Monday, 9 April 2012


Regular readers of my blog will probably be aware by now that the tone of my posts tends to vary wildly between flippant and maudlin - sometimes even within the same post. I'm going to be honest; this isn't one of the flippant ones. Consider yourself warned.

'Experience is the name everyone gives to their mistakes' - Oscar Wilde

There's a nice little word that you can use in medical terminology - you may have heard it before. I may even have mentioned it in the blog before. That word is 'iatrogenic'. It's especially useful for those of us in the field because it sounds nice and official, slightly intimidating, and mysterious. Here's what it means - the doctor did it. Your physician ballsed up in some way, and now you're ill because of it. If you've got iatrogenic Cushing's disease, it's because the doc gave you too many steriods. If you've got iatrogenic aural trauma, then it's likely he was a little overenthusiastic with his otoscope. If you're iatrogenically monorchid...well, you get the idea.

There's a reason that this word was created, and that reason, of course, is that doctors (or in the case of this blog, vets) make mistakes. You may be getting an inkling of where you think this blog is going, now, but you may be wrong. I'm afraid this isn't going to be an 'Alright on the Night' style list of amusing veterinary cock-ups, where the poor James-Herriot-alike accidentally drills through their own finger whilst attempting to pin a fracture (though, I must admit, I have known that happen). No, this is really a confessional blog, a penance for me for a mistake I made. I did warn you at the start.

You see, I've been reading through my blog posts recently, and much as I like them, I do rather give the impression that I never make any mistakes myself, and that the hard positions I've found myself in have been due outside influences. This is, I will admit now, not the case. I have - in common with most of humanity, I suspect - made many mistakes, both in and out of my career. It's possible that this blog post is one of them. But I am so weary of politicians and others in the public eye avoiding even talking about, let alone admitting to, errors they have made on the basis that they may - horror of horrors - actually be called to account for them, that I wanted to make my own claim to honesty here.

I've been a vet for a long time now - ten years - and it has been quite some time since I felt that awful 'out of my depth' feeling that lived with me as a new graduate. Considering how much I've learned since then (and see Oscar Wilde's quote above for the true meaning of 'learning'), I'm a little surprised, when I think back on it, how few serious problems I got in to. Most of them were learning how to communicate with clients effectively and fairly, or easily corrected surgical mistakes, but here is something that has stayed with me down through the years :

I was a new graduate - maybe three or four months into the job, and it was one of those evening surgeries - the kind where all your old cases come back to haunt you. Nothing has got better, some things have got worse, and even the vaccinations have got heart murmurs, or sinister-feeling lumps that the owner has never noticed. I've had many, many of them since, and have discovered that really all you can do is take things one at a time, and remain calm. Back then, watching with alarm the list of people waiting grow whilst I was trying to think about a Chinese water dragon that had just been presented to me 'off-colour' (as I recall, it turned out to have been dead for a few days), panic was setting in. It was the first time I had experienced anything like it.

I was on my own - my colleague (a keen surgeon - a classic of the breed, very interested in the technicalities of the work. The animals, not so much) had left me to take one of his spinal cases to...well, I remember it as MRI, but I wonder now if, all those years ago, it would have been far more likely to be a C-T scan. Doesn't matter) and no cavalry  was coming to save me. The 'complaints' list on the computer, a brief description of what was wrong with each animal, read like a thesaurus - 'worse','no better','no improvement'','poorly' etc - and I had just run out the back with my immobile water dragon to try and get a better look, when I got the phone call.

I forget the name of the breeder, and I wouldn't put it here even if I could remember, but she had phoned the practice to speak to my boss, and was upset that he wasn't around. She was even more upset to discover that the only vet she could talk to was the new graduate - and if she'd realised my state of mind at the time, she probably wouldn't have spoken to me at all. She had a reputation at the practice for being incredibly demanding - and any vets reading this will have a picture in their minds right away of exactly the sort of client I'm talking about. Flustered, with one eye on the water dragon (about which I was starting to suspect the truth - it's not quite as easy as you might think to immediately diagnose death in a reptile. Well...not if you've never seen one before. Anyway, that's not the mistake. I got that one right, in the end, it just took me a while) and another on the ever-growing waiting room list, I took the receiver from my nurse.

The situation explained to me was this : one of the breeder's bitches has just finished whelping. The births had gone fine, but one of the puppies had been born with a severe umbilical hernia - it's intestines had prolapsed through the large hole and the pup was not looking at all well. The breeder wanted me to go straight out to her and put the puppy to sleep.

