Complicated, Part 1

On the same day my article on coping with complications was published online, I met with my doctor.  I was recovering slowly from my hysterectomy and eight weeks along, my belly was still sensitive and swollen.

A week later, I was in the hospital, one tube draining my belly, another in my left kidney. My left ureter had been damaged during my hysterectomy, and urine had been leaking into my abdomen. The first drain would remain in place for 10 days to relieve the abdominal pressure and drain the urine that had accumulated in my abdomen, while the drain in my kidney, a nephrostomy tube, would send the urine from my left kidney into a bag I would carry with me for months like an external, second bladder.

It will be two months before the urologists surgically reimplant my left ureter into my bladder, before they dissect through the scar tissue and reveal the injury. Until then, we won’t know the nature of the injury or what could have been done to prevent it.

In veterinary surgery, ureter damage during ovariohysterectomy is rare enough that this complication isn’t reported in most studies of spay neuter complications (one summary of the literature on spay neuter complications mentions only 3 case reports ). Ureter damage during spay is like the monster under the bed: it is the star of horror stories that happened to someone else, never actually seen or experienced by you or anyone you know but still terrifying and perhaps possible.

The strange, compacted, biped anatomy of humans, though, places the ureters in the surgical field and at risk during hysterectomy. Ureter damage happens in about 0.5-2% of hysterectomies in women and can be the result of ligation, kinking by suture, transection/ avulsion, partial transection, crush, or devascularization. Exactly which of these happened may become clear during my ureter repair this spring, but until then is only guesswork.

So my doctor is left in that unenviable circumstance of having an unresolved complication of indeterminate cause. The long delay between my surgery and my return with symptoms would make the details of my surgery itself difficult or impossible to recall. The unknown error (and known result) leaves her hanging, no guidance for improvement, no specific oversight or action to correct in her next surgery, or the surgery after that. Only worry, and caution. I recognize the feeling, and the fear.

At my initial surgery, the humor in being a spay neuter veterinarian undergoing a hysterectomy wasn’t lost on me, nor now is the unfortunate coincidence of writing about surgical complications and then experiencing one. I appreciate the perspective and can’t help but use it as an opportunity to keep exploring the experience from within the domain of human factors and ergonomics. In addition to considering surgical complications, my experiences of the last few weeks and months have led me to think about topics as diverse as error taxonomy and latent error to organizational leadership. Between now and my repair, I plan to explore these topics here. Stay tuned!

As I wait for my repair, I am fine and happy, and feeling physically better than I have in months, despite the nephrostomy tube and external “bladder.” This morning I went for a 9 mile ice skate at Lake Morey, and it felt good to be out on the ice and moving on such a beautiful day.

So much ice and blue sky!

Sign on the ice by the pond hockey area. No, I didn’t. But I can pee standing up now…