Monday, April 14, 2008

“Stand by Ghost Rider!”

Strolling by the medical imaging console I find Dr. Daniel Lindsay, a radiologist from Winnipeg studying an abdominal CT scan. Only it doesn’t look like any abdomen I’ve ever seen before. The shape is smaller and more ovoid than I’m used to. The liver looks weird and the spleen is elongated and kind of wispy.

“We’ve got a dog in there with hemoperitoneum” he says with eyebrows raised pointing over his shoulder in the direction the scanner.

It’s a quiet morning and out of sheer curiosity I head in to the scanner. Sure enough, a furry black creature is sliding out of the gantry and the camp’s veterinarian Dr. Rance Erwin, a tall energetic US Army Captain is striding across the room with a syringe filled with blood that he has just withdrawn from his patient’s abdomen. “This looks bad. We’re gonna need t’get ‘im over to the vet tent rawt now” he says in the sonorous drawl of his native southern Kansas.

“What happened?” I ask addressing a man who is bending over the dog stroking its neck in silence.

“A Humvee hit him. We were playin’ ball and he ran out in front of the truck to get the ball. He saw it coming and tried to stop, so did the Humvee but there just wasn’t enough time…. The driver was an Afghan guy. He jumped out, seen what happened, froze for a second then took off.” He says this quietly, trying with difficulty to keep his emotions from surfacing.
“You’re his handler?” I ask.

He nods.

“How long have you guys worked together? I ask. “’Bout two years now. We were in Iraq. He’s been a good bomb sniffer, found lots of IEDs and saved my life a time or two,” he says to me never taking his eyes off the dog who lays muzzled and sedated, though not enough to take away the disconsolate look of a sentient creature in pain.

The dog’s name is Patrick. He’s a six year old Alsatian. The health and welfare of these animals is a very serious matter for the US army who regard them as soldiers, albeit of a different species.

Dr. Erwin heads out to prepare for his operation and I help to transfer the animal on to a purpose-made red plastic dog stretcher. While a vet assistant and I each take a corner at the front, the dog’s handler picks up the rear and we hurry out across the road to the vet tent.

When we arrive, the vet is already on the phone arranging for a canine blood donor. “Hi Sir, this is Captain Erwin over in the veterinary tent. We’ve got ourselves a little bit of a serious situation rawt now. We’ve got a military workin’ dog that was hit by a Humvee about two or three hours ago, and he’s got a lot of blood in his belly … Uh huh.... I’m not sure if it’s his spleen or what but I’m gonna have t’open im up and we’re gonna need some blood from another dog. I was wonderin’ if you can send over one of your dogs, one that has a nice-easy going personality ... Uh huh.... You have one that’s a little heavier, maybe 60 lbs or more? ... Sure, she’ll do fine. Thank you. Goodbye Sir.”

In one motion he hangs up the phone and leaps from his chair directing his assistants as he searches for a surgical mask and a pair of sterile gloves. “Stand by ghost rider!” he calls out which is loosely translated from US Armyspeak as “Help is on the way!” He then selects a bottle of isofluorane and begins to fill the vaporizing chamber on his anaesthetic machine. “Make sure you shave him way down. I’m gonna have to make a pretty long incision” he says as two assistants clipper the fur from the abdomen. “OK. Let’s get ‘im up on the table.”

Patrick, groggy from incipient hypovolemic shock and the canine sedative mixture of morphine, medetomadine and atropine, is limp as he is hoisted by three assistants in to a prone position on the stainless steel operating table. While this is going on, Capt. Erwin draws up a syringe of propofol and begins infusing it in to the IV taped in place on Patrick’s foreleg. Moments later, Patrick has drifted into unconsciousness and with the vet techs holding his jaws open and his long tongue off to one side, the Captain uses a strait bladed laryngoscope to pass an endotracheal tube in to position. Once the tube is secured, he is rolled supine. The surgeon pulls back the dog’s upper lip, assessing oxygenation and perfusion clinically by inspecting the colour of the gums and the tongue. Satisfied with what he sees, he sets himself to the next task: scrubbing his hands for surgery. Without the benefit of continuous electronic monitoring of tidal volume, cardiac rhythm, respiratory rate and oxygen saturation, Patrick will be breathe spontaneously for the operation, monitored at regular intervals by the veterinary technician who keeps watch on the pinkness of the tongue, the rate of his breathing, and by stethoscope, the soft “lub-dub-ing” of his heart.
Inexplicably, there is a lull in the action and with the exception of the Captain the others in the room find themselves at a loss for something to do.

“C’mon people, I see a lot of standin’ around let’s go!” says Capt. Erwin. “Let’s get this abdomen prepped. We’ve gotta speed up or this dog’s not going to make it.”

