The unprecedented times of veterinary medicine and the pandemic.

It is the middle of August 2020. We are 5 months into full on COVID-19 pandemic mode. Within my professional life as a veterinarian the ripple effects of this have reached places I never saw coming.

We are a 7 day a week, 5 doctor veterinary clinic about 45 minutes north of Baltimore, MD and we could not have imagined, never mind prepared for, what COVID has delivered. I have been a veterinarian, and practice owner for 15 years, and although there have been numerous rough spots along this journey there has never been a time where I more question my stamina, and fret for my patients, than now. The current state of our profession has become an ever growing chasm of unmet needs meets unparalleled exhaustion on all fronts. There is also no discernible end to this "new normal." The degree of personal stress, emotional questioning for well-being, and the public's visceral anger and ugliness has us all at a boiling point of which I fear great personal, professional and accessible losses will result.

Here is a break down of where we, my little vet clinic is, and, how we got here. Jarrettsville Vet used to be the routine general small animal veterinary clinic where doctors saw appointments with pet parents holding their pets on their laps, or on a leash, all the while going over important patient points. It was a calmer exchange where personal time was fostered. I have always been honored to be a part of a pets care, and, to a great extent also their parents life. Feeling needed an appreciated is the purpose so many of us strive for. In clinic personal care was delivered in real-time with multiple options given for treatment care and an all-for-one team approach. We have always taken pride in being transparent with affordable prices for a huge range of pet ailments. We do not turn away care for anyone who needs it. We have stayed true to our values and we have been in business for over 8 decades.  With this pandemic a few things have altered our approach on delivering this care. We have to wear masks, we have to stay distant, and, we still have to hold onto what makes this personal emotionally enriched care genuine. 

We began curbside services, thereby keeping the public out of the clinic because we could not provide adequate or acceptable social distancing, began in April. We split into teams to try to insulate at least half of the staff if a positive staff member would cause us to have to quarantine, or even shut down. We did everything we could to stay viable while also trying to stay safe. It has not been easy to lose the personal connections, most notably for the terminal, the dying, and the euthanasia's, as we tried to stay open with some semblance of doing the best we could in meeting our patients needs. We have had to rush dying patients into the clinic and witness them die without their families who were outside in uncontrollable hysterics. It is not who we were, nor ever wanting to be. 

With all of this change it has also brought along a never ending list of unmet expectations and needs. We are not unlike many, if not most, of the veterinary clinics in the U.S. right now. The current state of this pandemic has left us saying we cannot help, and, we cannot keep up. We also are afraid more then we ever have been. It is a mounting storm without ceasing winds to calm. 

What's the cause to our current patient care dilemmas?

Demand has over run supply.

There is an increasing demand for care, as there has been an increase in pet care ownership, and, a decrease in vet staff availability.

As of this week my clinic, we are booked about two weeks out for routine care. This has never happened to us before. We are now having to place blocked appointment slots into each doctors schedule for every shift to try to manage the same day requests for urgent cases. There has rarely, if ever, been a time before where we couldn't fit someone in within 24 to 48 hours for an exam. Almost all emergency cases were provided a spot within the same 4-8 hours. We  are a small town, deeply rooted within the community, practice and we know that long term relationships built us. To abandon our clients in their time of need only undermines the trust and reliability we have worked so hard for so many decades to establish. For most of the clinics around me they are booked days, weeks, or even months out. When they are and they get an urgent call the client is told to "call around," or, "go to the ER." No one wants to be told that. But, it is the reality across the board for all vet clinics. We are seeing more cases than ever. Why would we be immune to a pandemic, or, even over burdened with patients within it? 

The answers lie across our spectrum. 

Where did the increase in pets come from? This is the results of a multi-factorial burgeoning of demand.

• increase in adoptions/purchasing of pets.
• clearing of shelters.
• people have at home and personal time they never had before.

The shelters were placed on indefinite closure as they had to keep the public out. If they cannot allow the potential adopters in to help advertise their adoptable pets then the outflow was going to come to a halt. To avoid this many shelters offered free, if not significantly discounted adoption fees, to try to clear them before the next shoe dropped, (i.e. staff gets sick and no one is available to feed, water, clean and house). 

