The Other Lives I Could Have Lived.

Do you ever wonder which path you would take if the whole book of your life had been refreshed? Sent back to that first word on page one. What if your whole life's narrative suddenly all went blank? You got to do it all over again. Restart. Relive. Redo.

I do. 

Hamilton

I seem to imagine these avenues where I find myself lost in the other things my life takes light within. The other things I could have been. The lives I could have lived. I live them now and again, in tiny moments, but, as a spectator. Set away and apart, at a distance. Able to enjoy but not influence. Absorb but not immerse. Be, but not be included within. I wonder if I would have been happier there? Would have had a different outcome? Would have been a fuller person? Lived another life in the same canvas with a whole different set of trimmings to set the stage and act the part.

Color and music. I would have done a whole lot more with these two. Maybe a fashion designer? Draping sumptuous silks in jewel tones with operatic bellows to inspire me as I work. Sopranos to swallow me into.

I could have left the bleach washed walls a hospital requires and have been a street artist. Playing a harmonica in the subway watching the world rush by to their cubicles and plastic potted plants. Making money by predicting the tides and hedging the cortisol surges of a gambler playing with other peoples monopoly money as stock broker on the floors of ticker-tape scribbles. All adrenaline and dollar signs as the carrot promising a life of caviar dreams and champagne stained yachts.

A humanitarian rushing off to a foreign land to protest human rights violations and expose the cruelty no one wants to acknowledge. The Audrey Hepburn/Lady Di cupping starving faces in their coiffed manicured hands with smiles of false optimism for a more stable and safe tomorrow.

Droog Shelter in Alexandria Ukraine. April 2022

A gardener praying to a seedling with the umbrella-like healing palms over the verdant shine of the two cotyledons who carry so much promise in their two tiny appendages reaching upward for the sun. The caretaker to natures bounty among the war for food by all the other beings who seek to profit from the seeds sown by others. Find my place in the balance of sharing resources and not taking more than the earth can balance. A silent partner to the provisions the seasons dictate. Spend every moment of everyday the observer. The Cicada listener. The observer to the flashing color of the hummingbirds, the butterflies, and the flowers they dance between. The deep breathes of the grass as I walk on her carpet of cosmic energy. The goddess of all that is green in a forest that emits only the crickets and the buzzing of the beings far smaller than I and yet so massive they drown the rest of the world away.

Wren in our rock garden

Is it possible to live all of these lives in a profession that requires all of the time that my eyes are open within? That I don't know. I live in snippets. The opportunities between the sick calls. The place where I can steal a few minutes to walk outside. The seconds between lunch (I never eat) and the next scheduled appointment to hold Seraphina and press her into my face. She is a muted galaxy of greys and gold. A tangible downy gosling of fluff emitting a halo of feathery hair. She is my time out in the middle of the endless chaos that is a work day. Hamilton, the paralyzed ginger kitten who belongs to Autumn now. The kitten thrown from a moving car window thrown away like a piece of trash. Brought here for a chance at mercy and now one of ours. He is so perfect in his purpose. He simply wants to be held while he purrs into my chest. Alters the rhythm of the blood coursing through his symphonic blissful lullaby. I painted the vet clinic staff bathroom hot pink/fuchsia. The one place the door can be closed and the color can envelope me whole, half naked to the world that exists on this side of the tsunami treatment door. I put up 1930's advertising prints. Who else has $150 artwork in their work bathroom? I also added a mirrored make-up table and a crystal chandelier. it's handicap accessible per MD state law and glammed to my alter-ego. 

Hamilton

I struggle to fit fashion into a workplace graffitied with urine, feces and anal glands on an every-single-day-of-my-work-day-existence. It might just be a pair of bright cartooney socks. Or some vibrantly-glittered Begdorf eye shadow to add a hint of glimmer to the disposable day scrubs.

