Carry Each Others Burdens

Hank begs for a back rub, 24 hours post accident and happy on his analgesics.

You know those dreams where you slip down the rabbit hole and wind up in a land where up is down and down is up? The place where caterpillars spew advice via poetic puffs from a hookah pipe. Where tea parties incite riots and mice talk in drunken proverbs. There is such a place. Seems that veterinary medicine has landed itself in the Wonderland of who are we? (Big or small?) And how did we forget where we came from Alice?

One of the best pieces of  advice that my former practice owner and 40 plus year veterinarian ever gave me was, "Remember that every client you see is your neighbor. You will see them again and they will remember how you  treated them and their pet." It was sage advice that I have carried close to my heart since I bought this practice from him a decade ago.

When I first started practicing at my clinic I had to remind myself that first impressions count and trust could be built and broken by one brief visit.

The face of veterinary medicine has been slapped, scarred and dismissed over the last few decades. Gone are the days of blind trust, loyalty and high regard for our profession. Where did our impeccable reputation go? We slaughtered it. We have done it by ourselves and to ourselves. We forgot to treat each client as our friend, our neighbor and the guardian of our purpose.

How do I know this to be true? I see it every single day in practice. It breaks my heart, wounds my soul, and in-freaking-furiates my core.

Our profession was built by men and women on humility, hard-work, fortitude and integrity. We used to be a profession people trusted. We used to deserve it. We didn't have to prove it. It was there because our forefathers had built it.

The state of the profession now is fractured, injured, and almost intangible now.

Can we trace back the pivot point? Can we blame it on millennials who "question everything," and "research all aspects of their decision before taking anyone's word for it?" No, this happened before them. It happened sometime between when I entered vet school in 2001 and when I graduated in 2005. Before I went into vet school it was commonplace for veterinarians to provide free services and prescriptions for pennies. I was part of that hippie revolution protesting for fairer wages for the new wave of females in vet med. Proudly burning coveralls, pulling and palpating cows with all of the vigor of the dirty nailed muck booted farmers before me. I wanted to work hard, prove my credentials, and make a descent living from the return of my measly $40,000 vet school investment. I was one of those doe-eyed newbies star struck by the title and wanting to advance the profession from its humble Herriott beginnings. Did I no where I was going as I chased that white coated rabbit?

Some want  to point the blame of our predicament on greed. I'll accept that. We have created an ecosystem intent on providing an Ivory Tower standard of specialized care that is focused on exhaustive diagnostics paralled to the human care options available at the most world renowned medical hospitals. As a patient myself of the Johns Hopkins University medical empire I know what the best and the brightest from human medicine has to offer. I am blessed and grateful for access to state of the art medical facilities spear headed by doctors who shape the future of science fiction meets God into miraculous cures to the most elusive and aggressive diseases. To get in the JHU door I needed either limitless black holed deep pockets, or insurance. My patients in large part lack either.

Sedated for x-rays. A muzzle is needed for moving and positioning dogs in pain.

Today a patient named Hank arrived in shock and bleeding from a compound fracture of his femur in the back of the pick up truck he had previously traveled in without incident. He had been rushed to the ER immediately by his young, disbelieving emotional millennial parents. Within 1 hour his $215 ER examination, pain injection and consult produced two written estimate options. The attending veteran emergency veterinarian provided a low end estimate of $1700 and a high $4500. And, because it is customary in vet med there is always the third option of do nothing, and we throw in the last of death.

Not having immediate access to liquid resources of $1700 the clients left the ER and showed up at my clinic 20 minutes before we closed searching for another option.

In the back of the massive hyped/hopped up pick-up lay Hank bleeding, panting, face swollen, in pain, in shock, and in desperate need of help. A pet (or anything else) in shock cannot be sent home and cannot be placed in a cage 20  minutes before you close for 17 hours. Hank at minimum needed iv fluids, pain management and mercy.

His dad stood next to Hank quietly stoic contemplating the reality that he had to break the emotional tie to his dog that he could no longer provide for. The only words out of his mouth were to beg for me to not judge him. Judge him on what? Being a fool who thinks that a dog won't jump out of a car. (They ALWAYS JUMP! Yours just hasn't jumped yet). Judging him for not having $2K in his checking account. (I don't either). Judging him for not being prepared for disaster (who among us is)? The despair in this scene was palpable. The harsh truth was that Hank's life lay in the balance of veterinary greed and desertion to our duty.

