Being me... Who do I blame for my grief?

This is a blog written in response to a meeting I had with a group (I'll call them Joey's Group) getting lots of attention in both the private arena of veterinary medicine and the many veterinary groups where vets seek shelter from the too often cruel world we live in. Pet parents who feel their pets suffered at the hands of their veterinarians  are growing angry to the point of building support groups centered around their pets injustice. I contacted them to try to understand their feelings and thoughts as well as try to understand their advice on how to resolve the injustices they feel are occurring. I also feel that I align with their pain more often than the vet forums my profession has created. I love my pets like they are children. My life is devoted to them. Losing them is an unbearably painful experience. Trying to imagine how that grief would change when I believed my pets loss was due to malpractice would probably make that pain morph into anger fueled by seeking retribution just so they could hurt a little bit as much as I was. This group wants more accountability, more legal means to seek compensation, and license consequences much harder and easier to obtain than presently found in the veterinary leadership. These members are hurt, angry, and now organized and seeking vengeance. Here is my attempt to introduce the difficulty that being a practicing veterinarian in this climate presents. This blog is not to chose sides, it is to attempt to inform based on my life's experiences.  

Our annual vet clinic Pets With Santa photo

I love my pets more than anyone could imagine. I also know that when it comes to that time of losing them it can cripple you. I have felt as so many of us do; that no one can understand my grief, my loss, and that only I can feel my palpably paralyzing pain and suffering. What do we do when the grief is so consuming? We either fall into ourselves as the introvert and hole up with the hopelessness so it drowns us in despair that feels too suffocating to begin to contemplate addressing, or, we lash out. We use our anger to fuel the pain of the grief that we know we must do something about, but, don’t want to lay up all emotional over. Putting that grief to something that makes a difference, fuels a purpose that gives that life you miss so tragically meaning, well, that’s the harder, longer more arduous path.

I wish that I could tell you I consistently chose the last. Unfortunately, I am a mom who has tragically and utterly bereft with grief in losing my two beagles, and my dear diabetic cat who (almost) broke me. To make their death even more bitterly corrosive I feel that I can only blame myself for their passing. I am after all a veterinarian, shouldn’t I above all others be able to make miracles happen? Isn’t that the reason I went into vet school to begin with? I dedicated my life to them, my career, every tiny tidbit of my professional knowledge base just so that when the time came that I needed all of those tools, resources, pearls of knowledge, I could bestow all of it into some cumulative tsunami of healing re-genesis. My kids, my dear beagles, cats, (and yes, two potbellied pigs), were, and, should have lived forever because I have spent every moment of my life to make that so.

My Storm. Who saved who?
Rescued before minutes before euthanasia. He had just been surrendered to a NC shelter who was about to kill him as they all evacuated an impending hurricane.

Of course, life is that elusive magical thing that only insures one other thing; death. We are all going to die. That inescapable ending looms for all of us, even those of us who deny it. 

