C-Section

Monday, June 7, 2003

The giant dog waddled into the exam room. For a moment, Dr. Allan Pritchard thought the dog would get stuck in the doorway because her mid-section was distended and as wide as the door. She passed with a couple of inches to spare.

"Looks like a cross between a St. Bernard and a double-wide mobile home,” he said with a smile to the petite lady being dragged along by the hemp rope tied to the dog's neck.

"Oh, but such a sweetheart she is,” Alice Parker replied. "She wound up on our doorstep a couple of weeks ago, in a motherly way. She was wet, cold, and hungry. One look with those soft brown eyes, and I was hooked. She's come close to eating us out of house and home since then, but I can think of worse ways to end up in the poorhouse."

Alice and her family had been clients of Dr. Pritchard ever since he'd opened his practice in Waynesboro six years ago. Like most of his clients, the Parkers were good ole southern folk, not high on the cuff of life financially but with a wide-open heart. Somehow they always paid their bills, although not as quickly as he'd like all the time. At last count, Alice had three other dogs and no telling how many barn cats, and her two-footed family was almost as large. If the truth was known, a hundred-pound pregnant bitch was the last visitor they needed on their doorstep, but for some reason, Providence seldom stopped to consider such details.

Allan noticed two of Alice’s strapping teenage sons standing awkwardly outside the door. Thank goodness for strong help. He'd already called Dawn, his receptionist and right-hand assistant, but it would be another twenty minutes before she would be dressed and at the clinic. Hopefully, by then he'd know whether a C-section was in the making for the early morning hours or not. Gazing down at the rotund mid-section of the dog, he suspected that would be the case.

"Boys, how 'bout coming in here and giving me a hand? Given the size of mamma dog here, I don't think we'll lift her on the table.  But I'd like to check to see if she has a puppy in the birth canal. She's less likely to drag us into the next county if you two help hold while I do it."

Dr. Pritchard turned to Alice and smiled at her. "No offense, ma'am, but I'd like you to take the bow. Get in front and talk to her. All this is really frightening to her, and she could use your comforting."

"No offense taken, Doctor Pritchard. Lord knows, I ain't got much control over her. I'm no more than a fly pestering at her neck with this here rope."

Alice relinquished the rope to her two sons and knelt down in front of the dog and spoke softly in her ear. "It'll be alright, Molly. Doc here is going to take good care of you."

She looked up at Allan with a sheepish grin. "Don't rightly know what her name is, but she reminded me of Molly O'Brien when she was carrying her triplets. Since she don't come to any other name, we figured Molly was as good as any."

"And better than some,” Allan replied as he slipped the long fingers of his right hand into the latex glove. "I'm going check to see how far along she is and if I can tell if we've got a pup lodged in the canal."

"If she's breech, does that mean you'll have to cut the puppy up to get it out of her?" Buster, Alice's younger son, asked.

"Where'd you get such an idea?" Alice asked, her eyes growing large at the thought.

"That's what Doc Williams had to do with Jimmy's milking cow a few months ago. She couldn't have the calf, so he went in and sliced it up and yanked it out piece by piece."

Alice turned to him, her face white with fright. "I don't care so much if we save the pups, that's not what's most important here, but you won't have to put Molly through such an ordeal, will ya, Doc?"

Allan smiled reassuringly. "Don't worry, Alice. Small animal practice is a bit different from a farm practice. I'm going to see what's what in here first. If we have a breach, we'll simply do a C-section. Molly will be asleep, and she won't feel anything. Let's not jump to conclusions." He smeared the glove with lubricant.

"Hold her still, fellas. This may be a bit uncomfortable for her.”

A soft groan of anguish worried Allan at first as he inserted the gloved finger into the dog's vagina, but he relaxed a little when he realized the sound came from Molly's concerned owner. Molly continued to stand patiently, apparently unconcerned by the invasion of her privacy.

"It's times like this that I'm glad I have such large hands,” Allan said. He felt around for a few seconds and didn't like what he found. "There's a pup in the canal, no doubt about it, and it feels huge. How long did you say she'd been in labor before you called me?"

"I'd say a good two, three hours,” Alice replied. "At least half that time she's really been straining, but she wasn't having any luck."

Allan pulled his finger out, slipped the glove off his hand, and tossed it in the trash can. "Well, we could take an x-ray to confirm what I suspect, but all indications point to a C-section."

“To tell the truth, Doc, if it's all the same to you, I'd just as soon avoid the extra expense of the x-ray. As it is, I'll have to pay for the surgery over time, but you know I'm good for it."

