Who do you bet on? The horse or the rider?

 

Do you wager on the horse? Or, the rider?

What if the horse is the medical staff, and, the rider is the patient? Who then?

Let’s say the medical staff is Johns Hopkins. One of the most influential, advanced, respected medical entities in the world. Or, what if the medical staff is a single veterinarian, who has a solo practice and is expected to wear every hat you would find at Hopkins.

Let’s play our scenario out even further. What if the patient was my mom? Diagnosed with end stage breast cancer, and, quickly thereafter told it was in every bone in her delicate barely identifiable out of pubescent body. What if this diagnosis with its formidable prognosis finds her when she has never faced a challenge of personal merit defining obstacle in her life? My mom was always the easy way out option elector. Too much sweat, effort or scrutiny and she would immediately decline. Politely wasn’t even considered. She was adamant about easy living. She died less than 6 months after being diagnosed without a wrinkle to weather her face.

Then there is Havah. She is my dearest friend. The person who has been my most consistent bestie for over three decades. She was given the same diagnosis, same prognosis, similar disastrous landing of a cancer too invasive to shell out, this time her brain, spinal cord, and meninges, and yet, she has faced every toxic infusion of chemotherapy, every radiation eradication, and every step as a short jaunt to a recovery via hope-based endeavor. She has never wavered on her mantra to recover. To survive this regardless of how insidious it had grown. Not one modicum of doubt has entered her process. She is the rider on a life saving journey to the other side of terminal. She is the fearless mercenary who keeps charging on to a disease that has no eluding.

Both of these; my dearest, closest, most cherished souls are in the same fight. Both have unparalleled medical teams, and yet, my mom lived 5 months, Havah, well, it's been over three years. It was the rider who made all the difference in the race.

Why is this relevant? For me the doctor of animals, the rider is never the question. Every animal fights to survive with their chin up as they press on, with no time for self-pity or reflection. They face each moment focused on little else. Amputate their leg riddled with cancer and they walk on three with little instruction within a day. Animals fate is determined primarily in the medical access they are provided. Nothing else influences a pets prognosis more impactfully than the pet parents decision making process. It is where I find the most difficulty in being a doctor whose single goal is hope based care. Electing to “do nothing,” “let nature take its course,” “end suffering at the onset of a medical challenge,” has always implied giving up without attempting to palliate. It is a tough, bitter, jagged pill to force down. Especially in light of knowing how well most of these patients will do with even the minimal cost of effective pain management.

And then I ask myself if my personal opinion, my belief that medicine has all the answers? Is too biased? Maybe the quality of my mom’s short life was better than the medical maze of the labyrinth that the human system fills its unprecedented greedy coffers with? Maybe content and "comfortable" at home is just as hopeful as fighting with every cell you have? Maybe faith is based on fueling liberty and independence to heed your own cause and not my biased based case-based experience?

As I try to dissect, categorize, and compartmentalize the losses that I am reeling within I am finding that I cannot help find the answers to the personal choices made around me, only the ones I have to face for my personal healthcare decisions and those of the animals I am responsible for. I don’t have answers based on fortune telling crystal balls. I simply have gnawing for loss I cannot resolve without understanding the influence it has had on my own personal beliefs. I still grapple with the “quality versus quantity” of life arguments that is soo prevalent in my profession. I still take a quiet humble step back when my clients ask for my opinion as to which path they should endeavor upon. The all out fight for every best chance at life and possible recovery which almost always includes a life altering schedule of specialists, treatments, and tens of thousands of dollars, often to buy a few more weeks or months. Or, the go home stay eating, comfortable and as stress free as possible and let fate decide for you.

Even as a veterinarian my choices have spanned all aspects of the decision making spectrum. I still don’t know if I made the right choices, or even if hindsight has helped me evolve into a more accepting parent for their lives. I fought so hard for Jekyll, Savannah, Ambrose, and yet, I peacefully let D.C. Belle, the pigs go. I hope that knowing them, the individuals they are, helped me in those choices. If so, how well do I know myself? I wonder if the inner turmoil is focused there? Coming to terms with our own mortality. It was the one over looked, too painful to ponder place for Havah and my mom. They were so afraid to die. So unprepared to pass on, afraid for the loss and the unknown, and yet it has been so heavy to unravel it stole the last pieces of life worth feeling.

Maybe my lesson to learn lives here. That my decision is mine alone. Maybe theirs was theirs to live, die, learn, accept? And maybe the answer is fluid, influenced, nuanced, and never truly defined or settled?

I think that is what I need to live through. I say to others almost daily, “I deal with death every day. The loss of a life that mattered. Was hugely influential and deeply sorrowful to prepare for, live through and move beyond. How can I see my life so differently than theirs? I don’t feel as if I do. I don’t wear, consume, or associate with the cruelty in animals sacrificing for my life, how can I elevate myself, my death over theirs? We are all equal. Missing me is as earth shattering as them. We all go someday. The goal is to live now, and accept that when it comes to call for you. For me this will be after the folks at Hopkins tell me it’s a game I’ve already lost. Accepting that with gratitude for all that I leave behind is the key. Its all a gift up unto then. After it’s the price for the ride.

Related blogs;

Jekyll's story; 

Grieving the Loss of Your Pet.

The Aftermath of Losing Jekyll.

My Beloved Jekyll-Pup

The Turmoil of Contemplating How Long To Fight For Your Pups Life.

The Agony Of Being The Patient. How the Vet Mom Faces The Reality of Being The Vet Client.

Here is a story on my mom's journey;

My Mom's Story; Dying In The Pandemic.

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