Hello all. I'm pleased to report that life went back to normal today and that Anna and I were quite relieved to see the staff ready to work at 7:30 this morning. I was a tiny bit concerned that this whole New Years celebration was actually going to turn out to be a two-day holiday and that our Moroccan friends were looking to have some fun at our expense.
Today was a steady and satisfying day of interesting cases and dramatic surgeries. There were a couple of colics and wounds to treat early on. An older man, whom we have seen at least 4 times since we got here, came in to have us give his mule some bute (an anti-inflammatory). This is one of the few mule owners who has some genuine affection for his animal. We've seen him lovingly pet his mule while he's waiting on multiple occasions. Perhaps more importantly, he seems to recognize discomfort in his animal enough to bring him in on a regular basis. When I went to give his mule the bute IV, he knew that his mule's left jugular vein didn't work well. He was able to communicate that and direct me to the mule's right side.
A man brought in a trio of horses for "control"--deworming and a shot of vitamins. The colt (maybe 6 months old) was covered head to toe in huge prickly burrs. They were in his ears, under his belly and had totally taken over his neck. Some had been there so long they were becoming embedded in the skin. I imagine that that must have been incredibly uncomfortable for the colt, especially when he lay down. I whipped out the clippers and went to town removing hundreds, if not thousands, of burrs. My clip job might not have been up to show horse standards (he did look a bit, um, patchy afterwards) but I imagine he already has to be feeling better. The man who owned the horse was not the most patient client that's come to the Fondouk--he announced (in Arabic) that he had to go before I was done.
Even though I still had about 10 minutes of clipping left, I felt okay about letting him go. I should mention that I was particularly impressed by this colt's manners. He surely hadn't seen clippers before and lots of horses don't like the noise and vibration of them. This guy, however, was very well-behaved and tolerated it well. That's in sharp contrast to the poorly mannered stallions who have come in. Across the board, they've come in snorting, aroused, and jumping all around. Today, we had one come galloping up the cement courtyard (with no handler) and stop only when he got caught up in the rope. Apparently, he just couldn't get enough of our pretty mares and jennies.
While I was clipping the colt, a sad little donkey with a huge gash in his side came into the courtyard. His heart and respiratory rates were high enough that Jeremy was concerned that either the wound communicated with his abdomen, he had a diaphragmatic hernia, or he was possibly dealing with a collapsed lung. The owner of the donkey told us the mule had fallen and that this injury had just happened. This is what they all tell us--that the injury just happened--but that is almost never the case. For example, the uveitic eye that I saw this morning was allegedly new, but I could tell by looking at the changes in the eye that this had been going on for a long time. I'm not sure why the mule owners don't bring their animals in sooner given that the care is free. It seems obvious to me that little problems stay little problems when you address them early but little problems become big problems when you don't. Some of the non-American grooms and farm hands that I work with back home in New York also seem to have trouble recognizing pain and suffering in animals. I don't know if this is a cultural difference, an educational difference or a combination of both, but I find it very frustrating and a problem without an obvious solution. We could do so much more good if we saw these critters 3-4 days before their owners think they need to bring them in.
Anyway, Jeremy ultrasounded the wound on this donkey and determined that, thankfully, there was no communication with the chest or abdominal cavities. He then told Anna this wound was hers if she wanted it. She was elated. Anna clipped and scrubbed up the wound and did her first ring nerve block with lidocaine. I threw a couple of sutures in the muscle since that's not the easiest place to start when you're learning to suture. It took a couple of sutures before she had the hang of it, but after that, Anna was suturing as if she'd been doing it all her life. Once the wound was sewn, Anna sprayed it with an aerosol bandage and the donkey was sent on his way. I joked that Anna has gotten so much hands-on experience in Morocco that she can probably skip college and vet school altogether and just go right into practice.
After lunch, we re-grouped in the courtyard to watch Houssine do a Caesarian-section on a ewe that came in this morning. Her owner told us that she had been in labor for 3-days but that nothing had come out. She was clipped and scrubbed and placed into the sheep cradle on the small animal operating table. Houssine anesthetized her at the last possible second with fears that the lambs inside her would also be anesthetized since they were still sharing a blood supply with their mother. We placed bets on how many lambs she was carrying--I guessed 4 since she was huge. Houssine opened her abdomen very quickly and without gloves, although he did take the time to rinse his hands with betadine. He exteriorized her uterus, made an incision, and removed the first lamb who was dead. The second lamb was also dead. The third lamb was clearly the runt, but Houssine felt a heartbeat on him and handed him off to a student waiting with a towel to rub him awake and get the fluid out of his nose. Those of us watching were so excited that there was a live one. The fourth lamb (I won be bet, by the way) was also alive.
Houssine replaced the uterus and sewed up the ewe's uterus and abdominal wall while the rest of us worked on the lambs outside. Our little runt gave a tiny little bleat but the larger lamb stopped moving soon after we got outside. When his heart stopped beating, Jeremy gave him some Dopram IV and then an intra-cardiac stick with epinephrine. Although his heart started beating again, he never took another breath on his own. Not even Jeremy's loving mouth-to-mouth resuscitation was enough to save the lamb.
The only surviving lamb never stood up but we were able to direct him towards the ewe's teat and he did swallow some colostrum. We'll have no way of knowing whether or not he will survive since his owner took him and the ewe home immediately after the ewe woke up. We can only hope for the best.
Anna and I are headed out now to grab some dinner. The night watchman will tell our taxi where to go since the taxi drivers don't speak French and my Arabic is still not up to snuff. After dinner, we will have a waiter from the restaurant hail us a cab since it's not advisable for women to be out on the streets alone in this city. Never a dull moment here in Morocco.
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