Sunday, December 13, 2020

Bentley's Betrayal

 Unequivocally it was one of the single hardest acts to participate in, and, come to terms with.


The “act” is the surrendering of hope. The abandonment of responsibility and the letting go of a strong-willed fiercely determined soul full of so much life it was blinding. The front half of Bentley was solid, foreboding and always smiling, The back half was a re-arranged anatomical list of deficiencies that made his life as a pet impossible.

Bentley was a tyrant for attention and a brute of force too dangerous to contemplate if he felt that his needs weren’t being met. And, yet, for all of his deficiencies it was impossible to not fall in love with him. He had this charming way of falling into to you so trustingly that you couldn't reprimand him for it. He would come tumbling towards you, mouth gaping open, cheeks grinning ear to ear, and a tongue flopping with wet intent to embrace you. Just as you braced to meet the catapulting 80 pounds of sheer muscle lopping into your body he would bow his head and summersault into your lap. Wagging the whole time about being in on the joke only he knew the punchline to. He was always like that. Affable to the point of ill mannered and too childlike -a-giant to argue with. 



He came to me about a year ago. I remember every tiny clue as to how hard his case would be. I remember listening to the medical reports, second, third and even forth hand, from all of the people he had been to visit, and telling myself secretly to stop listening. There is an inverse relationship to prognosis and the number of medical opinions. The less medical opinions I have at presentation the better the prognosis. Bentley had already been to numerous vets, and numerous veterinary specialists. The more he went to see the longer his list of burdens became. I was now being called. I am sure I was so low down on the list his fate was almost sealed. I remember his phone call vividly. I was standing in the breezeway of a hotel in Sanibel Island Fla. for a vet conference in late January 2020. My mom was at home suffering from the early stages of her terminal breast cancer. Losing her ability for any kind of life day by day and I had selfishly taken 4 days to attend a conference and take a break from the dismal life unfolding before us. The rescue had emailed all of Bentley's information, asking if I could review it and possibly even help? Could I do the $6,000 surgery he needed? Could I find him a more affordable treatment option? His owner had exhausted all financial and conservative options. It was me or death. He was growing fast and he was unable to stay in his home.

I felt cornered. Why I don’t just reason myself into the obvious answer and back down I don’t know? 



I remember hearing myself say out loud in that breezeway; “well, if you get to the place where you are euthanizing we will take him.” I cannot swallow these words right  now without a goiter-sized lump of grief, remorse, and turmoil. 




Yesterday, after about 8 months of procrastinating, praying, and hoping I had to euthanize him. It feels more like kill, euthanize is our packaged with a  bow term to settle the reflux such an act elicits.


It took months to come to terms with even trying to set the day. It took every member of the staff of 20 who care for him day to day to say that they agreed it was the only answer. Truth is he is so lovable when he wants to be that you forgive him too quickly for the times he is dangerous. It took multiple episodes of us, the women who run this veterinary practice to feel as if he held their lives in his whim, his mood, his determined anger to get his way that we had to either keep him so sedated him might doe overnight, the “safe” doses had become increasingly less reliable. 


As the months passed we abandoned hopes to 'cure' his urinary issues. Every medication failed. Every recheck, retest, diagnostic yielded worsening progression of a congenital defect that spiraled into being the "40% that never resolve with favorable outcomes." At every option he failed to find a break. He would never regain control of the bladder or his urinary system to be able to hold his urine to be housebroken. He leaked urine all day all the time. He smelled like urine all day, all the time. And you couldn't keep him clean. He required loads of laundry with bed changes daily. Daily, if not more often, bathing. And, it was never going to change. To make his bleak diagnosis more ominous without a sphincters' to hold the bladder closed, and because he was essentially always leaking he had an open conduit from the dirty floor to his bladder and up to his kidneys, Ascending infections that would ruin his kidneys were a reality. Recurrent urinary infections were also looming every single day.


