There’s a catchy colloquial term used to describe the times we undertake surgical procedures that are well beyond our abilities. You may know it as the “peek and shriek.” And we all do it at some point or another in our careers. These are the times we wish we’d never anesthetized the patient and had the hubris to think we could cut him up. These are the times when the room suddenly seems to swelter and spin and the sweat starts to pool at your waistband. These are the times when vet surgeons incite our envy for their ability to surrender their stress to the knowledge that their skills make them much better at this than the rest of us. Whether it’s the raging mass coursing with monster vessels, the urethral stones encrusted in secret urethral cavities, the recalcitrant fractures splintering beneath our fingers, the bowel regurgitating its contents intra-abdominally, the heavily necrosed post-torsed stomachs or the ginormous cutaneous masses we somehow couldn’t manage to excise without leaving equally colossal wounds with no hope of primary closure, they give me nightmares. I detest these cases. They mostly make me want to curl up into a little ball in the corner behind the dental machine. Failing that, I suck up whatever pride I’ve got left and call the local vet surgeons for a hefty dose of hysterical-vet hand-holding. "...there are the times we misjudge; when what we expected would be straightforward and simple turns into a harrowing nightmare beyond our worst expectations." Hmmm … How to Re-attach a Ureter 101. “OK, Dr. Khuly, now just take a deep breath and we’ll all get through this…” I’ve finally learned (after 12 years) how to spot most of these cases before they go under the knife—and I send them to the surgeon, ASAP. Sure, for every three I ship I probably could have cut two without breaking a sweat. But fear of the third’s nightmare scenario stays my hand every time. Occasionally, though, we’re all faced with the should-I-or-shouldn’t-I cases. It usually happens during late-night emergency visits (“I’m either fixing this hemoabdomen and possible ruptured bladder right now or they’re driving two hours to the on-call surgeon’s digs in the neighboring county”) or, more often, when the surgeon’s fees are impossibly untenable. In these cases I’ll go for it—albeit reluctantly—and manage with middling success, all the while knowing someone could have done it so much better. And then there are the times we misjudge; when what we expected would be straightforward and simple turns into a harrowing nightmare beyond our worst expectations. If the client has the funds, that’s when I close them right back up and drive them to the surgeon—heavily sedated. If that’s not an option, I just sweat—a lot—and get it done to the best of my ability, all the while reminding myself it’s either me or nothing (as was my mantra when I worked emergency for a couple of years right out of vet school). It’s a nasty business, this “peek and shriek,” what with all that sweat, stress, humility and self-criticism. The whole issue mostly makes me feel like a second-rate vet. But I manage OK by reminding myself that Mark Twain has a mouthful to say on this subject: “What gets us into trouble is not what we don't know. It's what we know for sure that just ain't so.” Dr. Khuly blogs regularly at www.dolittler.com <HOME>
