You bettah sew dat up, Boy Part 2

It’s another incident from my time with Dr. Livingston…

It was a brilliant stroke of luck that the metro Atlanta practice I was working at was right next door to a Mexican restaurant.  I had just finished another delicious lunch there, heavy on the sour cream and spicy beef, and was walking back to the clinic with a lovely carbonated beverage in hand when a car tore into the parking lot and went sideways into a parking space.  The occupants of the car sprung out of both sides, grabbed a cat carrier out of the back seat, and hurried inside.

I picked up the pace and hit the side entrance to the clinic. Bob The Tech was already looking for me.  

“You gotta see this one, Doc. The owner thinks a bee did it” was all he said.

The two of us headed into the exam room, where the rattled owners pulled a cat out of the carrier sitting on the table. The problem was obvious as soon as Bob The Tech turned the cat’s head toward me. The left eye had ruptured and was shriveled up like a raisin sitting there in the eye socket.  The fluid that should have been contained inside the eye had drained down onto the cat’s cheek and dried there. I had read about these injuries before and the recommendation was always the same. General practitioners were recommended to remove the eye or refer to a specialist to see if some kind of salvage would be possible. The odds on any kind of functionality are near zero, and the odds on complications are very high.

I talked to the owners about options. Their major concern was the way that their 4 year old child would react to seeing his buddy with one eye. In fact, the cat had been playing out in the front yard with the child when the trouble began. The owners had heard the cat howl, and saw a bee buzz away from its face when they turned to see what had happened.

Even though removing the eye seemed the first choice for treatment, the clients simply weren’t ready to own a one-eyed cat.  They had turned down every other option that I had offered.  Just about that time, I heard the side door open, and knew that Dr. Livingston had just come back from his lunch. I asked the owners to excuse Bob The Tech and myself while we stepped out to clean the cat’s cheek.  This gave me a chance to get a better view of the wounded eye … and to get some advice from Dr. L.

I told him what was going on as he calmly sipped his sweet tea.  When we showed him the cat,  he looked at the eye, thought for about ten seconds, and then looked at me and said (drumroll, please) “What would happen if you just sewed dat up? You can tell ‘em dat it might not work, and they’d have to take the eye out anyway, but it would give them some time to think it over.”  What he had suggested was suturing the lids shut over the damaged eye, forming a biologic bandage, and giving Mother Nature a little time to do her thing.

Once again bowing to superior wisdom (I had been out of graduate school less than a year at this point), I went back into the room and talked to the clients. They immediately decided to give it a try. The name of this procedure is tarsorrhaphy. I have thought about nominating it for the “Most Difficult Word in the English Language to Spell” award. Pronouncing it is a lot easier: tar-sore-a-fee, if you’re from the South like me.

Bob The Tech and I sedated the cat and started prepping the eye for surgery. When we were just about ready to start suturing, I noticed something odd about the eyeball.  There was a little splinter-like structure adhered to the middle of it, just to the side of the point on the cornea where it ruptured. I looked at it under a microscope, and it was a bee stinger. The owners were right: a bee sting had been the cause of the trouble. We sutured the lids together, started the cat on antibiotics, and hoped for the best.

Ten days later, the family came back with their cat for suture removal.  I was expecting to see a ruined eye when I pulled the stitches out. Instead of seeing a shriveled raisin sitting in the socket, I uncovered a fully re-inflated eye that was apparently not painful.  The entire cornea (the part on the front of the eye that is supposed to be clear to let light through to the inside) was a milky white from being covered. I shined a light into the eye and there was no response- the pupil stayed the same size.  I told the owners that while the eye had returned to its normal shape, the vision in that eye was gone. Considering that we expected the cat to completely lose the eye, the owners were happy with the outcome, overall.  I asked them to come back in a few days for me to check things over.

Three days later, they were back in the office. My appointment notes from the receptionists said “Owner believes that cat can see.”  I was skeptical.  I went into the room and looked at the eye: almost all of the white discoloration was gone, and there was only a single small scar surrounded by clear cornea again. I shined a penlight in the eye, and the pupil constricted like a normal pupil should... the interior structures of the eye were working.  I moved my hand toward the eye to see if the cat flinched or blinked, and it did. You could have knocked me over with a feather at this point. The cat went from having a  totally wrecked eyeball with little chance of recovery to having a functional eye. It appeared that everything was going to be fine.

While I tried to recover from the astonishment, the  cat just sat on the table, angrily switching its tail from side to side, wondering why I had been so rude as to shine a penlight in its eye.

Thanks again, Dr. Livingston.

Merry Christmas, everybody!

-RAB