Sunday, May 19, 2024

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..


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.

Living the Dream

 Somewhere along the way the mirror becomes a microscope. 

Garfield. My latest project.
These are the moments of vet med I live for.

The reality that the sand in the hour glass is less glass half full and more the other.

You ask yourself some hard questions and are forced to face the reckoning of a lifetime of decisions.

If you are lucky enough to have time to ponder you better ask yourself if you are proud of what you see behind you, and prepared to make actionable demands of your present self.

Frippie and Oriole.
The path that lies ahead.

I took a big jump 20 years ago and bought into someone else's nest. I put my heart and soul into being the third owner of one of the oldest veterinary practices in my county, perhaps even my state. 80 years (maybe closer to 90) a humble veterinarian set his shingle out to start Jarrettsville Veterinary Center. A small make shift barn was the small beginnings of a practice focused on hoof stock. We have evolved into a 5 doctor 7 -day-a -week busy practice with 9 exam rooms and a staff of about 50. We have renovated, rejuvenated and re-invented ourselves as the place in pets lives have influenced our decisions for them. There is stability in our sturdy foundation and I am able to sit back (just a little) to ask myself what is next?

Its been about 5 years of asking myself that question.

Garfield.. the moments that suspend and define our lives.

The answer is simple. I am still the same small girl who always dreamt of nothing more than to be a veterinarian. What has changed is that now I can be the veterinarian to those who need me. I don't have to be chosen as a vet in a time slot of availability. It's a lovely twist of fate. 

Cats. The answer lies in cats. The most needy. The most abused, neglected, disposed of and the place my heart lies.

So that's what I am going to do. Set out on a new path, with a new purpose and put a few decades into them.

There are a lot of moments that I am proud of.. 
these girls.. well they are the best part of everyday.
Love lives here.

Learn more about Garfield here.


Go live your dream... what are you waiting for?

Saturday, May 18, 2024

It's The Courage That Matters. Garfield the kitten and his broken jaw.

 The real joy in medicine is not the repetition of doing what you already have mastered, it's the courage it takes to trudge into unchartered territory with nothing to lose and a life in the balance.

...at least that is what I am trying to convince myself to believe these days.

Garfield, 24 hours post op

I get these cases more and more frequently as the garden of availability for care shrinks to a place of abysmal, if not completely absent viable options. It seems all too frequently the pool of practitioners would rather swim in the waters of comfort and ease doing vaccines and avoid the whole messy territory of risk critical care for the common people. With its potential for failure and lack of the obligatory at the ready/disposable $10k we are becoming a profession so pigeon-holed we are petrified to challenge ourselves out of our own comfort zones. Human medicine made this leap many decades ago. They parceled out the person into parts, made a specialty for each of those parts and consciously decided to ignore the whole for the rest. Those specialists now demand high dollars and police the gate of admission based on your anility to pay the entrance fee. You may hope to be seen as the sum of your parts, but in medicine you are just that piece-meal-parts. Vetmed used to do it all, and try to do it all for the sake of our patients. Now we just refer. Regardless of whether that works for anyone else but ourselves.


Yesterday was one of those days. Seems the more I call out the ER's for ditching treatable cases when they don't meet the non-negotiable deposit required, the more calls I get to take the cases with the worst traumas and the lowest budgets. Me and my big mouth.

Yesterday it was Garfield. A speck of a puff of orange fluff with his big green eyes and his cock-eyed jaw. It was obvious he had met some sort of trauma. A 2-pound kitten with a dare devil perspective and a primitive naive sense of caution. His dad cuddled him in the exam room nervously. He had come home from work last night and found him this way. Garfield would attempt to open his mouth and scream. He was in pain, his mouth wouldn't close properly, it was fairly obvious the dilemma lay here. Dad did what all of would. He headed to the ER, screaming kitten in tow.


