There’s a colloquial term we vets sometimes use to describe the [thankfully rare] times we undertake surgical procedures that are beyond our abilities. We call it 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 a patient and cut him open. These are the times when the room suddenly seems inordinately warm and the sweat starts to gather at your waistband. These are the times when vet surgeons seem like gods to us for their ability to surrender their fears to the knowledge that their skills make them much better at this kind of stress than the rest of us. (Sometimes I hate them for this. I’m just a jealous person, what can I say?)

Whether it’s…the raging cancer coursing with 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 stomachs or the ginormous subcutaneous mass we couldn’t manage to extract without leaving an equally huge, gaping wound…I hate these cases.

I’ve learned (after twelve years) 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. Occasionally, I’ll go for it—reluctantly—and manage OK, all the while knowing someone could have done it so much better.

And then there are the times we misjudge; when what you 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 ship them to the surgeon—heavily sedated, if not completely anesthetized. (That’s happened to me only once.) If that’s not an option, I just sweat—a lot—and get it done to the best of my ability while reminding myself 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 feel it the same way most of us do. They plow on ahead and take their chances on every case. Mark Twain has 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."