A Tale of Two Chalupas

When I sit down at my computer to write another story, I tend to pick one that has touched my heart, challenged my skill as a veterinarian, and, above all, one that I believe will be interesting to my readers. If this one should disappoint, it will be my failing as a writer, because the little subject of this chapter has me, my staff and everyone who has seen us through this week, riding an emotional roller coaster that, I hope, will rock your world as well.

My former staff members at Hillcrest Animal Hospital remain dear to me to this day.  They often read my accounting of my new life and adventures here in Florida and they all know and understand my sincere, heartfelt love for little Chihuahua dogs.

With my admission of the fact that I love Chihuahuas, by offering that confession, I now feel my emotional underbelly is exposed.  I feel like I am at a support group meeting droning something like, “My name is Norm and I have a Chalupa problem.  I just love a stinkin’ Chalupa.”

Well, it is true.  I call them Chalupa’s because of the old Taco Bell commercials that said, “Drop the Chalupa!” featuring the little Taco Bell dog. I just like that name better than the original.  That’s just me, but more importantly, I must tell you how the little stinkers stole my heart.

Years ago, a frantic client at Hillcrest bolted through the door carrying a lifeless little dog in a bloody sheet. It was a terrible moment and, an honest to god, emergency.  Everyone went to battle-stations because this event had disaster written all over it.

This sweet little Chalupa, that weighed a scant 4 pounds, had been viciously attacked in her own back yard, by a large Chow belonging to a neighbor.  Her wounds, at first glance, appeared to be terminal.  She was barely conscious due to shock and blood loss.  She had deep, open wounds to her neck, back, thorax and her intestines, covered with grass and dirt, protruded through large lacerations in her abdominal wall.

Sadly, another of their dogs, a little Yorkie, arrived dead from the same attack.  I remember well that I later learned that their third little dog, another tiny male Chalupa had escaped, only by squeezing through a tiny hole in their deck into the safe space underneath. The owners later had to remove boards from the deck to rescue the frightened little dog. There are no words for how they must have felt. I cannot imagine…

Those who have worked a trauma case with me would probably tell you that I am no fun. I offer no apologies.  The more hopeless, the more demanding the cause, the more of a laser sharp focus I bring to bear on my patient.  I cannot explain it, but my brain goes to a place where courtesy cannot play.  I ask 200% from myself and at least 110% from everyone on my team.  Life, once lost, will never come back.  The finality of that statement is all the motivation I need.  There is nothing I hate more than losing a patient and talking about what “should have” or “could have” changed the outcome. I insist we simply do everything, we do it in the proper order and we do it “NOW”.

I was surrounded by great, dedicated veterinarians and technicians that day. While the rest did their best to answer my demands for the patient, Donna, God rest her soul, quietly prayed for that little creature. Somehow, we managed to save that little dog.   There is no feeling like that of saving a life.  Every person in the room that day knew that joy.  We won, and we had won big.

When she was, at last, reunited with her grieving family the emotions were suffocating.  What should have been a celebration of a glorious triumph against all odds was juxtaposed with the profound tragedy of the loss of their other dog.  Again, there were just no words.  I told the little dog’s owners that she was the toughest, bravest and sweetest little dog I had ever met.  Most of that was true, some of it just seemed like the right words to ease the tension of the moment.

With sweet and sad tears mixed on everyone’s face, she thanked me by kindly saying that if this little survivor ever had pups, they would be honored if I would take pick of the litter.  I was stuck.  I was destined to learn about life from and with a tiny little fraction of a dog.

I believe it was about 9 months later that the obviously ”over pregnant” little girl showed up at the clinic.  Because of the size of her pups and the scars to her abdominal muscles she could not deliver her litter.  We had to perform a Caesarian section and bring four brand new little stinkers into this world.

As a side note here, there is no telling how many little pups I have welcomed into our world.  I am, and will always remain, awed and enchanted by the miracle of birth.  One moment a complete parasite in a mom’s abdomen and the next a complete new life with its own color, sex and personality. Incredible. Absolutely, incredible.