This (like most things in those days) was not a situation I had been in before - I had never seen, or even heard of a puppy with such a severe problem. The breeder was adamant that the problem could not be fixed, and it certainly sounded serious enough to me. This is painful to write - but that's the whole point of this blog, isn't it? - but I agreed the puppy needed to be euthanased. 

That's painful to write, because it's wrong. It's a treatable condition with immediate surgery, and I have fixed a number of puppies in a similar situations since. I was wrong, but that wasn't the worst of it.

I couldn't get out on a visit; I knew that. I had a waiting room full of people and no back-up. I asked her to bring the pup in, and she absolutely refused - she couldn't (she said) leave her bitch, and all the other puppies, just to bring this one in.

I wince to think of it. Older now, and wiser, I would have told her to bring the whole lot in right away. I also would have told her the pup could have been saved. I didn't. I merely feebly protested that I couldn't make it out.

'That's okay,' the breeder said. 'I'll deal with it myself.' She wasn't rude, or annoyed. She had really just wanted to check whether I thought the puppy should be put to sleep or not. She put the phone down. I didn't ring her straight back. Instead, I got on with my evening surgery.

Twenty minutes later my boss phoned me. He had a number of missed calls on his mobile phone from the breeder in question. When he got back to her, he found out what had happened. It was here that I discovered that the condition could have been surgically corrected. My boss had also discovered what had happened to the puppy.

She had drowned it.

I cannot tell you, dear reader, the number of times I have played that phone conversation over in my mind, wishing I had handled things differently. I can't count the number of nights I have lain in bed, staring at the ceiling and thinking of the pup, struggling against calloused hands, bubbles escaping from its mouth. That one mistake, based on a lack of veterinary knowledge and poor client handling, has haunted me for years. Its taken me ten years to write it down.

I don't even know, at this stage, how bad that seems to someone else. Its grown to be so large in my mind that I find it hard to think and write about, even now. I've made mistakes since then, of course - some worse that this one. But it was my first one, my first realisation of what can go wrong in just a few seconds of thoughtlessness. The drowning puppy lives in my mind (and only in my mind - it's painful to think that it could still be alive even now, all these days, weeks and years later, if I had acted differently) as a symbol of failure, and mistakes. Whenever things go wrong - which thankfully is not so often, these days - I think of that pup.

So, my confession is done. Don't think for a moment that this is my only error in ten years. As you may have suspected, this blog was prompted by a mistake as well, and of a similar kind. A few moments thoughtlessness, forgetting what really is at stake if I don't try my hardest, may have cost another animal its life. I ignored my instincts and took an easier path, and I was wrong. Likely it would have made no difference - in fact, I'm almost certain that in my recent error of judgement, acting different would have merely meant that the animal ended its struggle in the practice, rather than at home. Almost certain. But I'll never know now.

I suppose the hallmark of a mistake, as opposed to simple bad luck, is that if you think back over the situation - like I have, many times, thought over my phone call to the breeder - and you wish you had done something other than what you did, then you made a mistake. And that's how I feel today about this new mistake. I could have acted differently, and I wish that I had.

I'm not perfect. I wonder, if any vets are reading this, how many of them have their own version of the drowning pup, that swims into their mind when things go wrong? More than a few, I suspect. I'm so sorry that I failed then, and I'm saddened to realise that the lesson, hard and painful though it was, still needs reinforcing to me from time to time. This post is a way of doing that.

Thanks for reading.


  1. Hi,
    I am a vet nurse with 14 years' experience, and last Friday I made a grave error when setting up for and then subsequently monitoring an anaesthetic. It is a machine I'm relatively new to, and we were having a crazy busy day, but this is no excuse. Long story short, I caused the death of a dog on the table.
    I am absolutely devastated. One momentary lapse in concentration compounded by a number of contributing factors has led to an outcome I would give anything to change.
    It was a mistake - pure and simple. And everybody makes them, I know. But few people have to live with such adverse consequences of their actions.
    I know I will never forgive myself for what happened, and don't know if I'll even be able to continue nursing (which is a job I absolutely love).
    How do you get over something like this? Or don't you?
    Thanks for writing about your feelings - I know that deaths due to human error occur at vet clinics, but it seems like a taboo subject and not many people want to talk about it.

  2. Hi
    Thanks for your honest response. I can assure you it does get better, over time; but more than anything I'd like to tell you what a lot of people told me when I wrote the blog - the fact that you're feeling as you are feeling now is exactly why you're well-suited to be a nurse in the first place. Don't give up.
    Mistakes in medical circles are, as you mention, something of a taboo subject, and it's partly a response to the litigious culture we live in now (though not entirely; I suspect it's always been a secret shame to make a terrible error).

