Call the vet, p.6
Call the Vet, page 6
‘Do you know how bad it is?’ I ask Pat.
‘The horse is standing and has a large flesh wound to its shoulder. That’s all I know. It’s probably one of Lilo Blum’s. Her stables are in Grosvenor Crescent Mews.’
‘Does Brian know I’m allergic to horses?’ There’s a hesitation in my voice.
‘You mean you don’t like treating horses?’ Pat queries.
‘No, I mean I’m allergic to horses. They make me seize up.’
‘How did you get through college, then?’ she asks.
‘With friends covering for me.’
‘Don’t forget the bute. It’s in the fridge,’ Pat reminds me.
I packed my medical bag with Betadine,* a new skin antiseptic we had just purchased, developed by NASA for the recent lunar landings, xylocaine cartridges and the cartridge gun, a spool of autoclaved surgical silk ready for use, a selection of sterilised surgical needles, a surgical pack of forceps, needle holder, scalpel, scissors and swabs, the phenylbutazone, or bute, a painkiller and ACP, a sedative, in case the horse was difficult to manage.
‘Did the knife-sharpener sharpen all the scalpel blades and scissors?’ I ask.
‘Yes,’ says Pat, ‘and Mr Singleton has ordered new, disposable blades, so we’ll be hearing less bloody grinding from that sodding cart in the future.’
At a brisk walk in a fresh autumn wind it took less than five minutes to get to St George’s, where the injured horse was standing on the crescent-shaped ambulance entrance, surrounded by a crowd. There were several girls in nurses uniform in the throng. All of them looked gorgeous, even the ones who probably weren’t.
A ginger-bearded man, blue-green eyes, my height – a little over six feet tall – and my age – late twenties – wearing an olive-green tweed hacking jacket, tan riding breeches and brown boots, was holding the reins and halter. He looked great. I was envious.
‘Hi, I’m Bruce Fogle, the vet. How’s the horse?’ It is a little Arab-Welsh grey pony.
‘I’m Jeremy Livingston and this is Euripides. He’s surprisingly relaxed considering what has happened to him. I ride Euripides at lunchtime each day. He’s immune to the traffic but today, as we turned into Hyde Park Corner towards the park, for no reason at all he came to a full stop. He has never done that before. The traffic stopped, but then a lorry tried to go around us and caught him on his port side. It looks rather angry, and so am I.’
By now, between working at the zoo and for Brian, I had been in London for almost a year, was getting more familiar with British understatement, and I liked it. It sat well with how I felt. I walked around to Euripides’ left side and saw the damage, a raw, ragged skin tear about fifteen inches long, with many red trails of both dripping and drying blood running down his leg. Fortunately, there was minimal muscle damage under it.
‘Nasty,’ I say to the rider. ‘Jeremy, are you his owner?’
‘Yes. I stable him at Lilo Blum’s.’
‘Do you have your own vet?’
‘Yes, Mr Eaton. In Sutton.’
‘Before anything else, I want to give Euripides some painkiller,’ I say. I get the bute from my bag, raise his right jugular vein and inject a few millilitres of it.
‘Is Mr Eaton on his way?’ I ask.
‘I have had people ring from the hospital but they can’t get hold of him. Will you please take care of the wound?’
‘Yes, of course,’ I say.
So far so good. In a horse stables, thanks to my allergy my lungs would have sounded like bagpipes by now, but outdoors at Hyde Park Corner they produce no whistles and breathing is easy.
Euripides is an experienced urban pony, wonderfully relaxed, so I don’t use the ACP sedative. Pat’s grinning advice as I left the surgery – ‘If the horse is a male and you use ACP, remember you’ll probably have to carry his penis back slung over your shoulder’ – influences my decision to avoid it. ACP relaxes the muscles that keep a horse’s penis where a horse penis should stay.
While Jeremy holds Euripides by his halter, I cleanse the tear with Betadine. On the upper edge of the laceration, one region of skin is raised and rounded. I feel both sides of the mass and it’s as if a pellet has lodged just under the skin. I squirt xylocaine over the open flesh, then inject the surrounding skin, including on the far side of the pellet. On dogs I usually use about half a cartridge of xylocaine. Euripides needs six cartridges.
