This week: Triage At the end of a busy day, the clinic often looks like the aftermath of a war zone. But instead of shrapnel, there is blood splattered on the cupboard doors and towels strewn all over the soiled tiled floors. Most of the desktop surfaces are covered with equipment and drugs that need to be cleaned and placed back in their rightful containers. There is an atmosphere of tangible relief among the staff that all went well. In fact, after 10 years on the job, I still find it amazing when everything works out the way I had planned. There is nothing worse than a surprise in my line of work. It has usually been a difficult day if I tell my loved ones at home I had a surprising day. Following is an account of just one day that was full of surprises. Tuesdays at most veterinary clinics where I have worked is usually a day of respite. There are usually fewer clients then normal and it is a good time to catch up on paperwork or just have a good, old-fashioned gossip session with fellow staff. That line from the movie Forest Gump, 'Life is like a box of chocolates, you never know what you are going to get', certainly applies to being a vet. I know I am going to face people presenting sick animals, but I never know what problems I am going to face. One Tuesday last year was most unforgettable. No appointments were scheduled and I was planning to treat the crew to an impromptu breakfast when the front door of the clinic slammed, making a loud noise that startled the clinic cat. I knew immediately that some kind of emergency was waiting. In fact, there were not one but three stressed families outside with their beloved animals. I realised then that the quiet morning had been the calm before a storm. Part of a trained veterinary nurse's duty is triage. That is the process of assessing the condition of patients and prioritising medical treatment given the resources available, urgency of treatment and chances of survival. It is practised on battlefields and the term has continued to be used in emergency wards around the world. The nurse took stock of the situation by quickly assessing the animals' demeanour and asking the clients for a simple medical history. It turned out that one of the dogs came from the outskirts of Sai Kung and had a week-old bite wound on the rump that was maggot infested; the other was a poodle bitch that was dripping bloody pus from its genitals; the last one was a dog that had been seen eating rat poison. Which would you have picked as the most urgent? The maggot wound was certainly grossly disgusting, with rotting meat that stank to high heaven, but it had been there for a week and a few more moments wouldn't make a big difference to the end result. Realising the animal was in pain and that there was an accompanying bacterial infection, I arranged a painkiller and antibiotic while it was waiting. Most of my nurses have seven years of experience or more and they identified the second dog's problem as 'open pyometra', or an infected uterus, which certainly can be classified as an emergency. Fortunately, the dog was bright and alert and didn't need immediate attention. The rat-bait poisoning was the most urgent and life-threatening. The family's maid, having seen a rat in her room, had bought some rat bait and spread it around her room without considering that a greedy little Pomeranian would find the bait as tasty as a rat would. So, they had poisoned their own dog. Well, accidents happen and it's my job to deal with their aftermath. The client was quick to bring the poison victim in and that probably saved the dog's life. Rat baits kill by causing a deficiency of vitamin K, which then causes a blood-clotting disorder; the animal, any warm-blooded animal, will then bleed to death internally. I used a special drug called apomorphine that melts in saline. When a few drops are placed on the eye, it causes severe vomiting and nausea. We have to handle this drug with care, as a touch with ungloved hands can cause the same reaction in us. The response to the drug is quick and the little guy started vomiting earnestly after a minute or so. The maid was able to identify the poison pellets in the vomitus. To play it safe, I started the dog on a long course of vitamin K to prevent any bleeding. After that, I admitted the dog with the infected uterus for surgery to remove it. The lesson here is to get your pet desexed early to prevent such life-threatening emergencies. We also admitted the dog with the maggot-infested wound in the afternoon to clean the wound under a general anaesthetic. The lesson here is not to leave an injured dog outside, exposed to the elements and flies. It's a recipe for disaster. When a dog lives in a backyard, it should be examined every day for wounds and maggots.