Letter To UPenn Veterinary Teaching Hospital Seeking Access To Care

 Access to Care

There are those of us who live our lives with the hope that our pets will find us worthy. We spend the majority of our time giving gestures of thanks for all that they give us, without asking or expecting anything in return. We feel humbled by how little their loyalty costs, and yet we still want to offer more knowing it can't repay all that they give us. The relationship between ourselves and our pets, the ones who share the most painful, joyous and raucous moments of our lives with, is unsurpassed. Our pets are our truest, most trusted, most faithful companions. Most of us would chose them over any, or every other human alive, even those we call a relative. This, this single sentiment, has forged many a veterinarian to face arduous years of study and turmoil. It, all of it, is worth those quiet, unseen moments with them for that one soft purr, a gentle wag, a velvet ear and wet nose. For these we would, and do, give everything. 

Jenn and Johnny Cash

Johnny Cash was the beloved dog of our hospital manager Jenn. He was growing older and like most large shepherds, was struggling with issues associated with his breed and age. He needed help getting up, staying up, and his self- assigned guard duties pressure suffered as these progressed. When he needed help she was determined to do everything for him. During the course of almost a week he went from not feeling well to unable to stand, eat or interact. Over that time he was given an immense amount care from the staff of our clinic. When one of our own is not doing well the hive swarms around them to lend a hand.

This is a story of love and the dedication/devotion that all pet parents feel when their pets life is tenuously suspended on the precipice of life meeting end of life. Veterinarians, those of us in the sweaty, grueling, chaotic trenches of day-to-day medicine life forget this. We lose sight how much we are needed. How much power we yield, and how devastating the loss of our companions can be when we fail to live and deliver the purpose our knowledge and skills provide. There is the potential loss of a life with every patient we see. We veterinarians all know that. We are so used to it that for some it is an acceptable, albeit an inevitable sequela that it permits a degree of indifference some call a "healthy boundary." It allows us to practice without prejudice and without emptying our own internal well so thoroughly that we can go on to help others. What we forget is what the loss of these patients does to their parents. The void of losing their unsurpassed love, and the living through the phases of grief that loss requires. But, the real pain of too many of these situations is the cold, indifferent manner that we treat those coming to us for help. This is the place that vetmed has gotten itself to. We did not come here to be this. We must never forget why we are here, and what kind of legacy we are building as we walk each footstep of our professional life.

Within 1 week Johnny Cash had 5 veterinary examinations, 2 ultrasounds, 4 lab works, 2 internal medicine teleconferences, 3 x-rays, and two radiology reviews. He had every person at our very busy practice working to help him. 

When his disease eluded us, and he continued to slip away, we decided we needed more help. We did for him what we would do for every case we cannot figure out fully, we referred him to those who could. In our part of the country the most competent place we can send a patient is the University of Pennsylvania Veterinary Teaching Hospital. 

The veterinary teaching hospital is the foundation of the crucible of all that a veterinarian holds as the building blocks to all that we are and all that we could hope to be. There is no other place that holds greater power nor greater minds. These institutions employ the most notable, credible and wizard-like masters. For the greatest medical minds of our world, these 30-odd colleges are all that we offer for the best of our abilities. They build us, each of us, and for that we are forever indebted. They also hold unparalleled optimism for the cases we cannot heal. With great power comes great responsibility. This, this is where the failure of all that we hope to be lies. This is where we sent Johnny Cash as our last hope to help him, and his beloved mom, Jenn. 

This is the communication sent back and forth over Johnny Cash's care. The first is Jenn's letter about her concerns and experience when she brought her very sick, very fragile, very much loved Johnny Cash to UPenn. What concerned her the most, as we look back on this, was how hard she had to advocate for her dog. How hard she had to insist on being heard, and how, if she hadn't been an "insider" and hadn't had me on the phone (3 times), during her stay at the hospital.

What strikes me as the most unacceptable part of her experience is that she wasn't treated as the instrumental part of the patient care experience as she should have been. This is a teaching hospital. The safest place for anyone to be. The place where mistakes are used as the crucial crucible of molding the future veterinarians. It is the place where asking  questions, challenging all aspects of medicine, and putting the patient above all else should happen. 

Good Morning,

I am sorry for the delay, as its been only a week since I lost my beloved dog and articulating our experience in a coherent manner does not come easy.  

I do want to preface this email by saying that I have utilized both Ryan Hospital (2019) and New Bolton (2021) in the past and was incredibly pleased with my experience and the care that my animals received. We were treated with respect and compassion. This experience was so outside of the norm I know from Penn.  As stated in Dr Magnifico's email, she had called ahead as the referring veterinarian to the Emergency Department hoping for a second set of eyes on the case. We were asked how far away we were to which we stated about 2 hours. Records were forwarded outlining all we had done in our clinic and Johnny Cash was loaded into my car on a stretcher. I kissed his head and promised that we were trying to help him. 

