There’s an idiomatic term we vets sometimes use to describe the (thankfully rare) times we undertake a surgical procedure that is beyond our abilities. We call it the "peek and shriek." And we all do it at some point in our careers.

These are the times we wish we’d never anesthetized a patient and cut him open. These are the times when the room suddenly seems inordinately warm and the sweat starts to gather at the waistband. These are the times when veterinary surgeons seem like gods to us for their ability to surrender their fears to the skillful knowledge that makes them much better at this kind of stress than the rest of us. (Sometimes I hate them for this, but I’m just a jealous person, what can I say?)

Whether it's the raging cancer with its monster blood vessels, urethral stones that just won’t budge, a recalcitrant fracture splintering beneath our fingers, intestines spilling their contents into the abdomen when manipulated, the heavily necrosed post-bloat stomach, or the ginormous subcutaneous mass we can't manage to extract without leaving an equally huge, gaping wound in its wake, these cases are equally dreadful and alarming to the general vet.

In my twelve years of practice, I’ve learned to spot most of these cases before they go under the knife — and I send them to the surgeon, ASAP. Emergency vets and those with lots of lower-income clients aren’t so lucky. They often don’t get a choice; it’s them or no one. They either don’t have the time to call in a surgeon, don’t have access to one, or their client can’t afford a four-digit price tag (on the procedure alone).

When faced with one of these "should-I-or-shouldn’t-I" cases (when the surgeon’s skills are impossibly expensive), I point out that my fee alone is perhaps equally untenable. And that’s where it ends, usually. On occasion, and with some reluctance, I’ll go for it and manage OK, all the while knowing someone  — a better equipped surgeon — could have done it much better.

And then there are the times we misjudge; when what was expected to be a straightforward and simple procedure turns into a harrowing nightmare beyond our worst expectations. If the client has the funds, that’s when I close the animal right back up and ship them off to the surgeon — heavily sedated, if not completely anesthetized. Thankfully, that’s happened to me only once. If that’s not an option, I just sweat it out — a lot — and get it done to the best of my ability while reminding myself that it’s either me or nothing (as was my mantra when I worked emergency).

It’s a nasty business, what with all that sweat and stress and self-criticism. But what I really hate about the "peek and shriek" goes beyond my own experience. It’s that some clinicians I’ve known don’t regard it the same way most of us do. They plow heedlessly ahead and take their chances with every case.

Mark Twain had a mouthful to say about this approach: "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. Patty Khuly