This veterinary surgeon can't talk to his patients -- but they speak to him loud and clear.
From
Reader's Digest Originally in
Tell Me Where It Hurts
"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."
译文:
性命攸关【读者文摘】
这名兽医不能和他的患者谈话 - 但他的患者却可以清楚大声地和他讲。
作者：Nick Trout医生
摘自【读者文摘】，原著【告诉我你哪里不舒服】
“告诉我患者的情况”
凌晨两点四十七分刺耳的电话铃声把我从梦中吵醒。“您好，我是Sarah Keene医生，一位新的外科医生住户，”我听到一个声音说道，“我这里有位狗患者，10岁已经切除卵巢的雌性德国牧羊犬。她的全身肿胀，而且......对不起。我的同事没有接听他的寻呼机。您能来帮忙进行这个手术吗？”
从床上坐起来，安抚过我的妻子Kathy，告诉她电话是找我的，然后接着对电话说，“没问题，Keene医生。请告诉我患者的情况。”
摄影：Jason Grow
作者和他的狗狗Sophie在家中，Sophie是一只杰克罗素梗。
摄影：Jason Grow
Trout医生在为Hannah进行外科手术，Hannah是一只1岁大的牧羊犬混血。“这就像弹钢琴，”他说，“这是一种可以学习的技能。”
摄影：Jason Grow
作者和他的狗狗Sophie在家中，Sophie是一只杰克罗素梗。
肿胀 - 或称胃扩张和肠扭结(GDV) - 是一个对于兽医来说真正的紧急情况，主要发生在胸部很厚的狗身上，像德国牧羊犬，大丹犬和标准的狮子犬。通常动物吃完一顿大餐，稍作运动，一小时候后有可能出现这种严重的情况。由于发酵气体而膨胀的胃缠绕并轻弹它的长型膨胀轴。这种症状出现后的结果很悲惨。动物尽力将食物和气体吐出，但什么也吐不出来。胃部无抑制地不停膨胀，严重挤压肺部，同时血液倒流回心脏。情况如此持续，严重情况下狗几小时便可能死亡。
“她情况稳定吗？”我问医生。
“不是很稳定，”Keene医生告诉我。“她的血压异常，我们很难找到象样的血管，更别提放导管了。”这只狗需要输液防止休克。
我一边摸索着干净衣服一边快速下床。“尽全力先做胃导管。我会尽快到医院。”
在清晨的这个时刻，我依然睡眼惺忪，而且还是一脸心满意足的睡相，幸好我的患者不会以貌取人。我飞快地开车驶向位于波士顿的Angell动物医疗中心，这个国家最大的兽医医院之一，我在这里度过了25年职业生涯当中的10年光阴。我看到了我的患者，Sage，躺在准备区域的不锈钢手术台上。她撇过的眼中充满了恐惧；脸上带着氧气罩。在我接近她的时候，她宽大而毛发浓密的尾巴友好地拍打了几下。
我喜欢德国牧羊犬，小时候也曾经养过一只。虽然眼前的这只牧羊犬情况糟糕，可她摇摆的尾巴依然让人惊讶，引起我的无限怜爱。我的手轻轻地滑过她毛绒柔软的耳朵，经过她的胸部，直到那鼓一样紧绷的腹部。Sage's身体侧面有一小片毛已经被刮去，试图用一个大号针释放胃里面的气体。她的皮肤还是那么紧绷；很显然，这次尝试失败了。
“胃导管没成功？”在很快寒暄并互相介绍后，我问Keene医生。
“恐怕没成功。她的情况很不好。心跳速度220，伴有偶然性VPCs。”她指的是心室早起收缩，或反常且无效的心跳。
当我帮Sage摘下氧气罩检查齿龈时，她的尾巴摇摆着向我表示感谢。相对于代表正常血流的健康、鲜艳的粉色组织，我看到了难看浑浊的紫色。“她已经注射了多少静脉流动液？”
“这是第四升了，”Keene医生说。
Sage的颜色看起来很糟。“她的样子看起来离死亡不远了，”我很着急地说。“开始用利多卡因滴液，给她一些静脉抗生素，再用药物让她昏迷。我们越快让她的胃部解开缠绕越好。我去换临时医生服。”
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