He developed calcifications on his surgery site. The drainboard his urinary system had been re-routed in He was dribbling little drops of urine all over himself, his bed, his cage all the time. I had a staff member designated to caring for him, often without any other paying pets just so he could be kept dry from his non-stop urine leaking. 


He, since the time he was born, had to be kept clean. He was swabbed, wiped, diapered, fooled with, every few hours of his whole life before he came here. By the time he arrived at the clinic, at 4 months  old, he would not let you near his pelvis, his belly, any place below the shoulders without a shark-toothed sneer and low guttural grumble. In the last 4 months of his life I was unable to examine him without elephant sized doses of sedatives. He became, like so many other patients I have, unwilling to participate in his treatment plan. He was essentially ignored as the only peaceful compromise to our collective existence. The more latitude he took, the more we gave. The  ultimatum of the resolution to his issues was pushed days-weeks- and ultimately months into the place yesterday became.

The dozen people who loved him most, spent the last year with him, made his days full of play and joy all gathered around him to say goodbye.


It took a massive amount of sedation to allow him to cuddle with us. Keep him calm enough to not feel timid in touching him. We all sobbed. I, felt a sense of regret deeper than I ever have felt before. I felt a sense of personal responsibility in a depth unknown to me before. This was mine to bear alone. I had said yes. I had committed us all to this place where grief is the only flotsam to seek refuse in. this was my act of betrayal to this soul who would have  been the best boy if his emotional needs could have been attempted to have been addressed around his insurmountable medical needs. 

I feel as if I am in the cross hairs of an impossible maze that I cannot live long enough to accept the failure within.


His story was public. As are all the things this clinic does. Hard, right, wrong, and most often miraculous, but, he wasn’t that ending. I posted a video yesterday confessing the pain this life leaves me with. The resounding number of responses were friends and family who have followed his story. Known his challenges and rooted for us anyway. There were a few that were nails in the coffin of despair I feel. One in particular was scathing in its burning condemnation. One comment was fueled with disappointment that we “hadn’t waited until after Christmas.” It is December 12 today. They were furious that we couldn’t have waited two more weeks, which I parlay as “endangered the lives of the staff for two more weeks. Sedated to the point of almost coma Bentley so that a magical date on the calendar could be passed. For those of you who read this, you know my mom passed away 6 months  ago. I remember wondering/wishing that she would pass a few key dates, like Mothers day. Who wants to remember every mothers day as the day your mom died?

What is most hurtful is the gall-ish arrogance to say that her feeling for him, a dog she has only known through Facebook posts is so influential that her opinion, and subsequent removal from her donor list matters. If you're reading I want you to hear me say that your reprimand to those of us who spent all day sobbing over a loss we spent every day of a year tending to, trying to give some semblance of love and quality of life regardless of how much work, time, effort and yes for me significant monetary investment is  hurtful to the place of irreconcilable. To be judged when you are already feeling like failure wrapped in personal betrayal is a pain no one who loved this much should feel. For all the pleas we made to try to get him the financial help he needed for his surgery, and the too numerous to count requests for a home of his own with a need such as “urinary incontinence, recurrent urinary tract infections, and a bully breed who is 80 pounds of childlike tantrums” is a big ask. Only we stepped up. Opinions are welcome within your own sacrifices,, the rest is judgement, unwanted, unneeded and unhelpful with the sorrow his loss brings us.

It is less than a day of trying to come to terms with this loss. My act of betrayal, and the damnation this voice inside me reckons with.


Right now I keep trying to remind myself to not stop being an open heart, trying to not close myself off to these phone calls which I know will never abate, and not giving up at the gate because it easier than trying.

I'm not sure how I am going to find the place where my sense of betrayal is accepted as my responsibility for the leader of my own pack of amazing staff who love more than they have to even when the price can cut so deep.


