Tuesday, January 12, 2021

Pandemic Induced Decision Making Catalepsy

The Queen of the clinic Seraphina

I am at the point within this pandemic that I have decision making catalepsy. I am paralyzed by each new decision. The dilemma lies within being almost empty on identifying right versus wrong, or, bad versus worse, or even when to intervene any more. I am at heart a pragmatic decisive democratic leader. I got here from spending four years at a federal military academy, and then a decade serving in uniform in the private sector where rank determines everything from where and when you sleep, to where and when, you eat. I have for most of my life been embroiled in leadership roles. I am also a veterinarian. I am wired to care more about those less fortunate than I am my fellow human beings. This pandemic has forced me to reconsider, and, perhaps even abandon, each previous decision making argument as I attempt to decide how to navigate these ever emerging uncharted waters. The entanglement of my decision making process has become the angles of individual alliances and personal motivations that have been so unprecedented I almost can't tell myself where to settle my soul of indecision and burgeoning heart of consumed worry.

Remy. A little nervous at first, a marshmallow at "hello."

This COVID decision-making jungle began in March. The forced closure of most businesses left us with a simple question? Do we dare deem ourselves "essential" enough to stay open? Put the staff at risk of, well, ventilator dependent coma or even death? Am I that arrogant to consider my job that necessary? Is the pride going to come before the fall? I dug deep. Initially I opened the decision making process in true democrat fashion with querying the entire staff. We offered free passes with an indefinite leave of absence to any and every staff member who wanted it. They could play it safe. Stay home. Insulate themselves with their families. The safest maneuver possible. All were promised full acceptance and support to whatever decision they felt best suited them. I pledged to keep their position open until they deemed themselves ready to return. I secretly prepared myself for a skeleton crew. Endless days of paltry appointments from only the most dire cases to be shuttled in by their masked, socially distanced pet parents. We would sacrifice our bread and butter routine spays, neuters, vaccines, well visits, and, just buckle down for the most darkened days of our 80 plus year existence. Even at this bleak unknown place I believed we would get through this. Perhaps scarred, scathed, nearing bankruptcy, whatever may come, I would not let this ship be lost on my watch. If I could keep myself off that COVID causing ventilator I could go on, even alone if need be. I truly went there. Imagined myself in this place. Alone and yet still having my neon sign burning as an "open" beacon to the rest of the world huddled within their isolated and hidden homes.

The decision to stay open, with the Governors blessing, turned into a weeks long hysteria about whether our pets could contract, or even transmitting, the bug. The paranoia that this brought to each phone call was unsettling. The pictures of people in the COVID birthplace throwing pets out of high rise windows to eliminate the baby with the bathwater. That lecture of quelling paranoia was left to my previous 15 years of dealing with zoonotic disease. I wasn't going to fall into that rabbit hole of fear. I knew my enemy well enough to not placate to personal paralysis because it was simply a novel pandemic. I know corona. It's been around my office forever.

My Jitterbug. Always on duty, never under command.

The first round of COVID forced decisions left us down about 25% of our staff. Which was about the amount of business we saw decline.

March 2020 also coincidentally delivered us the ability to start our long awaited hospital expansion. It had been ten years in the making and waiting. A decade of hoops to jump through. A decade of personal saving and planning to allow us to grow into the clinic we had outgrown 15 years ago. A building permit was finally granted. The clock to begin, and complete, the project started ticking as the personal promissory bond was deposited. I had voted to wait the construction out and let the pandemic pass. In doing this we were risking a rare chance to do what we had been told over the last 10 years that we could not. We took a big chance, dropped a million dollars we had spent my whole career saving for, and jumped in. It has made me sick with worry every single day since. Every nail and every excruciating decision. I didn't know what the future held and yet here I am putting all my chips in the game. To this day, mid January 2021, I still think/fear, that I just put a bigger anchor around my exhausted neck to sink into the abyss of bankruptcy both deeper and faster. The dizzying list of decisions that a huge construction project brings are daunting. Some I made by the bottle, others I made by coin flipping. Most were whatever the builder wanted. I couldn't focus on them, so, I didn't. Not the way to spend a million.

As COVID was settling in with her 24/7 news coverage of bodies being amassed like war torn canvas clad victims housed in portable freezers, March also brought the news that my mom was now terminal with breast cancer. Fear took her over, the cancer ate away the rest. I had to choose between seeing her, assisting her with trying to function at any kind of basic level, and the exposure my job left me open to bringing back home to her. I took time off. I decided the little time I had to advocate for her was not worth the limited appointments the other vets could see without me. Of all the decisions I have faced within the last year this was the easiest. For three months we faced COVID and her debilitating disease that stole everything she had and left. We all faced decisions that left only two options with every decision. She was either sent away to die in some patchworked mandatory isolation from us, or, suffer at home as cancer insidiously pilfered the rest of her. Trying to find in home care options in the early days of a pandemic was impossible. No one would help us. I moved in to live at my parents house. It was quickly apparent that she needed more than this one human could manage. Three times we had to send her away to try to save her a few more months of time. Each was excruciating to debate, and final in its potential consequences. Every time she was taken anywhere we knew it might be the last time we might see her. How do you weigh that? In May 2020 my mom died in hospice hidden away, and still very much afraid, at home with her family. We have never had any closure after her final breath. I'm not sure we ever will. It's dull and faded and blanketed in an anger I still can't resolve. So many of the decisions I faced outside of taking time off for her were fraught with coffin calling cards. I have no idea if any of them were right? But we made them. Twisting her arm to get in an ambulance as C-diff ripped her guts out in a bedpan her frailty wouldn't permit her to get to. She fought the interventions and surrendered to the terminal.

