Presentation
A 14-year old retriever/ beagle-mix presents to an after-hours emergency clinic with vomiting/diarrhea and depressed attitude. Emergency clinic sends a report the following day to the referring, general-practice doctor, a young vet only 2 years out of school, stating that they did a flash ultrasound and believe the patient has an abdominal mass.
Workup
Back at the general practice, the young doctor and her medical director, a veterinarian with 30 years of experience, perform an ultrasound and find that the patient has fluid in all four quadrants of his abdomen. An abdominal tap reports frank blood.
Pique
The junior and senior vets debate the risks of keeping the patient and doing an exploratory. The medical director warns that this could be a ‘peek and shriek’ case, that is, a surgery with a lot of unexpected complications, still he is eager to proceed. The younger vet, clearly concerned, is reluctant and thinks it would be best if the case is referred out. Both meet with the owner, discuss the risks, and the client agrees to entrust the patient to the practice’s care.
Shriek!
Once in surgery, the case indeed proves to be complicated. The source of the bleeding is an intestinal mass. Adhesions from prior surgery make its removal complicated. Then, as the two doctors make a last check of the bowel, they find an additional mass, this one in the cecum. The senior vet admits that he’s never done such a surgery. He asks the young vet to monitor the patient, he goes to a medical text, researches the procedure, and returns with an announcement, “I think we got this.” They remove the second mass, recover the patient, hospitalize it for two days, and send it home on the third.
Discussion:
The senior veterinarian likes his young associate, but secretly pines for the days when people took more…what’s the word… initiative. When asked why he was okay taking on such risk, the senior veterinarian said, “Look there will always be someone who is better than me, but at some point it’s important to trust what you know and what you can do. You have to try. It’s the whole reason why being a veterinarian is so interesting! I don’t understand this mentality of younger people always wanting to refer things. To me, it just seems…risk averse to a fault.”
What do you think?