Wednesday, April 6, 2011

I think that light at the end of the tunnel is an oncoming vehicle....

I returned to work, in a relatively upbeat and cheerful mood.  I love my job, and I love it even more when I'm busy, challenged, and saving pets.  My last two days, despite the crazy pace, had been amazing.

Unfortunately, when I walked in to the clinic that evening, Bo was no longer in the hospital.  He had declined over the day, and was euthanized by my colleague. His family had been present for the euthanasia, and they realized that they had done everything they could, and unfortunately, Bo wasn't responding well after surgery.  Several days later, his biopsy did confirm a cancerous mass.

Nala, on the other hand, was moving along like a rockstar.  She was already eating, bright, alert, and comfortable.  The fluid draining from her abdomen was improving, and it appeared that surgery plus antibiotics (etc) was doing the trick.  She was on the road to recovery, and her family couldn't be happier.  I couldn't be happier, either.  What an amazing save -- I was deeply proud of the work I had done for Nala.   (Nala discharged home to her family 36 hours later, and is expected to make a full recovery).

It's hard to explain how this case made me feel.  My whole career, and even my whole life, my friends, family, colleagues, and mentors have expected the best from me.   It's as if I could never do better than they expected, because they already expected perfection.  For example, after hearing this story, my closest friends and family responded with "You expect me to be surprised....?" (YES, YES I DO! That was such a hard case, and even in doing all the right things, the dog STILL could have died!!)  Of course, it's amazing and flattering to be surrounded by that type of confidence, however it's a completely separate thing to have that sort of confidence in myself.  Doctors (veterinarians) are people too, and although I may portray a cool, calm and collected exterior, I'm constantly self-judging, self-evaluating, and feeling inadequate.  Could someone do this better than me?  Would the patient have a better outcome somewhere else? Have I forgotten something important?   If the treatment fails, is it my fault?  This case provides me with an objective measurement to remind myself -- you did a great job. This patient is alive because of you -- and it's just the most amazing feeling.  I know I'm a good veterinarian, but good isn't good enough for me -- I want to be the best I can be.  Despite this positive boost for my ego and confidence, I strive to never rise completely above the level of being self-critical.  This is one of my most trustworthy tools to reduce my chances of overlooking a diagnosis, missing an exam finding, or selecting the wrong treatment regimen.

If any veterinary students are reading this, definitely check out the books How Doctors Think (Jerome Groopman) and Better (Atul Gawande).  These are both written by M.Ds., and definitely shine a light on the psychology of medicine.  The general population expects us to be perfect, infallible, never incorrect, and somewhat omniscient.  We're not.   Actually, these books are great for anyone to read -- from the perspective of a patient who may someday receive a difficult diagnosis.  I highly recommend them.

Anyway, I digress.  

The other critical patient in the hospital was a young miniature Aussie who had been hit by a car earlier that afternoon. She had arrived unconscious, with severe head trauma, severe hypotension (her blood pressure was 30!), and severe signs of shock. She also had a large de-gloving laceration on the left side of her chest (meaning the skin was peeled back from the body), and nystagmus had been present since arrival. She was treated with IV fluids, mannitol (in attempt to reduce swelling of the brain), pain medications, oxygen, antibiotics, and intense monitoring.  By the time I arrived, she was normotensive, slightly responsive, and had show some signs of improvement. We monitored her intensely over the evening, checking her vitals every 30 minutes initially.   (Over the following 24 hours, her progress was positive, but the outcome is unknown to me at this time.  I'll fill you in soon).

The rest of my evening was more even-keeled, and I had a chance to catch up on paperwork, make sure medical records were complete, contact owners with outpatient bloodwork results, check up on patients from days' prior and take a deep breath.

The ER is a highly stressful, emotion-filled, adrenaline roller coaster.  I'm so glad that it's my job.

Now for some R & R... I'm looking forward to your comments!

1 comment:

  1. What an intense few days.. I bet Nala's owners are over the moon. File that feeling away in your atta girl file for when you don't feel so great or have a crappy day!! Crappy days/moments happen but if you can remember why you do what you do it will help. Nala is a GREAT example..