Sunday, November 20, 2022

The Well Stocked Heart And The Anemic Fridge

It's a 1941 Westinghouse. White enameled, has poor food storage abilities, weighs a ton, and requires frequent defrosting. It's big enough for the two of us although it barely holds enough for two scant meals; one entrée with sides, but, no room for dessert, or appetizer. Its a throwback from a time long ago, where all meals were home cooked and nothing was wasted. It befits me. It also helps to explain, in part, why I'm always hungry. 


My kitchen, my little fridge, and my pups waiting for dinner

I have lived all of my years always feeling hungry. My mother weighed 90 pounds, she would brag about it. She never smelled of cigarettes or vodka. She never smoked, or drank. She liked one cup of coffee in the morning and to order four things from the dinner menu when we would go out. Price was irrelevant. She never paid when she was with me, and she never ate half of what was brought to her. She was a mouse, a bird, waif. She could blow away in a breeze. Tiny at 5 feet. Never an ounce of fat, or a hair out of place. She had kids at 20 because it solidified her standing as housewife. We, her kids, were all always hungry. Why would anyone cook if you always desired to be thin above all else? My life as a child was full of outdoor escapades with our Border Collie, my pet sheep and my pony. I fed them religiously their breakfast and dinner. We adored each other for as much as we needed each other and I took excellent care of them. My mom, well, she was a housewife, but never a cook, and never a snacker. She raised her kids the same.  We worked everyday of our formidable lives, like it, or not.

My mom and I collecting pumpkins

Today I am a vet in the country,, but, not the same one I aspired totally to be. I am a worker bee, as much as I may be the queen of my own veterinary hospital, but the days are long and the cases rapid fire. I am a servant to cats and dogs, no hooves, no fields, no trucks nor coveralls. White coat, comfortable shoes and long, long days with overbooked hours and a community I feel embedded within. This week is like the two decades of weeks that predate it: full of the never ending list of pages from my emergency meets internal, entwined in surgery life. This week I have also been foster mom to Cheerio and Waffles as a matter of the local health departments mandate. 

Cheerio and Waffles

They are 8 weeks old. They were brought in with their feral momma and a speck of black fur brother. He was the only boy in the lot and about half the size of his sisters. The flurry of technicians I work with are girls who keep me running and remind me that youth is not wasted on the young. They are a tightly bound bunch of skill and talent who giggle as much as they heal. They are the hive, always abuzz and working with a fervor of laughter and efficiency. They name all of our flock, the little charcoal speck who came in with his sisters was dubbed Scrapple, a run on a theme of food items that elicit warmth and comfort. There is never a time that we aren't housing, rehoming or saving a pet no one else wants to rally for. I am as much guilty for this as they are. It is our daily affirmation to give more than seek to get back. It is our glue. The faces of our purpose and our real-life examples of vet med to help build the techs own mental medical encyclopedia of experience. Two weeks into their stay with us Scrapple declined. Within days he was unable to walk and barely conscious. He came home with me over last weekend and I euthanized him Monday when he looked like a non-responsive, non-ambulatory, scrap of pelt. I submitted him to the state lab in a tiny garbage bag for rabies five days after he fell ill. He has become the second kitten in 5 years to follow this fate. A kitten with a wound and a decline that warranted decapitation for cytology. Scrapples came back positive for rabies. As I headed off to the hospital for rabies post exposure vaccines Cheerio and Waffles were ordered to stay quarantined for four months. They will be 6 months old when their sentence is up. The dreaded too big to be cute, and unlikely to be adopted as people seek kittens over adolescents or adults. For reasons that depress me the health department reminded me that every other vet they knew would just wash their hands, euthanize Cheerio and Waffles and move on. I get it, four months is a long time in kitten days, and I have a staff of people to protect, but this life, anything involving medicine isn't/shouldn't be about quick, or easy. So, they are staying with me, either at the clinic house, or my home for the long weekends and holidays for their required 4 month long rabies quarantine period. They are a smattering of orange and black on white luxurious fur. They are explosive pistols of jumps, pounces and curiosity. They play so hard they sound like stampeding water buffalo on the ceiling. They are in the guest room in my home. It is above the kitchen where I write, sit with my dogs in the morning sun, and drink my am coffee. The clinic is too quiet and lonely on the weekends and they need a large can of kitten food every 8 hours. They are ravenous kinetic beasts burning calories so fast the litter box needs to be cleaned with each snack time. They are so healthy, all fat, fur and purrs. They are the recipe for perfect animal husbandry; play, eat, pee/poop, play, nap. They will become 10 pound examples of ideal rearing. The epitome of a grain fed collegiate bound linebacker. There isn't one need they won't have met before they realize it to be desired. Every living soul should be as lucky. 

Scrapple, very sick

I can explain my obsession for pets, pet care, the long road to, within, and from vet school in this same breath. I was hungry, desperate to not feel this, and overwhelmed with a fear of being alone so powerful the hunger never motivated much protest. It has always been the same theme. 

