Wednesday, January 13, 2010

The Chocolate Esther Bunny

It's finally happened. My mind has snapped completely.

It's January. In Alaska. And yesterday driving home it was light out - just twilight, mind you, but my brain went: Ah. It's spring.

Just reminding you: January. Alaska. Snow. Dark. Howling wind. Five degrees Fahrenheit.

Oh, well. What are you going to do? Me, I'm fighting it, a little... I love love LOVE that my birthday is in the winter, and as that's next week, I really can't have it be spring just yet. Maybe if I just feel spring coming and let it start on, say, January 21st. That'd be okay. I'd still be born in winter, right? Maybe I should make winter last til, say, the 27th or 28th, just to be sure. It's a dead cert I'll never be able to hold out til calendar spring, but maybe I should have the decency to hold onto at least the pretense of winter til the end of the month.

It doesn't help that yesterday I had to do surgery on the Easter Bunny. If that doesn't make you think of spring, what will?

To be more accurate, it wasn't actually the Easter Bunny. It was the Esther-bunny. Little Esther was so named by her owners (a rescue farm) because she is a lovely, soft milk-chocolate brown. Naturally they could not resist calling her the chocolate Esther bunny.

Little Esther came in because she was in a bunny fight. Now, I know that sounds a bit comical, the idea of bunnies fighting; they're so cuddly. They are, however, also possessed of chisel-sharp teeth, and hard little pointy claws tip their feet - notably their hind feet, which they will use to dig into their opponent's belly, raking with their powerful hind legs, aiming for disembowelment.

Yikes. Bunnies is scary.

Esther was dropped off at the clinic while I was at lunch. When I got back, I went into Isolation to have a look at her. She was adorably cuddled up in a thick polar fleece blanket (decorated with bunnies, naturally), and all I could see of her were her silky little brown ears poking out, liberally decorated with scabs and dried blood. Well, naturally: Doesn't everyone go after the ears on their chocolate Esther bunny first?

Luckily Esther's ears were barely injured; she had a few scratches, but the majority of the blood was transfer from her other injuries: Apart from some deep scratches on her face and a partial-thickness bite on her back, someone had tried in good and earnest to bite her nose right off.

Urk. Well, this ought to be fun. Not.

I give little Esther some injectable anesthetic. Normally we mask down our bunny patients with anesthetic gas, but that method has its drawbacks when the surgery is on the face - which will of necessity be inside the mask and therefore awkward to attempt surgery on. So instead I figure up a dose of ketamine and valium and inject Esther in her meaty thigh muscles. Esther herself has little objection to this; she is a remarkably pleasant and good-tempered little rabbit, cooperative and amazingly unconcerned that her small, incessantly-twitching nose is now laid halfway over onto the left side of her face.

Twenty minutes later Esther is drowsing gently in her polar fleece bunny burrito; however, should anyone lift the edge of it to have a look, she rolls up sternal immediately. Jill herself, lulled by the peaceful aspect of slumbering bunny, droops drowsily over Esther's cozily recumbent form, monitoring her anesthetic depth. I wait a little longer, hoping the injectable meds will be sufficient. Dr. S happens back.

"What are you doing?" she asks.

"Sewing the nose back on a bunny," I tell her. "Some other bunny bit it half off."

"Oh, gah," she says, wrinkling her own nose. "Ever done that before?"

"Nope," I tell her. "This'll be my first re-nosing surgery."

"Well, good luck," she says. I'll take what luck I can get; in truth, given the mobility of the usual bunny nose, and the penchant they have for face-washing, I have some post-surgical concerns. Worse, the nasal tissue has swollen significantly as a result of the injury, and the flap of Esther's nose is now curling slightly up in consequence like the toe of a Turkish slipper. I'm not at all sure how amenable it will be to being stitched back down - or to staying stitched down, should I coax it to hold a suture and lay flat on its moorings once again.

Meanwhile a further 10 minutes are not enough to convince Esther that sleep is seriously in her best interests at the moment.

Okay, then. The gas mask it is.