I arrived at UPenn on 1/23/2024 around 3: 15 pm. The stretcher was loaded onto a gurney to take him back. I gave my information at the desk and signed all consents. Our stretcher was brought out along with the blankets that he had soiled. 

Around 4:20ish I met with a 4th year student to give Johnny Cash's history. 

Around 6:30ish I finally met with the attending to go over her assessment, more than 3 hours after we arrived. I was told that we needed to start "at square one" with diagnostics. It was recommended that fluid be pulled off his abdomen for assessment. I was told his pulses were low. There was concern for cancer and that he would need to go to the ICU. I was told a urinary catheter would be placed. I questioned this as he was not outputting urine despite being on fluids and was told this was to keep him clean. My estimate to start was $4,000 - $6,000. I was a bit in shock as we had called ahead to see if we could send him for a second set of eyes, along with record of everything we had done in our clinic over the prior four days. I wasn't sure why we would need to start at square one. When I questioned this I was told nothing was open at this time to do any diagnostics, ultrasound, etc.

I questioned why we were told to come up, two hours away, if there was no ability to provide the services that were requested. The attending told me that she would look through the referral log to see if there was anything recorded there, which she stated there was not. I was given the option to return in the morning when we could have the necessary testing which would eliminate the cost for overnight care and likely be around$2,000 but result in a total of 8 hours of driving with a dog who was in critical condition. After a lot of back and forth we agreed to at least pull off the abdominal fluid before we left. Some time around 7:30 pm his abdomen was tapped. Around 7:43 pm we were given the news that the fluid was septic. My estimate changed from $8,000 to $10,000 to start as he would need an emergency ultrasound and surgery. I made the decision to take him home to euthanize at our clinic in the morning.

As a pet owner, and someone in the veterinary industry, I have several concerns;

• I watched as less critical pets had histories taken quickly. They quickly met with an attending and  were even discharged before I had even met with the attending. If my pet were so critical an ICU was recommended shouldn't he have been assessed before the easy "in and out" cases? (Specifically a Golden Retriever with an eye injury stuck out in my mind, (although there were others). Are cases not assessed for urgency? (Maybe if mine had he would have gotten the services he needed before clinicians left for the day?). Your own website states "Patients are seen on a medical priority basis. Waiting times for clients can vary depending on the caseload at the time of presentation. All patients in life-threatening situations are immediately brought to the treatment area, where the emergency clinician performs a physical examination and provides emergency stabilization." Given our timeline this does not seem to be accurate.
• I was told that my pet could receive "better care" in the ICU than what he was receiving at home overnight. Yes, my dog was hospitalized at home overnight, under the care of someone who works in the veterinary industry and under the direct supervision of a veterinarian. These were the exact words used, and they stung.
• My dying dog was given no pain meds, even when we knew his abdomen was septic and I stated he would be euthanized in the morning at our clinic. A dying dog who was septic was discharged and given no pain meds.
• A week later Johnny Cash's records have yet to be sent to Jarrettsville Vet, I am glad no next steps were hinging on this.
• While I could have likely come up with $4,000 I was told that the $4-$6k estimate was "to start" I work in the veterinary industry because I love animals, unfortunately a love for money does not align with a life in our industry. I do not have unlimited resources. $8-10k to start was completely outside of reachable, and I fear this would be the case for many. I know most of our clients would not be able to manage this
• I have read over your Client Rights on your website, (see here), Johnny Cash and I were failed at every bullet point within those rights.

As humans we have evolved to love our pets as a part of our family. We love them in many cases more than we love many humans. We often grieve their loss more than that of a human as well. Somewhere along the way many in the veterinary industry seem to be capitalizing on this love and in turn emergency care is becoming out of reach for most. If this care is out of reach for someone in our industry I fear what that means for our clients.

I am grateful that I brought my dog back home. He was taken in for an emergency exploratory surgery at our clinic as a last effort to save him, and although that was not possible, I did get my answer (diagnosis) and with that came peace in letting my beloved companion slip away peacefully. I was only given this because I work at Jarrettsville Vet. My heart breaks for the average pet owner who would have had to make the decision to let their pet go amidst an impossible starting estimate, never knowing the diagnosis. 

While we worry about mental health in our industry the reality is there is a pet owner who is more often than not, loves their pet at the other end of the leash or the carrier who deserves to be treated with compassion as well. I hope relaying my experience somehow helps others; I have the unique perspective from both ends of the spectrum - someone in the veterinary industry and a pet owner.

Thank you for your time,

Jennifer

There were two phone conversations that occurred as a result of this letter. One with the social worker to better describe the care and client experience Jenn received. The second phone call was with the Emergency Hospital coordinator and the an ER clinician. It was not helpful to Jenn, nor in any way reassuring to me that what happened to her and Johnny Cash, wouldn't happen again this evening. There was an apology for Jenn's loss, a defensive posture that he was well cared for at their facility, and a lot of excuses and firm language that they are compassionate, they do offer a spectrum of care with affordable options being given when clients have financial constraints, and hurtful commentary from two veterinarians who want to stand by all of the reasons Jenn's concerns were wrong. It was a shocking phone call that further reinforces the state of veterinary medicine in this country.

