The Problem and The Compulsion

I have had this conversation a thousand times before.

A thousand times I have explained the same problem, the same outcomes, the current state of our profession, and the same desperate passionate plea to provide better for the sake of all living things.

With each plea for help, pitch for the solution, and nodding heads of understanding, the problem remains here at my feet grinning. 

The problem sits, consumes and grows.

Problems this big, the kind of big that swallows lives and breaks hearts, can define a life. 

I may have come to vetmed to save pets lives, but this profession is more than practicing medicine, it is about protecting and saving lives. When I can't do this it's a big problem. This problem has gripped my life's work and taken it into a place I never thought I would become so compelled and stuck within.

What do you do with a problem that allows suffering, denies culpability and consumes as it festers? Well, I guess if I am me I dig in. 

I am now companions with my problem. My problem has become my compulsion. As compelled as I was to become an adult and leave the shadows of a small existence in an even smaller northern town. Compelled to be unburdened by the confines of a family fleeing a city that left them feeling monitored and microscopic. To the girl who I once was compelled to find a bigger life with a chance at freedom to the cost of a uniform. To be compelled to go to sea for a decade to buy your second chance elsewhere. Compelled to fight and outlast the years it took to get into veterinary school and quench that little girls soul still alive inside her and be the Herriott she heralded. I am compelled to do this too. Shake the ground so hard that the tallest tress tremble and the smallest beings benefit. Just like all of these before I will not stop until this to is notched in my belt and a little piece of kindness is given back to those who never formed the language to ask.

Here's the pitch, (for the one-thousandth-plus time), in small bites;

"The house is ALWAYS stacked against you." Whatever veterinary clinic you walk into, (and for my analogy: any casino), they have the upper hand, almost all of the control, and very little, (if not intentionally absent), motivation to provide you all of the options available to you and your pet and no upfront transparency to allow you to be prepared, informed or flexible once you walk in their door. I used to hope that moral fortitude, ethical foundations, and our own soul-filled desire to make a difference within the profession we were all so passionate about might motivate a righting of the compass, but it appears the gap grows ever wider and the despair ever deeper. 

"There are so few governing rules in veterinary medicine that it has allowed the single minded behemoths to eat up the landscape for profits without limitations." If you work in a profession that is being acquired by venture capitalists there is a dollar figure so alluring you take notice. Why is it happening so quickly in veterinary medicine? Money. Just money. We are perfectly positioned to be so lucrative the vultures are eating us up in record numbers in record time. Here's the facts that allow vetmed to be so profitable. For many people our pets are our reasons for everything. Price is not set by, nor limited, nor overseen, nor fixed, nor ceilinged, for anything from anyone at anytime. We, the profession, the individual and the facility, can charge anything we want for anything you need/want. The reason; well pets are property, and the market will bear what costs are, until it's 2 am and your pet is dying and you have no other options, AND, no one publishes their prices. Consumers don't ask, don't know, and don't have the ability to query costs before, nor, negotiate during a pet visit. You are a victim to an establishment that now has you hostage, and we know it. How does that feel when your pet is dying, sick, and you are both at the mercy of someone just out to make money? The house is ALWAYS stacked against you. And no, you shouldn't trust us. We don't work for us, or you, or pets anymore.

What is the price you put on your pets head? Maybe its not a question you have ever had to ask yourself but be warned it is the only question the VC's in this arena care about. If they think you will spend $20,000 for a pyometra that's what they ask. How many of you have access to that at 2 am? How many of you couldn't afford this and will have only one other option given to you; euthanasia. 

The system is getting worse as the money gets fatter cats, fatter. Ask your vet if they work for a corporately owned VC? Ask them if they received a sign-on bonus? What if that sign-on bonus was $250,000? Who do you think is going to pay for that? How much is the price on your pets head worth? How else can those sign-on bonuses be paid? I promise it isn't coming out of the fat-cat at the top of the food chain who owns the place, and btw has zero interest, nor experience, nor knowledge of any aspect of vetmed other than its profitability.

