Hunting for Hippocrates. Warren J. Stucki

to Salt Lake City with Abe would have been an exercise in self-flagellation.

      There it was, on his workbench. Moe snatched up the flashlight and bolted from the garage. With each step, the flashlight punched beacon-like holes through the raven blackness of the night. As Moe sprinted toward the corrals, raindrops slapped his face and stung his eyes. With the thick cloud cover, the night was especially dark. The corrals and tack shed were barely visible, looking like shrouded silhouettes of a nineteenth century ghost town.

      Black stools! That could only mean one thing, the horse was bleeding. Even in the darkness and the pounding rain, Moe could see Dorey, the mother horse, milling around the pipe fence that separated her from Casey. He had been weaning Casey. As Moe fumbled with the chain around the gate, he noticed a dark mound, motionless in the center of the corral. In exasperation, he jerked gate, breaking the chain and charging into the corral.

      With his heart pounding and breath coming in quick, short wheezes, Moe expected the worst. He pointed the flashlight on the mound. The sight made him gasp. It was Casey and he was obviously dead. His head lay on the ground, his mouth and dark eyes were wide open and his purple swollen tongue hung lifelessly from the corner of his mouth. From his gaping mouth, a river of clotted blood had run a tortuous path through the corral as it searched for lower ground. Moe reached for the congealed blood, picking it up like a rubber ribbon. It smelled musty and stretched a bit, like taffy. A smaller piece broke free, as Moe jerked it from the ground. With a jolt, he remembered the black stools Tommie’s message had mentioned. Quickly, he arched the light toward the back of the horse. It was a similar ghastly sight. A river of clotted blood exited the rectum.

      Moe was numb with grief. Even though the old-timers had told him it was a mistake, he had made a pet of the horse. He had thoroughly enjoyed watching the little buckskin grow up, from his first halting steps to his graceful lope as he raced about the pasture. Casey had been gentle, inquisitive and trusting. Really, all the same qualities of human babies. Now he was dead! First the divorce, then his father, now this. Would it never end? Moe collapsed in the mud by the colt and wept.

      After a few minutes, Moe gritted his teeth and stood up, brushing clumps of mud from his pants. Why did Casey die? Obviously, he bled to death, but why? Six-month-old, healthy horses do not just bleed to death, not without a cause. His years of medical training had taught him that there always had to be a reason, even if not immediately understood. The universal law of medicine: cause and effect.

      Maybe milkweed? Milkweed could poison horses. With milkweed poisoning, the horses had a ton of G.I. symptoms, but they did not bleed to death. Anyway, where would he have gotten milkweed, or any toxin for that matter, in a twenty by twenty-foot corral?

      Maybe, a rattlesnake bite? The toxin of western diamondbacks could cause hemorrhage, but there should also be intense swelling at the site of the bite. As a thunder clap boomed and lightening flashed, Moe inspected all four appendages and Casey’s underbelly for sign of injury. There was none. No sign of fang marks or any type of penetrating wound.

      Perhaps Casey had a hepatic disease, preventing the liver from producing the normal clotting factors, but he wasn’t jaundiced. And how would a horse get liver disease anyway? Certainly, not from alcohol.

      How about a bone marrow disease like leukemia, suppressing the production of platelets? Moe was not even sure horses got leukemia, but Casey had not been sick. It was hard to postulate leukemia severe enough to destroy the bone marrow or a liver disease severe enough to affect clotting factors without any other symptoms.

      There was one way to find out what was going on. Moe gathered the little horse in his arms, staggering under the weight. Six-month-old horses were heavier than they looked. As he grappled for a secure grip on the horse, it started raining harder. Carrying Casey as gently as he could, Moe struggled toward the garage, his tears blending with the rain.

