by Barry B. Burtis D.V.M.
My wife and I recently returned from a two week visit to Nicaragua. While there, we learned a lot about the people, the geography and the history of this small country in Central America. We visited communities of the indigenous Miskitu and Rama people, we saw the active volcano, Concepcion, on Ometepe Island and of course, we enjoyed the warmth and sunshine.
A primary reason for the trip was to visit friends who have been living in Puerto Cabezas for the past 2 years. Puerto Cabezas has a population of about fifty thousand people and is located on the Mosquito Coast, on the Atlantic side of Nicaragua. Amongst the many fine traits possessed by our friends, they also love cats. Soon after arriving in the country they rescued and raised two little orphan kittens. Maddy and Rachel are now two healthy, happy, dearly loved members of their family.
Unfortunately, veterinary care for the animals in this region is not readily available. Rachel (who turned out to be a boy, not a girl, as originally determined) was neutered by a veterinarian from Managua, who once was in town. However, Maddy (who really was a girl!), now two years old, had never been spayed. In order to defray some of the bed & breakfast benefits we would be receiving, I had agreed to perform Maddy's surgery.
It turns out that this promise gave me a brand new experience, allowing me to do something I had never done before. I don't really know how many animals I have spayed since I entered my profession. However, this deep into my career, I am sure the number is well into the thousands. Despite those numbers, I have never done a spay like Maddy's before.
Our friends had given me the name and phone number of a veterinarian they had located, who lived in their town. I called Jacqueline, before we left home, hoping that I could perhaps use her facility for the surgery. Through broken English, on her part, and even more fractured Spanish, on mine, I learned that she had no hospital; no nursing assistants, no anesthetic equipment, no drugs or supplies and no experience with spay surgery. She had graduated from a veterinary school in Cuba, twelve years ago, however, to this point in time, she had only had the opportunity to watch one spay operation. She did say she would love to meet me and would be happy to help me, any way she could, when we arrived in Nicaragua. For me, this meant it was really going to be like veterinarian "old timers" talk about - frontier veterinary medicine, a kitchen table spay.
With the help of one of our veterinary technicians I made a list of everything I would need to take with me to perform the surgery. It was a long list, everything from animal clippers to scalpel blades, caps, gowns, gloves, a sterile instrument pack and a host of drugs and medications. The tricky part, of course, was the anesthesia requirements. Never before in my career had I done such an operation without using inhalant, gaseous anesthesia. No way, though, could I transport an anesthetic machine, vaporizers, oxygen tanks and all else that is needed for such a luxury. Fortunately, recently an anesthetic protocol for cats, using a combination of sedatives, analgesics and muscle relaxants has been developed. It can be given intravenously. Called "Kitty Magic", by some, this would have to be what I used for Maddy.
Well, let's make a long story short. On a steamy, hot, humid Nicaragua morning, wearing shorts under my operating gown, with my surgeon's mask hiding the sober, rather nervous expression on my face, my hand steadily made a bold incision through Maddy's skin. Her caring and concerned owners, standing nearby (talk about extra pressure on the surgeon!), briefly turned their anxious gaze away at that moment. I had successfully administered Maddy her sleeping potion a few minutes earlier, her breathing was regular, her mucus membrane colour good. She was in a proper surgical plane of anesthesia with Dr. Jacqueline, by her side. I had shaved the surgical area, washed and prepped the surgical site, positioned Maddy on the table and gotten into my surgical attire. My operating table had been moved from the kitchen to the front hall, by the door, where the light was better. I had found some cement blocks, outside in the yard, to raise the table to a more comfortable operating height. A cushioned plastic sheet, for patient comfort and warmth, covered the table top.
I was calmed and made more comfortable by the familiar steps and rhythm of the ovario-hysterectomy surgical procedure, as I tried to explain to my Nicaraguan colleague what I was doing. But oh, the silence was so frightening, without the beeps and the clicks and the screens with squiggly lines of patient monitoring devices that I have so come to rely on, to reassure me, that my patient is fine. The good news is that both Maddy and I survived her surgery. She made an uneventful recovery and I added another notch to my spay numbers belt, in circumstances that I shall never forget.