Recognition, Resolution, and Restitution

 

One of the few rescues who got out. We brought her to Romania.
She has since found a home.

I had hoped I would be at a different place then here. And yet I am not. I am still stuck. Mucking and muddling through the aftermath of a trip I was so compelled to journey upon. I was hoping to make a difference. Assist a place so fraught with injustice. Throw a fist in the air to provide a whisper of defiance to a place I have never been before, for a people I do not know.

The Ukraine story, my story within theirs, still nags and gnaws on inside of me.

Here’s where I am, and here’s what I didn’t know I needed to start to try get away from it all.

Sandbags and steel barricades. They are everywhere.

Validation. I needed this. It might be shameful to admit. (Heck, if it is I am ok with that). I needed to not feel so alone. It came from two voices today. One, Dr. Sarah, who felt as desperate to go and help as I did. And two, Dr. David who arrived at the group I was with a week after I left, and described it, his experience with them, (not even the Ukraine war debacle) as; “the worst experience of my life.” He has been a veterinarian for 37 years. I found myself apologizing to him. Sorry for what he had been through. Sorry that I couldn’t have helped discourage him from being there. I can feel his weighty regret. He, like me, wanted to go more than our due diligence in trusting commandos with nothing to lose brought us. He, just like I, was content to clean the kennels of the dogs that the egomaniacs who had retrieved them would not do. Silly how we were so easily and eagerly recruited to came care for the animals because there was no one with any veterinary training there to help, only to be trusted with kennel duty. For me, I was more intent on being useful than being disposed. It seemed from day one of my arrival in Ukraine that my two options for being a part of the ramshackle team was clean cages/walk dogs/try to lay low, or, be headed with the engine crew to drive all over Ukraine on a rescue mission. He, like me, feels misappropriated, cheated, and deceived to have come so far to clean kennels, while watching them die of disease and isolation in dark cramped cages. I feel most closely connected to the animals I was so intent upon helping because of the solitary time I spent with them. Regardless of my medical prowess my contentment, despair, and painful burdened heart lies most solely upon walking away from those animals. I am bitter, burdened and speaking out for them. I will not be able to find my answers to the nagging puzzle still in pieces around me, but, now I can share my story with the others who passed through after me. Revenge for the eyes of those needful, displaced souls I can no longer be walking near.

Jeffery. One of the few to get out.

Resolve. There is none of that here. So, I fall back into recognition. I keep finding myself chewing on the days, the quiet with a dog on a leash, walking, walking, walking. And the faces I will never see again. The eyes of those faces that I dream of. Want for, and beckon to.

Mischa, the compound kitty. I loved her, she needed us. I needed her.
I spent much of my days just holding her. 

Today I found a community. It was the first time I could talk about my trip and have it resonate with someone else. I can say that I needed them, and feel great comfort in them also needing me. A community of more than a singular being who still tries to settle for the dust that won’t fall. I have found three other people, (maybe four? Or, even five?) who went just to be helpful. Just like me. They put their lives into a precarious place for the pure humanitarian effort that is so desperately needed. Just like me. Three other people who went because we were silly enough to believe that we were needed just because we were told so. We all asked for references, a call from the one before us to help settle the voices within that we were doing the right thing with the people who shared our view on this preposterous invasion and had the gumption to not only say so, but to do. All of us received the same response. None of us were given each other’s contact info beforehand. We found each other afterwards. After we left. Came home. All of us struggling to come to terms with our time there. All still reeling from the experiences we had. All ostracized by the group we put our lives in the hands of. I can’t express how consoling having this community is. There is something inexplicably horrible about loneliness. Loneliness with a secret no one can digest. A rumination of fear-based failures from a faraway place that isn’t relatable, nor comparable. War is the most atrocious act of mankind. War upon fellow humans just because you believe your might is more than their spines can withstand is unforgivable. The weak, poor and defenseless who get caught in between, that, well that is enough to motivate foreigners to your shores. And yet there is this survivors remorse, this silent pain of abandonment, and the futility that seemed to have come from risking so much.