All these years later I find it a bit perplexing that the stature I have grown into still leaves me feeling hungry. I made some choices along the way to adulthood. First that if the animals governed every decision I made then I could not eat them. I certainly couldn't wear them either. Vegetarian at 12 in a home that requires the father to cook leaves you skimping on the side dishes. I ate a lot of veggies. I have lived on them. I moved out at 16. I ended up at a military college with a uniform, a shaved head and a mess hall with horrible food. I used to joke that it was so bad, like almost all of the ships I sailed on for the 10 years after, that I was left to decide whether they were or were not vegetarian. I ate my weight in PBJ for 10 years. Vegetarian is not a recognized religious right. Ships, academies, and the men who run all of them feed us like livestock. Maximum calorie meals in a slop-like stainless steel pan. If you are going to be at sea for 4 months at a clip fresh fruit and veggies aren't what you pack.


My friend of 20 years died recently. We all gathered at her home the day after to try to share our disbelief, and reckon with our turmoil. She had been well, happy, and her normal gregarious self the day of her outpatient procedure. Dead 12 hours later. She was unknowingly carrying around a liver full of cancer and her biopsy procedure sent the contents spilling into her abdomen. The doctors fought for hours to stop the hemorrhaging, but they could not. She passed away in a hospital bed from a needle that should have been too small to allow the flood gates to fail. It is almost impossible for me to imagine this can happen, save for my medical degree, and innumerous abdomens I have opened to be shocked by their hidden secrets. I have had to call parents to implore them to not wake up their beloved pets as the cancer had infiltrated and eviscerated all the organs within. I had to make this call last year for a 2 year old dog with a suspected foreign body obstruction. The obstruction had turned out to be cancer that was constricting the intestines in so many locations I could not remove them all. As all of us settled into her living and dining room to share our stories and an endless box of tissues we decided to start cleaning up the mess of 20 people and our casseroles. I went to put leftovers away. Her fridge was a double door walk in closet. Packed from top to bottom. She was a fabulous cook and her dinners were infamous. Her fridge, like so many other parts of her life were abundant with pieces to create into masterpieces. We all joked when COVID quarantine hit, or a snow storm loomed. She was prepared for months long stays in her own home. She didn't need to drive to survive a weeks long stay-cation. She is survived by her poodle, aging, long list of daily medications checked with date and time, the patient who never misses a meal, a lap, or his routine. As I walked through her kitchen he followed my footsteps. He is almost totally blind, likely the same for hearing and yet his nose searched for her among all of us.

Linda, Noodle, and her walk in fridge


Vetmed is like this. Alone. We are alone in so many cases, with so many unknowns, that we too often become paranoid, or, detached, or both. We empty our hearts so many times we forget to restock. Or, we eat, drink, or medicate to remind us to feel something again. 

Linda and Noodle at the clinic, just a few weeks ago

I had lunch with an ER vet yesterday. They confessed to going into vet med for the love animals over people, but admitted that it has become easier to remind yourself to not love these patients more than the owner does and not care if they chose to euthanize versus treat, or cure. To have been worn into this five years into practice is the reality I know many other vets, esp those in ER medicine, share. I was asked how I kept myself from this place. I replied that I am never going to abandon who I am. That I came here to take care of pets, and as an extension their families. I remind myself I carry a huge advantage in understanding the path a patient is on. Just that one simple fact, the road being familiar, is enough to make the journey less paralyzing. I know what all sides of this dilemma, all routes of this journey look like. I have lived through it enough times to know it isn't personal, it isn't meant to be a stopping ground. It is a storyline in a tributary to a life full of challenges, magic and heartbreak. There is not a way to live life with one and not accept the others. Our clients don't have this advantage. This is all new to them. I am here to help them navigate both the good, the bad, the easy and the heartbreaking. I accept this as my responsibility to both them and my patient. I have to make the journey a story worth listening to and living through. I cannot satiate the hunger by shoring up my heart so that it becomes impenetrable. I have to tread very carefully in not being a party to this happening in the lives around me; my staff, my clients. 


The answer to their question is two fold. I remember that to walk into my clinic with your pet means that they care about them. How many people don't even care enough to do this? If it seems that we are at a stale mate about how to proceed with the patients care I talk about every option in every outside box to make a miracle a possibility. I use words like; "what does it take to help you find a better answer for your pet?" this is often associated with payment plans, pro bono, or some hair brained deal like, "if it works you pay me, if it doesn't you don't." I even offer to relinquish ownership. I do euthanasia's pro bono if there is little else to do outside of watching continual suffering. If nothing works I forgive myself and I remind everyone that I took an oath. That the state I am licensed in requires me to report abuse. Neglect, abuse and the nuance of these is up to Animal Control and a judge to decide. Nothing good ever comes from this ultimatum. I have learned that the hard way. I never want to end up in this place, therefore I will offer anything and everything to avoid it.


My fridge is always anemic, my heart, my soul and my sense of purpose on my professional determination and passion to be here is not. It's easier to get up and decide your preference is the road less bumpy. The sales pitch that makes the client happier, even at the patients expense. How many of us do that? its not why I am here. If you can't put your kids before yourself I'm not your girl. 


