When Things Go Wrong: Navigating the Psychological Impact of Complications in Veterinary Medicine
When Things Go Wrong: Navigating the Psychological Impact of Complications in Veterinary Medicine
Written by Alessandro Didiano (Doctor in Veterinary Medicine, MRCVS)
Disclaimer: This article is personally written by me, a licensed veterinarian with more than a decade of clinical experience.
1. A Routine Surgery Begins
"Laura is dealing with an emergency, could you do one of her surgeries?"
"Sure," I replied, while typing the clinical notes of the last consultation seen.
I was in a good mood. The day had gone quite well so far, and I had received a lovely thank you card from someone whose dog I had signed off after several months of treatment.
While singing, I went to the surgical area and asked the head nurse what surgery she wanted me to do. It was a dog castration, and the patient was called Boo, a lovely 7-year-old Labradoodle. The reason for neutering him was an enlarged prostate, a condition that is well known to improve significantly after this surgery
By then, I had probably performed this surgery around 1000 times before, and I didn't give it a second thought.
I washed my hands, wore a surgical scrub, sterile gloves, and started my surgery. During surgery, I asked the nurse to put on some music, something which I always do while operating. I put double ligatures on each testicular pedicle as usual, using a thick suture material. As usual, I waited for a few seconds to see if any bleeding started. No bleeding was seen. I therefore started to suture Boo's subcutaneous layer and skin. While I was doing that, the surgical nurse and I joyfully chatted. She told me how she was looking forward to the weekend away with her son, and I told her how excited I was about the positive pregnancy test my fiancée had shown me a few days before.
Boo recovered well from his anaesthetic, and I left the surgery for my lunch break. Despite being November in the UK, it was an unusually nice day, and I ate my lunch and then read a chapter of a book. When I returned from my lunch, I made some phone calls and then started to see consultations again.
2. A Sudden Complication
It was not until 3 hours later that one of the nurses came to see me and said: "Boo is bleeding from his surgical site." I was not worried. I have heard that sentence many times before and, as the nurse was a new graduate, I thought she overreacted to the sight of a minor oozing from the wound. I went to see Boo, and soon realized my afternoon was taking a turn for the worse. Boo's surgical site was actively bleeding. At that exact moment, when I was watching his scrotum swelling up, one of the receptionists came to tell me that Boo's owners arrived, ready to collect him. I started to sweat but tried to remain calm. I knew exactly what to do: go outside, have an unpleasant conversation with the owner, apologise for the inconvenience, anaesthetise Boo again, stop the bleeding, and suture his skin again. A similar complication happened to me a few years before, and, apart from the awkward chat with the owner, there were no problems whatsoever.
So I did. I went out, explained the situation to the owners, apologised for the inconvenience, and added, "Don't worry. Unfortunately, these things happen, but we will stop his bleeding. You can come to collect him in a couple of hours". I went back, gave Boo a second dose of anaesthesia, and opened his surgical wound. To my surprise, I couldn't identify a specific bleeding coming from either of his testicular pedicles. Once I removed the blood clots and the blood, everything looked quite clean and tidy. However, to be on the safe side, I put one more ligature on both pedicles. I watched both pedicles for 5 minutes and no further bleeding was seen. Therefore, I started to suture his skin again. I called the owner and advised that it was probably a minor bleed from his skin, maybe a consequence of an abrupt movement in the kennel. As agreed, Boo went home a couple of hours later, his incision looking a bit swollen as expected.
3. The Unexpected Turns Worse
When I arrived home that evening, I had a glass of wine. Usually, I have a glass at social events, but I never drink during the week. The experience had probably given me some stress, I thought. Little did I know that the worst had still to come.
The following morning I arrived at work and, as usual, had my cup of coffee while chatting with my colleagues. Then, an email came through. I was later told that, when they saw me after reading the email, my face had gone white. Boo had been seen the night before at vet24 because his surgical incision was bleeding again. The notes said that one of the pedicles was actively bleeding and the emergency vet had to put an extra ligature. Boo was fine but had to have a scrotal ablation (surgical removal of the entire scrotum), as a consequence of the complications endured. I sat down, speechless. There was no way it had bled again. There was no way one of the pedicles was bleeding. I stood there for 5 minutes watching the pedicles, and no bleeding was seen whatsoever. My colleagues saw my emotional state and tried to comfort me.
In the meantime, a formal complaint from the owner came through, questioning my competence and accusing me of negligence. At that moment, my first consultation of the day showed up.
I don't know how I managed to see all the consultations that day. I clearly was in an autopilot mood, as my mind was stuck on a series of obsessive thoughts: how did it happen? How could I miss a bleeding not once but twice? I did that surgery around 1000 times before, how was that possible? Maybe the dog had a coagulation problem? Will the owners report me?