May you find peace Bentley. I am so sorry. You loved this life even though you were cheated so.

https://www.facebook.com/JarrettsvilleVet/videos/1242805499452384 

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Friday, December 4, 2020

The Blacktop Divide. How Vet Med was redefined in a pandemic.

 Nine months in and I still haven’t figured out the knocking on windows etiquette. 

I spend an inordinate amount of time these days amidst the middle (maybe? Hopefully? Dare I even hope?), of this pandemic in my veterinary clinic parking lot knocking on windows. I am not comfortable here. Too many people pulling in 5 minutes late (or more) for their appointments, going too fast, and congestion at every corner. The struggle to talk through masks, after I pound on the window to release them from their cell phone meets carbon dioxide trance, is real. I am also repeatedly finding myself in too many arguments about even putting the mask on. It has gotten so bad we have put laminated warning signs on the back of our patient record clipboards. 


The protocol is that if you walk up to a car, or client, without a mask on you just raise the clipboard up to your face so they can read the “mask required.” (It has very small (almost invisible) emojis adjacent with a poop face and a finger for staff motivation). 


The real fear of the black topped front office is losing a pet in the transfer to the staff. (Because we all know that if something awful can happen it will.) We have had this happen multiple times. One escapee had us spending three long desperate days and nights searching woods, roads and back yards fearing the whole time that they would be hit by a car in the interim. The other had the entire staff running down our busy two-lane road (where the speed limit is always pressed at 50 mph) to persuade a full on running dog to come back to the rioted crowds chasing it. I wasn’t sure which I was more petrified to see happen, the dog flattened, the staff tossed like road kill salad, or the owners meltdown within the whole endeavor. Or,, that even within the confines of our parking lot, entrance, and exit, that a pet will be run over, bitten, attacked or misplaced in the clutter of chaos as we do more and more outside. The parking lot has become our catch-all. The check-in and check-out point. The collection of pet information and the (thankfully dissipating) point of hostility contact place for the non-mask wearing amendment protestors. I had no previous emotional designation for my parking lot, and, yet, now within this pandemic year it has become an extension of my profit-making square footage assessment. I have invested as much into it this year it as I have my front lobby in years past. It is my first impression, my (by far) most dangerous spot on the property, and the new battlefield for healthcare provisions. Truth be told my hate for the asphalt grows daily as this pandemic grinds on.



The parking lot has been upgraded; glossed over, restriped, labeled by parking spot number to help identify where to find our patients, and as the months drag into winter we are adding portable heaters. I am proposing to also add check-in microphones, the sort of modern-day drive-in movie theatre comms system. All we seem to be missing is the jovial spirit of short skirts, knee-high tube socks and the roller skates. 


We have benches outside that allows for a change of scenery as people to wait to be seen, albeit used based on weather permitting. It allows some refuge from the confines of a car that can last a few hours at our busiest times. We also have a considered how to more easily implement the check in and out procedure. Phone lines are blowing up at record breaking unprecedented numbers. Our call volume is about 1800 calls a day. Which is up from about 300. It is significantly more than two receptionists can handle over 12 hours. The attempts to remain a place where people feel welcomed and well cared for is immensely more challenging while trying to maintain social distancing and public isolation. Removing the in-person examinations where the pet parent and veterinarian, and veterinary staff can exchange patient concerns in real time and together is nothing but detrimental to the overall patient care. As I have lost the ability to share my examination findings together, like showing a parent their pet’s degree of dental disease, eye issues, body and muscle condition changes, every little detail my eyes have been trained to look for and identify, is lost. It becomes reduced to a bullet list of items lacking the relative personal expression of invested concerns on a report card sent back out to the parking lot. Or, a summary phone call.


