It happens all the time – the receptionist takes a phone call about a patient not doing well after surgery. Maybe they aren’t eating, maybe they chewed at their incision line, maybe they need more pain medications.
Regardless of what the issue is, I always get that sinking feeling in my gut: What did I do wrong? My default is to always blame myself and I feel sick until I see the patient and know they are going to be fine. A couple of years ago, I joined a Facebook group for veterinarians. A lot of vets posted when cases didn’t go well and I started to notice a common theme – they blamed themselves as well.
The first few times I read these posts, I felt relief –it’s normal to blame ourselves. But when I looked at the case from another perspective, I saw vets torturing themselves for things that were beyond their control. Some were facing depression or considering leaving the field. I wanted to write something to encourage them when things go wrong, to tell them that’s not their fault. To tell them to learn from what happened but realize they are still great doctors and to move on. I knew the article needed to be written, but I couldn’t find the right words.
Then it happened to me. I performed surgery on one of my best client’s dogs. Things went well initially, but over the weekend, the dog ended up at the emergency clinic with septic peritonitis and almost died. When I heard, I was devastated! I immediately blamed myself and convinced myself that I had almost killed this dog. There were multiple factors that lead to the dog’s decline, most of which were out of my control.
But I couldn’t see that. I could only see my role and what I may have done wrong. I kept replaying the case over and over in my head. The what ifs went through my head: What if I had done the surgery sooner. What if I had referred it somewhere else. What if I had flushed the abdomen one more time. What if I had done the surgery quicker. What if I would have stood up to the client and insisted she follow my post-op recommendations. What if I’m just not good enough.
In my head, I tried to convince myself I was still a good veterinarian. I thought of the times when clients have said to me things like “Thank you for saving Buddy’s life last year!” Most of the time, I don’t even remember the life-saving procedure until I read the patient’s record. It becomes routine when the patient makes a full and unremarkable recovery. I knew that I had many cases where the clients saw me as the hero, but I couldn’t remember them. All I could think is that I was to blame for this patient and I didn’t deserve to be a veterinarian anymore.
I needed support so I turned to my online veterinary friends in a Facebook post.
I received many words of encouragement, but Dr. Ryan Llera had the right words that took me out of my negative spiral:
“You shouldn’t beat yourself up. Sometimes things go wrong and I revert to some of the rules of vet med (as taught to me by some awesome mentors 20 years ago): 1) No matter what happens or what you do, things are going to die or not do well. 2) Unless you’re God, you don’t get to change rule #1. For any of us, by feeling sadness over losing a patient, it shows that we haven’t lost our humanity. You can always question the “what ifs” but at the end, remember you’ve helped more animals than you’ve lost. You’ve given hope and happiness to more people than have become sad over losing a pet in your care. I think the good outweighs the bad and that’s the part we have to remember.”
When I read those words, it was like a huge weight had been lifted off of me. It wasn’t my fault. I did all I could for my patient. Sometimes things go wrong, despite our best effort. We are not working in a laboratory with predictable conditions. We are treating living, breathing animals who are all different. They heal at different rates. They react differently to suture and medications. Their activity and post-operative care cannot always be controlled despite our best efforts.
Even when everything seems right, sometimes things go wrong. I have heard that 1% of enterotomies fail for no obvious reason. All we can do is our best and learn from each case.
A few weeks ago, I had another case where a dog didn’t recover well from surgery and was euthanized five days post-op. To make it worse, it was my technician’s dog. It was a hard case for everyone involved and we were all heartbroken. But this time, I didn’t blame myself. I looked at the case objectively – I had done my very best for the patient and despite that, he didn’t heal. He had underlying issues that affected his recovery, issues that were not my fault and could not have been prevented.
Unfortunately, these issues lead to his death. I am sad for the loss of my patient, but I know that I am still a good veterinarian. I will continue to do all I can to improve the health and life of all the animals under my care. When the outcome is not what I want, I will learn from the case and move on, doing my best not to blame myself. I hope that all of my colleagues reading this will do the same.
