• James E Aarons DVM

Umbilical Hernia


The next morning Katie made coffee while Rory went to his truck to make sure he had all the supplies for his surgery.

“Here’s your coffee Rory,” she said when he returned inside.

“Thanks, Katie. What time are you calling Dr. Schwabe?”

“Nine o’clock.”

“Ok, I'll call Jen to let her know we’ll be a half an hour late.”

“Jen? I just saw her yesterday. She didn’t say anything about doing surgery with you.

“It’s a horse at Thistledown Farms. Sarah, the stable owner, is Jen’s friend. She offered to help me. Why is that an issue?”

“I’m not sure. Just vibes I’m getting Rory. She seems awfully interested in you. Let's talk later. I have to make a phone call before we go.”

“Okay.” Rory went back to the truck to wait for her.

“Good morning. Is this Dr. Schwabe? This is Katie Reynolds, Dr. Prasad urged me to call… Well thank you.”

She listened nodding her head. “That’s what Dr. Shivaprasad said, you need help with the outbreak.“ Rory heard one side of the phone conversation through the window.

“Umm huh… sure. Yes.”

“Really? Sure… yes, it sounds intriguing. Let me see what I can do. When can I call you back doctor? Ok, I'll call you soon.”

The back door burst open.

“Rory! I have exciting news!”

“Cool. Do you still want to come with me? We can talk on the way.”

“Oh yeah, let me get my things.”

On the drive to Thistledown Rory was quiet and waited for her to tell him her “good news.” Finally, she spoke.

“Dr. Schwabe has a project for me.”

“A project? I thought he wanted you to do classes first.”

“Those won’t start until the fall, and I don’t need classroom instruction to work on an investigation. He wants me to help Dr. Shivaprasad to see if we can find the origin of the outbreak of the distemper virus in California.”

“I thought you were going to work for Paula, stay here, and help me build up a practice. Remember?”

“I agree that’s our goal for the future, but I’ve never fully committed to be here with you Rory.”

“That’s the thing. You can’t commit yourself to us.”

“Now wait a minute here. What have you asked me to be? Your girlfriend, your wife, your partner? I haven’t heard anything concrete from you. Besides, you seem to have found a cozy place here with or without me. What exactly are you asking me, Rory?”

“We can talk about this later. We’re here at Thistledown Ranch already…”

“No, why is this so hard? René and Pelipa are married; did you know that?”

“No, they’re your friends. Why would I know of their wedding?”

“Because they fell in love and got married. It isn’t that hard. Now come-on Rory.”

“Shit, stop it, Katie. Help me with this surgery.” Rory put the truck in park and left quickly, glad to have something else to focus on besides Katie.

“Hi, Jen how are you? You looked good on TV, you and Katie.” He reached back into the truck searching for his hat nabbed it and jammed it on his head.

Katie followed, slamming her door hard, walking around the vet truck with a scowl.

“Hi, Dr. Rory. I’m good. Hello, Doc Katie. I thought you were tied up in Fresno for that study with Dr. Prasad. Doc Katie, this is Sarah. She owns the stallion. Dr. Rory asked if I could help today.”

“Hi Sarah, nice to met you.” Katie shook hands with Sarah, turned, and finished with Jen. ”All my questions were answered, so I was able to come home last night. You did a good job on the horses yesterday.” Katie smiled back at her even though she didn't feel like smiling. “How was your trip home?”

“It was all right. I’m glad I could help yesterday.” She looked at Rory. “Well, Doctor Evans are we ready to do this?”

“Yes let’s do it over there on the lawn.” He pointed to a grassy spot under a tree.

Jen went to the side of the truck to retrieve Rory's bucket and almost ran right into Katie. “Sorry Katie, I didn’t know you knew what he needed. I was going to help him.”

“Thank you, Jen, but I can handle this. There are some issues Doctor Rory needs to think about, and this is a good time for him to do that.”

Jen could feel the icy wind in Katie's comment. “But we’re good, right, you and me?”

“Certainly why wouldn’t we be?”

“Oh good, it’s not me. You know I’m here for you a hundred percent, whatever is happening. I’ll just scurry on over and help Sarah hold the horse. You call me over when you two need anything.” She wisely walked away.

Jen and Sarah walked the colt to the lawn allowing it to eat the grass while Rory and Katie collected their equipment.