After we got off the phone with UPenn and after we had put all of our thoughts, grief and taken the time to bring Johnny Cash's case into the learning and call for concern with the state of vetmed, we decided to write this.

Jarrettsville Vet never puts a pets ability to have a chance at a treatable outcome, and a clients ability to have hope behind anything other than our mission to Always Be Kind. This is where medicine starts. Where it lives and the only place it can succeed. There needs to be a better place for the conversations to start then the estimate. 

The letter reads;

Dear Referral Facilities,

    We hope that this letter finds you well. We are writing in regards to the patients and clients of Jarrettsville Veterinary Center. It's our hope and goal to honor our promise to stand by them in doing what is best for their beloved pets.

    We understand that emergency situations can arise unexpectedly and we want to ensure that the best care is provided to our clients/patients during these times. We also believe that every life is precious and deserves to be treated with compassion and respect. For this reason, and any other, should a decision ever need to be made to euthanize a mutual pet due to financial constraints please reach out to our facility.  We want to make it clear we do not condone this type of practice at our facility.

    We are dedicated to providing the best care possible regardless of financial constraints. We believe that every pet deserves a chance at a happy and healthy life. We will work with you and our client to find a solution that is in the best interest for all involved. Dr. Magnifico is happy to include her email and personal cell phone number to the DVM's and practice management staff to offer help when needed.

    Kindest Regards,

    Krista Magnifico, DVM

    Owner Jarrettsville Veterinary Center

This letter was sent to about a dozen referral and emergency practices within a 2 hour drive from our clinic. As of today we have received these replies. 

The UPenn Ryan Veterinary Hospital and Mason-Dixon ER in Shrewsbury, Pa. and the Animal Emergency Hospital in Bel Air Md

This week I tried, again, to refer a patient to UPenn. I was not able to provide the transfer without an authorization that the client would be able to afford the projected estimate even though, as in the case above, the diagnosis, diagnostics, and treatment plan were unknown. 

 

School of Veterinary Medicine

Department of Clinical Sciences & Advanced Medicine – Philadelphia

3900 Delancey Street

Philadelphia, PA 19104

 

 

July 11, 2024

 

Dear Dr. Magnifico,

 

Thank you for reaching out and for your thoughtful message. We appreciate Jarrettsville Veterinary Center's commitment to providing compassionate care to all pets, regardless of financial constraints.

 

At Penn Vet, we share your values and dedication to the well-being of our mutual patients. We understand the importance of ensuring that every pet receives the best possible care, especially during emergency situations. Your offer to collaborate and find solutions to avoid euthanasia due to financial difficulties is truly commendable.

We will certainly reach out to your facility if we encounter any situations where financial constraints might affect the decision-making process for a pet's care. We kindly ask that you discuss estimates with your clients and notify us of any financial concerns when referring a client to us. As we have many clinicians that rotate through our emergency service, this will be a critical step in communications to ensure that the emergency care team helping your clients understand the terms of your support and that nothing is lost in the transfer of information. Having your contact information will be incredibly helpful, and we appreciate your willingness to financially assist clients in such circumstances.

 

Thank you once again for your partnership and for your unwavering commitment to the health and happiness of the pets we collectively serve.

 

       Sincerely,

        PennVet -Ryan Hospital of the University of Pennsylvania

I will be reaching out once again to UPenn to discuss the practice of putting estimates at the gates. The estimates are formulated based on the referring veterinarians findings and suspicions. This estimate is based on many possible scenarios and presumed diagnostics, with presumed treatment plans. All of understand that this is difficult to cement into a narrow dollar figure. What it costs most clients is the fearful restraint that a large dollar figure, a potentially looming poor prognosis and the healthcare plan starting out, and being presented with financial influence at the welcome mat is both unkind, uncaring and costing care we can in all and every case negotiate and compromise. It seems, with all of the recent cases that we have sent, that the gates ability to open rely on the estimate. How can a learning institution practice medicine to train its students who will provide care to all kinds of clients with the admission set at worst case?. If they truly want to provide all clients options and follow the standards we were all taught, then these estimates have no place in greeting clients and patients BEFORE they are seen.

I have been a private practice veterinarian and practice owner for 20 years. There has never been one case that we have not helped in a manner that doesn't put the patient first, and the client feeling as if they are the at the center of everything we do, and that every patient has a team based approach.

There are many points of Jenn's letter that I understand as a veterinarian that are harder to explain to a client. The timeline. A clients idea of the passage of time is very different from the veterinarians. While I try to stay on time, Keep every client apprised of the time I am taking and explain/excuse why it is taking so long. It is inevitably impossible to be able to complete a complicated case, with all that we have to do, discern, digest, diagnose and report. Time in the clinic, on the floor, with a difficult case seems like seconds while the client is sitting for hours. We are always. always running behind, over extended, and never is there a moment where we sit down, relax, or eat, drink, or even pee. I will give them the time frame. I empathize.

