Second Opinion: Wake-up Call

By Nick Trout, January 2012

Sometimes I realize I may be getting too old for this job, particularly when I get a phone call from my resident in the wee hours of the morning.

“I’ve got a dog with a broken back,” he says. “Any chance you can give me a hand?”

I could groan, but it would take too much energy. I could say, “Can’t it wait a couple of hours?” but he’s already said the magic words. A broken back is a true surgical emergency, and there’s not a minute to lose if you want your patient to have the best possible opportunity to walk again.

“Sure,” I say, “be right with you.” I hope my robotic monotone and total lack of enthusiasm don’t register with him.

I make the 40-minute commute in silence, and though the fog in my head is beginning to burn off, I feel a low-level exasperation about having to head back to work in the middle of the night. But I perk up when I see my resident and the dog in question.

“Hunter is a Lab/Beagle mix. Eighteen months old. Adopted just two weeks ago. Owner went out for dinner at six, came home at 10 to find Hunter lying in the backyard unable to move¾he jumped through a screen in a second-story window.”

The resident shows me the X-rays: the orderly structure of Hunter’s bony spinal column is crunched and buckled in the middle. This image represents a finite moment in time. Who knows how much distortion and irreversible damage occurred before reaching this point?

“He can’t move his legs,” says the resident, “but he does have deep pain.” Deep pain is the last measurable sensation an animal retains before total paralysis.

“Good,” I say, “then we’re still in with a chance.”

Perhaps it’s the word “we” that gets the resident’s attention. “I was hoping I could do the surgery. That you could walk me through it.” Spinal fractures, which can be tricky, are respected and revered by surgeons in training, and he was up for the challenge.

There are lots of ways to fix these fractures, but the plan we devise for Hunter involves using a combination of pins and sterile cement to bridge and stabilize the break. Aim a pin in the wrong direction, push it in too far, and you risk puncturing the spinal cord (never a good thing) or, worse still, puncturing your patient’s aorta (invariably fatal).

I look at him. Unlike me, the resident was totally awake, excited and hungry for the opportunity. He was me, 20 years ago.

“Sure,” I say. “We’ll do it together.”

And we did, or rather, he did. He repositioned the broken bones and then placed his pins. I guided his hands; I approved pin positions and angulations and told him precisely when to start and stop. But the repair was his, and when we reviewed the postoperative X-rays, Hunter’s spine was once more perfectly aligned.

“Nice job,” I said, and meant it.

In the following weeks, I followed up on Hunter’s recovery, chatting with his owner, Tim.

“Hunter’s doing great, especially when he does his water therapy. He still can’t walk on his own, not yet, but he’s definitely getting there.”

In Tim’s voice I could hear the emotion common to every dog owner who’s had to deal with canine spinal trauma: eternal optimism. When faced with a forecast of slow progress, intense nursing care and an uncertain outcome, a “glass-half-full” attitude is essential.

“He’s always in a good mood. If Hunter never got any better than he is today, if I had to fit him for a cart, I know he’d still enjoy a great life.”

On the night of Hunter’s surgery, my sleepy indifference had vanished the moment I saw a dog in such dramatic need. The responsibility of trying to restore something as fundamental as the ability to walk across a room was a real eye-opener. Better than a double espresso any day.

“Don’t forget,” I had said to the resident after we finished, savoring his excitement and appreciation, “we’ve only created the possibility for recovery. The rest is out of our hands.”

I didn’t want to kill the buzz; I simply wanted to remind him that surgeons can’t play God. Nothing we do with our hands and tools can get a spinal cord to heal if too much damage has been done.

The resident nodded his understanding. I smiled, invested in and thrilled with what had been achieved for Hunter.

“Thanks for your help,” said the resident. “Next time. I won’t have to call.” And that’s when it hit me: I wouldn’t want to miss this feeling for the world.

“Call me anyway,” I said as I got ready to leave. “Remember, no two spinal fractures are ever quite the same.”

Nick Trout is a Diplomate of the American and European Colleges of Veterinary Surgeons and a staff surgeon at Angell Animal Medical Center in Boston.

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