AS I DROVE THE winding roads back to Treasure Beach, the transfusion supplies from Dr. Francis safely tucked on the seat beside me, I began to worry that I might not be able to find Molly before twilight. She might be off at Jake’s or roaming farther afield. Without adequate light, I wouldn’t be able to see to draw Molly’s blood and transfuse the puppy.
On the way to find Molly I stopped by the villa to pick up Marie-Paule so that she could help me draw the blood. I also collected the scissors I would need to clip the hair on Molly’s foreleg. With the precious few materials that Dr. Francis had given me, we set off for Miss June’s house down the road. I was lucky. Molly was there to greet us, along with her other puppies.
I explained to Miss June and Miss Maisy what I was about to do, and using the little table outside the house as a work area, I laid the materials out neatly. First I swabbed the rubber stopper of the heparin vial with the one and only alcohol wipe I had, carefully returning it to its foil wrapper for later use. I drew a little of the heparin into the 35-ml syringe, enough to wet the inside of the barrel, and ejected all but one milliliter or so into the air, the volume I would need to insure that Molly’s blood didn’t clot once I drew it.
Then I put together a rough-and-ready tourniquet, made out of a broad rubber band and a ballpoint pen, and I wrapped it around Molly’s foreleg, just above her elbow. Marie-Paule crouched low behind Molly, to prevent her from backing away from me as I withdrew the blood, her right hand holding on to Molly’s right shoulder, her left hand twisting and tightening the makeshift tourniquet. Molly’s brachial vein stood out clearly, and even in the fading light it appeared the size of a drainpipe. I reached for the scissors on the low table, clipped the hair over Molly’s bulging vein, gave the skin a wipe with the alcohol pad, returning it once again to its aluminum foil sleeve, and prayed that I wouldn’t screw things up; there would be no chance for a second shot.
“Good girl, Molly! Good girl!” I repeated over and over, through clenched teeth. “She’s such a good girl, this Molly,” I continued, trying to soothe her. Holding Molly’s leg with my left hand, I pierced the skin of her foreleg with the hypodermic needle, directly over the distended vein, and immediately felt the warmth of the dark, purple blood as it spurted into the barrel of the plastic syringe. Molly was as good as gold, and except for a slight jerk as the needle first pricked her, she sat calmly, licking my face, or turning her attentions to her foreleg, licking the site where I had inserted the needle, making it difficult for me to see what I was doing. Within a minute or so, the syringe was full, and I withdrew the needle, applying my thumb over the site to stop the bleeding. The tension over, I exhaled my pent-up breath. Molly had been a perfect patient.
Back to the villa we drove, the syringe full of blood tucked carefully under my arm to keep it warm. It was just about dark, and when we arrived at the villa I gathered as many table lamps as I could to give enough light to carry out the procedure on the puppy.
Marie-Paule sat in a chair close to the living-room table, the little puppy straddled motionless across her lap. I knelt down in front of her and took hold of one of the puppy’s front legs, trying to feel for a vein. It was there, but very small. The 21-gauge needle that I had acquired from Dr. Francis seemed huge in comparison, and I knew there was absolutely no way I would be able to insert it into such a tiny vein. The pale purple veins that meandered across the wall of her bloated abdomen appeared larger. I knew it would be a mistake to even try these, however; even if I were lucky enough to thread the needle into one of them, I wouldn’t be able to inject the relatively large volume of blood before the thin wall of the vessel ballooned and burst from the pressure.
I sat pondering the situation. I was worried that I had no vitamin K to act as an antidote to the heparin. Any excess heparin could cause uncontrollable hemorrhaging of internal organs, and even of the skin from the countless scores of flea bites the puppy had all over her. I also couldn’t allay my fear that the blood might have tiny clots in it. This would be the puppy’s death knell. I rocked the syringe back and forth very slowly as I held it up to the light, to see if I could detect any jellylike clots clinging to the side of the syringe. But even if I couldn’t see any, it didn’t mean there weren’t microscopic clots. Without a blood filter, I wouldn’t be able to trap them. As small as they might be, such tiny clots would be carried in the puppy’s venous system to her lungs, clogging the delicate capillaries in the walls of the alveoli. Great cone-shaped segments of her lungs would be instantly deprived of blood. There would be no saving her then; she would die from necrotizing pneumonia. But this particular concern was academic, in any case, because I didn’t have a needle small enough to give the blood intravenously. Maybe God meant it to be this way, I mused. It’s funny how you sometimes find yourself talking to God, even when you’re not sure you believe in Him.
There was no other way; I would have to give the blood intraperitoneally—into the space beneath the body wall that surrounds the intestines and other abdominal organs. At least I wouldn’t have to worry about the dangers of clots in the blood, and the heparin would probably pose less of a risk, given that way. I have always found it hard to believe that relatively large cells, like red blood corpuscles, can actually make their way through the thin peritoneal lining of the abdominal cavity into the bloodstream. Yet they can, albeit very slowly. One other benefit of this route of transfusion over the standard intravenous method was that I wouldn’t have to worry about the sudden overloading of the puppy’s vascular system if I gave too much blood or injected it too fast. This procedure wouldn’t be entirely without risk, however. If I inadvertently punctured the wall of her intestine as I passed the needle through the abdominal wall she would probably develop peritonitis, a potentially fatal abdominal infection.
Rolling the pup over onto her back, I clipped the hair from the lower right side of her tummy and cleansed the skin with the well-worn and almost dry alcohol pad. Slowly I began to insert the needle into the skin. In an effort of supreme concentration, my eyes tightly closed, my breath held firm, I began to feel my way, layer by layer, first through the skin, then the two muscle coats of the abdominal wall, until finally I felt the needle sigh as it pierced the peritoneum, the last layer before the abdominal cavity. I attached the small 12-ml syringe, which now contained dextrose solution, and injected slowly. The fluid went in easily, and the skin didn’t swell around the injection site, telling me I was truly in the pup’s abdominal cavity and not just under the skin or in the muscle layers. With extreme care, so as not to hurt her, I unscrewed the syringe of dextrose from the needle still inside her abdomen and attached the larger 35-ml syringe that contained the blood. Slowly I began to inject. The pup had yelped only when I had made the first puncture through her abdominal skin. After that, she lay perfectly still until I had finished.
“Well,” I said to Marie-Paule as I exhaled and withdrew the needle from the puppy’s abdomen, “it isn’t the greatest, but it’s the best I can do under the circumstances.” I had no idea how long it would take for Molly’s red corpuscles to be absorbed into the puppy’s system; at least many hours, I thought, and probably several days. Given this way, the transfused blood wouldn’t give the puppy the sudden curative jolt I was hoping for, but it would give her the boost she so needed.
AS I WATCHED THE little puppy now lying fast asleep across Marie-Paule’s lap, I thought about the primitiveness of my transfusion technique and the less than ideal conditions under which I had performed the procedure. It was crude, to say the least, compared with the highly controlled conditions that I was used to working under in the laboratory, handling dangerous blood-borne viruses such as HIV.