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Tuesday, December 2, 2008

A Doctor's Stress

I'm not sure whether or not people really understand how stressful a doctor's job is and how much pressure we feel in making the right decisions for our cases. We know that our skills and knowledge will determine a pet's health and life. If we're good enough, the pet gets better and does well. If we misjudge something, make a mistake, or do the wrong thing the pet doesn't get better, and perhaps even suffers or dies. That's a big responsibility, and sometimes weighs heavy on us. Frankly, I don't know how human doctors and paramedics handle it. It's hard enough when I loose a patient, but I couldn't imagine if it was someone's parent or child.

Today the doctor I work with had to re-do a surgery. She had spayed the dog earlier this year, but it had been a difficult surgery with some complications (not related to the doctor) and she had to complete the surgery quickly. The client was well informed of this, and knew that there was a possibility that one of the ovaries wasn't fully removed. This indeed happened, the dog went into heat, and my associate had to go back in today and find the remaining ovary. I scrubbed in and helped her, which was necessary since the ovary was pretty tricky to find and remove. During the surgery she was enlarging the initial incision and cut through a blood vessel in the abdominal muscle. This is common, and usually not a big deal. There was a quick spray of blood, and then she clamped it off for the remainder of the surgery. By the time the surgery was over and she was closing the abdomen, the bleeding had stopped. At that point it seemed like a pretty routine recovery.

The dog was fine all afternoon. Now keep in mind that this is a dog that is very difficult to handle, has to be muzzled, and one of the reasons for difficulties in the original surgery was due to her extreme excitement and need to be excessively sedated to be handled. When it was time to discharge her, the dog became excited to see her owner, and jumped around a little. Suddenly her incision started to bleed. This really freaked out her owner, and understandably so. My associate had to bring her to the back and try to stop the bleeding. However, the dog was struggling against us (I was trying to help), which made the bleeding worse. We needed to place a pressure wrap around her belly, but she was making it harder for us, and that made her bleed more. After quite a bit of work, we finally got the wrap placed.

Here's what we believe happened. That vessel that was cut had clotted, but when she became excited the clot broke, causing the bleeding. There were no signs of internal bleeding or that anything had gone wrong with the surgery. We see this happen rarely, but it does happen, and usually is not very concerning, just messy. However, even knowing all of that, my associate is likely worrying tonight and will loose sleep. I know, because the exact same thing has happened to me, and I worry and fret far too much. No matter how much we might know that some things are beyond our control or ability as doctors, we still realize that we're responsible. And if something very bad does happen to this dog, this doctor will have to answer questions about it. Even though she did everything appropriate and I was also there, she will wonder if there was anything she could have done differently. And though there really wasn't, she'll still blame herself. Again, I've been there, and will likely be there again in the future.

Doctors have very hard jobs, and the good ones take a lot of personal responsibility for their patients. This can make it very hard on them mentally and emotionally, and they often carry these concerns home to their families (just ask my wife). Please realize that your doctors are human, and really do care. When something goes wrong, they worry as much as you do. Say a prayer for your vet and physician.