Pets have been adopted/purchased at record rates. Along with the increase in demand for adoptables has been an increase in now-full-time stay at home workers to have the pet they never had time for before. People hit the internet looking for a companion as they socially distanced from the rest of the human world. 

Dwindling supply for pet healthcare caregivers;

• vets and vet staff who are home self-isolating.
• staff were hard to find before the pandemic.

Just like a swath of the population, there are veterinarians, and veterinary staff who do not want to expose themselves, or their families to infection from a disease they are at high-risk for. I have staff members with elderly parents they are caring for. The risk is too great for them, and hence, they are on an extended undefined leave of absence. at any given time 10-20 % of my staff is out due to COVID influences. We started this pandemic short on staff. COVID has exacerbated it.

The stress of a trying to be everything to everyone and not knowing if any decision is right.

• the difficulty of managing a practice through ever evolving,and changing, information.
• the strategic planning needed to try to stay open and safe.
• the ripple effect of bad practices now magnified by a greater need.
• the poor planning of not being able to catch up as you try to prognosticate ahead.

The allegiance and the pressure to meet all the demands across all spectrum's of personal, professional and ethical standards. Feeling like I am expected to meet every need of every soul under this practice is overwhelming on our best days, add the stress of non-stop phone calls for help, and knowing my own physical limits are at the brink has me thinking that maybe the vets sending all the excess elsewhere are serving best by serving self first? 

The fear/anxiety/and division while trying to keep ourselves safe and alive.

We all feel it, don't we? The anger/fear/and degree of stress we have never before experienced, and now it's daily, worldwide, and on a magnitude we cannot comprehend by any previous experience. People are stressed in a way we cannot ignore as real, and, they take, are taking out, this anxiety out on us. Add the emotional element to the package and the boiling point lowers. If you fail to serve them they can, and have, opened a wrath that leaves you with bad reviews, crying staff, and yet another reason to not work when pay is available elsewhere regardless.

Burnout. The staff, outside of the doctors, and hospital administrator, are all on hourly pay.  I have to keep this in place, even though we need them all at almost every breathing moment, to force down time. They stay longer than needed. Ask repeatedly about leaving us, and whether we will be "ok?" And, yet I have to tell them to just walk away. There is not an end to the day past the automatic shut off of the phones. 

I leave everyday with an unsurpassed list of things being left undone, and a chorus of faces I worry about overnight. Will they be ok throughout the night? Will their families stay safe and healthy to provide them the oversight they need for their own survival? Can they reach me if needed?

The vets, we are maxed out. We feel compelled to help. To answer every call. It is what we are cut from, and yet, we cannot work enough hours to meet the demand. 

The place we have found ourselves.

Emergency veterinary clinics are seeing the cumulative effects to the greatest degree. Many of these new pet parents cannot establish a veterinary clinic based relationship. They are not finding a clinic who will see them in the time sensitive manner all new pets are ideally seen within. (I say three to seven days max!). 

Where do people go? they have been turned away at the vets office, the ER was already too expensive for many, and, now the wait is, and can be, from 4-24 hours. Puppies with worms, and/or, who are sick are being told by their vet that the wait to be seen is weeks. They don't have weeks to wait. So, parents head to the ER to be told the wait might be 24 hours. Am I responsible for this puppy? What about if I know that minutes matter for survival? What would you do?

A larger number of the clients going to the ER have no primary care vet. They are turned away at every vet clinic that they call. The ER is all they have left.

My clinic is open for walk-in appointments on Sundays. Sundays have turned into our receptacle for all the non-emergency cases I couldn't find time for during the week. I am taking Saturdays off to rest, because I have to. My core has to, and without being able to see the spill overs on Saturday they are told to come in on Sunday. Last Sunday for the walk-in hours of 1-3 pm, I saw 20 cases. All sick, all in need of care. I stay all day Monday through Thursday. I see everyone who is a client and calls. Fridays I go into work to catch up, to see the spill over. 

