Dr. Dean Richardson called his time with Barbaro "an extraordinary privilege" and, although he knew the horse's chances of survival were low, he couldn't help hoping for the best.
By his own admission, Dr. Dean Richardson is better at large animal surgery than public speaking. But as fate would have it, Dr. Richardson was thrust into the center of a months-long media frenzy over Barbaro, the 3-year-old colt whose dramatic 2006 Kentucky Derby win and tragic injury and death captivated a nation.
On Dec. 1, 2007, nearly a year after Barbaro was euthanized, Dr. Richardson spoke at the 53rd annual convention of the American Association of Equine Practitioners in Orlando about the lessons he learned while the horse was in his care. "It was an extraordinary privilege to even have the opportunity to be involved in this case," he told the crowd.
Just seconds into the Preakness Stakes in May 2006, Barbaro suffered a lateral condylar fracture of the cannon bone in his right hind limb. The pastern bone was shattered into more than 20 pieces, and he tore the intersesamoidean ligament. Barbaro was stabilized and transported from Baltimore to the University of Pennsylvania's New Bolton Center, where Dr. Richardson is the chief of surgery at the center's George D. Widener Hospital.
"It was a complicated fracture, to say the least," Dr. Richardson recalled. "The nature of the fracture ... was such that it precluded certain options, I thought, such as external fixation and external skeletal fixation." He placed 27 screws and a locking metal compression plate on the shattered limb, and a cast was set.
Along with trying to save Barbaro's life, Dr. Richardson found himself as a reluctant spokesman, explaining to the media as simply as he could how his team was treating the colt, and the its chances for survival. His main objective in these talks with the media was getting across just how different equine and human medicine are—a point often lost on many people, including medical doctors who thought they knew better how to treat the injury.
Looking back, Dr. Richardson said the surgery was the least complicated part of the experience. "That's the part I do a lot. It's the part I'm best at," he said. "What you're not prepared for is ... the press coverage." He then showed the audience a photo of a standing-room-only press conference at the New Bolton Center.
"I'm not sure you can prepare yourself to speak to that many reporters. I prepared myself to tell the truth and be very aware that you may have to repeat yourself and speak very simple and keep on point. Those were my only real goals," Dr. Richardson explained.
For the eight months Barbaro was in his care, Dr. Richardson essentially lived under a microscope; his every treatment decision was scrutinized and second-guessed by veterinarians and many others following the case. "Having your post-operative radiographs show up all over the world, and having people calling from Hong Kong, Italy, and wherever else, is a little bit daunting," he said.
Barbaro was recovering nicely the first six weeks following the surgery. The surgical site was free from infection; moderate doses of phenylbutazone allowed Barbaro to stand on the fractured limb comfortably. His time in the equine recovery pool was also going well. Although he knew better, Dr. Richardson couldn't help feeling optimistic about the colt's chances.
"I knew all the problems were not going to be addressed in the first eight weeks. I've done this long enough to know that. I explained that to the media as emphatically as I could," he said. "But if you're human, you still get your hopes up. Mine were up because he was doing so well at that point."
Then, in early July, Barbaro started favoring the injured limb. The fixation had begun showing signs of instability, so the decision was made to operate to replace a bent screw. Looking back, Dr. Richardson believes this choice ultimately led to Barbaro's death. "If you're going to put one moment that probably led to the failure of the case, it is probably this instance," he said.
Up until that point, the surgical site was healthy, Dr. Richardson explained. After the second surgery, however, sepsis set in, necessitating a third surgery to clean the area and repair the joint. The day he knew Barbaro was in trouble was when he had trouble waking from anesthesia used to place him safely into the recovery pool. Usually Barbaro revived quickly, but not that day. "That was a very long and pretty heartbreaking day because I was pretty sure we were in big trouble at this point," Dr. Richardson recalled.
Shortly afterward, Barbaro started having problems with his left hind quarter—problems, as it turned out, that were caused by laminitis. Dr. Richardson knew the hoof was lost, so he had a heart-to-heart talk with Barbaro's owners, Roy and Gretchen Jackson.
"I told them things were very, very bad here, that this was catastrophic in every sense, and there's just no getting around it," Dr. Richardson said, suggesting that it might be time to end his struggle. "Frankly, none of us could do it, because we were standing in front of his stall and he was there looking like he didn't have a care in the world. We all voted, but Barbaro had the last vote, and we decided to press on."
With the decision made, Dr. Richardson resected the hoof on the infected limb. "You have to keep in mind," he noted, "the whole time we're dealing with his left hind foot, it's not like we have a normal right hind leg."
Dr. Richardson showed a video shot in August 2006, nearly four weeks after the hoof resection surgery, of Barbaro walking a short distance outside to eat grass, something he did through the fall. "He was a fairly happy horse. Certainly at this point, we didn't think there was any compelling reason not to continue on."
Fractures from the original injury had healed well enough that the cast could finally come off. Barbaro was able to bear full weight on the limb comfortably for more than a month. Barbaro's comfort diminished progressively, however, when a severe solar abscess developed in his right hind foot. To make matters worse, the left hoof deteriorated even further and his front limbs foundered. That was when the hard decision was made to euthanize Barbaro.
Dr. Richardson said he is often asked: Why did you go on? For a horse confined to a stall, Barbaro had a reasonably good quality of life much of the time. The colt had companions, such as Mocha, a cow that had a rumenotomy at the center. He received lots of attention and treats; Mrs. Jackson brought him fresh grass every day.
So, what did Dr. Richardson learn from his time with Barbaro? Primarily, people who know nothing about equine medicine thought they could save Barbaro. Many of the countless suggestions he received bordered on the bizarre. It was recommended, for instance, that the colt drink water from various holy shrines as well as the Jordan River and soak his injured limb in Atlantic Ocean water. Dr. Richardson also received letters with pages torn from 19th century medical books and even pages from James Herriot books.
All of these made him realize that one cannot overemphasize what equine veterinarians do is different from other types of medicine.
It wasn't all criticism, however. Dr. Richardson also saw that people can be very compassionate. Thousands of dollars were donated to the Barbaro Fund. The fences surrounding the New Bolton Center were plastered with get well posters, and baskets of carrots for Barbaro and treats for the staff came in on a daily basis. "The outpouring of affection was staggering," he said. "It was really, really amazing. Most of the people who wrote in weren't horse owners."