What do we all have in common? How do we start to understand why I react, or not, so differently than you? We all love our companions as our own family. We allow ourselves to be vulnerable. It destroys us when that leads to heart break. My dearest friend lost his mom and his dog within 4 months of each other. What hit him harder? His dog, he confessed. I just last week lost my mom after a swift devastating 6-month battle with breast cancer. I have also lost numerous dogs, cats, pigs, and although each one reduced me to a puddle of emotional waterfalls, but my moms’ passing lingers in a different way. I can’t even quantify one versus the other, but, where grieving fatigue burdened by responsibility pain struck me with the pets, I am angry-furious about her loss. It is a different kind of anger that I didn’t have with my pets. Why is that? Well, because in my mom’s case I wasn’t in charge of medical care. Her medical team (all 20 or so of them) smiled, held her hand and then went on their merry way to their next patient. They gave paltry advice in dribbles of meaningless drops, and in the end, they failed her a million times over. She died in pain because it was the only way to treat her relentless and excruciating pain effectively. Palliative care was an afterthought. I say that because for 5 months her biggest single request was help with paralyzing pain. Always too little too late. I blame them not for her cancer, but for her suffering. I have lived a life as a practitioner never exchanging one for the other. Palliative care is as much apart of every treatment package as antibiotics and vaccines. They are interwoven, interdependent and unwaveringly provided upon each other. Diagnostic tests, referrals, care in all forms and fashions ALWAYS comes with the patient’s comfort placed first and foremost. Her doctors wanted tests with answers before focusing on her pain. When asked what she desired most she would reply every single time with the same singular answer; "help with the pain." They got all of their tests, (which took forever as she suffered), and she was only pain free for the two weeks before her death. Furious, unethical, malpractice. She, and all patients, deserve better. So, you see I understand loss and grief, and yes, blame too. Where do I go with this? I make my decisions as a veterinarian with an open honest heart. I remember with each patient that my job is to serve them, my furried calling, (the puppies, kittens are the ones that break you). You see as veterinarians we have to serve multiple parties. Too often I have to make an immediate on the spot and under great duress choice about loyalties. In some cases these cannot always be to serve my clients, the people holding the leash as their motives are not as transparent. Human motives are complicated, sticky, and it makes me incredibly vulnerable to try to unravel theirs as I try to focus on unraveling my patient’s needs. Add to the burden of paying clients seeking care that is not always putting patient needs first, I also have to answer to public health threats and law mandated requirements. I truly have to decide who outranks whom. Do I put the patient first (my heart always does), the government public health requirements (ever worried about whether your life is in danger because you might have been bitten by a rabid animal? What about the four year old kid that was?), or, the client who is abusive and threatens you if you don't give them what they want? (Ever gone to court to get a restraining order on them because you really fear they will show up and unload an automatic weapon on the whole lot of us?).

I want to end my moms story with a few thoughts. I went with her to every appointment. I brought every concern to their attention. I asked my mom at every interaction “what her goals were?” I never, ever let them lose sight of her in their process. I have a very clear conscious about what my intervening on her behalf brought us. She is not me. I fight. She wanted to be comfortable. Do I wish I had mettled with her medication plan? Yes, I would have adjusted it every 3 days when it failed to deliver. I would have put my license in jeopardy as they were unwilling to do with theirs, (I suppose?). But she would have passed away sooner, which would have been my choice, it wasn’t hers. I have to forgive for the things I cannot change. I am working on it.

My pups. My life.

There is a bond we have with our pets that elevates them to children, best friends, companions we fear we cannot exist without. That’s what all we have in common, you, the pet parent, and me, the veterinarian. That love, devotion and companionship drives us to madness, feeling broken, shattered unable to go on without them. It is loss at its most intense and we try to replace that loss with suffering elsewhere. We try to blame. I live it, I know it, and I also know why I do it. But, I also know what it is like to live a life as a veterinarian who feels vulnerable because I am a human. I make mistakes, assumptions, and I am asked to be someone I am not too often. I am not everyone to every case. Human medicine is built upon referrals. Clear defined lines in the sand with boundaries. My mom was shuffled to the point of being a patient under numerous specialties; oncology, surgery, nephrology, general medicine, and even mental health. She was not my mom for those few minutes in their office that she waited weeks for, no, she a time slot and a quick visit, then shuffled to the next hat in the next specialty. All of that fractured care meant not one of her medical team was personally invested. That’s what veterinarians never hope to be, and yet, pressures dictate we must too often. 

My Fripp. The girl who reminded me I could forgive, move on, and love again.

Perhaps this all sounds foreign to you? Let me try to explain how different it is to be a veterinarian in a humans world. This is how your vet sees you and your companion in a time of medical need;

• Established client-doctor relationships. Does your vet, or this vet caring for your pet, know you? How can I if time hasn’t provided the luxury or history? I am incredibly blessed now to have been at my practice for 15 years. The first five were painfully rough. I wasn’t the vet they were used to. I wasn’t the old charismatic-charming-congenially and perpetually smiling guy they had know for over 3 decades. I was the newbie. Which pretty much equates to "worthless". Having the advantage of knowing your clients allows the assumptions (the deadliest part of this profession) to be a little more palatable. For example on an almost constant basis I know based on previous experience how each particular client values their pet(s). I adjust my internal and external patient plan based on this. 

