Post 1 Catastrophe and Cats


Catastrophe and Cats

This first post tells two strikingly different stories about medical emergencies. I hope you will enjoy reading them.


Catastrophe
Thought for the day;        
‘What is more dull than a discreet diary?’
                                                              Chips Chapman   1897-1958


Utterly dejected, I collapsed into the dilapidated armchair in the corner of the room, my head in my hands, tears in my eyes, my confidence shattered. I was distraught; my mood one of total wretchedness and despair. I felt sick, my mouth was dry and my hands trembled. It was four in the morning and it was the events of those four hours, events for which I had been wholly responsible, that were the cause of my distress. What had happened had been a disaster.
I had been the leader of the team, the one everyone respected, the one to whom they turned for guidance, the one supposed to be in control and able to cope in difficult situations; but the night’s events had shown me to have been a complete failure.


I felt ashamed. I had let myself down, had let the team down and still lying on the operating table in the adjacent theatre, drained of his life giving blood, was the man who had paid the ultimate price for my incompetence. The previous evening William Wilson had been fit and well. He had enjoyed a lively game of bowls followed by a drink and a chat with his pals in the pub. Now the nurses were washing the blood from his lifeless body in preparation for its short journey to the hospital morgue. Later, they would clean the operating table, scrub the floor and sterilise the surgical instruments in preparation for the next day’s list. By morning the theatre would again be spotless, all signs of the disaster that had unfolded in the night erased. If only they could wash away my shame, my pain and guilt as easily.


During my surgical training, I had grown accustomed to occasional disappointments. There had been lows in my life before, times when patients had developed complications from treatments I had initiated, such things were inevitable for anyone who chose medicine as a career, but I had never experienced anything remotely like this. If only the ground would open up and swallow me.  
   
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I glanced round the room, eyes vaguely noting the jumble of discarded caps, masks, vests and pants left behind by the rest of the team as, one by one, they had drifted wearily to their beds leaving me alone with my misery. Loyally, they had muttered words of sympathy, insisting that I should not blame myself; but their words brought no comfort. I did blame myself; who else was there to blame? My eye settled on the laundry skip in the corner of the room. A loose fold of a gown, heavily stained with blood, hung at an odd angle over the metal ring that formed its lip. A crimson pool was forming where blood was dripping onto the floor.
It brought to mind an image that had haunted me as a child. Whilst on a family holiday, I had seen hundreds of dead pheasants, their bloodied heads hanging limply, at grotesque angles over the side of a trailer, leaving a trail of blood on the rutted earth as they passed. The sight of their ruffled feathers and shattered bodies had sickened me. Walking alongside were half a dozen men, laughing and joking as they drank beer, their guns over the shoulders. Only a few hours before, we had fed the pheasants by hand as they roamed freely through our campsite. They had strutted proudly, bright eyed, their heads held high, showing off the brilliant colours of their beautiful plumage, iridescent reds, brilliant greens and blues. I suffered nightmares for weeks afterwards.
I looked again at the crumpled blood stained gown. Poor Mr Wilson had died as needlessly as those birds and in my heart I knew that I was responsible.


There was a quiet knock at the door and the theatre sister entered, a mug of tea in her hand.
“It’s been a long night, Mr Lambert,” she said, a sad, sympathetic smile on her face. “Have a drink before you leave.”
I mumbled my thanks, head bowed, not trusting myself to look her in the eye.
“Look, you mustn’t blame yourself. We must accept that from time to time these things happen; not all operations are successful. If all your patients made a full recovery, you wouldn’t be human; you’d be a miracle worker. Besides, when a major blood vessel bursts there’s a high mortality, you know that as well as I do. Had Mr Wilson not had surgery he would have died. You tried to save him, you did your best, no-one could ask for more.”
“And my best wasn’t good enough, was it, Sister?”
Sister laid a hand on my shoulder. I wanted to shrug it off, but didn’t. “Not this time maybe,” she said softly, “but I’ve no doubt that others you operate on in the future will survive. Now drink your tea and go to bed.”


