Surgical disasters in vet medicine... a long-distance consult on a case gone wrong
At the risk of courting oodles of personal emails on the subject of individual pet healthcare issues (beyond the heaps I already receive), I’m going to recount one particular correspondent’s tragic story.
This tale had me asking my vet friends for advice, soliciting opinions from human docs, and generally kept me up at night wondering what I would do in a similar situation. Here’s the story (modified somewhat to protect the innocent, undeserving or indefensible, whichever the case may be—you decide):
A reader in New York sent me an email after her dog’s pyometra surgery went awry. (A pyometra is an infected uterus common to older unspayed females. It’s usually treated as an emergency by spaying the bitch and administering antibiotics.)
Unfortunately, this not-so-simple spay resulted in the inadvertent snip of a vital structure which connects the bladder to the kidney: AKA, the ureter. This is not a common complication but it is listed among those more likely to occur during any urogenital surgery (due to the small size of the ureters and their ability to hide among fatty abdominal flesh).
Problem is, the ureter is absolutely essential because it carries urine from the kidney to the bladder. Without it, the kidney is a useless, urine-leaking liability rather than the detoxifier and electrolyte tweaking organ it should be.
It used to be that a snipped ureter led always to the removal of the offended kidney. This was true in humans, too, until we discovered that reattaching ureters was possible. But in animal medicine, only board-certified vet surgeons (not exactly a dime a dozen) are accustomed to doing the kind of fancy fingerwork required for this procedure. I, for one, would have no clue how to reattach a ureter.
So it happened that when the ureter was snipped during our girl’s spay, the general practitioner likely did what most of us would do: he panicked. Mustering his courage after the fact, he did the only thing he was trained to do: he surgically removed what he felt to be a now-useless kidney.
Now, this is an accepted way to deal with the very human problem you’ve created in this situation. Just thirty years ago, human medicine would have found the doc doing the same thing in most cases (it’s still done this way in many other countries, by the way). After all, everyone knows that a person can survive on just one kidney. Why else would modern medicine allow kidney donations from live patients?
In this case, however, things continued to spiral out of control. A couple of days later the owner was informed that her dog was in renal failure. Although bloodwork before the surgery showed normal kidney function, things now were not so hot.
So you know, the disease state of pyometra can occasionally ruin the health of the kidneys due to a variety of complicated mechanisms we don’t completely understand. Unfortunately, these mechanisms were apparently on overdrive in this girl’s case. Had she both kidneys, she might still have been in trouble. Now that she had but one, it was far too much to expect her to survive.
Now for the owner’s question: “Did the vet do something wrong? Am I wrong to be angry and upset? What would you have done, Doc?”
And here’s where I run screaming into the night hoping this person’s not actually expecting me to answer her tragic email and pointed questions. Because no matter how I respond, I’m still going to sound like a schmuck.
What would I have done? Considering there’s a specialty hospital right across the street with three surgeons on staff (one of whom I happen to be dating), I think I would have made one hysterical phone call. I would then have curled up into a little ball in the corner of the surgical suite until someone more qualified came to rescue me by reattaching the ureter.
But that’s not a good answer. It’s not really what she wants to know. After all, not every vet has hysterical-call access to a surgeon who will drop everything anytime a tear threatens.
So it is that I have no good answer. This vet certainly acted in accordance with accepted standards of care. But the tragedy of knowing it could have been prevented makes for a pretty stressful series of potential finger-pointings.
I know several vets who have sliced ureters accidentally. Sure, it’s bad—really bad. But things happen when you’re dealing in flesh and blood and the messiness that comes with it. When it’s your pet you want someone to pay-and we vets understand that. But when it happens to us, I guess all we can say is…I’m so sorry.