How am I coping? I am not sure I have a clear answer yet. I am desperate to keep the long game in focus. Remind myself that I carry the lives of my staff at my forethought, while reflecting on the legacy of the veterinarians who bore this clinics torch before me. Those who survived wars, depressions, and the plights of a rural community whose animals allowed them simple basic survival. Without the veterinarians who built this clinic I would not be here, nor, would my self-inflicted responsibility to carry on through whatever adversity facing us be so profound. We are deemed essential as we control the tide of zoonotic diseases, maintain a food supply, and protect the family members so many of us relegate our pets to. "Essential" adds a layer to this complicated bitter onion I never saw previously. With that I feel even more compelled to not lose my footing as I run this never to be seen horizon race. 

There are personal stories I have never shared. The clients who call needing immediate emergency care, or hiding within self-isolation and attempting to manage potentially life threatening cases via video calls. None of this is ideal for the patient, and yet I have made judgement calls I know I could be sanctioned for. I continue to practice medicine within a web of uncharted waters and a public as jarred as I am. 

Where I have seen this community come together and assist in ways I couldn't imagine outside of an invasion, I have also seen people react with vile vitriol I feel immeasurable to the insult at hand. The slightest, (seeming to me), insignificant annoyance reels people into fits of anger that leaves the staff fearing personal harm. I have forced clients in unprecedented numbers out of our practice in a desperate attempt to nix a fuse that I can only see more emotional trauma stemming from. We have had to add signs asking people to "wear masks and be patient," and, with these I still have people refusing. There are words coming out of my mouth that I feel will only add more vinegar to a wound surfacing before us. "This is private property that I own, it is my mandate that everyone wears a mask." To be met by spitting seething rebukes of "you cannot tell me what to do," and, "you cannot catch COVID outside." The point of helping a pet in need has soo often being overshadowed by an on-the-brink-of-breakdown of a human, and, too often I fear I am that human.

I am exhausted. More exhausted than I have ever been. This includes vet school training, working multiple day long shifts on the high seas, and the pains of being both a new grad and a new practice owner trying to shoulder a burden beyond my experience and expertise. The days I am working now start at 8 am and extend to, or even past, 9 pm. No bathroom breaks, no food, and so mentally stretched I have to tell the staff that I cannot safely handle another cases. For as much as I want to help, and cannot bear the idea of turning away a patient who may not get help otherwise, I have limits. If I push them any further I am going to make a mistake and it may hurt, injure, or even possibly kill someone. Fear, exhaustion, and pressure to be a vet, an employer to people I deeply care about, and keep the business alive when I feared for months I would not be able to, has me needing help I have never asked for previously. My village has become an interstate of traffic coming and going as friends leave food, walk my dogs when I cannot find time to, and help with laundry and household chores I cannot dream of returning to. I have had to say previously impossible "No's." "No, I cannot do a TNR." Or, "I cannot see that dying kitten," "I cannot take home that patient for overnight care as I fear I cannot get up if I fall asleep." No's I hate myself for uttering. No's that might cost me my personal legacy as I triage the others I am desperately trying to keep alive.

I have my email posted in every corner of every client interaction. We use Facebook messages, personal phone numbers are given to any client in possible need of immediate return. I have socially distanced from everyone outside of work so that I can remain at work with the least amount of risk possible. All decisions have been made to protect the hive. Isn't that what I promised myself at the beginning of this Pandora's nightmare box?

In the end, and the whole point of the lessons we are learning within this pandemic is, that we have to get out alive. For some this is best believed achievable by sheltering in place until the world rights itself again, a year, or two from now. Just stay away from people, accept the risks associated, and, hope this bubble approach doesn't cost you a fatal delayed decision. For others, like me, I go to work, I diligently wear a mask, wash my hands, stay 6 feet away from clients, and only allow close proximity for euthanasia's which we do in a separate location. And for the non-believers, the people who haven't seen a death from a bug you never saw coming, I am reminded that negligence is too often the backbone of all medical professions. 

Like all inferno's this pandemic is alike in that it will end. Will there be a Jarrettsville Vet on the other side? Yes, of course. It is bigger than me. It has always been bigger than me. There is comfort in this as the small one doctor practices shutter when the quarantine forces their closure. But, will I be alright with my choices? I am not sure? I, like all of the rest of us paddling upstream to a place we have no knowledge of, all feel the same. We all have to get out alive.

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