My girl is sitting on a floor telling her rabies quarantine kittens that they are in good company, along with her other animals from lots of far off, and not so far off places,, many of which who are often less hungry at any given moment than she.

Sunday, October 9, 2022

Dying With The Absence Of Intentions

"Two options," I usually start with telling clients that they have two options for their pets care when they come to see me. The operative word here is usually. I should have started this blog by saying "used" to. I used to say that there were two options when at the clinic. And here's why I now need to stop assuming there are only two options,,,

My pups play in the last rays of Summer sunshine and humming fields of daisies.

On Sunday I saw a client with a dog who looked like she had already passed away. A lifeless mass of fur laying without any sign of life. Her name was Lily, she was emaciated, laying on a blanket on the floor and not responding to anything happening around her. She appeared as a dirty, dusty, weathered coat of dull black poorly draped over a boney protruding skeleton of what a dog used to be. She could barely lift her head. She was so weak, sad, and weary looking that I assumed if she wasn't already gone she was surely here to be put to sleep. Where I had not previously realized that there are more than two options when at the vet clinic, I have learned that you shouldn't ever assume a pet parent sees their pet with the same veterinary trained scrutiny and collective experience to guide your prognostic indicator as I possess. So many people are so deeply emotionally embedded in their pets lives that they can't see their pets suffering, death, or the looming vultures of either at the cost of breaking their own hearts to say goodbye. There are times where I have to explain this in painstaking, emotionally devastating detail. On this particular Sunday I had two dogs who had arrived at the exact same time, and looked to be in the same predicament. Both were old big black dogs who couldn't stand, react, or show much of any signs of existence. They were dying, and they had been here in this pitiful state for quite some time. I also had about 20 other patients waiting to be seen. It was a Sunday. We are open for walk-in appointments for 2 hours, 1-3 pm. It was a bright idea (or so I had thought) about 15 years ago, or, as we all measure time now, before COVID changed vetmed into a war zone. Since COVID my Sundays have become the "open-to-all-neighborhood-ER." It's insane. Every single Sunday. It has gotten to the point where almost all of the people I see are non-clients, and all of the say the same thing; "I've been waiting for the ER to call me back to say my turn is up in another 12-24 plus hours." If these dogs have looked like this for over a day (and let's be honest I know they have) then the face of vetmed is no longer wearing a compassionate white coat. 

Our clinic vagabond, Saffie. Mostly trouble, occasionally demanding attention,
and almost always sleeping on the job,

The two women who sat behind Lily as she was slipping into her coma were sisters. Lily had been diagnosed as a diabetic over a year ago. The medical record was a list of missed appointments, phone calls left without follow throughs, and proposed diagnostics that hadn't been done to manage her disease adequately. Diabetes is a disease that leaches persistently. It can be managed with a huge amount of effort on both the clients and vets parts, but, it is a slippery, encumbering beast. Even people do a miserable job of managing their own diabetes and they have endless easy wearable tools to help monitor and guide them. Dogs get diabetes from eating crappy food and being too sedentary. It is incredibly difficult to convince a diabetic junk food addict couch potato to eat better and exercise. Old dogs/new tricks, the analogy is applicable. The two sisters loved Lily, it was obvious from the beginning. They never looked away from her as I spoke to the tops of the backs of their heads as they bowed over her stroking the dry brittle coat. (To this day I am not sure what their faces look like?). I could hear them sobbing. The assumption that Lily was here to die was so pervasive that the front staff had immediately placed the party of three in our comfort room, (our less veterinary medicine looking room that has real furniture in it). It also has its own entry and exit and a long bench for multiple family members to congregate.  There are two crystal light fixtures and multiple boxes of tissues. 

Hamilton

Lily didn't move as we carried her from the comfort room into the treatment area. She had lost over 20 pounds since her last visit which was many months ago.  Her breath smelled like nail polish, her eyes were not registering our movements, the foreignness of this place, or the sounds that made it so obviously worrisome to the other patients. She just lay on the stainless steel exam table absently.  I stroked her head and whispered into her ear that she would be "ok." While she is my patient and I have work to do on her, samples to collect and observations to assess her condition, she is also a heartbreaking site to see and a dying girl to protect. In this moment, in the place where patients are away from their families, on a stainless steel table, weak, and dying she is all I am here for. All I have ever strived to be, become, and exist as. At this moment she is one and all. The singular soul that mine is devoted to. It is at these times that I wish our hospital was like those old episodes of ER. The scenes where a caring, kind nurse stands over the patient clasping their hands and telling them calmly that they "will be alright." Why can't I have someone who tells my dying patients that? Someone to just be the angel and not the judge, jury and executioner too? 

