Saturday, February 4, 2023

My Circus.... Not Always My Monkeys

There never is adequate seating, nor food, at these venues. Convention halls designed to cluster crowds, and starve you. Their bathrooms hold the same predicament. What they can do well is seat a football stadium of vets on metal folding chairs with towering 100 foot ceilings cocooned by cement erected from framed steel and sheet metal. Veterinary continuing education venues, what we call CE, are almost and without exception (save for the uber-exclusive Swiss chalet-ed "escape" venues no one I know can afford), are inhumanely impersonal, and disastrously like a teen-boy-band concert spread over 4 days. Straggling zombified bodies following a river-like funeral procession, snaking into-out-of-and-around a convection hall labyrinth of gauntleted vendors offering pens, stress balls and poop bags, to-from-and within the stomach of lecture rooms as boring as they are blue carpet and oversized light fixtures humming a electric static lullaby. For all licensed professionals in the medical field they are a necessary endeavor based on a solar calendar.

Saffie, our clinic cat. Midday naptime.
Her story; she had been returned for urinating outside of the litter box three times.
She has now found her home. She is also perfect now that she has us as her humans.

I pack a breakfast, water, coffee and spare square toilet paper bag, along with a spare phone charger, (it takes a blood hound to find an outlet in these places and you don't get reception anyway), and remind myself this is a necessary evil until my prince pays for that plane fare to the land where hot chocolate and banks add an 'e' at the end for that extra panache. And have I yet mentioned that they are also a freezing cold reminiscent of a basement meat locker?

Among the 5,000 fellow vets at this years annual CE event, I found two classmates from my vet school that long 18 years ago. They were best friends at school and not surprisingly, remain so to this day. One of them is a towering giant at over 6 feet. She was, and still is, easily recognized by her ability to be the only face in the crowd above the peppered-hair sea. The periscope face singularly visible anywhere within the swimming crowd. Alongside her was the girl I knew better. The more talkative of the two. The girl who I always personified as an Afghan dog, yet upright. She moved like a slender, Rapunzeled sloth. Slow, yet graceful, waves of long curled blonde hair willowing to and fro, and a look as if drawn to a far off light only she could see. She was sweet, always smiling, and as I will always remember her, had this impressively captivating way of standing in a necropsy lab of 20 or 30 of us listening to the professor drag on and on, answer a question you weren't sure was intended to be asked of the crowd, (always correctly I might add), and then seamlessly slip back into her upright slumber. We, like the geniuses our 20 year old mind were, had diagnosed her with narcolepsy long before she went off and had a single species biped label her. 

Willow,, the face of the Amish puppy mills. Disposable because not sell-able.
She has been adopted via a local rescue. (Have I begged you not to ever buy a pet yet?)

Their vet career paths have run in parallel to their personal lives. They married, had kids, and bought their practices separate and yet in tandem. They have what so many of the rest of us do not; a never ceasing sounding board, experience well, and partnership that is both envious and formidable.

We met over our provided venue boxed lunch. Mine of the vegan variety as it was both preference and provided the only guaranteed availability of anything outside my knapsack smuggle. We, like all old friends, picked right up where almost 20 years had left us. 

We had built lives over the amassed days. They families, and us; collectively three independent vet practices. Which based on the trends of the profession and the newbies of millennials swarming in our convention hall pool, was remarkable. 

Hamilton.
Paralyzed from the waist down,,
and yet remains always a glass half full kinda guy

We started there. The talk of owning our own practice. More intimate than how their children mirrored them was their description of the clinics that they had built. The details of how these buildings, and all of the personal detail it enveloped defined who we are, and had become. Small businesses, and I would nominate; especially those created for animals or children, are exactly like this. A vision that manifests out of passion and empathy. A lifetime of desire to help those without ability to construct independently, and love. We didn't talk about income, profit margins, or retirement/exit strategies, we talked about what that building meant to us in our life long dream of being a veterinarian. We talked about our practices as if they were our professionally status defining custom built luxury yachts. 

