We All Make Mistakes
By: Dr. Amanda Glew
Everyone once in a while, you meet a client who is so understanding of the complications that can occur in our business, that you feel like saying “Why are you so nice?” Such was the case with a Bernese Mountain dog that I recently treated for a salivary mucocoele.
They were new clients, coming for a second opinion for what they thought was an abscess in the neck. Having seen these before, I explained to them that this was most likely a ruptured salivary gland, and would need the gland removed. When asked could they wait, I stupidly said they could. By the time I went into surgery, the “mass” in the neck had quadrupled. I remember briefly thinking to myself, ‘Could this be a tumour?’ and just as quickly dismissing it, because, although a Bernese, he was only 2 years old. Two weeks post-operatively, I asked all my staff if anyone had seen the dog. No one had, except for the tech who removed the drain, which was placed to reduce the accumulated saliva. No news, good news, even though I had requested a recheck 2 weeks after.
When I finally see the dog again, the lump, which had originally shrunk down to nothing, had re-appeared. By the time they came in again, it had grown much more quick. I did an aspirate, and to my surprise, saw bacteria and inflammatory cells indicating the likelihood of an abscess this time. To my relief, I suggested placing a temporary drain that evening, starting antibiotics, and then re-evaluating. This was when the proverbial all hell broke loose occurred.
The drain was placed, but there was quite a lot of bleeding. My technician asked me, “Could you have hit the jugular” to which I flippantly replied, “No way!” I continued with my clients. When I went to check on the dog in between clients, to my horror, he was lying in a pool of blood. I bandaged his neck, and placed the dog in the treatment room so that our techs, could keep a close eye on him. Half an hour later, the bandage was soaked, and blood was dripping onto the floor. The dog looked fine! Another bandage was placed, and I finished my evening.
Once again, the blood soaked bandage indicated that bleeding had not abated. I needed to go back into surgery. At this point in time, I was questioning my diagnosis, and thought that indeed perhaps I had missed a tumour, or had hit the jugular. I explained this to the owner, who thought it would perhaps be better just to put the dog to sleep. A 2-year-old Bernese? How could I do this without being sure? So I did what I call a Dr.Glew deal – if I am wrong, and it was a tumour all along, I will take the charges; if I was not wrong, then they would pay. They could only accept. The surgery was difficult, there was a lot of blood loss, and I dissected out this hemorrhagic mass leaving a dead space and about 12 inches of loose skin around the neck. I was sure it was a tumour. I closed him as best I could, and awaited the biopsy results. We finished at midnight.
One week later, the biopsy came back that indeed it was just a severe granulomatous cellulitis, filled with bacteria. Despite some post- op complications, the dog recovered. During all this time, the owners did not once give me any grief – which I know a lot of clients would have. So as things were calming down, I asked them why.
What I found out was they had lost a son only a year or two earlier to cancer of the brain, and that his migraines had not alerted anyone to doing further work-up for some time. They had learned that things happen beyond our control, and as long as we are conscientious and try our best, there is no one to blame. Which, funnily enough, is my own personal philosophy.
Humans, being humans, will make mistakes, and if we are true to ourselves, we admit them, learn from them, and try to make them better. In this case, the dog will hopefully live for many years to come, I have learned the importance of pushing for surgery earlier and making owners do the follow-up, and that we should not judge people too quickly. Many of us are walking around with heartache and manage to put on a brave face.
Finally, and happily for me, we got paid. 😉