The idea that any of us read every piece of paper, every diagnostic, each step another vet has taken, well, in reality we don't. We don't have time. And, after all, everyone, every other vet is is a charlatan. Don't waste your time reading over some half-wits work,, they couldn't figure it out, why waste your time looking at what they did.

No, what really lights me up is that they treated her like she was just another client. Just another replaceable mom, with another dying pet. She is a mom who loves her dog. She is the client we all worked so hard to get into vet school so we could take care of. She is the medium of all of our dreams. She almost walked out because they couldn't/wouldn't see her past their estimate. What an utter failure to even attempt to be anything of value. It doesn't matter what you are capable of if you cannot remember why you are here.

Tomato Sandwiches

In the closing days of July I can be found eating one singular thing in mass quantities; a tomato sandwich.

A soft, squishy, spongey white bread cradling thick slices of our own garden grown succulent watermelon-wet purple tomato. If I can sacrifice my inherent impatience I hold I will adorn it with three things; nayonaise, (the veal denying version of the fantastical Miracle Whip of my saccharine-sour youth), bread and butter crisp pickles, (homemade always), and elephant ear-sized leaves of basil, (the only other thing we grow). Summertime is about so many luxuries. The tomato sandwich is mine.

The Summer days begin with tomatoes as my morning coffee's spouse. Breakfasts are followed by a lunch a few hours later by my some-assembly-required sandwich, or else the soggy mess demands a spoon. I close each day with the only meal I yearn to have waiting for me when I get home after 9 pm work-weekdays. 

They never fail to fulfill, and I never tire. Those juicy thin skinned plumm-ey bombs so succulent and drip-ey messy you need to indulge over a skink, a towel, or with a bib.

By the time October rolls around our tomato vines have withered, the fruits shrunken and toughened. My belly is satiated and I resume the internet search for "clinical signs of toxic doses of lycopene."

todays bounty

(P.S. I would have included a photo of my breakfast tomato delicacy,, but I ate it too fast).

Tomato sandwiches are my lustful Summer mealtime desire. They remind me that there cannot be balance when the season is so narrow, and the yearning so insatiable. Who wants to try to be disciplined when you wait a whole other calendar to get back in season? Me, Nope, I will eat as many as I can for as long as I can, year after year. Summer and tomatoes, (Purple Cherokee's to be specific). What could be more perfect? 

Could it be that one good, no, great, (those Cherokees are that), thing marries one with another if you simply choose to recognize it as such? Summer sun and all that its bounty blooms.

prepping for another sandwich

Maybe the marriages are all that we need to look for? The ways in which one magnificent indulgent joy comes from a tiny place that everyone else overlooks.

Maybe if I can alter the perspective, just a teeny bit, I can marry one spectacular triumphant savor into the other parts that aren't so fanciful on the routine basis?

I imagine painting them as works of art. The color is so deep and robust

There is no balance in veterinary medicine. Nor, is there any longer a balance worth seeking. I live my veterinary work life in the maximum height and depth of everything I do. I chose this life, (or, it chose me. I cannot discern the difference any longer). It is the price of being me... so much passion for so many things and just a few trips around the sun to accomplish all that lies ahead. I don't know why people seek balance. That place where nothing swings, or moves, or gets felt for all that it beholds. We are veterinarians. The grittiest of the professions. There is no glamour here. There is no fortune to be won. There are quiet, voiceless badges of courage and lives that will never repay you for the impact that you have delivered. There is perfection in knowing that you can change a fate just because you set your eyes upon them, took a moment to listen, and decided that every little life has unimaginable power to heal another human. Our pets mean everything to us. They are the guiding influence on so much of our daily lives. They hold the calm presence that makes all of the inescapable turmoil of the rest of our lives worthwhile. I am so lucky to not have banal ordinariness about. 

Our clinic Queen, Seraphina

Do any of us want to live with just our toes in the water and not still want to dive in? Don't we all want to feel compelled to jump in, immerse ourselves in the glorious wonderfulness of that one thing that is just soo good you kind of get obsessed with it? That is my kind of balance. The balance of a veterinarian who knows what she loves and still loves it too excess. 

What are your favorite season based delicacy? I would love to hear about them! 

When I Get Lost.

 

Alvin. A true example of how much we adore our pets. His story here

The most obvious place to start when you are lost is back at the beginning. Therefore, I go here.. Back.. Back to the place I last remembered knowing my way. Having a direction. A footprinted fossil. That old place to call "start here."

It is all I know to do when the map has been lost, the sherpa abandons, and the world reminds you that you are merely a speck. A tidbit of dust. A fleeting, insignificant blip on a timeline too immense to even contemplate comprehension. Me, the bag of aging flesh with so much determined compassion that even this reality is dismissed.