My husband doesn’t understand. I can’t share this with him. It is still too raw, and my actions too selfish for him to make room for empathy on what that trip cost me, never mind him. He thought it foolish from the start. Empathy with a fool is permission to repeat. He wants me to see the experience in valuations from the economist’s eye. The weight of one life and the cost it requires. “Is one dog from Ukraine worth the thousands of dollars it cost you to care for them? Is it worth it when they still cannot get out? When 25 out of the 30 puppies that were brought to the compound died of parvo simply because they were rounded up, caged together and never vaccinated?” No, the answer is no. I wasn’t brought there to practice 30 years of medicine that I was armed with. I was brought there to be a pawn in a delusionist's collection. I was pled to so that I could be a talking point for more social media fuel. The lives can’t be counted as not valuable, not risk-worthy, not my problem to solve.

The first euthanasia I had in Ukraine. Heart failure.

If grief is part of this recovery I am past the heartbreak of not being able to bring the dogs and cats I helped smuggle into Romania. I am in anger. Anger that I wasted my time, watched those dogs die from sheltering, caging, and followers. Angry that this is the only place I have left to put the pieces. It’s not good enough that the wolf and the grizzly bear are safe and out of Ukraine. It’s not good enough that I came home safely. There is not a place I can shelve this and go on.

Can I continue to carry the stories of the faces I left behind? Can I find the will to put the pieces back into some assemblage of peaceful acceptance, or, am I at the place where restitution is the only resolution?  

Coughing all night. He just coughed all night. Antibiotics, sedation and a full grooming shave down. He was brought to Romania. In a shelter now.

I said once to a fellow, equally fried veterinary colleague, "yeah, I get it. I am so exhausted by the sheer volume of need, and the frustration of my inability to meet the demand that I went off to a war to try to feel better about myself, and my current place within vetmed." Maybe the muck is my own to own, and accept? Maybe there isn't such a thing as a peaceful recognition, nor resolve. And, then again, maybe the restitution only exists within?

Consequence Medicine. Does Knowing What Lies Ahead Influence The Course Taken?

I've been spending a lot of time immersed in the other side of medicine. The human side. It's been a very enlightening vacation from the dirty, gritty, completely un-glamorous life of dingy scrubs full of cat & dog hair and wipeable shoes caked in excrement from all imaginable canine and feline places. It's been an interesting, albeit eye-opening foray into what I might have been if I liked people half as much as I like furri-ed beings. The differences between these two species,, me and the MD's, is stark and vivid in contrast. I did a little informal study of the attire in human medicine. They are an excellent example of how different the life of an MD is versus a DVM.

Here was my attire for yesterday: layered short sleeve shirts, short sleeved scrub top (a motif of mugs of coffee of every color floating in haphazard directions against a charcoal background... one of my favorite shirts purchased within the last decade), scrub pants, (ill-fitting, baggie, completely unflattering, which is how most of us live our entire careers), and plastic covered flowered Danskos. God are these shoes durable and professionally forgiving, but fashion vomit. And, yet, I have dozens of pairs in every shade, season, and style. There's only one style, it's that bleak. Ponytail, trademark and omni present. No time for pretty hair you are just going to get ear wax puss, or anal gland spooge in. Is there? I dress for a power wash decontamination day, well, every day. No false pretense here. I aim to serve and be peed on,, it's a crap shoot I expect.

Here was how my moms oncologist (I met her just yesterday) was dressed: Silk dress jacquard print black floral cream background. Heavy duty, almost bullet proof leggings, and heeled ankle boots black. Immaculate white, nun inspired bleached, starched, pressed, cursive embroidered multi-lined, almost paragraph form, blue lettered, lab coat. I wouldn't be surprised it if has it's own glass box it is kept in off duty. She sported a double back pony tail. Pony tail start, flip up to sky ends. I liked her for her effort. The jealousy lies in the silk and jacquard.

It's a wide divide. Want to know how wide? Well, let's measure it in this. My humble wardrobe. It keeps me smiling more than I need to. And with that I get to show off the braces, (second attempt since puberty attempt at alignment failed many decades ago), which are also a reminder that I live and work amongst the mere mortals. It's real-life at ground level. I am dressed and ready for medical detective sleuthing and slaying. She, well she talks too much and never touches her patients in any meaningful medical way.. She dresses for luncheons at country clubs. My mom is dying in the dark corner of her small room and I am prepared to clean up any mess it might make, and then still see another patient 20 minutes after. Down, dirty, real-life messes that I can diagnose, treat, and sweep up the crumbs.

