Gerald O'Malley, DO: Emergency surgery on a horse

One of the best things about practicing emergency medicine is the fact that people think you can do anything. Work at this job long enough and you begin to believe that too.

I spent two of the best years of my life stationed with the US Navy in Okinawa, one of the most idyllic spots in the world. I worked with a young corpsman from Oklahoma named Barbara who wanted to pursue a career in animal husbandry. She was enrolled in classes and planned to apply to vet school when her time in the Navy was up.

Barbara was incredibly persuasive. She became friends with a local Okinawan man who owned a pony that he would bring down to the beach and allowed tourists to ride. Horses aren’t native to Okinawa so Barbara convinced the man to purchase three horses from the local meat market and keep them in stables that she had built from driftwood.

Barbara and I became friends and I began to hang around the stables and help her care for the horses. The horses weren’t ill, but they were all damaged and old. One of them had injured its neck and its head was cocked at a 45 degree angle when you looked at it head-on.

One day I received a frantic call from Barbara.
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She told me that one of the horses must have fallen down overnight and sustained a large, deep laceration to its right front shoulder or haunch. Barbara was distraught. “I’ve seen horses have to be put down for injuries like this,” she said “The flies are already getting into it. Do you think there is anything you can do?”

“Why don’t we call a vet?” I suggested.

“None of the vets on this island treat large animals. They are all dog and cat practices. The Army has a vet but he has been ordered not to help me.”

I went over to the ER and collected up a laceration tray, heavy gauge suture material, a stapler and some cast material and drove to the stables. Sure enough, the healthiest horse in the stable had a large gash high on her right shoulder and the flies were laying eggs in it. I confessed that I had no idea what to do. I remember Col. Potter on M*A*S*H* saying that despite their size, horses are remarkably fragile animals. What was the appropriate dose of lidocaine for a full grown horse? Plus, there was the issue of how to not have this 800-pound animal kill me while I tried to repair the laceration. Barbara reassured me that she would apply a nutcracker-type device to the horses’ snout and keep the animal from biting or kicking or stomping me while I was underneath it. Barbara probably weighed 100 pounds soaking wet. “I should have my head examined,” I thought.

There was no way to get to the laceration without getting partially underneath the horse, so I said a prayer and crawled up under the beasts’ belly. I waved away the flies, Barbara applied the nutcracker, and I plunged an 18 gauge needle into the horses shoulder and injected 200 mg lidocaine all around the wound. The horse jumped, but Barbara held on and I managed to get the lidocaine into the wound without getting my head caved in by the rear legs or being smooshed by the animal falling over on me.

The real test came when I scrubbed the wound with a Hibiclens sponge. The horse didn’t seem to mind, so I cleaned all the dirt out of the wound and tried to staple it, but the staples just popped out when the horse moved, so I did a three-layer closure with absorbable sutures for the muscle and fascia and some heavy grade silk for the skin.

I tried to dress the wound a number of ways using tape and Plaster of Paris cast material, but the horse would just shudder and the whole thing would fall apart. Barbara had the great idea to make an elastic dressing by cutting the foot off of a pair of pantyhose and slipping it onto the horse’s leg and tying it to the other leg of the pantyhose, which we wrapped around the horse’s neck. It worked like a charm.

We took the dressing down a week later and the wound was healing well. We left the sutures in place for three weeks. We didn’t ride her for another several weeks and the first time that I got back on the horse, she threw me about 10 feet and I landed on my back, knocking the wind out of me. As I lay there with my face covered in dirt, gasping for breath, spitting out sawdust, I watched the horse gallop away to the far side of the pen, Barbara in hot pursuit one thought crossed my mind.

I don’t get paid enough for this.