Three months in, June, 2020, and the phone began to scream incessantly. The holed away humans began adopting pets in record numbers. These humans also began to place a much higher value on their pets who were at home with them and now their only source of companionship in keeping them company. The business surged and the risks of contracting COVID followed. As the novelty wore off the fears abated a little into monotony. Life was soo busy we couldn't watch the news with the same fervor. A sliver of silver lining found us.

Six months in, September 2020 and the staff, and world began to grow restless. You can only stay quiet for so long. People started traveling. Families began to scatter. By this point we had at least a half dozen self-quarantine 2 week hiatuses to disrupt the scheduling obstacles. We had at least 2 dozen people pending tests, some of which took almost two weeks to return. We had dozens of near misses. We were due, and our numbers were too big to insulate us from the bug forever. We split into teams to try to lessen the contact of the blow when our luck faltered. December advent delivered our first COVID positive staff member. The rest of the team went home with quarantine induced fear and chaos. The fear led to real-life mortality concerns. It was the harsh slap in the face that reminded us we were still vulnerable regardless of the masks, hand washing and curb-side service.

I had to decide what to do about a positive employee? I took the safest route I thought possible. We sent everyone who had been in contact with them home to isolate and hopefully contain the spread. We paid everyone, as we had done before. We calculated how many more home stays we could afford? We called the health department, our legal counsel and scoured the CDC for guidance. The NY Times had just run a section long special eulogizing the huge number of landmark businesses across the country who fell to the pandemics passing. Was I going to follow?

Where has paralysis cornered me? Here;

The vaccine is now eminently at our doorstep and another series of questions that need to be asked. How do I handle vaccinations? Silly, stupid me thought this one would be easy? We are all medical professionals? Aren't we? Isn't that our pitch to stay open as we call ourselves "essential"? Don't we all want to get out of this fearful place where a virus still has us by the neck? We are the vaccine giving kings of the world. Right?

Turns out a significant portion of the staff doesn't want to be vaccinated.

So,, do I take my personal opinion and force it upon others? Do I stay true to the devote liberal I am and let you do with your body what you want to? Isn't that what I stand for?, (well, as long as it doesn't hurt others. Isn't that caveat pertinent? And doesn't it apply?).

Every decision up to this point has been based on others over self. My mom, the staff preferences to stay working or not, making sure they are financially secure for whatever time off they might need, the multitude of ways the business might suffer at the expense of treasuring and coveting life. And, here I am now. I can force vaccination to be a condition of employment and risk losing people I deeply care about as I force my firm belief that we have an obligation to eradicate disease with all measures available. Stop the spread of disease by the same means and manner we do, pitch, force, and testify to being effective to the staff who doles it out to our clients and patients. What if there are pregnant staff members who should not be vaccinated among us. What do i, we, owe them? What about the conspiracy theory staff who don't believe the virus is real. Is that a religious pass?

Here is my list of pro's and cons. The forces pulling me one way versus another. The network of squabbling synapses causing my current COVID catalepsy;

I find a few things odd and unreasonable. How can we be a group of doctors and medical professionals and not believe in science backed preventative care? How can we be the single greatest distributors of vaccines to others and not participate in being vaccinated ourselves? How can we not call ourselves hypocrites and cowards? How can I possibly protect the staff if the staff isn’t willing to protect themselves? I certainly can’t take the ostrich in the sand approach. Just not look, not ask, and not care, if this virus hits is like wildfire and mows out everyone it meets. 

When all else fails in medicine we often defer to what's the “worst case scenario”. Shouldn’t we always be talking about and prepared for that? Isn't it both helpful and insightful when stuck at a crossroads of indecision and perplexity? 

So, let's go there.

What’s worst case scenario for us? The collective group of jvc? My thoughts on this question is not that someone will get sick and have life threatening or even life ending complications. That’s what it was before we had a vaccine option. Mine now is that someone at jvc will get sick or pass on illness to someone else and that transmission will affect others. I now worry more about not the individuals who made a selfie choice, because they now have a choice, but the collateral damage to letting the choice be made. We have multiple staff members (3) who are pregnant. What would I feel like if I didn’t get vaccinated (and let’s be honest the only people who don’t here are doing so out of selfish fears) and then it affects the mom's fetus? I’m not living with that. Part of being in a society, a family, a group as tight as we are, is agreeing to go along with what is best for that society. So for as much as I too worry about the first generation of a population receiving a vaccine I worry more about it others than myself. I will be vaccinated because I care about my husband and you all more than my business and myself. This for me is yet another incredibly difficult decision in a years long list of the same and I am not putting me or the business first. I’m putting you all first. You can choose what you feel is right for you. But abandoning science and the best interests of each other is not how I vote. 

Do I split us up into “vaccinated” vs unvaccinated teams? Leave the expecting moms in the most vulnerable place? Just take the "don’t ask don’t tell" approach. 'Cause that never benefited anyone? Just keep hoping? Praying? 'Cause that didn’t work with breast cancer in 2020. I am not sure. What I do know is that not making a decision leaves everyone vulnerable. And like every other medical issue we face with our clients ignoring it doesn’t make it go away. It just leaves you a prisoner to fate. What good is any medical knowledge if that's your approach  to disease? 

