There’s a horrible moment we’ve all experienced – a nasty creeping sensation as it slowly dawns on you someone, somewhere has made a terrible mistake…
This is usually followed by an even more unpleasant sensation as panic threatens to set in and you ask yourself a simple, horrible, question: was it me?
This sensation is all the worse when you work in medicine, because we aren’t supposed to make mistakes. When you realise a cock-up has occurred, and you are involved in it – well, let’s just say it’s not one of my favourite moments.
The staffie wagged its tail and tried to lick me through the bars as I peeped in on it; one last quick check before its discharge appointment. The owner was here to pick it up and I wanted to talk about a few things.
Unfortunately, we’d found demodex mites on the skin scrape that would need a long course of treatment, so I wanted to make sure we had the owner on our side to stay the course.
The post-castration talk would be fairly routine, so I decided to combine it with the mite talk rather than taking up a nurse’s time and shuffling the owner from one member of staff to another.
I prefer to talk to the owner before bringing their pet to them (there’s usually too much cuddling and reuniting going on afterwards for any useful information to be passed on), so I called the staffie’s owner through to my consulting room.
She was a large, middle-aged woman with haphazard curly brown hair that made her look like she was recovering from a bout of electroshock therapy. She was wearing a stained white T-shirt and a confrontational expression, and my spidey sense suggested this wouldn’t be the simple conversation I was hoping for.
The owner marched into my room, folded her arms and stared at my table, managing to slouch without leaning against anything – a trick I had only seen teenagers successfully carry off before.
She didn’t say a word, and as my consulting room is no place for uncomfortable silences I decided to just start talking.
“So, Rocky has recovered from the anaesthetic fine, he’s ready to go. I just wanted to have a few words with you about what we found today.”
The woman grunted and stared at the table. I didn’t know if this was a response to me or a bout of indigestion, but I decided to carry on regardless.
Mite be a problem
“Unfortunately, on the skin scrape we found a mite called Demodex canis – a microscopic little creature, shaped a little like a cigar. It lives on the skin normally, but occasionally it can invade the skin. It causes a lot of damage when it does, which is why Rocky’s fur is starting to look patchy and threadbare.”
The woman remained silent.
“So, um, once it gets in, it needs a lot of treatment to get rid of it. There’s a special shampoo that…”
“Tell the PDSA,” the woman said. “I’ll take him there.”
“He’s eligible?” I asked. The woman nodded.
Shamefully, I felt a sense of relief. Rocky was going to get treatment for his condition (I had been concerned the owner wouldn’t be able or willing to pay for it) and his case was going to become somebody else’s problem. As lovely as Rocky was, two minutes spent in the presence of his near-mute owner was enough to make me think this was a good thing.
In just a few moments, I would be wishing she had stayed mute for the entire time.
Before the storm
Well then, that was the difficult bit over with – I’d sort out sending the history shortly. All I wanted now was to quickly tell this woman about postoperative care of Rocky’s castration and get her out of the room so I could carry on with the rest of evening surgery.
“Now,” I said. “About the anaesthetic – Rocky will be a little sleepy tonight and may feel a little sick after it, so a light meal like boiled chicken might be…”
For the first time, the woman seemed to come alive. Her face reddened and transformed into an expression of outrage.
“How the f*** am I supposed to f***in’ cook f***in’ chicken when I haven’t got a f***in’ cooker?” she said.
Hmm. Maybe this wasn’t going to be the easy bit, after all.
“I’ll tell you what,” I said. “I’ll give you a tin of our food for tonight.”
The woman didn’t look at all grateful, but she did look slightly less angry.
The moment arrives
“I’ll go and get him in a second. You may notice some swelling around his scrotum – it might even look like something is still in there – but that should settle down over the next few…”
I stopped, because as I was speaking I noticed the woman’s face growing redder and redder. I was worried that, if I actually completed the sentence, something would actually rupture. At this point, I started to feel the first tinglings of concern – the moment was very close now, lurking seconds in my future, ready to pounce.
The woman spoke very slowly and clearly, obviously trying to keep her anger in check.
“You. F***in’. WHAT?” she said.
“It’s really not a great deal of swelling,” I said, quickly. “I just wanted to mention it so…”
“Are you telling me,” the woman said. “You’ve cut his f***in’ balls off?”
Pounce! There it was – the moment. The dreadful lurching sensation that a terrible mistake had been made and something had gone very badly wrong.
This woman clearly was not expecting her dog to have been castrated, but his testicles were cooling in a clinical waste bin on the way to an incinerator.
That’s the kind of mistake it’s hard to come back from.
Surviving the aftermath
I remained outwardly calm, but inside my heart was fluttering and my mind was whizzing as images of complaint letters winging their way to the RCVS formed in my mind.
How could it even have happened? Were there two dogs in called Rocky, one for castration and one for skin scraping? It was possible, but, if so, the other one hadn’t turned up. And we were usually very careful with similar names and breeds to prevent this sort of mistake occurring.
Could someone have written him on the board for castration by mistake? I didn’t see how – we always check the consent form first.
That triggered a memory. I was sure I had checked Rocky’s consent form – sure of it.
“Just a moment,” I said, leaving the woman to fume while I rushed to Rocky’s kennel. The staffie grunted and rubbed his nose on the bars in excitement, oblivious to the stress his missing testicles were causing me.
“Is everything okay?” asked Amanda, the head nurse. She must have seen my panicked expression. The moment had left its mark.
“She says we didn’t… hang on.” I grabbed the form off Rocky’s kennel and scanned it quickly.
PROCEDURE: GENERAL ANAESTHETIC, CASTRATE AND SKIN SCRAPE
There it was, in wonderful bold letters. And underneath – a signature. The beautiful bloody woman had signed the form giving us permission for the procedure.
On fine form
Feeling less nervous, but more confused, I headed back into my consulting room, armed with the form. The woman was pacing like a caged, starved lion. I held up the form in front of me.
“I’m sorry if there’s been any confusion,” I said, quickly, before the lion could leap. “But this morning you signed this form giving us permission to castrate Rocky.”
“Yeah, I f***in’ did,” the woman said, dismissively. “But I didn’t think you’d cut his bollocks off at the same time!”
It became clear, over the course of the next few minutes, Rocky’s owner was under the misapprehension “castration” meant “vasectomy”. Nobody had thought to explain what exactly we would be removing, because… well, because it seemed obvious. We often did with spaying, because it’s a slightly different procedure to humans, but… well, castration. Everyone knows what castration means, right?
All’s well that ends well
I eventually managed to calm the woman down after convincing her the other dogs in the park would not laugh at Rocky for having no balls and, furthermore, a humiliated Rocky would be unlikely to launch into revenge attacks against them for their mocking.
Another 10 minutes of diplomacy and careful explanation later, the owner left a satisfied customer and as happy as she was ever likely to get.
This experience taught me a couple of things:
- You should never, ever regard anything as “obvious” to a client. It’s better to be patronising than to be unclear.
- The horrible, sinking feeling you’ve made a mistake isn’t irretrievable, isn’t always right, and can usually be sorted out by taking time with your client and being completely honest. Not always, but usually.
So when you start to feel the dreadful first tinglings of that horrible moment, I would suggest you follow the advice helpfully emblazoned on the front of The Hitchhikers Guide to the Galaxy…