• Value is influential. I suspect that based on knowing and being a part of Joey’s audience, it was the most influential factor. If your veterinarian had known what the value your companion brings to your life it would have, (might have?), changed everything? If your pet is your life tell your vet. Ask for "gold standard" of care. Make it public knowledge that your pets life is of paramount importance to you. You may assume that everyone feels this way about their pets. That everyone thinks the sun rises and sets on their whiskered wet nose, but, believe me they don’t. Here’s what you don’t know. Loads of people do not love their pet as much as you and I do, or, even a tiny fraction as much as you do. Or, they have struggles in their lives you cannot imagine, nor perhaps even relate to. If I know I cannot be the Jack-of-all-trades to every patient don’t I also know that I cannot be the vet to all people? Should my absolute requirement to keep my business alive, which is also the lifeline to my staff, influence who I am for them? Do I take on cases I know I want no part of? Can I afford to do that? Decades ago it was expected that every vet take on every case and you that you adapt to the clients needs and demands, and, you do it without judgement or personal reflection. The vet I bought my practice from was beloved. I had shoes impossible to fill. I was lucky enough to not need the same degree of financial stability most other new practice owners, and, new graduates, need. I got rid of (yes, harsh term but true), about 30% of his clients because trying to be who they needed me to be was going to kill me, or, at least bankrupt me emotionally to the point I would have to kill myself (in some degree) or walk away from the part of me I had worked forever to manifest. He was the vet to everyone regardless of what that meant to the patient. He had clients who wanted to euthanize because it was cheaper to "just buy a new one." And so he did that. I am not second guessing his decisions, I am merely saying I couldn't do what he did for the reasons he did them. He never lost a client, I never euthanize a treatable patient. There is the right vet for you out there. I wasn’t the right one for part of the population he called his own. Maybe it would be helpful for every client to know their vet as much as they love their pet before disaster strikes? Understanding a pet’s emergency warrants a referral to an emergency facility. Understanding that they don’t know you, or your companion warrants a willing ready and able compromise that you are going to pay twice as much at the ER as you will almost any other general veterinary practice. Being honest implies a degree of humility that all sides are arguing for more of. 

• Money decides almost every case. There is almost no pet insurance in this country. Humans can walk into any ER at any time with any condition and they must be treated. Not so in vet med. You walk in and you are expected to pay. I can tell you that most clients decide patient care (even for their most beloved companions) based on price point. If you have a price point you are obligated to state it up front. If you don’t have budgetary limits go to a referral hospital at every occasion that your pet is not acting perfectly normal. It may not seem intuitive but let’s use human medicine as the example. Asking your GP to see you when you are vomiting/diarrhea blood, or poorly responsive, or purple, labored breathing, weak, unstable, etc., is ludicrous. You know, at least I hope you know, that every single human medicine receptionist and answering service in the country starts with “if you are having a life-threatening emergency please hang up and go to the ER” statement. For all of the veterinary audience expecting human grade care go to the ER, not your vet, at the onset of an emergency. You will absolutely need immediate access to funds. These days you should expect an upfront deposit of, up to, and perhaps significantly more than, $5,000 available on credit cards or in cash. Do you have that if it is 2 am on a Sunday morning? The expectation that your companion is your life and we veterinarians are all about the money leaves us no place to move forward cohesively or productively. This is the dilemma vets face every single minute. Invested and devoted pet parents want the highest standard of care, but, they cannot, or too often, will not, pay for it. Try being everyone at every price point to strangers. It’s a landmine field of fear-based existence. It is one of the many reasons we have the suicide rate we do. 

