I listened to a report on the radio the other day about a British surgeon working for Medecins Sans Frontieres in the Congo. He was faced with a young lad who’d had his arm ripped off six inches from the shoulder joint, perhaps by a hippo, perhaps by a bullet during exchanges between government and rebel forces.
The remaining stump was now gangrenous and threatening the life of the boy with his only hope of survival being what is known in the medical profession as a forequarter amputation. An extremely rare and tricky intervention involving the removal of the collar bone and scapular, and one that is only carried out in Britain around 10 times a year.
The surgeon in question had never before performed this operation but luckily he knew a man who had. I’m certain that the reason for the story assuming such prominence in the media is that the surgeon received instructions from his colleague via text messages on his mobile phone.
There is something very “romantic” about this sort of story that I suppose harks back to the good old days when have-a-go treatment was a perfectly acceptable way of carrying on. As the saying goes, “In the land of the blind the one-eyed man is King”, and any doctor was better than no doctor at all and it would have seemed churlish to ask to see a specialist or for a second opinion.
Those days in medicine have long since passed and I fear that they are passing pretty damn rapidly in veterinary medicine too. Why do I fear it? Because specialist treatment and specialist facilities means specialist prices too and also removes many of the more interesting challenges that face your average veterinary practitioner in practice. Getting the right balance between competence/cost/ availability/ convenience is a very difficult judgement call.
There can’t be many vets of my era (1979 graduate) who haven’t done some sort of surgery with a book on surgical techniques open on the bench next to the operating table. Yes I know that it’s not ideal and is probably highly frowned upon now, but whilst I know that I’ve made a few mistakes in my time, I’ve also had some pretty good successes too.
And frequently, the alternative would have been euthanasia as the clients involved would almost certainly have been unable to afford the services of someone to whom the procedure was second nature. In these cases, going back to first principles and a bit of expect guidance from wherever possible, book or mobile phone, is exciting, challenging and frequently rewarding.
I can relate very well to the delight of the surgeon in the above story when the boy in question made a full recovery against all the odds. Particularly as I once spent three years working in the Falkland Islands, one of only two vets at the time, where have-a-go veterinary medicine was the weekly norm.
A positive slant
Knowing that there is no one on hand who can do any better gives a positive slant to even the most difficult problems because you know that the best you can offer really is the best that the animal in question can expect.
In such cases there is frequently much preparation in terms of reading about the technique in books or contacting friends and colleagues with more experience in order to receive practical advice. Then it is just a case of taking the bull by the horns and getting stuck in.
Even simple procedures like cat spays take on a new challenge when you are performing them literally on the owner’s kitchen table in full view of the whole family. Just getting the anaesthetic right when there’s only the owner to hold the animal and then top up the i/v drugs (so you don’t need to constantly rewash your hands) is the art of veterinary science at its very best and in many ways its most rewarding.
Similarly, castrating unhandled three-year-old colts, or attempting all sorts of previously untried orthopaedic surgery on dogs and cats because the only other option is amputation.
And it is always surprising that so few things do go wrong when you really put your mind to ensuring that all goes right. Which is a testament to the healing power of animals but also to humans too because the boy in the Congo survived despite there being no intensive care unit to speak of and only one pint of blood for the type of surgery that usually requires many.
Diminishing
And the point I am trying to make in all this? Firstly, the opportunities to experience the pleasure of performing have-a-go surgery are almost certainly diminishing in modern veterinary practice. I’m not saying that is a bad thing because it is ethical that procedures should be carried out by someone who is generally competent to carry them through.
However, that degree of competency usually comes at a financial cost and although the outcomes of the additional cost are likely to be better, I suspect that the further down this road we go the relative improvement in returns against the increasing costs becomes smaller and smaller. An improvement that is no doubt important to many animal owners but perhaps less so to others who may be prepared to accept a “poorer” level of treatment if that is what fits in best with their financial situation.
From a personal perspective I know that there is nothing in the veterinary field quite so rewarding as performing successful surgery against the odds.
Call me an old dinosaur but I do have some regrets that it is increasingly likely that in the future one will have to work somewhere as remote as the Falklands in order to experience it.
