The veterinary plague in the pandemic.
That's exactly how I have felt for the last 5 (plus) months.
These are unprecedented times. No one can argue that. It is a time none of us have ever seen. The layers and the ripple effects are worldwide and life changing. None of us could have guessed all of the layers of impact it would have upon us all.
When the whispers of a blazingly fast deadly virulent disease began in the late Winter of 2019 the science lover within me was steeped with curiosity. Infectious disease, population dynamics and the decisions that arise from these are the fodder we live everyday in veterinary medicine, and, to a much greater extent than human medicine gets to participate in. Over in vet med we deal with death from poor vaccine management, viruses, and transmission from multi-species hosts daily. Think about parvovirus for a moment. For every sick puppy I see I have to pine over poor, if not often absent, vaccine records, question interactions, clinical signs and scant hard to accurately elucidate human observations. I also know I have to test sooner versus later to get our best chance of survival as care needs to be aggressive and early for the best prognosis. I see upwards of 2-5 puppies a day in our current pandemic case load. In one day I saw 10. For every sick puppy I start with parvo and hope for anything else. Want to make the scenario even more bleak? Add lack of emotional bonding (new after all implies, haven't bonded with yet), and, almost unmanageable costs (average estimate for care, and btw should be at the 24/7 ER, about $3-6,000 USD) which almost no one can afford.
Rabies is the other viral monster with even more devastating reaches. There are still multiple patients walking in every day who have never (I saw a 10 year old with this presentation) been to a vet before. Or, have only been for sick visits, and, hence were never been fully vaccinated. Pouring over sketchy, to non-existent, medical records takes time I never have at hand. How can this be more devastating than parvo? Rabies kills humans. People can, and do, get rabies from cats and dogs. With every case I have to make sure I am protecting the public by monitoring for rabies.
The case load for my 7 day a week, five doctor practice has been steadily increasing over the last decade. Growing on trend with the industry standards. We have our typical seasonal quiet season, February through March, and, our busiest time of year May through October, with one little blip in business at Thanksgiving to Christmas. With the pandemic getting more news attention, the growing number of cases spreading through Europe and mounting pressure to begin government mandates to promote slowing the spread, we faced March with huge uncertainty trailing fear for both our own lives and the viability of our business.
When it became increasingly obvious that the virus had reached our shores and invaded our inhabitants I knew we had to do some hard talking and face some quick decisions. We had to face yet another outbreak in our clinic, except this time the victims might be us.
The first action I took at the clinic took was to ask each employee privately what they felt comfortable with? Who wanted to shelter in place, versus continue to work. Self isolating was being instituted in adjacent states and we knew we were not far behind. Each employee was given a letter to state our dedication to them in supporting their decision with whatever choices they made. If they chose to stay home we would promise to hold their positions. We would assist in unemployment benefits or exhaust benefit packages for as long as possible.While other veterinary clinics around us mandated employees remain working, I was not going to take worst case scenarios and force anyone to do anything. If that meant that I was going to be running the clinic alone, with my husband as the only receptionist and technician available, I was going to do it. If I had to open 24/7 and live there I was prepared to.
I was preparing myself for worst case scenario. This is the typical approach to everything in medicine. Personal and professional life are one in the same. I was preparing myself to stay at the clinic for endless hours melting into endless days. Man the caseload alone, or, enlist the help of my family, and work 24/7 to keep both the lights on, i.e. keep the business alive, and, keep the patients of my community cared for. If other vet clinics closed I was determined to not lose a patients life due to inaccessibility. Summoning the troops to see who was with me was where I started. Much to my surprise most of the staff wanted to stay working. The reasons varied from employment security, maintaining an income, age based health security (not that this came from my personal disease preference viewpoint), to boredom associated isolation avoidance. Personally I felt I had an ethical obligation to the pets JVC had taken care of for decades that have almost accumulated into a centennial. "This ship wasn't going down on my watch," once again rang in my head.
