I've thought about whether I wanted to post this or not for a few days. In the interest of representing what it is truly like to be an animal doctor, I think I would be heavily remiss in not sharing one of the the hardest parts of being a veterinarian (or any sort of doctor).
I made a mistake.
It's arguable whether or not it cost my patient her life.
On Sunday morning, a nice woman brought in her Golden Retriever. She had been hit by a car. Her respirations were rapid and shallow. I suspected a pneumothorax. Her gum color was not good, and her blood pressure wouldn't read.
We started stabilization: IV fluids, pain medication, and a chest tap. I removed over 3 liters of free air from her chest. At that point, I made the decision to put in a chest tube. She responded rapidly to this treatment. I discussed her condition with the owner, she left a hefty deposit and left her dog in my care.
Over the course of the day, we were slammed. I didn't eat, drink, or use the bathroom until 4:30 that afternoon. I was rushing around managing the patients pouring through the front door, as well as the 11 hospitalized patients in the back. See, we'd been open since Christmas Eve. I'd worked 14 hours on Friday, 14 hours on Saturday, and (as it turned out) 14 hours on Sunday. Further, I'd been sleeping terribly (Friday and Saturday night, I got a cumulative 6 hours of sleep). I was tired, emotional, and overwhelmed. I wasn't on my A game, or I can assure you, this never would have happened.
At any rate, over the course of the day, my patient's breathing became more and more shallow (despite the chest tube evacuating the air in her chest). Her gum color wasn't good (pale pink), and her blood pressure dropped repeatedly despite fluids.
ANY OTHER time - ANY OTHER day - I would have immediately suspected internal bleeding. The dog practically had a flashing neon light the size of a Mack truck above her head screaming HEMOABDOMEN HEMOABDOMEN HEMOABDOMEN!!!! It actually occurred to me that I should wheel the ultrasound over and check, but then something always intervened - another dying animal through the door, or something in the hospital needing my attention RIGHT THAT SECOND. I never did put the u/s on her.
As I transferred her over to the doctor on shift after me, my technician turned and said, "her blood pressure is 39 (normal systolic BP should be around 100!)." After I left, my colleague checked her belly, and sure enough: horrible internal hemorrhaging.
Surgery revealed a liver that was in multiple pieces and more than 3 liters of blood in the abdomen. My patient arrested under anesthesia.
My colleague has tried to make me feel better by telling me it wouldn't mattered had I caught it early or not, the liver was shattered. Somehow, that doesn't help. You see - somewhere in the back of my mind, I KNEW that my patient had internal bleeding, and I didn't look for it.
Why? Perhaps because I was exhausted and couldn't deal with the idea of an intensive surgery. Perhaps because I'd annoyed the techs enough that day and just couldn't stand seeing them roll their eyes when I asked that the ultrasound be wheeled over to the cage. Perhaps because my last hit by car hemoabdomen died on the table.
I'll never know the answer. I only know that I missed something that was blatantly obvious and now my patient is dead.
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