In the treatment area we quickly discover what I had already presumed; Lily is massively dehydrated and her brain and body are being intoxicated with polluted ketones, which will slip her into a complete coma and kill her imminently. She needs immediate and aggressive help. She needs a highly trained veterinary emergency facility that can treat her for a minimum of 3-4 days, and even with that her prognosis is abysmal. She is too far gone and too sick. I tell her moms this. I do what I very rarely ever do, I tell them they should alleviate her suffering and say goodbye. They tell me that they have no money to do anything past $500. Lilly needs about $10,000 of care. I try to ease their grief and pain by saying that even with this it is vey unlikely she can survive this with much quality of life. They tell me that a transfer to the ER is impossible because of the cost. I leave the room so they can spend some time with Lilly and process what I have said. I move on to the other 19 cases waiting for me.

The war room,, aka treatment area.

I came back some time later to a very quiet room. 

Lily's moms weren't able, or ready, to say goodbye. So we did what we could for her. We gave Lilly all of the quick patch band-aids that I could. I dumped a massive amount of fluids under her skin, gave her an antibiotic, anti-emetic, and an injection for pain. I essentially given her all of the options I had without being able to hospitalize her. I had given them instructions to continue her insulin and they had agreed to bring her back first thing the next morning for more care. 

Lily, her moms and the mass of 19 other cases came, and went, (both black dogs went home). Although I leave the clinic for the evenings at home, it never leaves me. I carry it, the weight of every patient, their plight, and the families who love them with me. I dream about them. I wake up with surges of adrenaline coursing through me. I head to work each day ready to slay a dragon that medicine is and fate wins at. I prepare for battle everyday knowing I buy time, never destiny.

Vela. Our latest rescue effort. 
Her story to follow soon.

Lilly did not show up the next morning so I called to check on her. I had expected that they would tell me that she had passed away over night. Instead they told me that she was up, eating and walking, and therefore they wanted her to stay at home. I was so relieved to hear this, and yet, worried for what today, tonight and tomorrow would bring. I begged them to bring her back to us to run some blood work, give her another round of the medications we had done the day before. I reminded them that these had helped, and without them she would be back where she was 18 hours prior. They said that they wanted her to pass at home. They didn't want anymore medical interventions. It seemed that they were very upset that I had helped her the day before and that they no longer wanted interference. 

So here I am at option number three; People show up for care at your vet clinic, but, they don't want your help. Since when was this an option? Why did they drive over to the hospital, check in at reception, wait in a room, wait for me to explain her condition, agree to all of the treatments we gave her, and then get angry about it all 24 hours later?

I was dumbfounded on the phone. I could hear the anger in their voices, the betrayal that they felt I had provided them all. I paused. That long pregnant, my brain can't quite process this, pause. I offered them financial assistance to get Lilly some much needed medical care. I got back more anger. We were both doubling down and Lily was going to lose another round.

While I understand passing at home, hospice care, and the deep swath of divide we all feel about the act of dying, I also feel compelled to speak on behalf of the patients I have who cannot. In some cases I have to remind myself that I am bound to picking sides. I have to chose humans over my patients if there is a viable fear that the patient might impact the humans life.. (think rabies, aggression, etc). Then there are the cases I can't discern neglect and cruelty within. Do I honestly feel that Lilly is suffering? Yes, 100%. Do I feel her moms can care for her? No, even though they love her so much. Does the degree of love supersede the obligation to put our pets well-being above our own? Can passing at home without any kind of pain management ever be peaceful? Fair? kind? I don't know? I didn't know for Lilly. I told her moms that. 

I do think that a key part of my job, and everyday,
is kissing every dog and cat I come across.

They hung up on me. And then they went public and called me some really hurtful names. 

Maybe its me who needs that nurse holding my hand?

P.S. I have changed names and details.,, I feel that I have to, this is a diary on display. 


Friday, September 30, 2022

The Calls Home. NYT Russian Troops cell Phone Calls in Ukraine

It is a cancer within me. I cant un-see it, un-want it, or banish it. I made it mine and so it is. 

Droog Shelter Alexandria Ukraine late April 2022

I suppose it is a cancer of a conscious that won't let rest. Dismiss it as too far away, and not mine to feel parental guidance for. It's another place, other people and even that isn't a clear enough choice to eradicate it. Preserve the self for the necrotic within.

Triggers. Todays was a full two page list of the collected phone calls tapped by Ukraine as Russian soldiers called home. Will America read them? Will they share my disgust and dismay? Can a cancer have a community of witnesses to grieve as one? Isn't humanity supposed to have kicked in by now. Like sometime in the tweens after AD occurred? 

A street dog in Ukraine. A small act of kindness within a country at war.

How are we still so tolerant of such aggression and egregious acts? I'm going to assume that these phone calls are legit, and I am going to say that I, from the little I saw when I was there, believe them. I just cannot feel much more than shame and empathy. Shame that madmen still walk among us and no one will step up and take down that plane before it hits its target and annihilates another thousand innocent civilians, and empathy that two countries children have to fight, die and witness what war turns people into for that same madman's ego.

Where are you going to fall in the course of history that marks our species? What cancer eats at you?

For more on this see Uproxx

For The New York Times article go here.

For more on my trip to Ukraine please see these previous articles;

The best recap I have on my experience is the podcast with Brendan Howard, The Veterinary Business Success Show. 

