Gazette Vet: Detachment

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By John Andersen, DVM

One of the disciplines of veterinary medicine I love most is surgery.  As veterinarians, we have a unique ability to be a “family doctor” as well as practice specialized disciplines like surgery, dentistry, oncology, etc., depending on where your passion and skill set lies. Like human medicine, the veterinary field has board-certified specialists who are required to do three to four years of residency after veterinary school as well as pass a specialty board exam.  Orthopedic surgeons, cardiologists, internists, dermatologists, these and many more specialties are available for your pet depending on where you live.

Unlike human medicine however, there are no limits to what a “general practitioner” can do.  As a new graduate from veterinary school, you are expected to be able to spay a dog, aka perform an ovariohysterectomy. Yep, as a snot-nosed new graduate, I was doing major abdominal surgery!  I’m not saying this is good or bad, but it’s a very interesting difference in expectations and “normal” between the two fields. Every veterinarian is expected to be able to proficiently remove an overweight, 80-pound Labrador’s ovaries and uterus, or extract a three-rooted molar tooth. Human doctors are expected to go through years of rigorous training to perform these same tasks.

Don’t get me wrong. I love the high standards and excellence of human medicine. And there are some problems with the veterinary model, namely, that some veterinarians probably shouldn’t be doing surgery. Fortunately, most people avoid doing things they are not comfortable with, so for the most part veterinarians aren’t going to get involved with something they may not be able to finish. And we do have a board of veterinary medicine that will come have a talk with you if you are doing a crummy job.

I love performing surgery and, after 12 years of it, I have become confident and proficient at it.  Working with your hands, combining skill with art, and permanently correcting problems are some of the high points.  It has taken 12 years of never biting off more than I can chew, but always pushing my limits, to continue to improve in both skill and problem solving.

Taking on the challenge of major surgery on my clients’ animals—life or death situations like bleeding abdominal masses or removing sections of diseased intestines—takes a lot of experience, confidence, and focus. You have to be able to be responsible for the outcome, which is a lot of pressure. To play such a high stakes game, you’ve got to be skilled, confident, and calm under pressure. But at the same time, somewhat detached from the patient.

This particular topic of detachment came into my mind recently as I was doing a corrective eyelid surgery on my family’s new puppy.  This was not a life-threatening procedure, but one with pretty big implications if not done correctly.  I have done this before many times successfully, but as I was getting ready to operate on our own puppy Hank’s eyelids, I was a stressed out mess.

I preemptively apologized to my staff for my grumpiness and soon-to-be annoying behavior, and sure enough I delivered!  From being anxious and overbearing on his anesthesia protocol, to just emitting a negative, stressed-out aura, I was not my usual confident, optimistic self.

And this matters for a good surgeon. You often hear of some human surgeons being stereotyped as jerks, jocks, or just uncaring people (Note, I’m not saying this is true, just saying it’s a stereotype). Well maybe those are good traits in a surgeon!  I’m not sure if I would want a surgeon to be so emotionally involved in my outcome that he or she becomes distracted and unfocused. Give me the confident one who makes jokes about my underwear while I’m under anesthesia.

In the end, I got through Hank’s surgery just fine, but I was very tense the whole time and felt immense pressure if things didn’t turn out just right. It made the process somewhat excruciating for me. The same with my other dogs’ routine spay and neuter, or extraction of a broken tooth. These are things I do everyday, but because they are on my own pets, I’ve had anxiety and fear get in the way of confidence and focus.

Later that same day of Hank’s surgery, I did indeed have a dying dog/surgical emergency come in. This dog had been sick for about a week and I found a large intestinal mass and a lot of fluid in its painful abdomen. My assessment was that the tumor had just ruptured and the dog had a terrible peritonitis. A complicated emergency surgery was this dog’s only option.

I noted to myself just how calm I was for this urgent life-or-death surgery and what a mess I was for my puppy’s eyelid surgery earlier in the day. It’s not that I didn’t care for this dog or its owners—I actually had a long standing relationship with them and their dog—however, it wasn’t my dog, and that is the difference. I was able to work with clarity and confidence to do what was needed for this sick dog without being distracted by too much emotional attachment. That may sound cold, but it’s really a perfect and necessary balance.

Navigating through the maze of human or veterinary care for major illnesses can be about as stressful as being sick itself. But we are blessed with so many great healthcare options and so many different people to give us that care. Our friends and family may be the ones who comfort and care for us when we are down, but it may be that jerk of a surgeon, or zero-personality internist who’s going to do an incredible job because he doesn’t have any deep connection to you. And that is okay!

In fact, we’re all here on this planet, made with different skill sets and passions. Don’t be afraid to use yours, and let someone else use theirs. It can be hard to give up control, but as they say, “It takes a village.”

 

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