But the reality is that I chose this one. This life, This path where the road is not full of whimsy, trends, public performances, and striving to be a house of notoriety in this label conscious crowd. I am a small town vet working my ass into a dust trying to save this most recent disposed of kitten who without us would face a world intent on consumption. I am the force of nature determined to hold back the raging bull wearing expensive shoes in the phone booth, and I couldn't be anything else. No matter which door I had chosen to open; pick the hidden prize behind, I would have ended up here. The heroine in my own set of Herriot novels. Still sweating under urine soaked scrubs with turquoise socks stenciled with cats in Santa hats feeling like I make a difference even when there is no audience to applaud, and no orchestra to bow to. 

Permission in Veterinary Medicine. When Is It Not In The Best Interest Of The Patient, and Why Not?

 

The start of today's NYC 10k

Permission is one of those words that come seasoned with disdain. It’s a word spiced with hierarchy. Flavored with rank, status, and inherently poised to provide unwritten, un-equivocated submission to being less than, therefore in need of,,, permission.

It’s a silent caste admission. A way to assert while it sentences subservience. 

Hamilton. One of our best examples of compassion and not needing permission.
When you are unwanted its not relevant or pertinent,, at least to me.

Permission in medicine, the human variety, occurs at almost every level of care. Today I was running a race and right in front of me a fellow runner was broadsided by a bicyclist going about 40 mph. He hit her so hard that she was sent flying and landed like dead weight on the asphalt. She was unconscious for 20 minutes. In that time three doctors rushed to her aid (2 md's and a veterinarian from N Maryland). Without any consent her clothes were cut off and she was hooked to a defibrillator. We held her hand, kept our fingertips on her pulses and called an ambulance. Passerbyers flocked quickly and everyone was directed to keep clear. We placed her in a neck brace, slipped in an i.v. and began collecting vitals. It took 5 minutes to get an EMT and 20 for an ambulance. She was still barely conscious as she was transported into the ambulance to be brought to the hospital.  This is how we would all want to be treated. Right? A freak accident occurred, people immediately jumped in to help, and life saving care was not given one second to allow for a poor outcome. This is how it should always be, right? There are things we can do to help with pain, disease, and even immediate emergencies and we help? Well, let me tell you about vetmed. Vetmed is all about consent from the first second to the last. Consent requires permission. Permission is the crown wielding the fate.

Permission is where fate meets traffic signage.

Permission in my experience rests on spousal influence. I wish I could feel that permission rested on ethics, soul designation, and the inherent irreplaceable value that is the truest level of devotion and companionship any of us will truly have,,, but it isn't. It is so often about control. There are broad sweeping generalizations I could pepper in here, (most apply spot on), and much makes reminds me daily to be so grateful I have financial independence. Control/permission, the lot is an ageless reminder to women that their voice carries a 2/3 vote. It’s the acceptance that the purse-strings are provided with a budget in mind. It’s that one thing that drove me to not becoming my mother. Permission is that one last vestige of inequality that manifests at the vets office. Permission is as venomous to me and a chastity belt and a maiden name. I have given up asking for permission. It places me back, mentally and emotionally, into a time and place where skirts were too tight and white gloves were fashionable. Permission implies ownership, deference, and allowance for others that is far too generous.

Permission was something my mother needed too much of. She was resentful because of it. And I learned to never want to be in her shoes. It is quite simply the reason I went to vet school. I see it a lot, (too much quite honestly) in my day-to-day vet med life. It makes me seethe inside. It breaks me, daily. Why, why do so many of us need permission?

I have been married for decades. I know the difference between conversation and negotiation and compromise and permission. Permission denotes control. When it comes to pets, their lives, and the precarious place they hold value, permission turns into earnest negotiation and pleas for mercy.

..end of the 10k. Frippie and Storm are happy to see me!

It’s a high wire act founded upon compassion and rooted in property replacement values. Very rarely does permission for care hinge on sparing from pain. Occasionally permission to treat manifests around a lunatic discussion of perceived appropriate care. Last week it was the trapped barn cat caught on the vet clinics property. Small, frail, afraid to blink, or move a muscle and the neighbor who believes he is a wild animal and therefore does not deserve veterinary care. He will either be eaten by a predator, injured by a rabid animal, get and possibly infect other cats with FIV, or continue to live his life full of fear outside. They feed him by the way. They refused to give me permission to vaccinate, neuter and provide flea prevention. I am reminded of the saying about “good fences” although how many of these are cat proof?

