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Friday, August 9, 2019

Hope. Stealing, Losing and Resurrection. How the fate of veterinary medicine hinges on hope.

Fighter. Maybe not a "prized fighter," but, none the less, fighter. This is my job.

Driving home last night it hit me. I fight. This is what I wake up, diligently-doggedly do all the day long, and then attempt to subdue myself out of each night. And, I do this every-single-day.

It's exhausting, don't get me wrong. I'm sure that there wasn't some detour along my life-path where I made a conscious decision to become this person. Live this life. But, alas, it is the one I recognize as my own now and I wonder if I am alone? I suspect I am not. There is great angst in always being cortisol-intoxicated to fight the next brawl in the next room. Junkie-syringe slasher style. This is the stuff ER doctors, race-car drivers, Navy Seals, and inner Baltimore City high school teachers are cut from.

Many vets are compelled into vet school to be that healer of furred affections. I took it a step further. I started to advocate, demonstrate and change the way I lived my life because of how I saw the world treating, or rather, more aptly, mistreating, animals. I couldn't live to save some of them, the "pets" and eat the rest. Or, wear the others. Ask the moms at my clinic who have chickens, cows, goats, or pigs as "pets" if they can eat them? Resoundingly the answer has become "NO!"

The fighter evolved. She grew. She came from that place where you recognize all living beings are looking for the same things. A place to belong. A family to love them, and a day full of liberty and freedom within the world around them. At our most basic level we all want to be free to live our life as our soul tells us to.

The fighter in me has molded the doctor I became. The person who sees each patient who walks in as an independent life worth saving. An integral part of some persons life that is incomplete, emptier, and less valuable without them.

When I started to fight for more than I was, more than I needed, and more than I had to, I realized that the most important part of that fight was the hope it gave to others. I realized that where I saw a fight they saw a chance. A glimmer that it was not all as hopeless as they feared and they didn't have to surrender in desperation to avoid their companions suffering.

Hope is abundant and yet it isn't shared enough. Why? Why wouldn't we give away the few things we veterinarians have in our over-abundant, yet too often over priced tool box for free? Like confetti? Why aren't we casting it like raindrops? Why isn't every single case started from this place? This mantra;?

I will fight for your pet,
and,
I will not steal, squelch, or dismiss hope, ever!

Why doesn't every healthcare decision start here? Universal investment at ground zero.

Now I know the pessimists out there, the jaded, angry, and lost are going to balk at my over optimistic view. They are going to lash out the defensive, dismissive banter about why this isn't realistic! Or, why it isn't even responsible. God forbid they even throw out some legal crap about liability in the face of unethical moral conduct.

So, to all of them here's my real-life professional advice to this beaten, broken, angry, over abundantly suicidal profession. We aren't God. We have to get off our power tripped judgmental pedestal. For ourselves and our patients sake we have got to stop being so brash and burnt that we spread that pessimism like a plague. We are all the same, each of us is a practitioner. There isn't one person who knows everything. None of us have some magical crystal ball that miraculously tells the future. We cannot spew a diagnosis to our clients who so often come to us with few, if any, resources for the diagnostics they need, like a magic 8 ball. We, more often, and too many more times than we want to admit it, we just don't know. We don't know what's at the core of our patients issues more often than not.. And, if we don't know the diagnosis why are we even speculating the treatment options, never mind their associated costs? Why, because we think we know. We think we know better than the parents who love them. And, erroneously, we think we are liable and/or responsible for these. We aren't. We are supposed to be honest. We are supposed to be advocates for our patients. We would all be better off if we were just verbally and emotionally open, honest, and humble about the depths with which we do not know. We are also supposed to protect the public who shares this community with these patients, but, these are exceptionally rare cases. Stop using fear as bait. Stop telling our clients all the stuff our lack of diagnostics can't rule out. Be honest. Treat people like the loving parents they inherently have to be if they are going to walk in your door and ask for help.

We would also benefit if we all allowed hope back in to live in medicine. If we all fought for it we wouldn't be killing ourselves off in numbers 3 times higher than the next statistic of the next most depressed profession. We wouldn't be emotionally bankrupt and our debts wouldn't be mounting. Our guesses are too often incorrect, assuredly without being medically sound, and these cost lives. It burns souls, and can destroy the lives of those people who call upon us for help.