As the commotion of human hospitals reaching maximum capacities almost overnight in our surrounding states ballooned the realities of our potential doom motivated action. Within a few weeks of the diseases arrival half way around the world the state governor ordered a very quick mandate to self isolate. A list of "essential businesses" was circulated and our importance to world health became endorsed. Veterinarians were expected to stay open. How we were to do this safely was open to scantly provided guidelines and interpretation.
The world around us slowed to a snails pace of cleared roads, hysteria based grocery shopping (none of us will ever look at toilet paper the same will we?), and, solitude like we have never seen outside of a few days of a previous weather catastrophe. The news was buzzing with charts, graphs, daily tallies and "curve flattening" chants. Masks became a commodity I felt oddly out of place wearing in public. My work life of disposable clothing, replaceable and disposable was now the new normal. Coming and going to work included placards for the car announcing my place of importance in the pandemic saturated society. Working was a risk we were all volunteering for. Would there even be a reason to show up? Would there even be clients brave enough to go out into the infected world around them to get their pets care? We didn't know how bad this would be, or, how bad it would get, never mind the collateral damage we would invite ourselves into. What if I went to work and brought the virus home unknowingly? I had a very sick mom to care for. A husband who fit the age based "high-risk" classification. Me, well, I was comfortable with steam cleaning clothes I changed out of at the office. I was fine breathing in a mask, wearing gloves to work, and washing my hands like death was colonizing with complacency. Me, well, I was ok with me facing a ventilator, but being the fomite who brought it to others, nope, no blood on these hands please.
What happened was a 20% decrease year over year for the first month, March. Then a steady April. Business was running its (almost) normal course and people went to and from 2 week quarantines if they felt sick, or were told to do so by their physician as the tests took weeks to process. Temperature monitoring, letters of CDC guidance on what to look for, when to play it safe and stay home, and the myriad of vague clinical signs to alert oneself to possible COVID exposure/illness were circulated, signed and kept on file.
There were weeks of one, two, and, even three staff members being out for quarantine at a time. Managing the staffing schedule was a best attempt daily. The teams further isolated us, and magnified the difficulties of scheduling appropriately for the days case loads. We didn't know if we would be able to manage with either our own staff being too short to function, or, the clients being too cautious to take their not-going-to-wait-for-the-pandemic to abate pets. Would we lose a whole generation of puppies to distemper (which we have never seen before because our clients are too sensible and savvy) to have been susceptible too? Would we see a huge influx of rabies cases as people avoided vaccinating? What about pregnancies when spays and neuters (aka "elective surgeries") were ordered to be postponed to save valuable short supply medical equipment for the front line workers? SO many questions and no guidebook to assist in assuaging the fears. Would those staff members who were out at home come back to us as "positives" and throw the whole rest of the apple cart into hysteria? Would I lose people I cared about and feel responsible for that for the rest of my days? When I asked myself the really hard questions I couldn't come to terms with the idea I might be swapping one life for another. Was my efforts to save my four-legged patients going to cost me any of my two-legged colleagues? Was it a trade off I could ever justify? Deep down I strongly considered closing the clinic. Shuttering the windows and leaving a "gone fishing" sing without a due back date. I would prefer belly-up versus 6 ft under.
I just got up everyday and went in. I left my husband at home with the animals. He was telecommuting and able to take over their care regardless of what my day might bring.
What happened was totally unexpected. Business exploded. It blossomed and burgeoned on record breaking. People fostered, adopted, paid attention in much greater detail and scrutiny to their pets and we struggled to meet the demand. We, for the first time ever, had to turn new clients needing emergency care away. It hurt me bitterly to do so. We received pleas form the local ER to help. They routinely had 4-24 hours wait times. I went into work exhausted and unable to catch up. I left the house at 8 am, arrived after 9 pm and the time in between was case after case of sick, dying, intensely managed patients. While the rest of the staff saw the routine vaccine appointments I saw the immediate need walk-ins. It was grueling and mentally so taxing I fell into bed every night wondering how I would manage the same day tomorrow. I started to fall apart physically, emotionally and internally. I understood why everyone else defaulted to their protective limitations, and, I wondered if I would get out of this wanting to be who I thought I was. Sleep became a fleeting precious and unreliable commodity.
