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May. 2nd, 2013 12:29 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
estelracaSo I've hit that terrible milestone--my first mistake that ended up in a patient's death.
A cat came in for a spay. It was a stray, pregnant, just adopted by a really nice family. I did the surgery, because I love surgery. It's one of the things I usually feel most confident about. Whenever you do abdominal surgery, there's layers of the abdomen to close, the most important being the linea alba. It's the part that holds all the intestines and everything where they're supposed to be. They pound into us again and again in vet school to make sure to close the linea properly. Towards the end of the surgery one of my long-running patients came in, so I was hurrying to finish things. I remember hurrying. I think I checked the linea. I usually do. But I don't remember.
The cat came in the day after with an incisional hernia. It wasn't severe, just some omentum (basically special abdominal fat), but it means I fucked up the linea closure. I didn't put the stitches close enough together or I missed one at the end or... I don't even know. But the only way this happens is if the surgeon made a mistake. It's something we have to put the animal back under anesthesia to fix.
One of the other doctors put her back under anesthesia, and she crashed. Dead for ten minutes. We got her back, but not fast enough. She spent two days in the hospital, with us trying everything we could to see if we could get some kind of functionality back, and she just kept lying on her side and staring at nothing. Or crying methodically, every thirty seconds. Both were pretty terrible. And then she went downhill even from there, and we euthanized this morning.
I just.. don't know how to handle this. They told us this would happen. Two of our professors, in two different graduation speeches, told us that we would make mistakes, and that at some point those mistakes would result in a patient's death. And I, like the stupid little proud thing I am, thought, "I won't let it happen to me". But it did. I screwed up, and a gorgeous cat died because of it. I'm afraid to do surgery. I just want to curl up somewhere and hide. And the usual things I do to help with work-related stress aren't really helping. I tell people about it and their first response is "it's not your fault". Which, no, the anesthetic death wasn't my fault. I wasn't involved in that part at all, and it's something awful that happens randomly. But I'm the reason it had to happen, because I screwed up the surgery. If the cat had come from another vet, and I'd seen the incision like that, I would blame the other vet. Not to the client's face, because professionalism and who knows what else was going on, but I'd think that the vet screwed up closing the incision. But how do you deal with that? Always, in fiction (published or fanfic, because reading about Combeferre or Joly or McCoy dealing with Doctor Things is another one of my coping mechanisms, sometimes), when doctors are having a hard time dealing with something, someone else tells them "oh, it wasn't your fault" and somehow absolves them of their guilt. But I am guilty.
I don't know. I'm just rambling now. I'm tired from two weekends in a row on. Cat's going to be gone this weekend. And I just want the whole world to disappear for a while, except not, because then all I hear is the kitty crying.
A cat came in for a spay. It was a stray, pregnant, just adopted by a really nice family. I did the surgery, because I love surgery. It's one of the things I usually feel most confident about. Whenever you do abdominal surgery, there's layers of the abdomen to close, the most important being the linea alba. It's the part that holds all the intestines and everything where they're supposed to be. They pound into us again and again in vet school to make sure to close the linea properly. Towards the end of the surgery one of my long-running patients came in, so I was hurrying to finish things. I remember hurrying. I think I checked the linea. I usually do. But I don't remember.
The cat came in the day after with an incisional hernia. It wasn't severe, just some omentum (basically special abdominal fat), but it means I fucked up the linea closure. I didn't put the stitches close enough together or I missed one at the end or... I don't even know. But the only way this happens is if the surgeon made a mistake. It's something we have to put the animal back under anesthesia to fix.
One of the other doctors put her back under anesthesia, and she crashed. Dead for ten minutes. We got her back, but not fast enough. She spent two days in the hospital, with us trying everything we could to see if we could get some kind of functionality back, and she just kept lying on her side and staring at nothing. Or crying methodically, every thirty seconds. Both were pretty terrible. And then she went downhill even from there, and we euthanized this morning.
I just.. don't know how to handle this. They told us this would happen. Two of our professors, in two different graduation speeches, told us that we would make mistakes, and that at some point those mistakes would result in a patient's death. And I, like the stupid little proud thing I am, thought, "I won't let it happen to me". But it did. I screwed up, and a gorgeous cat died because of it. I'm afraid to do surgery. I just want to curl up somewhere and hide. And the usual things I do to help with work-related stress aren't really helping. I tell people about it and their first response is "it's not your fault". Which, no, the anesthetic death wasn't my fault. I wasn't involved in that part at all, and it's something awful that happens randomly. But I'm the reason it had to happen, because I screwed up the surgery. If the cat had come from another vet, and I'd seen the incision like that, I would blame the other vet. Not to the client's face, because professionalism and who knows what else was going on, but I'd think that the vet screwed up closing the incision. But how do you deal with that? Always, in fiction (published or fanfic, because reading about Combeferre or Joly or McCoy dealing with Doctor Things is another one of my coping mechanisms, sometimes), when doctors are having a hard time dealing with something, someone else tells them "oh, it wasn't your fault" and somehow absolves them of their guilt. But I am guilty.