Jeezy,, he loves me,, he loves me not,, it kinds goes like this with him.

Permission to provide pain management post operatively was a battle for the first few years of practice. I had to absorb it into the cost of the surgery to make it appear as if it wasn’t a line item that was negotiable. Permission for analgesia? Yeah, not under my scalpel. Permission is the most precarious part of vetmed. It may not seem so obvious but it is. Permission to help is often used as a wedge to drive price points. I admit I do this too often. Where I am strong in my ability to not show, ask, or desire permission my deference to advocating for a patient’s well-being lies in my willingness to negotiate anything for my desire to obtain permission. I will wheel and deal more cunningly than a used car salesman. I will wager the house to heal. I do it daily. I have amassed coffers of contributions so large there isn’t anything I can’t give away for free. I have turned my disdain for seeking permission into a black and white disclaimer of empathy. Still with this there are those who won’t provide care regardless of whether or not they have to pay for it. That’s the ultimate control. The ultimate heartbreak, and the ultimate reason I am not a veterinarian to all, in spite of all who need one.

Peggy. Allie's rescued kitten

Personal Note; please remember what the title of my blog is. It is my diary. The place I put everything I try to sort, package, and categorize when it lays bubbling under the surface of a profession I feel so passionate about and the lives of the patients who cross the threshold of my small town vet practice and eat away at my heart for the plights they face. I have come to be paranoid about euthanasia requests. Not because I don't feel they are warranted in so many cases, but, because they are also totally unwarranted in far too many. I have come to despise permission and the inherent control it inflicts.

The Little Luxury Of Time Off.

 

My back porch with Magpie

Time off

Luxuries in my world have become sparse, and hence, heavily scrutinized. I just get too little time off to allow for idle luxuries anymore. They are now pre-planned and weighted. I am also now humbled to be notified by my withering infrastructure to have to allocate ‘recovery’ time into the sparse luxury free time category. For the bulk of my 2022 summer the days started at 6 am. I have had to forego my treasured morning runs so I can arrive at the clinic by 930 am. I work until 8 pm every day. I come home most nights after 9 pm, so worn out and hungry that I internally argue about which needs to be resolved first, or, even if at all. I typically eat dinner at about 930 so fast that I cannot recall what it tasted like. I land in bed 15 minutes later. I would guess I consume 3,000 calories after 9 pm, and less than 500 before. I go to bed with a stomach left on the night shift and a vision of gastric reflux with all its secondary consequences to haunt my comatose sleep. I used to wake up at 2 am to flounder for an hour or so. It was the couple hours of needed slumber that gave way to the demons of the day that could no longer be kept quiet, or silenced. 2 am, eyes open, mind charging, and the little lurking nagging oversights take hold. It's the time I am captured by my unconsciousness and awoken to address the needs of all the patients and clients from the day I just slipped away from. Awoken to face their elusive illnesses and diseases as my own incapacities. Now I wake up at 7 am arguing that the sun must still be up from the night before. Some all-night bender that altered its rhythm? It can’t possibly have been 8 hours from when my eyes slammed shut? There is no longer a slumber with its quiet pre-slumber conversational interlude with my husband. There is the parking the car, walking inside the house and a fog until I question whether my cell phone has been locked out of knowing the correct time. I best describe it as feeling like a professional athlete who is stuck in their Olympic trials’ day after day. An endless loop of running your best time. Swimming your fastest lap, and clearing the endless set of hurdles. I leave my soul on that field, on my veterinary clinic epoxy floors, every single day.

Kirby kisses... the best part of the job, hands down.

Now I realize many will see this as venting/complaining. A complaint for the life I have chosen. It isn’t. I know I can say no. I understand that I have options. The thing is that all of those options aren’t things I think I can live with. For every friend with a pet related emergency that calls, texts, or show up I feel needed. There is immense power, I would argue it is far more powerful than money, fame, and restful toes in the sand (or sleep). I cannot dismiss a plea for help. I cannot excuse it as ‘inconvenient’ or ‘poorly timed’ or ignore it. I just dig deeply, plow my nose into the ground harder and deeper, and hope my absent happy game face isn’t too obvious. The issue is the consequence for the need. The exhaustion for the hours and days that run into each other and drain the engine in the process.

