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Sunday
Apr082012

Laica

Alexander Robb, V’13
Tufts University
Cummings School of Veterinary Medicine
Experiences

I never would have guessed that scrambling eggs would be an important moment in the course my veterinary education.  This summer, such a seemingly mundane act took on a much larger significance.  For a week in July, I traveled to San Juan del Sur, Nicaragua with WorldVets to participate in a small animal spay/neuter campaign.  San Juan del Sur is a beautiful coastal town with many nice shops and restaurants lining the beach,remarkably friendly people, and an unfortunately limited supply of regular veterinary care.  Our group of veterinarians, veterinary students, technicians, and volunteers spent a week in town, with three days totally dedicated to clinical procedures.  We spayed, neutered, enucleated, drained abscesses, repaired wounds, did healthy consultations, and administered medication for over 400 animals in that short period of time.  For some in our group, the highlight of the trip was their first spay, for others it was treating a crocodile with a wound or a monkey with a urinary tract infection.  For me, it was one dog in particular. Laica in her body suit Her name is Laica, and the fact that I can still use “is” to describe her, is amazing.

Laica came into our clinic on the second day for a routine spay.  I wasn’t involved in her surgery, but there weren’t any complications that we were aware of while she was under our supervision and care.  Once ready to go home, she was discharged to her owners with instructions to keep her inside for the next day and keep a close eye on her as she recovered.

Towards the end of the next and final clinic day, Laica came back to us sitting in a cardboard box.  Without looking into the box, I could tell that she was bloody.  I figured she might have gotten into a fight or hit by a car or suffered a wound of some other variety, so I went to grab a pair of gloves and a surgery pack for one of the veterinarians to use.  When I got back, a crowd of people had formed around her with shocked faces.  As it turns out, Laica had opened up her incision both at the skin and body wall levels, and pulled out a large portion of her intestines.  Her guts were literally hanging out of her abdomen in a messy pile.  Amazingly, she still was trying to get at them, so we picked her up out of the box and put her on the table to be anesthetized.  The news got worse when we looked into the box and saw an approximately four foot long piece of jejunum that she had torn off.  

Once the catheter was placed, it seemed like time stood still.  We only had a small amount of fluids left, she was already missing a large portion of her GI tract, and even if she could be put back together, we had limited antibiotic options.  But her owners wanted us to try to save her.  In that respect, she’s a very lucky dog.  We later found out that one member of her family was ready to shoot her when they found her with her guts hanging out, to put her out of her misery.  Instead, the rest of her family had brought her to us hoping we could help.

Once the decision was made to go ahead with the procedure, everyone snapped into action.  All of the veterinarians on our trip jumped in on the resection and anastamosis procedure for Laica.  Fingertips became Doyens, towels on the floor served as suction and a half empty bottle of water was used for lavage.  The doctors had to connect her small intestine from the level of the pancreas to her colon and patch together what was left of her shredded mesentery.  They did an amazing job, considering the very limited resources available, especially compared to a modern operating room in a veterinary hospital back home.  While this was going on, the other veterinary student and I spayed a cat that had already been on the table when Laica came in.  The technicians and assistants with us did a great job placing catheters, monitoring anesthesia, cleaning and sterilizing instruments, and keeping the rest of the clinic under control.  It was a total team effort.  Someone even found a small amount of injectable enrofloxacin at the local human pharmacy.  Laica woke up from the surgery but obviously was not feeling her best.  Her owners sat with her in recovery, the young son in the family borrowing a stethoscope to listen to her heart.  Knowing the grave prognosis made it even more heartbreaking to watch.  We decided it would be best to take her back to the house where we were staying and monitor her overnight.  After realizing that we didn’t have any more e-collars left, I made something resembling one out of a gallon jug and tape to use until we could get one back from a previous patient.  It wasn’t a great situation, but we tried to make the best of it.

Laica was still alive when I came downstairs the next morning, but hadn’t eaten anything yet.  She lapped up a little bit of broth, but otherwise was lethargic and seemed disinterested.  We happened to have a lot of eggs left over from earlier in the week, so one of the veterinarians and I decided to give it a shot.  Maybe, just maybe, she’d be willing to eat something a little tastier than ramen noodle broth.  So I scrambled two eggs, cut them up into small pieces and brought the bowl over to her.  The doctor and I hand fed her the eggs at first, and eventually she scarfed down the rest of the bowl on her own.  A short while later, Laica got up and walked around, urinated in the grass outside our house, and sat with us under our hammocks.  Though she was still quite pale, at that point I let myself become a little hopeful that she’d make it after all.  Her owner arrived later that afternoon and Laica immediately perked up.  She cried and wagged her tail in excitement.  Clearly, she was a well-loved and loving pet.  A few hours later, she was at home with her family; we all kept our fingers crossed that she would survive the numerous challenges that she now faced.

A little over a week after leaving Nicaragua, we got an email from our WorldVets trip coordinator with an update on some of the animals we had treated.  Miraculously, there was a wonderful picture of Laica, seeming quite content and comfortable, now dressed in the body suit fashioned to keep her from getting at her incision again.  Laica’s survival is a testament, both to her own resiliency, and to the determination and skill of the veterinarians and technicians who cared for her.  Though scrambling a couple of eggs was a minor part of the whole ordeal, it was an important moment for me.  Being able to partake in a seemingly impossible success story like this strongly reinforced my passion for veterinary medicine.  The job can be stressful, frustrating, even painful at times, and frequently the ending is not a happy one.  But in this case, getting Laica to eat, watching her recover, seeing her happy reunion, and knowing that she survived all served as a great reminder of why I chose this career.  She is a cool dog and I’m glad I had a chance to help her.

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