A Dog's Life
This veterinary surgeon can't talk to his patients -- but they speak to him loud and clear.
By Dr. Nick Trout
"Tell Me About the Patient"
The phone call came at 2:47 a.m., jolting me awake. "Hi. I'm Dr. Sarah Keene, the new surgical resident," I heard a voice say. "I've got a dog here, a ten-year-old spayed female German shepherd. She's bloated and, well ... Sorry. My backup's not answering his pager. Can you come in for the surgery?"
Sitting up in bed and reassuring my wife, Kathy, that the call was for me, I said, "No problem, Dr. Keene. Tell me about the patient."
Bloat -- or GDV, for gastric dilatation and volvulus -- is a true veterinary emergency typically occurring in deep-chested dogs like German shepherds, Great Danes, and standard poodles. Often the animal eats a large meal, gets some exercise, and develops a serious problem about an hour later. The stomach, distended by fermented gas, twists around and flips over on its long axis. The effect is catastrophic. The animal tries to rid itself of food and gas, but nothing budges. The stomach keeps expanding unchecked, squashing the lungs and the blood flowing back to the heart. A dog can die in a matter of hours.
"Is she stable?" I asked.
"Not really," said Dr. Keene. "Her pressures are off the charts, and we're having a hell of a time finding a decent vein, let alone placing a catheter." The dog needed fluids to prevent shock.
My feet were now swinging out of bed as I fumbled for clean clothes. "Do your best to pass a stomach tube. I'll be there as fast as I can."
At this hour of the morning, my eyes were piggy and I had a jaunty case of bed head, but thankfully my patients didn't judge me on my appearance. I drove quickly to the Angell Animal Medical Center in Boston, one of the largest veterinary hospitals in the country, where I'd worked for the past 10 of my 25 years in the field. I saw my patient, Sage, lying across a stainless steel surface in the prep area. Her darting eyes were full of fear; an oxygen mask was on her face. As I approached, her broad and bushy tail offered me a couple of friendly beats.
I liked German shepherds and grew up with one. Yet the wagging tail was utterly surprising and endearing to me given this dog's dire condition. I ran my hand across her soft velvety ear, over the chest and down to the drum-tight abdomen. There was a small shaved square on Sage's flank, where an attempt was made to release the stomach gas with a large-bore needle. The skin was taut; clearly the attempt had failed.
"No luck with a stomach tube?" I asked Dr. Keene after we'd quickly shared hellos and introductions.
"Afraid not. She's in bad shape. Heart rate's 220 with occasional VPCs." She was referring to ventricular premature contractions, or abnormal and ineffective heartbeats.
Sage's tail beat a message of thanks as I relieved her of the oxygen mask and inspected her gums. Instead of healthy, vibrant pink tissue, signifying normal blood flow, I saw an ugly muddy purple. "How much intravenous fluid has she had?"
"This is her fourth liter," said Dr. Keene.
Sage's color looked awful. "She's acting like she's near the end," I said urgently. "Start a lidocaine drip, give her some intravenous antibiotics, and knock her down. The faster we get her stomach untwisted, the better. I'm changing into scrubs."
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译文:
拯救狗狗的生命【读者文摘】
拯救狗狗的生命
兽医虽然不能和他的病人谈话--但动物们却能清晰而准确的告知自己的状况
作者：尼克·托特医生
"告诉我病人的情况"
清晨2点47分，一阵电话铃声将我吵醒。“你好，我是萨拉·吉肯，新来得外科医生”电话里传来一个声音。“我这里有一只已结扎的雌性德国牧羊犬，十岁。她出现膨胀，恩···对不起，我联系不到我的助手，所以你能过来动这个手术吗？”
我坐了起来，示意妻子凯茜电话是找我的，然后回答道:"没问题，吉肯医生，跟我说说病人的情况。"
该图由詹森·格罗提供
图为作者与他的杰克罗塞尔梗犬索非亚，摄于家中。
膨胀—又称胃转，是由于胃扩张和肠扭转造成。对兽医来说，这是相当危急的一类疾病。这种病例常常发生在诸如德国牧羊犬，大丹犬，标准型贵宾犬等胸深大的犬类身上。犬类常常是在大量进食并且剧烈运动后的一小时出现这类危急症状。胃部涨满了消化产生的气体，胃体沿纵轴发生扭转其结果是致命的。出现该症状的动物会企图将食物和胃气吐出，但无济于事，它的胃部会一直呈膨胀状态，挤压着肺部，血液回流至心脏，可能在数小时后死亡。
“她的情况稳定吗？”我问。
“不太妙”吉肯答道。“她的胃压太高，该死的，我们找不到正确的静脉，只能先给她插了根导管。”这只狗需要输液以防休克。
我转身下床，开始找干净的衣服穿上。“你最好先给她插根胃管。我尽快赶到。”我答道。
在清晨的这个时刻，我睡眼惺忪，蓬头垢面，还好我的病人并不介意我这副样子。我尽快赶到了波士顿天使动物中心医院。天使动物中心医院是城中最大的兽医医院之一，也是25岁的我工作了十年的地方。我的病人塞奇正横躺在洁白的钢制准备台上，失神的眼睛中满是恐惧，脸上还罩着氧气罩。我刚一走近，她毛茸茸的大尾巴就轻轻的拍打了我两下以示友好。
我喜欢德国牧羊犬，孩提时还养过一只。但是，这轻轻摇动的尾巴还是让我吃了一惊也让我更加同情她的悲惨处境。我轻轻抚摸她柔软而光滑的耳朵，胸部，最后停在了涨得像鼓一样的腹部。医生剃掉了她侧腹上的一小块毛并企图用一根大口径针头放出她胃部的气体。可惜这里的皮肤明显绷得太紧，这个方法行不通。
我匆匆和吉肯医生打了个招呼，问道：“没有胃管吗？”
“恐怕没有，她的情况很糟，心率达到220并伴有偶发的心率失常”她已经出现心室早发收缩或者心率失常和心藏衰竭了。
我为她戴上了氧气罩，还给她用了生阿片，塞奇摆动着尾巴向我表示感谢。我看见那象征着拥有正常的血液循环，健康而有生命力的粉色组织消失了，取而代之的是一团丑陋的紫色。“她输了多少液？”我问。
“已经四升了，”肯吉医生答道。
塞吉的状况看起来很不好。“她好像快不行了。”我匆匆说道。“准备一支利多卡因，给她注射静脉抗生素，开始抢救。我们要让她的胃复原，越快越好。我来当助手。”
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