So, now that you understand the money, let's talk about the other thing the house has on its side; liability.

Liability is managed in CYA documentation. We are very good at this. We are, after all now owned by the fat-cats with the fat-cat lawyers. Although the single veterinary practitioners liability insurance hasn't met any other kind of human medical malpractice comparison, we pay hundreds, they pay tens of thousands, when we start to ask $20,000 for a pyo, (remember pets are property, we only need to provide "replacement" value) it might be time to change the valuation of our culpability. 

Are you beginning to believe that the house has this gig rigged yet?

Let's talk about signing documents? Are we the only profession in the world that has customers sign something AND NOT GIVE THEM A COPY IMMEDIATELY? Why is that? And why can't clients turn the table on this practice? Why aren't we providing guidance to save lives instead of practicing a professional skill to avoid liability while we with hold access and options? (More on this via Pawbly.com soon).

Here are some of the stories I get sent every day. (Find all of them on my YouTube channel and Pawbly.com)

From my friend;

"My cat was a diabetic. He was having some kind of crisis and needed emergency surgery? Our $5,000 walk-in deposit went to $10,000 within a few hours. We didn't have the $5,000 and we certainly couldn't pay the $10,000." I knew what was coming next. Yes, they euthanized."

What the actual,,,, I have never had a emergent diabetic case that needed surgery. And every, (yes people EVERY) case has options. Like, let's start with insulin and fluids. Basic medicine every vet was taught. We don't practice affordable care because it is not maximum-profits care.

The practice owner I met last week at the veterinary career fair summed it up perfectly. "It is our job to offer best practice care (i.e. most profitable) and if they cannot afford that, then we offer other options." Sounds kind of unfair to you, the consumer, doesn't it? 

To the weekly requests I receive to unblock a cat, look for a nasopharyngeal polyp, or save a pyometra (all of these cases are given with real-life pets on my YouTube channel) for a tiny fraction of the costs being given elsewhere, I have to remind myself that I am not alone. I cannot fight for all of these pets, provide all of these services alone. And so my war with the current state of vetmed wages on. 

Unblock cat here.

Cat with polyp case here. And here.

Pyometra here.

For those of you who don't care, maybe you think you are sheltered? Some of you are. Some of you have a great vet who you know and care about, and, who you believe cares about you too. Some of us are still out here working for ourselves. Putting our own reputation and shingle on the line. We are affordable because we care about you AND your pet. We value what we always have; being a trusted part of our community. We care about lives, legacies, and ethical traditional vetmed values. But what will happen when we leave, or retire, or die? What will happen to you and your pet when we have to decide what the future holds for our clinics? What happens when its 2 am, we are closed and you need help from someone else?  What do you think your vet will do for you when you are at the front door of the fat-cat clinic? Ask them? Don't wait until you find out in real-time with a real emergency.

Go back to rule number 1. The house always wins. When your pet needs something, critically needs something you will very quickly be reminded that pets are now a luxury for the rich. No longer the middle class, but the rich. Rich people seek other rich people to get richer,, they don't apologize for this. When I started in vetmed in the 80's an exploratory surgery, let's say for a corncob stuck in the intestines, was about $300. Ten years ago it climbed to about $1,000 to $1,500. Five years ago $4,000. Today, at almost every specialty, and some ER's it is $10,000. How many people can afford this? What happens when a corn cob isn't removed? Your pet dies. Dying of a treatable condition used to be far less common because veterinarians had obligations they took personal responsibility. We had our own practice to protect. We were a part of our community and word would get around fast if we failed to help, failed to provide care, or even worse if we failed to provide an affordable service. 

the easiest thing for you to do, and the way the house insures its victory, is by you giving up. Once you sign that euthanasia form, it is over. You have conceded all and given permission. I know, and I do believe that there is no greater gift then ending suffering kindly, but, how many pets are given up on because vet med has made any other outcome impossible? There is a war coming to vetmed. There will be enough people forced to abandon the one being they love more than anything this world holds and the war will be for them. There is a class action lawsuit that will follow, and with this a littany of others will follow. People will have their voices heard and this profession will have the first righting forced upon them after never have had one before. 