During a break from the consultations, I had to call the VDS (Veterinary Defense Society) and explain to them what happened. They sent me a document to fill, sign, and send back. I had to state I did not believe I had been negligent. They reassured me saying these things happen. I had an official meeting with the practice manager and HR, again going through everything that had happened and how I couldn't understand what was going on. I was informed that the owners, after 11 years with us, would change practice as they didn't "feel the medical staff was qualified enough". I struggled to take it all in. Things were happening really fast, and my brain struggled to keep pace. I arrived at home that evening and discussed what happened with my fiancée. She was amazing, comforting me. As grateful as I was, that didn't make a big difference to my mood. I didn't know why it happened and couldn't find peace.
4. Struggling with the Emotional Toll
That emotion didn't leave me the following day. I woke up, and the pain was still there. While I was relieved to know Boo was alive and well, I couldn't stop picturing his face and the image of the severe swelling sent by the emergency vet in the email. In my imagination, he would look straight into my eyes and ask 'What have you done to me?'
I would love to say I recovered after a couple of days and slowly got back to normal. But that was not the case. I lost my confidence at work. Clients were not as happy about me as they usually are, because I was moody and "short". I had another surgical complication a few weeks later, for which I had to call another vet in surgery to help me (everything went well). My usually mild and barely noticeable stuttering suddenly became very prominent. I was nervous at home and declined some social invitations from friends.
5. Finding a Break
A few weeks later, my fiancée and I went for a holiday in Spain. It had been booked a few months before and to say that I was happy to get a few days' break would be an understatement. The first day was nice. At this point, Boo was not in my thoughts as prominently as before, but that feeling of incompetence and inadequacy hadn't left me and it became my baseline mood. However, tapas and some sunshine helped to alleviate the pain.
On day two, we went to the beach. It was January, not warm enough to swim, but still warm enough to have a nice lie down. Suddenly, while lying down and looking at the waves of the sea, it hit me. I started to cry uncontrollably. All the pain came out, and I must have cried for at least half an hour. I remember my fiancée saying, "I didn't know it had affected you so badly. I am so sorry." It did. I hadn't heard about Boo again, and I still couldn't understand how it all happened. The past few weeks had been horrible, and when life finally slowed down for a couple of days, my mind had the time to process it all.
6. Reflections on the Journey
I would love to say that moment on the beach everything changed, but this was not the case. Although that moment was extremely important, it took me longer to recover my confidence at work, especially with surgery.
Reflecting on this painful experience, it is very clear to me that complications in veterinary medicine (and in medicine in general) are not always the result of negligence or lack of skill.
Despite our best efforts, unexpected outcomes can (and do) happen. It is a hard truth that every veterinarian must face, but one that is particularly difficult to accept when a routine procedure turns into a nightmare for both the patient and the operating vet.
One of the biggest challenges in veterinary medicine is the weight of responsibility we carry. We are entrusted with the lives of our patients, and when things go wrong, the guilt can be overwhelming. That's what happened to me, for sure.
The fear of making a mistake or being perceived as incompetent has been paralyzing for months afterwards. I found myself questioning everything I had done, and I still don't know the reason why Boo's surgery went wrong. The rational part of me knew that I had performed the procedure as I always had. I have performed the same surgery several times since, following the same technique, and everything went well. The first time I performed the same procedure after Boo's episode, I asked a colleague to stand there and watch me while I operated, and tell me if they could see anything wrong. They couldn't.
This experience, in my opinion, also highlights the importance of resilience in our profession. Veterinary medicine is not just about treating animals; it is about managing emotions, communicating with owners, and handling some inevitable setbacks. The complaint from Boo's owners, while deeply painful (but absolutely understandable), was for me a reminder that despite my best intentions, some pet owners are going to think that I am an idiot. Having been the cause of losing one of the practice's longstanding client because of me was difficult, but it reinforced something very important to know: trust is fragile, both in personal and professional relationships.
Another lesson I took away from this story was that, it doesn't matter how strong we think we are, we all need support. The kindness of my colleagues and fiancée were invaluable. Without them, I might have internalized the experience in a way that could have had long-term consequences on my mental health and professional confidence.
Finally, this situation made me reflect on the importance of professional resources such as the Veterinary Defence Society. Reaching out to them was a necessary step in navigating the formal aspects of the complaint, and it reminded me that professionals don't need to face such difficult moments alone. Organizations like the VDS exist to provide protection and reassurance to medical professionals, helping us move forward from these difficult cases.
As time passed, I regained my confidence but, undoubtedly, the experience left a lasting impression. I now approach my work with even greater attention to detail, not just in surgery but in how I communicate with clients and manage expectations. Even before a routine surgery I spend a long time discussing the procedure with the owner, making sure they understand that complications can always happen, even for the "easy" surgeries.
I have also learned to be kinder to myself, recognizing that perfection is not attainable. As James Herriot brilliantly said: “I could see that, sometimes, a vet’s life was not a very glorious one. One is inclined to appear in a very ludicrous light at times"
This article is dedicated to Boo, not just because of what happened but because of what I learned from him. Veterinary medicine is a lifelong journey of learning, growth, and sometimes painful lessons. I will always strive to be better.