I don't know. I'm just rambling now. I'm tired from two weekends in a row on. Cat's going to be gone this weekend. And I just want the whole world to disappear for a while, except not, because then all I hear is the kitty crying.
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Date: 2013-05-03 02:42 am (UTC)It's weird. Everyone else keeps trying to tell me that I didn't do anything wrong, and my reaction is to want to scream "but I did". (Except my boss, but he's busy feeling guilty because the cat died when he was putting it under. Yay, guilt party for all.) Having someone finally say "yep, you fucked up" makes my brain go "but maybe something else happened!". And I'll never know, because I can't remember the end of the surgery. Probably I made a mistake; much less likely something happened with the suture or the cat picking at the incision; either way, my surgery went south and the kitty had to pay the price.
I actually had to go and do surgery on a five-week-old kitten immediately after lunch, and it went fine. I'll get back on that horse--I do love surgery, and it's something I'm good at, something I got an award for at graduation.
I want to be superhuman. I want to be perfect and have all the answers and solve all the problems and save all the animals and remember everything and catch all the little things that owners say at the most ridiculous times and not have to worry about money or compliance or timing or things going wrong. But I can't be Superman. I can just be the best human that I can be, and try to make that good enough.
And be really grateful that people don't hate me when I do make mistakes, even when the result is terrible.
no subject
Date: 2013-05-03 02:57 am (UTC)Your boss, I'm sure, is trying to make it easier on you. Considering how hard you're taking this, your boss' actions are fully understandable. I'm sure they want you to bounce back from this, but it's not always that easy. And it shouldn't ever be easy to just bounce back. You should feel what you're feeling. Aside from letting it guide you and learn from it, it also keeps your humanity in check. It's good that you're taking it hard. That, of course, doesn't make the feelings hurt any less, nor will it bring any comfort, but you're not looking for comfort now, I'm betting. Any given would seem almost...I dunno. False in a way.
You are, however, very strong. You need to be for this line of work. I would love to work with animals and save 'em and all that, but I know I'd lose it bad if any ever died. I can't put myself out there like that. But you can, and you're needed to make up for the wusses of the world like myself.
And you're right in knowing that you're not Superman and all that. I think, deep down, we all have a savior complex of sorts. Sometimes it's predominant, and we take a failure harshly. Sometimes it's mild, and we can move on fairly quickly. But the lesson of 'you can't save everyone' is always hard to learn. It's never learned easily. Because while others can tell you this, everyone refuses to believe it until they experience it for themselves. The lucky ones escape with minimal scarring.
In a way, though, it's also a passage for you. You have made your first real life-or-death mistake. It's, in a way, akin to a child becoming aware of their own mortality. A step up both mentally and emotionally. You're wiser for it, though the lesson hurts like hell.
I'm glad you're continuing with surgery. I'm glad you're willing to get back on that horse.
On a sidenote, it's my headcanon that Joly is way above par when it comes to surgery. He stutters a little and twitches nervously when having to tell someone their diagnosis, at least when it pertains to a STD, but surgery is where his talents really reside. Partially because he's normally put in warzones - barricades, etc - where surgery comes as a necessity rather than saying "Got some bad news for you. Your leg's gonna have to be amputated, and it looks like your colon had a bright idea when you shoved that lightbulb up your rear, but here's the real bad news. Everyone here who hasn't got syphilis, raise your hand. Ooh, not so fast there."
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Date: 2013-05-03 05:07 pm (UTC)I can totally see Joly as a surgeon. Those of us who suffer from Med Student Syndrome, believing we have every disease we see and learn about, tend to be detail-oriented, which also works really well in surgery. Poor Joly. Trying to tell someone they have syphilis would be so incredibly awkward--bonus awkward points if it's a friend. People are so weird about anything involving genitalia anyway--especially men with female dogs, it seems. The married ones with kids who can't manage to spit out the word "vulva" no matter how many times I prompt it to them but rather have to go "privates" or "bits" or "down there" (which isn't even an accurate euphemism in dogs since it's more "back there") are the ones that always make me want to head-desk.