Friday, May 26, 2017

Believe in Me.

Being a veterinarian and most especially the practice owner, is essentially nothing more than asking people to believe in you.

True, I need to have studied, practiced, and display the fundamental skills associated with being a veterinary medical doctor, but, there is very little oversight and even less direction provided for us while we are out in the trenches. Leadership skills are not provided as one of the important tools to carry in your medical bag. Some of us are born with them, others fight gallantly to escape having to earn them, and still others flee with great fear at the idea of having to take charge of anything.

I have had the audacity to try to build something far outside of the normal parameters of a vet hospital. I have learned the hard way there is a price to pay for that.

I believed I could do more. I also believe I can do it honestly, transparently and with integrity. It presents its own set of challenges.

If I invest the majority of my heart and soul into my practice I run the risk, like in every other relationship, of being taken advantage of, dumped, and/or feeling heartbroken. I can confess that this happens. I don't know how else to trudge through? How do I possibly remain a "heart on my sleeve bleeding heart kind of person" and not maintain some degree of caring when I get rejected?

I don't know how to be any different? I don't even know if I even want to? Which leaves me sitting here staring at the stars wondering where my place in the world is? How do I remain the eternal optimist in humanity, reason, fate, and the tiny steps of this ethical minefield, full of precious pets and messed up humans that I have to navigate through? (OK, I am trying to remain optimistic,, in fact I am jaded and jilted, and maybe even a little paranoid about the next perpetrator of my vulnerability).

Believe in me? Do I still believe in me? There are days.. when,, I... just... don't... know?

The problem is that you have to keep convincing yourself that you still believe in you when it seems that no one else does.

At the intermission of this one lifetime I know I made some hard decisions, taken some leaps of faith and tried every single time to be kind instead of right. I leave my head and neck on the chopping block because I don't see a pet, an animal, any living thing as a piece of property. I vehemently disagree with my colleagues policy of euthanasia as an acceptable answer to every-damned thing. I also give a great deal and expect to be treated respectfully and honestly.

This week I said "no" to two requests. I dug my heels in, left myself vulnerable to whatever legal repercussions to follow and I stood up to protect a pet knowing that the client might just walk out the door, drive 0.2 miles up the road to the next nearest vet clinic, walk-in, pay the $50 bucks for euthanasia on request and walk out 10 minutes later free of the burden their pet became. (PS to my vet neighbor up the road who may, or may not, hate or love me? I know I am probably the biggest PIA neighbor-vet who ever lived).

I have also made business relationships that transitioned into personal friendships. I provided an expectation for special treatments to these 'friends' and then disappointed them. The example list is long with friends who have "unfriended" me because I drew a line. I cannot ever leave well enough alone...Why? Why do I over extend myself and then feel hurt when I get dumped? Why do I always muddy the waters between business and friendship? (OK, I do know the answer to this.. because I feel obligated and compelled to be there for my patients, like, always).

Let's review my jilted list and see if it is an exercise in cathartism, or, just a gross display of dirty laundry? (Please refrain from casting a vote).
  • The many decade long client with too many dogs who worries I will rat them out for not having a kennel license because they have too many dogs. (Did I ever mention I once had 12 cats?). They want special boarding prices because they cannot afford to board them all. They left the clinic when we didn't provide special pricing. (PS we are the cheapest place in town.. we know,, we checked). 
  • The client who calls screaming that her dog "isn't breathing! She is coming in right NOW!" We direct her to the ER. We are closing within minutes. She is a nurse and she is livid. I try to call her the next day to explain that if anyone of her patients called her general practitioners office with this condition the first thing that would be said is "If this is a life threatening emergency please hang up and dial 911." Apparently added fuel to the fire. Relationship extinguished. (PS an emergency should always be treated like an emergency).
  • The client who routinely calls demanding immediate appointments for whatever disaster-du-jour has occurred. If not provided an immediate appointment I get a personal cell phone call requesting such. All are always granted, and always seen within hours of the phone call. I am fairly certain the other vets at the clinic hate me for always insisting they see emergencies even when we are booked. Who do I try to make happy? (PS I still don't have the answer).
  • Financially capable client requests an extension on paying the latest emergency bill. This request turns into constantly carrying a multi hundred dollar account for months. We ask nicely for payment, we are met with hostility, until finally the account is paid and they move to a "better" clinic. Who knew there are "better clinics" that are free? (I will pass along the info when I get their name).
  • The client who has over 40 cats spayed/neutered/vaccinated and treated pro bono who accuses a popular widely used topical flea & tick preventative of killing their cats. Hysteria ensues at the clinic, adverse event report case is opened and then they refuse to answer any phone calls or provide any information because there is a "vet and vet manufacturer conspiracy" theory going on. They ended up getting away with over $3,000 worth of vet care and services and think I am the "corrupt" one.
  • The number of vets who have left for greener pastures and the promised land. This one breaks me.. (note to self,, stop getting attached.).
  • The client who is always reprehensibly nasty to the receptionists.. Why? Why would anyone be mean to them? I bid them adieu.. and I always call to tell them why. No one deserves to be spoken to with derogatory comments, profanities, and anger. (OK, I have no remorse here. But I find it sad that these clients are always nice to me. Like that's ok? If you have a boss who lets you get walked on, while they get treated like royalty call me,, anonymously., I will call your boss. What the hell do I have to lose? Doesn't everyone deserve a friend with a big mouth who has your back?).

