How Poor Communication Gave Me An Ulcer



Tracker’s ultrasound was pretty conclusive: His elevated liver values were indeed due to a liver mass, and his enlarging abdomen was due to a hemoabdomen. The 12-year-old Australian shepherd’s future didn’t look too bright.

Dr. P. had called me on a Friday to perform surgery and remove the mass. We started with a blood transfusion to raise the PCV of 18 percent. Then we explored Tracker’s abdomen, found a very friable liver mass, which was ligated and removed. Omental adhesions were ligated and freed up. And for good measure, a splenectomy was performed after another mass was found. Oh, and we aspirated a total of 4 liters of blood from the abdomen. All other abdominal organs were within normal limits. The transfusion was continued intra and postop.

Tracker was transferred to a local emergency clinic for intensive care over the weekend. On Saturday, I called to inquire about my patient. He seemed to do well. His PCV was stable around 24 percent, his vitals were good, and no VPCs had been noticed on the ECG.

On Sunday, I called again to check on Tracker. The receptionist asked me what the last name was. Although it was a simple last name, I spelled it for her, at her request. Then she put me on hold. She then asked me what breed he was. “An Australian shepherd,” I replied. Then she put me on hold. They must be really busy, I thought.

Then she picked up the phone and told me that Tracker has been transferred to the University of Pennsylvania. Then she put me on hold again.

My heart sank. Through a new, unexplained pathophysiological phenomenon, that caused an instant gastric ulcer. What could possibly prompt a transfer to the local vet school? What complication could an emergency clinic not handle after a seemingly routine laparotomy?

Well maybe it wasn’t so routine after all. Maybe he developed uncontrollable VPCs. At least, that wouldn’t be my fault. Maybe I should have called more often to check on him. Maybe one of my ligatures slipped. Maybe he bled internally again. Maybe I can call the university and talk to the vet who took over the case. Maybe I didn’t mess up after all. Maybe they saved his life. Maybe double ligating the splenic artery wasn’t enough. I’ll always quintuple ligate from now on! Meamwhile, my ulcer got deeper and wider…

I knew it, I should have quadruple-checked my ligatures. Three times wasn’t enough after all.

The receptionist finally picked up the phone and casually said: “Turns that I was talking about another patient, let me transfer you so they can update you on Tracker.”

WHAT?

The innocent woman had no clue what she had just put me through.

The emergency vet promptly reassured me: Tracker’s PCV was even higher, he was eating on his own, he had walked outside to eliminate, and he was due to go home shortly!

PS: Tracker’s biopsy revealed hemangiosarcoma. He was recently euthanized, a little bit over three months after his surgery. His quality of life was excellent during the extra time he spent with his grateful owners.

Dr. Phil Zeltzman is a mobile, board-certified surgeon in Allentown, PA. His website is www.DrPhilZeltzman.com. He is the co-author of “Walk a Hound, Lose a Pound: How You and Your Dog Can Lose Weight, Stay Fit, and Have Fun Together (Purdue University Press).”

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