What Compels Vets to Forgive? Response to the veterinarians open letter to the vet who killed the cat with an arrow.

I recently read a published open letter from concerned veterinarians worldwide to Dr. Kristen Lindsey. Dr. Lindsay is the vet who killed a cat with an arrow and then posted it proudly on Facebook. She is likely to lose her license and has been the subject of an intense social media backlash. I have already written about this (here) and still feel as sad and angered as I did when it first happened.

A group of vets around the world wrote an open letter to her offering "support and an empathetic ear."  It was published without names to protect anonymity, but I am finding providing forgiveness  for this action a very difficult thing to do.

Clearly my biggest dilemma in life is this unyielding passion I have for animals. It is what compelled me to put up with the grueling list of "required items" to get into AND out of vet school. The degree of personal (and for many financial) sacrifice is what makes the career path both revered and sought after. It is earned. No one would argue otherwise. 

For me, personally, it is why I struggle within my day to day vet life. For every empathetic client who apologizes to me as I euthanize their very sick and suffering pet, I want to say, "Oh, God, this is not the worst part. The worst part is all of the other cases abandoned from assistance due to lack of resources, compassion and options. That's the shit that kills me everyday. Treatable meets unattainable because some human decided to give up than,,, well all of the reasons we get barraged with. People either don't care or can't afford to care. These are the pets that nibble away at my heart. To see a veterinarian so blatantly and callously NOT care about a cat, someone's pet who very likely might have, could have, or would have, been one of her patients, well, that's appalling and disturbing. How can she be a small animal vet and kill a cat like this? And then be so stupid and lacking of remorse to post it? There is not a viable excuse or reason? And now we, the collective group of vets already dealing with stress, anger, debt, suicide, and unresolvable emtional baggage are supposed to say "we care about you anyway?" It tells the world of loving pet parents that we are empathetic to her? For the record I am NOT empathetic to her. I think she needs professional psychological help and to lose her license but not empathy.

When I can take a breath and step back I start to think that maybe it is not lack of empathy but the world of greed, anger and caring that is the disconnect? Maybe if we could all care MORE we could make all of this better? Is that the intent of the letter? But, damn it that big-hearted-rose-colored glass-wearing 6 year old kid inside of me who refuses to let go of the dream of "someday being a vet so that I can save everything,' is still inside me. It makes me crazy with having to protect her from the sad reality of the world we live in. Everyone seems intent on killing everyone and everything else. How do you explain that a  6 year old? How do I tell the 6 year old who someday wants to be a vet that there are some bad people in the world? What do I say to her? To be kind, to be forgiving and to try to always see the good in others? 

Where is the problem of disconnect between vets and the public?
Here are some of the most common reasons I hear on the pet message boards;

1. More concerned about money than the pet. 

2. Inaccessible by either time, price, or indifference.

3. We lack compassion.

4. We are too expensive.

5. They don't trust us.

And I have to admit I do see all of these as being problems within our profession.

But, aren't we a part of the problem? Could we possibly be? Is this letter of open arms and acceptance to an individual who clearly lacks the moral and ethical fiber to stand amongst us not still a reason to forgive but not accept? DO we have to do both to be sincere with either?

I can only speak personally of course. I can tell you that we vets kill (yes, it is kill "to end a life" packaged pretty in a more palatable term "euthanasia") have gotten so comfortable with ending a life that we now have difficulty drawing lines to where "acceptable" meets "unacceptable". I spent about 30 minutes on a vet forum centered around trying to offer help to the staggering number of vets among us at risk for suicide, and still scattered amongst the many pleas for support through rough days, mean clients, rotten practice owners, and cases gone wrong their were members advocating euthanasia for behavior cases (who inevitably were the result of some human hand) because "there are lots of 'nice' dogs being killed already." I was struck by how easily we all have to justify actions that people are struggling with. And we wonder why we are all tired and suicidal?