As dad relayed the story my mind wandered off to my beloved Seraphina. The kitten who came to me so many years ago. She had been found in the middle of the road, another tiny speck, grey and mangled. Her chin hanging from her jaw bone, a pitiful meow to landmark the site. She had been the same dilemma; a very broken kitten, and no training to pull from vet school on how to treat her. She, unlike Garfield, had been a found, unwanted kitten. She was so broken that no one would have claimed her. If you don't have the love of a human who has already bonded to you it is very hard to instill a strong enough sense of empathy to pay for the couple thousand dollars a broken kitten of her magnitude that it required. With this she became ours. Our pet project to offer a chance to, fight like hell for, and find a way to solidify her perfect presence within. She remains to this day, perfect. She is the one being I find myself seeking when the Garfield days find me. As the veterinarian who never goes looking for her next companion she will remain the most beautiful, elegant, super model caliber pet I will ever call my own. She adores me as only a once-ago-lost soul can. 

Seraphina

Her story can be found below, just in case you don't know her already.

Seraphina, Lip Avulsion

Seraphina, The Why In Who I Am

Garfield's dad told me that his girlfriend had gotten a kitten, but they had broken up some time ago, she took the cat and left, and he just missed the cat. So, he had found a fluffy orange tabby of his own, and named him Garfield. The two had only been together for a few days, but he was already smitten with his kitten. Garfield was loved and his dad wanted him back to better with whatever means he had to do it. For as long as I have been a veterinarian this is all it takes for me. If a pet parent wants their pet better, if they are truly willing to move mountains to get them the help I will move the mountain with them. This is where the joy lies for me. It isn't in the assets and the accolades. It isn't the work-life-balance and the easy living of being the apex edification-aficionado in a profession you will never master fully. It is the little endeavors where we all put our heart and passion together to make the meaning of life humanity. Give me this a million times over and you can keep your yacht and Birkin bag.

The ER visit was a brief one. At two pounds, and with obvious fractures/dislocation of the jaw, this kitten needed a surgeon. They, kindly, gave a free exam, a bombshell of a projected treatment plan, and sent them on their way, with a comment that "Jarrettsville Vet takes these kinds of cases if you can't get help anywhere else." 

..and so the next morning, as my first emergency appointment of my already booked day, I met little Garfield and his worried dad.


A very brief exam later and I reiterated the same advice; Garfield is really small. Our options for treating this were limited. To make the dilemma even more precarious, I had to be really certain I knew what was wrong before I go jumping in all "damn the torpedoes" to render interventional aid. I had to know whether this was a broken jaw or a dislocated jaw. To diagnose a bone problem we rely on an x-ray. To take a picture of anything in a 2 pound kitten is fraught with impossibilities, They are too small to hold still. There's that. There is no way to not have your hands in the shot.. and the bones of a kitten are more mush than formidable. We tried three times to lay him in different positions to get a head x-ray. None were diagnostic quality. I went back to the exam room to lay it all out. It went something like this;

  • Garfield is really small.
  • Garfield is in pain and therefore does not want anyone to hold him anywhere near his head. (Where else can I hold a two pound anything?)
  • Garfield should see a surgeon for his best chance at a life long functional mouth. 
  • I don't think surgeons wake up in the morning and do anything for less than $2,000. If it is a fractured anything that number starts at $4,000. 
  • I don't think I can get a diagnosis of what exactly his problem is without sedation. I have not sedated a two pound anything, ever.
  • If I can manage the sedation I will need to intubate him to take an x-ray, and figure out what to do to try to treat him. I don't know if I have a tube small enough to intubate him.
  • If I can get the above done I still don't know if I can fix it.

(Way to be all Debby-downer Krista)...Want to try?

They took a few minutes to talk about it. 

I returned to the exam room and they agreed the specialists were too expensive, (preach to the choir, and can I have an "amen!" brother).

"So, we would like you to try."


I am sure I muttered something sarcastic like; "thanks" and, "if this works you owe me a big gin and tonic." I tried to keep it light and I hated myself for offering. I don't know how to fix this? I don't even know what this is.