“What anesthesia are you using Rory?”

“The usual, xylazine and ketamine, nothing fancy.”

“Do you want me to get out a tetanus shot?”

“Dunno wait. Sarah! Are we current on shots, especially tetanus?”

“Yes,” she replied. Rory drew up the medicines, grabbed a plastic tray, threw stuff in it, and pulled out a bucket. “Here Katie. Can you fill this up?” He squeezed brown Betadyne disinfectant solution into the pail before handing it to her.

“Hey Jen, we need a beach towel and four more lead ropes please.” Rory put his stethoscope around his neck and walked over to the colt. He wanted to become acquainted with his charge so he could listen to the heart for abnormalities that might suggest anesthesia would be too risky for the procedure.

Uh oh, he thought to himself as he watched the colt. The horse’s eyes widened and focused on him as he walked closer. It held its ears straight up, the neck straightened, and the young thing snorted and fidgeted. Rory slowed his approach, lowering his head, slumping his shoulders showing the colt he was relaxed and not a feared aggressor. The horse continued to snort, less so, as Rory persisted in pushing into the colt's personal space.

“Whoa boy, whoa, it's ok,” he said softly and calmly. The horse calmed down somewhat as Rory petted and reassured the anxious animal. Slowly e removed the stethoscope from his neck, placed the headpieces in his ears, and advanced the diaphragm end toward the tense and snorting patient. Finally, he was able to position the scope onto the chest to listen to the heartbeat. He nodded his head signaling all was well with the heart and walked back to the truck. “Jen we’re also going to need two hay bales.” He turned to Katie who was giving him and the colt some space. “Do you want to check the heart or anything?”

She shook her head and remained standing outside the colt’s interest sphere.

Rory picked up the smaller of two syringes and placed it in his pocket. He put the nose twitch in his back pocket, nodded his head, and walked to the horse. “I’ll take the rope please, Jen,” He gathered the length in his hand and slowly pulled the colt to him murmuring and encouraging the horse forward. A few tentative steps later Rory was able to lift his hand to touch the horse’s head. If he could get a good grab of the nose, he could just… Crap! This guy doesn’t want any touching around his head. Rory handed the lead back to Jen and looked over at Katie.

“What’s Plan B Rory?”

“That was Plan B. Plan A was some far away dream I would be able to walk right up, say the right things, and slide the syringe into the jugular vein. Now I'll have to go to plan C.“ As he was talking, he again made his way to the colt’s left shoulder. And again the fellow snickered, snorted, fidgeted, and slowly calmed down. Emboldened, Rory backed off and pulled the twitch from his back pocket. He continued to pet the horse, talking to him, and touching him again on the neck with his right hand. Soon he was working his hand up the neck and onto the head.

He was waiting for the chance to grab the ear as quickly and as tightly as possible. Soon… NOW! In an instant, Rory circled his palm around the base of the colt’s ear and squeezed hard and tight. Can’t let go! This is the only way to control him. Rory grabbed the horse’s nose with his left hand, locking his fingers and pinching the thick, soft tissue septum dividing the nose into two nostrils.

With the twitch dangling from his left elbow Rory knew it was ready to be clamped onto the colt’s nose just as soon as he could get his right hand free to use it. And now the rodeo started. He was squeezing the colt’s ear tightly with his right hand and the nose with his left. These were the only two handles available to restrain this fellow without cowboying him down with a lariat.

The colt protested mightily jumping up trying to pull away. Rory pulled him back holding tighter onto the ear with his right fist while pinching the nasal septum with his left.

The colt struck out with his left leg, straight out, trying to clear the way in front of him to get rid of the asshole grabbing his ear. Stay to the side! I need to stay away from his feet! Moving backward nearer the colt’s shoulder Rory stayed outside the strike zone, squeezing harder until the horse finally responded to the severe ongoing pressure. As soon as the young horse stood still Rory let go of the ear to pull the twitch up from the elbow of his left arm, advancing it slowly from his wrist to the colt’s nose.

He squeezed hard on the twitch, clamping the soft septum within its metal arms. Now Rory controlled the entire horse. But he could not let the twitch go. If that happened, the rodeo would start all over again beginning at step one. He squeezed harder a final time, and the colt succumbed standing still for the injections.