Would everything be easier if we all just forgave each other? Would the inner turmoil so many of us have about so many difficult aspects of this profession get better? Or should we all take a long look in the mirror and ask ourselves if there is any reasonable expectation to be good an kind to each other and hold a moral compass high? There is a pervasive over arching anger problem among us, but at least we care to challenge each other to invest more of ourselves instead of becoming so hardened by the indifference we loose ourselves in the process. It is a matter of getting out alive, but surrendering your compassion along the way might just be as bad.

Can I forgive Kristen Lindsay? Yes. Just like I have to do with so many of the day to day travesties that walk into the clinic. Do I have to publicly profess that I hope she finds peace with herself and her actions? No. I am not that strong, and I am ashamed of her, the excuses, and the acceptance of caring so little. Perhaps that is the thread that still holds my faith in humankind?

Here is the letter to Kristen Lindsay, as it was published:

"Aug 11, 2016

By dvm360.com staff

DVM360 MAGAZINE

Editor's note: The following letter was a collective effort from veterinarians via Facebook to send a message to Kristen Lindsey, DVM, the Texas veterinarian infamous for shooting a cat with a bow and arrow. Lindsey filed a motion for a partial new trial that was recently denied.

Also, a number of veterinarians originally signed this letter with their full names; however, after they received backlash on social media that included death threats, the editors and authors together decided to use initials for all signatories out of concern for personal safety.

Dear Dr. Kristen Lindsey,

The most important trait of any veterinarian is compassion, and we extend our compassion to you. As much as we find your behavior unacceptable for a professional in our field, we can still support you as a person.

As veterinarians, we consider life sacred and suffering abhorrent, including yours. Our profession is already fighting to maintain integrity in the public’s eye, and the veterinary community is now wrestling with the ethical issues—and clients’ subsequent reactions—raised by one of “us” being proud of killing a cat using a method not listed in the AVMA guidelines. Indeed, many supporters of this letter wish to remain anonymous so that they are not associated with these practices. Still, there are larger issues which we hope to address with you in this writing.

Our profession’s suicide and mental illness rates rank among the highest in the United States, and even the world. The fact that public shaming, like that aimed to you, can have serious effects on a person's mental and emotional stability has not escaped our notice, especially given the all too recent links shown between bullying (cyberbullying and other forms) and the preventable loss of our colleagues. Because of this we are concerned for your well-being, and urge you to seek help as necessary. While we cannot speak for you in any legal matter or otherwise—even if that means the veterinary profession may not be in your future—we hope that you find the support you need to emerge from this as a wiser, stronger and more effective member of the community.

You matter. We are here for you should you need a supportive or empathetic ear.

Signed:

Drs. MMK, DD, LB, JM, EA, DLB, CD, SS, AMvH, MK, MSH, RH, EKB, EE, EA, JGNM, LW, LS, BE, RS, CGN, KF, LPO, CR, NL, CR, LCH, SH, MEB, LTG, EA, RV, KWW, AW, DA, JLP, MML, HL, JP, BRP, JS, MvCP, LN, KS, KC, SA, CG, JH, JG, MS, BB, AG, JS, VH, LS, AHW, PG, CS, TKSR, JE, LP, CR, TKK, EKB, MD, JM, AH, NS, LE, ZJ, JT, CMC, MD, KN, MEG, VMG, KAP, KHP, MED, TMD, JMM, CLS, JCK, KPR, MYR, RAV, RO, KK, LAB, MSR, AIN"

There is cruelty, neglect, pain, and suffering in every corner of life. For Cecil the Lion, the trophy hunting Trump kids, factory farming, feral cats left to repopulate without restriction who are not given medical care when URI hits to leave them victim to be eaten by predators, dogs surrendered by their owner who was too whatever to try another option and are actually told the dog will be killed, and the people who abandon anything I am not sure I want you to know that I am empathetic? Does it add a burden to my already heavy heart? Yes. But I am still here NOT euthanizing healthy treatable animals, still offering every single imaginable option to a person who is in need, and still not surrendering my soul to the excuses that make it easier to be paid to kill, give up, walk away, ignore, disconnect, etc..