Retracing my steps as I attempt to resurrect my direction, (albeit a direction with accoutrements like “purpose” and “fulfillment”), I remind myself cautiously that I know, admit, publicly, that I have never chosen the easy path and I am fraught with a conscious empathy that propels me. This small character flaw is a burden. At times it has led to compulsion, but along that path I was moving in a  direction I believed in, and with it I had always gotten to somewhere. After a few decades of kinetic acceleration the directions have become more cumbersome. The world seems to close in, and be far less welcoming. Age, has privileges which lessen the compulsion for manners, but, you pay for that in diminishing opportunities. Gravity clutches your intentions and suffocates them into mortality. You can't get to the previously proposed destinations with the same vigor nor timeframe, but you don’t give a damn, so it all balances out in the end. Problem remains there just isn't a calendar with a timer counting down to designate END, so you plug away hoping it isn't aimless, fruitless, and depressing as hell.

Garfield. The reason in everything that I am and who I still dream of being.
His story here.

Maybe it's mid-life? Maybe it's inertia calling my bones to pivot? Maybe it’s the reflection of those around me nesting and preparing for a hibernation I'm not prepared for?

The conundrum remains. I am lost and searching. Fueled by frustration and losing a voice in the mass of bigger fish this world has to fry. My little cause lost in earthquakes, tsunamis, wildfires, and genocides in Africa, Gaza, and Howler monkeys falling from the skies over global warming induced desiccations. How do these compare with the with blocked cats, pyometras, and nasopharnygeal polyp looksies being fined out of emergency care? I don't know, I lost my map. 

There isn’t a megaphone big enough to hold my tune next to that cacophony of desperation the rest of the world is grieving. Yet, my plight, my purpose and my internal quest for recognition and empathy in animal welfare and companion animal needs remains as steadfast as ever.

The lost part was also my beginning. No one goes to vet school to change the world. It’s a futile fight in a world of humble hardworking blue collars. Purpose exists in heartbeats for utilitarian use. Sure, dogs and cats have gained a bit of status with their handbags, service vests, and bedfellow pampering, but, vet school, is equal parts food and pushing the limits of biology and financial cushions. I went to vet school with an agenda. I went to attain credentials to argue with bigger guns than the fodder could muster. A worldwide awakening of public opinion ripe for disruption. My hope was to be a pioneer on the frontier of acceptance that the pets we call family could earn some status that provided rights and consequences when infringed upon. Cruelty comes in many forms but the worst is the mass cover-up with just how poorly these beasts are treated, and how little value their lives hold for the food supply to remain cheap and domestic. No one likes to see suffering. The Styrofoam and plastic wrap allow it to be bacon versus Babe. Dogs and cats aren’t much better off. They are considered property in the eyes of the law. Replacement value for your four legged furry kid is about $100. Pain and suffering if they are killed or tortured are unlikely in the lobbying world of minimized liability the vetmed profession defends. We, the collective veterinary profession, lure out incredible medical advancements and opportunities out one side of our mouth when we recommend MRI’s, stem cell therapies, cloning, or organ transplants and protect liability with "property" status out the other. It is an unsustainable mixed message against a public so bound to their companions. We provide some pets month long stays in ICU's and chemotherapies with price tags now hovering around $50,000 and up. While others are bred to be mute lab-rat beagles. Compliance their greatest asset, yet doomed to die unnamed. The Auschwitz inhabitants of our day. We offer. We profit, and we refer to our own knowing price tags that begin at 10k lie ahead. We admonish when parents aren't prepared and yet we defer responsibility when heartbreak is delivered. We, the lowly GP's, always offer “economic euthanasia” as a mandatory treatment therapy option. We offer this to make our clients feel empowered and compassionate as the last true gesture of kindness to alleviate suffering we hardly ever have firmly diagnosed, nor been specialized to treat in its maximum effectiveness. We know you will get another pet. We also know it is much cheaper to replace than treat. We did this. We are responsible for that mathematical reality, yet, we judge and castigate when it happens. We are even so egotistically privileged that we feel good about recommending euthanasia as a benefit to our treatable yet priced out of affordable options within the bullet points of acceptable treatment options that we have now made this a lucrative part of the profession. (And people wonder why the profession is plagued by self help via iatrogenic euthanasia?). We kill ourselves as an option to seeking compassionate resolution to unanswerable dilemmas.

Pickles and Geisha. Rescued by a client who cuddles them like they are the most precious lives anyone of us has ever been privileged enough to be entrusted to protect. 

There are veterinarians so fed up with the anger of negotiating between need and availability, options and finances, or the endemic corporate structures of avoiding on call and surgery, they can either head back to training to specialize, expose themselves to most often kind side of medicine; in home euthanasia, where your clients always speak nicely to you and show gratitude or wash out and switch professions.

There is no map for this place. This crossroads of incongruities. This place where we have to be human in places of lost humanity. The place where greed greets celebrity. Kindness is annihilated by power hungry egos. It is dizzying to know where to go at times. It is harsh to look in the mirror and ask yourself if you can dissect the problem  from the solution when you know you live within both as a matter of necessity and survival.  

