A cardiology moment of Zen
Sometimes the best moments in veterinary practice rival our best moments in life.
I had a cardiology moment the other day. I don't have many anymore-now my days are mostly filled with routine elective surgeries and the occasional trauma repair. My current cardiology work consists of checking for murmurs on pet store puppies and pre-operative cases. But then this happened.
I was cutting a dog with a silent diaphragmatic hernia. He was sweet for his pre-surgery exam, pressing himself around my legs and thumping his tail, a goofy grin on his face. He was a big red chow-chow-mix from the shelter, where he'd ended up three months earlier, when animal control found him in a ditch with a fractured leg and no ID. The surgeon who fixed the fracture diagnosed a pneumothorax, and we were repeating the radiographs, more for protocol than anything else. We didn't expect anything to be amiss, but it was-by a mile.
This is gonna suck
I opened him up and slid my hand into his belly, around the curve of his stomach to move it out of the way. But I quickly realized there was nothing to move it out of the way of. His entire intestinal mass was in his thorax, leaving me looking at the distal end of his proximal duodenum disappearing into his chest. I got that sinking feeling I get when something's about to really suck. Remember, this guy was three months out from the original injury. That's a lot of time for displaced organs to settle in and get stuck to each other. To see what sort of fight I was going to have, I pulled just a little ... and his pancreas plopped into my hand. Happy, fluffy and pink-so much like cotton candy. This was followed by shiny grey loop after loop of perfectly happy jejunum, piling up all slick and folded over as I kept pulling. Suddenly, there was a little resistance-just a little. I had just registered the resistance when it gave and was gone, as the cecum popped out like a party balloon and the whole jumble fell free into the empty space waiting for it. What a lucky dog. I still hadn't gotten to see the hole itself, so I decided to feel instead.
Dude. The hole was huge. I was wrist deep in his chest in an instant. I slid my hand across and down the inside of his diaphragm and curved my first two fingers around the caudal vena cava. I tipped my hand a little to lay the third finger down-and that's when I felt his heart. It wasn't so much thumping the back of my hand as it was rubbing itself up against me. It was turning and twisting back, making that motion only hearts can-that motion so distinct you can recognize it by feel alone, against the back of your hand through a glove inside a hole you haven't even dared look straight at yet. It was an unforgettable sensation.
The intimacy of surgery
The times I've touched a living heart have been among the most intimate experiences of my life. The only other moment I can liken it to is when I was in the late stages of pregnancy. Lying still, I would feel my baby turn over inside me and know she was intentionally moving herself in the warm, close dark space.
But now, I was frozen. For a second I couldn't breathe. I felt like I'd gotten caught copping a feel. At the same time, I wanted to flip my hand over and cup it around his heart. Instead, I slipped my hand out of his chest to ready my needle and suture. The defect closed up nicely, and he was doing well enough under anesthesia that I neutered him, which is what he was there for.
A local rescue posted his case to Facebook and gathered donations to cover his care before he'd even left the clinic. His adoptive family has brought him to the clinic several times for preventive care, and he's still a big, sweet dog with a goofy grin and a dangerously happy tail.
For me, having that gut slide out so smoothly-that right there is what makes surgery sexy. But damn, did it have to be followed by that remarkable, unsettling moment when all of me was feeling his heart pressing against the back of my hand
Dr. Eden Myers serves as a relief veterinarian in Mount Sterling, Ky.