My mom is back in the hospital. Again. This time it was a quick three week stay at home after a week of intensive trials to find her pain management for her stage 4 metastatic breast cancer. I have to say it like that, seems more ominous. I try to lower my bravado, enunciate like I'm introducing the sporting class entrants at Westminster, "Sir Lancelot Cumberbund of Landsley, 4 year old male Bishon. He likes long walks, and peanut butter laced Kongs".. kinda drawl. Add flavor if you can't add humor, and we all need to try to add both lately. It was a long hard discussion about where to go from the discharge instructions out of the hospital the first time. My mom chose home. In retrospect I am fairly certain she was feeding me a line of BS not even she believed. It was what she wanted, not what she needed. She needed to go to the rehab hospital to have the full time staff inflict a regiment of tasks upon her to rebuild her. She needed post hospital boot camp. She got furlough. It cost her and the consequences were realized within a month.

Among the very different way we doctors dress, (yes, grant me the use of "doctor', even if vet med precedes it), is the way we dish out the dirt. For me, in my daily practice it is 100 % honest with very little chance at a thick file full of data filled diagnostics to support it.

Veterinarians have a few big challenges to face with every patient. It has been one of the big stark observations for my days living on the other side of the tracks. MD's ask a lot of open ended questions. Vets do this too, with our human clients, our patients we just can't get honest answers out of... BUT, we take all chatter at about 60% face value. We listen, we take notes, and we KNOW that about 50% percent of the time our clients are lying, embellishing, flat out oblivious unaware, or hiding something out of guilt, shame, or overwhelming personal blindness. Veterinarians KNOW to listen to our patients responses to our internal questions far more weighted than our speaking pet parents. Here is where MDs need to spend some time in our trenches to learn some valuable diagnostic skills. Let me give you an example,, or a few..

My mom has been under hospital care for weeks, cumulatively. The doctors, the nurses, the entire staff changes every 12 hours, like shuffling a Vegas deck. The house holds the upper hand, and the player is always likely to lose. Same applies here. There needs, really, desperately NEEDS to be some consistency. There is not personal investment if there isn't at least familiarity. So that's where family advocacy plays such a vital role. For the past few days my mom has been eating better. This little step alone is immeasurable. At the vet clinic every patient is monitored for food intake. We, the collective small consistent bunch of us, provide direct oversight. My mom, nope. They bring in food, clear food, always some cafeteria dressed orderly who says "hello" and flashes away. I am very certain she could go days without anyone knowing how many calories she is, or more aptly, isn't consuming. At the vet clinic we also weigh our patients DAILY. Examinations, done at least once, usually twice a day. My mom gets a "nurse assistant" who is always too indifferently distant to allow her four times daily numbers to interrupt her after work plans.

In three days in the hospital no one gave a thorough exam. Lots of specialists chatting, and no step back use your noggin deductive reasoning.

Back to meals: In the two days she has been attempting to eat a meal she has started to cough. The progression of her disease is so abrupt that she struggles to cough well enough to clear her food obstruction. I watch her and think, "crap, if she needs a Heimlich I am going to shatter her. If I try to slap her back I will likely send her into so much pain she will need a drug induced coma." So, I watch and wait. She hasn't needed emergency intervention yet,, but,,, it's probably coming.

She made mention to her nurse. "I get a tickle in my throat when I eat."

"Your lungs are still crackly, we will add a mucolytic." Essentially Robitussin to break up the chest congestion. She was after all admitted four days ago for pneumonia.

"She has dysphagia." I added. She is also on oxygen, lying in her bed for 23 hours a day, and not getting better.

Open eyes appeared.

We called the doctors in. After an hour of conferring I told them all of the observations I had made over the last two days.

She is oxygen dependent because she has lost so much muscle mass she can no longer inflate her lungs on her own. The same mechanism causing respiratory difficulty is causing swallow inability. She also needs to be told to sit up all waking hours, walk, and work on her internal muscle function as determinedly as her external muscle function. She has had three negative cultures for pneumonia. Therefore she does not have infectious pneumonia she has aspiration pneumonia, and atelectasis of her lungs. Her lungs are shrinking and shriveling inside her chest because she lacks the ability (whether that is pain, disease, etc.) to fully inflate them. Over time, weeks to months she is further failing to inflate them so they are shrinking inside of her, and now without forced 100% oxygen she cannot breathe."

