This veterinary surgeon can't talk to his patients -- but they speak to him loud and clear.
"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."
Photographed by Jason Grow
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."
The author with Sophie, his Jack Russell terrier, at home.
译文:
一只狗的命运【读者文摘】
兽医不能和他的病人说话，但是病人们却可以大声地、清楚地对兽医说话。
“告诉一些关于病人的情况”
夜里2：47分来的电话，把我惊醒了。我听到一个声音说：“你好！我是莎拉 凯尼，新的外壳手术者，”。。“我发现了一条狗，十岁的被切除卵巢的德国牧羊犬。她身体在肿胀，而且，还有。。。对不起，我带的设备救不了她。您可以归来一下做个手术挽救她吗？”
我从床上做起来，安慰了一下妻子凯斯道是我的电话。我对那个医生回答说：“没问题，凯尼医生。告诉一些病人的情况。”
照片由杰森 格柔拍摄
肿胀，或者叫做GDV，胃扩张和肠结的所写。这个病是动物典型的急性病，通常在后胸脯的狗身上，比如德国牧羊犬、大犬狗、中型的卷毛狗。通常这种动物吃完一顿饱餐后剧烈活动，而一个小时后就会产生严重状况。胃里充满发酵的气体，翻江倒海，牙长轴突然翻转。感觉是异常痛苦的，动物试图沁出食物，排除气体，但是动也动不了。胃不可遏止地膨胀，挤碎肺部，血液倒流至心脏。狗狗一个小时后就会死去。
"她还平静吗？”我问道。
“不好呀，”凯尼 医生说，“她的血压都感觉不到了，我们费了九牛二虎之力才找到微弱的静脉，更不用说安插一个导管了。”狗狗需要液体防止对对身体的震撼（恶化）。
我快速下床，摸索干净的衣服。“尽最大可能插入胃导管。我以最快速度到。”
那天早上我困极了，头倒在床上心满意足地睡了一觉。令人满意的是我的病人并没有因为我的外表（而不接受治疗）。我快速驾车到了波士顿天使狗狗治疗中心。这家医院时这个国家最大的家畜医院，我过去的25年有10年就在这里工作。我看到了我的病人，赛其，躺在准备室的不锈钢平台上。她投射来的目光里充满了恐惧；氧气面罩戴在脸上。当我靠近的时候，她的又宽又浓密的尾巴友好地向我摇晃着。
我喜爱他们，我从小和一只德国牧羊犬长大的。然而摇摆的尾巴让我很是诧异，让我对这只处于严重状况的狗狗充满怜惜。我抚摸她毛茸茸的耳朵，拂过胸部，轻抚象皮鼓一样密实的腹部。在她的侧腹有一块被刮了毛的一片。这个地方本来是试图用令人生厌的针头把胃里的气体放出，但没有成功，皮肤一直紧绷着。
“插入胃管没有好的迹象吗？”快速地打过招呼和介绍后我问道。
“恐怕没有，她现在很糟糕。心率220，伴有不太常有的VPCs。”她这样是因为过早的子宫收缩和膨胀导致的，或者反常的和无力的心脏搏动。
我去掉氧气面罩给她检查牙龈时，她感激地摇了摇尾巴。不是健康，没有精力充沛的粉红色组织和正常的血液流动，我看到的是一团糟的紫色。“静脉流体做了多少？”
“这是第四升，”凯尼说。
赛其的皮肤颜色看起来很可怕。“她现在就像处于生命末尾了，”我焦急地说道，“注射利多卡因麻醉滴，打入静脉抗生素，然后把她放到。我们把她的胃破开得最快越好。我开始冲洗（胃部）。”
作者和他的索菲拉塞尔小猎狗在家里。
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