This letter needs to be sent to the masses of us. All of us, vets, clients, staff. All. We all need empathy and acceptance. Instead we cling to the opposing conflicting laws of pets are property, herd medicine and its ag-gag laws, over inflated costs of care, and worst ROI of any profession, and for profit vet schools. It's ours to own. Forgiving each other when the shit storm takes possession is a nice start. But now it is time for accepting that we aren't the humble agriculturally rooted members of our community who helped everyone because we were happy and privileged to be in the position  to be blessed and empowered to do so. We like white coats and exceeding the avg client transaction quotas too much.

We have lost our integrity because we make excuses to justify giving it away. We do care but we gave up fighting for it so now we are trapped, alone, afraid and excusing the suffering by ending it. Just what we were all trained to do.

There isn't one member of this profession  that doesn't have bad days, make mistakes and get caught in between a rock and a hard place for your conscious to try to navigate out of. BUT a public display of a lack of moral integrity, compassion and cruelty is not where my empathetic ear is going to be offered. There are "too many nice people out there" who need it first.

About me. Typically I put links to my other social media accounts and activities. For todays raw post I will only add that I struggle with how to be a better member of the pet loving community I serve. I never wanted to be anything  other than the person  I am, and I understand that the world looks different from others perspective. I also understand that posting anything personal leaves me subject to opinion and  backlash. BUT if  I write it, post it, and publish it I own it and stand by it. I don't believe in anonymity. If you want to help other pets find your calling and feed your compassionate heart on Pawbly.com.

IVDD. The days immediately following the diagnosis. Recovery, post-op problems and how to conquer them all.

Without a doubt the fear, apprehension and sense of dismay is thick and overwhelming for most clients dealing with IVDD (intervertebral disc disease). It is persistent and pervasive at the time of diagnosis and for the first days to weeks of recovery, regardless of whether the patient is recovering post-op or with conservative care. With each case there are always many questions, with many remaining unanswered left to the decision of time, circumstance, and luck. It is the equivalent of sudden decisions, life changing odds and prognoses, and fate in some unnamed higher power's hands who refuses to show their face to claim responsibility. 

For these cases I try to reiterate and reinforce a few simple things;

1. Be Strong. Even if you don't know what to do or which end is up. Just stand, breathe, and believe you and your dog can get through this. We have wonderful tools to help heal, but giving up defeats them all.

2. Listen to your pet. They will look at you for help. They will wag. They will try. Take heed in them. They always decide, and they rarely give up. 

3. The first 48 hours are hard. The first week challenging. But if you can get through the first week and if things have gotten easier with encouraging signs of interest in food, better understanding of bathroom needs, a routine with a friend who needs a little more TLC, then you can get through this. 

4. Lean on someone as much as you feel you need to. Ideally this is your vet, your neurologist, your vets staff, your friend and fellow pet lover, or even those of us at Pawbly.com. Ask lots of questions. 

Don't leave the vets office until you have been taught and are comfortable with the following;

1. How to pick up safely. I like one hand on the sternum and the other behind the back legs supporting the pelvis. Hold on don't squeeze and don't let a nervous pet make you nervous. If you are worried about wiggly use a towel to wrap like a burrito and be safe.

2. Know how to check for a full bladder. Learn how to palpate, express and monitor. Yes, it takes practice, and yes! you can do it. (I promise, you can).

3. Learn how to monitor defecation, and keep it soft so it can pass easily. Every client gets worked up about lack of poop. I am usually not too worried. Even after 3 or 4 days. If your dog has a disc protrusion/extrusion they have a very painful time even sitting. They usually aren't eating for a few days. If your pet isn't eating there won't be feces for days. Also, posturing to defecate is painful. They either won't try, or they can't push the feces out. Every IVDD dog is placed on wet food and given an oral laxative to keep the feces from becoming dried and impacted in the colon. Use the wet food and laxative to desired effect. The dose is never set in stone, it is used when, if and as much as needed.

