Stephen J. Birchard DVM, MS, Diplomate ACVS

Monday, January 13, 2014

A Surgical Disaster, and How a Veterinarian and Dog Owner Saved My Career

Audubon,  New Jersey, 1977

I had graduated from veterinary school just 3 months prior to experiencing one of the darkest moments of my career. I will never forget the little sheltie that I spayed in the small animal practice in Audubon, New Jersey that I joined right out of school. I forget her real name but lets call her “Shelly”.  It was one of the first spays I had ever done. My boss, the owner of the practice, was on vacation but I was comfortable doing the surgery on my own. Heck, I had done 2 or 3 of these before; I was an expert, right? The surgery went well; Shelly recovered without any problems and was discharged the following day. The owner, a nurse, was given the usual postop instructions.

The following Monday, about 5 days after the surgery, I arrived at the clinic and I was greeted by Shelly’s owner. She was holding a cardboard box and was crying. She opened the box and there was Shelly’s dead body inside. She had chewed out her sutures, developed an evisceration, and then chewed on her own intestine. Obviously she then went into shock and quickly died.

I was devastated. Although Shelly’s owner did not blame me, she was upset and I know that in the back of her mind she wondered if this inexperienced young doctor had done something wrong to cause this catastrophe. My confidence sunk to an all time low.  What a way to start my career. I did a limited necropsy on the body and found that several of the sutures in her incision were missing or broken. The suture used for the linea alba was catgut because that’s all we had back then. Believe it or not in those days it was the suture used by most practitioners for the linea and most animals did fine. We have so many better options now, PDS being the suture of choice for most surgeons today and the dehiscence rate is much lower.

I became afraid to do surgery. In fact I was afraid to do anything that involved technical skill. I was convinced that I had fallen short of the skills necessary to perform a routine surgery and thus could not trust myself to do anything and even questioned my career choice. This experience was worse than the near disastrous splenectomy during my student surgery lab (see post on 11/3/13).

I once read an article about “imposter syndrome”. This is the condition that many people have where, regardless of their accomplishments and recognition from others, internally they think that they do not deserve their success and that they are frauds waiting to be discovered. I think I suffered from this malady for a time as a result of this surgical episode.

As I mentioned, Shelly’s owner was a nurse. She did rehabilitation therapy for cardiac patients. One of her patients was a veterinarian, Dr. Dick Klesmer. Dick practiced in Collingswood, just a few miles from where I worked. I knew Dick pretty well; he was a nice guy and an experienced and excellent vet. As Shelly’s owner was working with Dick on one of his rehab sessions she told him the story of the spay disaster. She said she had already purchased another female sheltie puppy and wanted to have him do the surgery this time when she was old enough. He suggested a different strategy. He said that she should bring the new puppy back to me for the spay. He told her I was a good doctor and for her to come back to me would help restore my confidence (assuming this time all went well!) and send the message that she did not blame me for what happened.

Amazingly, she did just that. I was shocked when she brought the puppy in but of course I tried to mask my surprise and act normally. We didn’t talk much about Shelly; just focused on the puppy and made arrangements for her spay.

It was the most nerve-racking surgery I’ve ever done. I was careful to a fault on every aspect of the surgery, especially the closure of the abdominal incision. I closed it in about 16 layers and used bridge cable on the linea alba. Then I put her in a body cast for 6 months and kept her in the hospital. Of course that’s all an exaggeration but I was really careful and did keep her in the hospital for a few days with a belly bandage on. She healed fine and everyone was satisfied with the results. My confidence and professional life were back on track.

Dr. Klesmer’s act of kindness saved my career as a surgeon and a veterinarian. I thanked him for what he did but he passed away some years later and I wished I had thanked him more. I will never forget his unselfishness and professionalism, and I will always be grateful to him. I wonder what he would say if he learned that I became a board certified veterinary surgeon and spent 27 years a surgical instructor? I will also always be grateful to Shelly’s owner for her courage in having faith in a very young, green and shaken doctor. I learned many important lessons from this experience that helped shape my career and my actions toward my colleagues.

One of my favorite quotes is an African proverb: “Smooth seas never made a skillful mariner.” What makes us better doctors are the problem cases that challenge us to learn from our mistakes. We never want bad things to happen but they are a part of life and sometimes occur regardless of our best efforts. The best thing we can do is to try to understand why, and always strive to be better.