"I neutered a kitten at the spay/neuter event last weekend and he didn't do very well under anesthesia," said Dr. Laura Levengood, my associate.

"The story we got was that he'd been rescued after someone saw him flung from the window of a moving car," she went on. "I think he has a diaphragmatic hernia and he didn't do well with anesthesia because he couldn't breathe. I asked the Spay/Neuter Task Force to drop him by our clinic so we could see what was wrong and maybe fix him. Is that OK?" Laura knows me well enough by now that asking was a formality. We arranged for the kitten to be dropped off later that day.

The unnamed cute black-and-white kitten arrived in the early afternoon and we radiographed his chest and abdomen. The X-rays confirmed what Laura suspected: The diaphragm, a thin muscle layer that separates the abdominal cavity from the chest cavity and is integral to breathing, was torn; the kitten's liver and stomach were in his chest cavity, compromising his lungs. Surgery was his only real option for survival, and the task force organized funds to pay for his repair.

Anesthesia would be tricky. With a tear in his diaphragm, he couldn't maintain the negative pressure he would require to breathe. Barely compensating while awake, once he was anesthetized and his abdominal cavity opened, there would be no way for him to breathe, and without ventilation, he would suffocate and die.

I discussed the game plan with my surgical team. Laura would be prepared to assist with keeping organs out of the surgical field; Josh, my prevet student would ventilate him during the surgery. Nicole, who leaves shortly for her first year of veterinary school, would be prepared to keep any exposed internal organs moist. I explained to Josh that his job was crucial to the survival of this tiny kitten; he would have to breathe for the kitten every 10 seconds through the entire anesthesia and surgery. Then, at the end of the diaphragm repair, he'd have to inflate the kitten's lungs when I placed the last suture to ensure that very little dead space remained in the chest cavity.

Each person was ready to do his or her part, and I carefully anesthetized the ailing kitten. When he was asleep and the endotracheal tube was placed, Josh started to ventilate him.

The kitten's shiny, short black and white hair was clipped from his abdomen and the clipped area scrubbed to prepare for surgery. I made a long incision from just below his sternum nearly to his pubic bone and gently moved his internal organs out of the way to see the extent of the damage. I found his liver and stomach completely through the large hole in his diaphragm putting pressure on his lungs; no wonder he did poorly under anesthesia!

I cautiously retracted those organs from his chest cavity and identified the frayed and torn edges of his diaphragm. Carefully placing sutures, I brought both sides of the thin muscle together. As I placed the final suture to seal his lung space from his abdominal cavity, I asked Josh to inflate the kitten's lungs and hold the pressure while I quickly seated and tied the last suture.

When his diaphragm was repaired, we watched to see if the kitten could breathe on his own, holding our own breath while we gazed at the tiny unconscious form on the surgical table. He breathed! He could breathe on his own! We looked triumphantly at each other and I quickly closed his abdominal wall, then his skin. I held the fragile body of the kitten while he woke up and carried him to my husband Derek's office to show him the infant. I looked at Derek with a question in my eyes and he nodded: We could keep this kitten for ourselves. This would save the task force precious funds to spay and neuter more cats, and we could watch this kitten heal and grow up in our own home.

Herkammer, as he became known, has become a dearly loved and deeply enjoyed member of our fur family. He is growing well now and when he ferociously attacks our feet at night I giggle with delight remembering how fragile and frail he was when I first met him. I pondered the forces that would motivate a person to casually toss a helpless kitten out of the window of a moving car, and I am grateful that there are some things I will never understand.

Tia Nelson is a local veterinarian specializing in an integrated approach to animal health that combines traditional veterinary medicine with holistic, natural practices.