4. Learn how to safely use a sling. I want you to keep encouraging and challenging your dog to be a dog. Walk, pee and poop. That's dog basics. Use a sling, place their feet correctly and encourage them to support their weight. As the foot righting improves encourage walking. Physical therapy is 10% putting them in the right spot (I like outside in the cut grass for footing and softness if there is a spill) and 90% giving them the opportunity to go back to the life they remember.

5. Obstacles happen. Don't get discouraged, stay active and have faith. Sometimes medicine comes down to faith, and it is always the better for it.

6. Cage rest is imperative. Not encouraged, but rather, required. If  your pet is not used to being in a cage it is often very difficult to keep them calm. Calmness, quiet, rest and rebuilding of the broken damaged tissue is what is needed. How can you discourage movement if you cannot cage them? I will warn you that they will move faster, try to do more, push themselves to doing what they did before, and if allowed to make decisions, they will make bad ones. Keep them caged and know it is for the health, well-being, and sanctity of having a rest of their lives.

This is Wrangler. His stumble in the recovery process was licking his left knee to the point of an open wound. In spite of his e-collar he was wiggling his nose to the point of his knee and licking obsessively.

Now I firmly believe that our pets are always trying to tell us something. Wrangler was telling me that there was a problem ad he was trying to point me in the direction of it. Wrangler was leaking urine. He knew he was leaking and no one likes dripping pee. 

He needed some laser therapy for his knee, another e-collar, and a medicated ointment for his prepuce. We also instructed his family to palpate the bladder with each trip outside. First to get a urine stream going, and second to try to make sure he was emptying his bladder completely. Residual urine in the bladder turns into a possible pool for infection. An overly full bladder will leak.

Double e-collar anyone? If we can't make Wranglers nose shorter we have to make the e-collar longer.

Laser therapy had the lick granuloma cleared up in less than 3 days.

A drying healing knee. 

IVDD is the one disease that comes on like a freight train and sinks a  pet parent to their knees. It is frustrating, painful, and often seems overwhelming to parents. Have faith, be calm, be patient and don't give up early on. It is a disease your dog can conquer, even if you cannot afford the neurologist, the MRI, or the surgery.

I always try to add associated costs of care with my blogs. All estimates are in USD for East Coast USA
Here is the break down;

Conservative care; Non-surgical medical treatment. Cage rest.

• initial exam to get a presumptive diagnosis. $40-$80. These cases are usually able to be diagnosed on the first visit and do not require advanced diagnostics like an MRI. They have a high incidence of suspicion that is usually accurate at presentation.
• x-ray $100-$200. Should be done at initial visit if the vet suspects IVDD.
• analgesics $50-$150. Includes NSAID or steroid, opioid patch, oral opioid. Do NOT decline these. Your dog needs them. There are lots of cost effective options (like a steroid at Wal-Mart is less than $10. Call me I will loan it to you. If you decline it is simply because you are an awful person.
• Elizabethan collar $20-$40. They can be made. Ask the vet for an old xray film to make your own.
• Sling, free, use an old shopping bag with the sides cut out, or use a towel. 
• Cage; borrow from a friend if you don't have one.
• Many places will recommend blood work. If you are tight on funds skip it. It is not going to make your diagnosis and it may not help with the treatment plan. It can be done later.
• Follow up care. Ask how your vet charges for rechecks, phone calls, and emergency care. Expect to see the vet about 3-5 times in the first week or two.

Gold Standard care. No expense is too great, or, I have great pet insurance;

• Includes referral to an emergency care facility for the first 24-48 hours. Usually $500-$2000 and for all of the items listed above.
• Referral to a neurologist for MRI and surgery. $3000 to $9000.
• After care at a facility to help recovery. May be 3-5 days $2000-$3000.

