Vet Adventures: Nerves of Steel

My hands were shaking, but I couldn’t let my clients see, or they might lose confidence in me. Clients don’t want a nervous veterinarian. That would probably finish me off.

Some days, I was totally fine; calm and confident when faced with the same procedure. But not today. I readied my equipment and laid out my instruments slowly, hoping that the ritual would calm me, but my heart was racing and my vision was blurry.

Scary Complications for a Nervous Veterinarian

It was only a few castrations. No big deal, right? I’d done many in my career, and generally they went well, although there were a memorable handful that had not.

Over the course of 18 years, I’d lost two horses when their intestines had pushed out through the scrotum during recovery from anesthesia. This was a dreaded event known as evisceration, and every horse vet I knew had it happen at least once in their career. It was impossible to predict, and it was totally devastating for the owner and for the veterinarian who’d promised to prevent and relieve suffering in their veterinary oath.

I’d also had some massive post-castration bleeders requiring me to return hours later, re-sedate the horse, and struggle to locate and clamp the offending blood vessel that somehow had burst open after being firmly crushed by the emasculators. I’d had several develop seromas at the castration site, and several painful infections requiring antibiotics and followup visits.

Because of my fear of eviscerations and hemorrhages, I’d learned to castrate horses standing, a procedure that raised eyebrows among some veterinarians, and was no longer taught in many vet schools, perhaps because of the close proximity to the hindlimbs of the horse, which understandably have a tendency to suddenly start flying at your head as you attempt to cut the testicles off.

I normally escaped injury, but on one memorable occasion, the horse kicked me squarely in the knee, fracturing my tibia. Another time, my patient kicked both emasculators free and sent them whizzing past my face.

Nervous Vet: Calming the Nerves

I guess I couldn’t be blamed for getting a little jumpy when castrations were on my books. A little fear generally made me a better vet, as I slowed way down, became very detail-oriented, and double and triple checked my decisions and my steps in the procedure.

But lot of fear could be debilitating when it randomly hit. I’d wake in the middle of the night, fretting about things that could go wrong, and in my dreams, I’d geld the horses several times over, each more ridiculously difficult than the last. I’d crawl from bed, bleary eyed, with dread heavy in my gut. I would try to eat breakfast, knowing that I’d barely be able to manage tea and toast.

I’d worry and obsess on the drive to the farm, clenching the steering wheel and barely hearing the music playing on my stereo. The refrain, I can’t do it, I can’t do it, would pound in my head, and I’d have to resist turning around and heading back home. I became a more and more nervous veterinarian for the task at hand. Finally, I’d pull into the driveway and have a final wild hope that no one would be home.

No such luck. The farmhand was walking my first patient over, a huge 5-year-old draft cross, and I was taking deep breaths and exhaling slowly. Breathe in faith, breathe out fear.

Mechanically, I placed the stethoscope on the massive chest and listened to the slow thump of the horse’s heart. I gave the sedative, washed the surgery site carefully and got my local anesthetic ready.

This was the tricky part. If I could get the horse’s testes and scrotum blocked and numb, the rest of the procedure would be relatively easy. But this was also the part where I learned quickly what my patient thought of large needles going into his privates. But suddenly my hands were steadier, and my heart had quit pounding. I was going to do this castration and I was going to do it well.

I had both testes in my left hand and my cheek was pressed against my patient’s side.

“You ready?” I warned the ranch hand, as I slid the needle into the first testicle. The man had the twitch in place and worked it gently as I injected a large volume of a numbing agent in and around the testicle and cord. The second injection was equally smooth. Soon I was re-scrubbing, snapping off my exam gloves, readying my pack, opening my scalpel blades and sliding on my sterile surgical gloves.

Under Control

Time seemed to stop. Breathe slowly in, hold the breath a moment, then exhale slowly. Take another and do the same. Make myself wait for the block to take effect. Check vitals, and sedation depth. Double-check all instruments. Do I have gauze and suture handy just in case? Yes, I’ve already set it out.

OK, check block, draw testes down firmly, warn handler to work the twitch again and make two quick incisions, one over each. The hind feet stayed planted, thank God. Breathe again. Draw testes firmly through incisions and exteriorize all parts.

Suddenly the procedure was easy, and I routinely removed each testicle, confidently crushing and cutting them in two places. They wouldn’t bleed. The horse wasn’t going to eviscerate. It was a perfect castration, and I looked up smiling at the owners who were huddled anxiously over by the fence.

“All done!” I announced. “Say hello to your new gelding.” I injected some pain medicine, a tetanus shot, and an antibiotic shot, then started washing my instruments in preparation for the next horse. The color had returned to the day, my vision had cleared beautifully, I could breathe, my hands were steady, and everything was just fine. I wasn’t a nervous veterinarian anymore.

One owner walked over to me, hands still clenched.

“Dr. Diehl, I just don’t know how you do this for a living,” she said shakily. “You’re so calm and professional, and that was so smooth to watch! You must have nerves of absolute steel!”