I'm still fighting. Fighting to refrain from accepting the self protective blank faced indifference that permits clients who can't pay to be turned away with some excuse about everything being “their fault.” Or, the litigious liability paranoia that defends our patients as being replaceable within the big scheme.

Sparky. Rescued within minutes of being euthanized, and hours after his owner surrendered him.
His owner was told he would be given less than a day to be rescued as the shelter did not have enough space to keep him longer than that.
That smile says it all. 

I don't know if I will ever find that yellow brick road. Or, the map I had predicted so long ago that would lead me to tranquility. Or, even my self-proclaimed Utopia of purpose driven bliss. Maybe mankind is so inherently flawed these just aren't possible? But, maybe, just maybe my path lies right here at my feet. The inherent perfection of the pets I call my companions. The wet noses of the patients I know to be my purpose. These beloved companions who love so completely and unconditionally they inspire me to keep marching on.

Lil D. Rescued from an online ad. Transferred to her foster mom in the WalMart parking lot.
22 toes (2 shy of the world record) and now living her best life in a home she confidently calls her own.

Where did I leave that torch and megaphone?

Cooper. Waiting for me to leave

Let The Attacks Resume

No one likes to hold a  mirror up to themselves. It can be painful when the life you worked so hard to build holds you accountable for your own actions. We are so good at blaming, shaming, and pointing fingers. But, we are absolutely terrible at accountability. This is universal isn't it? Aren't we all just a little but guilty of this?

No one likes a whistle blower. If you are an insider there is supposed to be this secret pact of loyalty that prohibits ratting on each other. If there is another way to stop this killing of the unprofitable patients at the excuse of ending suffering I don't know what it is. But I can tell you with an open honest heart that veterinary medicine is killing pets at an unprecedented rate with the excuse that we know better than the pet parents do, and we don't owe these patients anything if they cannot afford what ever increasingly astronomical fee we are asking. 

Yet, everyone is perfect, so, there goes the bubble that is living in denial. 

If the meek are going to inherit the earth they better get bigger and better ways to defend themselves, never mind arm themselves.

Sophia

This profession that I adore is broken. We have become a bunch of spoiled, self affirming brats who feel entitled. Its killing us like a cancer.

Why is it that when there is a problem called out the masses rally around the validation they feel is long overdue, and, the messenger is now the bad guy.

The truth is, (and lets be honest, not all of us want the truth spoonfed to us), is that people love, I mean deeply and without equal, love their pets. There is no greater love in this world for many of us than our pets. The law provides almost no measure of their value. Vets hold so much power that they have forgotten what this costs our clients, these pet parents who come to us in their most desperate of hours, on their hands and knees begging for help and we just don't take the time to meet their pleas with help that matters. We reduce the care their pets need to a list of line items delivered by a messenger that is not the person who yields all the power. We do not start the conversation with a conversation. We start it with a price tag few can afford. We need, we are being asked to help in a manner that is helpful. Why can't we start with an invitation that goes something like this;

"What can we do to help?"

Here is the story of Sophia. She came to us for help. That is just what we did. We did it without all of the lines items that her mom couldn't afford. We did it the old fashioned way. We did it with skill, compassion and a common goal.

Let the naysayers, the haters and the handcuffed to corporate greed agendas come at me. I'm here,, waiting to help the next wet nose who needs me.

Oreo, Clinic cat.

this one is from Heather Sartwell, on Facebook;

I’m glad this dog was saved, but ALL the facts should be laid out there, not just the ones that benefit your hospital.

1. Why exactly does an emergency facility cost so much? Pets in the ER receive a much higher standard of care with state of the art equipment, often in facilities with highly trained registered technicians, board-certified specialty surgeons, and staff that monitor patients around the clock. The ER isn’t a “cut-and-go” facility. They would never recommend doing a procedure that you claim is “simple” without mitigating risk. YOU may not think that IVs, bloodwork, or imaging is necessary, but the ER is going to check for any conditions that a pet already in a compromised condition due to age and presentation has before putting them under so that they can present the owner with ALL their options and reasonable expectations. That is an elevated (appropriate) standard of care! If you have done this for 20 years, you would have had at least one patient in your career that you thought would be fine for a procedure but ended up having complications due to a condition that could have been caught on pre-anesthetic screening. Additionally, the estimate from the ER likely included round the clock medications, post-operative hospitalization, and re-check labs to check for infection. The $7k was also likely on the high end of the estimate (the ER provides a range) and likely includes extraneous fees in the case this pet did not do well post-op. Corporate or not, ERs and general practice have the same goals - to help their patients. If you can offer these services, great! But I don’t think it’s fair to bash on veterinarians that charge higher fees.

2. You claim this is an “easy” procedure, like spaying a cat and “any vet can do that”. It’s important to note that when you are spaying a cat or dog under normal circumstances, this is done often in under 15 minutes. In the case of a pyro, however, you are removing an enlarged, friable organ filled with pus. If there’s any rupture, you risk sepsis. In a small dog like this, it could take only 15 minutes best case scenario. OR it could be a complicated procedure, which you may not know until you are in there. So I’m glad this was an easy case for you!