The flagship.
Jarrettsville Veterinary Center

I am 10 years older then they are. The prodigal girl who entered vet school a decade later than the rest of my class. The girl who took a 10 year detour into another profession before her compass called her back to where her heart lay. When you are 32 and the rest of your vet school class is 22 that decade delta has significance. I was, for those years at vet school, the older, seasoned classmate. Here cross-legged on the convention floor eating a veggie wrap, I remained such, although even these small differences were quickly fading into insignificance.

The engine. Our treatment and surgery area

"My best piece of advice?" they had asked...was to "be careful for what you wish for, and be ready to have your heart broken." We all want/need an extra vet, or two, (three for me, please), to fall out of the sky and into our laps, but, I paused,,, "no one will break your heart more in vet med than an associate." Eighteen years in, and 12 vets who have come and gone later, and yes, some of them have absolutely broken my heart. "And your staff, well, they can crush you just as hard." We are a profession based on emotional ties. You know your patients won't live forever, but, for some reason you expect your staff to be there always. You cannot build a house around a purpose, with a bleeding heart full of good intentions, and a desperate hope for it to survive both from and after you, without feeling hurt when those people you hand the keys to your yacht to, abandon it, and you,  to leave all of your passions afloat in an ocean of wet noses that need antibiotics and a list of clients trying to make same day appointments cause the ER's are full. 

my circus,,, not always my monkeys.

I wish us all well.

Seraphina.. because there is a heart and a soul,, she reminds me to treasure and protect both

For every journey there is a vessel to carry you. A crew to guide you, and an anchor to help weather the storms. Here is a small tribute to the people at JVC I call my anchors;












The heart of every institution is the crew that guides the way. To all of my peeps at JVC I am so proud of you, who you are, what you work so hard for, and for being as much the inspiration as the joy that makes it all possible. XOXO Krista

Wednesday, February 1, 2023

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Saturday, January 21, 2023

Idle Hands and a Place Under the Moon

It's all oddly outwardly imperceptible, and yet to me, its perfectly congruous.



My life, it's little steps, the irony that is never lost,, and me,, well, my place inside of it.

Today is housecleaning day. The lunar calendar marked bi-weekly as the tidal flow of hair bunnies lollygagging their cotton candy dances on the fringes of every corner within this old house. I shuffle a vacuum in our customary cadence, the Charleston footwork and Lady Liberty extension wand. The movement of wreckage that once held such necessary value. A place of me belonging to it, and fixed in a place I felt a feeling of belonging within,, (you know simply because familiar is ensconced around me). The cement to the broken pieces that would fly out of alignment, the centripetal force of me spinning around within a planet that I evolved from, but do not feel belonging to. A home is supposed to do that for you. Give you a defined, owned place under the moons glow.


I pick up the towels at the front door. Their terry cloth fingers, anemone-papilla that collect and store the muddy feet traversing from countryside to domestic domains. A quick wave to disperse all back out the front door back into their places in the free universe. The dog hair floats uninhibited by gravity, and yet the mud does not. I shake them outside furiously, a force of a blow against itself reminding the fabric it has a purpose, and a master and it finds its greatest pains back up and against itself. Hitting hard as it folds in two, and smacks the life both out of and back into itself. 


My front doors are ancient mahogany. Worn, faded, hand ironed finger holds to remain steadfast to the Pennsylvania weather whims of snow, ice, wind, rain and varied onslaught of generations of inhabitants. Old, like everything else within this house, she is a single door to a large front stone and a brick path to the yard in front. As I open the door the wind blows in burnt leaves, desiccated and crisp, lighter than the mud landing on the hallways dance floor as they billow into warmth. They crunch under foot as I crackle them to confetti pieces and make more work for myself. I should have put a storm door up many years ago, saved myself the extra effort of having to clean up as I clean up.. and yet I never have time for such time saving tasks.


