On Thursday in Part 5 of this excerpt from the new book Equine ER,
we returned to the operating room where surgeon Scott Hopper was trying to remove a portion of the small colon trapped in a diaphragmatic hernia of Thoroughbred Marching Orders. Today, we go back to the operating room.
The mood in the operating room was relaxed and a little chatty. Dr. Scott Hopper had his left arm in the horse’s abdomen up to his armpit. Somehow the conversation got off onto people whose arms were double-jointed or abnormally flexible like Hopper’s. Dr. Megan Romano, an intern doing the anesthesia, came over for a moment and commented about how Dr. Embertson and Dr. Brett Woodie could bend some of the joints of their fingers so they looked clawed. She said she found it bizarre: “It’s so gross,” she added, as she stood right next to the horse’s guts, with blood and feces all over the floor. Then she went back to monitoring the anesthesia.
Hopper couldn’t get the hernia dilated with his fingers; he had to cut the scar tissue to widen the hole. That done, the muscle tore easily and he got the opening big enough to pull the colon out. But now the problem was trying to close the hole. The muscle comprising the diaphragm is thin, flexible, and hard to suture. And now, because of the hernia’s location, he couldn’t see what he was doing. He’d have to close by feel.
With a headlamp on even though the light added almost nothing to help guide him, Hopper plunged his left arm into the horse’s abdomen up to his armpit again to draw back some of the bowel and liver away from the hole, followed by his right arm and hand to suture it closed. The curve of his right index finger shielded the point of the needle to keep it from piercing the horse’s gastrointestinal tract. “There’s almost no way in hell I can get to this,” he muttered after about an hour. He didn’t need to suture the hole completely closed – as he would with a laceration – he just needed to get enough sutures in to keep anything from going back through it. But the muscle around the opening kept splitting. Hopper kept trying. The muscle kept splitting.
Another half hour passed: “C’mon, bastard,” said Hopper.
Thursday: What happened to Marching Orders.
We recently got a letter from reader Jackie Betts, telling us what she thought about the new book Equine ER (Eclipse Press, 2009). She wrote: "I found myself swept up in the day-to-day, sometimes minute-to-minute drama of this group of dedicated [vets] ... [the book shows] their private moments of fatigue and doubt and tears; all of this information is accessible and captivating." To order Equine ER, click here.
