So this weekend was a little bit of a nightmare. And by weekend, I mean Monday also, because the horribleness extended into last night as well.
Saturday night, a really painful impaction colic with displacement of the colon comes in. Owner can't really pay for surgery even though it's necessary, so the attending and intern agree that medical management can be tried overnight. Well, that night this horse proceeded to kink it's IV catheter and pull out the fluid line (there goes 20 litres of LRS) because he was rolling in pain. Let me say first that this horse was on a substantial amount of pain medication and sedation to try and make him comfortable. At 4am, I was the first one down to check on this horse. Fluid line was wrapped around his front leg and was pretty much destroyed, another 20 liters of LRS in the shavings. Not my happiest moment. We manage to salvage the IV catheter, but have to replace the fluids and the IV fluid line. Put him on more pain medication. Next morning (Sunday), things are as bad as the night before and the owner decides to call it (after a thorough explanation about how he might not make it through surgery even if we decide that is the path, etc). Really sad.
Sunday night, as the other extern and I are getting ready to go downstairs for midnight treatments and we see a trailer drive by our bedroom window. Didn't get any heads up from the intern on call, so we wander downstairs to see what's up. Unexpected colic case walks through the door. Come to find out that their referring vet had called another emergency clinic and expected them to go there even though they said they were coming to us. Frustrating, but obviously not going to turn them away because of it. Another horrible no good colic which, after an hour of workup, the owner decides to euthanize because surgery isn't an option. Another sad ending.
Monday goes well, lots of appointments to see and lots to do. Get told around 4pm about an emergency colic coming in around 6:30-7pm. 2500lb+ Belgian with a colon torsion. Sigh. Surgery not an option, due to the size of the animal and all the complications that can occur. Also, high possibility that the colon will rupture as it's being moved onto the table. Ok.
6:30pm rolls around and this giant horse walks through the door, full of sweat and obviously in a lot of pain. Two nice guys from Maine are handling him and explain what the deal is. Intern on call starts the work-up while the attending vet is handling some important paperwork. One of the vet techs stays to help (superstar). Intern gives him some sedation and pain meds, but they don't have an effect. Really super bad sign. Also, this horse is huge and in a lot of pain and not really paying a whole lot of attention to anything (not surprisingly) so being around him alone is scary as sh*t. I won't sugarcoat this. Working up an animal this large and this unaware is terrifying. The intern (also a superstar) did her best. Attending comes in and takes one look at the horse and is basically telling the handlers (the owner wasn't present) that the horse is dying. Because he is. I saw this horse's gums - they were white as a sheet. As the attending goes to try to place a catheter for the third time, the horse starts to collapse.
Now, when a horse like this collapses, it doesn't get up. Period. That is the awful truth. And it was awful. I've never seen an animal die like this in front of me, but everything is a learning experience. Thankfully everyone there was smart and stayed safe when he started to go down, but it was really scary to see it.
For all those people who are thinking "why didn't they do more?"
Well. I have to say that it was handled in the best way it possibly could be handled. These situations are never easy, and it's very hard to make sure everything goes smoothly. Unfortunately, the horse should probably have been euthanized instead of traveling 3 or 4 hours to get to this referral clinic. But he wasn't. He also should have gotten an IV catheter placed by the referring vet and gotten a bolus of fluids and pain meds before traveling, but he didn't. By the time he got to us, he was so dehydrated that an IV catheter was impossible to place. It was an upsetting situation that no one could really have changed that late in the game.
I'm just happy this horse's suffering didn't go on for too long after he arrived. The whole thing was over in about 20 minutes, even though it felt like much longer.
Anyway, these things happen in threes, right? So fingers crossed the next emergency colic cases that come in have happier endings.
Here's a picture of my kitten to make this post less depressing.