Jill applies the mask carefully to Esther's face, careful to slip it over her semi-amputated nose without touching the injured tissue. We wait patiently. Eventually Esther's little legs relax and we de-mask her so that Jill can prep the surgery site. On shaving, it becomes clear that the laceration is - most fortunately - detaching the nose only across about 60% of its width. The lac extends from mid-bridge on the nose to the edge of the right nostril. It also transects the nasal septum where it connects to the upper lips. The left side is still attached as God intended.

Ouch. Poor little Esther bunny.

Right about the time Jill finishes her delicate surgical scrub, Eshter begins to coil her legs. On goes the mask again. I gather my surgical instruments, some absorbable monofilament suture, surgical gloves. We wait. After a while Esther's legs relax again. Jill cuts the anesthetic and pulls the mask. I dive in, squinting and holding my breath against the biting reek of the anesthetic gas trapped in Esther's fur. I press her nose back into its original position. Luckily there isn't any tissue missing, nor any dead tissue that must be debrided, so despite the tiny size of the nose in question I have something to work with. I throw my first suture, snugging it down carefully. As thin as Bunny skin is, Esther has a little gift for me, and the skin over her nose is strong and holds my stitch without protest. I go fast now, aware that my time is short and that at any moment Esther may elect to sit up, necessitating a quick return to the mask (preferably without my needle drivers still attached to a needle half embedded in her skin).

With one finger pressing her nose into position, I take several more quick bites with my needle, whipping knots into each stitch as quickly as I can, setting it against the chance of an abrupt awakening of my patient. I debate trying to suture the inner surface of the nose to the underlying tissue, but am afraid of occluding the nostril so that Esther cannot breathe through it; so instead I hope I can get reasonable alignment and security of closure with external sutures alone. Miraculously, the small nub of Eshter's nose lines up perfectly, preserving the shape of her nostril. I set a suture in the tiny thin septum, delicately tying it to her upper lip at the philtrum. Turning her head to double-check, it appears that her left nostril is uninjured, and despite the nasal swelling, the nostrils look symmetrical when viewed head-on. It still looks like a bloody mess, but not so much of one as when we started. I set one last suture between my first two bites, tightening the repair now that I know my other sutures will prevent this last one from deforming the shape of the incision.

Esther stirs.

"We're done," I tell Jill as her hand hovers above the mask. She sets it down and picks up cotton swabs to clean the incision. I glove out, disposing of my sharps, setting my instruments out to be washed.

"Look," Jill says. "Look at this."

I bend over the table. Jill has Esther's face tilted nose-up, the surgery light brightly illuminating the cleaned-up surgery site. I can see her right nostril, perfectly aligned both inside and out, resuming its busy bunny-twitch in exact symmetry with the uninjured left one.

Huh. What do you know. Re-nosing surgery numero uno looks like it might be a go. Suddenly I feel like the Queen of Reconstructive Rabbit Rhinoplasty.

"Oooh," I say. Then, judiciously: "That doesn't look too bad." I tilt Esther's head to get the profile view, frowning. "Except that now she looks like a proboscis monkey," I add, inspecting the pronounced Romanesque hump of Esther's repaired profile, rendered all the more obvious by its shaven nakedness.

Jill snorts and rolls her eyes. "It looks perfect," she says, shaking her head at my skepticism. "That'll go away when the swelling goes down, and you know it."

"Nice job on running the anesthetic mask Olympics," I say, grinning at her. She grins back. We are both suddenly amazing cheerful, bolstered on the little rush of our surgery. A successful surgery is always cause for satisfaction, but there's some extra euphoria to be gleaned from succeeding in the ones where you're winging it. Realistically, you can't be trained for every eventuality in vet school. They could not know that one day I'd be called upon to re-attach the Esther Bunny's nose, after all; there's no class called Bunny Nose Re-Attachment 101. What they do is teach you to think, to see the anatomy the way it's supposed to go, to determine the means by which the original blueprint can be recreated as best as possible in view of the injury at hand, and the skills by which to achieve this. If all goes well, the Esther bunny - or whoever your patient is - will emerge on the far end of the adventure with no more than a scar and a good story to tell.