Property. As the legal liberties are awarded, and the price points become both transparent, publicly provided, and openly traded services will provide some degree of stability and fairness. Does the profession want to lose the legal status of pets being property? No. With this definition there is a limit to liability we face when clients seek compensation for damages. But, the classification of property 

ways to escape being a victim;

independent practices. find, meet and ask the owner what you can do, or need to do, to be cared for. P.S. "get insurance" should not be, and cannot be, the only answer.

This profession has wounds that run deep. We have apologies to be spoken, and we have a path that cannot continue at the pace and prices we are requesting.

I have been a veterinarian for almost 20 years. I have seen every kind of case with every kind of pet parent behind it. Very, very few are without hope nor options. I have also owned a practice for almost all of this time. Are the prices skyrocketing into exorbitant? Yes, they already have. Are there veterinarians and owners out there profiting without remorse? Absolutely. When you live in a place that loves money more than life, profits more than 

Be very careful what you wish for? Want to be the one-and-only decision maker for your pet? Then they are property. Want to have every treatment option available for the most beloved being in your life? Better have deep pockets and instant availability for those dollars. Want to be insulated from heartbreak because your love for your pet leaves you vulnerable? Just remember that the person who decides whether or not your pet gets the care they need has a limitless ceiling and you are at the ends of their strings. They give you care based on two things; your ability to pay, and their willingness to help you. Thats it. Feeling like a your pet is a pawn in a venture capitalists portfolio? They are. Welcome to my problem. I suggest you get pissed enough to do something about it before you get screwed and have your heart broken over the loss of your treatable companion.

And maybe think about the price on your pets head before it's 2 am and you have to consider it, and start demanding a change now. The divide between need and access is getting wider and the 

Here's what's ahead;

its time to put liability CYA paperwork in pet parents hands.

its time that pet parents be given all of the options, with written line item estimates, before a deposit is given.

its time for transparency;

its time to publish who owns the clinic you are at.

who was given a sign-on bonus that might have influenced the price on your pets head.

its time to publish average costs of care before a pet parent drives to your facility at 2 am.

its time for accountability outside of the faces of the veterinarians who are already emotionally bankrupt and emotionally unwell.

its time for the public to re-think the laws that dictate the unconditionally loving, uniquely beloved soul sleeping/purring next you in bed every night as disposable/replaceable property.

it's time to compel the house to meet your needs and standards and put them out of business before they bankrupt your ability to love your pet.

The Hardest Days.

The hardest days are lived in snapshots.

Frozen moments of the day that solidify, remain indelible, and scar. 

I have collected mountains of them. Held them in my arms like a clutch of kittens too fragile to walk away from and too demanding to dismiss. I know they are the villains to my story that makes the read worthwhile, but when away and alone I sit and wonder if I need to be so burdened by them. How can I extract the color without bleaching the meaning they must hold for me to carry them for so long?

The past few weeks have been vibrant and jarring. The color that propels heartrates into arrythmias.

I live within the proverb; intentions matter. I also suffocate screaming for merciful reprieve because these two words are so impactful. Within these intentions you are left to question motives at every movement. Veterinary medicine is a quagmire of bipolar extremes. Emotionally charged, diabolically opposing, with violently swinging requests of the pet care spectrum you often cannot foresee. What gives a family the gift of a graceful, peaceful passage, also leaves the other owner with a disposable/replaceable burden they simply want eradicated. The purveyor of these passings is too often  given a heavy burden. Or, what one family wants and will fight for another will dispose of without whim or wait. I have been bullied, berated and threatened for caring too much, and too little. Never have I euthanized a treatable pet without fighting to give them every chance, at no cost, which somehow vilified me even more. I have been dumped for an easier practitioner who works on an upfront-pay-and-I'll-remain-mute basis because I dared to open my mouth to attempt to defend a pets life. I have been threatened when I refused to be a part of a pets undoing unjustly. And with each I remind myself "that no good deed" often comes with punishment, however unintended, and unwarranted. I have also come to realize that a dignified end of life death is often a merciful act. But, dare I try to be the inspector of this intention, question the reason, and the tables will swiftly turn from humble request to angry accusations. How is it my place, my duty, and my obligation to question who dies and when? 