The next few sentences were fraught with tears, blatant brutal honesty and conviction to not accepting the life in the cross hairs that lay in front  of me.

Here's what no one tells you. If a veterinarian starts to provide care they are committed to your pet. The real-life reality is that my clients could have declined every single line item on that $1700 list and walked out of the ER without their dog. The ER cannot call the police and they cannot throw Hank out the back door. Hank would have gotten much better care sitting in the ER then being sent in the back of a pick up truck to my clinic at closing time. With an iv catheter, iv fluids, pain medications and antibiotics Hank had a chance of survival. For these Hank's 18 hours of ER care would probably cost $500.

Now I admit Hank needs help. There is a femur actively bleeding sticking out of his leg and this will need to be addressed soon. There are many vets who think it is perfectly acceptable to call it quits here. My opinion is that God gave Hank four legs and you can search YouTube for lots of dogs playing in the beach sand on 2. Legs are accessories. I don't kill the body because a fixable leg isn't working. But right now Hank is in shock. Shock can be, and is treated around the world every single second for far less than $1700.

Hanks dad wanted "something for pain and to take Hank home to see what fate would deal." What was I supposed to do hand him a syringe of morphine and waive "adios?" Another vet failing a pet because there is a standard of care, an average client transaction quota, and a life no one is willing to compromise for? I had to plead with the clients to go back to the ER that had failed them.

It is utterly criminal that there is no option between shock in the back of a pick up truck and $1700. Does Hank have internal bleeding, irreparable head trauma, multiple life threatening fractures, and a whole long list of questions yet unanswered? Absolutely these are possible. Does Hank have a chance? Absolutely, unless his family gets intimidated and scared to the point that they don't even try. In the back of that pick up truck my technician could recognize that Hank had a chance. She saw normal mucous membrane color, shock, rhythmic steady chest movement, deep pain in his legs, ability to ambulate, and reason for hope.

I am angry about this place in veterinary medicine that we have alienated ourselves into. I know my clients are upset, frustrated, scared and distrustful. I don't blame them. Is Hank my responsibility? Yes, Hank is my patient. His family are my neighbors. We carry each others burdens. If I have to post my cell phone number on the billboards outside of the ER's I will. If I have to pay a vet to stay overnight every night at my clinic to provide a safe haven, I will. But, this lack of compassion and pricing our patients out of the possibility of a chance has to end. How much more trust can we afford to surrender? How can we promote a standard of care and emulate throwing a dog in shock out of our pet care facility?

Hank went back to the ER for iv fluids, pain medication, antibiotics, and an overnight stay. If tonight it is discovered that his injuries are life threatening he will be humanely euthanized by someone competent to recognize this. If he survives he will come to JVC tomorrow and JVC will help Hank face the next steps in his recovery process.

Hank had his femur fixed three days later at a local veterinary hospital. The general practitioner placed a plate for $2,000. Hank was up, wagging, and happy 24 hours later. These are the photos his mom sent us,, along with a big Thank You.. 

Hank and his mom.

Hank's bill ended up being about $3,000. I know it was an expensive lesson for them to learn about the dangers of transporting your dog in the back of  pick up truck. BUT, I want every person to know that most of the accidents, illnesses, and diseases veterinarians see ARE TREATABLE. In too many cases the sticker shock we vets provide our clients, (especially those after trauma or serious impending life threatening conditions), on those fat well-padded cost of care estimates, that we all know are based on "worst case scenario" and "ideal treatment options" results in pet parents making decisions they feel they have no other option to make. I simply do not believe that there is not a more cost effective, life sparing way to get people real help.

Here's to you Hank! May you have more happy days ahead.

I welcome your thoughts and hope that you will help in providing advice, guidance, and support to pet parents across the globe. Pawbly.com is a free information and assistance network dedicated to helping pets and the people who love them.

I am also on Twitter @FreePetAdvice, or at the clinic Jarrettsville Veterinary Center in Jarrettsville Maryland.

Update; Hank had his fractured femur repaired three days after his accident. He is expected to make a full recovery. I think his parents learned a hard lesson. DOGS DO NOT BELONG IN TRUCK BEDS! We wish Hank many happy years running, wagging, and exploring the fields of Harford County.