So who is liable? Me the person who let the unvaccinated work with the vaccinated? Let the pregnant employees work with the unvaccinated? 

Do I give monetary incentives? What does that say about us all? Are we at that place in society where baksheesh is the only way to get selfishness to take a back seat to population protection? Have we completely abandoned the notion that the sum is a product of the courage of the parts?

My obligation to this place where so much good happens, so much love exists, and so much healing is given so unselfishly is probably where I need to focus my answer. The answer is that this, like all the rest of the decisions behind me, is just another test to see if I can adult harder? Can I salvage my liberal democracy where people can be confident in living their authentic life and not see it as the selfish, myopic, obsession with individual-above-all in America?

Take a minor risk, get the vaccine, require the staff to unless they have a valid medical exemption.

And yet I sit here torn. Catatonic to Covid.

For more information on anything and everything pet related please ask us for free at Pawbly.com.

If you are a pet care provider who is willing to help pets in need with your advice and compassionate words of kindness please consider joining us and adding your pet care experiences and thoughts at Pawbly.com. We are always in need of reputable professionals who can educate and inspire.

For more information on Jarrettsville Veterinary Center please visit our Facebook page, or website; JarrettsvilleVet.com

I am also posting lots of informative videos at my YouTube channel here.

Sunday, December 13, 2020

Bentley's Betrayal

 Unequivocally it was one of the single hardest acts to participate in, and, come to terms with.

The “act” is the surrendering of hope. The abandonment of responsibility and the letting go of a strong-willed fiercely determined soul full of so much life it was blinding. The front half of Bentley was solid, foreboding and always smiling, The back half was a re-arranged anatomical list of deficiencies that made his life as a pet impossible.

Bentley was a tyrant for attention and a brute of force too dangerous to contemplate if he felt that his needs weren’t being met. And, yet, for all of his deficiencies it was impossible to not fall in love with him. He had this charming way of falling into to you so trustingly that you couldn't reprimand him for it. He would come tumbling towards you, mouth gaping open, cheeks grinning ear to ear, and a tongue flopping with wet intent to embrace you. Just as you braced to meet the catapulting 80 pounds of sheer muscle lopping into your body he would bow his head and summersault into your lap. Wagging the whole time about being in on the joke only he knew the punchline to. He was always like that. Affable to the point of ill mannered and too childlike -a-giant to argue with. 

He came to me about a year ago. I remember every tiny clue as to how hard his case would be. I remember listening to the medical reports, second, third and even forth hand, from all of the people he had been to visit, and telling myself secretly to stop listening. There is an inverse relationship to prognosis and the number of medical opinions. The less medical opinions I have at presentation the better the prognosis. Bentley had already been to numerous vets, and numerous veterinary specialists. The more he went to see the longer his list of burdens became. I was now being called. I am sure I was so low down on the list his fate was almost sealed. I remember his phone call vividly. I was standing in the breezeway of a hotel in Sanibel Island Fla. for a vet conference in late January 2020. My mom was at home suffering from the early stages of her terminal breast cancer. Losing her ability for any kind of life day by day and I had selfishly taken 4 days to attend a conference and take a break from the dismal life unfolding before us. The rescue had emailed all of Bentley's information, asking if I could review it and possibly even help? Could I do the $6,000 surgery he needed? Could I find him a more affordable treatment option? His owner had exhausted all financial and conservative options. It was me or death. He was growing fast and he was unable to stay in his home.

I felt cornered. Why I don’t just reason myself into the obvious answer and back down I don’t know? 

I remember hearing myself say out loud in that breezeway; “well, if you get to the place where you are euthanizing we will take him.” I cannot swallow these words right  now without a goiter-sized lump of grief, remorse, and turmoil. 

Yesterday, after about 8 months of procrastinating, praying, and hoping I had to euthanize him. It feels more like kill, euthanize is our packaged with a  bow term to settle the reflux such an act elicits.

It took months to come to terms with even trying to set the day. It took every member of the staff of 20 who care for him day to day to say that they agreed it was the only answer. Truth is he is so lovable when he wants to be that you forgive him too quickly for the times he is dangerous. It took multiple episodes of us, the women who run this veterinary practice to feel as if he held their lives in his whim, his mood, his determined anger to get his way that we had to either keep him so sedated him might doe overnight, the “safe” doses had become increasingly less reliable. 

As the months passed we abandoned hopes to 'cure' his urinary issues. Every medication failed. Every recheck, retest, diagnostic yielded worsening progression of a congenital defect that spiraled into being the "40% that never resolve with favorable outcomes." At every option he failed to find a break. He would never regain control of the bladder or his urinary system to be able to hold his urine to be housebroken. He leaked urine all day all the time. He smelled like urine all day, all the time. And you couldn't keep him clean. He required loads of laundry with bed changes daily. Daily, if not more often, bathing. And, it was never going to change. To make his bleak diagnosis more ominous without a sphincters' to hold the bladder closed, and because he was essentially always leaking he had an open conduit from the dirty floor to his bladder and up to his kidneys, Ascending infections that would ruin his kidneys were a reality. Recurrent urinary infections were also looming every single day.

He developed calcifications on his surgery site. The drainboard his urinary system had been re-routed in He was dribbling little drops of urine all over himself, his bed, his cage all the time. I had a staff member designated to caring for him, often without any other paying pets just so he could be kept dry from his non-stop urine leaking. 