The dogs rush underfoot and scurry to stay close. Keep my company as I clean up their weeks worth of toys, and detritus. They are no help but great company. I serve their needs and they more profoundly have taken residence to serve as my place within the world.

This house, the housework is the one small piece of my home life I hold dear. I would never imagine letting it go onto another's hands. it reminds me that I have built a legacy while I cluttered myself around a nucleus of a home that reminds me I have been, I was and I still am.


While I am growing up, and old, learning that the jewels of life exist in the experiences much more so than the accumulated paraphernalia, it isn't lost on me that these days of housecleaning remind me to take stock and place immeasurable inherent value in just the being here. The being here with my family, the pets I call my most treasured companions and the moments they make for my time here more valuable than anything this house holds. I am constantly reminded to take great stock in the wealth this lifetime has afforded me, and that they have given me. It will never be an equal exchange rate, the gift they give me of belonging and the care I repay them in return.


It is my little life within a greater place under the moon.


The larger looming admission is to never forget how much my clients companions mean to them, and to never grow old, indifferent and callous to their needs and rights.


For more on my old stone house please see my other blog Stone House Beautiful on Blogger


Tuesday, January 3, 2023

Kittens and Rabies, My N=2.

 

Raffles, 4 months old

Twice in one career. Ok, let's put it all out there, twice in under 5 years. It shouldn’t happen. The odds are staggeringly not in my favor, well, at least for anything else. Perhaps in the very high density, over-crowded, collection bins of the shelters, it might happen, but, me, little home town vet me, well, surely it couldn’t happen to me?

And here I am. Just notified that one of the kittens I was taking care of, the second kitten I have ever taken home to spend the weekend in my bathroom, is positive for rabies.

The staff had named him Scrapple. One of three we had been given custody of to try to find homes for. The finder of the litter is a wonderful long time client of ours had humanely trapped, vaccinated and spayed their mom. She had also decided to keep the other little tortoise shell kitten sibling named Kali.  

Scrapple

We do a lot of this. We do a lot of helping out when a client finds themselves with a stray pet (or four) on their property. While I recognize most other vets would simply point to the local shelter for the answer to their "not my problem" dilemma, the shelters are burgeoning with too many unwanted animals already. Further these little ones would be at great risk of euthanasia due to space constraints or acquire a respiratory infection from stress, overcrowding and inability to be vaccinated fully before their arrival. This is a client we have known for decades. If she is willing to step up and help these cats I am happy to assist her. It works like that, a compromise for the sake of the animals involved. Jump in, be compassionate. Make a difference. Live your purpose, all of the things we veterinarians came into vet med to do,, and then conveniently dismiss as "no good deed" comes along.

Scrapples story began as a simple kind gesture for the sake of need and ability. He needed us and we are more than best equipped to help. So we do. Period.

But, Scrapple had a past that preceded us. That past is what the "no good deed" and it's "punishment" brought.

He had been with us at the clinic for about 2 weeks. He and his two bouncing, bigger, buoyantly bubbly calico sisters. The little black Scrapple was always smaller, more subdued and quiet. On Wednesday (2 weeks into his stay with us) he started limping. By Thursday we took an x-ray. He had an old fracture of his femur. It was healing (as all kittens do), but why was he limping now? The fracture must have happened many weeks ago. He was about 2 pounds,, so at around 1 month old? Why would a kitten have an old fractured leg? Probably fell? There were no wounds ever evident on him. 