Recognition, Resolution and Restitution blog

Better Left Undone

Purgatory

Walking Away

The Faces and The Ghosts, Coming Back from Ukraine

The Compound

My personal note,, to those I left behind,, two and four legged,, I think about you everyday. My heart still beats within Ukraine. I will be back.. there is too much left undone.




Monday, September 26, 2022

This One Perfect Moment

 

Storm. Relaxing in the last moments of Summer 2022.

Captured and captivating. Not the same thing but seriously kissing cousins. I have been chasing this one moment my whole life. All 52 trips around the sun,,, and finally I am happy to exclaim; I am here. This one moment. The one to outshine and oust all those before it. And, here's the real kicker, I am alone. (Who saw that one coming?).. Well, not totally alone, I have a cat, Wren, grooming and purring beside me, and two dogs curled at me feet. I am never truly alone. Another decision of complete choice. I couldn’t imagine being completely alone, ever. (Who would want to be that? Isn’t it just dark and claustrophobic there)?

Waiting for me to finish laundry, and keeping an eye out for squirrels.

I spent my whole life to be this one solitary thing. This singular being. The only person I ever imagined myself wanting to be. A veterinarian. I suppose some women want to be mothers, wives? (Maybe? Right? Isn’t that who we are supposed to want to become)? Well, me, nope, just a veterinarian. I put so much importance on that one thing, that one place of being, that it blocked out all of the light and choked out the life of everything else. Lucky for me that it also afforded me pets. I could have as many as I wanted. The quintessential polygamist of pets. No rules here. I can't be accused of neglecting them anything. I could be my own Dr. Doolittle-zoo-style. And who is going to challenge me? Yep, not one single soul. I set it up this way. If I knew more about pets than anyone else I could have free reign to have them all if I so wished it. How perfect is that? For me, the spinster of all else, it was everything. It's all I wanted to be, and here I am, there.

The back porch workspace

Sitting in this one perfect moment.

Wren keeps me company, (or I keep her warm, I never know which applies), as I write.

What does it look like? An Aperol spritzer. My drink for summer 2022. I really do this. I pick one drink I want to try and then if it works I ride that spritzer all summer long. A warm kitty purring her hearts desire out next to me on our porch couch. Her name is Wren. (All of my cats are named after birds; Magpie, Oriole. The most sensible way to assist the too numerous cats is to have a theme from the get-go. The dogs also have a theme; Fripp and Havana Storm. There was Charleston, Savannah before them). She always has to be near me. She is the most affectionate, reliable, and heart warming girl.  Always has a paw on me. A reassuring hand to let me know she is there. Beside me and supporting me. In bed she sleeps on the pillow above mine. I pet her all night until we both fall asleep. I will wake up and she will be laying on my hand. The heating pad to her heart and the adoration to my slumber. She is my second feline who stole my heart. There was D.C. before her. My guardian and salvation embodied in one little 7 pound ball of demands and fur. The pups lay at my feet. Always with me inside the house or out. They guard me as much as follow. They never want to be left out of the activities and stay close by so as to not miss an opportunity for an adventure. This house. So grand in her country manors. So noble in her stone façade that has stood here nestled in the woods for over two centuries. The birds all squawk and bellow around us. They are the subtle reminders that the seasons change and the populations shift. Winter is approaching and the song birds have started their own snow bird migration to warmer skies and distant shores. The jays and chickadees stay. I reward their loyalty with seeds and thick evergreen trees. I have this one moment caught between summer departing and fall clamoring in with its vibrant colors and sweater adorning chills.

There is warm cider, hot tea and blankets to remind me that I am still youthful enough to face her cold days. And the warmth of the memories tucked in every corner of my home to keep me company as the long days emerge.

The den and the dahlias

I never thought I would get here. The place where the moments hang suspended in the hopes I had for the days that I would be old enough to slow down and admire them. And yet here I am, resting on the laurels of a life that is upon its tipping point between already been there and done it, and don’t want to be pestered by that burden anymore, and the leisurely admiration of the beauty that surrounds me without me wishing it to be anywhere and anything else.


I'm going to pick dahlias now. The third grand bouquet of the weekend. Just to place them beside my pillow for my beloved Wren. The cat I refer to as royalty in the home that a castle would be envious of. In the midst of the towering dahlias of all shapes sizes and colors twists the cherry-red tomatoes. volunteers from last year that somehow made a stronghold in the garden we have to re-till every year as we replace the giant tubers of dahlia zygotes we dug up in late fall the year before. These tiny bursts of sweet eluded the genocide of all of the other plants we forced out to let the dahlias thrive. and yet they are so deliciously insidious I cannot feel anything but gratitude for their perseverance and abundance. i picked them twisted around the steel cages the dahlias require for support, spine serpentined, arms outreaching, tiny berries that fall with any degree of disruption. I placed them in handfuls into the small antique basket my mom had purchased at an antique show many years ago. I remember it held antique chicks nestled on their tissue paper shredded grass. She, like me, never wasted a thing. She could see me now, all those many years after, using this basket in my imperfectly glorious garden, and she would tell me the same thing she always did, "this is the most perfect day." 



