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MIDNIGHT (AND BEYOND) by Ken Keckler DVM

Midnight.


Time to be sleeping. Or, as a famous author once wrote, "the most witching hour of the night". Many mothers and coaches have said "Nothing good happens after midnight." As veterinarian on emergency, I would agree wholeheartedly. The pager goes off around 11:55 PM, and wakes me up out of a fitful sleep. I call the answering service to get the name and phone number of the client with the problem. He's a nice, middle-aged guy who works in a post office. I'd worked for his older sister for several years, and if something could go wrong with her horses, it did.

 

The phone rings and the voice on the other end sounds worried. "Hey Doc, my mare has a huge cut over her hock. She got caught in the fence and it needs sewed up." My heart sinks. This isn't just a phone consultation. I'm going to have to go out. It's late in the spring, so at least I'm not going to freeze. "Alright," I mutter. "I'm on my way".

 

It's really dark, especially the further I get into the country. The night is clear and the stars are bright and impressive. Too bad I'm awake to see them. This gentleman boards his three horses at a small barn, with plenty of pasture space, much of it enclosed with high tensile wire. High tensile wire. Just like a cheese slicer, it carves up horses' legs in an instant. Nothing good happens around high tensile wire.

 

He pulls the mare out of the stall into the long aisleway. Actually, the aisle goes all around the outside of the barn and could be used as a track for exercise. The stalls were back to back on the inside. The outside of the aisle was lined with old glass windows that would have looked out onto the pasture if they weren't so grimy. He ties the mare to the wall post to the right of one of the windows, and I start to look her over and ask questions. "What the heck were you doing out here after 11:30 at night?" (Most important question first!) "I was bringing my horses in from pasture." he says. "OK, but why so freakin' late?" (It's important to get a full medical history!) "Well," he says, "I was bringing my stallion, gelding, and mare in together, and the stud started acting up, and the mare got upset and got away from me." Suddenly, the hour wasn't as important as this new information. "Wait a minute", I question. "You were bringing the stud and the mare in together, at the same time? Are you crazy?" He looks a little sheepish. "Well, I was in a hurry 'cause it's late. Darn mare must be in heat or something."

 

 Hmmmm. Or something. Nothing good happens bringing a stallion and mare in together.

 

There is quite a long gash across the face of the left hock, very possibly involving the upper joint. It's dark, so I set up an electric light in addition to the weak incandescent bulbs on the wall. Since most of the laceration is toward the inside of the leg, I'm going to have to work on it from the right side, reaching under her, past her right hind leg. I get a tetanus vaccine into her, some tranquilizer, and get to work scrubbing the wound, trimming strands of injured tissue, trying to identify good skin edges and whether the joint is involved. I pull up a large volume of lidocaine and inject it subcutaneously around the margins, going pretty wide because I'm going to have to put in tension relieving sutures. This is a fairly complicated, time consuming laceration.

 

Meanwhile, outside on the other side of the wall, a horse has been pacing back and forth this entire time. While it doesn't sound frantic, it is certainly anxious. "Somebody is impatient out there." says I. "That's the stud. He's fine" the owner states. "Don't you think you should bring him in?" I ask. (It's a little disconcerting hearing the constant hoofbeats of a horny stallion while you're working on a mare, sedated or not.) "Nah. Leave the son of a gun out there." I shrug and continue to work, crouched mostly underneath her right side. The wound is starting to look cleaner as I am trimming away damaged skin.

 

CRASH! The window on the opposite side of the mare explodes inward with a shower of glass. I'm incredibly lucky that the mare doesn't jump on top of my head. "What the heck was that?" I gasp. "The stud. He must have bitten the electric wire that runs across the window and snapped it." "Are you sure?" I ask. "Maybe you should go check on him." "Nah, he's fine," states my overly optimistic client.

 

I begin to place vertical mattress sutures in the hock wound, which is going to be a challenge to pull together. The stallion outside is quiet, no pacing. This worries me. Mr. Optimistic still thinks every thing is fine, but he hasn't looked outside. Many minutes pass, and the Mr. O's curiosity finally gets the best of him, and he heads for the pasture door at the other end of the aisle. He brings in the stallion and stops inside the door. "Doc, I've got another one for ya."

 

My heart sinks. "You're kidding me, right?" I haven't gotten very far with the hock, and I can faintly hear what sounds like an open spigot with water hitting the ground. As I approach the stallion, I realize that it is blood spraying from the back of his right front pastern. "         !" (I can't print what I said). Scrambling back to the truck, I get bandage material and quickly pressure wrap the heck out of the bloody pastern for a few minutes, hoping it clots. Meanwhile, I can work on the mare's laceration.

 

I am throwing sutures in the hock as fast as I can, double spacing just to get the edges pulled together before swelling makes it impossible. My plan is to get to the stallion that is bleeding profusely (and already soaking through the bandage), sew him up, stop the bleeding and then return to finish the hock. As I suture frantically, Mr. Subtle (the owner) looks over my shoulder at the gapping skin and the placed sutures hanging over the face of the hock and asks "Is that the best you can do with that?"

 

Resisting the urge to put a twitch and a lip chain on Mr. Subtle, I unwrap the stallion and find that it's even worse than I had hoped. The skin across the back of the pastern is lacerated horizontally, cutting through the vein, artery and nerve on the lateral side, through the tendon sheath, and superficial digital tendon.  Most discouraging, the deep digital flexor tendon (DDFT) is severed. There is no good way to repair the deep digital tendon: it supports the lion's share of the horse's weight down the pastern and into the foot. Sutures will tear through it. Without it, the toe flips up. Nothing good happens when the DDFT is transected in the pastern.

 

After gentle cleaning, (don't disrupt the clot!) I close the tendon sheath, then the skin.  A heavy pressure bandage goes on and then I duct tape a wooden wedge onto the hoof and bandage to elevate the heel and hopefully keep the severed ends of the DDFT close together.

 

Next victim.

 

The mare is still standing patiently (thank goodness for tranquilizer) when I finally get back to her. I finish closing the skin of the hock and bandage the heck out of the leg. Antibiotics and anti-inflammatories all around.

 

I throw out the garbage, clean the surgical instruments, and walk out of the barn.... to the sunrise. A beautiful sunrise with pink sky and wispy clouds on the horizon. Birds are singing. I am not. All I know is that it's time for me to go to work. Nothing good happens when you've been working all night and still have to go to work.

 

Worst. Night. Ever.

 

The mare's hock healed with a scar (as could be expected). The stallion's tendon sheath leaked fluid through the laceration and became infected despite antibiotics and frequent bandage changes. The owner (no longer optimistic) took off the wedge and the tendon could not reattach. I ended up having to euthanize the poor guy several weeks later. Not every tale has a happy ending.

 

The moral of the story: castrate your stallions, and bring in your horses at a reasonable hour! Please?

 



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