Abby never has a day she doesn't go googly-eyed-happy over.

I was reading a post about the life inside vetmed as of late. For many of us COVID came on like a veiled and sinister mysterious uninvited house guest.  We had no idea of what we were in for. Absent clients stuck in their homes with their (hopefully) very happy and healthy pets just watching the days of monotonous a quarantine drag on? Would it be a repetitive cycle of wash, rinse, repeat, stay inside and pray your pet doesn't get sick. Or, would we all hide and survive, or chose to work and die? I made an internal promise that my vet clinic was going to stay open, be there for our patients, and weather this storm as we have the previous 80 years of storms, even if it meant I did it alone. My pets are the most important part of my life. I know that I am not alone in saying that, and I am going to be there for them, and all of the rest of those who are for their parents what mine are to me. Two years later and we have made it through. Unbelievably we were slow for a few weeks of COVID and then a scant few weeks later the sky-rocketing demand for everything pet related blew up. It has been unyielding and unprecedented. I have never known such need. We have never heard from so many people so desperate for help. We have dozens of new clients seeking care for their pets because the ER has a 24 or more hour wait. Or they tell clients that they can only make time to see them if their pet is imminently dying. Who can wait for that? 

Allie, our amazing technician and our resident cat Saffie

I didn't come here to have a life of routine rabies vaccines and spays/neuters. I came here to be the place you go when your pets aren't healthy. 

It has become a storm. An unparalleled time and consequences that I cannot accept even at the expense of the machine that attempts to answer the call.

I say all this knowing that along with the incredible demand for help there is immense gratitude and new life-long friends we have gained. The other side of a pandemic is the lives that aren't so inclined to be a little nicer, a little more compassionate, and a little more grateful that we are all still alive. It has been really hard to still want to help the mean people. The people who are mean to the staff and sweet as pie to the vets. The people who are soo ridiculous they don’t think my staff tells me. We know. It’s a small family. We take care of our own.

Hamilton. Our newest act of kindness and the reason we are who we are.

There are lessons we are all going to learn in the hardest of days. These are the people we will be remembered as. 

Remember the people who make you feel good about who you are, and why you are here.. here's to a few (of the many) people who I rely on everyday.

Thank you to all of you who help JVC be the place where miracles happen, and help nudge them along their path with your big hearts and your endless smiles.

Weathering The Heartbreak Within The Purpose

 

Saffie, our (one of ours) clinic cat.
She is no help, but always a shoulder to lean on and laugh over.

I sit here surrounded by fodder. Aberrant news clippings, half read magazines, a pile that represents time to do what my heart finds joy in, and not a second to do any of it. My life is a serious of tiny snippets, all left over from a place before, where I had hoped I would find time later. It is all elusive now. I cannot amass the hopeful day to make it a quiet time for me to enjoy. I have given up almost everything to be here. Everything save for the one thing that is the most important; the feeling of being a veterinarian who rises each day to stem the tide that manifests into a tidal wave that just grows, and looms larger with each circadian revolution. I have become the 2022 version of all of those I knew before me. None of them had much of a life outside of their work. All of them made choices of neglect to answer their call of duty. All of them did it silently, with their actions, their blunted birthday celebrations, too tired to make it vacations happen, and holding on to their practice until they were too withered to walk away productively and do anything else. Retirement is a short stay and no vet dies broke at the end of it. It is a calling as much as it, (I’ll admit to more), than it is a sacrifice or a curse. As exhausted as I am, my tattered, disheveled home to prove it, my aching legs and stress fractured feet now abandoning my morning runs, I am meant to be here. It is the place I belong. How fortunate am I to have that? How many others work in factory assembly lines, toll ticket booths, or check out lines with angry faced clients and fell this way? How many walk this journey of life never feeling that they gave more than they received and feel purposeful because of it?

Two of the 54 we saved and found homes for.