My one perfect moment inside my gloriously magnificent imperfectly mine, my own life.



For more photos of this old stone house, or the animals I spend my at home and at work days with please follow me at 

Stone House Beautiful link here

or

Jarrettsville Vet Facebook page here




Tuesday, August 30, 2022

The Other Lives I Could Have Lived.

Do you ever wonder which path you would take if the whole book of your life had been refreshed? Sent back to that first word on page one. What if your whole life's narrative suddenly all went blank? You got to do it all over again. Restart. Relive. Redo.

I do. 

Hamilton

I seem to imagine these avenues where I find myself lost in the other things my life takes light within. The other things I could have been. The lives I could have lived. I live them now and again, in tiny moments, but, as a spectator. Set away and apart, at a distance. Able to enjoy but not influence. Absorb but not immerse. Be, but not be included within. I wonder if I would have been happier there? Would have had a different outcome? Would have been a fuller person? Lived another life in the same canvas with a whole different set of trimmings to set the stage and act the part.


Color and music. I would have done a whole lot more with these two. Maybe a fashion designer? Draping sumptuous silks in jewel tones with operatic bellows to inspire me as I work. Sopranos to swallow me into.


I could have left the bleach washed walls a hospital requires and have been a street artist. Playing a harmonica in the subway watching the world rush by to their cubicles and plastic potted plants. Making money by predicting the tides and hedging the cortisol surges of a gambler playing with other peoples monopoly money as stock broker on the floors of ticker-tape scribbles. All adrenaline and dollar signs as the carrot promising a life of caviar dreams and champagne stained yachts.


A humanitarian rushing off to a foreign land to protest human rights violations and expose the cruelty no one wants to acknowledge. The Audrey Hepburn/Lady Di cupping starving faces in their coiffed manicured hands with smiles of false optimism for a more stable and safe tomorrow.

Droog Shelter in Alexandria Ukraine. April 2022

A gardener praying to a seedling with the umbrella-like healing palms over the verdant shine of the two cotyledons who carry so much promise in their two tiny appendages reaching upward for the sun. The caretaker to natures bounty among the war for food by all the other beings who seek to profit from the seeds sown by others. Find my place in the balance of sharing resources and not taking more than the earth can balance. A silent partner to the provisions the seasons dictate. Spend every moment of everyday the observer. The Cicada listener. The observer to the flashing color of the hummingbirds, the butterflies, and the flowers they dance between. The deep breathes of the grass as I walk on her carpet of cosmic energy. The goddess of all that is green in a forest that emits only the crickets and the buzzing of the beings far smaller than I and yet so massive they drown the rest of the world away.

Wren in our rock garden

Is it possible to live all of these lives in a profession that requires all of the time that my eyes are open within? That I don't know. I live in snippets. The opportunities between the sick calls. The place where I can steal a few minutes to walk outside. The seconds between lunch (I never eat) and the next scheduled appointment to hold Seraphina and press her into my face. She is a muted galaxy of greys and gold. A tangible downy gosling of fluff emitting a halo of feathery hair. She is my time out in the middle of the endless chaos that is a work day. Hamilton, the paralyzed ginger kitten who belongs to Autumn now. The kitten thrown from a moving car window thrown away like a piece of trash. Brought here for a chance at mercy and now one of ours. He is so perfect in his purpose. He simply wants to be held while he purrs into my chest. Alters the rhythm of the blood coursing through his symphonic blissful lullaby. I painted the vet clinic staff bathroom hot pink/fuchsia. The one place the door can be closed and the color can envelope me whole, half naked to the world that exists on this side of the tsunami treatment door. I put up 1930's advertising prints. Who else has $150 artwork in their work bathroom? I also added a mirrored make-up table and a crystal chandelier. it's handicap accessible per MD state law and glammed to my alter-ego. 

Hamilton

I struggle to fit fashion into a workplace graffitied with urine, feces and anal glands on an every-single-day-of-my-work-day-existence. It might just be a pair of bright cartooney socks. Or some vibrantly-glittered Begdorf eye shadow to add a hint of glimmer to the disposable day scrubs.


But the reality is that I chose this one. This life, This path where the road is not full of whimsy, trends, public performances, and striving to be a house of notoriety in this label conscious crowd. I am a small town vet working my ass into a dust trying to save this most recent disposed of kitten who without us would face a world intent on consumption. I am the force of nature determined to hold back the raging bull wearing expensive shoes in the phone booth, and I couldn't be anything else. No matter which door I had chosen to open; pick the hidden prize behind, I would have ended up here. The heroine in my own set of Herriot novels. Still sweating under urine soaked scrubs with turquoise socks stenciled with cats in Santa hats feeling like I make a difference even when there is no audience to applaud, and no orchestra to bow to. 




Saturday, August 27, 2022

Permission in Veterinary Medicine. When Is It Not In The Best Interest Of The Patient, and Why Not?

 

The start of today's NYC 10k

Permission is one of those words that come seasoned with disdain. It’s a word spiced with hierarchy. Flavored with rank, status, and inherently poised to provide unwritten, un-equivocated submission to being less than, therefore in need of,,, permission.

