More trauma

"So how's she doing?" I'd fielded the question many times in the past two weeks, but now I needed an antecedent for the pronoun.

"Which one?" I figured I knew, given that the person asking was my (almost) ex who had performed both Caesarians but who was fairly transparently fishing for compliments.

His expression told me he'd forgotten there was another; no surprise there, he can't keep my dogs straight. He covered with "The one that nearly died" hoping, I'm sure, that distinguished the one he was thinking of, and also confirming my suspicion that he wanted a little ego-stroking. He had, afterall, saved her life.

"Her" being Rio. I blogged about Cymri two weeks ago when she had to have a Caesarian to deliver her three pups. In the meantime Rio blossomed to a size that was painful just to look at. I knew she was carrying a huge litter, and the potential complications of overly large litters are scarier than unusually small ones. So I'd been on pins'n'needles for the last couple of weeks, especially when Rio stopped eating. That in itself is not terribly unusual; a female carrying so many puppies has trouble finding room for food. But she just didn't seem....right.

She went into labor a day early, again not surprising with her body under such stress. Two pups were born readily then nothing more happened for five hours. A little calcium coaxed two more, but once again she shut down for several hours. More calcium brought forth another three, but she was exhausted and depleted...more ominously, she was pasty, wan, and frightened. I pressed her gums...they stayed white. Minimal capillary refill...she was going into shock. Given the size of her uterus and the struggle, I worried the uterus had ruptured and she might be bleeding internally. I pulled out my little Doppler and couldn't find any fetal heartbeats; there was no more time for midwifery no matter how skilled-- she needed immediate veterinary intervention. I called the clinic, gathered up the five living puppies into a box with a hot water bottle, grabbed Brianne in case a blood donor was needed, helped Rio into the backseat and wished I could teleport to town.

An X-ray revealed three more puppies. Surgery was commenced quickly, and once again I found myself receiving three soggy, limp bodies warm from their mother's belly. Unfortunately one was long dead and though we got gasps from the other two, only one of those progressed to steady breathing in spite of our best efforts.

Puppy resuscitation attempts took place in a treatment room so I wasn't present to watch the struggle going on in the surgery ward. But the techs' comings and goings back and forth past the doorway had a hushed urgency and finally I had to go check, carrying the puppy whose heart I was still massaging. The heart monitor was beeping, the O2 stats looked fine, but several saturated towels on the floor attested to the amount of blood that had overflowed the surgery table, and the intensity with which the two techs were struggling to get a blood pressure reading dropped my heart into my gut.

"No pulse?" My question was sharper than I'd intended. "Oh, she has a pulse, we just can't find it." I couldn't tell if Keith's answer was meant to be reassuring, glib, or if if I should take it at face value. I opted for the latter and retreated for the puppy room, but snagged the next tech as she raced back by. PCV (packed cell volume) was through the floor. My hope went right with it.

But I knew Brianne was there, I knew we had blood available, we just lacked a trauma team to be able to work several procedures at once, and this was a situation that required a multi-pronged effort. The office manager had run to another clinic to get a blood-collection bottle, but everyone else already had a role to play in the process. And our surgeon was also our clinician so we couldn't collect the blood that Rio so desperately needed while he was still in the middle of surgery. He had her on a hyper-tonic (?) IV to help stabilize her blood vessels but that was only a stop-gap.

Finally he got her closed, I abandoned my fruitless efforts with the second pup, put the surviving one with the five from home, and brought Brianne into an exam room. Her face revealed her thoughts, thoughts which astounded me...the wrinkles on her forehead might have been concern, might have been fear, might have been foreknowledge. All I know is that she walked onto the exam table, looked me in the eye, licked my chin, and held completely still with her nose pointed skyward for ten minutes while a needle in her jugular pulled deep rich, platelet- and red cell-laden blood into a bottle.

Then the wait began while Rio lay inert on a blanket, babies tucked in beside her to nurse, an IV pumping fluids into one foreleg while the other, the beautiful crimson one, dripped life back into her other foreleg one pulse at a time.

Today as I watched her race towards me through the snow, grinning and beautiful, I marvel. I marvel that she doesn't waste a moment of today thinking about how she almost died last Tuesday. She doesn't regret, she doesn't bemoan, she doesn't fear. She lives.