I walked back to the treatment area with an angry, screaming in pain Garfield. I had every justifiable reason to punt this case. It was 12 pm, I was booked solid with appointments until 7 pm, and I, have I said this yet?, did not know what I was doing.

I asked the techs to help. If I never have anything more than the support and kindness of the staff I am still the luckiest veterinarian on the planet. For every crazy, sad, lacking in the hope department case I take on they always jump in to help. "Damn the torpedoes" is our company huddle song. They won't abandon me, or these patients, and we are as close as any military unit I have ever fox-holed up with. This is the marrow of veterinary team building. 

I pulled up the smallest dose the smallest syringe we have and jabbed Garfield in his non-existent thigh muscle. He screamed, I was hopeful that maybe this was an indication the medication had hit its mark.

A few minutes later we masked him with a little aerosol of isoflurane to get him quiet enough to try to place a tube down his trachea. Anesthesia for neonates, sure I remember that lecture, (there is no lecture).


Tiniest tube in the rack, you know the one I have never used before. Yep, let's see how that goes. What do I do if it doesn't fit? We wing it? (We are already winging it).

2.5 endotracheal tube slips into the trachea like Cinderella's slipper. (I say a quiet prayer of gratitude).

Lowest setting for the anesthesia machine? Well, if he stays asleep we got that right. (He did).

Now thay the endotracheal tube in place that we saw the blood in the back of his mouth.
 This is the site of his fracture.
This was the clue we needed to focus the x-ray on.

Now it was time for the magic to happen. That place every veterinarian inherently learns by being a mental ninja of anatomy. Experience and the miracles our fore-parents instilled into us when there wasn't a textbook to follow. (Did I mention I had my Emergency and Critical Care Manual on the surgery table with me?).

Three technicians jumped in to help. There was a Fossi-fanfare of hands circling Garfield's little body.



Our dental expert took the time to take/retake and keep taking all of the dental x-rays until we finally got the picture we needed to confirm our diagnosis. There was a fracture in the mandible on the left side right next to the ramus, or angle of the mandible. (I know I swore here). There are ways to fix this, (did I mention I haven't done them myself), but you need bone on either side of the fracture site to stabilize it for the whatever many weeks it takes to heal a broken bone. It's also super helpful to have had 4 years of residency training in dental surgery.

Ok, check off numbers 1,2,3 we have a diagnosis.,,, and now what. A diagnosis isn't where this kitten needs to be. He needs help in the way of a treatment plan so he can get up and go live another 20 years fully and functionally.

 My dear friend Dave broke his jaw playing baseball in our senior year of college. He was pitching, his face got in the way of a slugger headed low and hard for center field. His jaw cracked upon impact. We were all there. He spent the next 8 weeks with his jaw wired shut after the surgeons put the pieces if it back together. Senior year at the Academy is called our First Class year. You show up, take your exams, pass your license test and drink to oblivion in between all of it. Four years of that pressure cooker and drinking (along with swearing) is your rite of passage. Dave wasn't going to miss out on any of this. To insure his airway could remain open if he ever got sick he carried around a wire cutter necklace. "In the event of vomiting cut wire" in bold letters. Safety first. We are trained merchant mariners who live everyday knowing the sea will claim your life if it deems appropriate. 

"Sure, I just wire his jaw shut."

I walked back into the exam room with the news. Want to keep going? Don't know what I'm doing but I will keep trying?

They nodded yes. 

Ok, if I wire the jaw to get the bone to heal how will he eat?

Let's place a feeding tube. I have actually done this but it was in a 10 pound cat. (Size matters).

Open Emergency Care Manual and read-re-read instructions.

An 8 French red rubber was placed. Three full body x-rays later, and a few minor adjustments and it was in. 

