Physeal Chaos
Alexa, still reeling from the school run, was perusing her morning’s appointment list whilst cradling a mug of ‘builders’ | 3 min read
“…whether ‘tis nobler in the mind to suffer the slings and arrows of outrageous fortune or stick thy head under thy pillow to mask the heartache and the thousand natural shocks that come from the shrill tones of thine on-call mobile” passed through Bill’s mind at 2am one not very fine April morning. Thomas Erpingham had called, as he felt one of his pedigree Limousins required a C-section. Whilst Bill’s heart sank somewhat, he was buoyed by the fact that both Mr Erpingham and his daughter ran a pretty tight ship and always appeared in good humour irrespective of the time of the day. With the prospect of a warm welcome and the knowledge that both the Erpinghams could at times be a little cautious when attempting calving’s themselves, Bill set off into the abyss. As expected, Bill was met with a warm handshake and led into a well-lit barn where gravid Limousin waited expectantly. Both the Erpinghams had tried to calve her unsuccessfully and volubly expressed their expectation that Bill would crack on with a C-section. Bill proceeded with a vaginal examination and ascertained the calf was alive and normally presented. Moreover, he did not feel the head or shoulders were particularly large and there appeared to be a reasonable amount of room in the pelvic canal. The dam was also big, even for her breed, and had calved naturally before.To Be Informed or Not to Be Informed? | 3 min read
"Bill remained confident and with exchanged glances and perceptibly raised eyebrows, the Erpinghams stood back and let him continue"
Much to the Erpinghams’ quite obvious surprise, Bill announced he could confidently calve the cow per vaginam, prompting Ms Erpingham to nervously pipe up that they really were quite happy for a C-section to be carried out as “that usually results in a live calf”, words that were to ring in Bill’s head for some time thereafter. Bill remained confident and with exchanged glances and perceptibly raised eyebrows, the Erpinghams stood back and let him continue. Sadly, the calf came as far as its pelvis and then jammed tight as a cork in a bottle. To make matters worse, just as Bill was processing the calamity unfolding, the calf sadly shuffled off this mortal coil. The calving from hell had not finished with Bill yet; no sooner had he performed an embryotomy than the hindquarters of the calf disappeared into the cow’s voluminous uterus beyond effective reach. As is the fate of the large animal practitioner in situations such as this, Bill just had to soldier on and perform a C-section to retrieve the unsightly remains, not helped by the cow going down halfway through. With a distinct chill in the air, due only in part to the weather, Bill, with a forlorn realisation of the risk of peritonitis, administered broad spectrum antibiotics and left the farm without the usual offer of a full English forthcoming on this occasion. The cow was reasonably chirpy the following day but on day five, she was dull with minimal rumen sounds and despite further supportive treatment joined her calf; for in that sleep of death, what dreams may come. Bill was not surprised when he received a letter from the Erpinghams suggesting that he might wish to contact his insurers in view of the fact they had lost what was a valuable breeding cow and her calf. They were courteous when contacted by the Claims Consultant who stepped in to lighten Bill’s burden and willingly provided all the requested information, including a well-formulated valuation report that the Claims Consultant felt was ambitious. The Claims Consultant’s cynicism was however unfounded, since the Society’s valuer arrived at an almost identical figure, confirming the value of the Erpinghams’ pedigree stock. The Claims Consultant chatted things through with Bill, sympathising with him over the case and indeed the difficulties frequently faced by bovine practitioners when making decisions over the vaginal delivery of a calf and agreed Bill had quite reasonably exercised his clinical judgement.
Illustrations by Rhiannon Wright @rhimalous
Nevertheless, Bill was forced to concur with the Claims Consultant’s view that little, if any, discussion was had with the owners regarding the risks and benefits of a vaginal delivery versus a caesarean and it was this lack of informed consent, rather than Bill’s decision per se, that created a chink in the Society’s armour. An offer was made, with no admission of liability, for the valuation of the cow and calf unit, less a reasonably modest reduction to reflect the fact the cow had dystocia and was always at risk of developing complications. The offer was accepted by return and it was not long before Bill found himself reinstated in the Erpinghams’ kitchen after a more successful early morning adventure, attacking a well-earned bacon sandwich.
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