"I'm not worried about that, Alice. You sit here with Molly and make her as comfortable as you can. I'm going to get the surgery suite set up so we can begin as soon as Dawn gets here. We'll take good care of mamma and the pups."

Alice patted the dog’s broad head, and Allan noticed her eyes glistened more than usual. "Take good care of her, Doc. I've gotten attached to her. Like I said, I'm not so concerned with the pups. If it's a question of her or the pups, save old Molly here."

Allan understood what Alice was saying. There were to be no heroics saving the puppies if they were in trouble.

––––––––

"KEEP THE GENERAL ANESTHETIC as light as you can and still keep her down, Dawn. I'm also using a local so she won't feel the incision,” Allan said as he draped Molly's newly shaved and washed belly. "We want to get in and out as quickly as possible and get her awake."

Dawn nodded and smiled. Allan knew what she was thinking. In the six years she'd worked with him, she'd heard the same speech many times before. More than once he'd used her as his sounding board extolling the virtues of quick surgery. Not so fast that you were sloppy, but not so darn fired slowly that you lost the patient from too much anesthetic. She squeezed the bag of the anesthetic machine, then refilled it with fresh oxygen.

The two worked like a well-oiled team. They both knew what to expect from each other. That's why even though Allan had two other fully trained and qualified technicians, he called Dawn for the emergency surgeries. Besides, she lived the closest to the clinic, and she was divorced with only a teenage daughter. She didn't mind the late-night calls. At least that's what she told him whenever he asked.

Allan finished clamping the last drape in place and reached for the scalpel. He made a bold incision along the midline between the two rows of engorged mammary glands and watched as the blood mixed with the milk of one of the glands where it had been nicked. It fascinated him that tissue could bleed milk as well as blood. He sponged the incision for a moment before making a second incision through the connective tissue of the midline of the abdominal muscles.

"It feels more like I'm operating on a horse than a dog,” Allan said to Dawn as he finished the incision and laid the scalpel down on the instrument tray. "Do you have a box and towels ready? In a minute, we'll be up to our knees in squirming yelping pups."

"All ready, Dr. Pritchard. You start tossing them out, and I'll start catching them. Don't worry about the umbilical cords. I've got the suture material ready to tie them off."

Allan smiled behind his mask at Dawn's formal use of his title. It didn't make any difference how often he told Dawn it wasn't necessary to call him doctor after hours. Old habits die hard, and since she'd been in human medicine for five years before starting with him, she was trained to use the formal title long before she came to his clinic. Besides, as she often said, "Once you're a doctor, you're always a doctor."

He reached into the incision and pulled the right horn of the uterus out. As he did so, Molly's side collapsed to normal size. "Whoo-wee, we've got some large puppies here. I wonder if she mated with one of old man Jacob's Shetland ponies."

He rested the thick tubular uterus onto the surgery drape and worked to free the left horn from Molly's abdomen, looking for an area without major veins coursing through it to make the next incision. Blotting the glistening surface with several gauze sponges, he reached for the scalpel.

"How's she doing, Dawn?" Allan asked as he prepared to cut through the muscular organ.

"She's stable, and her gums are nice and pink."

"How 'bout increasing her I.V. drip a little? This is about the time her blood pressure is likely to drop."

"It's done,” she replied in a few seconds.

"Good. Well, get ready for some pups that might resemble Shetland ponies." He slid the scalpel smoothly across the body of the uterus so he could pull all the puppies from both horns through the one incision.

Allan was always thankful when he cut into a uterus for his years of training at the emergency clinic where C-sections had become a routine piece of surgery. A cut too deep could leave one or more puppies missing a toe or worse. He made the incision lightly through the uterus, deftly stopping short of the fetus that lay beneath.

Placing the scalpel back on the tray, Allan reached into the incision to pull out the first puppy. His hands made contact with the creamy white surface at the same time his eyes told him he was touching a huge pulsating maggot. Without thinking, he yanked his hands away and stepped away from the table, feeling an involuntary shudder course along his back.

"What is it, Doctor? What's wrong?" Dawn asked at the sudden movement. "Did you hit a bleeder?"

Allan stood frozen to the spot, a good two feet from the table, his hands clutching the surgery gown at his chest. A wave of nausea passed through his body and up his throat. He swallowed once, twice, tasting the foul stomach acid.

"No, no bleeder. Everything is fine—I think,” he finally said.