“Can you take the twitch Katie?” he asked as he finalized Part 2 of Plan C.

Katie nodded her head and eased up behind Rory staying to the side of the horse lest he kick out again. “I’ve got it,” she said. Bringing both her hands up to his she grabbed the twitch, keeping the pressure tight.

“Thank you.” He walked backward a few steps and pulled the first syringe from his pocket.

“Keep squeezing the twitch, Katie.”

Rory placed his left hand at the base of the colt’s neck to raise the jugular vein. Once he saw the jugular fill from his occlusion, he pushed the syringe containing the xylazine into the vein. Pulling the needle from the neck, he stepped backward again to wait for the xylazine sedation to peak. The colt changed instantly dropping his head, swaying sideways.

“Ok, are we ready to drop him?” Rory asked.

Katie nodded. Rory retrieved the second syringe, the one with ketamine, and injected it into the jugular. Throwing the beach towel over his shoulder, he turned to take the lead rope from Katie.

“That’s okay Rory. I’ve got this,” she said.

Nodding he handed her the towel and backed off, watching her guide the drugged colt to the ground. The horse teetered more and was in danger of hurting itself by flinging itself backward. To prevent this Katie pulled steadily on the lead rope when she felt the colt try to fall. As the horse sank deeper into anesthesia its legs buckled. As the chance of a flip diminished Katie loosened the tension on the rope and eased the colt safely onto his side softly letting the head come to the ground.

“Jen bring us the hay bales,” he requested. Katie lifted the colt's head allowing Rory to wrap the towel around the horse’s eyes. Katie gently set the head on the ground, and Rory helped Jen position the colt upside down between the two hay bales. The two young vets worked well as a team. Katie scrubbed the hernia site while Rory showed Sarah and Jen how to wrap a lead rope around each foot.

“Sarah take these two lines and keep the front feet forward towards the head. Jen, you do the same, keep the back feet away from us. Oh, and let me know the second the fellow starts moving his leg. I can give him more drugs if needed.”

Katie finished scrubbing the area and used a straight blade to shave the hair from the surgery site one swipe at a time. “Make sure you use plenty of soap Katie. Makes the shaving easier.”

“This isn’t new to me Rory. I’ve shaved horses before you know and my legs. This would suit me more if we were castrating a horse instead of repairing an umbilical hernia.”

Rory wasn't sure what she meant by that, so he didn’t respond. “Oh I need sutures.” He conveniently remembered a reason to get away from his assistant, went back to the truck and retrieved two types of stitches, vetafil was for the skin, and mersilene for the inside muscle layers. And I also need two pairs of surgical gloves. Size 7 ½ for me and size 7 for Katie.

“You ready Katie?”

“Yes.” Finishing her shave job she performed a final surgical prep.

Rory handed her a pair of surgical gloves and opened the surgery pack with his gloved hands. “Let's see. I’m going to need a scalpel, a blade, a needle holder rat-toothed forceps, Metzenbaum scissors, and the suture material. Good, its all here,”he mumbled.

He incised an elliptical circle around the hernia bump, dissecting the skin away from the underlying tissue. Tossing the oval circle of skin on the ground he used Metzenbaum scissors to clean up the site by trimming the edges of the hernia to allow the muscles heal together solidly.

“Can you hand me the mersilene sutures please?” Katie had five ready to give him. Each held a long strand of thick braided line swedged onto a curved needle the diameter of a fifty-cent piece. Using his needle-holder, he grasped each presented suture by its needle and placed stitches through both sides of the hernia opening every half-inch. This hernia was three inches long so he pre-placed five stitches leaving them in place but not tied.

“Let's make sure none of the sutures has grabbed the wrong thing.” He slid his gloved hand underneath the pre-placed suture setup.

“You want to check for adhesions Katie?”

“Okay.” She slid her hand under the open sutures, felt no abnormal attachments, and nodded her head. It was safe to close the defect by cinching the knots.

“Pull tight on these ends before I tie them.” He used the needle holders to make three square knots in each suture closing off the herniated space by pulling the belly wall edges together. Now the skin needed to be sewn over the repair.

“That was the hard part, making sure we achieve a secure and safe closure. Now it’s time to close the skin. I’m going to use number one vetafil. Do you want to sew out?”