‘How old is Euripides?’ I ask.
‘Fifteen this month.’
The hundred-yard spool of sterilised surgical silk is in a separate autoclaved bag, but as I open it the spool unexpectedly rolls out, not onto relatively clean pavement but into Euripides’ fresh green manure. I am surrounded by a crowd of onlookers. I’ve dropped my suture material in horse poo. Can you imagine how I feel?
‘Damn!’ I mutter under my breath, but before I even think of asking someone to go back to Pont Street for more, one of the pretty nurses steps forward and says, ‘Would you like me to get you some suture material?’
‘If you could, that would be great.’
‘What size?’ she asks and I tell her ‘2–0’, a size I feel comfortable with.
‘Thank you so much. I’m Jeremy and this is Mr Fogle,’ the rider says to the nurse.
‘Hi, I’m Nicole,’ she replies with such cute dimples in such rosy, soft cheeks that I forget about Euripides. I hadn’t been on a date since I started working at Pont Street. My last date was with an American girl whom I met while working at the zoo. She’d come over to talk while I was examining a rhea, a South American ostrich-like bird that had a lolly stick stuck in its mouth, and asked me out. When she kissed me goodbye the following morning she said, ‘You’re cute. You’re fun, but you need to be more assertive. If you don’t ask, you don’t get.’ (But I did get, I thought at the time.)
Minutes later, desirable, shiny-haired, well-formed Nicole is back.
‘This is what we use,’ she says, and hands me a packet labelled ‘Dexon’. ‘It’s absorbable, with swaged needles.’†
Nicole strips open the outer packaging and inside is further packaging. When I tear this open there is twelve inches of suture material, with a small, attached needle. I grasp the needle with my needle holders and push it through the horse’s skin. It feels like putting a warm knife in soft butter – no resistance at all, and Euripides doesn’t flinch. Using mattress sutures, each package of Dexon stitches no more than three inches, but Nicole is there, smiling, radiating hormone, peeling open the outer packaging each time she sees I need more material.
‘If it’s okay with you, I’m going to remove that little pellet of skin at the edge of the tear,’ I tell Jeremy. ‘I think it’s a skin melanoma.’
‘That sound’s bad!’ he says.
‘Not as bad as they are in us. Melanomas are pretty common in grey horses as they get older. Usually around the bum. If you see one and it’s easy to remove, it’s best to remove it.’
‘Would you like some formalin?’ Nicole asks.
‘Yes, please, if you have any,’ and she asks one of the other nurses to get some while she continues to hand me more Dexon. Her hands are perfection. I continue to tidy the edges of the wound and place tension-bearing mattress sutures.
‘Under the circumstances, your horse has a good name,’ I comment to Jeremy as I place more stitches.
‘Why is that?’ he asks.
‘Well, your horse gets back to his stables, the Italian groom goes over to sponge him down, looks at his shoulder and says, “Euripides?”’
I’m still the smart alec.
‘Rather good that,’ Jeremy replies.
In less than fifteen minutes, the wound is closed and Euripides looks rather good too. And my lungs are still clear.
‘That’s wonderful suture material,’ I say to Nicole as I pack away my instruments. ‘I’ll tell my boss about it.’
‘The surgeons here are always opening the outers but not using it,’ she says. ‘I’m supposed to throw it out, but that’s such a waste so I keep it. The material is still sterile inside the inner packaging. I’ve got hundreds of packets. Do you want some?’
I want to say, ‘I want some of you.’ But instead I say, ‘Yes, please,’ and Nicole disappears through the emergency entrance to St George’s. I decide that when she returns, I’ll ask her out.
‘That was excellent work, Bruce. I very much appreciate what you have done for Euripides. Will you walk with us back to the stables?’
‘Yes, but the nurse is getting something,’ and as I speak, delectable Nicole returns through the hospital door with a shopping bag bulging with Dexon packets.
‘Nicole, I don’t know how I could have managed without you,’ chirps Jeremy. ‘You are Euripides’ guardian angel. If you are free this evening, would you like to join me for a glass of champagne at the Grenadier?’