The straws were taken away.
The bed is taken away.
The food has to be monitored. It needs to be small bites, liquid more than solid, and swallowed under supervision.
The nurses need to encourage her to walk and move. Even in bed exercises will help.

But what really hasn't been given to her, and what I find most contrasting in how I practice medicine is that there are no discussions of consequences. Lots of chatter about findings, the latest diagnostic results, but no talking about what will happen. What her course, her current path, where she is and how she has migrated within the spectrum of health, freedom, prognosis, life in general has come from, or gone to, or ending up.

Am I the only one who feels like every patient deserves that? Am I just a glutton for stark, cold hard reality so I can feel like I led a life of choice?

And here is my quandary?

Does my mom want to know? Do I just sit quietly and give her quality time as it escalates to short time? DO I deny her the ability to know so she can understand what lies ahead?

My husband thinks that she just can't do what is needed. I can't possibly relegate her to "lost cause" on the assumption of can't. Can I?

The absolute torture for me is being able to see what lies ahead.. To be asked to sit quietly as doctors miss things while they lack the intuition to question their patients ability to accurately represent their condition. I can see her future and I am not sure I can sit sidelined and not yell in the warning of the linebacker about to sac her.

Mom, if you are out there you need to move, and eat, and yes, dare I say it, fight. It's almost too late to turn this game around. The coach, the vet, they all know the consequences. Aren't we here to remind you of them?

Alone in the Jungle

Alone in the jungle.. How often does everyone else feel like this? I suspect, (dare I say, hope?), that it is most. Otherwise I think that I might truly be all alone in this deserted jungle? (And how crappy would that be!)? Why do we, (or, at least me?), seek solace in knowing the rest of the boat is in the same boat with us?

Day One, USMMA plebe line-up. Second Company 1987

Maybe the grown up me just hasn't totally accepted the rest of me as "all I need?"

Why do so many of us feel so alone? And, with that, isn't that exactly why so many love their pets so intensely? If that presumption holds true then why do I feel so alone, and all alone, in my profession? I have somewhere along the way learned that I am less abandoned and more appreciated by my clients than my colleagues. (How many other vets feel this way?). I know there are vets out there sighing a sad despair-a-tive exhale with that admission. The vet profession has become a gaggle of cohorts all protecting each other from the demons lurking in the self prescribed pink juice. There are collectives who have your back regardless of your shortcomings, mistakes, or inadequacies. You just have to be a vet and they have your back. Right? Well, maybe for the other vets. But, for the small group of us not in the in-crowd it's an existence of cosmic outpost inhabitancy. You are really, really alone if you pick your clients side over your professions allegiance. What if you are the poor Schmuck who still likes your patients better than your clients and your colleagues,,, well, then you are totally fucked. What if on top of all of that you are a vegetarian,,, well, there isn't a category for that, fucked, alone, pariah. Great. 

Droog shelter, Alexandria Ukraine, 2022

That's me, totally unequivocally alone. And yet I still sit here in my dingy throwing out life preservers to the gulls passing by offering quiet applause and anonymous cheers. Last week I spoke to an internal medicine expert who said to me, "I wish you luck, this one is not going to be easy, or make you any friends." Thanks, just what I needed to hear. 

Storm, blissful in the buttercups

I wonder if my legacy will just become the Ralph Nader of the vet med profession? I wonder if I will take any kind of joy in that title? Can't anyone else see that our misery might just lie right next to our denial? Why aren't we all just on our patients side, if you know we need to pick a side? Why not them? I think it's because the us gets in the way of the them? Doesn't anyone but me see they are one in the same if you just open your lids a bit more? Who says you can't do everything for them, our patients, and not have it come back to you in spades? Or, I just have to convince myself that alone is ok, I'm not going to like myself if I try to make my colleagues like me. I'm not going to have patients that purr, wag, or cuddle me in those quiet places that we spend together. They look at me with enough gratitude to make up the chasm of difference that the profession can't fill. it is enough, it has always been enough.

