He will have to live with it the rest of his life?
Sep 12, 2011
Rob's View From The Passenger Seat
by Rob Koontz DVM
Early in my veterinary career I was asked to look at a wound on the tip of a horse's nose. It seems a few weeks ago Poco was tied to a picket line after a long day on the trail. Somehow he had gotten his nose caught in a snap and tore a 2 inch gash along the side of his nose. John, another veterinarian in our practice had gone out and sutured the laceration. John thought it should heal fine with very little scarring. But today Poco's owner had called and said the laceration was healing badly.
I left for her barn immediately, we always try to respond quickly to any laceration but we especially want to do a good job on a laceration that someone in our practice had seen previously. As I drove to the farm I imagined a wound that had completely fallen apart. The wound was probably bifurcated, filled with pus and proud flesh. I had not handled a lot of old wounds so this one would be a challenge; I hoped I was up to the task.
I drove up the driveway, an attractive young lady leaned out the house window and directed; "go ahead to the barn, I'll be out in a minute". I walked into the barn and up to a stall, the placard read "Poco the Trail Boss". There was a horse in the stall but it couldn't be Poco. There was no bifurcated laceration, there was no pus, there was no proud flesh. In fact this horse didn't even have a wound.
The woman rushed in and put a halter on the "Trail Boss". I noticed that she was a little older than I had initially thought; her hair color was red but not quite a natural red. The skin of her face was a little tight and also not quite natural. She looked at me, pointed at Poco and whined "isn't it AWFUL?"
It took me awhile to realize that she was pointing at a small divot and a tiny skin tag that was left when the edges of the wound healed slightly misaligned. Relieved that there was very little too the problem I simply stated; "all we have to do is snip off the skin tag." Horrified she asked; "but won't he have to live with that divot for the rest of his life?"
"Well sure", I said a little confused, "but he doesn't care. He would rather live with a small divot than go thru a surgery to fix it". A little more resolutely she stated; "he will have to live with it the rest of his life." "He won't be looking in a mirror" I reasoned. "He will have to live with it the rest of his life" she pronounced a third - and what I could tell - was her final time.
I proceeded to do standing cosmetic surgery on Poco the Trail Boss. Under tranquilization I blocked the area and carefully cut the edges of the old wound. Finally I meticulously sutured every ½ cm so the wound would heal properly. When I was done it looked pretty good, if I do say so myself.
When I returned to the practice I asked about the attractive lady and her insistence that we repair a divot that was truly very difficult to see. The staff in the office informed me that Poco's owner worked for a cosmetic surgeon and that she had undergone several cosmetic surgeries herself. I realized that if she was willing to endure such pain for her own cosmetic benefit, she must place a high priority on appearances.
I returned two weeks later to remove the sutures. The wound had healed wonderfully with no noticeable scar. Poco's owner was delighted. Poco would not have to live with an imperfection the rest of his life. As happy as she was with the outcome, the next time she made an appointment for Poco she asked that the young vet not be sent out; she would rather have the vet that did not fix the wound correctly the first time than the vet that tried to make Poco live with a divot the rest of his life.
This experience taught me not to force my values on other people. To live with a small divot on a trail horse was less invasive then re-opening the wound; so in my opinion the better option. Obviously this person, who had been thru several cosmetic surgeries, could only see that divot as a large imperfection. Neither one of us was right nor wrong we just saw the divot differently.
As a veterinarian I make many decisions every day. Sometime those decisions are value judgments. I try very hard not to place too much emphasis on my values. After all we all see that divot differently.