time, until eventually... you're moving mountains.