He felt a droplet of sweat trickle down his temple and had the absurd urge to ask Dawn to wipe his brow but refrained. Taking a final gulp, he stepped back to the spot he had so recently vacated. He stared into the incision at the pulsating mass partially hidden by the pooling blood that seeped from the incised uterus but didn't take his hands from where they were glued to his gown.

"Are you okay, Dr. Pritchard?" Dawn asked as she rose from the stool she sat on next to the anesthetic machine.

"I'm fine; stay where you are,” he said too brusquely. "I'll let you know when I need your help,” he added in a softer tone.

Taking the longest forceps from the surgery tray, Allan gently prodded the blunt end of the mass. It retracted itself away from the probe. As it did so, he could see what appeared to be a similar mass lying beneath the first one. How many of these horrible things could there be? he wondered. As the shock of the discovery subsided, the inquisitive mind of the scientist emerged. How could these things have gotten inside her? Were they parasitic? Had they eaten the puppies that should have been in there?

Allan noticed the pool of blood slowly expanding, seeping from a medium-sized vessel. He clamped it off with forceps then cleared the pool with a wad of sponges. Molly still needed help in delivering whatever it was inside her. With another shudder, he reached into the incision and gently cupped his hands around the swollen lump. It had a firmer feel than he had expected and was warm to the touch. Still feeling the pulsating motion through his gloves, he fought a strong urge to withdraw his hands.

Allan pulled the mass out of the uterus. It slipped out with a sucking sound like pulling a shoe out of the mud. At about eight inches, it was much longer than he had imagined. Pulling the wormlike mass out of Molly's abdomen, Allan looked for some sign of an umbilical cord but couldn't find one. As the other end reached the surface where he could see it, he noticed it was lightly attached to the inner lining of the uterus and was a little more sharply tapered. Could this be its head? he wondered. He wiped the glistening surface with the partially blood-soaked sponges and as he did, he heard a gasp of astonishment escape from Dawn's lips.

"Oh my God!" she whispered when she finally found her voice. "What in God's name...?"

Allan gently laid the larvae-like mass in the towel-lined box that Dawn had prepared—the box that had been intended for cute, cuddly puppies. The lump wiggled much like a newborn pup, but there was no chance of confusing the two.

"I don't know what in God's creation it is, or if it even is of God's doing, but there are plenty more where that one came from,” Allan replied as he pulled the second squirming mass from the incision. By this time the beads of sweat dripped from both sides of his face, but he ignored the tickling sensation. He was repulsed by the eight-inch maggot-like masses and at the same time drawn by curiosity.

Surely they can't live, he thought. What if they did? What would they grow into, and from where did they come? How could nature be so arbitrary with such a miracle as birth? He continued to pull them out of each horn of the uterus until six white sausages lay in a row in the box.

Finally convinced he had the final one, he looked up for the first time at Dawn's pale face. He tried to smile and was glad the mask hid the feeble attempt. "Well, Dawn, aren't you going to goo-goo over the little bundles of joy like you always do?"

"No way!" she screamed at him, an edge of hysteria in her voice. "I'm not touching those horrid things, whatever they are." She stared down at the box despite herself. "What are they, anyway?"

"Well, they might be the ugliest litter of pups ever recorded, but I kinda doubt it," Allan joked in an attempt to lighten up the atmosphere of the room. "All I can guess is they are some bizarre parasite that somehow made its way into Molly's reproductive tract. Not that I've ever seen or heard of such a thing."

"What are you going to do?" Dawn asked.

"I'm going to finish this piece of surgery first. Alice wanted me to go ahead and spay Molly if possible. Given what we delivered, I think it’s an excellent idea."

"What are you going to do with those?" Dawn pointed to the box, a look of disgust still glued to her face.

"I don't know. I suppose we could save them for a barbecue this weekend." He knew as soon as he said it that it was a mistake. He'd been accused more than once of having a sick twist to his sense of humor.

"Dr. Pritchard! Sometimes you say the most horrid things—really."

"Well, don't worry about them. I'll dispose of them. I'm sure whatever they are, they don't have a chance of living."

Several minutes went by without either one talking as Allan concentrated on the surgery. As he finished removing Molly's enlarged uterus, he paused and looked at Dawn. "Alice wasn't concerned with saving the puppies as much as she was with Molly. I think it would be best to tell her the puppies were born dead. No reason to have her all worried about something we can't explain."

"You don't have to worry about me, Doc," Dawn replied, glancing down at the box one last time. "As far as I'm concerned, the less said about this night, the better."