Like most things in life, do something long enough and often enough, and it gets easier. Drawing blood, placing catheters, passing a nasogastric tube, suturing…do it often, with a goal of doing it well. Then, there comes the added benefit of confidence. And there’s no better way to appreciate a skill, than to have acquired it and then lost it. About halfway through a “typical” day, I was made aware of those skills I take for granted.
BAL Gone [every kind of] Wrong
It started with performing a bronchoalveolar lavage on a gelding with intermittent coughing over the past year which fluctuated with weather, exercise and environment. With non-specific findings on ultrasound, we proceeded in our diagnostic plan to determine the nature of the cough. We elected to retrieve a non sterile sample from the lower airways to evaluate for RAO and IAD. I’ve passed an endoscope countless times, and performed it successfully and easily enough that I consider it at acquired, reliable skill.
By the conclusion of the BAL, I felt like I had rehearsed for a performance demonstrating everything that could not go right. The highlights of this performance included:
- BAL tubing hit the ethymoids, causing a profound nosebleed
- Projectile, unrelenting spraying of clots across self, assistant, owner, trainer and three innocent onlookers
- BAL tube entered the esophagus, rather than the trachea
- BAL tube retroflexed and came out the oral cavity
- BAL tube severed by teeth when traveling through the oral cavity
- BAL tube #1 ruined, retrieved BAL tube #2
- BAL tube positioned correctly in trachea, cuff would not inflate
- BAL tube #2 leaky cuff confirmed
- Continuation of #2 problem (Projectile, unrelenting spraying of clots across self, assistant, owner, trainer and onlookers)
- BAL tube in position, cuff inflated, saline injected in…unable to collect any saline
- Added more saline through tubing, retrieved <40 ml
I was relieved when the whole thing was done. After all the above complications, at least the sample was collected and submitted. What else could go wrong? Then, I got the lab report stating:
Sample has insufficient cells, inconclusive. Recommend collect second sample for analysis.
This was just the first appointment of the day.
Miscommunications, mistakes, mishaps and misfortune
When not a soul could be found at our second appointment, I called the owner. Turns out, the appointment had been rescheduled to the following week…news of which, didn’t happen to make it to today’s day schedule.
Our third appointment canceled.
Our fourth and fifth appointments had the wrong addresses (showed up at a neighbor developement and then mistakenly went to the owner’s house instead of the boarding facility).
Collected the wrong blood tubes, forgot to dispense a medication refill, double-charged on an invoice, made at least 12 U-turns…
And the cherry on top? At 6pm, as we’re wrapping up at the last appointment and about to begin our 90 minute drive home through late rush hour traffic…my assistant hesitantly asks,
“Hey, have you been having problems with the gas gauge?”
I hadn’t. No one had. About 4 minutes later, the thing we were dreading came to fruition. We ran out of gas.
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