He, since the time he was born, had to be kept clean. He was swabbed, wiped, diapered, fooled with, every few hours of his whole life before he came here. By the time he arrived at the clinic, at 4 months  old, he would not let you near his pelvis, his belly, any place below the shoulders without a shark-toothed sneer and low guttural grumble. In the last 4 months of his life I was unable to examine him without elephant sized doses of sedatives. He became, like so many other patients I have, unwilling to participate in his treatment plan. He was essentially ignored as the only peaceful compromise to our collective existence. The more latitude he took, the more we gave. The  ultimatum of the resolution to his issues was pushed days-weeks- and ultimately months into the place yesterday became.

The dozen people who loved him most, spent the last year with him, made his days full of play and joy all gathered around him to say goodbye.

It took a massive amount of sedation to allow him to cuddle with us. Keep him calm enough to not feel timid in touching him. We all sobbed. I, felt a sense of regret deeper than I ever have felt before. I felt a sense of personal responsibility in a depth unknown to me before. This was mine to bear alone. I had said yes. I had committed us all to this place where grief is the only flotsam to seek refuse in. this was my act of betrayal to this soul who would have  been the best boy if his emotional needs could have been attempted to have been addressed around his insurmountable medical needs. 

I feel as if I am in the cross hairs of an impossible maze that I cannot live long enough to accept the failure within.

His story was public. As are all the things this clinic does. Hard, right, wrong, and most often miraculous, but, he wasn’t that ending. I posted a video yesterday confessing the pain this life leaves me with. The resounding number of responses were friends and family who have followed his story. Known his challenges and rooted for us anyway. There were a few that were nails in the coffin of despair I feel. One in particular was scathing in its burning condemnation. One comment was fueled with disappointment that we “hadn’t waited until after Christmas.” It is December 12 today. They were furious that we couldn’t have waited two more weeks, which I parlay as “endangered the lives of the staff for two more weeks. Sedated to the point of almost coma Bentley so that a magical date on the calendar could be passed. For those of you who read this, you know my mom passed away 6 months  ago. I remember wondering/wishing that she would pass a few key dates, like Mothers day. Who wants to remember every mothers day as the day your mom died?

What is most hurtful is the gall-ish arrogance to say that her feeling for him, a dog she has only known through Facebook posts is so influential that her opinion, and subsequent removal from her donor list matters. If you're reading I want you to hear me say that your reprimand to those of us who spent all day sobbing over a loss we spent every day of a year tending to, trying to give some semblance of love and quality of life regardless of how much work, time, effort and yes for me significant monetary investment is  hurtful to the place of irreconcilable. To be judged when you are already feeling like failure wrapped in personal betrayal is a pain no one who loved this much should feel. For all the pleas we made to try to get him the financial help he needed for his surgery, and the too numerous to count requests for a home of his own with a need such as “urinary incontinence, recurrent urinary tract infections, and a bully breed who is 80 pounds of childlike tantrums” is a big ask. Only we stepped up. Opinions are welcome within your own sacrifices,, the rest is judgement, unwanted, unneeded and unhelpful with the sorrow his loss brings us.

It is less than a day of trying to come to terms with this loss. My act of betrayal, and the damnation this voice inside me reckons with.

Right now I keep trying to remind myself to not stop being an open heart, trying to not close myself off to these phone calls which I know will never abate, and not giving up at the gate because it easier than trying.

I'm not sure how I am going to find the place where my sense of betrayal is accepted as my responsibility for the leader of my own pack of amazing staff who love more than they have to even when the price can cut so deep.

May you find peace Bentley. I am so sorry. You loved this life even though you were cheated so.


 For more information on anything and everything pet related please ask us for free at Pawbly.com.

If you are a pet care provider who is willing to help pets in need with your advice and compassionate words of kindness please consider joining us and adding your pet care experiences and thoughts at Pawbly.com. We are always in need of reputable professionals who can educate and inspire.

For more information on Jarrettsville Veterinary Center please visit our Facebook page, or website; JarrettsvilleVet.com

I am also posting lots of informative videos at my YouTube channel here.

Friday, December 4, 2020

The Blacktop Divide. How Vet Med was redefined in a pandemic.

 Nine months in and I still haven’t figured out the knocking on windows etiquette. 

I spend an inordinate amount of time these days amidst the middle (maybe? Hopefully? Dare I even hope?), of this pandemic in my veterinary clinic parking lot knocking on windows. I am not comfortable here. Too many people pulling in 5 minutes late (or more) for their appointments, going too fast, and congestion at every corner. The struggle to talk through masks, after I pound on the window to release them from their cell phone meets carbon dioxide trance, is real. I am also repeatedly finding myself in too many arguments about even putting the mask on. It has gotten so bad we have put laminated warning signs on the back of our patient record clipboards. 

The protocol is that if you walk up to a car, or client, without a mask on you just raise the clipboard up to your face so they can read the “mask required.” (It has very small (almost invisible) emojis adjacent with a poop face and a finger for staff motivation). 

The real fear of the black topped front office is losing a pet in the transfer to the staff. (Because we all know that if something awful can happen it will.) We have had this happen multiple times. One escapee had us spending three long desperate days and nights searching woods, roads and back yards fearing the whole time that they would be hit by a car in the interim. The other had the entire staff running down our busy two-lane road (where the speed limit is always pressed at 50 mph) to persuade a full on running dog to come back to the rioted crowds chasing it. I wasn’t sure which I was more petrified to see happen, the dog flattened, the staff tossed like road kill salad, or the owners meltdown within the whole endeavor. Or,, that even within the confines of our parking lot, entrance, and exit, that a pet will be run over, bitten, attacked or misplaced in the clutter of chaos as we do more and more outside. The parking lot has become our catch-all. The check-in and check-out point. The collection of pet information and the (thankfully dissipating) point of hostility contact place for the non-mask wearing amendment protestors. I had no previous emotional designation for my parking lot, and, yet, now within this pandemic year it has become an extension of my profit-making square footage assessment. I have invested as much into it this year it as I have my front lobby in years past. It is my first impression, my (by far) most dangerous spot on the property, and the new battlefield for healthcare provisions. Truth be told my hate for the asphalt grows daily as this pandemic grinds on.