• Blame the other guy. The best way to understand who is to blame is to accept that we are all party to the case at hand. The rest of the hurtful banter is fuel for litigation. Where most victims feel that they had no party in the disastrous consequences that unfolded I can say from experience that losing a pet is not always unavoidable, but, if all parties were respectful, kind, patient and willing to listen the outcomes don’t need to scar everyone indefinitely. Medicine costs money to access and provide. I often have clients come to me with an open admission of having “$50 only" for care. The exam at my clinic is $45. Can anyone really expect a treatment plan for $5? Yes, they indeed do. Where others would say it is impossible, I would add it is my ethical obligation to try. In all cases of a client with a pet in need every patient is seen. After that an open honest conversation is had. The truly compassionate people will listen. The others get angry. Here is how these real-life cases unfold. For $45 dollars I perform a thorough physical examination. I am obligated to give my honest assessment. I rarely know the diagnosis by an exam alone. I then offer my diagnostic plan and proposed treatment options. A list of all of these are made with the appropriate cost estimates for each. If everything needs to be declined we focus on the treatment options. If all else fails, i.e. we cannot find a friend to help financially, we construct the best plan possible based on the options at hand. I will write a script to be filled at a big box store, or, donate to the cause myself, or, use funds from our Good Samaritan Fund, or start a social media campaign (with permission of course), or even offer to have the pet surrendered if the cost of care and, or, follow up care is believed to be too great. What often happens? A client gets irate. I hear things like, “I am all about the money.” Which I clearly am not if I let them come in the door with only $50. Or, worst of all, “I would rather have him dead than with anyone else.” Well, doesn’t that let me know how invested you are in your companions life? Those are the people I know I cannot help. The anger will kill us all. It makes it hard for me to like what I do, hard for me to remember where my allegiances lie, and hard for me to find that common ground. Anger will be the death of medicine. Not malpractice, not mistakes, liability or standard of care. Anger. You cannot love and let anger rule. Think this isn't really true? Meet Mufasa. He is at my clinic now. More on him here.

• Mistakes happen. People aren’t prepared for the emergencies that present. (That is the clients fault, right?). They aren’t prepared to make on the spot hard decisions which have to be made because pets aren’t people and the ER cannot provide care without consent. (Which we should add would also influence your ability to euthanize when you feel "it's time"). My mom, well, I wish she had this option. Suffering is something that should only be saved for the human who elects it for themselves. We've already discussed how people are expected to know things they cannot know; like whether you love your pet above all things. Whether you can care for a sick, debilitated animal, and whether you will walk away from telling the vet “to do anything and everything possible” and not feel like your vet profited from your pets ending in suffering. Who makes these mistakes? Are they all based on assumptions with unrealistic expectations influencing a vet to offer any and all possible treatments, even if they think your pet is going to die anyway? There is a consequence to every action and decision. Isn’t it more honest to say that both parties are responsible for a pets care and eventual outcome. Vets love to use the line “if you cannot afford a pet you shouldn’t have one.” Or, “having a pet is a responsibility, not a right.” Both are so offensive they drive a wedge of hatred into our clients we ask to trust us. Both are so counterproductive to both sides we must abandon them.

• Resilience. Why are the vets so cold and callous? Well, because life, our ability to survive, and I use the tag line all the time, “we all have to get out of this alive,” depends on our own resilience. Try euthanizing a treatable puppy because its owner knows its cheaper to euthanize than treat, and that puppy has about a $50 value to them. What would you do? Let’s add the fact that if that owner tells you to euthanize you have two choices, euthanize and harden your heart so you don’t have nightmares for the rest of your life, or, say no, and imagine it being drowned in the bathtub at their home. Which by the way is legal, and/or at least almost impossible to prosecute. Most vets know the death at their hands is far more humane, so we do it. How do you feel about our life choices now? Oh, and for all of you delusional Polly-Annas out there, I always, (ALWAYS!) offer to take the pet myself. Want to know how many people take me up on that offer? Less than 20%. They are offended. That makes them feel like they are a shitty person. They would rather have a dead pet than feel responsible.