There are patients who step into our clinic that are so sick, debilitated and distressed that they require 24 hour care. Within a few days of his arrival Scrapple started to look, and act sick. He was too quiet, too small, and not looking like his thriving sisters. In vetmed he would be called "a kitten failing to thrive." In reality he is a kitten with a mysterious disease that would have gone undiagnosed had he not landed here with us. When it became obvious that he was still declining in spite of our sq fluids, antibiotics and TLC we needed to make some decisions. For Scrapple to go to the ER for the degree of care that he needs would be about $1,000 to $2,000 a day. I estimated that if he was going to survive he needed at least 5-10 days of this. So, I took him home for the few days I hoped he would need to get better. He did after all look like this;


Scrapple and his sisters had been dewormed and microchipped at their arrival to us. They had also gotten their first feline FVRCP vaccine. They were too young to have been vaccinated for rabies. Their mom was spayed, dewormed, microchipped and vaccinated for her FVRCP and rabies.

Within two days Scrapple was just lying around. Barely walking, barely eating, and he was separated from his sisters. By Thursday night I was very worried about him. Based on his unknown outside history and rapidly declining status I was worried about him dying, and I was worried about rabies. I took him home to minimize the exposure to the rest of the staff if he declined like the last rabid kitten I took care of did.


The last rabid kitten was Mauna. She had become an angry, exorcist-needy demon over 4 days. It was a Hyde from Jekyll. It was a change so intense and awful that I wish I had captured it on video. In the last two days of her life she only did two things; slept and attacked. When you woke her she used every tiny minutia of energy to kill you. She was a piranha possessed demon just alive to bite you. She was a virus nestled in her brain to pass on her disease. It was almost impossible to kill her. There was no way to euthanize her. There was no kindness or compassion or ethics in what I had to do. I was not able to hold her, restrain her, or be what I inherently am. She bit me twice in the last moments of her life. I had to stand in the room with her watching her violently attack me and ask myself how I was going to be able to euthanize 2 pounds of terror trying to kill me? I had to put her in a pillow case, tie it tight around her, wear thick leather gloves and inject a monumental amount of barbiturate's into whatever part of her lay under the case. I had to repeat it 4 times. I got my second round of post exposure rabies vaccines a few days later when the lab called me to say that she had been positive for rabies. This is a clear example of the "furious" form of rabies. Scrapple, turns out, had the "dumb" form.

Scrapple declined to a comatose state. He was still eating his syringe fed meals like a monster. Turns out that rabies virus is just that.. very convincing to the host to keep it alive, even when the host can no longer carry to its next victim.

It has been over 2 months since Scrapple died. It took a lot out of me to have to put him down. I will tell you that as a veterinarian you often have to separate yourself from your emotions and do rally hard things. You have to have some pretty excruciating internal dialogues about reality, civic duty, compassion and allowing death to be a part of a life you live even when it is absolutely unwelcome. Putting a kitten to sleep that weighs less than 1 pound via a needle into the heart so that you aren't going to be bitten and further jeopardize your own life, and then go to the ER for post exposure rabies injections to the tune of a couple thousand dollars, is a stark reminder as to why the saying still sticks. No good deed can be punished.

When the health department called to notify us that Scrapple was positive they required that the remaining kittens, and their mom all had to be placed in quarantine also. Mom was sentenced to 2 months, and the kittens four months. Our client decided that she wanted to keep her bunch and has them quarantined together in a spare bedroom. The calico kittens had an adopter who decided that they didn't want them, nor to wait four months, so they adopted elsewhere. When the Health Department asked me what we were going to do with the calico's we had I told them I would keep them for as long as they needed me. They were shocked. They had never had another vet do anything other than euthanize and move on. Learn their lesson and let the future kittens in need be someone else's problem.

Birdie and Raffles

They have names, Birdie and Raffles. They live in my spare bedroom at my home. And I love them to pieces. For whatever time we have together there is love, there is kindness, bustling thundering playing above my kitchen, and a reminder that life isn't supposed to be easy, it is supposed to remind you that you have choices to remind yourself who you are, and what you will be remembered by. It is about acta non verba.
















Thursday, December 29, 2022

The Train Wreck and the Captain

The cops came by for a visit last night.

The example in real-life of how to handle an unmanageable escalating crisis when words have failed you.