3. When it comes to cost, it is ultimately up to the owner to be able to provide care. Unfortunately, veterinary care is not like human medicine where you can let it go to collections if you can’t pay. That is why there are options like Care Credit, Scratch Pay, and even pet insurance. Did you know Trupanion covers up to 90% of emergency care for non pre-existent conditions? This is an unpopular opinion, but owning a pet and having it cared for is a privilege, not a right! It’s up to the owner to make sure they have a plan in case of emergencies.

4. There are comments here that state that people who are upset about this video are “Karens”. People are upset about these types of videos because they are misleading and are pretty much fear-mongering people regarding corporate entities, or really just any veterinary facility that charges higher fees that are appropriate to the standard of care they are providing, at a charge that is compatible with and sustainable for the changing times. What happens if you go to the hospital for appendicitis and you don’t have insurance? You will be charged $55k+! And to top it off, Dr M comments on one of these videos that her staff isn’t susceptible to the high suicide rate that the rest of the vet industry is due to the way she runs her facility. But what contributes to this high rate of suicide in the veterinary industry? May I dare say that it could have to do with being told that you’re staying late to accommodate patients that will be seen after your shift ends? That you have no choice but to sacrifice time with family unless you want to be called heartless? Do you think staff feels comfortable advocating for themselves when they see their employer bashing others in the industry? Do you think that veterinarians want to watch an owner face euthanizing a dog because they can’t afford the estimate they just presented, (then be scrutinized on social media because a vet that doesn’t set boundaries for herself or her staff posts misleading videos where dozens of people comment on how greedy and heartless the ER is)? Your website tagline literally says “be kind”. I don’t think this is an example of that message.

This an opportunity to promote spying and neutering early to prevent these issues.

This is an opportunity to educate on pet insurance!

This is an opportunity to support your community and your fellow veterinarians!

Do better! We are all in this together.

My Reply;

Heather Sartwell this diatribe  is a whole page of defending excuses that would have cost treatable Sophia her life. I’m in the trenches everyday trying to save every single patient because my colleagues still doent  see the forest of justification that lacks compassionate pet centric care.

This profession of broken souls is exhausting me because they  refuse to see their  actions as part of the problem.

Yes. I am calling you out   And yes I am saving the patients who aren’t lucrative enough for you to do better

This one is from Dawn Michelle

Dawn Michelle

Jarrettsville Vet Center I'm glad she said it!! I find it in extreme poor taste that you are always bashing the ER (who are some of the hardest working, most compassionate people I know).

Also, the local ER has saved many of your very own patients that you couldn't see yourself. Vet med is in a tough enough situation as it is with trying to cope with the extremely high Dr.-patient ratio. There just aren't enough doctors or techs. You need to support one another.

These ERs doctors and their staff are your colleagues, it should be a community, not a competition!

You should stop putting others down in order to elevate your own ego. You should know better.

Your response to Heather was immature and unprofessional.

She's right, use it as an opportunity to educate pet owners, not to pat yourself on the back.

 

My reponse;

Dawn Michelle I find it ethically unconscionable that vets are euthanizing treatable conditions because it is not lucrative enough for them to find a middle ground. A reckoning is coming. I’m not putting anyone down I am calling us all out that we are responsible for our actions and responsible to save these lives. I am also not patting myself on the back. I don’t need to do that. I am 20 years into this profession. Thirty years into being a professional. I have done more with my life than anyone else here. (Yes. That is a pat on my back),  I have taken an oath  to serve my country. I have owned a veterinary practice for 20 years and in that time I have NEVER put a pet down because of economic euthanasia and I went to Ukriane. So. Please. Tell me how immature I am. You came here for a fight. You get what you give.
Krista.

Seraphina, the Queen clinic cat

.. and  from Renee Mckenna Barker; 

Didn’t you give a rant like this 5 years ago?
Why not promote spaying and neutering your pets before it gets to that point? Then you wouldn’t have to go to the ER.
Or maybe Magnifico could do it all for free?!?!?!

From what I’ve heard, her husband bought her practice for her and she has no school debt. So how she charges will never be the same as other veterinary practices who are dealing with the mountain of college loans.  She’s very frustrating because most of the veterinarians I’ve worked with would do it all for free if that was an option. It’s just not. The cost of staffing and running an ER 24/7, 365 days a year will never compare to the cost of running a primary care practice.  Yet, she leaves all of that out of the story.

My reply; 

Renee Mckenna Barker hello. It’s Dr Magnifico. I have no debt because I went to a federal academy (which required a congressional nomination) and then served my country for 8 years in a naval reserve capacity for which I was given an honorable discharge. Then I bought this clinic and worked the 20 yrs it required to pay it off so that I would NEVER have to be told I COULDNT SAVE EVERY PET.   I would happily share what my staff is paid with anyone else working in the profession. I would bet I pay better and they won’t be part of the statistics that is our professional suicide stats.