• Abilities. Do you know how hard, like impossible it is to be the Jack of all trades? How can you be the master of any while you are trying to wear all of them? This expectation is unrealistic. A good vet will try to dabble only to be able to recognize when it is time to refer to a specialist. Think there isn’t a can of worms with that? You would be wrong. Many clients will become irate at the mention of a referral. Why would I dare assume that they can afford that!? If I can’t fix it, then, it isn’t going to be fixed (thanks for the pressure). Or, (and this is the excuse I most commonly get) “Doc, I trust you. I don’t know them. I don’t want to bring Fluffy anywhere else.” To which I always reply, “thanks, but we are here to do what’s best for Fluffy. She will be better served by someone who only focuses on this particular ailment.” What I really want to say is, “you are setting us all up for disappointment, despair, and an unhappy ending.” I would guess that 75% of the time people won’t go to a referral. At least on the first visit and recommendation. I can get a client to go about 50% after the third request for a cardiology consult.. that’s usually three years later. Not the optimal time to intervene on a heart condition. And yet, still I am so grateful they finally are willing to go I would never elucidate that disappointment. Think a human GP would do a heart assessment on you because, well, ya know, you know her and it is so much more convenient to not have to make another appointment or waste a trip elsewhere. NOPE!

People are hard. Pets, the whole driving force that veterinarians chose to work harder, make less money and deal with grief that drives a suicide rate every single pet loving person should be compelled to act on behalf of, are easy. Pets will not give you a false sense of security. They won’t take their grief and use it against you. They won’t blame you for loving them, although they aren’t always understanding of i.v. catheter placements, nail trims, and restraint. They are pure live in the moment unconditional love. They are why clients, heck even ourselves go a little crazy on the grief scale bereavement.

After all that spilling my guts to you, ranting about how incredibly hard my job is, how I am routinely set up to fail, asked to do impossible things and then expected to be a whole, fulfilled person on top of that, where do I go now? I am brutally honest. I fess up. I make hard calls. I clearly know that I am in the profession I have always wanted to be in. I treat people fairly. I love unconditionally (patients absolutely, people I am trying). I do not judge. I assume everyone loves their pets as much as I love mine. If they don’t they need to find a vet that suits them. I say no, a lot, and I stand by it. I don’t do convenience euthanasia’s. I don’t turn away clients who need me. I am transparent, honest and accessible. (Want to see for yourself? Go to my YouTube channel, my blog KMDVM.blogspot.com, or Pawbly.com to see real-life cases with costs of care included.) I stand by my patients every  time they need me. I call the authorities on neglect cases, and I stick my neck out for pets every single time. It has cost me huge. I will walk away still liking how I am, even if others don’t.

What is my job now? 

• Forgive. I have to know that I always did the best I could. It was never able to be perfect, but perhaps the flaws remind me that it was real. I got to live it. The textures added the uniqueness and that was what made it recognizable to me as my own.

• Let go so I can love again. Jumping back into another companion has always been fraught with too much scrutiny to make it easy. The one truly amazing part of my profession is that the more I put myself out there to help the more disastrous cases I place myself in the path of, (the moth to the flame), the more lives I learn I could make a meaningful change to. Hiding as the introvert so my grief, fear, anxiety and depression wallow over me leaves me just there. I may not be able to see out of this place when I am in it, but, damn I hate only knowing that landscape. Go to a rescue, hug another pet just for the sake of feeling their warmth. Jump back in. you will never be ready so don’t wait for that stop on the road of life. Try. You may fail, but the real magic only happens in the risk taking of trying.