People are so much like the pets we take care of. You can tell the ones that are going to be the problems, heck even the ones who are outright dangerous, if you stick around long enough and use your Spidey-sense acutely enough times.

We have a few pets who just aren't their best selves when they get stressed or overwhelmed. In the people world I can use the recent example I had on a commuter train from NYC to my hometown station of Lancaster Pa. Just outside of Philadelphia at about 5 pm the train came to a stop. Shortly thereafter the announcement came over that there was "a trespasser struck on the tracks" and the train would be stopped until further notice. Oddly, (although this is my life so I dare not say coincidentally) this had happened to me a few months before. The train had stayed paralyzed for 3 hours. I was with two friends, we were all seated together, and I passed this along to them. We commented and giggled about how smart we had been to pack goodies from our weekend trip and settled in with our books, tarts and trashy Netflix series. The hours passed. No news of relief came. 

Sometime after about 8 the announcement notified us that another train would meet us and we would switch over to them. It was dark and trains are trains. Visions of cowboys, Indians, and stowaway-runaways started to swirl. It was a new adventure for the story book of the life and so we kept on idly seated. Mutterings of a train parked next to us began to pass through the car. It was so dark outside that you had to be seated at the window seat and press your head against the glass to make out the dark silhouette. No announcements came so we all stayed seated lost in our own distractions. Half an hour passed and the door to the car in front of us opened. A small young business suited woman walked in. She was holding her phone and announced too loudly that her friend was also on this train, many cars back and the train had already been evacuated. Had any of us been alerted? Her voice was too loud and too panic stricken to process without scrutiny. She didn't understand why we all looked at her blankly and so within seconds she said, "If you all don't get up and start running I am," to which the nerve of panic hit the passengers. Two of us in the car of what must have been about 80 seats stood up and told her to calm down. The staff would come get us and we weren't going to start a stampede to get off a train that was parked god only knows where. 

She didn't like the answer she got. She demanded again that people start heading aft and swiftly.

Again the two of us took charge and this time challenged her with restraint. She was impatient and lacked authority. She is the patient zero of mobs where people are crushed and die. She is not the person you want directing life rafts.

A few minutes later we were directed to start moving and the night was long and a bit harrowing, but we made it home safely.

My two traveling companions this trip were my two surgery technicians. The two girls I rely on more than anyone else to help the patients at my clinic at their absolute most vulnerable and most needy. Many of the patient I take to surgery are scared, stressed, debilitated, and some are even dying. If I don't have a team that can listen, follow, and still be ready to jump into action when they see danger looming our patients will suffer and perhaps expire. We are a team with clear objectives and unique talents, but, we are also aware of each others responsibilities and protect the team as much as we protect the individual. You cannot teach this without living it to reinforce it.

I do see my role, my profession and my life in this light. I am the leader, the fall guy, and the example. 

Last night at the clinic I was called to come and help diffuse an angry client. He was refusing to pay his bill because it was over the estimate provided. To summarize as I have to defend others whose prices are often seen as being exorbitant for vet care, this was a dog who could not be safely handled with a dog bite wound three days old who the owner also wanted to have neutered while under anesthesia to repair the bit wounds. The cost of his invoice was $660. We fit him in as an emergency within hours of his phone call. We kept the dog for half of the day to manage his care safely for everyone involved. We performed an hour long surgery to clean and repair the wound that was half of the dogs back leg, which included a drain and multiple suture packs, and we neutered him (in the hopes it might help avoid another dog fight down the road). 

The estimate provided was too low for the degree of the infection we found when we could safely examine it under anesthesia. He was here at 730 pm (we close at 8 pm) stating it was "our error and therefore he shouldn't have to pay for it." To add fuel to this he was driving a Cadillac that was about the same size as the train car I refer to above that was brand new, and stated that he's a lawyer. He was so rude that the techs had to call me after he "excused" them for talking to him about our mistake.

