Waking Dr. Devine, Part Three

(This story is getting harder and harder to write. Tonight’s portion required a bit of liquid courage and I still found that I wasn’t ready for it to end. I appreciate your patience. The next installment will be the last.)

After I put the kids to bed, I went out to the barn to help Brian complete the evening chores. All I could do was look at Alex. He looked so bright and alert for a horse that was slowly dying. He had still managed to maintain reasonable hydration, though his sides were terribly sunken in from days of not eating enough, if anything at all. I knew he expected me to feed him since I was standing in the barn at dinner time. I asked Brian to follow me out so we could discuss the plans for the following morning.

“So, if it comes down to it, where do we want him to go down?” I said, looking away from my husband, trying to avoid making eye contact.

“Well, we need to be able to access him from the driveway – either the barn or the lower drive. We could take him a good ways to the south and – ”

“I don’t want him too far from Yak,” I interjected, “I don’t want them both feeling nervous and upset because they can’t see each other.”

“Ok. How about right here.”

I looked at the ground, then I looked up at Brian. “Oh Brian, I don’t think I can do this!” I began to lose my composure, the one which I had held strong all night in front of my family and my children. “Right here? I just don’t know if I can be here, I don’t think I can do it. I am not okay with this happening right here, right now. I am not okay with this! I’m not ever gonna be okay with this!”

“Well, you don’t have to be here for it, Jen. And that’s ok.”

“No, it’s not okay. I could never do that to him, I have to be here.”

“Well, we could wait through the weekend and see how he’s doing on Sunday.”

“No. I only want Leslie to do it and she is leaving tomorrow. We’ll do it here. But I am not going to be okay – I need you to know that. I might just curl up and die with him.”

“Ok. We’ll do it here. You coming in?”

“No. I’m going to be with Alex.”

“Alright, don’t be too late.”

I didn’t sleep well that night and the alarm went off bright and early. I crawled out of bed with swollen eyes and very little energy. The dawn, as is common on nights like these, came entirely too soon.

I went into the barn more to be with Alex than anything else. I already knew he had not miraculously improved. I called Leslie. She had been up late, just as I had, looking into causes of both laryngeal and pharyngeal paralysis in horses. Her main concern was that if it was a case of botulism, we would need to know that for certain so we could protect our other animals from the cause of the infection – most likely the soil in this instance. The other possibility was rabies. She didn’t think he had rabies and she wasn’t entirely sure how likely botulism was, but the possibility of either meant that he needed to be euthanized at a hospital and necropsied. I decided to call Littleton Equine to see if they considered either of these illnesses possible and if I should bring him back to them or if we had to go to the University.

When the on-call Doc rang me back, I was standing outside the barn drinking some coffee. I tried to explain my concerns to her regarding Alex’s apparent inability to swallow, how I worried some larger issue may have caused the partial laryngeal paralysis and a pharyngeal paralysis. I brought up Leslie’s points about botulism and having a necropsy done.

“There is no way that a laryngeal paralysis could lead to an inability to swallow or a bout of choke. I don’t think your horse ‘can’t swallow’ I think he has simply choked again and it needs to be cleared by your vet prior to feeding him a runny mash.”

“No, I am aware that the laryngeal paralysis is not ‘causing’ any of this, but I don’t believe he has choked again. I think he is losing his ability to swallow and my concerns now are figuring out why for the safety and management of my other animals. Maybe I am wrong, maybe I’m misreading the signs, I just want to know what is wrong with my horse.”

“Ok, I’ll tell you what, I’m going to have Dr. Devine call you back since he saw the horse yesterday. He might have a better idea of what is going on. It may take a few hours, but I will have him get in touch with you.”

I felt a bit battered and unsure of my reasoning. I went over the signs and symptoms of botulism and rabies and felt confident it could be neither – but I am not a vet, I am not trained in animal science. I could be wrong. In fact, I kind of wished I was.

The phone hadn’t rung in over two hours. We got the kids dressed and ready to go to the hotsprings for the afternoon with my parents. I was glad to have a distraction for the kids throughout this ordeal which had started out bad and just kept getting worse. I decided to phone the equine hospital in the chance that the on-call Doc had written me off as crazy and neglected to relay my message. I left a message with the front desk ladies who had informed me that Dr. Devine had surgeries all morning. I wasn’t expecting the phone to ring when it did, ten minutes later. Dr. Devine expressed the same sentiments that the on-call Doc had expressed: the two things were not related, if Alex had botulism or rabies he would be dead by now, and that he most likely choked again and needed to be cleared. I was beginning to feel like no one believed me – or that I was dead wrong. We spoke for a bit about leaving Alex at the hospital to be cared for and treated under Dr. Devine’s supervision. I decided it was the best thing to do for a couple reasons: 1. I was beginning to lose my faith in my ability to read my horse and treat him accordingly. 2. I wanted to buy into the idea that he might pull through this and come out the other side. So we loaded up in under 10 minutes and hit the road, back to Denver, without hesitation.