The other side of the pandemic sword was anger. The quarantine brought out the best, and, the worst in us. We had to call the police to have people forcibly removed from the premises. We had to use strong language. Make ultimatums and have the courage to lose clients for them. We drew hard lines with harsh stern mandates behind them. We split the staff into teams with the hope that if illness ran through one team like wild fire the other would be safe. I did everything I could to minimize the villains reach, potentially deadly grip and keep the people I care about most safe and feeling secure at work. It was harder than I had imagined it would be, washing, cleaning and sanitizing after each day. Seeing one team lose more members than it could function without to stay at home orders. We were tired, worried and facing unknown client aggression every minute of every day.
We applied for loans we didn't know if we could meet, or get, or payback? The unknowns mounted to stress at unparalleled and nauseating levels. I remember telling myself everyday that I just had to breathe, go into work to try to help people and the pets I was so devoted to taking care of, and I had to tell myself that "this too will pass" as everything else behind me had. I had to remind myself that I know what disease looks like. It isn't personal, it isn't fully fatal, and there was a myopic meets universally pellucid lens that made it all relatable, comprehensible, and even purposeful. We have to remember we are a part of a whole. A tiny piece if a planet that is complex, self-regulating and unforgiving in its counterbalancing efforts. we are mortal. You get one life, one chance and you better be analyzing your place, your value and your compromises along the journey.
It is September. 2020 has cost me dearly. I lost my mom to cancer that COVID crippled, arrested and tortured her within. We had so few options for a deadly cancer that swept faster than most of the cancers I have dueled with. Cancer has plays. Definite steps it takes. Obvious signs it flags, and yet hers was just as swift, devastating and immobilizing as any I have ever witnessed. I have seen thousands of pets get, battle with, and eventually die from their neoplasia, but, my mom died and suffered more severely than any patient I was ever charged with. She suffered. Nothing should ever suffer to the extent she did. Medicine has better to pardon such pain. So many of us lost to this pandemic. Time, loved ones, events, experiences, vanished to trying to stay alive. There is still no normal to our newest evolution to the current pandemics plight. We are still not allowing clients into the hospital. Still providing mask enforced curbside service, and, I am still turning away non-clients so I can meet the fact that we are booked weeks in advance, while we receive requests for immediate care from our current the clients with their same day emergency requests. I have worked to the point of physically debilitating exhaustion, and then worked through that. It has been challenging and for someone who thrives on adrenaline based medicine I can say I cannot keep this up. I have to turn away people who I know need us because doing so will cost us a mistake we cannot forgive ourselves if we make. And yet through the worst of my veterinary journey I have been reminded that hope springs eternal. That little lives were saved, protected and spared because we showed up and did our best. Friends brought posters, cakes, wrote letters, and reminded us that we mattered. We made a difference, and we were appreciated. There were layers of kindness that were returned in waves more powerful than a disease can encroach upon. There are people whom I saw give the most incredible acts of compassion. Spread love and hope with generosity, kindness and for which I will never forget and never stop repaying.
So far I have lived to tell the story. We have all done such amazing things through the most troubling time of our collective lives. We have no end date, but, we do have the confidence of knowing what perseverance feels like and it's as good a guide as we will ever need.
I have learned that the foundation I am most assured of is that life is precious, short and fleeting, and at the same time it is invaluable and magnificently beautiful. I wouldn't trade one for the other. You cannot have one without the other. I also know that the more I give the more that comes back. It has to be genuine, but it is always enough to get through the worst of days.
Thank you to the clients who share their stories, photos, and lives with us. The photos above have no relation to the events or cases. They are snapshots of the days through this story. The loves that mold us, touch us and shape our views on crisis. They are reflections of what we can be if we chose to see value in sharing.
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