Alone again, I took off my theatre greens, pulled on my shirt and pants and looked in the mirror. A pale unshaven, weary face looked back at me. I stared at it in disgust.
‘Bloody idiot’ I muttered, cursing the ambition and misplaced ego that had reduced me to this state. “What the hell are you doing trying to become a surgeon? You haven’t the skill to be a success, nor the strength, the resilience to deal with the pain of failure.”
 Then, turning away from the mirror, I collected my white coat and braced myself for the task that would compound my misery. I had to meet Mrs Wilson and tell her that her husband had not survived my surgery.
                                             This story is an extract from my latest novel ‘Invisible Scars’

Cats


Thought for the day;


‘Cats no less liquid than their shadows,
Offer no angles to the wind,
They slip, diminished, neat, through loopholes,
Less than themselves’                            A S J Tessimond  1902-1962


Patients from all walks of life attend the emergency department, injuries and illness having no respect for social class or status, but this particular lady looked distinctly out of place. She was about 70 years of age and stoutly built. She was sitting primly to attention; knees and ankles clamped tightly together. A large string of multicoloured glass beads hung round her neck over her cardigan, which had a bold and colourful floral design; it had clearly been hand knitted. A heavy tweed skirt, a pair of thick woollen socks and walking boots completed her outfit. She had a round gentle face and grey hair with matching whiskers on upper lip and chin. She reminded me of a maiden aunt who used to visit each Christmas when I was a child. My brothers and I tolerated her hugs and kisses only because they were followed by a generous gift of cash which my Dad promptly confiscated; ‘for safe-keeping’ he used to say!


On her lap she held a wicker basket covered with a tea towel. She would have looked more at home attending a country craft fair on a Saturday afternoon, than a city centre casualty department in the early hours of the morning. She didn’t appear to be in any pain or distress; indeed she looked sheepish rather than ill.
I introduced myself, tersely. I was irritated. It seemed to me that this woman had absolutely no need to attend hospital, or to waste time which I would have preferred to spend tucked up in a nice warm bed.
“Hello, I’m Dr Lambert. I’m told you’ve got some tummy ache.”
She looked embarrassed and sounded apologetic.
absolute-dear“No,” she said. “Actually I haven’t, though I confess that’s what I told the lady at the reception desk. If she’d known what I really wanted, she would have thrown me out. And I do so desperately need to see you. The truth is there’s nothing the matter with me at all. It’s Kitty.”
Gently she took the tea towel from the basket and revealed a large, but distinctly unhappy looking cat, which was lying on a pad of heavily blood stained cotton wool. The cat mewed in a weak and pitiful way as she stroked it lovingly.
“For God’s sake, I’m not a vet. I don’t know anything about cats.”
“I know you’re not a vet,” she said softly, “but you’ve studied medicine; you must have some ideas.”


It was obvious she was genuinely concerned about her wretched cat and was pleading for some assistance. I was tempted to end the consultation there and then, rather than make any further enquiries. The more involved I became, the more difficult it would be to back out of the situation. There was a bed and the prospect of sleep waiting for me when the waiting room had been cleared. There was no need for me to be concerned about a cat. My responsibility was to care for humans not animals. It was however the look in her eyes, begging for help, that caused me to weaken.
“What do you think is the matter with it?”
“Not ‘it’, Doctor. Kitty is female and I think she must be pregnant. I know I should have taken her to the vets long ago to get her doctored, but I couldn’t bear to think of Kitty having an operation. I thought that if she was kept indoors and I kept a close eye on her, this wouldn’t happen.”
Knowing how cats love to wander the lonely streets at night, this seemed to be highly optimistic. Miss Mullins, for that was the lady’s name, had clearly failed to appreciate that Kitty, her beloved pet, had not adopted her own prim virginal existence. Free to roam the neighbourhood at night, it appeared she had met a Tom who had put her in the family way!
“And what makes you think she might be pregnant?”
“Well, she’s been trying to make a nest in the back room and she’s been ‘yowling’ something terrible. It’s been so bad that I’ve had complaints from the neighbours. Now Kitty is in a lot of pain and she’s bleeding. I think she’s in labour and I can’t bear to see her suffer.”


