My major misstep in front of the Marlboro Men

My major misstep in front of the Marlboro Men

Dr. Brock reflects on how life goes full circle—but a nasogastric tube shouldn't.
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Aug 11, 2016

I stood across the expanse of the horse clinic and watched Dr. Tyler Stevenson, our new veterinary intern from California, trying to pass a small catheter up a nasolacrimal duct in a horse. He was contorting his expression the way folks do when performing a task they thought would be easy but turns out not to be.

Tyler was working hard to get the catheter passed into the opening in the nose and then push a penicillin mixture up the duct and back out the eye. This retrogrades the mucoid mess that clogs up the duct back into the eye where we can wipe it away and make a happy horse. It is quite impressive to clients to see the white fluid bubble up and drip out of the eye when the veterinarian is working down in the nose.

But Tyler was having a hard time. There was white fluid all over the floor in front of the horse but none coming out of the eye. I knew what he was doing wrong, but I just stood back and watched, letting my mind drift back to my first few days in practice. It’s funny how life goes full circle …

Bending back to the past

It was 1990 and I had been out of vet school just a few days when three hardcore cowboys showed up with a horse with colic. I was nervous about every critter that came through the door in those days.

In vet school I’d been taught to pass a tube about as big around as your thumb and roughly 10 feet long through a horse’s nose and down into its stomach. This is a procedure horse doctors do often in practice to relieve gas or reflux if there’s a blockage causing stomach distension that may result in rupture or to put a laxative in the gastrointestinal tract if there’s an impaction downstream. I did it exactly twice in vet school, both times with an instructor standing next to me telling me what to do.

But all my education on how and why to pass a nasogastric tube on a horse made no difference to me at this moment. All I knew was I was about to have to do it in front of three dudes who looked like the Malboro Man. I gathered all the needed equipment and tried to act cool and confident as I began pushing the tube into the ventral nasal meatus of this belly-aching critter.

The thing just wouldn’t go. I knew that once you hit the pharynx, you had to time the push of the tube with a swallow. It’s an art. You lightly tap around on the back of the throat hoping to stimulate a swallow reflex, and when you do, you push the tube into the esophagus with the wave of that swallow. It wasn’t happening. I could feel my blood pressure go up and my face contort into an expression that reflected having trouble doing something that should be easy but is not.

Here’s the rub: the longer that rubber tube stays in the pharynx, the softer it becomes from the heat of the region. I discovered this as my constant failed attempts had resulted in a nasogastric tube that was now very bendy. And the force I was placing on the back of the throat caused the tip to bend and start coming back toward me. I finally felt a loss of resistance and assumed I was at last heading down to the stomach. But in fact, the tube had done a 180, and as I kept passing and pushing, it actually came out the other nostril!

There I was, standing in front of a horse with three high-eyebrowed cowboys wondering what the heck just happened. I pushed a nasogastric tube in one nostril of their horse and now the thing was coming out the other nostril. This defies the laws of physics. I was mortified.

Before I could even formulate a sentence, Dr. Chuck Deyhle, my 67-year-old mentor from Clarendon, Texas, was standing next to me taking the nasogastric tube out of my hand and talking confidently to the three cowboys. He pushed the tube until about 10 inches of it was sticking out of the other nostril. He grabbed that end with his free hand and began pulling with one hand while he pushed with the other. He did this several times making a motion similar to what you do when you have both ends of a towel and dry your back off.

“Dr. Brock has passed the tube in one nostril and out the other in order to make sure the horse is not choked. He did an amazing job of getting this done. I will go ahead and put it down in the horse’s stomach now and we will give it some mineral oil,” he explained in such a calming voice that I even believed it for a second.

This old veterinarian was already my hero, but getting me out of such a humiliating situation without looking like a total buffoon made him climb even higher on the superhero scale in my mind.

After the horse and three cowboys departed, Dr. Deyhle caught me in the clinic and started laughing like crazy. “Big Doctor (what he always called me), I have been a veterinarian for 40 years and I have never seen or heard of anyone passing a tube up one nostril and out the other. I hope you didn’t mind me stepping in, but I was watching from across the expanse of the clinic and didn’t want you getting too discouraged.”

Circling around to the present

Finally I went over and showed Dr. Tyler how to flush a lacrimal duct. I taught him why what he was doing wouldn’t work, and I remembered my mentor telling me that he had watched me from across the expanse of the clinic and rescued me just before I became too discouraged. It’s funny how life goes full circle.