I need healthy boundaries. I am not good at this..

Maybe I only need to believe in me? Maybe, if I am super lucky there will be others who stick with my vet clinic-pet crusade quest and we can change the world? Maybe one single pet at a time, and maybe only with my soul still inside my own heart.

No one ever said this life was easy.. at least I can bank on that.

(PS to those who think this is a personal note of defeat and submission I will leave a post script here to spare the phone tag inquiries.. I am OK. Promise. A diary, public as it may be, is still a one way vessel. You don't need to intervene. I m, learning, growing, and trying to spare my compassionate obsessive self along the way.. Maybe tomorrow? Maybe I can do it all better tomorrow?)

For those of you in vet med I know you understand this.. for those of you not in vet med please understand that all of us are human beings with big hearts (too often on our sleeves). To not care is to grow indifferent which is the death of the soul that fuels the heart of a caregiver.

Juice.. saved by JVC twice.

If you want to help pets please reach out to me. Leave a comment here, join me on, or find me at the clinic Jarrettsville Veterinary CenterFacebook at Jarrettsville Vet, Twitter @FreePetAdvice, or YouTube.

Stop and Smell the Reflection.

"Please submit 5 stories for review and consideration."

A personal letter from a dear old veterinary friend came in the mail a few weeks ago. It was short, simple and inquiring about using my veterinary blog posts for submission to a compilation book about the stories that make the fabric of a veterinarians life.

"Sure! I would be happy to submit a few of my stories!" I replied eagerly and instantly... I mean, come on,, I write a blog! I have tons of stories. It will be easy to find five.

And thus began the stroll through the 900 stories I have written. Easy? Right? Well, not so much. Seems about three years ago I started writing cases, all cases. Cases to learn from. Cases to help others. Cases to provide transparency for pet parents to learn from,, and in the process I lost my fun. I became the rote routine pet care professional who was all business and no cute fluffy stories. I lost my ability to share what I love most about being a vet in an effort to help other pets..

I took a little break from writing. I had to. I had to remind myself about what my voice was and who I wanted to read about if I was the audience. There had to be balance. Truth be told the world is a mess and I felt lost and disheartened to be in it.

It seemed that I had to shed my joy to shoulder the ever burgeoning burden of need. I feel that Jarrettsville Vet needs to be the answer to all of the pet problems in my community. Jarrettsville Vet also has become the place I spend the biggest part of my life. I am not alone. I know many other practice owners of every other kind of business share this ideology and compulsion. It can take you over. There are many vets before me who have given up everything else to the point that they don't remember, recognize or even reflect on what life used to look like.

We call it our "work-life balance". The terminology the new grads throw around in interviews when they chart the 'pros' v 'cons' list. They have to feel like you aren't over loading them because they need to preserve their "work-life balance". To which I reply, "you just got out of vet school, you never had it and you shouldn't be protecting it now." But I am not that predecessor and these are millennials. They feign from intimidation and crumble under pressure. They don't want any advice that I have short of mentorship on a healthy, less than 40 hours a week.

For me the balance has not been re-calibrated and the work became the life. Hard as I tried to be savvy and see it coming.

The request asked for 5 stories and I had three Herriott-esque ones from my first year out,, none since then. The reflection in the blog mirror proved I had become what I saw coming, drove into, and plead no contest to. Sure, I could dismiss it, pardon it, or even refuse to believe it, but, it happened.

I lost the puppy in the exam of the search for congenital deformities. The purr in the auscultation of abnormal lung sounds. The wag in the assessment of neurological function. The joy in the patient that is more than the sum if its parts. The emotional had succumbed to the analytical.

I needed, I wanted, and I had better take a second to stop and smell the roses. I at least needed to take pause to check my own health status.  There has to be a funny, cute, happy ending story in my day?

