"You betta sew dat up, Boy..." Part 1

I’ve had the good fortune to work with some pretty sharp veterinarians over time.  If I was seeing something new or needed a fresh set of eyes to look at a problem I was having, I had some folks to lean on. One of those was a semi-retired veterinarian from South Carolina, Dr. L.  He’s a Korean War vet and has a neat Low Country accent that becomes more pronounced when he’s excited or unguarded.

Dr. L. was in his seventies when we were working together, and I was in my twenties.  He had owned a practice in Atlanta and sold it, and was working two or three days a week in retirement. He had a wealth of experience and a good way with people.  As a matter of fact, he is good people.  I learned a lot from him. Here’s an example:

A dog named Scoot came to the clinic with a lipoma on his elbow.  Lipomas are benign fatty tumors. They rarely pose any kind of health threat to a dog, but they can become so big that they have to be removed. And Scoot had a massive one.  He weighed about 42 pounds at the time of surgery, and a significant portion of that was the massive growth.  It was interfering with the range of motion of his leg and making him unable to lie down on that side… it was about the size of a child’s bowling ball. Taking the growth off was going to make his life a lot better. The growth was so huge that I debated as to what was more correct: Was I removing a tumor from the dog, or the dog from the tumor?

We got Scoot on the table and I made my incision. I started to work around the massive growth with my fingers, and it started to detach from normal tissue at the edges like these tumors usually do. As I started to work my fingers around the underside, I started putting upward compression on the rubbery mass. When I had nearly worked a full circle around the mass, the upward pressure I was putting on it overcame the strength of the tissue holding it in place. It tore away from the thin strands of connective tissue, flexed to get through the incision, and shot out of Scoot’s chest. Gravity did the rest of the work, pulling the massive clump of fat down and onto the table, tearing away the last remnants that held it inside.

Unfortunately, one of the last things holding the tumor inside was a huge blood vessel that had been hidden on the back side of the mass. The weight of the falling growth had torn it in two, and blood was spurting everywhere. It was under tension when it tore, so when I looked into the space where the tumor had been, I saw the end of the vessel slowly retract to its original position… behind a rib.  And it was bleeding heavily.  Needless to say, this was a problem.

I quickly ran out of gauze sponges in the surgery pack trying to keep things in check, but was getting nowhere- gauze was getting soaked within seconds no matter how hard I pressed. Being on the back side of the rib, there was no way to get to the vessel with a clamp without potentially puncturing into the chest. I realized that I was in trouble, and sent the tech to try to find me some help. Dr. L. came into the surgery room within seconds and looked at the mess I was in. I gave him a rundown of what was going on.

“Lemme see dat, young man,” he said in his characteristic drawl.  I took the gauze off the top, and the flood started again. Dr. L’s eyes went wide.

“Woo Hoo! You betta sew dat up, Boy!” he exclaimed.

And then he just walked out of the room with an amused grin on his face, shaking his head.

I was dumbstruck, expecting some sort of complex plan.  A plan devised from his years in practice?  Maybe from something he had seen in Korea?  … Well, no.  But his plan was better than mine, and he had been in practice for far longer than I had been alive, so I decided to go with it.  I pushed my doubts aside and began to sew like the wind. With the first layer, I pulled in all the subcutaneous tissue I could, trying to build the Great Wall of Georgia, filling the space where the tumor had been. I did more of the same with the second layer, and, to my great relief, the bleeding slowed to barely a drip. I finished the closure and monitored Scoot as he began to wake up from anesthesia.

We put a compression wrap around Scoot’s chest after surgery to help prevent any further bleeding.  Scoot went home the next day with a heads-up to the owners about bleeding from the wound.  That turned out to be pointless, because he recovered with no issues.

I learned a valuable lesson that day from a man who had seen a lot more bad situations than I ever had. When all else fails, sometimes the appropriate course of action is to “sew dat up”.

And the tumor?  We put it on the scale after we were done.  It weighed 7.3 lbs.

-RAB