7th inning stretch and recap; pt is under general anesthesia with breathing tube in. HUGE accomplishment! Patient has feeding tube in, Second standing ovation! Patient have jaw closed with canine teeth lined up perfectly, YAY! But, how do I keep it this way? 


The dental/oral surgeons use a quick drying epoxy to lock the teeth together. I am not a surgeon therefore I do not need, or have, locking putty. I do however have suture. So I use what I have. "Damn the torpedoes!" I close Garfield's mouth with his canine teeth lined up as they should be. Put the anatomy back where it belongs and place stabilizing material to hold. I take a big bite of the inside of his upper lip with my suture and loop it down to the same place on the inside of his lower lip. Then I tie a knot. I remember Dave had just enough room to open his mouth to allow a straw. We blended every meal for him for 8 weeks. Steak, pasta, beer. Beer with NY bagels and cream cheese. Dessert, every kind of ice cream imaginable with more beer. Initially it was a great, albeit drastic, weight loss plan. It wasn't always palatable but we were young and resourceful.

..and so I used my dear friend Dave's treatment plan as I concocted Garfield's. He had just enough room to open his mouth, extend his tongue through his canine teeth, but, the canine teeth remained in their correct position because he couldn't open wide enough the unlock them.

Now, all he had to do was wake up well enough that I could remove his breathing tube. He had to be breathing, calm and stay this way, because I had just sealed our fate in NOT being able to re-intubate him. (This requires opening the mouth wide to see the hole for the trachea). This is where the courage lies. All of these things, most I had never done before had to work. They just had to.

I was not going to euthanize a kitten without throwing my butt in the very hot, very unchartered territory seat, I haven't done it in 20 years and I am not starting today.

I placed a pink turtleneck over his neck to secure the feeding tube as he was waking up.

Garfield needed to be held for the next two hours or he would caterwaul a cry that only a desperately afraid kitten can produce.

A few doses of gabapentin, buprenorphine and a Zorbium later and he was sleeping.


After all of this, everything going so perfectly, I just didn't feel right about sending him home with two grateful parents who still had no idea of what they were doing. Can't lose the race in the last few yards.

As I carried him back to his dad I asked if he would be ok if I kept him for the next few days. The site of Garfield with a neck bandage, black suture ends sticking out his his clenched mouth, and a long orange tube extending like an antenna from between his ears did all of the persuading.


Garfield stayed with me for the next few days. In my attempts to not over fill his stomach via the syringe I forced the gruel into his stomach with I had induced a hunger strong enough to convince him to lap up the blended kitten food with vigor. In 24 hours Garfield was eating on his own feeding tube still in place, jaw sutured closed, and yet he marched on. The biggest victory for his recovery I could have hoped for. 


It's smooth sailing from here kiddo! I told him at our next 4 am check in.


Garfield's YouTube video

Never, ever, ever give up on a kitten. They are braver, fiercer, and more stubborn than even the saltiest of the most weathered magicians we call veterinarians.



Garfield went home with his dad on Monday 5/20/24. He had been with me for 4 days. He had survived a traumatic event strong enough to break his jaw, sedation, general anesthesia, a feeding tube, and having his jaw sutured closed. He is a survivor. A little life with so much desire to thrive that nothing will hold him back. He is resilient, determined, and joyful no matter what he is faced with. 



His dad was so excited to see him again. To hold and to hug him. He was a smile and a thank you that we too often neglect to share with one another. I was full of pride, joy and purpose to have helped them both. There is no nobler profession and no greater gift to be given that we can give back so fully. Vet med has so much power within its humble existence. You just need to look for and acknowledge those tiny specks of fiery courage to let the spark build an inferno of love.

For Garfield's story and the cost of his care with Jarrettsville Veterinary Center please go to Pawbly.com storylines and search Garfield Broken Jaw

Friday, May 10, 2024

Gentle Persuasion

The essence of meaningful change is best sought in the gentlest of approaches.

