Diary of a Fourth-Year Vet Student: Life and Death

Death is ever present in veterinary medicine. Both GPs and specialists have to address death on a daily basis. As part of our training, vet med students are introduced to it in many different ways.

I was on call one night during my anesthesia rotation, and got called in around 9pm for an emergency colic surgery on a mare. Students aren't left on their own for this sort of thing--an anesthesia technician is called in too. It was evident minutes into the procedure that the prognosis for this horse was going to be extremely poor, but the surgeons do their best to make absolutely sure that they have considered all possible solutions, so I had to monitor the anesthesia and keep this poor horse alive for almost an hour even though everyone in the room knew what the outcome was going to be.

The mare had a strangulating lipoma wrapped around her small intestines. Her large intestines were so distended with gas that they literally popped out of the initial incision. The lipoma was large, about the size of a cantaloupe, and was wrapped around a part of the gut called the ileo-cecal junction. In a horse, this is a pretty critical section of gut plumbing. Upstream of this junction is the part of the small intestine called the ileum. The entire ileum in this mare was black and necrotic. It smelled terrible. It smelled like death. When dealing with sections of dead gut, it is theoretically possible to cut out the bad part and rejoin good (i.e., living) tissue to good tissue, but the extent of the necrosis and the location of the strangulation combined to make an extremely poor prognosis for this horse.

I will spare you the photos of the horse's guts but I will share this with you. It is a picture of a toxic line in the horse's gums (lower jaw). I had only read about this particular clinical sign and never had the opportunity to see it before.

Notice how her gums are very pale above a sharply defined, dark red line. This is a sign of impending septic shock. There were a lot of really bad chemicals coming out of all those dead intestinal cells that were now in her blood stream, wreaking havoc with her vessels and immune system. Even if the surgeons could have successfully resected her gut, when she was revived from surgery, her body would have been flooded with the bad chemicals. She likely would not have survived that.

Anesthesia lets us straddle the line between life and death. Alone, it is not a cure for anything. It is just one of the many tools we use to make our animals better if we can.