September 11 ten years ago we were watching Omega Man, a Charlton Heston film, when Graham’s brother rang and told us to switch on the telly. We saw the North tower burning after a plane had crashed into it and then proceeded to watch as the second plane hit and then the towers collapsed, falling straight down like they were made of paper. I was pregnant and spent the next two days watching the television and crying, disbelieving the scale of the tragedy.
In 2011, September 11 is a Sunday; one of my regular work days at the vet clinic. I have a routine caesarian to do on a French Bulldog called Blondie. This is her fourth litter. Last week another bitch owned by the same breeder had three pups by caesarian, but all the puppies died without explanation. I don’t want the same thing to happen on my watch. The caesarian goes smoothly and six puppies are born. One, we discover has a cleft palate, so it is not allowed to survive. The other five are fine. Frenchies are not good breathers and I take many precautions to ensure a smooth anaesthetic recovery. She is kept intubated until she is fully alert and able to hold her head upright. Then we extubate. The pups have their first feed off her and we send them all home. Her mucous membrane colour is paler than I would like but I reassure myself that the surgery was dry when I closed up her abdomen and she is, perhaps paler, only because she had an ovariohysterectomy as well. But two hours later she is back in the clinic after two episodes of collapse at home.
The owner has had to slam her on the concrete to get her breathing, she tells me.
Blondie is indeed extremely pale and I conclude she must be bleeding internally. I reanaesthetise her and open her up, yet again. Her abdomen is full of uncoagulated blood. Her intestines swim in a soup of dark red. I soak up the blood with laparotomy sponges and search for the bleeding. I retie the uterine stump where I suspect the bleeding has come from and retie both ovarian pedicles despite all ligatures being still in place. We take a blood sample and measure her packed cell volume (PCV) to find it is 13, less than a third of what it should be. She has lost so much blood that she needs a transfusion.
The breeder is sent home to get another healthy dog to act as a donor and we collect a bag of blood from a drain pipe jugular vein in the robust Staffy cross. We run in some blood to Blondie and she has had about half a bag when I notice her puffy eyes. She looks like a dog which has been stung by a bee. She has oedematous eyelids. I think she is having a transfusion reaction. Her PCV has come up to 23. We stop the blood transfusion. I give her steroids and antihistamine to stop the allergic reaction, but her face still looks like it has gone ten rounds.
When she is awake enough to have her tube out we withdraw it slowly. She attempts to breath but makes only gurgled, choking sounds. It is a sound I dread. She throws her head back, arches her neck and collapses. She is not breathing, and is not going to. We need to reinsert the tube. But now her airway has disappeared into an oedematous swollen mess of mucosal membrane. She is apnoeic, her gums are blue and her pupils are dilating to black unresponsive pools. She is dying fast. The breeder beside me cranks open the jaws as I attempt to intubate her. Even with a laryngoscope I cannot see the airway. There is no hole to tube. As I keep trying to find an airway I am thinking she will not survive this. I can see her black eyes like her soul has gone. I search with a finger down her gullet for an airway and miraculously get a tube down. She is hooked up to oxygen and a vet student is doing chest compressions. I give her adrenalin. I listen to her chest and remarkably she has a heart beat. She’s back, I tell the stunned staff and the two breeders.
Now we have a dog who is alive, but one which we cannot extubate. I make the decision to perform an tracheostomy. She will need a safe breathing passage until her airways have lost their swelling. From an endotracheal tube we fashion a tracheostomy tube and I look up the surgical text book on how it’s done. The tracheostomy is performed and on unattaching the gaseous anaesthetic the end of the ET tube comes away. I nearly lose the tracheostomy tube down the trachea. I manage to grab it with forceps before it disappears altogether and then secure it with superglue, from the vet student’s flat. Blondie is ready to be recovered for the third time.
I make the decision to take her home with me since it requires that someone spend the night by her side making sure the tube stays open and she keeps breathing. We have spent five hours saving her. Her respiration is fast but she has a better airway now than she does normally and so her oxygen saturation stays at a high level. In a basket with warmed wheat bags surrounding her, I take her home, driving without the radio, listening to her breathing.
At home, Murphy our Border terrier, is locked outside and the Frenchie is in the lounge room, the drip hanging from the lamp. On the TV is a documentary about 9/11 called Rebirth. I set up my bed on the couch, beside her. She has pain relief every three hours to keep her calm and settled. She survives the night. I am reminded of being a breast feeding mother. In the wee hours I switch on the light and check her vitals. She is responsive and sad looking. She cannot make a sound except for her breathing, fast and regular. I am reminded of being a vet student doing the shift at the university hospital. Padding downstairs in bare feet to the kennels to check on patients and give medication. I am desperate for her to survive for I feel I have put her in this predicament. I am the surgeon who started this whole cascade of disaster going and I must stop it.
By three in the morning she is looking more normal and her breathing isn’t as fast. I am beginning to think she will make it. She has a pinkish hue around her muzzle.
I take her back to the vet clinic and we measure her blood pressure and her PCV. It has risen to 28 and her blood pressure is 80. Not bad, considering. Today we will take out the tracheostomy and hopefully she will breathe on her own. We reanaesthetise her and place two stay sutures on either side of the cut tracheal rings so that we can easily locate this hole again if she fails to breathe unaided. We place an ET tube through her mouth and then we switch her off the anaesthetic. Finally she is awake enough to have the tube out and she breathes. She doesn’t gag or gurgle or choke. She breathes. She looks concerned, confused. She breathes. We breathe.
She spends the day in the clinic looking doped out and tired. She goes home about 4pm, more than twenty four hours after her dramas began. The bitch whose pups all died the week before has fostered her puppies so she will not be required to nurse them. Blondie can spend her time recouping.
I have the remainder of the day to work but cannot stop thinking about her.