I met him in the reception area with the itemized invoice in hand. I attempted to discuss the definition of estimate and the degree of unknown findings that every surgery can bring. He interrupted every sentence two words in with lawyer tactics meant to intimidate, bully, and prohibit answers that weren't going in his favor. When I stated that I would not continue until he was willing to let me finish a sentence he began to name call. In the course of our 10 minutes he called me "stupid" "arrogant" "Karen" "liar" "irritating" "annoying" and "holding his dog hostage for payment." I had at least 5 employees behind me listening. After it was apparent things were just going to keep escalating, and I was absolutely intolerant of the name calling, I directed the receptionist 5 feet behind me to dial 911. She looked at me frozen. I guess she thought I was bluffing? 

There have been dozens of staff meetings where we have run through this fire drill before. I wasn't bluffing, and she wasn't dialing. So I picked up the phone and dialed it myself.

Here is my advice for situations like this;

1. You cannot diffuse a bomb, but it is super helpful to recognize that it is ticking in front of you before it goes off.

2. Train your staff to use the chain of command and make sure whoever sits at the top does it willingly and is capable. Vetmed needs more fire drills for these situations..

3. Have witnesses if you think it is safe to do so. I have to admit that when the dispatcher asked me if "I thought he was carrying a weapon?" I had to pause. I replied "I don't know?"

4. The dispatcher asked me if I wanted her to stay on the line until the police arrived. I paused again. The all too empower woman in me never wants to ask for help in holding my hand,, but the inability to foresee the future and the potential train wreck that might happen because of this left me answering very humbly, heart pounding in my throat, "yes, please" in a voice that cracked as the words came out.

5. The "caution" pets have treatment options. Short and long term behavior modification tools that the profession has long been addressing. We can refer to behaviorists and trainers. If we can intervene early enough we can save the victims of bites, attacks and surrenders and euthanasias. People,, yeah,, I think the cops have to deal with too much mental instability outside of their wheelhouse. I am empathetic beyond measure for the situations they are asked to intervene upon. And to the Sherriff last night who was also treated so disrespectfully (and of unknown relevance, was the Black officer, if you can hear this I am sorry for how you were treated, and I applaud (grateful) you kept yourself together. I could see you wanted to pound his face into pudding also).

There are inherent strengths a woman (yes, I am going to go here because I exist here) has. We are super good at keeping our place. I hate this about myself at times. I am just as capable (likely more so in the case of an emergency) and yet I stood there quietly and took his abuse. I have never in my life allowed another person to verbally berate me like this. It is the single part of last night that is not to be forgotten. For this I am glad I had 5-7 women who I take responsibility for watching.

The police arrived and he made sure to intercept them first to give his side of the story only to end up treating them (almost) as poorly as he treated me. I gave him enough rope to hang himself and he took the bait. He told the Sherriff he "needed conflict resolution" training multiple times, and as he was being escorted out of the building, to "stay in his lane" as he ordered him to leave. The girls erupted in stifled giggles to that one. They turned their backs to the door to cheer together.

The night ended at after 9 pm with him paying the low end of the estimate only, (you know to "teach me a lesson)." And me telling him that he was no longer permitted on any of the private property that Jarrettsville Veterinary Center owns and a police report to document it.

I am home this morning reminding my blood pressure that worse things in life will come and I have girls to raise, and, a clinic full of pets to protect so I better get my shit back together before I step foot back at work and try to lead a Calvary again.


P.S. Of the many threats this former client made to me last night they included; social media, YouTube, and community page smear campaigns, along with word of mouth public humiliation. Good Luck to you,, I am sharpening my pen as I drink my coffee and type away.


P.S.S. This is my personal blog, It is entitled appropriately. I often write raw, unedited posts in an effort to shed the burden this life and the difficulties I struggle with airing out. For the horrific statistics vetmed suicide has shed light upon, we really all are struggling to stay alive.