Everyone of the littles is adorable.
Thank you to Grace and Britt for helping

I have found this to be true with every patient that I encounter and every endeavor in medicine I stumble upon. There is very little too gain with brute force. Nature punishes unwilling interventions. She is the only one of us that is permitted disastrous force with unmerciful annihilation and no apologies for her unexpected wrath.

I am currently bottle feeding three 3 week old kittens that my sister rescued.  They are tiny balls of fluff with only two preferences; eat and sleep. They are helpless, fragile, and adorable. If there is a core of all of humanity for such innocence it is spawned from the twitching of ears, the rhythmic kneading of open paws and the purr of suckle on a bottle. If mankind has one central weakness it is the precious life that littles elicit. These three kittens as tiny, meek and vulnerable that they are, were also born with some primitive, compulsion to survive. The first time I offered a bottle they were angry. They wanted what they knew, what was working just fine for them in the past, and, they were reluctant, resistant, (no, that's not the right word),,, they were pissed to change. The bottle is hard, plastic, chewy rubber nipple and there's me anchored to all of it. Not very tempting save for the desperation that hunger induces. It took two days of gentle persuasion to convince them to abandon the old fleshy-furry-momma they once knew and adored. Problem was that momma was feral. She was ferrying her babies form one shelter to the next to avoid incarceration from the good intentioned onlookers providing her free room and board. We captured these three as she attempted to once again avoid intrusion. These three boys were lost from the home they knew and the mom who has thus far been everything they needed. Who wouldn't be disgruntled about this turn of events?


We have a very well-qualified technician we are interested in hiring. Her credentials and work history are impressive and it would be so nice to have someone just slip into our work schedule who didn't need a year of training who then discovers they want to be a cosmetologist, or nurse, or tattoo artist. She interviewed, gave us a high dollar start figure ultimatum and then requested a shadow work day to see us in action. She left that shadowing day feeling as if we were incapable of the changes she felt we needed to make to fit her work style and standards. In a polite decline she made us feel like we were below her standard of care. While I appreciate knowing who you are and maintaining a bar you are not interested in negotiating I found it poetic that the staff felt much the same about her. Her obvious insinuations that there was room for improvement put them on the defensive. They felt she wouldn't fit in because she had little interest in trying. I explained to them, all strong, very talented, experienced technicians that I was pretty sure they would do the same if they were transplanted into a different clinic. What remains at the core of each of us is, needs to be, the same nidus of inspiration. We all have to be here with a common goal. Perhaps we need to be reminded, or inquired as to what that is, and then ask ourselves if we are capable of gentle persuasion to work together for this instead of competing for who gets there more efficiently? Also, maybe the carrot, and the warm bottle are not our preferred substitute but we can learn to tolerate it, maybe even embrace the change that is inevitable.


Maybe the whole world, every interaction, every moment needs to be centered on gentle persuasion when the life around us reminds us there is a wrath of consequences awaiting.







For more pet care tips, veterinary medicine cases, and all of the stories that make up my WHY please follow me on my Jarrettsville Veterinary Center Facebook page, or, my YouTube channel, my free pet centered advisory company Pawbly.com, or Instagram.

Wednesday, April 17, 2024

Greed, Gouging and Your Legacy in Veterinary Medicine

I am just a few months away from having twenty years as a veterinarian are under my belt. It is a benchmark I was sure I would attain, and yet, I really never thought about my life, or this journey, past it. You get caught up in the pace. The one foot after the other. Keep moving. Don't stop to look back, or, forward. Trek away, day after day, after day. Never ask yourself; what's next? What does the journey on the other side of this mountain look like? You get so consumed with the cases. The lives. The challenges both internal and around you that you are tormented by the expectations to cure them that you never give yourself time to plan, or prepare for the later. The next phase. The thing before you hang up your stethoscope and slip into crossword puzzles to stem your time. I am this place now. It is daunting. This summit atop the professional expedition I spent my whole life living for. 

Unlike my first forty years, where I struggled for acceptance and worth within this profession of over achievers, I am finally at peace with where I am and how I got here. But the after this part, that I don't have an answer for.

