Veterinary medicine is a profoundly human science. So much so that it perfectly mirrors the many deficiencies, uncertainties and flaws that characterize our human experience. It is, by its very nature, shockingly imperfect.
But that’s not what anyone wants to hear when they bring their pets to the vet ...
... They want to believe that a) their veterinarian has paid her dues and graduated at the top of her class, b) that she’s spent at least twenty years acquiring the skills only experience can burnish to perfection, and c) that she never, ever makes any mistakes.
It’s clearly impossible to supply a veterinarian who can offer c), much less all three. Not only does everyone, without fail, make mistakes, but not everyone can graduate at the top of their class, and (guess what?) it takes twenty years to acquire twenty years of experience.
So it is that when you walk into that after hours animal ER facility and encounter your very first fresh-faced intern when you most believe you need the absolute best, most experienced clinician … you’ll come face-to-face with the most visible reminder of the reality of the allied medical professions: They are imperfect. And sometimes you just have to live with it.
That was the case last month when our hospital hosted one of the worst clinical disasters of my career. As the result of a simple misunderstanding, a staff member gave ten times(!) the normal dose of a subcutaneous medication to a post-operative patient.
Thankfully, I double-checked on my team, read the recorded dose, and flipped out in time to do something about it. But, unfortunately, this was not an antibiotic or one of any number of drugs for which an antidote is available. To fix my mistake I had to surgically excise the area and pump this seven-pound kitten full of a fat-binding solution to help clear his body of the toxin.
Three days later I knew we were in the clear. But can you imagine the owner’s shock as I’d explained the mistake? What would you have done during those three days of stressful waiting? You’d have been right to blame me. (I did, for sure.) You would have a right to expect your veterinarian to pay for all treatments. (We did, of course.) And you would have been justified in feeling angry and harmed.
But here’s the thing: It might not have been fair if you’d condemned me roundly or perceived my act as a betrayal of trust. This was a mistake. An honest one. One that was caught in the course of the checks and balances medicine has to employ by way of mitigating risks we know we take each time we suck medicine into a syringe and administer it to a patient. Because almost everything we do carries risks.
After losing exactly one patient to an anesthetic complication in only twenty years of practice, I was starting to feel rather charmed. (So you know, one to four out of every thousand anesthetic procedures yields a significant anesthetic complication.) But if you practice medicine long enough, things will happen. Good things and bad things. I choose to believe it’s how you react to them that counts.
Here’s where I’ll blatantly appropriate a quote by my favorite medical writer, human surgeon Atul Gawande, from his seminal book, Complications: A Surgeon's Notes on an Imperfect Science:
“[Veterinary] medicine is, I have found, a strange and in many ways disturbing business. The stakes are high, the liberties taken tremendous. We drug [pets], put needles and tubes into them, manipulate their chemistry, biology and physics, lay them unconscious and open their bodies up to the world. We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, however –– close enough to see the furrowed brows, the doubts and missteps, the failures as well as the successes –– is how messy, uncertain and also surprising [veterinary] medicine turns out to be.”
Atul Gawande is no James Herriot, of course, but in this book he uses stories to make many of the same points Dr. Herriot so charmingly made in his All Creatures series of books: Medicine, even veterinary medicine, can get messy. Very messy. And that's as it should be. To err is human ...
Thankfully, as Gawande and Herriot teach us, it is in the midst of all that mess that we learn and progress. Indeed, it’s often by making mistakes that we learn the most. After all, though it won’t make most pet owners (or patients) happy to hear it said aloud, they don’t call medicine a “practice” for nothing.
-Dr. Patty Khuly