So maybe it was this that made me all spring-like: the surge of cheer and adrenaline that comes of sewing the nose back on to the Esther bunny, or maybe it's just the relief that the skills instilled into you by the dedicated teachers who came before have not failed you - nor yet your patient. Maybe it's the rich ultramarine of the twilight, the unequivocal proof given in the western sky of the inevitable rising of the light.

Or maybe I've just snapped. But it's hard to feel bad about that, full as I am of the rising tide of spring. It won't be long before there are actual chocolate Easter bunnies in the stores. Maybe I'll get one this year, commemoratively, for Jill and I. But I will NOT be biting its nose off first. Really.


Holly said...

"Queen of Reconstructive Rabbit Rhinoplasty."

You are going to have to change your personal acronymn!

You will now be dubbed QRRR. Esther for short.

(ducking and running)

Dragon43 said...

Wish you were the one taking care of out cats....

::: Is it time to color Easter eggs yet? ::::

Rose said...

I super-glued my dog's nose back on once. Not quite rabbit rhinoplasty but it was definitely a first in my book as well.

AKDD said...

Thanks, Dragon! I'd be happy to, if the commute weren't such a killer! :D

Rose, I imagine that'd be a first for nearly everyone! :)

AKDD said...

Holly... I'm trying to pronounce my new acronym, and it sounds like I'm purring. I kind of like it!

Michelle said...

I'd love to see a picture of the chocolate Esther bunny..she sounds adorable!

AKDD said...

Well, if I ever get my new camera figured out, I'll put up the post-op picture... the pre-op look was a bit gory, and in any case I didn't think to take a picture until I saw the proboscis monkey nose. Kind of cute, in a weird sort of way.

Anonymous said...

I heard that ketamine was recalled last month, and now butorphanol too.

Are there lots that are made places other than Teva? I'm worried about this because my foster dog is having knee surgery on Monday...

AKDD said...

Only certain lot numbers were recalled. We've checked our entire stock, and are not in possession of any of the affected lot.

As for suppliers, I actually would not know... I don't do any of the ordering at the clinic.

MaskedMan said...

Next up on the surgical schedule: The Black Beast of Arrgh!

Rabbits are fierce little warriors. Tim the Enchanter knew of which he spoke. ;-)

Happy days for Esther!

AKDD said...

Yes, but for the Black Beast of Arrgh we plan to round up some of the ketamine from the recall list.

;-) :-D

I think years ago I had as a patient that bunny that Tim the Enchanter was talking about. Little fiend bit me in the jugular. I had quite the hickey from that. (Picture trying to explain THAT away to your boyfriend: "Really, babe, it was a rabbit! The most cruel and foul-tempered rodent* you've ever seen! It had grrrreat nasty pointed TEETH!") [Insert little fang-y gestures here]

* Although of course we must all remember that rabbits are NOT rodents, they're lagomorphs.

I need orange said...

Poor Ester, encountering the Great Nasty Teeth of one of her fellow bunnies.......

She was lucky that you were on hand to help.

Wondering if there are e-collars for bunnies............

You surely deserve extra chocolate in your Easter Basket this year! Maybe in the form of eggs (or even bars) rather than bunnies.........

AKDD said...

You CAN E-collar a bunny, but not for long. They have a nutritionally obligatory behavior in which they - erm - collect (with their mouths, since they don't have opposable thumbs, and directly from the source) a specialized stool that is produced at night; this contains essential nutrients and if they are E-collared for very long they develop nutritional deficiencies because they can't reach around to their fluffy little bunny butts to get the night stool.

There, now aren't you glad you're not a bunny?

As a BTW, if you lack an appropriately-sized tiny E-collar, X-ray film makes an excellent substitute.

At any rate... I'm all for anything that designates extra chocolate for me - the darker, the better!

Smartdogs, did your foster dog have surgery yet? How did it go?

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