I am often asked if euthanasia's are the toughest part of my job, (I have written about this before), and no, when I am being asked this it is always at the hand of someone who loves so deeply they see beyond themselves. A euthanasia request for a pet that hasn't seen a vet in years and is suffering from a treatable condition they still don't want to try to treat, yeah, that's soul-sucking. A euthanasia request because it's cheaper to buy a new one than deal with the old one, yeah, that's a cancer you never recover from. This is my life. The one I chose. The one I fought so hard for.

For the pet owner (emphasis on owner for this is the only title that provides such privilege), the mere perception that I would ever question their intentions or motives can/has unleashed raw anger and threats of questioning your own compassionate humanity. On the flip side there are so many euthanasia's I have declined for fearing my thinly skinned heart could not bear witness, nor survivors remorse, from the act. I believe that for almost all of us veterinarians our internal parting words for excusing these acts, even when we cannot understand, nor agree with the motive(s), are; "if not us, who?" For within these requests there is always a pet, this piece of property, that will be/can be abandoned, tortured, hurt, or dropped to be surrendered at the shelter for the same request. If an owner wants it to be done, it will be done. Just as all property can be disposed of. No law, shame, or unjust reason will change this. So it happens, almost always, that these pets can leave by my hand with me telling them softly that they mattered and they are seen. I, in every goodbye, steal a moment for myself to say that they are everything that holds value and they are loved. I can at least always give them that. And then pardon myself in silent solidarity later. 

Euthanasia, in vetmed is the Medusa of intentions. I am the Master of my own acceptance that I am confident in my own intentions, I will never be everything to everyone. I have grown into an adult who rarely cares anymore if I am liked. I am not mute and I insist on this being married to my intentions.

This week brought us two families who tragically had to say goodbye to two pets within the same day, two days apart. When I admit that this has never happened before in my 18 years of practice I cannot believe it happened two days in a row. How is it that luck never translates to lottery tickets? I had been asked if I would do both dogs at the same visit? A way to condense the pain into a more efficient way to let one dog say goodbye to the other before we said goodbye to him? Thankfully we both agreed this would be too difficult on our hearts.

I have done double euthanasia's on two other occasions. Both were excruciating. After each I promised myself I wouldn't/couldn't do this again. The grief around these always leaves me reeling. I feel twisted in my intentions, and guilty in considering to deny it. How can I be a veterinarian who knows there needs to an end to a suffering we cannot avoid, and not feel a stab of feeling selfish within considering how to address and face this request. Euthanasia's however hard, can't ever be about me I reminded my inner gooey-yolk of a heart.

The first double euthanasia was two old black labs. They were 13 years old brothers, struggling to remain ambulatory. They had great difficulty getting up and walking more than a few steps without collapsing in pain. They lived on a sprawling, verdant bucolic farm and their quality of life was significantly impacted. The owner was not able to get one of them in the car, never mind two, so I agreed to come to the house. When I arrived they saw me approaching, and as if by some divine interventional miracle managed enough energy to get up from the front porch and run a half a mile in different directions. I followed the slower one to the west, sunset in my eyes, dragging my medical bag to the edge of the property to find him solo. I knew then that I had made a significant rookie mistake; coming alone, agreeing to do this in the first place and a massive miscalculation on time, ability to drag a deceased 80 pound dog back to the house and then repeat the process on the other. I too had not planned for how I was going to get them into my car. (Have we ever talked about the physics of dead weight being much heavier than alive? Someone has to have done a research paper on this?). The logistics, inability to walk so far, bring dogs back from so far and the emotional turmoil about how to make this horrible day less horrible for a pet parent who couldn't/wouldn't help me with this was traumatizing to all of us. Pets, all animals, all living beings, seem to sense goodbyes, and regardless of how warranted they are, they react. The reserve of adrenaline to preserve their life defies all diagnostics and prognostic indicators. The primitive call to get up and run even when you know you are no longer viable to evade allows bodies to defy biology and physiology. I can tell myself every moment of my professional, and personal life that I am here to relieve suffering, but yes, the desperate plea of those pitifully sad eyes looking at you as you send them away can hurt so bad you cannot find solace in the present, nor your intentions.

