Sunday, August 26, 2012

Know When To Keep Your Mouth Shut

OK, I needed to write something irreverent to make up for all the deep thoughts I’ve been having lately.  This is a tale of the occupational hazards that accompany my profession…I have been limited as to how much information I can give when I’m at school because of client confidentiality issues.  Many of my patients have singular personalities and diseases, to where it would not be difficult for anyone loosely associated with the institution to pick out who I’m telling tales on, but this one is pretty generic, and names are withheld to protect the guilty. 

I was on necropsy duty recently. (For any naïve to the ways of veterinary medicine, this is like an autopsy for an animal.  We take apart the dead things and see what made them stop ticking.)  On the table was a horse that had colicked and died.  He hadn’t been dead long, but due to the nature of his illness he was bloated up like a giant, hairy balloon.  We wear a lot of gear on the necropsy floor; coveralls, rubber boots, long latex gloves, safety glasses, and thick cotton “cut” gloves to protect your non-knife-wielding hand is the minimum.  Things get more complicated when there is a potential zoonotic disease case, but colic is generally pretty safe for the bipeds in the room so we were in basic gear.  I made the first few cuts, then began the ticklish procedure of opening the abdomen.  Why is this the ticklish part, you ask?  Because when a horse is bloated, it is easier than ever to pierce a pressurized piece of gut, which results in rapid deflation accompanied by a projectile rush of fetid air, rank fluid, and partially fermented feed material.  I went at this horse like a bomb squad rookie, enduring mild ridicule from the duty clinician for taking so long to get the abdomen open.  I didn’t keep track of time, but I’d estimate I took around 20 minutes to carefully slice through the various abdominal muscle layers to reveal the shining, fragile peritoneal membrane.  Once there, I still had to make final landing, so I tried the old trick of “tenting” the peritoneum with a pair of forceps to lift it gently away from the pressurized intestines clamoring for exit just below the surface.  Tenting was a no go, the membrane was already stretched to the limit.  After making sure my safety glasses were in place and my mouth was closed, I tickled the peritoneum with my eight-inch necropsy blade as the rest of the crew stood at a safe distance, offering “encouragement.”  The membrane parted like an electronic gate and an unviolated loop of small intestine crowded out of the newly made opening.  Now, I could safety up and use the metal bar of my forceps as a stop as I finished removing the muscular wall.  Success!  I had opened the abdomen and I was not covered in intestinal schmoo! 

Once the abdomen has been laid open, the next step is to lift the back edge of the rib cage and stick a knife through the diaphragm, checking to make sure that the thoracic cavity was still at negative pressure and opening the way to come in with the long-handled rib crackers in order to remove the rib cage and allow full access to the lungs and heart.  The duty clinician stepped forward to make entry into the thoracic cavity as I stood nearby with the giant metal yard implement, ready to clip some ribs.  My mentor lifted the back of the rib cage and made a quick stab into the diaphragm.  Suddenly, I was hit with a rush of not-so-fresh air and a light baptism of green-flecked material.  The view from behind my safety glasses was…well, gritty.  Thankfully my mouth had been compulsively clamped shut as the knife made its arc.  The clinician looked at my shocked expression and said, “That was just the thoracic cavity.”  Ummm, well, ok.  I guess having green chunks in the thoracic cavity would help explain why this horse had died, but if the diaphragm had a hole in it, and the gut also had a hole allowing feed material to escape, wouldn’t that have released some of the pressure before we started opening cavities?  Upon closer inspection, we discovered a tiny, clean (read: made by a sharp blade and not by overwhelming pressure from inside) slit in a section of the large colon that was up by where the ribs connects to the spine, where it does not belong.  Welcome to veterinary medicine, where keeping your mouth shut is almost never a bad decision.

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