Heidi, the three-year old bulldog, waddles across the floor of the prep room. She tries to sit, but her hugely distended abdomen makes that uncomfortable for her, so instead she stands, and pants. Her thick eyelids droop with weariness. Sam and I lift her onto the prep table with some difficulty. Heidi gurgles and splutters as we set her down, then starts panting again. Green viscous fluid drips from her vulva, onto the table. We haven't much time.
Sam raises Heidi's vein with some difficulty; this is uncomfortable for Heidi too. Not because of her distended abdomen, this time, but because her elbow dysplasia makes it hard for her to stretch her leg forward. I look sadly down at her. Her whole life is a struggle with her own body - whenever she tries to walk, or eat, or defecate, or breathe, she has to wrestle against her own bizarre anatomy. I inject the propofol into her vein, her eyes roll downwards, and she starts to sink to the table.
'We'll take it from here, love,' I say, and Sam smiles. Placing an E-T tube is difficult too - Heidi's soft palate is too long for her mouth, and it takes some searching before I manage to locate her epiglottis - but the moment it's in place, Heidi's tongue loses its alarming bluish tinge and turns a reassuring pink.
'Probably the best lungful she's had for a while,' Sam says, as she ties the tube in. We roll Heidi onto her side and start prepping her abdomen for surgery. I don't want to roll her on her back until absolutely necessary; her abdomen is so bloated I'm worried what the weight of it would do to the spine, and the blood vessels that run below it. We can't support her blood pressure nearly as well as I would like - Heidi's owner has declined intravenous fluids on cost grounds - and so I just want to get on with the caesarean as quickly as possible.
It's late on Monday night. Heidi was booked in for an elective caesarean this Thursday, which would have been her 63rd day of pregnancy; a sensible precaution, because fewer than fifty percent of bulldogs manage to give birth without the operation, but in the last few days Heidi's abdomen has swelled to alarming proportions, and over the course of the day it's become clear that the pups need to come out, ready or not, or Heidi isn't even going to make it to Thursday. The green discharge, which started in the last hour, generally indicates that the placentas have started to separate from the wall of the uterus.
Sam and I carry now extremely-heavy dog into theatre, and I only swear and complain about my back once; something of a record, as Sam, who is just over half my size, politely points out. I look at Heidi's immense abdomen, and suggest there is probably more swearing to come. I'm right.
As I scrub, my mind wanders back to a consultation I had with Heidi and her owner, three years ago. It was her first adult vaccination, when she was about fourteen months old. Heidi's owner, a short, likeable man, tells me that he was thinking of breeding from Heidi, and wants to know what I think. I glance at Heidi's clinical notes, and try to hide the expression of dismay that must have crept across my face. Despite her tender years, Heidi has had surgery four times - twice to replace prolapsed tear glands, once to correct her entropion (a condition where her eyelids are so fleshy that they scroll inwards, allowing her fur to press against her eyeball, leading to chronic pain and frequent eye ulcers), and once to surgically remove her tail, which is so deformed it has formed a tight-corkscrew shape, leading to repeated severe infections around her back end and, again, chronic pain. I wonder how I can delicately state that Heidi is about the worst candidate I can imagine to have more progeny. I want to grab him by the lapels, and scream 'No, no! A thousand times, no! Can't you see how much she is suffering, just trying to walk?', but I feel that's not very professional.
While I am thinking, the hitherto likeable owner, who seems slightly surprised that I am not immediately excited at the prospect of Heidi producing puppies, says, 'I'll have all the tests, you know. I want to make sure I'm doing the right thing.'
This gives me an in. I calmly, and, I think, quite logically, explain that I don't need to do any 'tests' to tell me that Heidi is a poor choice of mother, both medically and genetically. All the conditions that she has had surgically corrected, as well as the many she has which can't be, are heritable conditions, and any puppies that she has is likely to suffer from them too. I further explain that the Kennel Club, finally drawing a line in the sand long after the country behind the line has been invaded and razed, wouldn't allow any pups to be registered, due to the number of corrective procedures that Heidi has had to endure.
As I talk, I see Heidi's owners attention start to wander. I'm not saying what he wants to hear, so he's stopped listening. I say it again, in a slightly different way, and then again, finally ending with an extremely strong recommendation that Heidi is speyed as soon as possible. This last is too much for Heidi's owner. At reception, I hear him asking never to see 'that vet' again.
Now, three years later, Heidi's owner doesn't have much choice, because I'm the vet on duty tonight. When I admitted her tonight, he didn't mention his request not to see me, and I didn't mention my advice never to breed from her. There didn't seem like much point.
Now scrubbed up, I enter theatre and don my surgical gloves. Heidi's abdomen already has a long scar along it; this isn't her first caesarean. In fact, it's her third. Heidi's owner says he won't let her have another litter after this one. He said that last time, too.
I open her abdomen with a large incision, cutting through the scar tissue of her previous surgeries, and ease the huge, bloated uterus out of the wound. Incising it, I remove the first puppy in its amniotic sack. It is enormous: truly a camel would have more chance passing through the eye of a needle than this puppy would have had of passing through Heidi's pelvis. I hand the puppy to Sam, who quickly breaks the sac, clearing the fluid, while I start to milk the next puppy towards the incision in the uterus.
'Nick...,' Sam says. I look up, and understand why Heidi was so bloated. The puppy looks like someone has been at it with a bicycle pump, bearing more resemblance to a hippo that a bulldog. The skin is thickened and distorted with fluid, and has torn in a number of places around the mouth. As Sam gently shifts the puppy's position, its abdomen splits open, and she gasps in dismay. Fortunately, was dead before I ever removed it from the uterus.
'Anasarca,' I mutter. Also known as 'water' or 'walrus' puppies: a condition of bulldog pups that causes severe oedema in the days leading up to birth. Mild cases might, just might, survive. The pup I have so far removed is not a mild case.
So it goes for the remaining four puppies that I extract. All of them are severely affected. Two of them have weak heart beats, so I ask Sam to euthanase them for me.
Heidi's colour has improved dramatically now that we have reduced the load on her uterus. I wish, once again, that we had her on fluids, but she seems to be doing well now that all the puppies are out. I start to suture up the uterus. When I admitted Heidi, I asked the owner if he would like me to spey her at the same time, as he already had suggested that Heidi wouldn't have any more litters. He declined.
Suturing up a caesarean is often done to the noise of puppies crying for their mum's milk, but tonight Sam and I finish the operation in silence. Afterwards, Sam stays with Heidi while I telephone the owner with the news. He's annoyed and depressed. Of course he is: a single live pup would have recouped double the cost of the caesarean. He wants to know how many of the pups were female. We didn't think to check at the time, and I do so now. Only one of the five was a bitch, which seems to be some comfort to Heidi's owner. Bitches are worth more than dogs. Finally, with genuine concern, he asks how Heidi is. I reassure him that she's fine, and he sounds relieved. He thanks me for my help. I put the phone down, and sit down in dispensary, looking up at all the medicines I have at my disposal to treat sick animals, and wonder just how complicit in Heidi's suffering I am.
Well... this was going to be a short introduction to a post that discussed dog breeding, breeders, and some of the difficulties I encounter in practice... but I'm afraid it rather got away with me! I'm going to follow this post up, hopefully at the weekend, with a (hopefully) less emotive piece discuss some of the points I touch upon above. The above caesarian is an extreme case, but the details are not, I'm afraid, exaggerated. This exact scenario was occurred, with minor variations, to me personally, on three occasions, and I suspect it won't be entirely unfamiliar to any vets reading it, either.