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Mildred went to surgery right away, and the string and damaged intestinal tissue were removed. She awoke from surgery and seemed to be recovering as well as could be expected, given the severity of her injuries and the extent of her surgery.
When Mildred’s owner picked her up that evening, we discussed what to do next. I talked through the severity of her condition, the value of IV fluids in keeping the intestine healthy and the benefits of having Mildred monitored overnight by a veterinarian. I told him that she needed to go to the emergency clinic.
If I could change what happened next, I would do it in a heartbeat —and I know Mildred’s owner would, too. He asked me, “What will happen if I take her home, watch her myself and bring her back in the morning?” and I said honestly, “I don’t know.”
I told Mildred's owner the truth: I didn’t know what would happen overnight —no one did. I told him that Mildred might be fine at home, although the chances of her having serious postoperative problems were very real. We then reviewed all the possible surgical complications that could arise. We talked about how quickly she could get sick and what signs would indicate trouble. I told him that she was not out of the woods yet and gave him a business card for the emergency clinic, along with directions for getting there. Mildred and her owner walked out into the night, happy to be together again.
The next morning, Mildred was back, but this time she was on a stretcher. She couldn’t walk, and her blood test results were horrific. She was rushed to surgery, where she died on the operating table. That was 30 minutes before the crying man and I sat down together.
I learned a lot that day.
I learned that veterinarians are not the only ones who carry guilt for health care decisions, although we have more practice in handling it. We, as doctors, are reminded constantly that there are no certainties when battling illness and disease. Medicine is a science. Practiced well, it is a reliable science. But it is not all powerful. In complex cases, answers and consequences can seem hidden from us in a shell game in which our patients pay the price if we lose. The thing I learned that day is that every time we play the shell game, a pet’s family plays right beside us. They are even more affected by the results than we are, and they are not used to coping with the guilt of a poor outcome.
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