• Not forget the whole reason I came to this place. The joy my kids bring to my life and the perspective I have to chose are those that tell me my life still has purpose. If I allow myself to stray from who I came here to be, allow the pain and loss to define me how is that a memory worth preserving. Action is an admirable quality. Putting someone before you is unconditional love, and remembering that forgiveness is the peace gained from a life well lived if only how it brightened others is the real magic to a perfect love story that never lasted long enough no matter how you tried to preserve it.

To the vets out there still assuming, still wondering about the expectations of our clients we don’t know well enough to dare to guess, and to those of us struggling with not being perfect at every avenue of medicine, I want to remind us all that we know who we are. Why we came here. You have to get out of this alive. For me, that is doing more than I have to. Being braver than I think I can be. Jumping back in when the lunacies of life pop-up in front of you, and yes, helping every furried creature that crosses my path. I cannot save them all but I am damned sure never going to stop trying. I have to take only myself to my grave, I darn sure don’t want to spend eternity with her still being angry that I didn’t try, and still like and respect myself along that long road to my coffin.

Here’s my advice for Joeys members;

1. Interview your vet beforehand. Tell them who you are, how you feel about your pet and what you are willing to do for them. Put that in your pets (all of them) medical records.

2. Expect a bigger bill when an emergency strikes. Also expect to be sent to an ER. Be prepared for both of these and be grateful for both.

3. Go interview the ER. If you are unhappy with them interview others. Here’s a pearl; go to a veterinary teaching hospital at any and all times possible. They are exceptional in all areas of companion care. You will never get better service or a more reasonable fee. 

4. Avoid corporate veterinary care if you are financially restrained. They are, in general, less willing to work with clients who need help with cost of care. 

5. Have available credit for emergencies. They will happen so you should be prepared. 

6. Ask to record every moment of every conversation with the vet (write down their name(s) and vet staff (names). If they are recording you, which most are, then you should be granted the same. If they decline write every word of every conversation down. Leave a copy with them as you leave. Paper trails matter more than any other piece of legal fodder. Sign the copy of the account and make a copy for them in their presence. If they deny a copy make a note. 

7. Ask for a copy of the medical record upon your departure from the clinic. If they do not have it ready ask them how long it will take? Tell them you are making a note of their response and return on the day and time they say it will be ready. If they decline make a note ask them if they would like a copy of your notes? Sign and date with time. (note longer than two days is unacceptable by most board standards, unless the patient is still present for care).

8. Never leave your pet behind if you don’t feel confident about it. Stay at the hospital. Tell them you are staying. Be a pest. Not rude, but your pet, like my mom was, is your responsibility. 

9. If you aren’t comfortable there move to another place. I am not the vet for everyone, I don’t even want to try to be. Its ok to admit that.

10. Have a follow up plan for each visit. If they aren’t telling you what to watch out for, and what to do about it, then you don’t have a follow up plan. Ask for it is writing. Every vet, like every descent doctor, has you leaving with a written plan. Accountability only follows reputability. 

11. For the crowd holding torches remember the anger and threats breed more of the same. Transparency is two-way, honesty is the same. I know that vet med lacks transparency. It is our greatest fatal flaw. It sets us up for unrealistic expectations. Lacking honesty is a grave sucker. No one goes through life happily if they aren’t honest. You cannot demand others have ethics or honesty. So, we are left only to be the example.

Want to know how is the center of every decision, action, and motive I have? Here it is.

Who are you here to be? And whose hand of loyalty do you hold? For veterinarians these are too often a difficult questions to answer.

If you would like to know more about my side of the exam table please find me at the following;

Pawbly.com. It is a place for all pet people to exchange information to benefit pets worldwide. It is free to use. We are always looking for credible, reputable pet care experts to offer advice, and we welcome people posting their pets stories so that others may benefit from them.

My blog can be found at KMDVM.blogspot.com. It is called “Real-Life of a Veterinarian” and that’s exactly what it is.

YouTube is Krista Magnifico, DVM. Meet my real cases and my real-life responses.

For everyone struggling you are not alone, your pets are never forgotten. Be well and I wish you peace. 

I’m wishing the same for myself.