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Thursday, August 30, 2007

When things don't go smoothly...

Yesterday was a day that many would call a nightmare. I was scheduled on surgery from 8 AM to about 1 PM. I had three surgeries scheduled: one cystotomy (opening bladder to remove bladder stones) and two cats for dentistry.
I started with the cystotomy. The patient: a Yorkie that weighs less than my pinky finger. He was not the best anesthetic patient.... Thank goodness we have excellent monitoring equipment. While at no time was this little guy in danger, we kept having to adjust his anesthetic gas concentrations, fluid rates, etc, all to maintain a good plane of anesthesia while preventing a dangerous drop in blood pressure. Ok, so that took effort but certainly manageable. After removing one large stone and dozens of tiny ones from this guy's bladder, I stitched his bladder up, brought him to radiology to snap an X-ray, to ensure that no stones remain. Shoot. The processor just died. Tried three times. X-rays aren't being developed properly. Shoot, damn, and insert more swearing here. So I stitch up the rest (abdominal wall and skin), and call the owner to let him know that quality medicine has just been thrown out the window, but what could I do? It was certainly not anybody's fault that the processor had decided to die at that moment.
About a half hour after the dog wakes up from surgery, in come the service guys for the processor. Shoot. Great timing.
I get one of my dentistries under general anesthesia and start working on that big job. In comes my tech with two X-rays he had just taken, which would have been much more useful had they been taken just 30 minutes before. They showed a single beautiful stone remaining in the bladder. I was tempted to send the stool on which I was sitting straight into orbit! Ok, not the end of the world. It sucks big time but all I have to do is remove the stitches, no new incisions, and find that single stone.
I finished the first dentistry during which I had to make a flap over three lower teeth, extract all of them, and sew the flap up again (usually looks great when healed). Ok, that surgery went well.
I put the other cat under general. Started on that big job.... My techs meanwhile had to take the first cat out of his cage, as the cat started profusely bleeding from its mouth. Vets and doctors hate nothing less: hemorrhage. Funny, the cat bled minimally little DURING the surgery and likely banged its face on the cage wall while waking up (they do that sometimes when they wake up). So that cat had to be RE-anesthetized and the pressure had to be applied to the area for about 20 minutes. Bleeding stopped. My heart rate and pressure already sky-high.... Woke the kittie up.
So I finish THAT surgery. Went well, nothing interesting to report. This cat wakes up fine.
The first cat, dysphoric (stoned) from the pain drugs, smacks its face yet again against the cage wall (after adding more comforters and pillows than a bed at the Ritz) - a warm, bright-red liquid starts flowing... A third time, we put the cat out, I remove several stitches, pack the extraction sites with a packing material, and close up. Now we're good.

Back to the Yorkie. Unfortunately the dog had to be put under general again... Thank goodness the owner was a total sweetheart. I explained everything to him, was completely honest about what happened, and apologized to him most obsequiously.
Repeated the surgery, removed the single remaining stone easily (where was that little bugger the first time that it couldn't be flushed out like the others?) and woke the dog up. Time: 6:30 PM.

I sat down in my office at my computer to type out my notes for the day. It took much for me not to break down and cry.

Addendum (August 31, 2007): all patients discussed above are doing fabulously, as if nothing had happened.


Anonymous said...

The Sake is on moi...u know who it be...peace out

Cashew said...

Doing our best with good intentions is the most we can ever do. If we could control everything I think life would be boring and we would never learn. Sounds like you handled a series of unepected and uncontrollable events VERY WELL. The only thing to consider is: are there any learnings from what happened? If so, use them well. You did good Doc.

P.S. Crying is a valuable action. It releases negative, built up emotions and toxins from the body and let's you think straight again. But, hey, I'm a "Chick". :)

Susan and Cashew



Thank you. I think you're right. I did the best I could in light of these unplanned events. I always try to glean something from the mistakes I make.