I had not forgotten my pledge, in that moment of great emotional stress, to accept one of these four pups as the newest member of our family.  Sure enough, when I notified their owner that our new mom and four pups were all fine she immediately asked if I had picked mine out.  I did not need another dog but how in the world was I going to say “no”?  I picked a little silver-grey female and declared that I would be proud to accept her when she was weaned.

The first day I took her home we all became “stupid” over that little dog. We had, as usual, several dogs around the house at that time.  But they were all “real dogs”.  This new addition was somehow very different.  It looked like a dog alright, but it was so cuddly and you felt like you needed to rub it on your cheek and what the heck is that all about?  It’s about puppy love.  Plain old starry-eyed, can’t put it down, always wanting to hold it and baby talk to it, puppy love. And worst of all, it doesn’t matter if you act like a googoo idiot in front of others.  You just expect everyone to “understand” and don’t really care if they do or not.

We named her “Nugget” because she was solid gold to us.  That little dog was so special.  The time I spent with that little dog changed me, my heart and my perspective on dogs.  Through her, I saw things in all dogs differently.  She slept each night in our bed with us.  We would never have even given a thought to such a thing before. I started each new day with a smile when I gently peeled back the covers to find her curled up, warm and content.  It was through that little dog that I was to fully understand the wonderful human-animal bond. Little “Nugget” taught me how to truly love a dog and to understand how so many people sincerely loved their dogs.

At the young age of just  two years, my little dog, the apple of my eye, was killed by a Great Horned Owl in our own yard. With tears creeping down my cheeks, I type these painful words.  I do so as a warning to all who hear – never, never forget the danger to these little dogs. It has been 17 years and the pain is still immeasurable.  Melody and I can hardly mention her name because of the profound sadness that we share over her memory.

Compassion.  I suppose it was always in me somewhere, but before “Nugget”  it was never on the front burner in the day-to-day life of this veterinarian.  In school, we studied hard science.  We learned things that helped us understand disease and life-and-death stuff like that.  Things that we could wrap our hands around and understand, and be tested on.  How can you learn compassion?  I don’t know the answer.  I just know that my gifted teacher was a little dog named “Nugget” and her lessons live firmly in my heart, not in my mind.  The things that she taught me forever changed my perspective on veterinary medicine and surgery.  I learned, and continue to learn, how to see through the eyes and heart of a dog.

I would fall miserably short of the appropriate words if I had to explain what I just wrote. Dogs cannot speak, but they can tell you what is own their minds.  And, just as they can learn, they can teach.  I promise you, my readers, that for everything that you can teach a dog you will learn one or more thing in return. What dogs thrive upon is pure honesty.  They read you like an open book with large print.  If you are to ever be a true, trusted friend to a dog it will be necessary for your heart, or feelings, to be pure.

If I could give a gift to a friend, a true friend, it would be the simple gift that my little dog gave to me.  It was free and it was, at the same time, priceless.  What greater gift can one receive, than to “feel” and “understand” in its most elegantly simple form?

Chapter 2

It was exactly one week ago that a couple, whom I had never met, brought a little 7 month old Chihuahua pup into the clinic because she was very sick. When I first saw the beautiful little tri-color puppy I had to smile.  That smile, however became sincere concern as I looked her over and heard the sad story of her illness.

Her name was Panda and the owner suspected that she had swallowed a bone at least 2 weeks prior to our visit.  Her owners obviously cared a great deal for her but I could tell that they desperately wanted whatever was wrong with Panda to be something simple.  We spoke about the events that had led up to this visit while I examined her.  While they proposed more possible causes of her condition I became more convinced that this dog, indeed, had something lodged in her esophagus.  The look on her face of fear and pain was all it took to convince me that bad things were ahead for this little life.

Times are very hard for many people these days.  Sadly, many decisions for treatment of pets is based primarily on the cost of such.  Although I am very sensitive and concerned about costs, the reality is that it costs a great deal of money for me to open the front door each day.  I don’t like it but I simply cannot provide care at a cost less than we do.  It’s a simple business principle.  My staff expects to be paid, my suppliers, rent, utilities and so on.