It’s a silent caste admission. A way to assert while it sentences subservience. 

Hamilton. One of our best examples of compassion and not needing permission.
When you are unwanted its not relevant or pertinent,, at least to me.

Permission in medicine, the human variety, occurs at almost every level of care. Today I was running a race and right in front of me a fellow runner was broadsided by a bicyclist going about 40 mph. He hit her so hard that she was sent flying and landed like dead weight on the asphalt. She was unconscious for 20 minutes. In that time three doctors rushed to her aid (2 md's and a veterinarian from N Maryland). Without any consent her clothes were cut off and she was hooked to a defibrillator. We held her hand, kept our fingertips on her pulses and called an ambulance. Passerbyers flocked quickly and everyone was directed to keep clear. We placed her in a neck brace, slipped in an i.v. and began collecting vitals. It took 5 minutes to get an EMT and 20 for an ambulance. She was still barely conscious as she was transported into the ambulance to be brought to the hospital.  This is how we would all want to be treated. Right? A freak accident occurred, people immediately jumped in to help, and life saving care was not given one second to allow for a poor outcome. This is how it should always be, right? There are things we can do to help with pain, disease, and even immediate emergencies and we help? Well, let me tell you about vetmed. Vetmed is all about consent from the first second to the last. Consent requires permission. Permission is the crown wielding the fate.


Permission is where fate meets traffic signage.

Permission in my experience rests on spousal influence. I wish I could feel that permission rested on ethics, soul designation, and the inherent irreplaceable value that is the truest level of devotion and companionship any of us will truly have,,, but it isn't. It is so often about control. There are broad sweeping generalizations I could pepper in here, (most apply spot on), and much makes reminds me daily to be so grateful I have financial independence. Control/permission, the lot is an ageless reminder to women that their voice carries a 2/3 vote. It’s the acceptance that the purse-strings are provided with a budget in mind. It’s that one thing that drove me to not becoming my mother. Permission is that one last vestige of inequality that manifests at the vets office. Permission is as venomous to me and a chastity belt and a maiden name. I have given up asking for permission. It places me back, mentally and emotionally, into a time and place where skirts were too tight and white gloves were fashionable. Permission implies ownership, deference, and allowance for others that is far too generous.


Permission was something my mother needed too much of. She was resentful because of it. And I learned to never want to be in her shoes. It is quite simply the reason I went to vet school. I see it a lot, (too much quite honestly) in my day-to-day vet med life. It makes me seethe inside. It breaks me, daily. Why, why do so many of us need permission?



I have been married for decades. I know the difference between conversation and negotiation and compromise and permission. Permission denotes control. When it comes to pets, their lives, and the precarious place they hold value, permission turns into earnest negotiation and pleas for mercy.

..end of the 10k. Frippie and Storm are happy to see me!

It’s a high wire act founded upon compassion and rooted in property replacement values. Very rarely does permission for care hinge on sparing from pain. Occasionally permission to treat manifests around a lunatic discussion of perceived appropriate care. Last week it was the trapped barn cat caught on the vet clinics property. Small, frail, afraid to blink, or move a muscle and the neighbor who believes he is a wild animal and therefore does not deserve veterinary care. He will either be eaten by a predator, injured by a rabid animal, get and possibly infect other cats with FIV, or continue to live his life full of fear outside. They feed him by the way. They refused to give me permission to vaccinate, neuter and provide flea prevention. I am reminded of the saying about “good fences” although how many of these are cat proof?

Jeezy,, he loves me,, he loves me not,, it kinds goes like this with him.

Permission to provide pain management post operatively was a battle for the first few years of practice. I had to absorb it into the cost of the surgery to make it appear as if it wasn’t a line item that was negotiable. Permission for analgesia? Yeah, not under my scalpel. Permission is the most precarious part of vetmed. It may not seem so obvious but it is. Permission to help is often used as a wedge to drive price points. I admit I do this too often. Where I am strong in my ability to not show, ask, or desire permission my deference to advocating for a patient’s well-being lies in my willingness to negotiate anything for my desire to obtain permission. I will wheel and deal more cunningly than a used car salesman. I will wager the house to heal. I do it daily. I have amassed coffers of contributions so large there isn’t anything I can’t give away for free. I have turned my disdain for seeking permission into a black and white disclaimer of empathy. Still with this there are those who won’t provide care regardless of whether or not they have to pay for it. That’s the ultimate control. The ultimate heartbreak, and the ultimate reason I am not a veterinarian to all, in spite of all who need one.

Peggy. Allie's rescued kitten

Personal Note; please remember what the title of my blog is. It is my diary. The place I put everything I try to sort, package, and categorize when it lays bubbling under the surface of a profession I feel so passionate about and the lives of the patients who cross the threshold of my small town vet practice and eat away at my heart for the plights they face. I have come to be paranoid about euthanasia requests. Not because I don't feel they are warranted in so many cases, but, because they are also totally unwarranted in far too many. I have come to despise permission and the inherent control it inflicts.


