My amygdala flooded my brain with the neurotransmitters that told me I should be freaking out—running from a flood, dodging a predator, or, more realistically in our modern world, preparing for a potential lawsuit, a threat to my veterinary license, or the stereotypical “only in it for the money” accusation that we’ve all heard.
The stress-inducing patient responsible? The one we have all seen: a young pitbull-type puppy with vomiting and diarrhea, whose owners had limited financial resources. Despite the negative parvovirus test and the owners’ attention to my warnings and recommendations, I left that exam room thinking that was another patient “lost to follow-up” with the feeling of dread that I had failed this puppy, his owners, and the profession. I had not been able to provide the gold standard of care that we put in such high esteem during our academic careers: unable to hospitalize, review x-rays, analyze bloodwork, and refer to the criticalist or internist. In fact, I didn’t know anything about how this case was going to turn out or if my treatment plans were successful! But why did that mean I failed?
My amygdala was ruling my practice of medicine. In trying to protect me, it had overridden my frontal lobe, which logically knew the parvo test was still more likely to be a true negative than a false negative. It had dominated my hippocampus, which remembered the myriad other causes of gastrointestinal distress in young dogs that were far less serious. It had even overridden my anterior insular cortex, which would have empathy for the owners, who were caring and devoted to a puppy they had only adopted a few days before.
A few weeks later, during a rare social outing, a woman came up to me. While I initially couldn’t place her, she continued to smile at me cheerfully. I realized that she was the owner of the puppy, and she wasn’t mad. She thanked me for the symptomatic care I provided that day and was thrilled with how her puppy responded. She followed up with her family veterinarian and began regular preventive medicine.
My amygdala had tricked me! In this case, and in many others we never get to hear about, the less-than-ideal care we often have to provide is a cure—not just in a pet owner’s view but in reality. To this day, I still have to tell my amygdala to relax and make sure I am using all parts of my very expensively educated brain to make balanced decisions. When that anxiety rises, and I get convinced that something horrible has befallen a patient that I didn’t get to see again, I think of that puppy and know that sometimes the care that I provided and the reason there was no follow-up was because the owners and the animal are thriving.