Snapping back to the situation at hand, one of the assistants begins with bare hands to soak 4X4’s of gauze in poviodine and swab them over the dog’s shaved, greyish-pink abdomen turning it a golden yellow colour and filling the warm tent with iodine’s distinctive thick, sour odour.

The Vet calls out for sterile drapes, abdominal sponges and laparotomy tray to be unpacked. He directs a tech to check the pulse.

“125, resp rate is 8 and his colour’s good” comes the reply.

“That’s fine, that’s fine” murmurs the surgeon.

“I think I’m gonna step outside for this part” says Patrick’s handler as Capt. Erwin steadies the scalpel for the first incision.

Dr. Lindsay enters the tent to give Capt. Erwin a full report of the CT. After carefully comparing the dog’s scan with his intimate knowledge of human structure, he has a serviceable understanding of canine abdominal anatomy. The spleen appears intact but the liver looks contused or lacerated — this news is not encouraging, for a splenic injury would certainly be the easiest to contend with.

Dr. Lindsay washes his hands and dons a pair of sterile gloves offering to assist Dr. Erwin. During the rather mechanical skin incision and dissection through the subcutaneous tissues to the peritoneal fascia there is a brief opportunity for small talk, and I learn that Dr. Erwin is an Army Reserve Vet, has been in practice for five years and is married to another vet. At home in the US, he divides his time between two private practices in Kansas.

“How long will you be here?” I ask.

“Six months it looks like. They’ve got it down to six. Use t’be 10 months y’know, but a lot of guys were losin’ their clinics back home ‘cos of those long deployments.”

Within minutes, Dr. Irwin’s fears and Dr. Lindsay’s predictions are confirmed: the spleen is fine. The liver looks quite beat up and to everyone’s surprise there is also a tear in the bladder. 375 ccs of blood have now been collected in the suction apparatus and the need for a blood transfusion is urgent.

My assignment during these events is to try and collect 120 cc of blood from another military dog that has just arrived outside. The donor’s name is Alaska and, rather ironically for a military dog, she is known for her good temperament. She also has an injury of her own. Her left front paw is bandaged up after losing part of it to an insurgent’s bullet that flew through the tailgate of the truck she was riding in. I am very apprehensive about trying to phlebotomize a wounded attack dog, even one in a muzzle with a reportedly good nature. Therefore, following Dr. Erwin’s orders the assistant steadies the hind leg of this docile canine soldier who under different circumstances is certainly capable of chilling ferocity. I inject a mixture of medetomidine and atropine in to the muscle and 10 minutes later the dog lies dozing at his handler’s feet. The vet tech has shaved and prepped the right foreleg and kindly shows me where to put the needle. I can’t find the vein. I try again. Still can’t get it. She tries unsuccessfully. She preps the right hind leg for a different vein, which we’re sure we can feel. We both try again but get back only a tiny trickle before we lose flow. Patrick’s handler is watching and offers to try but the veins elude him as well. I wonder if the dog is a little volume depleted from not drinking enough water in the hot Afghan sun as approximately 45 minutes has passed. I turn back to enter the tent to report that I’ve not been able to obtain the needed blood.

Walking through the door, I see Dr. Lindsay performing chest compressions while Dr. Erwin is delivering a dose of intracardiac epinephrine. CPR on a dog is performed by placing the hands on either side of the rib cage and pushing the sides together. I join in by bagging but Patrick’s tongue has turned to a deep purple, almost black. Dr. Erwin grabs a stethoscope with bloodied hands and listens. The heart is silent.

“I’m callin’ this,” says the veterinarian, fatigue and sadness clearly evident in his voice as he adds “Damn! He was lookin’ so good there for a while.”

Dr. Lindsay and I look at one another and are at a loss for words as we consider the surreal events that have lead a radiologist and an internist from Canada to be standing beside the lifeless body of an American Army dog. Dr. Erwin composes himself and leaves the tent to break the bad news to Patrick’s handler.

“We lost him” he says directly, extending a hand of condolence towards the handler.

“Are you fuckin’ serious?!” yells Patrick’s handler slumping to a bench and burying his face in his hands.

Dr. Lindsay and I also try to offer condolences to the handler but his thoughts are elsewhere. In the manner of those who are suddenly and unexpectedly bereaved he is all alone in a maelstrom of memory and regret.

1 comment:

cvda said...

Peter, it is kind of weird to leave you a message on this blog
I don't know why I thought of you today and why I "googled" your name
I am not that surprised to find you in Kandahar, doing the best as you can
take care
avec mon meilleur souvenir
Cécile Van den Avenne,