Maybe I will try to find the comfort in the challenge of the situation?

Maybe I will just try to recognize my own reflection and ask her if she knows where I went? Or if I just temporarily misplaced her?

Maybe too many of us work harder to find the balance and can't stop the pendulum from swinging higher as we jump from side to side?

Maybe all of this is what makes the greatness within the greater good? Or, maybe I let the grindstone take my nose to spite my intentions otherwise?

A happy ending lives here
About me;
I am available to answer  pet questions for free if you visit Pawbly is an open online pet community dedicated to educating, empowering and inspiring pet parents around the globe. 

I can also be found at Jarrettsville Vet in Jarrettsville, Maryland for appointments, or visit us on Facebook

I am also on Twitter @FreePetAdvice. Or check out my YouTube channel.

Thursday, May 25, 2017

Lost In The Sea Of Need. When the Vet Needs the Advice.

Hello Everyone,

While my usual blog posts are about my veterinary life's stories and experiences in an effort to educate and inform the public about the pet needs I see as imperative to overall pet health and welfare this post is different.

In this post I am asking for YOUR advice. Hard as I have tried I don't seem to have figured out how to come to peace with how to not feel compelled to help those pets and their parents in need.

Weasely's Story

Here's the typical scenario...

The phone rings and someone on the other end of the line is desperately pleading for help for their pets condition that they cannot afford to treat elsewhere. We have gotten calls from across the country, the Big Apple (where everything is astronomically expensive), to around the globe (these are especially puzzling. How do I help you in South Africa?), to our own backyard.

Whenever possible we offer the following;

1. Come in for an exam and assessment. We will give you an honest opinion and reasonable prices. We are also full-service which implies we can do the work-up and surgery on premises. It is the whole reason we publish prices and cases.

2. We offer options. Options come in all sizes, shapes and scenarios. They can be life-saving and/or life changing.

3. A chance. Often we just offer a chance.

Some of these cases involve an ambiguous undefined disease process that after a quick exam are deemed "lost cause-leading to pro bono euthanasia". It may sound cold and cruel BUT life can be exactly that. We see cases that are so progressed and difficult the prognosis is grave and eminent. This is suffering without tangible hope to improve. These are the cases where mercy was overlooked at the last rest stop. These are the cases I feel compelled to intervene as the last option for empathy to provide peace. Even with these too-little-too-late cases; a client without resources, a pet dying in front of us, and no real way to provide even the most bare-boned plan for any chance at remission or cure, even then, SOME of these cases are not provided a consensual to euthanasia. If you think suffering is bad, dying without hope, or, hospice care, is worse. Despair is unavoidable, but, the crippling inability to relieve suffering is cruel and criminal. It is as unsettling as the suffering you know is occurring. It is where my words need to be concise, direct, and well-intentioned. For these cases clients have to step outside of their grief, their blame and their denial. These cases call for real-life intervention. They are not frequent but they do happen. I don't need advice for resolving these cases. I need advice for how to notify clients to avoid them in the first place.

One of the pets who needed us.

We, the whole lot of us in veterinary medicine, need help in providing guidance so that too late isn't when we are sought to begin. 

What is the most basic tidbit of advice I can give them?

Don't assume that you don't have any options, OR, wait so long that you don't have any left. 

I need help in spreading this message!


Here is a real-life example.,,

We received an email asking to help a dog with a suspected pyometra who was living in the DC area. The dog belonged to an older woman who didn't realize how sick her dog was. Her daughter was visiting and on inquiry was told that the dog hadn't eaten or gotten up in days. She rushed the dog to the local vet to be told it was likely a pyo and the cost would be upwards of $2,000. They, like many of us, couldn't afford this. They went online looking for affordable help. They found me, via this blog, and called the clinic looking for help. This was on a Friday. We offered to see them but explained that we don't do surgeries on Saturday or Sunday and urged that they call every shelter, rescue, and vet they could asking for a quicker surgery and a way to afford it.

The next time we heard from them was Monday morning. We saw them on Monday night. By this time the dog was almost in a coma. She couldn't stand, walk, or lift her head. Her color was purple-blue knocking on deaths door. She was labored to just try to breathe. They had $300.

I made myself a promise many years ago to never walk away from a pyo or a parvo. Two savable conditions that never survive with a death syringe, but often surprise you with skill and time.

The conversation with the owners went like this...

"I'm sorry." Anything and everything that could be said after was irrelevant and shaded with unneeded character references.