The second double pet euthanasia was a long time client who battled a many-years long breast cancer battle. When she went into remission after a year of treatment she bought herself a Corgi puppy. She had set that as her accomplishment prize and she wanted to be well enough to take on another Corgi. Her original Corgi was about 3 years old by now. Young enough for a sibling and sweet enough to allow one without bitterness or jealousy. She wanted to be sure she would be well enough to care for both of them. Almost 8 years passed and her battle reappeared and raged again. In a matter of a few short months she lost all of her body weight, her hair and her spicy wit. When she elected hospice her last wish was for her dogs to be with her in her casket. She made an appointment with me to ask me if I would be there for her in this request as I had been there with her in all of the rest of her pets lives. I struggled with this request so deeply and profoundly that it almost broke me. Truly, it was the single most wrenching thing to be asked. I was this woman's trusted veterinarian for almost 12 years. She valued my compassionate care for her dogs, and knew that I cared for her as I cared for them.  We had been a team for all that was our lives with her most beloved companions and she had one more request for me to assist her with. She wanted the four of us to be together to say goodbye to her dogs that she could no longer take care of. I spent hours almost begging her to see if we could find them a place to go together. She was convinced that they would be neglected, mistreated, or unable to build a new life without her. She wanted to be present at their departure and she wanted them to be with her as she was laid to rest. It was one of the most emotionally gutting moments. How do I put all of my love, attention and energy into one euthanasia and then within moments try to muster it all genuinely for the other? I had flashbacks of being at the county shelter where the pets would be lined up as if in a genocide to clear the cages. One, after another, after another, Void of the dignity that ending a life turned into out right killing should be made of. It was the longest, most brutal, most conflicting experience. A few months later their mom passed away at home from metastatic breast cancer, I hope they are all together on a couch feeling like their family of love has enough belly rubs and wiggle-butt endearments to make the after life as magnificent as we all hope it to be.

These last weeks I have averaged about 3 euthanasia's a day. We joke that euthanasia requests always uptick in the days before major holidays, (Thanksgiving for the win), with all of the family arriving and the incontinent pet being the main incentive. Or the days before Summer vacation departure when you cannot come to terms with the emotional trauma of leaving a sick pet in someone else's care, or the inner turmoil of cancelling the trip because you expected they wouldn't have lived this long when you booked it 6-8 months ago. Or the back to school chaos and the days that you have to go back to work, the kids will be away all day and the luxury of constant care via Summers timetable. 

Last week a very old, very poorly looking lab came calling for help. She could barely walk or lift her head. She was labored, exhausted and sporting a severely distended belly of fluid. Within a few minutes I had confirmed what my fears told me. She was bleeding internally and there were only two options and a stopwatch timer to decide them within. She was dying in front of us and we either needed to get her on the surgery table immediately or euthanasize her now before she died imminently.

The response is universally the same. A tidal wave of tears, and a few moments to talk amongst the family to decide. They decided to let her go but only after they called the kids to come say goodbye. What ensued was two girls under age 6 bawling and screaming in agonal grief. The girls insisted on being present, a decision I feel very strongly is not theirs to decide, and subsequent hatred toward the veterinarian who was "killing" their dog. I was yelled at, thrown fists at, and made to feel like the most horrible human on the planet, which to this day, and likely every day of their lives I will be referred to as. How else can they process their heart break? How would I have been any different at their age? Why do we have to let our little kids see things that aren't going to be anything other than devastatingly painful?