This life quest began when I was 8. I was a child of Long Island, N.Y., which lay at Manhattans suburban outskirts. We had just moved to N.H. from the melting pot of the culturally diverse neighborhoods abutting NYC because my parents chose to chase the Tasha Tudor temptations of a life surrounded by  animals and homesteading. My mom was a woman in juxtapositions. She loved the outdoors, the wildlife in our front yard, but she disliked the hoops of attaining resident status in a place that was adverse to any changes of any sort. We were transplants from a city they wanted no parts of. I never felt at home in the bucolic mountains, lakes and entomologists cornucopia of N.H. It was with this feeling of isolation that I re-invested all that I was, all that I hoped to escape from, and, all that I ever wanted to feel needed within, into the newly amassed farm of my soulmates. At 10 I earned my horse as a prize of patiently accruing babysitting and farm chores money. She was a pony by stature named Sweet Memory. I called her Morie for short. We were the stuff of tween dreams. I can still smell her fluffy-downy coat full of dander and hay. I remember brushing her for hours in the cold just to have some place, some thing, to feel connected to. Our life together was a mish-mash of leather parts to make a happenstance riding rig just secure enough to carry a young skinny girl away into the 50 acres of woods that lay behind our white clapboard farm house. She was sturdy and rugged and never afraid to go roaming with just a bridle and a saddle pad. Her sidekick in our tiny barn was Lambie. She was a whim of an auctioneers mallet at the local country fair once my mom realized the show animals had no other purpose but to be consumed after the ribbon ceremonies concluded. My mom convinced my dad to bid on her tiny white newly shaved military buzz-cut as she was being forcefully coerced to enter the middle of a dirt floored circular show ring under the big top flags. Little spindled legs reluctant to walk, scared and screaming for mercy. Her "baaaahhhhhh!" cries broke my mom and cracked the weak spot that was my moms empathy for animals outside of her dinner plate. She was about 4 months old when we packed her up in the luggage area of our woodie-sided station wagon for the ride home. Over the decades that were their lives in our back field the vet only needed to be called out twice for Lambie. Once when my mom couldn't figure out what kind of strange ailment had acutely caused her to not be able to stand or walk in the dead of winter. This turned out to be an overnight affliction of her over grown woolen onesie to the frozen tundra that cemented the under carriage of her. An emergency shearing of her over grown, albeit incredibly warm and cozy fleece wool, to the clutches of the frigid ground she took refuge upon cured her. For the rest of the approaching spring you could see her forensic woolen outline marking her preferred sunny spot in her paddock. The second time was for another poor husbandry charge. Every veterinarian learns early on that one of our primary diagnostic tools is our nose. One warm summer day my nose told me something afoul was about. There was a wet spot near Lambie's backside with a terribly foul odor. Upon inspection the skin of her wool could be lifted from its tissued-foundation revealing an entree sized dish plate matrix of  wiggling naked worms. Maggots had found her and she was too rotund and Rubenesque to bother with them. These were my indoctrination to large animal medicine. I was hooked. Enamored. Smitten. Called. The more gross and gritty the more I wanted to be a part of it. That and my parents were miserly with their willingness to make financial investments into our livestock lawn decor.

My parents moved to N.H. with one dog. They, like all true homesteading farmers, quickly, quietly, and unintentionally amassed multiple cats from the fringes of unwanted free-to-a-good-home classifieds. Within a few years of our farming life we had 2 dogs, 4 cats, Morie, and, Lambie the Southdown. 

If necessity is the mother of invention my ah-ha moment came when the second unplanned pregnancy occurred in our also-bored-with-the-country Border Collie Bonnie. For all of the preaching I do about avoiding pyometras my parents dog never lived long enough to worry about this disease as the accidental breeding's kept her lady parts from making bad decisions and getting all life-threatening infected. 