The parking lot has been upgraded; glossed over, restriped, labeled by parking spot number to help identify where to find our patients, and as the months drag into winter we are adding portable heaters. I am proposing to also add check-in microphones, the sort of modern-day drive-in movie theatre comms system. All we seem to be missing is the jovial spirit of short skirts, knee-high tube socks and the roller skates. 

We have benches outside that allows for a change of scenery as people to wait to be seen, albeit used based on weather permitting. It allows some refuge from the confines of a car that can last a few hours at our busiest times. We also have a considered how to more easily implement the check in and out procedure. Phone lines are blowing up at record breaking unprecedented numbers. Our call volume is about 1800 calls a day. Which is up from about 300. It is significantly more than two receptionists can handle over 12 hours. The attempts to remain a place where people feel welcomed and well cared for is immensely more challenging while trying to maintain social distancing and public isolation. Removing the in-person examinations where the pet parent and veterinarian, and veterinary staff can exchange patient concerns in real time and together is nothing but detrimental to the overall patient care. As I have lost the ability to share my examination findings together, like showing a parent their pet’s degree of dental disease, eye issues, body and muscle condition changes, every little detail my eyes have been trained to look for and identify, is lost. It becomes reduced to a bullet list of items lacking the relative personal expression of invested concerns on a report card sent back out to the parking lot. Or, a summary phone call.

We are fortunate enough to have a little house that accompanies the veterinary clinic, grooming and boarding facility, and, the 5 acres of land it all resides on. The house has never been used as a part of our veterinary services. It has for the last 50 plus years just been a domicile for rent. This year it has become an integral part of the personal approach to the care we used to pride ourselves for having given each case. In this oddly distancing time of self-protective warnings the house has given us two things many other practices don’t have; a indoor bathroom, and, a place for quiet peaceful passage. My septic system for the small family it was built to support now holds a reservoir for dozens of people a day. I have fingers crossed every day that it can manage the load, same as the rest of us. And, I wonder how do I renovate it to resemble the facility at Ravens stadium? The house has also served as our last tiny vestige of compassionate centered care for the euthanasia’s. Since the beginning of the curbside COVID service discussions I knew that I could not remove this last piece of humanitarian kindness. How others justified, (and perhaps my bottom has not been met yet and I will have to eat these words?), and permit only drop off services for euthanasia’s I don’t know? I have been that person so consumed in grief, while desperate to hold on for every last second as I say goodbye to my family member. Doing that as a ‘drop off’ service, well, I could never forgive myself for that. Nor could I ever look that person in the eye again and proclaim myself as compassionate. The clinic house is our one last sanctuary for providing the intimate care we all came to this place for. The most meaningful moments of my vet life during a pandemic have been there. Taking that last good-bye, those final moments, and reducing it to a drop off service puts us all in a place that undermines all we have collectively prided ourselves as. This pandemic has already taken so much; it can’t take this. Even if I have to gown up in hazmat gear to be there, I will. I can’t surrender this last place of empathy.

I find it jarring how much the place I practice has changed within the world around us changing. That piece of ever engulfing black top has been the divide between the clinic still bustling with activity and yet absent from the people I share these patients with, and that little house where we say goodbye and still remain human.

People are tired, worried, and fed up. I am with them. Everything is thought out, measured, weighed on a risk-based analysis, and the duration that feels omnipresent along with annually recurring in its resplendence. 

I wake up every morning wishing this looming veil of fear would be eradicated. Yet, I know disease doesn’t work like that. It does what it wants. It takes it’s time on a calendar that is intangible, mysterious and elusive. That’s the single thing driving me the closest to the brink of breaking. The unknown. Looming over me day to day and unending in its grip. 

My closed clinic doors. My masked face, and my painful hesitance to hug the client crying beside me as they say goodbye to another loved one in a time where companionship is scarce and fleeting. 

Yesterday I had to help a 2 pound kitten into the only peace she has available after her previous 4 months of struggling to survive. She was one of those few neophyte patients who has failed to thrive. Her mom has dedicated the last 4 months and thousands and thousands of dollars to multiple specialists across the eastern seaboard to help her get over her too many ailments. She passed away in her mom’s sobbing arms, desperate to fight another moment with a poking prodding vet who hurts. We cried together. The injustice of it all. The finality to a time with so many already to mark its passing. That kitten, (her name was Honey), fought so hard. She was destined to fail by some minute failure of her tiny bodies’ creation, or lack thereof. All I could do was say how sorry I was. What I wanted to do was hug her and her mom as firmly and re-assuredly as she was being held and cry together over the loss that was so painful and unfair. That, this personal grief met by self-protective perimeter defense is carried every day. It is an elephant that is dying on top of me. The degree of suffering is transcending every moment of everyone’s life. Like it or not. Deny it or not. 

The parking lot is just my tangible, dangerous reminder of how much distance we have lost in our taking care of each other during this pandemic. 

