Inherent Risk

“First, do no harm.” – Hippocrates

It has been a rough few days. I seemed to have a number of physically straining cases – big draft horses with hoof issues, a tough bull, a few large hogs. It has also been very hot and humid, which is draining in itself. All of that aside, I had an incredibly sad case that brings “inherent risk” to the front of the mind. A sad outcome that has weighed heavy on my heart and mind.

We are all fairly accustom to “signing our lives away” prior to procedures in a medical office. We read or skim over a list of risks associated with the procedure and sign that we understand them, accept them, and will not hold the providers accountable for these risks. When things go wrong, it is not always the fault of the medial professional who is handling the situation. Sometimes unforeseen events cause a patient to suffer unexpected consequences. We sometimes call these adverse events. As a practitioner, it is incredibly disheartening when one of these rare instances occurs, particularly for the first time in a career. Every single day that I see patients, I am typically sticking a needle into a jugular vein in the neck to give a dose of sedation. Risks include accidental injection into a carotid artery, and all of the side effects that these sedatives are known to cause, like decreased blood pressure, decreased heart rate, ataxia, and on and on. If you castrate enough horses, the statistics say that you will eventually have the unfortunate encounter with a horse who’s intestines come out of their scrotum, despite having done the procedure correctly as you have for the other 1000 animals you’ve castrated. Every day, I stick my arm into the rectum of patients that have colic pain, or to diagnose pregnancy, or for an ultrasound exam. As one professor told us, “if you stick your hand in enough rectums, you will eventually face a rectal tear.”

The other term we sometimes use in medicine to define these injuries is “iatrogenic” (/īˌatrəˈjenik/), meaning an illness that was caused by the treatment or examination itself. Sometimes humans make mistakes and are liable for the action – commonly known as malpractice. But many times, things are done correctly and you just have super bad luck and you have to guide the client and patient through treatment of the injury. Sometimes those patients cannot be saved and practitioners have to bear the burden of knowing that someone is grieving a special animal and they are very frustrated with you. We give ourselves a mental thrashing over it all, we go through all of the what-ifs. Eventually, we have to come to peace with it. We must learn from it, accept that we could not have done anything to prevent it, pick ourselves up, dust ourselves off, heal, and get back to work, realizing that really bad things happen, despite doing our best. We have to not psych ourselves out each time we perform the same procedure in the days that follow, adhering to all the same safety measures, knowing that it still could happen again, despite our efforts.

Inherent risks of every day procedures. Sometimes you lose clients over these things and it is really hard not to take it personally. It is really easy to let these things consume you and make you doubt yourself. These are temporary emotions that just need to be processed. Sometimes you don’t get forgiveness and you simply have to forgive yourself. Forgive yourself for being so hard on yourself, forgive the client for passing judgement, and focus on being better and helping those you can.