We stopped off to fill up the gas tank and air up the tires at a busy gas station off the highway. I took a few minutes to go ahead and give Alex his next dose of Metronidazole, which we were using to get ahead of the aspiration pneumonia. I opened up the top half to the back trailer doors and went to work at Alex’s tail, inserting 15 pills into his rectum. Hopefully no one was paying me too much attention – except for Alex, he had his eyes on me the whole time. “So it’s going to be one of those cruises, is it?” I giggled at the sideways glances he was shooting my way, patted him on his rump and we headed out of the valley. I felt anxious, hopeful, and ready to fight the good fight.

After we pulled up to the equine hospital, I had my husband stand with the trailer while I went to the front desk to let them know we were bringing Alex in for treatment and a stall. It was only a few minutes before they were out to check Alex before having me unload him and bring him into the same exam room as before – Dr. Devine wanted to examine him again. I had my husband stand outside as Dr. Devine prepared to scope Alex. It appeared that they were busy, with only half the hands in the room as we’d had the day before. I assumed that was why Dr. Devine was having a hard time getting the scope into Alex’s esophagus.

“Hmmm. I’m having a hard time getting the scope in, he’s not swallowing as he should be. See…you bump a horse there with the scope and they should swallow every time. Let me try again.”

After several more tries, he managed to get the scope into Alex’s esophagus and down into his stomach. There were no signs of a recurrent choke. Shit. Dr. Devine went to a different scope so he could check Alex’s guttural pouches.

“Guttural pouches are like our eustachian tubes,” he explained to me as he led the wire through a series of acrobatic flips and slides in Alex’s head, “only a few species of mammal have them and…oh, damn. There it is, there is the source of our problem.”

I was looking at the screen but it meant nothing to me, it was a tangled web of foreign languages I would never come to understand.

“So, what is it?”

“Aspergillus. Alex has guttural pouch mycosis. It’s pretty rare, but I saw another case of this just yesterday. That never happens, you could go three or four years without seeing a single case like this. This one is advanced, it spans from the carotid over the smaller arteries and all the way over to the nerve. Ugh, I am so sorry. Has he been in Colorado all his life?”

“No. He lived in the Midwest when he was younger, I’ve only had him for about 18 months. Is this something I’ve exposed him to? Should I be concerned about my other animals?”

“It’s possible, but not very likely. You might see more of this in Florida or somewhere very moist, but it is very rare in Colorado. We have had more rain this year than usual but, …no, it’s too advanced.”

We talked about the surgery techniques used to correct guttural pouch mycosis as well as the effectiveness of the techniques on varying degrees of artery and nerve exposure. I appreciated the information, but I already knew what was coming.

“If it was my horse and I was going to choose a surgical technique to try and fix this, I would take him to the University for ligation and balloon catheter occlusion of the internal carotid artery. But if it were my horse…if it were my horse I would do the humane thing and put him down.”

“Well, to be honest I had already decided that was the thing to do last night, I just didn’t know why. Alex was rescued from a starvation situation at a young age and I just couldn’t let him go out that way too. Thanks for taking the time to figure this thing out, I was starting to feel a little crazy.”

“I’m sorry, he’s such a good horse – he’s a sweet guy. I should’ve seen this yesterday. I mean, I was so focused on the choke and we cleared that. I didn’t think to look any further, but you’re right. If it looks like a duck and quacks like a duck and walks like a duck, it’s a duck! I don’t know how I missed this, I truly apologize. I’m so sorry.”

“It’s ok Doc, finding out yesterday or finding out today doesn’t change the end of the story. I’m just relieved to know why I’m saying goodbye.”

“Alright then, I’ll give you a moment – as long as you need. Just let us know when you’re ready.”

I opened the door to the front of the hospital where my husband had been waiting and motioned him over. I explained the situation and asked him if he wanted to be with me to say goodbye. He was in shock. He thought I wanted him to come help me get Alex settled into his stall. He didn’t realize we would be saying goodbye so soon. He nodded yes, he wanted to be there. Then, I took a small fraction of space, I beckoned time to stand still, I stole precious moments from the continuum, moments which I plan to hold onto forever – never to give back. They are mine and mine alone. They left wrinkles in his neck and dirt under my fingernails. They left a hole in the universe and an emptiness in my heart. I let go and slowly opened the door.

“We’re ready,” I said.

To be continued…

Alex and I.

Alex and I.

Advertisements

2 thoughts on “Waking Dr. Devine, Part Three

  1. Thank you, dear one, for giving us a glimpse into true strength, love and great beauty. I’m so sorry for you all, and am so happy Brian was there with you. Hugs and flowers in your hair.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s