Veterinary Complications: If You’ve Been Warned Do You Deserve to Get Angry at Your Vet?
It’s one of those inevitably stressful things about practicing veterinary medicine (any kind of medicine, really) — You’re doing the best you can, practicing your science and craft to the best of your ability with the best intentions and still … things fall apart …
… because bodies being bodies, they will. It’s inevitable. In certain cases, for certain conditions and for certain procedures, we’ve even gone so far as to quantify how often things tend to go awry.
These are the cases that tend to keep us up at night. And altogether too often, it’s not because the pet is having a hard time. Rather, it’s because the owner is fuh-reaking over the fact that things have not gone 100 percent according to plan.
I have one of those clients in my uncomfortable clutches right now. His dog is an oblivious old golden retriever. Her condition? A low grade mast cell tumor I removed six weeks ago. The problem? An incision site that refuses to keep it together long enough to heal.
So you know, mast cell tumors are locally invasive cancers that usually start in the skin and can spread. Low grade tumors (not so aggressive) tend to have a good prognosis as long as there’s only one tumor to deal with.
Unfortunately, mast cell tumors are a PIA to get off the body, seeing as you’ve got to give them a wide berth. One to two centimeters is the minimum amount of skin you’ve got to take along with your mass in order to feel secure that you’ve removed the whole thing. It’s invariably a big incision.
Which, in part, is why 20 percent of mast cell tumors –– unpredictably, it would seem –– like to open up and give us a hard time during the post-operative healing process (this process is called dehiscence.)
In this case, I explained that the mass (a) needed to be removed ASAP, (b) that a board-certified surgeon is always the best choice for removing anything but the smaller mast cell tumors (this was not one of those), (c) that all mast cell tumors have a one-in-five chance of opening up post-operatively, and (d) that this one, over a pressure point and a highly moveable site on the hind limb, was more likely than others to open up after surgery.
None of this, however, seems to have stuck in the owner’s mind. The only thing he focuses on is that this is taking for-ever (!) to heal. He’s so steeped in his own personal frustration that he can’t get past the obvious up-side: More than likely, I’ve cured his dog of cancer.
Never mind the positives. All I get is stress about how impossible this incision site is and whether it’ll ever heal and whether it really needed to be removed in the first place and how it’s ruined his summer and yada yada so that all I want to say (but won’t) is that he should remember what I told him the very first day: the specialist is the best and no matter what (specialist or no) the dehiscence rate is 20 percent.
Sigh. I don’t think he deserves to be angry. At the universe for the cards he’s been dealt? Perhaps. At me? Nu-uh. I did my job well. And I warned him, to boot.
My biggest sin? Not recognizing that this client was the kind who would give me grief when things didn’t go his way. Too bad the likelihood of client anger is something veterinary medicine still hasn’t learned to quantify.
Dr. Patty Khuly