Before I can say anything, Nicole accepts smooth Jeremy’s invitation. I envy his utter ease with women. After a few more thank yous to those who had helped, Jeremy, Euripides and I walk up the mews by the side of the hospital to the stables.
‘Jeremy, I’ve learned something today,’ I say as we arrive and one of the stable cats comes over to greet us.
What I want to say is, ‘What I’ve learned is that my last date was right. I have to be more assertive, like you,’ but I find that too difficult. I find talking about feelings or emotions too difficult. I still do. That might be why I feel so comfortable with animals. We intuitively understand each other’s feelings without having to put them into words.
‘What I’ve learned,’ I say, ‘is that I’m allergic to horses in their stables but seem to cope pretty well if they’re in fresh air.’
‘Why not go riding, then?’ Jeremy suggests. ‘You might get less sensitive to them. Miss Blum charges £2 an hour, and now that you know him you can ride Euripides if you like.’
‘I might just do that,’ I reply.
And do something about my appearance too, I think but don’t say.
* A brand of povidone-iodine.
† A swaged needle is attached to suture material without the need of an eye to thread the suture material through. It can also be called an atraumatic needle.
6
I would like to think that my life is my own creation, but of course it’s not. Our past lives on in us, integrated into our present, knotted so perfectly that sometimes it can be hard to know one from the other. All of us are built out of a succession of personal stories. I know my early experiences and my family’s stories intimately but I don’t know Brenda’s or Jane’s, so when I look at people like them I see unique, stand-alone individuals. They seem spontaneous. And somehow that makes me envious of them.
‘You have how many cats?’ I ask Brenda. ‘Nine? Do you know that’s enough for a baseball team!’
Brenda, our trainee RANA, is orderly and fastidious, a tidy, proficient girl who always had everything – sedative injections, anaesthetic-filled syringes, surgical instrument packs, gauze swabs, suturing material – neatly laid out in perfectly straight rows for each surgical procedure.
I use the word ‘girl’ intentionally. Pat was in her forties, wise, experienced and reliable for advice. She instinctively knew where a conversation was going, and if it was going where it might get uncomfortable she gently guided it towards a better place. Today, her gift would be called ‘emotional intelligence’. Pat was the surgery’s unpaid counsellor, offering sound advice to the other staff and to me. I wonder if she realised that was her greatest strength. Whether she did or didn’t, Pat was a grown-up.
So was Pat’s assistant, Jane. In her late twenties, frumpy, with short hair that looked like she cut it with bandage scissors, thick, putty thighs and skin that went scarlet for no reason at all, Jane was a bit dull but steadfast. She was sober, sombre, married and, although she hadn’t yet told us, pregnant.
Brenda was neat and petite, with green eyes, freckles that melded into each other and hair as shining red as an Irish setter’s. She looked like the resolute, toothy-faced little sister of your best friend, and from my perspective someone who would never think of sex let alone have it.
She was concerned about one of her cats. ‘I had four until yesterday, but the stray I took in last month? The one they found in the theatre foyer in Sloane Square? She gave birth last night and there’s something wrong. None of her kittens are taking milk. I’ve got them in the incubator downstairs.’
We spiral down the stairs from the second floor flat we use as our lunch room during the day and where I slept at night, past the consulting rooms on the first floor and reception on the ground floor to a tall cupboard in the basement, where washed dogs are placed on wire shelves to dry after bathing. A loud hot-air fan at the bottom of the cupboard provides heat, and this is also the ‘incubator’, the environment where we can ensure added warmth for our patients.
I take out the wire cat carrier the litter is in, open it on the prep table and lift a kitten from the bed inside. It looks both right and wrong. It is plump and fleshy, but its head, rather than sitting between its forepaws, bobs too much and twists oddly. I hand the kitten to Brenda and examine the next. It looks better, but when Brenda puts the first kitten on a towel it starts to roll off it. When I place the second kitten on the towel it too rolls. So do the other three kittens in the litter.
