‘Her pale gums indicate severe anaemia.’
‘And what do you think might be causing that in such a young cat?’
I hazarded a guess. ‘Well, it’s either loss of blood, a destruction of blood, or a lack of production of blood. Since there’s no obvious haemorrhage, I think a good starting point would be to rule in or out IMHA – immune mediated haemolytic anaemia.’
‘OK, can you tell me about that?’
‘It happens when the cat’s body is destroying its own red blood cells. But we would need to run blood tests to check.’
‘Good, right, take some blood, get it down to the lab, have a look under the microscope, and come back and tell me what you reckon, fast as possible.’
I leaped into action, filling a small vial with blood from Pepsi’s jugular vein. Many cats would object to this and miaow loudly, but Pepsi was silent and unresponsive.
‘Don’t worry little thing,’ I said, stroking her head. ‘We’ll get you better.’
With no lab assistants there at night I needed to do the blood test myself. I hurried down the hospital’s hushed corridors to the lab, smeared a few drops of blood onto a slide and looked at it through a microscope. Some of the red blood cells looked almost transparent; they’re known as ghost cells. The diagnosis was right; Pepsi’s body was behaving as though her own blood cells were foreign bodies that had to be destroyed.
Giacomo was back at my side. ‘So, how do we treat it?’
‘We could downgrade her immune system, but that would make her vulnerable to other diseases.’
‘Or?’
‘Give her a transfusion?’
‘Yes, we’ll need to ask reception to ring around for a donor. And in the meantime we’ll give her the synthetic substitute. It might take a while to find a donor, and she can’t wait.’
Along with one of the interns I went to explain to Pepsi’s owners that she would need to be with us for a while and that she would need a transfusion.
‘Why has she got it?’ the mother asked.
‘We don’t always know. It can be triggered by something like a vaccination or certain types of drugs, but sometimes it just happens and the cause is unknown.’
I promised we would call with an update first thing in the morning. The little boy smiled and waved to me as they headed for the door.
Back in the ER Pepsi was being given Oxyglobin, a synthetic substance that could be given to cats and dogs needing transfusions as a temporary substitute for donor blood. Within a few hours she was sitting up and looking around and her eyes had turned bright gold, a side-effect of the Oxyglobin that made her look distinctly weird.
Cat blood types are commonly A or B, and occasionally AB. It’s dangerous to give them the wrong type – it would kill them – so we needed to find a match to Pepsi’s A-type blood. The QMH had a long list of willing donors, but finding one meant ringing to ask the owners to bring their pet in to have blood taken. The whole process could take half a day or so, and given that it was now late in the evening, possibly longer.
Pepsi was taken through to the Intensive Care Unit and placed gently into a cage lined with a soft blanket, where the nurses would keep a close eye on her until it was time for her transfusion.
While I was there I nipped over to check on Misty, the Westie with the severe bee-sting reaction. She was fast asleep, her breathing was normal and so was her temperature. She would almost certainly make a full recovery, and I knew just how much that would mean to Mrs Stevens.
The new patients rolled in non-stop that night, and I would discover over the following week that this was the norm. We students would deal with a patient and then run to take the next on the list. It was so busy that after the first few cases I forgot all about my nerves; I just had to get on with it.
Adrenaline-fuelled, I was buzzing, with no time to stop or to eat. Around midnight Stacy, one of the interns, stopped me in the corridor as I headed back to reception for my next case. ‘Take a break after this next one and get some sugar into you or you’re going to collapse,’ she said in a tone that brooked no argument. The interns and clinicians were well aware of how easy it was to forget to eat and end up making yourself ill.
That night I saw a dog with heart failure, another with unexplained bleeding and a cat with seizures. After each assessment I would report back to Giacomo or one of the interns, and we would discuss what might be wrong and what should be done.
More than once I had to hazard a guess under the fierce gaze of an intern waiting to know what my diagnosis was. Thank goodness most of the time I got it right – and each time that happened it boosted my confidence a little more.
Around one in the morning, after I’d wolfed a bar of chocolate and downed most of a cup of tea, the phone shrilled again. Off I went, hurrying back towards the waiting area to collect a dog I’d been told was in a lot of pain.
I could hear his howls and whimpers from the other end of the corridor. I arrived to find a young yellow Labrador lying on the floor yelping. His owner, wrapped in a huge parka, looked exhausted. He introduced himself as Doug.
‘Barney’s nine months old, he’s normally the life and soul, but he’s not been himself today,’ Doug said, raising his voice to make himself heard over Barney’s cries. ‘Tonight I got home from a night out to find him like this. I can’t think what’s happened.’
I had a pretty good idea, but I needed to be sure. I knelt beside him in the waiting room to give him a quick check. His abdomen was bloated and tight, and he yelped when I touched it.
‘He’s very bloated. I’m afraid this could be quite serious. Would you mind waiting? I’ll take him straight through to the senior vets, then come back to get a fuller history from you while they start working on him.’
I ran to get a trolley to wheel Barney through to the ER. Doug helped me to lift him gently onto it and then patted him on the head. I wheeled him through the double doors and Stacy rushed over. ‘He’s really bloated. I think it’s a twisted stomach,’ I said. She checked him over, put the ultrasound probe on him to confirm the diagnosis and nodded.
‘OK, he’ll need surgery, but first we need to deflate his stomach; the build-up of gas is what’s hurting him. Jo, you can do this.’
We clipped a small patch of fur from Barney’s abdomen and applied antiseptic, then Stacy handed me a two-inch-long needle. Clenching my teeth, I plunged it straight through the clipped area and into Barney’s stomach.
The whoosh of gas escaping sounded a bit like a balloon when you blow it up and then let go. Almost immediately Barney calmed down and stopped howling. I knelt and stroked his head. ‘You’ve had a tough time, haven’t you, young chap?’ Barney raised his head, licked my hand and managed two thumps of his tail.
A few minutes later he was taken to a kennel in the Intensive Care Unit to be prepped for surgery while I went back, with Stacy, to talk to Doug and to take Barney’s history.
‘What is a twisted stomach?’ he asked. ‘How did it happen?’
‘It’s not uncommon in deep-chested breeds of dog,’ I told him. ‘It’s a condition called gastric dilation volvulus or GDV, in which the stomach twists and dilates when it can’t expel food or gas. The blood supply can also be cut off. GDV sometimes happens after a big meal followed by exercise, but frequently there isn’t an obvious reason.’
‘Barney always seems to be hungry,’ Doug said. ‘He steals anything he can get hold of; we have to keep all our food out of reach. The only things he doesn’t seem to like are carrots. Yesterday he ate my son’s headphones, a plate of biscuits and the insole of a boot.’
I