Personal Note; Nothing disturbs me more than a client being directed down a path they cannot afford to be on. If you cannot afford the decompression surgery and follow up care with a neurologist it is difficult for me to advise that you have an MRI done, UNLESS it is to rule out an untreatable life threatening condition like a tumor, blood clot, etc. If the vet or neurologist thinks it is a disc AND you know you cannot afford surgery DO NOT FEEL PRESSURED TO continue diagnostics. Elect cage rest (be compliant and follow up with your vet) and don't feel bad. Whatever you do, don't feel so bad that you give up and elect euthanasia.

For more information on this disease please see these related blogs;

IVDD. A Tale Of Two Outcomes.

Dr Kelcourses' IVDD advice. How to diagnose, how to treat. Tips from an expert.

If you have a pet in need you can find a community of helpful people at Pawbly.com. Pawbly is free to use and open to anyone who loves their pet and wants to help them.

I am also available for personal consults at Jarrettsville Veterinary Center in Jarrettsville Maryland. Or find me on YouTube or Twitter @FreePetAdvice.

Re-Post Of Compassion Fatigue blog.

In light of the publishing of NPR's article on compassion fatigue, I thought I would re-post the original, unedited blog written almost 3 years ago. It was one of the few blogs that came to me in a downpour of words compelled to put to paper. Written in an hour it is one of the most honest genuine pieces I have ever produced (next to those on Savannah).

I can say things have gotten better. I know who I am and who I protect her inside. I accept the struggle and forgive more readily. I let go from the things I cannot change more easily and I listen to the voice that reminds me that giving is a gift, not a burden. I am less afraid and more empowered. I embrace the challenges instead of wishing it could be easier. I smile, hug my pets and am thankful for the good friends in my life.. I try to chose to cherish instead of grieve.  

To those struggling you are never alone. 

Compassion Fatigue. When the candle you are burning at both ends consumes you.

“The Lord giveth and the Lord taketh away.”  BUT in the case of our pets,  should it be “the Lord giveth and the vet taketh away?” How does the responsibility, the quest for providing a service, and the weight of the burden that this profession puts upon you keep you from becoming exhausted? And how does the emotional stress not accumulate to the point where that stress breaks you?

In the trade we coin it “compassion fatigue.”

It is the burden of the beast.

I read somewhere that something like one-third of US women are on some sort of tricyclic antidepressant. If the general public can’t make it through their normal day without some help how is our profession not supposed to end up not heavily self- medicated, depressed, or seeking a way out from under the mountain of emotional turmoil and  strain?

There is a common belief amongst vets that our profession has the highest suicide rate. We know what death from the end of hot pink syringe looks like. We talk about ‘quality of life,” “making hard decisions,” “letting go,” “saying goodbye,” and ending suffering” enough times to almost believe it ourselves.  And there is a knowing that if the cards are stacked against us, and the chips are really down we do what we practice, we take matters into our own hands, we end suffering.

How do we get here? It’s a long road and many small steps, heart aches, and tears on the way  to Oz.

Being a veterinarian can be exhausting. You can get to the marrow tired. It can eat you from the inside out to the point of being all consuming. A gluttonous feast of your soul until there is nothing left to give and nowhere to seek salvation. A curse? Yes, it can be a curse. To care so much, to invest your whole heart, which is what many of our clients want for us as we care for their family members, and then there are the clients who ask you to remove a pet that they see as a burden. To juggle these emotions, these responses, and these ends of the emotional spectrum make it hard to navigate through each day.

We are all provided preservation mechanisms to protect our most precious inner self. Your choices are yours. Mask the difficulty of dealing with the stress with drugs, alcohol, and addiction, withdraw and leave the profession, start caring less, investing less of yourself, or burn out. Veterinarians are determined, driven, type A people. We as a species hate to give up, we loathe defeat, and we give until the bank is empty. Wear your heart on your sleeve long enough and someone will take it. But like every other thing in the universe with enough wear and tear on the system it will break down.

Four years at a school learning about the biggest, heaviest, and bulkiest transport vehicles in the world, steel ships, and I know that one big wave, one scrape on the bottom, or a swipe from an iceberg and that tin can will crumble, crack and sink. Nothing is impenetrable or unbreakable. Ask the Titanic or the Costa Concordia.