While I am not going to attempt to list all of the challenges COVID has brought to us as a veterinary clinic I would like to remind everyone that we are all in this storm together. Paddling in the dark, not sure which direction to go, desperate to hold on as the weather unpredictably rages around us. And, yet we aren’t really truly alone. It just feels like it amid the isolation of a parking lot which seems to feel like the best way to stay safely afloat. Being kind isn’t an act of exclusion., The challenge is maintaining it as inclusion amid the chaos of the unknowing. 

If you would like to learn more about veterinary medicine you can follow me here, at my blog KMDVM.blogspot.com, or my clinics website JarrettsvilleVet.com, or, our Facebook page Jarrettsville Vet Center.

I also have a YouTube channel, and the best place for free pet centered advice at Pawbly.com.

Saturday, September 26, 2020

Who do you bet on? The horse or the rider?


Do you wager on the horse? Or, the rider?

What if the horse is the medical staff, and, the rider is the patient? Who then?

Let’s say the medical staff is Johns Hopkins. One of the most influential, advanced, respected medical entities in the world. Or, what if the medical staff is a single veterinarian, who has a solo practice and is expected to wear every hat you would find at Hopkins.

Let’s play our scenario out even further. What if the patient was my mom? Diagnosed with end stage breast cancer, and, quickly thereafter told it was in every bone in her delicate barely identifiable out of pubescent body. What if this diagnosis with its formidable prognosis finds her when she has never faced a challenge of personal merit defining obstacle in her life? My mom was always the easy way out option elector. Too much sweat, effort or scrutiny and she would immediately decline. Politely wasn’t even considered. She was adamant about easy living. She died less than 6 months after being diagnosed without a wrinkle to weather her face.

Then there is Havah. She is my dearest friend. The person who has been my most consistent bestie for over three decades. She was given the same diagnosis, same prognosis, similar disastrous landing of a cancer too invasive to shell out, this time her brain, spinal cord, and meninges, and yet, she has faced every toxic infusion of chemotherapy, every radiation eradication, and every step as a short jaunt to a recovery via hope-based endeavor. She has never wavered on her mantra to recover. To survive this regardless of how insidious it had grown. Not one modicum of doubt has entered her process. She is the rider on a life saving journey to the other side of terminal. She is the fearless mercenary who keeps charging on to a disease that has no eluding.

Both of these; my dearest, closest, most cherished souls are in the same fight. Both have unparalleled medical teams, and yet, my mom lived 5 months, Havah, well, it's been over three years. It was the rider who made all the difference in the race.

Why is this relevant? For me the doctor of animals, the rider is never the question. Every animal fights to survive with their chin up as they press on, with no time for self-pity or reflection. They face each moment focused on little else. Amputate their leg riddled with cancer and they walk on three with little instruction within a day. Animals fate is determined primarily in the medical access they are provided. Nothing else influences a pets prognosis more impactfully than the pet parents decision making process. It is where I find the most difficulty in being a doctor whose single goal is hope based care. Electing to “do nothing,” “let nature take its course,” “end suffering at the onset of a medical challenge,” has always implied giving up without attempting to palliate. It is a tough, bitter, jagged pill to force down. Especially in light of knowing how well most of these patients will do with even the minimal cost of effective pain management.

And then I ask myself if my personal opinion, my belief that medicine has all the answers? Is too biased? Maybe the quality of my mom’s short life was better than the medical maze of the labyrinth that the human system fills its unprecedented greedy coffers with? Maybe content and "comfortable" at home is just as hopeful as fighting with every cell you have? Maybe faith is based on fueling liberty and independence to heed your own cause and not my biased based case-based experience?

As I try to dissect, categorize, and compartmentalize the losses that I am reeling within I am finding that I cannot help find the answers to the personal choices made around me, only the ones I have to face for my personal healthcare decisions and those of the animals I am responsible for. I don’t have answers based on fortune telling crystal balls. I simply have gnawing for loss I cannot resolve without understanding the influence it has had on my own personal beliefs. I still grapple with the “quality versus quantity” of life arguments that is soo prevalent in my profession. I still take a quiet humble step back when my clients ask for my opinion as to which path they should endeavor upon. The all out fight for every best chance at life and possible recovery which almost always includes a life altering schedule of specialists, treatments, and tens of thousands of dollars, often to buy a few more weeks or months. Or, the go home stay eating, comfortable and as stress free as possible and let fate decide for you.

Even as a veterinarian my choices have spanned all aspects of the decision making spectrum. I still don’t know if I made the right choices, or even if hindsight has helped me evolve into a more accepting parent for their lives. I fought so hard for Jekyll, Savannah, Ambrose, and yet, I peacefully let D.C. Belle, the pigs go. I hope that knowing them, the individuals they are, helped me in those choices. If so, how well do I know myself? I wonder if the inner turmoil is focused there? Coming to terms with our own mortality. It was the one over looked, too painful to ponder place for Havah and my mom. They were so afraid to die. So unprepared to pass on, afraid for the loss and the unknown, and yet it has been so heavy to unravel it stole the last pieces of life worth feeling.

Maybe my lesson to learn lives here. That my decision is mine alone. Maybe theirs was theirs to live, die, learn, accept? And maybe the answer is fluid, influenced, nuanced, and never truly defined or settled?