Tears filled her eyes as gently she lifted the large tabby out of the basket, placed the basket on the floor, then sat with the cat on her knee, all the while stroking the fur on the back of its neck and making soft cooing sounds.
“Look,” I said, looking desperately for an exit strategy, “I really don’t know anything about cats. When I was a lad at home, I once had a couple of white mice and a budgerigar. My brother had some goldfish, I think they were a prize he won at a travelling fair but they never lasted more than two minutes. And there was a time when my father kept chickens in the back garden, but we never had a cat or a dog.”


With tears now rolling down her cheeks, she reached for my hand and pleaded. “But you will look at her for me, won’t you, Doctor? She’s so weak and she’s lost such a lot of blood. I’m afraid she’s going to die.”
It was a request that was impossible to refuse, so crouching down beside Miss Mullins I took the cat from her. It failed to react in any way to being handled by a stranger. It simply lay still, with eyes glazed, its head lolling weakly from side
to side. The cat’s abdomen certainly looked swollen, which suggested that it could be pregnant and from time to time its whole body went rigid and then quivered, as if it was experiencing a spasm of pain. And despite me having no knowledge of feline anatomy, it was clear Kitty was bleeding from an orifice that I assumed to be the vagina.
I was completely out of my depth. What the hell was I to do?
Dealing with this feline obstetrical emergency was outside my experience and training. Despite having treated thirty or more human patients during the course of the day without recourse to assistance, I clearly needed help with this veterinary case.


absolute-dearThe obvious answer was to ring my boss. How often had he told me that failing to ask for assistance when in doubt was a greater sin than asking unnecessarily? And yet I daren’t! If I woke him at this hour, he would curse me. My career would probably be at an end and I should have to seek employment on some distant windswept Scottish island.
It struck me that perhaps by chance, there might be someone in the department who knew more about pregnant cats than I did, so I placed Kitty back in her basket, covered her with the tea towel and asked Miss Mullins to accompany me to the office.
Bill Makin, the medical registrar was there, together with the casualty sister. They were chatting to a couple of ambulance men, who were enjoying a break whilst waiting for their next call.
“Does anybody know anything about pregnant cats?” I asked as I ushered Miss Mullins through the door. The question was something of a ‘conversation stopper’ but immediately George, one of the ambulance drivers, a rotund, ruddy-faced man in his fifties, expressed interest.
“Yes, I do. I’ve kept cats for years. Indeed I breed them. It is a hobby of mine.”
This was an unexpected stroke of good luck.
“Excellent,” I said, “because I’ve got a rather unhappy moggy here who seems to be struggling in labour.”


Quickly George took a concise clinical history from Miss Mullins that would have done credit to any medical practitioner. He ascertained that in the last few days, as well as ‘yowling’ and attempting to create a nest, Kitty had lost interest in food, had been anxious and restless and had spent many hours licking her belly and perineum.
He took a look at the abdomen and confirmed that she was indeed in labour. He then voiced concern that this had lasted significantly longer than the three hours that was normal for a cat, adding that the bleeding was also much heavier than he had previously witnessed. Clearly he shared Miss Mullins’ anxiety about the matter.
“For some reason the kittens aren’t coming through as they should,” he said, a frown on his face. “There must be a blockage of some sort. I really think this cat ought to be seen by a vet.”
“Or maybe by an obstetrician,” Bill Makin remarked. “I’ve already been on the telephone to St Margaret’s Maternity Hospital earlier this evening about one of our patients. My old pal, David Winterbourne is on duty there. He and I used to be students together. We’ll send Kitty there. He’s sure to know what to do. I’ll give him a ring.”
It was the Sister Bennett who spotted the obvious flaw in this plan.
“You really can’t send a cat to a maternity hospital, even if she is pregnant,” she protested.
“Of course we can,” Bill replied. “I’ve known David for years, he won’t mind in the least.”
“And we can run her there,” said George, knowing that St Margaret’s was only half a mile away. “We’re not doing anything at the moment; just sitting here twiddling our thumbs waiting for the next call to come through.”
Bill Makin reached for the phone and rang his friend.
                                                         This story will be concluded in the next post.


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