Almost-Deadly Mistake

I've mentioned this before, but it bears repeating.  Veterinarians (and other doctors) are humans; therefore they can and do make mistakes.  The bad thing about these mistakes is that when things go wrong it can affect the life and health of the patient. I just had a mistake that was almost very, very bad.

Yesterday I neutered a Yorkshire terrier.  This isn't normally a big deal, as by my calculations I have performed over 2,000 of these surgeries.  This case was slightly complicated by the fact that one of the testicles had been retained in the abdomen (a condition called "cryptorchidism"), which means we have to make a second incision and go hunting after it.  Again, this isn't normally a real concern as I've done several dozen cryptorchid surgeries over the years.  The pet recovered well and was sent home.

This morning the owner called, concerned about the fact that he was trying to urinate but couldn't.  He also wouldn't eat or drink and seemed more painful than expected.  I told her to bring him in for us to look at him.  Once I examined him I could immediately tell that his bladder was extremely full as well as painful.  It appeared that he had been completely blocked overnight, and was in a very serious condition.  However, I couldn't figure out how that could have possibly happened.  When we neuter dogs, we don't actually do anything to any part of the urinary tract.  Even going into the abdomen we don't handle the bladder or any other part.  So I was perplexed as to how it could have happened.  But mostly I was worried.  Very, very worried.

I have made mistakes in the past, but rarely have I felt this concerned.  Because I genuinely care about the outcome of my cases, I take my mistakes seriously and personally.  Though I know it isn't good to do, I will worry over some of my cases for days, especially if I think I might have messed up.  With this puppy I was so worried about what I might have done that I started getting nauseas and light-headed.  My anxiety was so high that I had to actually sit down for a while because I was afraid of passing out.  I can't remember ever being that worried and anxious, but this time I was severely affected.

In cases like this we can't simply give up and tune out.  The dog needed me to figure out what was wrong and fix it.  I also had other patients that still needed to be seen.  So with a round of prayer, I steeled myself to continue.  I sedated him and passed a urinary catheter to see where the obstruction was.  Surprisingly it was at the site of the standard neuter incision.  I couldn't figure out what I had done, but I knew that something had blocked his lower urinary tract at the base of his penis, and the only thing that could have caused that was the suture.  I knew that I had to go back in surgically and try to fix things.

I anesthetized him, opened up his incision, and removed the suture I had placed just 24 hours previously.  Once I had done that I had my tech try to advance the urinary catheter.  This time it passed easily into his bladder, and we were able to empty it of urine.  Somehow a suture had passed around or through part of his penis, obstructing his urinary tract and keeping him from being able to urinate.  I closed the surgery site again and recovered him.

He did well post-operatively and recovered quickly.  I knew he was doing better when we gave him some dog biscuits and he ate them with gusto, something he hadn't done in over a day.  He was much improved when we did send home.  Thankfully the owners were understanding and we covered all costs of the second procedure.  I was very honest with them about what had happened, as I don't believe it is right to ever lie, especially in situations like this. 

Part of being a doctor is having do deal with situations like this.  And I can't say that it ever gets easier.  We are expected to be perfect by the law and by most people, often including ourselves.  Yet it's impossible to be perfect.  Impossible to never do something wrong.  I'm the worst when it comes to expecting myself to do the impossible like this. This was a once-in-a-lifetime fluke that I still can't figure out.  It shouldn't have happened, and I don't know how it did.  But the reality is that I did make a mistake and the pet could have died because of it. Thankfully, he seems to be doing well now. And yes, I will continue to worry about this dog until I know that he does well over the next two days.