Why am I leaving myself open to this cyber-bullying? Why would I continue to call out the transgressions of our profession. The worst of the skeletons we amass in our closets? I am doing this because if I don't who else will stand up for these patients. If you think I am doing this for me I will tell you that I am doing just fine without the caterwauls of Facebook. 

What I am not going to do is sit back and watch the cruelty unfold. I am not going to be silent while others put pet parents into impossible situations. Ask them to make decisions on the facts they want them to have, instead of the plethora of options that exist in every disease and every scenario. We are too quick tp kill and soo arrogant in our belief that we know all and should decide it all for others in their most vulnerable moments and depths of despair..

Sophia's video can be found here.

Her story is not unique, and she is not alone. How many thousands, more ? do we euthanize because its easier to blame, shame, and demonize our clients who we have shut out of affordable care.

There is a reckoning coming. Maybe it will be in the face of a challenge so powerful it further fractures the current model? AI is upon us. How many veterinarians will lose their income to being replaced by a machine who doesn't have a school debt? What about the class action lawsuits from monopolizing care to the point is it secluded to all but the Uber rich. Yes, this current climate of greed based corporate earnings squeezing the care most pet parents need is not sustainable. 

You Can't Help Them All

Be kind. 
Be compassionate. 
Be full of grace. 
Give as much as they ask for. More if you can.
...and,,,
Let there always be hope.

Let there always be hope.

I wrote this on my way to work as a fleeting reminder. My daily affirmation masked as inspiration.

Driving to the clinic knowing I am already overbooked, and will be understaffed due to this, I needed a little self proclaimed pep talk. I knew I had 5 patients waiting for me for their surgeries. Five beloved companions who were left by their families, families who would worry all day, and 5 pets reliant on me to get safely onto, and, off of,  the surgery table and be better off for it. I go to this head space every morning, every transit to work, every-single day to affirm and re-affirm the focus. I cement the purpose internally. I reiterate to myself that imposter syndrome is real, and 20 years of practice probably has earned me the right to admonish it. Perhaps after another 20 I can boast this as abolished, but not today. After the surgeries are done I will have to face the onslaught of same day fit in requests to be seen for every ailment and emergency imaginable. I am Atlas, at least I feel as if I am her, as I drive to the asylum. I love what I do, the purpose that I possess, but the days are insane chaos. They run into each other. A bleeding ombre of one-into-the-next until I have to take pause to remember which day it is. I have done this to myself, albeit driven by the best of intentions. 

Yesterday I euthanized two cats a wall apart who were double booked within the same appointment time. It had been an oversight perpetuated by desperate pleas from the clients to be seen as soon as we could. A request that takes precedence and makes my ability to partition empathy in a calm manner with a sympathetic ear and papal hand into their appropriate and necessary compartments impossible. I left last night feeling as if I failed both cats and their parents due the chaos that surrounded their poor timing and punctuated time table placement. On the worst of all days for these patients and their families I am now left feeling as if I fell short of my own expectations for this, the most sacred of all provisions, while searching for their names on the tip of my tongue. Hoping my respects didn't fall short of their due value.

"I have become an ER." 

It is the next prophecy that slips into my thoughts. I hadn't planned to. The staff reminded me that we needed to. Our clients made us this, not me. We are simply available, respected, and affordable. The market will build as much as it will shape what it bears,, and so my legacy as the small hometown vet is marred into a title I never sought. Another crown upon the head that wears enough hats already.

I repeat it again;

We will help. 

You have to be brave enough to ask, generous to give back, and put your pet first. Just like we are going to do.

We get a phone call a day, (maybe 10 more), where someone from elsewhere is in need of immediate assistance. We take every call. We carry the burden of every plight. It affects us. We willingly listen and feel compelled to help.

I am told all the time; " you cannot save them all." I refuse to listen. What is the purpose in being reminded that their are limits on compassion? On hope? On attempts at kindness? I can. I can at least try. Why can't we just start there?

What I have learned is that the next action after that spark, plea, cry of desperation is a link in a bigger picture. The piece in a lifelong, worldwide puzzle of how you fit, hope to influence, the global network of all that is possible, or may follow. I don't have to save them all, I have to be hear to help them all. almost always this small action leads the course for a cataclysmic meiosis of magic. hope, life, and passion live in these moments. they are influential, life changing, powerful beyond money, fame, and possessions. they are the nucleus of humanity. the greatest gift man is given is our ability to build reflections of our most precious moments and store them for future incentive. this is the power of medicine and our companions place within our lives. It is why i am a veterinarian whose single mission is to save them all, and ourselves as the collateral preservation to it. 

Being comfortable with the chaos is my newest challenge. Is it possible to find that place where I accept it and welcome it with open arms?

I spoke to a practice owner in Texas who told me; "we give whatever they need and ask about payment later." I have held these words as my incentive. She owns an ER. Who in this day does that? How can I be so kind and let her words carry me for the next 2 decades?

I will try to be brave. I will try. I can do that again, today.