The conversation with the staff and associate vet seeing them was that they couldn't afford even the most pared down treatment plan. Three hundred dollars wouldn't get us past anesthesia and antibiotics. They needed a $500 surgery on top of these to remove the rotting uterus festering inside of her. Even if we offered to use the Good Sam Fund (overlooking that fact that they aren't a client) this dog needed to go to the ER after and that was going to cost at least $500. The ER isn't going to admit a dog without a deposit. If I had to guess I gave her a less than 10% chance of making it through surgery even if they had enough money for the intensive care she needed to provide any real chance at survival. It is not about the money, it is about what is fair for everyone involved. I didn't even think she would survive surgery  and I felt that it wasn't right or fair to them to take the little money they did have for a patient who wouldn't survive.

When I explained this to the client she said she wanted to take her dog home.

While I had elected to withhold my previous chatter to spare the client from feeling any more sadness than they already did, it was time to be the advocate for the patient.

"What can you do for her at home? She needs medical and surgical help that you haven't been able to find elsewhere. I am afraid she will die on the way home, and even if she does make it home she will probably not make it through the night. How are you going to feel if that happens? What do you think you would want if you were in her position? She is dying and she is suffering."

After 30 minutes of deliberating they put her down. Everyone felt better after. It is something we don't often admit, but, peace can come after death.

Sweet Baby Rae.. mom needed in patient help Baby Rae needs a home.

I need help in figuring out how to not get cases at this point. 

The next scenario is the more common one...

The phone call goes like this...

"The shelter/the vet I go to/my friend told me to call you and that you could help my  pet...."

Nothing (yes, NOTHING!!) burns my butt like my neighboring vets referring cases to us that they can do, but don't want to do because the client lacks the money up front. These are YOUR clients and YOUR patients...  Shouldn't they be YOUR responsibility? Or, do you just help those who can pay upfront? Take a note from our play book. Use CareCredit! Offer third party billing! OR, ask for help from your compassionate clients who WILL HELP IF YOU ASK! Heck, you might even get more Facebook likes and more clients because you CARE.

Yes, these clients often have little to no available money, BUT, they all have desperate and dying pets. They all also have DEAD pets if someone who can help doesn't step in. 

When one of our patients is surrendered at a shelter we go and get them.
Beignette,, she needs a home too.
What might happen if you surrender your pet at a shelter.

So my friends,, 

WHAT SHOULD WE DO? How do we make an impactful, meaningful difference for these pets? 

For those of you who aren't familair with how we extend our help to our clients in need, here is a review of our policy;

1. We do not deny care to our patients when they are in need. Emergencies may need to be referred on a case by case basis, but, we will assist the pet if it is safe to do so. 

2. We do not offer "economic euthanasia" (euthanasia as a means of treating due to financial constraints).

3. We provide multiple ways to pay for needed care. 

4. We provide the option of signing over a pet to one of our affiliated rescues if the burden is more than the client can or will provide for.

5. The vet has the option of providing pro bono care IF they want to, IF the case has a reasonable chance of survival, and IF we believe the client can follow through with the after care needed to insure successful resolution.

6. We don't treat a good paying client's pet any differently than a struggling financially client. Their pets have exactly the same diseases, conditions, and needs. Financial profiling should be so distaseful and shameful that the profession should take a stand AND do something about it! WHAT ARE WE WAITING FOR? A MUTINY? A competitor to figure this out (P.S. It is my dream to have PAWBLY be that meaningful change for these animals).

Extension outreach foster family

Here's where I need help! 
  • What should we do so that we can provide meaningful timely help?
  • How do we extend that reach to people who aren't local?
  • Can we convince other animal care facilities to be both the business and the provider when the situation is complicated and resources are tight? If we haven't been able to do it on the human side can we do it on the veterinary side?
  • The rescues think the vets are the problem (we have priced ourselves out of accessibility AND we don't care), and the vets think it is the public's problem (after all if you cannot afford a pet you shouldn't have one). Meanwhile pet is sick and dying.. don't argue when the need is in front of your face.
  • What does your vet do? Have you ever asked "what would happen if your pet needed something that you couldn't afford?" Are you prepared for the answer?
Thanks everyone for reading and contemplating. I am all ears.. let the ideas fly!

One of our TNR friends.

Related Blogs;

Jarrettsville Veterinary Center For Clients With Financial Constraints blog.

Affordable Options Are Everyone's Right.

Rescue Economics. When The Expense Costs You Your Ability To Care.

If you want to help pets please reach out to me. Leave a comment here, join me on, or find me at the clinic Jarrettsville Veterinary Center, Facebook at Jarrettsville Vet, Twitter @FreePetAdvice, or YouTube.

Together we can save lives! It is who we are and at the heart of every pet parent and animal lover.