Did I learn about burn out, or compassion fatigue in vet school? No, you learn it in the field with those tiny sacrifices, those tiny blows, and those moments between the lines. You wake up one day and you realize that your life, your dream, and your reality are not one in the same. You dread work, you can't process the grief, the exhaustion, and the demands placed upon you.

Compassion fatigue is burnout when the candle that you are burning at both ends runs out of wax and wick. The profession can put unrealistic expectations on us. Our ability to maintain a level of empathy for every client, every incident and every patient is unrealistic. Our ability to wear every hat, mirror every clients expectations, and maintain a personal protective zone requires a strict code of rationing emotional handsels. 

Palmer

How does a normal rational empathetic person put a pet that they have watched grow from infancy to geriatric to sleep in one room and then walk ten feet away to another patient who you are expected to be jubilant and clear headed to examine, diagnose, and treat? Somewhere along the way we learn to mask, shelter, or disregard our emotions. Somewhere it became expected, and we learned to push feelings aside and press on. It is a recipe for a sychopath and a schizophrenic. And we do it every single day.

I will be the first to freely admit that I grapple every single day of my professional life with compassion fatigue. When you invest so much into one thing you expose yourself to being bankrupt should your house of cards fall. Can I tell myself that this is just a job, yes? Do I believe that being a vet is just performing a job? No.

How do I keep going? I pay attention. All the time.

I try to put myself first, I have to. I say no, a lot. I stay true to who I am. If you don’t care about your pet I am not the right vet for you. I stand by my core values.

I am also very honest. I tell my clients when I have just had to say goodbye to an old friend, and that I might need a moment to collect myself, refocus and devote the time and attention that I want to to their pet. I also invest my whole heart into what I do. I know that I cannot practice any other way. To do this I have to understand that there are clients that I am not right for. I can’t care more for their pet than they do, and I can’t be a compassionate vet any other way. I give termination letters to clients that do not share my perspective and I stand by my true clients come thick or thin, hell or high water.

And every day I remind myself how much I love to be a part of my client’s family, and how lucky I am to be living my dream.

Here is the advice from the professionals;  

1. Put yourself first. 
2. Stay an active student. Learn, grow, and challenge.
3. Exercise, eat well, take care of your temple. 
4. Be realistic with your expectations.
5. Attitude is everything, keep your chin up. 
6. Seek help if you feel overwhelmed.

Help, and seeking help, is something the doctors often feel embarrassed, ashamed, or beneath us to do. We are comfortable and expected to always be giving the medical advice and unable, unwilling, and mute to ask for it when it applies to ourselves.

Symptoms of compassion fatigue include excessive complaining, isolation, compulsive behaviors, poor sleep habits, poor hygiene, apathy, difficulty concentrating, chronic physical ailments, and withdrawal from friends, family, or prior interests.*

The next time you see your vet, tell them that you appreciate them, and remind them that you know that we are real people with real hearts. And for as many times as we vets tell our clients who say to us that they "will never get another pet because it's too hard to say goodbye when we lose them," the same goes for us. Don't lose your compassion in the trenches of our daily life. Remembering to love, care for, and maintain our empathy is what keeps us human.

*This blog was based on the facts presented at the 2009 CVC Baltimore lecture given by Renee Rucinsky, DVM, DABVP of the Cat Hospital of the Eastern Shore in Cordova MD.

I started Pawbly.com as a way to help more people with their pets care.  Every pet parent will tell you that the worst part of pet care is not knowing what to do, where to go, or who can help. I also know that the best place for help is with a vet, or their pet care professional.  I hope that it remains a community of support regardless of socio-economic status or access to accredited care. I know that giving back can replenish a tired soul. Helping people and pets can be fulfilling and there is great need. If you would like to join us in helping others please visit us on Pawbly.com. We are a free open community dedicated to sharing information to empower people who love their companions. 

I am also on Twitter @FreePetAdvice, on YouTube and at the clinic Jarrettsville Vet, in Jarrettsville Maryland.