“No, you paid close enough attention in school to learn to do that all by yourself. I’m done here.”

“Well thank you for the help, dear.” He said.

Finishing the outer sutures he motioned to his helpers. “Let’s roll him over onto his belly. Get these hay bales out of here but leave the towel on his head.” Rory assumed the recovery director’s position. In fact, he assumed everything else because Katie left for a walk.

He held the lead rope loosely while the colt lay flat on the ground. After a few minutes it raised its head, weaving it back and forth in a dizzying manner, and soon began snorting. Finally, Rory removed the towel. The colt pushed both front legs straight out and teetered forward. Remembering where his back legs were, he pulled them under him, and lifted his rear end off the ground.

“There you are, buddy, better than new!” Rory presented the colt to Jen and Sarah and looked around for Katie.

“She went that way. Here I’ll clean up; I did this a lot for Uncle Bob,” Jen offered.

Rory was free to find Katie even though he wasn't sure he wanted to. He spotted her walking towards the paddocks.

“Katie! Wait up.”

She stopped and waited for him. “What?”

“Why are we fighting?”

“Because you are afraid to let me go further with myself,” she complained. “I thought we were still exploring our options.”

“It's you who can't commit,” he retorted. “How much more of “we” do we need to explore? Why do you have to keep running off to school?”

“That has nothing to do with our relationship. This is, you are, what I want from a relationship. You are the man I love.”

“Why can’t you stay here? Aren’t you filling in for Paula?”

“I'm not finished with my education yet. And as far as taking over for Paula, that’s a temporary favor.”

“It's just an excuse. You’re not ready to settle.”

“Then don’t wait for me, Rory. You made a conscious decision not to pursue school any further. I am not like that. I love you, I love this, and I want to have a practice here. But not right now! It’s just not time yet. I am not looking for another love in my life, but I have to follow my passion. You shouldn't even want to sway me from that path.”

“I don't want to sway you from anything Katie. I just want to have a life with you in it.”

“I want that too Rory.”

He frowned and she reached out for his hand.

“I do, but just not now okay?”

“Okay I'll wait, but I don't know for how long,” he spoke tersely. “I've spent my whole life studying to get to this point. I finally have everything I want except a life partner. You are my first choice, shit, my only option. I love you so much.”

“I love you too Rory, so please wait for me. It won't be too long, I promise.”

Having found common ground, they walked hand in hand back to the truck.

“So when are you off again Katie?”

“Now don’t start a fight. This is my home base… you are my home base.”

“Then when will you stay home more?”

“Slow down here. I’m already filling in for Paula, and if I work with Dr. Prasad, I'll still be working in this area.”

“So you would marry me if I asked you?”

“Yes, if you want a wife and not a babysitter.”

“Ok tell me when and where.”

“You’re serious?”

“Of course I’m serious. It’s now or never Katie; this is the first last, and only time I'll ask you.”

“So you’re proposing to me with a threat?”

“It's not a threat; it's a promise. Are you going to marry me or not?”

“Why is this so fucking hard for us? Yes, Rory, I will marry you.”

“Good I feel better. This is best for both of us.”

“Slow down the romance before I cry here, Tarzan.”

“Oh no, this wasn’t the real proposal, this was just a work through, a rehearsal, Katie. The actual proposal will be a lot better because I want it to be special.”

“Should I act surprised when the real one happens Rory? ”

He just looked at her. It made her feel guilty.

“Let’s just settle for a happy surprise okay? Yes, I will marry you, Rory Evans, and I look forward to that beautiful special day.”

“You’re still teasing me.”

“Just a little but it's more truth than a tease. Oh, I love you so. You make me so happy. Thank you, Rory.”

“If I had known it would be that easy I would have asked you freshman year or when we graduated. You make me happy too Katie. We're going to love our life.”

Jen and Sarah heard the last of the lover's quarrel, and the proposal part, as they came up to thank Rory and say goodbye, but they didn't comment on it. They just watched the happy couple as they left the ranch.

“He proposed to her, Sarah! Do you believe it?”

“Maybe so but it was the most unromantic proposal I've ever heard. If I were Katie he would have to come up with something magnificent for the 'real one.'”

“Oh don't be so hard on him. He's just a clueless guy.”

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Umbilical Hernia: Yéiitsoh Omen, Chapter 24

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