Friday, August 26, 2022

The Little Luxury Of Time Off.

 

My back porch with Magpie

Time off

Luxuries in my world have become sparse, and hence, heavily scrutinized. I just get too little time off to allow for idle luxuries anymore. They are now pre-planned and weighted. I am also now humbled to be notified by my withering infrastructure to have to allocate ‘recovery’ time into the sparse luxury free time category. For the bulk of my 2022 summer the days started at 6 am. I have had to forego my treasured morning runs so I can arrive at the clinic by 930 am. I work until 8 pm every day. I come home most nights after 9 pm, so worn out and hungry that I internally argue about which needs to be resolved first, or, even if at all. I typically eat dinner at about 930 so fast that I cannot recall what it tasted like. I land in bed 15 minutes later. I would guess I consume 3,000 calories after 9 pm, and less than 500 before. I go to bed with a stomach left on the night shift and a vision of gastric reflux with all its secondary consequences to haunt my comatose sleep. I used to wake up at 2 am to flounder for an hour or so. It was the couple hours of needed slumber that gave way to the demons of the day that could no longer be kept quiet, or silenced. 2 am, eyes open, mind charging, and the little lurking nagging oversights take hold. It's the time I am captured by my unconsciousness and awoken to address the needs of all the patients and clients from the day I just slipped away from. Awoken to face their elusive illnesses and diseases as my own incapacities. Now I wake up at 7 am arguing that the sun must still be up from the night before. Some all-night bender that altered its rhythm? It can’t possibly have been 8 hours from when my eyes slammed shut? There is no longer a slumber with its quiet pre-slumber conversational interlude with my husband. There is the parking the car, walking inside the house and a fog until I question whether my cell phone has been locked out of knowing the correct time. I best describe it as feeling like a professional athlete who is stuck in their Olympic trials’ day after day. An endless loop of running your best time. Swimming your fastest lap, and clearing the endless set of hurdles. I leave my soul on that field, on my veterinary clinic epoxy floors, every single day.

Kirby kisses... the best part of the job, hands down.

Now I realize many will see this as venting/complaining. A complaint for the life I have chosen. It isn’t. I know I can say no. I understand that I have options. The thing is that all of those options aren’t things I think I can live with. For every friend with a pet related emergency that calls, texts, or show up I feel needed. There is immense power, I would argue it is far more powerful than money, fame, and restful toes in the sand (or sleep). I cannot dismiss a plea for help. I cannot excuse it as ‘inconvenient’ or ‘poorly timed’ or ignore it. I just dig deeply, plow my nose into the ground harder and deeper, and hope my absent happy game face isn’t too obvious. The issue is the consequence for the need. The exhaustion for the hours and days that run into each other and drain the engine in the process.

Abby never has a day she doesn't go googly-eyed-happy over.

I was reading a post about the life inside vetmed as of late. For many of us COVID came on like a veiled and sinister mysterious uninvited house guest.  We had no idea of what we were in for. Absent clients stuck in their homes with their (hopefully) very happy and healthy pets just watching the days of monotonous a quarantine drag on? Would it be a repetitive cycle of wash, rinse, repeat, stay inside and pray your pet doesn't get sick. Or, would we all hide and survive, or chose to work and die? I made an internal promise that my vet clinic was going to stay open, be there for our patients, and weather this storm as we have the previous 80 years of storms, even if it meant I did it alone. My pets are the most important part of my life. I know that I am not alone in saying that, and I am going to be there for them, and all of the rest of those who are for their parents what mine are to me. Two years later and we have made it through. Unbelievably we were slow for a few weeks of COVID and then a scant few weeks later the sky-rocketing demand for everything pet related blew up. It has been unyielding and unprecedented. I have never known such need. We have never heard from so many people so desperate for help. We have dozens of new clients seeking care for their pets because the ER has a 24 or more hour wait. Or they tell clients that they can only make time to see them if their pet is imminently dying. Who can wait for that? 

Allie, our amazing technician and our resident cat Saffie

I didn't come here to have a life of routine rabies vaccines and spays/neuters. I came here to be the place you go when your pets aren't healthy. 

It has become a storm. An unparalleled time and consequences that I cannot accept even at the expense of the machine that attempts to answer the call.

I say all this knowing that along with the incredible demand for help there is immense gratitude and new life-long friends we have gained. The other side of a pandemic is the lives that aren't so inclined to be a little nicer, a little more compassionate, and a little more grateful that we are all still alive. It has been really hard to still want to help the mean people. The people who are mean to the staff and sweet as pie to the vets. The people who are soo ridiculous they don’t think my staff tells me. We know. It’s a small family. We take care of our own.





Hamilton. Our newest act of kindness and the reason we are who we are.



There are lessons we are all going to learn in the hardest of days. These are the people we will be remembered as. 

Remember the people who make you feel good about who you are, and why you are here.. here's to a few (of the many) people who I rely on everyday.







Thank you to all of you who help JVC be the place where miracles happen, and help nudge them along their path with your big hearts and your endless smiles.