Welcome to my penultimate blog post! Today was our final working day here at the American Fondouk and it proved to be a busy one, just as Dr. Frappier promised. I can't believe that our two working weeks are already over. Anna and I are exhausted and maybe that's because time seems to pass differently here in Morocco. I don't know whether it's because we're so far from home and everything here has been very new and stimulating or whether we're just fatigued from the constant drain that this experience has had on our emotions. It's hard to wrap my head around all the unique, challenging and gut-wrenching veterinary cases we've seen. I know one thing is for sure--I am a different veterinarian than I was when I arrived.
This morning we were fortunate enough to do a lot of re-check exams which was very satisfying, especially as we prepare to leave Fez behind this weekend. I was thrilled to see the steady flow of donkeys, horses and mules whose wounds had healed, whose lamenesses had subsided and whose all around attitudes had improved thanks to a good rectal and tubing. The mule whose proud flesh I debrided at least 4 times over the last 2 weeks looked great when his owner came to retrieve him. Our mean mule who came to us with a rope embedded in his leg also looked great. He'll go home as soon as his owner gets around to coming for him. The mutilated mule who had a knife taken to his hind end is mending slowly but surely, largely due to the loving attention and constant care that his been bestowed upon him by our Czech friends. They call him the "We Will Win" mule which is a pretty befitting name. Our piroplasmosis mare with the crippling canker on her hoof got some help today from Azami, the Fondouk's capable farrier, and a hoof wall resection from Jeremy. She's already walking better.
While so many of our patients are doing better, we have many who are not going to win their battle. Our third neurologic donkey has rapidly declined and is not responding to any of the treatments and medications we have given. We had a lengthy discussion about whether or not to euthanize him today since he's not eating and his quality of life is deteriorating. The group finally came to a consensus to euthanize today but Houssine strongly advised against it. Since this donkey is not in pain or facing imminent death, he will have to wait until Monday to be euthanized. We learned that if we euthanized him today, his body would just lay around til Monday anyway. I was fine with this decision for partly selfish reasons--the smell of burning mule meat which wafts directly into our bedroom is enough to make anyone lose her appetite.
We saw a bunch of sheep today, too, including a neurologic lamb who had come in yesterday for significant acute weakness in the hind end. We could find no evidence of trauma or a fracture yesterday but the diffuse ataxia made us wonder about White Muscle Disease, a degenerative muscle wasting disease that is caused by a lack of selenium and/or vitamin E in the diet. Although we treated him for White Muscle Disease yesterday, when he re-presented this morning it became very clear that White Muscle Disease was not this lamb's primary problem. Today he came back with his ewe and both were starting to break out in Sheep Pox. Houssine was fairly confident that the neurologic deficits we saw in the lamb yesterday were due to an early phase of the Sheep Pox infection.
We processed our patient load very rapidly this morning and probably saw at least 30 mules and horses. Friday is the Muslim day of rest so many owners opt to bring their animals in for "control" then so as not to have to give up a day of work. Jeremy and Anna probably floated 6-8 animals this morning. We saw a bunch of colics and some other interesting sheep cases, including a young ewe with a dislocated hip. Because they had waited so long to bring her in, it was not possible for us to "relocate" het femoral head into the hip socket. They decided to take her home and eat her.
The most frustrating case of the day hobbled into the Fondouk on three legs sometime mid-morning. This mule clearly had some kind of fracture in his upper left front leg. The owner was adamant about not euthanizing him (again because it's not Allah's will). We later learned that this mule was seen by a local Moroccan veterinarian yesterday and that vet referred him to us for x-rays. We were very upset by the fact that this mule owner seemed unphased by his mule's excruciating pain--if I didn't know better, it almost seemed as if he were taking some kind of pride in his animal's misery. When Anna walked over to give the mule a shot, the owner went to pick up the mule's good leg so as to force him to stand on the broken leg. After Anna sharply reprimanded him, I was mildly concerned that she was going to punch him in the jaw.
At least several hours was spent trying to locate the fracture through x-rays. The upper limb of a horse or mule is difficult to image under the best of circumstances due to the heavy muscling. Since the x-rays are developed via hand-dipping at the Fondouk it was a very tedious and lengthy process. Finally they got "the money shot" and it was clear that this mule was suffering from a large olecranon fracture (in his elbow). To make matters worse, we learned that this fracture occurred 50 days ago and the owner had waited almost 2 months before seeking medical attention.
After the diagnosis came the difficult decision of what to do with him given that sending him home wasn't an option (for us) and euthanasia wasn't an option (for the owner). After much hemming and hawing (ooh, no pun intended) we decided to try to splint his leg and manage him medically with stall rest. After 1 week, when Anna and I will be long gone, Jeremy and the Fondouk gang will re-evaluate his condition. If they still want to euthanize him (which they likely will, given the duration of the injury) at least they can say they tried everything. Jeremy had to track down some PVC piping and once that was acquired, we set out to immobilize the leg. This mule fought us every step of the way but, as Anna said, he has every right to be angry about everything. With some significant padding and a ton of duct tape, we got this mule's leg splinted. Hopefully he'll be smart about things and not try to lie down.
Our big afternoon procedure featured a rumenotomy on a ewe--they opened up her rumen, removed the plastic bags that were causing her inappetance, sewed her back up and sent her on her way. I was planning to do a C-section on another ewe today but she went into labor before we could open her up. Houssine and I had to work hard to manipulate and re-position the lamb in order to get it out. As expected, it was dead. When I asked Houssine why we were seeing so many dead fetuses rotting in the ewes, he said that it's usually trauma that kills the fetus and that the injury is often induced by the owners. After the unsatisfactory feeling that comes with delivering a dead lamb, I was given the opportunity to open up two abscesses on this ewe's neck. Many of you know that there is little I enjoy more than opening up and draining a good nasty abscess--it turns out that it's just as awesome in Morocco.
Anna and I have elected to lay low for the evening although we're trying to organize a rousing round of charades. That should be extra fun with a crowd of non-native English speakers. We have a full day of eating to look forward to tomorrow between going out for an elaborate multi-course Moroccan lunch followed by a casual dinner out with the staff. We may need to be rolled to our Sunday morning train.
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