    We always have made mistakes, and we always will, but I think we need to talk about them - not only to reassure ourselves that we are not as wretched human beings as we feel like when we make them, but to remind ourselves just what the stakes are when we allow our concentration to slip.

    After I wrote this blog, a friend sent me a link to the following video - which says a lot of what I feel far better than I managed to above. I hope it makes you feel a little better too.

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  3. I agree with Nick. It seems you are entirely suited to nursing. In sales, they call this 'levelling'. You feel for the animal in your care, their owners feelings, and for your craft.. and the reason you feel 'wretched' is because you're so good at that. 'They dont care how much you know, as long as they know how much you care' as the saying goes.
    I know Nick but I'm not a vet, just an artist. But I can talk about empathy. When I was little I had a fever and developed 'mental problems' such as mild synesthesia (seeing certain frequencies of colours sent me into a blissful trance or made me throw up), moments of bliss (which pleased my catholic mum no end), and extreme empathy. Thats what they used to call it.. Like it was a disease. Its much milder now. I spent 30+ years thinking being empathic was a mental illness. I'm still not there. Sometimes music sends me into complete catatonia, and sometimes I'll say something without any regard to how another is feeling. But I've accepted me as being unique. I've done charity stuff, saved someones life, been part of a worldwide movement to do random acts of kindness, and I have the ability to love people instantly, without judgment, and to always look for the best in them. I win.
    The reason i've just gone on like that is this; this is a horrible thing to happen to anyone. You are reacting exactly as you should. You understand the ramifications, yet you express yourself regardless. You are obviously both amazing people (I know this of Nick already).
    It gives me heart to hear vets are human beings like everyone else, but I suspect, because of your abundance of empathy, you both have an amazing capacity to console those grieving in the best possible way anyone can. It's easy for professionals to look too hard at the mistakes they make, because they tend to be perfectionists. For me, try to look at the good you do too. Learn the lessons necessary, be kinder to yourselves, and carry on saving the lives of animals and giving back hope to those who love them.


    1. Four years on Steff and I just wanted to let you know that your words of encouragement at a really difficult time made all the difference to me. I'm still nursing (and I hope I'm better at it) but your support was timely and kept me going. Thanks from the bottom of my heart.

  4. Nick, you didn't drown the puppy, the breeder did. Probably knowing that surgery would be possible. She should be the one having nightmares, not you.
    Anon Vet. Yes, you made a mistake, and the consequences were the worst. It's horrible and I sympathise for you. As both Nick and Steff said, the fact that you ARE upset is why you do the job in the 1st place. Learn, but don't give up.
    My £0.02

  5. Thanks all for your words of wisdom. The Brian Goldman clip is excellent, and expresses a lot of the same sentiments I feel right now. Shame, grief, anger (at myself) and a distinct lack of worthiness. When Brian Goldman talks about feeling not like a person who's done a bad thing, but like a bad person, I can totally relate.
    I think the worst part of something like this is the fact that my actions have affected so many others, and this is the part that hurts the most. Self-pity doesn't even come into the equation - it's the reality that I'm not the only one who has to live with this that is the most crushing part.
    My colleagues have been amazing and very supportive, and I'm fortunate to have a very understanding partner. I hope in time to feel the emotions I feel at the moment lessen, but I won't ever forgive myself, or forget what I have done. To forget it ever happened would be nice for me, but it would be disrespectful to my colleagues and downright dangerous for the animals in my care.
    I'd really like to give up, walk away, wash my hands of the whole thing (and the veterinary profession) and try to forget it ever happened, but I also feel that would be the most cowardly thing I could do. Returning to work was extremely difficult, but I feel I owe it to my fellow staff to try to become a better nurse as a result of this awful incident. I don't think I could live with myself knowing that when the going got the toughest it ever gets, that I jumped ship and refused to learn from it.
    I know I'm going to make more mistakes, but I also know that I'll never make this particular mistake again.
    Sorry for rambling, and if you've got this far, thanks for listening (considering I'm unloading on someone else's blog!). And thanks again, Nick, for speaking about a subject that not many are willing to broach.

    1. Thank you very much for your kind comment, Anonymous - I'm glad things are better for you and it gave me a big lift to know that I may have helped even a little bit. I'll let Steph know too, I know it will mean a lot to her.