As I prepare to go back to work tomorrow after my 20-day “surgical vacation” (see here for why I needed a surgical vacation), I have been reminded of one of the reasons I first became interested in human factors and ergonomics in veterinary practice: our willingness to work while physically injured or unwell. Eleven years ago I was talking to a vet who bemoaned the fact that the technicians and schedulers at the spay neuter clinic where she worked weren’t taking into account that her surgery speeds were slower because she had broken her arm only the week before and was working with a cast on her arm. I was in awe at her toughness, but then recalled working the previous fall with a broken finger (just a small fracture of an extensor process, and just my fourth finger, not an “important” one), and two years later thought little of returning to work the week after my own hip fracture.
Of course for some veterinarians, the physical pain that they experience is directly related to their work, and often it’s chronic—for example, spay neuter veterinarians attribute 91% of their musculoskeletal discomfort entirely or in part to their work. In chronic cases, the injury isn’t an event but a process, so missing work would often at best only be a temporary fix.
There are plenty of good reasons for our tendency to work through injury and physical compromise. Whether in spay/neuter, shelter, or general practice, many of us work in small practices as the only veterinarian, or one of only a few veterinarians. Missing work due to injury or illness only means more work upon return, disappointed clients, patients left untreated, and loss of revenue (for the practice, and often for the individual as well). We often have little or no provision to cover for our absences, so we feel pressured to come back.
One interesting study found lower rates of musculoskeletal discomfort but higher rates of missed work due to discomfort among veterinarians working in regulatory practice compared with clinical practice—perhaps a reflection, as much as anything, on their ability to get coverage and financial compensation during their absence.
Also, it can be boring sitting at home waiting to heal, and it’s easy to feel wimpy while taking time off. (Interestingly, despite the preponderance of women now entering veterinary medicine, veterinary culture still glorifies stereotypically masculine toughness)
Our tendency to work while injured or physically compromised combines nicely with our tendency to self-treat (see here and here). A 1988 study on veterinarians and trauma states: “Self-treatment of injuries was common. Four per cent of veterinarians reduced their own fractures and dislocations, 20% sutured their own lacerations, and 67.5% self-administered antibiotics.” In instances of bite wounds, this self-treatment may lead to greater complications; as far as I can find, the consequences of veterinarian self-treatment for other injuries hasn’t been studied.
In my current case, of course, self-treatment wasn’t an issue or an option (though I did have more than one spay-neuter veterinarian suggest that they should have been the one to perform my initial hysterectomy surgery).
In any case, I’m fortunate because, other than a 4-week restriction against lifting, I am physically capable and ready for my return. I was able to schedule the time off that I needed to heal and didn’t need to push myself to go back as soon as I could walk or drive. Now, it’s time to get back to work!
For those of you who are curious, my own surgery on April 10th was a ureter reimplantation surgery with a psoas hitch. For a do-it-yourself, detailed description of the surgery and some useful illustrations of the psoas hitch, see this paper. Basically, in order to prevent tension on the new connection between the healthy part of the damaged ureter and the bladder, the surgeon tacks the bladder to a nearby hip flexor located along the spine. What results is a bladder that slants to the side of the injury.
Several days after surgery, once I started moving around more, I could feel the pull and soreness of my psoas muscle, especially when I made a big step up with my left leg or put my left leg across my knee to put on a sock or tie a shoe. The feeling of having a strained muscle is still there a bit, but much less than it was a couple weeks ago.
I stayed in the hospital for 3 nights, which was a day longer than expected, but with my mild postoperative anemia and my wife showing the first symptoms of what turned out to be a case of anaplasmosis on the same day as my surgery, it seemed wise to spend the extra night. (Never fear, a quick diagnosis and the wonders of doxycycline made quick work of the tick borne menace).
My Foley catheter was removed 10 days post-op, after a cystogram showed no bladder leaks, so now, for the first time since January, I no longer have to carry around a bag of my own urine. Small victories…