I think that is what I need to live through. I say to others almost daily, “I deal with death every day. The loss of a life that mattered. Was hugely influential and deeply sorrowful to prepare for, live through and move beyond. How can I see my life so differently than theirs? I don’t feel as if I do. I don’t wear, consume, or associate with the cruelty in animals sacrificing for my life, how can I elevate myself, my death over theirs? We are all equal. Missing me is as earth shattering as them. We all go someday. The goal is to live now, and accept that when it comes to call for you. For me this will be after the folks at Hopkins tell me it’s a game I’ve already lost. Accepting that with gratitude for all that I leave behind is the key. Its all a gift up unto then. After it’s the price for the ride.

Related blogs;

Jekyll's story; 

Grieving the Loss of Your Pet.

The Aftermath of Losing Jekyll.

My Beloved Jekyll-Pup

The Turmoil of Contemplating How Long To Fight For Your Pups Life.

The Agony Of Being The Patient. How the Vet Mom Faces The Reality of Being The Vet Client.

Here is a story on my mom's journey;

My Mom's Story; Dying In The Pandemic.

For more on us, our journey, and this life we lead please follow us here;

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Friday, September 11, 2020

New Beginnings and Old Responsibilities. The Building Of My Legacy

Lately I have been hung up on this legacy thing. The idea that I haven't left enough meaningful pieces behind to have ever mattered enough for a memory. A condolence without substance. A farewell without a book of accomplishments to pass on. It's the curse of caring. Its really not a prideful thing. This late in life I don't care enough about others opinions of me to let it mold me into a more normal-vanilla being. I still fear not in posting defamatory remarks on the politicians. Broadcast my shame on others as the naysayers of climate change. Fight for a greener planet, a more compassionate place to share with all other species, my personal protest to single use plastics and my unwavering devotion to never being able to kill anything never mind consume them. I am so hard on myself it is unfulfilling. In vet med they call it imposter syndrome. I strive to live this perfect life of example within a cold place of global consumption. The veterinarian in me is no different. She has to know everything, be everything, and answer every tiny meow in the night. It is facade we put up to sound like we don't "just play one on t.v."

Getting to this place was a series over-analyzed, albeit well intentioned, steps. The plan was never set in stone. It began as a loose leafed alternative to a life I was pretty miserable in. (Note to all of my sea going and KP buddies here, I do sincerely love you and am incredibly grateful for the time we had together.. You helped shape me into the cast iron kernel of uncompromising charlatan sitting at this crossroads. P.S., no sarcasm here, promise). I was going to go to college, and I was going to go out into the world and do something meaningful. Seemed simple and honest enough.

The plan was derailed almost immediately. College, the stepping stone to adulthood, had little options that were palatable. My parents didn't have college funds prepared, and, I wasn't going to go if it was on their dime. If there wasn't a scholarship with benefits for ancillary costs it simply wasn't an option. I was expected to go to college, and, it was expected to be free. It was, it just wasn't ever my choice. Military academies work like that in some cases.

The lack of options has often led me to a search for uniqueness. I discovered I had to push through the endless hallways of the closed doors and never be discouraged from trying another avenue. In the worst places I landed, which were never the places I chose, I learned to survive. I learned to look for the long game as I was fumbled in the short haul. Sending a girl who wants to be an artist to a military school suffocates the soul of creativity. That muffled girl did her time. Time that was almost always spent alone, and almost inevitably dangerous. I never made a courageous decision, but I never walked away from being backed into a corner. I learned to silently strategize and I learned to not be afraid to fight. I could further reduce that to I learned to not be afraid.

How can a self speculating imposter not be afraid? Well, you learn to face every decision with a clearer mind and a definitive goal. That is part of what the military instills as a leadership quality. I am also grateful for that. You aren't born with that. You earn it.

Being a veterinarian is not dissimilar. You need to know how to manage people, decisions, look at a problem from all the possible angles and be prepared for your enemy to outsmart you. Not being caught off guard is as an important a survival skill as those years of medical training.

Four years of college and a degree in hand I set sail for the only thing I was trained to do, and, the one thing I thought would be the biggest challenge I could face. I went to sea. Tell me I can't do something and I will exhaust all efforts to not have to swallow the opinion of others as my own. It's not anything anyone should be proud of. It took me another decade to learn that I only had to make myself content in this lifetime. Everyone else was following that, why didn't I??

I did what I had learned at the Academy. I put the plan for the long game into action. I went back to school for what I wanted to do. (No, it wasn't art. I wasn't that brave). I went for my other passion. I was going to become my version of James Herriott, (minus smelly farmer and muck boots) who had carried me dreamily through that decade at sea. I read, re-read and lived a life of honorable purpose through his books all those many long days melt into nights abroad on an ocean. It took 6 years to get from able bodied seaman to vet school applicant. Everyone told me I was delusional. I was too old, my grades from the Academy weren't strong enough, I had a career path ahead of what others thought was "extremely lucrative and desirable" right in front of me.  No one changes their successful trajectory mid-way through. Do they?

For all of the  too numerous to mention sacrifices I had already made it seemed silly to walk away from a job that paid so well at the pinnacle of the ladder to accomplishment. But, for everyday at sea, coveralls, steel-toed boots, hard hats and solitude, what I really wanted was more broken kittens to mend.
Weasely. The tiny meow with the deformed legs.

I left a hundred grand a year for 6 months of solitary confinement work on the ocean for a chance at beginning my own story. It wasn't a leap of faith as much as a "get out alive" escape.

It took me years to get into vet school. Years of beating the odds, outlasting the competition, and, perseverance to determination leading to the acceptance of my own limitations. 