How many vets work so devotedly to getting into vet school only to leave a few years later? I saw Karmen, a 3-year-old German Shepherd, yesterday who had become lethargic just the day before. She is the dog of my surgery technicians, Autumn. Karmen was fine one moment and distressed the next. It was early Sunday morning. Within two text messages and a master key to allow access to the clinic 24/7, my tech had her on her way to getting vet help. We got her into the ER with one phone call. Something unheard of these days where waiting to be seen can take days. Days pets die from. Karmen was immediately hospitalized at the ER to have her blood work done, x-rays completed, and barium administered. Less than 24 hours later she came to me, yesterday morning, (a 6 am Monday morning transfer to our vet clinic, the place she had been vaccinated, spayed, our patient coming home to the place her mom works at), and I knew the moment I saw her that she was unlikely to make it through surgery. It is a gut feeling that only comes from decades of being in practice. I just knew. I tried to break it gently, (there is no such thing) to Autumn. She is the kindest, hardest working 22-year-old me, and just like me she feels too much, and devotes her life to her pets. I adore her. I feel like her mom most days, encouraging her to not put limitations on herself, being her support system for all of the adventures and misadventures she attempts. She saves every unwanted critter that steps into our clinic. One year she found homes for 54 cats from a hoarding home. This year she adopted Hamilton, the kitten brought to us after I suspect having been thrown out of a car, who has a broken back yielding him paralyzed from the waist down. Through her Hamilton has amassed a following on social media exceeding 6 million views. She did this. She has no idea how influential and inspiring her actions are. And here we were, me the aging seen too much to not be realistic vet, and her, still trying to save everything, looking at Karmen together. Karmen needed emergency surgery now, probably last night at dinnertime, but we are here and now with decisions to make. We put Karmen on the OR table within minutes of getting to the clinic. The clinic transforms into a quiet vacuum on these occasions. I.v catheters running, monitors beeping too fast and too loud, people shuffling back and forth hyper-focused on the task in front of us. These are many of the too numerous to count clues that things were at disaster status and Karmen was barely holding on. Autumn stood beside us as we opened her up. It is a rare thing to be able to separate yourself enough to let the body be a body.. the soul to be levitated over the shell it is housed within. It is the gift, or curse, I am never sure which, that allows magic and miracles, and quite honestly closure to occur. We spent two hours doing a surgery I had never done before. A surgery I know has horrible chances at a good outcome, and yet it was the only hand we had to play short of euthanasia on the table and waking the dog up to die a day later in still constant intractable pain. We tried. I place so much emphasis on this. These two words govern all my days. All my efforts. I just want to try. How immensely lucky am I to be able to have the freedom to try?

Karmen

Karmen died on the table as I was suturing up the incision that ran the length of her abdomen. Medicine is like this cruel to the place of pondering fate and our futility in considering ourselves influential in its whims. Karmen died from a colonic torsion. I have only seen it one other time in 20 years. The other vets at the practice, four of them, had never seen it before. Karmen was fine one day, Saturday, in the ER Sunday and deceased Monday, and she had the immensely, (not even the right word to describe the magnitude) fortune to have a mom who knew she was in need of immediate care, access to the ER, and a surgeon at the ready. Nothing would have been more advantageous for her. I am quietly whispering to my inner self that I should have just done the surgery immediately on Sunday an not have waited for her to stabilize, rehydrate, get antibiotics. And yet my 20 years tells my aggravated mom self that it doesn’t always fall this way. Forcing the hand, cursing the cards, and dictating the outcomes. She is the third patient I have lost under anesthesia. Shockingly the two others were my sisters feral cat, and my former groomers kitten. Two grey cats with unknown histories and unknown underlying issues. Three in 20 years. I remember their faces. I will always carry them with me. Thousands of successes and the few indelibly scar. Even with this haunting I feel grateful. The glass half full must always be the lens we utilize when the mess around us reminds us of all the work left to do, and all the joys left to be had, someday.

Karmen going home after her spay.

Karmen at home

For more information on Hamilton please follow the Jarrettsville Vet Facebook page. 

Thank you to Autumn for letting me share her story.