      In medical school Moe had taken an elective class in clinical pathology, this included a somewhat disturbing two-week stint in forensic pathology. Obviously this did not make him an expert, but Moe remembered a bit about how to properly conduct autopsies. Also, after years of doing abdominal surgery, he was pretty damn sure he could recognize a diseased organ when he saw it, even if it was from a horse. Moe carefully laid Casey on a work bench next to the sink. Then he went to the house and rummaged through his extensive first aid kit, retrieving some latex gloves, a scalpel and a suture set with some O-silk suture. Cradling his supplies in his arms, he returned to the garage.

      Moe took a deep breath and steadied his shaking hands, he needed a moment to disassociate himself from the task he was about to perform. It was like operating on a relative, which was never a good idea. He had to put aside the idea that this was Casey and just focus on the task ahead. After a moment, he picked up the scalpel and with jaw set, approached the colt.

      Almost immediately, he realized how awkward it was to do an autopsy on a horse. Horses were not at all like humans, with a fully exposed abdomen and all appendages in the neutral position, lying in the same plane as the body. Even though Casey’s knees were stiffly bent, his legs protruded straight out from his body, like fence posts, and would be in the way.

      With some difficulty, Moe placed Casey on his back and propped his legs against the wall to keep him from rolling. Finally, he wedged his shoulders between the hind legs and gritting his teeth, made a midline abdominal incision. With the skill of an experienced surgeon, he continued the incision sharply through the subcutaneous fat, through the midline fascia, finally opening the peritoneum. On entering the peritoneum, Moe was immediately hit with a nauseating rush of rank air. Casey’s internal organs already smelled like unrefrigerated, three-day-old fish.

      As per his training from surgical residency, Moe began to systematically examine each organ. First, he palpated the kidneys. It was habit. After all he was a urologist. They felt smooth, no masses or hydronephrosis, and were normal size. Next, he inspected the liver and spleen. They also looked normal, no grainy leukemic infiltrates and no scarring associated with cirrhosis. Next, he examined the stomach. It looked full, but had normal consistency and color. Finally, Moe ran the entire length of the small bowel and colon, inspecting every inch.

      Then there it was, the first abnormal finding. Moe had seen that blue sheen to the bowel before in humans, it simply meant the bowel was full of old blood. When looking from the outside through the relatively thin walls of the bowel, the blood looked blue, like venous blood. Other than that, the bowel looked okay, no palpable lesions, no dilation to make one think of obstruction.

      Gripping his scalpel like a pencil, Moe sliced through a longitudinal muscular band, one of the taeniae, opening the large bowel. There was a myriad of small, petechial hemorrhages, but certainly not a single, major bleeding site or lesion.

      Somewhat confused, Moe went back to the stomach, incising through the fundus. The stomach was full of clotted blood, which Moe simply scooped out with his gloved hands. Again, there were those same petechial hemorrhages, but there was more. In the most dependent portion of the stomach, there was still a small amount of gastric content that had layered out when peristalsis ceased, the heavier particles at the bottom, the liquid at the top. Systematically, Moe inspected this gooey amalgam. It contained mainly gastric juices that formed the top layer, but underneath this veneer, were a few intact grains of barley and some particles of undigested alfalfa cubes.

      Moe dredged up the stomach contents in cupped hands, dumping them into a coffee can. Slowly, Moe swirled the stomach contents in the can, almost like panning for gold.

      Wait! There was a fleck, something blue in an amorphous sea of pea green. What the hell could that be? What could a horse eat that was blue? Moe reached down with the tip of his scalpel and retrieved the fleck. It was robin-egg blue and about one third the size of a pea. It resembled a jagged piece of a pill. Moe examined it more closely. By god, that’s what it was, a piece of a crushed up pill!

      Moe had done that plenty of times with his horses. More than once, he had ground up butazoladine and put it in the horses’ feed when they had gone lame. But he’d never given any pills to Casey, never had any call to. Furthermore, butazoladine was white, this pill was blue. For the life of him, Moe could not think of a common horse pill that was blue. Obviously, someone had been giving Casey blue pills,