Story of survival: Sometimes two negatives make a positive
One day I was walking my dog, Trixie. Since we live in a rural area, she was off the leash, and she spotted a squirrel, sitting upright, his back to her, and eating an acorn. He was about 50 yards from me and only about 15 yards from her when she locked in on him like a heat-seeking missile.
I yelled to try and warn him, but it was a windy day and the rustling of the fall leaves drowned me out. Trixie closed the gap quickly, and when she was just 10 feet from him, he was still unaware. At 3 feet, I cringed and wanted to look away; a violent death was inevitable. Trixie seemed to be accelerating. As she made her final thrust, mouth open wide, a large, reddish flash streaked in. Wings spread above the squirrel like a guardian angel warding Trixie away.
But this was an angel of death, a red-tailed hawk, also bent on killing the oblivious rodent. Neither Trixie nor the hawk saw each other coming, but their chance simultaneous appearance had the effect of canceling each other out. Each was so startled that they both pulled up short. The squirrel capitalized on the momentary confusion and made safely for the trees. I thought there must be a moral in this somewhere, but two negatives making a positive was the best I could muster.
I thought about this story last weekend. I was home on a Friday night and had just gotten to bed when the phone rang. It was our North Charleston Emergency Clinic and they had a serious emergency. Savannah was a 4-year-old greyhound who also was getting ready for bed when she suddenly cried out and collapsed. The emergency clinician and the internist determined that she had a rapidly bleeding mass in her abdomen. They were transfusing her, but without surgery, she soon would be dead. I was not on call that night, but both of the doctors who were on call were not immediately available. One was delayed and the other in surgery.
I quickly came in and assessed the case. She was recumbent, very weak and pale. She was being treated for shock. She had actually improved slightly since her arrival.
Her family was distraught. They surrounded her lovingly and listened intently, and sadly, as a very guarded prognosis was rendered. We felt that we had improved her as much as we could, given the ongoing blood loss, and it was now time for surgery. As the family left the treatment area to wait, the mom looked directly at me and said, “Please do not let my dog die.”
I reviewed the X-rays again. Something was making me very uncomfortable, besides the comment about not letting the dog die. There was a large mass of blood that seemed to be centered above, not in, the abdomen. I suspected that the bleed was coming from an adrenal gland tumor that had ruptured. If this was the case, I would have to dig through the clot, find the bleeding vessels, and ligate them. By that time, even with a technician assisting me, Savannah likely would have bled to death. I decided I wanted another surgeon doing this with me.
I called the Mount Pleasant Emergency Clinic to notify Dr. Lori Ludwig, who was finishing up a surgery, that I was on the way. I explained to the owners that Savannah’s best chance was a quick, efficient surgery. There was no time to direct an assistant. Everyone had to know their role. Two surgeons could be the difference between survival and letting this dog die.
IVs dripping, we placed Savannah in the SUV and made the 12-minute trip to Mount Pleasant. In another 10 minutes, Savannah was draped for surgery.
The surgery was every bit as difficult as I had anticipated. The tumor was under the main vein in the abdomen, the vena cava, and it was pouring blood as fast as we could suction it away. Ludwig held off the aorta and, with our four hands working together for the next hour and a half, the tumor was excised and all bleeding was stopped. At 2:30 a.m., we left the operating room with Savannah miraculously alive.
Like the squirrel, Savannah had two factors that seemed to be potentially fatal. Each of the on-call surgeons was unavailable. Had either of them been available and decided to do this procedure alone, I am certain it would not have ended well. Yet without immediate surgery, Savannah would have died.
This led to my involvement and altered the timing slightly so that by the time I was ready to go in North Charleston, Ludwig was finishing in Mount Pleasant. This allowed me to take the highly unusual step of moving a patient so a second surgeon could scrub in to an after-hours emergency. This was exactly what Savannah needed and when she needed it.
The absolute topping to this case was that the biopsy returned a few days later. The tumor was benign and the long-term prognosis is excellent.
Dr. Henri Bianucci and Dr. Perry Jameson are with Veterinary Specialty Care LLC. Send questions to email@example.com.