I learned that after a dozen "No's" I could more easily accept their diminishing worth. The value of excess dilutes the emotional impact. All the many "No's" allowed me to accept a challenge. After years of failing you learn to embrace the challenge as a way to reflect upon your own value. I learned to not back down from a challenge unless I thought it wasn't worth my time. That little decision took until my late 30's to recognize. It had to be my challenge to accept, not someone else's taunt to prove wrong. There was a tiny bit of growing up in the process of weeding out options.

I left shipping after 10 years with a Captains license and the promise of a new ship, a new build and a legacy of a girl with four stripes on  her shoulders leading a unique, albeit incredibly lonely, life to say adieu to. I yearned viscerally for things like the smell of fresh cut grass, the sound of my own refrigerator opening, my purring cats to sleep with at night, and some small group of friends to hold close. You just lose these little sparks of normal life when you are at sea. Where others see Hemingway tales of far away lands and secrets you can harbor in places no one else bucket lists I just felt alone, and always vulnerable,, the bad kind of vulnerable. 

Once I had tasted the top of the heap I would never accept an apprenticeship again. And so upon graduation from vet school I bought the clinic I was newly employed at. One episode of witnessing the previous owner euthanizing an 8 month old treatable puppy because the wealthy owners knew it was cheaper to replace than repair and the line in the linoleum was drawn. I wasn't working for him, or them, or anyone else who didn't care enough to try. There wasn't room for two sheriffs in this one horse town.

It was a brief, urgent leap of faith into practice ownership about 8 months after vet school graduation. Slightly insane decision for a nubile practitioner. It had to be this. There weren't any other palatable options to survive this profession I had spent a decade to fall within the ranks of.

And now 15 year later I am at the crossroads again. Twenty years left within this career and I have to decide one again how many cards I am willing to throw on the table and whether or not I believe in my hand, or ability to bluff, to see if I can come out of this alive again.

We are at the place where we are about to double the working footprint size of our vet clinic. It's time to reinvest back into my heart and soul and commit to another decade, or two, of being the sock puppet user I swagger through the hallways as. I have to recommit to another project, a long term goal, and all of the faces, souls, voices and emotionally invested beings I make this commitment to. It is not an easy undertaking to jump into. I have to do this wide eyed, willing and prepared to meet and exceed all of the needs of those I have made a promise too, and on top of them, the scores of others who will cross our threshold.

As I grow older it seems the consequence of decision, and vice versa indecision, have more magnitude. A more perceptible punishment, the times isn't as plentiful to squander and the resources have a finite time frame.  With this I also have this immense burden of feeling like I never shied away before so why start now? And, if I do start now how many more places will my feet hesitate to step? What value is there is being timid now? I have lived with nothing and flourished, abandoning my mission now is not only shying from responsibility but blunting my own vision.

I have to swallow the imposter, overcome the fearful intimidation of this price tag, the loan, the risk every small business owner assumes. I have to become the artist composing my own legacy and jump arms wide, chest thrust forward, chin up, eyes full of possibility.

To all the Kevin Costners out there with dreams as big as the ghosts who honor them, "if I build it they will come."

This is Cora. She came to us looking much sadder than this. This is her submissive plea for affection after she recovered from the parovirus her family abandoned her from. She is the subject of the Herriott stories I yearned for. She was a total financial loss, and I am immensely proud of her, and us for taking the leap of faith to try to save her. She is 8 years old today, living in Maine with my college friends, and she is alive, perfect, and the miracle that courage and dedication built.

At this place I have to jump in. I have to build this dream. If I don't it will be the fear talking. The doubt deciding, and the artist losing her belief in a vision that imagination too wing to.

For every person out there wondering what the limits are I guess I can only offer this tidbit..

  • You won't know until you try, and, failing is more important than surrender.
  • Your legacy is yours alone to scrutinize. Be kind, even to yourself.
  • Never lose the girl you dreamt you would become. Her vision is your guide.
  • As long as you have love and compassion you have all you need to thrive.

This is Dunkin. He never had one break of luck,, except us, who loved him every day of his short, completely unfair life. And yet he is one of my greatest joys. He reminds me to see the beauty in life every single day and just be grateful for it.

My pups, Storm and Fripp, This morning. They remind me to stop and enjoy the sunshine.

We are one month away from the ribbon cutting. Eight months into 2020 where so many chapters have already closed, and I stand on the precipice of a new chapter of an 80 year legacy two other Herriott's of their own right built. I am the third in line of the  place so many have called their place of healing. We have shared stories, saved lives, ended those who were suffering and all the way we have been honest, accessible, and affordable. 

When we started this new chapter I had one over arching requirement; we would never lose our place or our purpose to those we serve. JVC has been a part of this community for over 80 years. We carry a legacy forward and I am not going to allow this new chapter to cause change for those who need us and have always depended on us. 

JVC is my legacy. We are not going to build a big-bright-shiny practice that doesn't meet the same needs of all who enter. We aren't going to start excluding people to pay for the McMansion the ego armored imposter needs to feel better about our own place in others lives. Isn't that what vet med is all about? We serve others, all others who need us, not those who can afford us as we 

The all too often abusive statement that rising pet care costs are a reflection of veterinary costs is vulgar. If you couldn't afford vet school, your vet hospital, your equipment, or your ego you shouldn't pass it on to others as their complicity. Its not theirs to own. If I am not affordable because I made poor decisions my patients pay for it. That's what a legacy is and that's the way we slay our imposter syndrome.

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