When my Jekyll-pup was diagnosed with prostate cancer, one of the most deadly types a dog can encounter, I sought and bought hope in bundles. I specifically sought out an oncologist who doesn't carry a medical bag with rationed  portions. I sat down with her on day one of our journey to help my pup with an agenda. I needed to feel like I had  teammate on my wrestling squad. I also knew that I needed a map to start our journey. A place to begin, and a speculative place (or places) to stop. I knew I could, would, and even was ok with visiting crazy-town along the way. Crazy-town for a vet like me is that place where the stuff no one else conjures as 'acceptable for a pets quality of life' resides. I was concocting up novel surgeries to re-route the urethra around that pestiferous prostate. I could rebuild him, make him better, stronger, (not faster? maybe?) then he was before. I had the technology to build the first bionic beagle! I knew I had this fighter in me who wasn't going to surrender my beagle without a knock-down-drag-out fight! I knew I needed help with navigating myself away from crazy-town. My oncologist, Dr Jeglum, helped me stay hopeful while not going all Oscar Goldman and Dr Rudy Wells. We agreed to keep trying as long as Jekyll needed us to. We wouldn't stop at the conventional. We would try every option, every possible combination and therapy. I was hoping for more time, which I got 9 months of, while buying hope in bundles I bought time in months. I needed these to get me through his passing. I needed him to be living while I was fighting and then I needed to be able to go on without him at least feeling as if I had done everything I could for him.

People pay for hope. It is a valuable commodity and a religious tenet. Whole civilizations were started there.

What I see far more often is people who have been dismissed, over looked and cheated of options. Options that have hope intimately anchored to them.

Why???!!! Why would we ever NOT give options? Are we so lazy, so jaded, so indifferent that we can't take the extra time to sit down, look into our patients eyes, see the soul of a fellow being as still fighting for their life and their time in the sun of this planet we call home? They still have a life to live. A soft patch of grass to submit to. A warm purring tune to play on our laps. A day to make better for the human that adores them.

I see the cases that other vets have denied hope for. I see the cases no one else took time or interest in fighting for and in them I found the reason to keep going.

Where it has brought me is to this place, driving home, where I want to exchange the fighting gloves for the surgical gloves. The place where tears of pet parents change from inability to accept fate to hope filled possibility. We all want to face life, our mortality and the lives our days have accumulated into as this, Hope.

Never steal the hope. It is the single greatest gift we can give.


This week brought me two crying clients.

One was Joey's mom. Joey passed away this week. I had been taking care of him, his diabetes, his urinary stones, and his omnipresent smile for a year. He was built of defective parts. They eventually quit on him, but, he never quit being joyful. His mom told me, as we were talking about how far he had progressed into multiple diseases with little hopeful outcome that she trusted me because I was "the first person who spoke to her, not at her." She loved her Joey and I know that as I write this she  is at her home missing him. She has had 5 strokes over the last year and Joey was her only constant companion. She had to let him go and I know it is hurting her immensely right now, and will for the rest of her life.







The second case was Spencer. He is 12 years old. A lab. Most labs are lucky if they see a dozen years. His years had brought him painful joints, diabetes and blindness. He also had a huge ugly, awful death smelling tumor on his wrist. Someone had decided he wasn't worth options. The tumor grew, as tumors will. It got so big it couldn't feed itself, so, it started rupturing and dying. Dead carcass is fetid smelling. You can actually be alive with dead tissue hanging, falling and breaking off of you.. This is what his tumor, on his wrist, was doing as he stumbled his way along.. wagging, lab-fashion the whole way.







His mom was hysterical when I proposed we remove it. "No one ever told me it was possible." She was a new client. New that evening. Spencer was not a good surgical candidate, but,, this was his only hope. We were either going to save him from his tumor, or, euthanize him because of it. She told me that "this was the first time anyone had given her hope for him."

Here are his post op photos;






Here is his story.. in video time.






I cannot save every life, in fact, every life I see, help, embrace, will be lost. We all die. I have to tell every client this. That at some point in our journey the road will end. There is always death. But along the rest of this road there is love and with love there is always  hope.

If you are a pet parent and your companion is struggling there are ALWAYS OPTIONS! ALWAYS! And please never lose hope. You can lose everything else in life... hope is given away. Relinquished, and no one can take it from you unless you surrender it.

If you need pet help please reach out to me at Pawbly.com. It is free for all to use. If you have a pet story you would like to share please add it to our collection.

I am also available at Jarrettsville Vet and YouTube.