In the meantime, their mother lies in her bed and contentedly purrs, looking relaxed as we take her kittens away from her. I squeeze her nearest visible teat, then another. Milk expresses easily. She has a good milk supply, has released it and the kittens look healthy but aren’t suckling.
‘Do I know her?’ I ask.
‘No, I told you about her,’ Brenda replies. ‘She’s a stray, not a feral. She’s lived with people. That’s why I took her home. When the theatre manager brought her in, all she wanted was cuddles. I figured she’d be okay with my other three but never thought she was pregnant.’
Back in those days, vets saw cats to sterilise them when they were young or to put them down at the end of their lives, but rarely in between. We supplied flea powders for cats that went outdoors and now had a new, more effective organophosphate aerosol flea spray, although it was proving almost impossible to use because to a cat the aerosol sounded like another cat hissing at it. That proved fortunate for cats, as organophosphates were eventually banned because of their toxicity. Cats were very much second-class pets. Stray cats lived everywhere, from Belgravia coal cellars to Buckingham Palace’s gardens, but especially in the many World War II bombsites that still filled London. Some of the grand terraces around Regent’s Park and the whole south side of Fitzroy Square had not yet been cleared: perfect homes for rats and mice, and cats. Cats cost nothing to replace and there was always a ready supply of them. Taking them to the vet didn’t offer good value for money, even if a consultation at the most expensive surgery in London, Pont Street, was two guineas including any injections.
But there was a new and promotable reason to take your cat to the vet. A vaccine had been developed to protect cats from a common, life-threatening virus called panleukopenia or ‘feline enteritis’, and clients were starting to bring their cats in for inoculations, as they did their dogs. The first vaccine was a modified live virus, changed just enough to stimulate protection but not cause disease in the injected cat. It was marketed by several vaccine manufacturers. More recently, a killed virus vaccine had become available. We used the new killed vaccine at Pont Street.
‘Brenda, it looks like the mother either contracted feline enteritis virus during the first three weeks she was pregnant or she was vaccinated with live enteritis vaccine during those first few weeks, but either way the virus has affected the kittens’ brains and they can’t balance themselves. That’s why they’re not suckling. I’m afraid it’s hopeless.’
Brenda had returned the kittens to their mother in her bed in the wire carrier. She reaches in and rubs the back of her fingers over them.
‘They look so normal,’ she says, and continues to gently stroke the litter. ‘Why is it hopeless?’
‘Remember your anatomy? The cerebral cortex for cognitive abilities and the cerebellum for motor activity? The panleukopenia virus prevented their cerebellums from developing. It’s hopeless because they don’t even have the part of the brain they need for balance and coordination. That’s why they roll on the towel. They can’t tell up from down.’ I look at this soft mass of innocence. ‘And never will.’
The mother cat continues purring. She shows no resentment to our handling her kittens; she isn’t protective, as a feral cat would be. She seems almost indifferent to them, as if somehow she understands they are not right. Brenda picks up one and thoroughly examines it, its closed eyes, its tight shut ears, and when her finger examines the kitten’s mouth the tiny creature instinctively sticks out its thin, rounded pink tongue to suckle on it. Brenda continues examining the kitten, its drying umbilical cord, its belly, its bottom, then she puts her baby finger back at the tip of the kitten’s mouth and once more the kitten tries to suckle.
She gently puts the kitten back into the carrier, but this time she puts the kitten’s head close to the teat I had easily expressed milk from and holds it there. The kitten grasps the teat and sucks. Brenda takes her hand away, and as soon as she does the kitten rolls off the nipple. She picks it up, puts it back, and it latches on once more. This time she holds it there. And as long as she does, it suckles.
‘It’s not hopeless,’ she says intensely. ‘They can eat if I hold them while they suckle.’
‘Yes, they can,’ I answer. ‘But what then? How do they live with half their brains missing after they finish suckling? How do they walk? Or groom themselves?’
Brenda continues to look at the kittens, not at me.
‘I’m due my annual two weeks’ holiday,’ she says. ‘I’m going to take it now.’ Then she looks at me. ‘Or is it better that I tell Pat I’m ill?’