When I took an X-ray of Panda’s chest and found a bone lodged in her esophagus my heart sank.  Her owners had a great deal of difficulty saying OK to the cost of the X-ray.  When I told them the serious nature of her situation there were no other viable options for them.  They gave us the dog with the hope we could fix her and she could live.

Remember how I explained that dogs can speak?  I consider myself fluent in dog.  What little Panda was saying, however, did not need a translator.  She had the same look of stark terror on her face that you or I would if we had a bone lodged in our throat for over 2 weeks. She was dying and she had suffered terribly.

My girls at the clinic were instantly in love with her and I don’t think there was a single doubt among them that I would help Panda.  However, there would be great risk if we chose to attempt to help her.  Surgery would require us to go into her chest to access the esophagus where the bone was lodged.  There is no question that this was very high risk surgery in an attempt to save her life.  I went to great lengths to explain to them the gravity of this surgery and everything that could go wrong.  That risk included her death that could occur in our hands as we tried to help her.  That is a bitter taste that never goes away.  Take my word for it.

As the morning passed I was really busy dealing with other patients. But in the back of my mind I was contemplating my next move on Panda.  Because of her very small size and her poor condition I was sweating this surgery.  It is very rare for us to ever open a dog’s chest.  I had so many concerns with Panda and the circumstances of her problem that I phoned a surgeon at my school – The University of Tennessee College of Veterinary Medicine – to discuss the case.  In our conversation I was briefed mainly on what I already knew.  I was also warned there was a good chance that I would find something that could not be fixed.  That notion stuck in my craw.  I felt that I would do anything possible to save Panda, but I was having a real problem accepting the fact that I might lose, indeed the outcome of this case may already be decided.

My surgery schedule is generally booked each day.  Usually the surgeries are routine spays and neuters in dogs and cats along with excision of various skin masses and biopsies.  If we work in an orthopedic case, as we often have to do, time begins to get critical.  I usually have to be finished by 2:30 for afternoon appointments to begin.  It is very rare to leave the clinic any time we are open. This surgery needed to be done ASAP but the schedule was hopelessly full for Monday.  We agreed that if this was going to happen it would have to be after we closed.

Maria was critical to the surgery because of her anesthesia skills.  She would be full-time on the anesthesia during chest surgery because she would have to ventilate every breath for the dog while her chest was open. In addition she was responsible for all the monitors and the IV pump.

Julia, our second year vet student, who is a great Summer hand around the hospital gladly agreed to stay on as my surgical assistant.  Once again I gathered my team and briefed the entire procedure.  I am quite sure that they understood the gravity of our situation as I am also sure it shown on my face and words.  In every sense of the word, this was truly “life or death” for Panda.  As the last appointment left the hospital I began to mentally go into my “zone”.

Maria already had the surgery room set up.  Everything that she anticipated we would need was out and ready for quick access.  We placed an IV catheter into the tiny leg.  Little Panda was so brave and cooperative.  As the fluid pump started its quiet grinding indicating it was pumping lactated ringers solution into the little dog for support during the procedure, we took a deep breath and slowly injected Propofol into the catheter port to induce anesthesia.  Panda immediately yawned and went to sleep.  We rushed to place the tiny 4 mm endo-tracheal tube into place and inflated the cuff to seal her airway.  Next we hooked up all the leads for the monitors. She quickly was covered with wires and tubes.  We were all “wired” as well.

Her respiratory system was now completely connected to the anesthesia machine.  A seal was needed because as soon as I opened her chest the lungs on the side where my incision was located would immediately collapse. The only way for her to get oxygen from that point until I finished the surgery was for Maria to ever so gently squeeze the bag on the anesthesia machine, thereby inflating her lungs and providing her with the oxygen to survive. This is an extremely critical procedure.  It is imperative that the pressure be correct so as not to rupture a lung.  In addition, when we are in the thorax, I give all ventilation control to the anesthetist.  She has to coordinate each breath with where my hands and instruments are at the time.  When the lungs are inflated, my hands and all sharp instruments must be clear or the very fragile lungs may be damaged. We communicate continuously, my needs and her needs.