Life on a farm is hard work. For my parents the utility of farm hands fell squarely on the humans. The pets were, well, pets. None had a purpose outside of emotional company, so none had a value worth investment. People in N.H. are frugal, rugged, and independent. Pets were never meant for this. The cats got the worst of it. They always do. The second generation of farm dogs turned into Jack Russell Terriers. In the trade we call them 'Jack Russell Terrorists'. The name is fitting. They terrorized the cats to no end other than death by cornering, or death by poor timing. I knew they wouldn't be fixed unless fate took mercy upon them. It was this spectator helplessness that compelled the quest I now find myself on the descent from my professional mountain from.

My mom, RFD #1 New Durham, NH 03855
circa 1984

I have done what I came here to do. I am no longer the unprepared, incapable pet parent, companion colleague I was. There hasn't been one pet who crossed my professional path that wasn't cared for in the same manner I wanted someone to care for my childhood pets. I am the spitting image of the veterinarian my parents called upon all of those decades ago. A little bit of farm-raised ingenuity, a smidge of humble boot-strap sensibility, and a bitter swallow of knowing these people I serve decide my legacy, (not the other way around). 

In twenty years of practicing I have saved thousands of pets like my parents pets needed. I have found new second chances for hundreds of lost, forgotten, abandoned, over looked and always under appreciated dogs, cats, kittens and puppies. I have done pro bono work so extensively the local ER's, rescues, clients, and community all hail my name as the place to ask for help when no one else is interested. I used to worry about this lot in life I have cast for myself. I now recognize it as the fostering of that little girl I was, am, remain. 

You can find yourself in the oddest of places but it usually is a reflection of the path you were always on. I guess I will just put up a road sign, a billboard, and an empowered concession flag for peace in the place my feet have found me and hope that this journey bolstered my crossword puzzle prowess.

December 2019, our last Christmas


P.S. I wrote this after reading the commentary to a post about the NY Times inquiring readers to submit their stories about being "gouged" at the vet office. It has stirred a lot of intense emotional outcries on both sides of the leash. I use the word "emotional" because this is exactly what small animal veterinary medicine is about. All of the marketing adjectives and verbs we use in describing the importance of our craft is 100% emotion based. We exist because people, our clients, need us. They need us as we need to be accessible, empathetic, and skilled in caring for the beloved members of their family. I wrote the story above to reflect two things; one I needed, and still need, my pets every day of my life. When the clouds congregate above, and the days seem too dark to warrant me stepping foot into them, the pets in my life, heck, the patients in my life, remind me that I have a purpose far greater than the fears, insecurities and apprehensions of this moment. Losing a pet, as we all must face, is grief-riddled enough to not feel that I lost them because I couldn't afford, or find access to help to provide them. The impetus of why I am who I am was that little girl on the farm who wanted to do more for the things, the companions, the souls, I loved most. The veterinarian who was my mentor never, ever, ever made our pets care about the money. Now I know my current collection of colleagues would excuse, or even disparage him for this, but, he was a legend. He left behind a legacy. Me, well I have every intention of doing the same. Can I be financially comfortable over the next 20 years from the fruits of my labors because of the last 20 years. You betcha. I simply choose to walk this path with nothing more as my guide. 


As for the NY Times article, here is my opinion. The words we use, the actions we take, and the intentions we put forth into the world matter. "Gouging" is happening in vetmed. It is happening because enough veterinarians have decided that they can seek refuge in the collective defensive banter that permits economic euthanasia, one sided conversations about the spectrum of care we are willing to offer, and simple plain old vilifying of the emotional empathy that this profession is built upon.

There is a cost effective treatment plan for every single condition we are faced with. We just have to be willing to lower ourselves to seeing these patients as the pinnacle of purpose our companion pets represent.


If you have to defend so angrily, and cannot see the hurtful impact your actions have upon others it might be time to ask yourself if you are a part of the problem, or, if your legacy reflects the person you came here to climb that mountain.