A veterinary C-section by the sea

I recently introduced you to what life is like in Anguilla-a lovely island with an abundance of beautiful beaches but limited access to the outside world and its resources. As a result, the island can be slow to get many of the modern conveniences we're accustomed to in the States.

When my wife Georgia and I decided we were going to establish a concierge house call practice in Anguilla, we figured most of our time would be spent on wellness and preventive health. Reality turned out a bit differently.

You have GOAT to be KIDDING me

Providing top-notch veterinary care with modest resources is a daily challenge, but one recent case takes the cake. One evening, in the middle of my local Rotary Club meeting, I was called to the phone. It was Georgia. She had gotten a call from a local who had a goat kidding. No-I'm not kidding, but the goat was. She had been in labor for some 18 hours and her kid was presenting.

So, off I went. Rotary could wait. I met Georgia on a dark dirt road and we walked into an even darker field where we met Winslow, the goat's owner. Communication with Winslow was difficult, so his friend Lady stepped in to help fill the gaps. With no one else available to help, we reluctantly stepped forward.

An agrarian Cesarean

By the time we met the goat and saw the presenting kid, both were in sorry shape. I could feel the kid's head up in her pelvic canal and his front feet were protruding, but he was huge and simply could not budge-in or out. We had to assume that the kid was most likely dead but needed to make some effort to save the distressed and distraught first-time mother. If the kid wouldn't come out, we were going to have to go in and get him.

My wife and I are small animal practitioners, and while we have performed countless C-sections on small animals, we were ill-prepared for a large animal operation in terms of both experience and supplies. We just don't have the setup for sterile abdominal surgery.

Anguillan farmers are amazingly adept at midwifery, and C-sections are not usually performed on the island's farm animals, so we soon amassed a noisy, excited crowd of spectators who were busy filming the spectacle on their cell phones. It was an event! It was somewhat surreal to be in the middle of the muddle with only the light from a dim overhead bulb and a few cell phones.

Thankfully, we were just a couple of miles from home, so off Georgia went to grab supplies and a lantern (cell phone lights weren't going to cut it). Meanwhile, I sat on Winslow's back porch and tried to recall anything I'd ever learned about C-sections in the field. I conjured up images of inverted L blocks and flank incisions (“Let's see…right flank or left?”), but this was still going to be a challenge with no drapes, no appropriate drugs, and only 3-0 sutures. I was sure we were doomed to failure.

Miracle and her mom looking content and healthy after Miracle's emergency C-section. Photos provided by Dr. Mike Paul.It's a Miracle-literally

Well, to cut to the chase, we got the kid delivered and damn, if he wasn't still alive! Unfortunately, the mama goat was nearly dead and in shock by then, but she revived when we rubbed honey on her gums. We rinsed everything with sterile lactated ringers, poured injectable antibiotics into the abdominal cavity, and Georgia made sure I didn't inadvertently tack any loops of bowel into the surgical site. By the time I had the mom closed, she was trying to stand, and the kid, named Miracle by Lady, was trying to nurse.

We had a live goat and a live kid. While both were very weak when we left them, they were still alive the next morning. We called the owner to check and were told, “She be strong, and he be lively!” We tried desperately to impress upon him the fact that her surgical repair was tenuous at best and that confinement was essential, but he could not be talked out of taking the new family to the beach so they could wade in the sea and benefit from its healing properties.  

The 10%

Reflecting on the event a week later, Georgia said, “Those two were definitely among the 10%.” She was told in veterinary school that provided we don't screw things up, 80-85% of patients get better without our help, while around 5% will die in spite of our best efforts. But in 10-15% of cases, what we do makes the difference. We don't always know which ones those are, but in this case we did. This time we pulled two goats from the edge of the abyss.

I hope this was my last goat surgery, but I have a feeling I may be drafted to do more. I must admit it was a fun experience, and I would like to express my appreciation for the late John Noordsy, DVM, who taught this city boy what he never imagined he'd need to know. How wrong I was! Dr. Noordsy was an amazing surgeon despite having only two fingers on his right hand. He taught me that being adaptable and making do were invaluable skills in veterinary practice. These are the principles that carried us through Miracle's miracle birth.

While Drs. Mike and Georgia Paul worked hard to save the lives of Miracle and her mom, they know their former patients are an important part of the Anguillan diet.Patient today, dinner tomorrow

Unfortunately, Miracle is a ram kid and is thus not particularly valuable in Anguillan agriculture. We heard he is destined to be the guest of honor at dinner in a few weeks. Georgia and I aren't accustomed to saving a patient that is destined for the dinner table.

Dr. Michael Paul is a nationally known speaker and columnist and the principal of Magpie Veterinary Consulting. He lives in Anguilla in the British West Indies.