The tiny little dog was scrubbed and ready. I draped her in and arranged my instruments in the order I expected to use them.  The monitors all said “go” and the three of us in the O.R. exchanged glances.  From this point on everyone had to be on their “A” game.  Without delay I located a mark that I had previously made on her 8th rib and made a 3 inch incision through her skin in a line parallel to the arch of her rib. Next I dissected through the subcutaneous fat and to the intercostal muscles which connect each rib together.  After a quick glance at the monitors and an OK from the anesthetist I incised the muscle, extended the incision with my scissors, pried open her chest cavity and placed a retractor to hold it open.  As expected, her lungs collapsed and I stared at her tiny heart beating at 144 beats per minute.  My focus sharpened.  The hard part was yet to come.

We adjusted lights repeatedly so that I could better visualize the structures in her chest cavity.  I gently searched for the section of her esophagus that extended from her heart to her diaphragm.  What I found first was a large hole in her mediastinum (the tissue thin membrane that divides the chest cavity into two halves).  The hole meant that now all of her lungs were collapsing between the artificial breaths.  That was not good news.  I advised Maria of the complication and continued my work between breaths provided by the anesthesia machine bag. I located her esophagus and began to gently palpate it to locate the bone. I found the sharp bone right at the base of her heart. It bounced along with the beating heart which looked like a speed bag that a boxer practices on.

I just stared and contemplated what the heck I should do next. I would have to make my incision in the esophagus below where the bone was in order to work around the heart.  There was no guarantee that I could get a forcep into the esophagus and get a hold of the bone.  And, if I could grasp it,  I did not know if I could remove it without the jagged ends of the bone tearing a hole in the, already very sick, esophagus. I then spent a long moment contemplating how I would sew up the wound in her esophagus with the constant pounding of her heart.  Somehow this would all work out I convinced myself.

My fingers looked like clubs working 2 inches inside her chest.  I made the incision, inserted the curved forcep into the lumen of her esophagus and immediately grasped the bone.  I gave it a gentle tug and out it came. The girls let out a collective gasp at the site of the jagged bone.  A flood of joy came over me.  Two weeks of sheer hell for this little creature just ended, I knew her terrible prediciment was solved.  My remaining job was to repair the damage that I had caused to her esophagus and chest wall.

The esophagus is a tough little tube.  It requires reconstruction in two layers.  I found it extremely difficult to sew with anything but the smallest needle in the surgery room.  There just was no room for me to gently hold the esophagus with a forcep, place a needle in a precise location and pull the suture through and get out of the way to allow the dog a few breaths.  Then I had to go back and tie the knot and cut off the ends. Again this was with that happy little heart bounding like a Mexican jumping bean. I repeated this 12 times, one for each suture in her esophagus. I was pleased with the way it all looked when I finished.  I exhaled the weight of a sandbag off my back and said the happiest words of the night, “Let’s close”. Elapsed time in her chest - about 45 long minutes.

Prior to sewing her ribs back I inserted a tiny tube into her chest cavity and extended it through the skin. After I finished reconstructing her chest wall we attached a syringe to the tube and removed all the air from her chest cavity and, by so doing, reinflated her lungs. For the first time since the surgery started she could again breathe on her own.  He vitals were all good and Maria had already started waking her up.  Within 10 minutes little Panda opened her eyes and looked around the room at three very tired and happy people.  We were all short of words.  I felt very, very lucky.  I was also very proud of my girls.  Maria wrapped Panda in a warm towel and I cradled her in my arms and walked into my office, sat down and rocked her to comfort her.  I wondered just what in the world she would be thinking as she looked up at me through glassy eyes.

Panda’s recovery has been stellar.  I take her home each day and back to the clinic the next morning. Her resilience has been most impressive for a 3.2 pound canine. Interestingly, the little thing has developed an almost unbelievable bond with me.  She shadows me constantly.  She allows everyone to love on her and pet her but she runs to find me whenever she is released. It will be a couple of weeks before I can relax and feel it is all behind us.

Soon there will be a day when she has to go to a new home.  Sadly, I just cannot keep another dog. She will warm the heart and spirit of another person like she has me. The little stinker will always own a piece of this old vet’s heart.  I am, and will remain, hopeless.  I just love a stinkin’ Chalupa.