And why do my shoulders have to be so broad as my heart grows so hypertrophied, thin, big and bulging with the responsibility I cannot always accept as kind?

Why if I am so convinced about the inherent holiness of my intentions do my convictions question my motives?

Ok, I know this one was a tough one,, so for all of us who need a reminder.,,, Here are some photos of my week and why I still love being who I am and doing what I do,, and how often one bleeds its color into the other,,, my ombre life.

Seraphina,, my beloved cat waiting for me to get back in my desk chair.

Winnie takes a quick nap while waiting for more treats during her puppy visit.

One of my favorite faces,, this is Goose. He always makes me feel like being a veterinarian is the highest honor possible.

Josie getting ready to go home after her spay.

These two are my giggles in my day., This is Lydia and Grace holding our beloved Hamilton.
If a clinic has a soul it is the reflection of the people who make all we do possible

Penny,, and her worried face. Beagles are my favorite breed but the lack the badge of courage,, which they make up for in adorable-ness. She was here for a 2 second visit and a hug from her mom.

The most challenging internal medicine case of my career is crowned by this little one. This is Snickers.. the most loved pup you will ever find. 

I write about the life I live. Complicated, conflicted and full of purpose. For more please search a topic and see what 10 years of blogging and 18 years of practice yields.

What Am I Supposed To Do?

The question plays on repeat. Over, and over. And, over again.

It is inescapable. Perplexing, vexxing, and excruciating. All of these and sticky beyond excision. 

Nana, broken leg, ER advice; "surgery 10k, or euthanize"
my advice; "cage rest" 
she is alive and doing well today because her dad refused to have only two options for her

There are fixable veterinary problems all around me. In my effort to provide exposure to these treatable and yet often ignored veterinary issues, encouragement to face and fix them, I seem to have made myself the wailing post. I have become the beacon for hope and last place for help when there is none to be found at the footsteps of present veterinary provider. 

My question isn't why I have become this person, my question is how do I keep from becoming the only vet who cares enough to put the patient before the profits and the fear?

And all of those blocked cats..

I have spent a great deal of  time asking me how I got here? Why I feel so alone here, and what the hell I do about it? 

I have spent so much time in the problem that I cannot walk away. I cannot shutter it, suffocate it, stow it, or sacrifice it. I am in it, wholly and without reserve. 

What would you do if you knew there were answers, some of them ridiculously easy to solve,  answers that would save lives, save human hearts from being crushed, and right a wrong that just grows more egregious as it  consumes the caring around it.

What do I do?

And all of those PU surgeries

Today it was another desperate plea. A question on the Pawbly, the pet care site asking for help. They are always the same. 

"I love my pet. They are my whole world. They have this problem..... I have been to so many vets, no one cares. I saw your video. Is there anyway you can help me?" .. and there is always a photo. A photo of the pet. So sweet, innocent, and fragile and in desperate need. How do I turn away from those faces?  How do I stay in this profession if I sacrifice my ability to have compassion so strong it compels?

Babybear

Veterinary medicine is about taking care of animals. Somewhere along the day to day grind this got lost. It became about money, and egos, and trying to be bigger than our britches. We became distant from our purpose, and divided from our clients. When it was not profitable, or easy, or worth our time we blamed them, the clients, the people who make all of this possible. We used cruelty to remind pet parents that this illness, this unforeseen accident, disaster, (albeit treatable), isn't worth us intervening if they can't pay us handsomely for it. The cost of care has skyrocketed, the treatment for all of the ailments remains what it was decades ago when everything was a few  hundred dollars, or less. 

.. and so I remain here. Asking myself the same question and dedicated to finding, exposing, and disrupting the same problem.

Want to see what I am talking about?

See my YouTube channel 

or Pawbly.com