We are fortunate enough to have a little house that accompanies the veterinary clinic, grooming and boarding facility, and, the 5 acres of land it all resides on. The house has never been used as a part of our veterinary services. It has for the last 50 plus years just been a domicile for rent. This year it has become an integral part of the personal approach to the care we used to pride ourselves for having given each case. In this oddly distancing time of self-protective warnings the house has given us two things many other practices don’t have; a indoor bathroom, and, a place for quiet peaceful passage. My septic system for the small family it was built to support now holds a reservoir for dozens of people a day. I have fingers crossed every day that it can manage the load, same as the rest of us. And, I wonder how do I renovate it to resemble the facility at Ravens stadium? The house has also served as our last tiny vestige of compassionate centered care for the euthanasia’s. Since the beginning of the curbside COVID service discussions I knew that I could not remove this last piece of humanitarian kindness. How others justified, (and perhaps my bottom has not been met yet and I will have to eat these words?), and permit only drop off services for euthanasia’s I don’t know? I have been that person so consumed in grief, while desperate to hold on for every last second as I say goodbye to my family member. Doing that as a ‘drop off’ service, well, I could never forgive myself for that. Nor could I ever look that person in the eye again and proclaim myself as compassionate. The clinic house is our one last sanctuary for providing the intimate care we all came to this place for. The most meaningful moments of my vet life during a pandemic have been there. Taking that last good-bye, those final moments, and reducing it to a drop off service puts us all in a place that undermines all we have collectively prided ourselves as. This pandemic has already taken so much; it can’t take this. Even if I have to gown up in hazmat gear to be there, I will. I can’t surrender this last place of empathy.


I find it jarring how much the place I practice has changed within the world around us changing. That piece of ever engulfing black top has been the divide between the clinic still bustling with activity and yet absent from the people I share these patients with, and that little house where we say goodbye and still remain human.


People are tired, worried, and fed up. I am with them. Everything is thought out, measured, weighed on a risk-based analysis, and the duration that feels omnipresent along with annually recurring in its resplendence. 



I wake up every morning wishing this looming veil of fear would be eradicated. Yet, I know disease doesn’t work like that. It does what it wants. It takes it’s time on a calendar that is intangible, mysterious and elusive. That’s the single thing driving me the closest to the brink of breaking. The unknown. Looming over me day to day and unending in its grip. 

My closed clinic doors. My masked face, and my painful hesitance to hug the client crying beside me as they say goodbye to another loved one in a time where companionship is scarce and fleeting. 


Yesterday I had to help a 2 pound kitten into the only peace she has available after her previous 4 months of struggling to survive. She was one of those few neophyte patients who has failed to thrive. Her mom has dedicated the last 4 months and thousands and thousands of dollars to multiple specialists across the eastern seaboard to help her get over her too many ailments. She passed away in her mom’s sobbing arms, desperate to fight another moment with a poking prodding vet who hurts. We cried together. The injustice of it all. The finality to a time with so many already to mark its passing. That kitten, (her name was Honey), fought so hard. She was destined to fail by some minute failure of her tiny bodies’ creation, or lack thereof. All I could do was say how sorry I was. What I wanted to do was hug her and her mom as firmly and re-assuredly as she was being held and cry together over the loss that was so painful and unfair. That, this personal grief met by self-protective perimeter defense is carried every day. It is an elephant that is dying on top of me. The degree of suffering is transcending every moment of everyone’s life. Like it or not. Deny it or not. 


The parking lot is just my tangible, dangerous reminder of how much distance we have lost in our taking care of each other during this pandemic. 


While I am not going to attempt to list all of the challenges COVID has brought to us as a veterinary clinic I would like to remind everyone that we are all in this storm together. Paddling in the dark, not sure which direction to go, desperate to hold on as the weather unpredictably rages around us. And, yet we aren’t really truly alone. It just feels like it amid the isolation of a parking lot which seems to feel like the best way to stay safely afloat. Being kind isn’t an act of exclusion., The challenge is maintaining it as inclusion amid the chaos of the unknowing. 


If you would like to learn more about veterinary medicine you can follow me here, at my blog KMDVM.blogspot.com, or my clinics website JarrettsvilleVet.com, or, our Facebook page Jarrettsville Vet Center.


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