Here's to being alone, saving every goddamn blocked cat and pyometra dog that my colleagues turn away. Those dogs and cats deserve a chance, a palliative nuance of possibility, and an advocate who's lonely. 

Always kiss the cat goodnight

Here's to intention having merit. Self-preservation being empowering, and lastly here's to all of the vets out there throwing stones and not able to look in the mirror at the faces of the skeletons in their own closets. 

Chief Mate CS Global Mariner, 4th of July cookout.

Here's to the Fourth of July meaning just a little bit more to us that feel alone, and a world of possibilities if we all start living a life of freedom instead of loneliness. 

rsity doesn't Include Inclusion. The Division In Vet Med That Exists When We Talk About Access To Care, And Vegans

 

The world reminds us to look inward and ask ourselves how we, the little tiny ant of the mound that is this planet, influence the behaviors of the rest. Now, at this time when the pandemic wanes, the invasion of Ukraine dominates the news, and the ever-increasing faces of color peppering the professional rags and conferences reminds us that others should not no longer be marginalized, and the Supreme Court further divides the able from the oppressed, I wonder how far have we really come? For the many in vet med who refuse to recognize the invisible challenges, countless extra steps, and years (if not decades) of extra that are required to be seen, never mind deemed, a ‘colleague” there is no possible way we will convince them of the patterns, biases, and inherent hate that too many above inflict on too many below.

Diversity only happens when one oppresses the other, or a chair is pulled from the table to invite another in peaceful kindness. I don’t see a lot of this in vet med. I have rarely if ever, and 30 years in, I still do not. Even with the diversity we are inheriting amongst us.

For my own journey in getting into veterinary school I know that being white left options others didn’t have. I admit it with humility and shame. I was allowed, or more aptly granted permission, because I was a white woman with an anomaly. I had a path behind me that set me apart. I was already established in a career overwhelmingly dominated by men, and making more money than anyone in my vet school admission interview. That simple fact left me unafraid to break glass ceilings, dig my steel toed boots in, and stand strong face to face challenging them to exclude me. It worked. It worked at the academy I went to college for, the sea life I spent working in for 10 years, and the getting into and out of vet school. It has not, however worked for the life after graduation from vet school. I would still call myself a pariah of this profession. I am not wanted, nor welcomed IF I chose to be true to who I am. I am not alone here, but, we are not big enough, loud enough, or protected by any organized facet of the society we live in. I would most compare it to a religious sect without federal recognition, save for the fact that assigning a religious undertone is equally disgusting.

I wonder if this is the rejection of diversity, or, the lack of inclusion? I wonder how much the division, exclusion, and alienation empowers versus subdues?

I was speaking to a friend affiliated with the profession. He is not a veterinarian. He, like every other human who is not a veterinarian, is flummoxed by the assertive defensiveness that is elicited when I show my face in a veterinary forum. I am not included, often harassed, and I often wonder if it has made me stronger and more contentious about staying within the ranks and file as complicit in our negligence and neglect that so often leads to suffering and death? How often do we look away when a patient needs us but cannot afford our compassion? How often do we deny them of analgesics when all else has been declined, or become too expensive to provide? Why aren’t we charged with the same awful labels we denigrate our negligent, too poor to be privileged with a pet, lacking in responsibility to warrant pet ownership, it’s not a right labels? Why aren’t we taking some of the blame? Why do we still wonder why the public has become so enraged by our lack of compassionate access to affordable care?

In my opinion we have to stop trying to explain why our life is so hard that we cannot be kind and understanding to other people’s struggles. We have to take ownership in the fact that the cost of our care is priced out of much of America’s ability to pay for it. Maybe we should start explaining how $100,000 sign on bonuses aren’t a part of the problem? Maybe we should keep trying to convince heartbroken pet parents that the life saving surgery their pet needs would cost 10-100 times what it does in the human forum. That will settle the angry masses, right? No, it won’t. It doesn’t matter what kind of excuses, deflections, blame and accusations we make, we are creating a profession that increasingly only serves the wealthy, which in this country is still the white and the fortunate. We are not opening our inclusion to anyone; we are increasingly excluding the people and the pets who need us most. We cannot try to become a profession where everyone is welcome just because we all share a love for pets when we alienate so many on both ends of the leash.