The Right Question

Perhaps I had it all wrong all those years ago? Perhaps my perception of the distant, reserved indifference that I saw on my older, wiser, decades in the trenches, weathered predecessors faces was the quiet contemplation of whether or not to ask the question? More specifically, the right question. At the right time. Maybe that is the whole secret to life and all of its layers? Maybe the enthusiasm of the young vibrant newbie vet got confused by the quiet contemplation?

This little one is one of the many we have tried to save along the way.

It is the maturing in medicine that has brought me to this pondering on the mountain. The question for the ancient one that is the singular question I will be allowed to ask?

Medicine is built around questions. To be specific, the contemplation of the right questions, and the internal pondering of the dialogue it manifests. This is the place I feel we have strayed the most at the cost of our patients’ outcomes. We don’t talk to each other anymore. We don’t share information for the chance it might be mutually beneficial. We don’t pause for reflective answers. And we don’t invest in each other’s experiences nor heartfelt desires as the mortar to each other’s foundational awareness. We don’t seem to care enough about each other to extend a moment of contemplation. Without this, everything that medicine has to offer is reduced to a tiny spark of its true power.

This is what sets the people of Jarrettsville Vet apart. We aren’t just a face in a time slot. We are a person with an investment of ourselves into each patient.

Last night, as with every night before it, I texted my husband to tell him I was leaving the clinic and headed home. We are three years post COVID and he has become the stay-at-home-dad to our 5 cats and 2 dogs. It was after 8 pm, he had already inquired, hours earlier, if “I needed food?” (Don’t I always? I replied to myself). I told him I would “love a glass of wine,” (don’t I always?) and, that I was “bringing home a big box in the back of the car of the party lights,” I had forgotten for weeks at the clinic, and a “little box with a kitten to bury.”

There was no text reply back. Clearly, I would have to clarify that this wasn’t an autocorrect mishap upon my arrival.

What happens at JVC when a breeder brings in her litter of blind puppies and their mom and tells us they will all be surrendered to the shelter? They stay with us.
(P.S. they are all still looking for homes, see Black Dogs and Company for information on them).

“What's up with the kitten in the car?” he said as I handed the tiny box to him as he helped me carry the days fodder inside our home. He wasn’t upset, nor surprised, but he knew there was a story. This is how we end each day. He meets me at the car as I drive in, glass of wine in hand, the other to help carry the days endeavors. The end of the work day summary is a quilt of crazy colored stories shared over a quick dinner and 30 minutes of taped tv. I came here, to vetmed, for the allure of the stories. The Herriott stories. The place where others who adored their pets as much as I do, would share their journey together. I have a place that I belong here in these  stories. It is what keeps me from retiring to greener pastures with sun filled vistas to nap upon.

"Her name was Elouise," I began. She was a rescue. The family whom she was born into had forgotten to spay and neuter their cats who were brother and sister. She was the last survivor. She was as doomed as her siblings. I had known that from the second I set eyes upon her.

Elouise arrived at the clinic swaddled in a small towel. Tenderly carried in, too quiet to be healthy. If you pay attention long enough you learn that the neediest patients in your clinic are the silenced. The ones too weak to protest, too near the verge of death to allow their survival instincts to protect them any longer. Only her tiny face was visible. A mottled face the size of a tangerine, and oddly the same dimensions. A broad face with wide set eyes. In the 18^th century she would have been called a Mongoloid. A horrible description of a skull that was burgeoning from within. Her eyes were unresponsive and resting laterally (the left eye was turned outward to the left, and the right faced far to the West). She was not present mentally. She did however still possess the one magical power to keep us human’s captive in fighting for her; she purred the moment a hand met her head. She purred, and purred and purred. A trans-like rhythm that pulls an emotional compulsion to continue to care when the biology has stolen the chance.

Gracie, found with severe wounds, covered in fleas and ticks, and microchipped.
It allowed us to find her home but she wasn't able to return. We have loved her everyday since.

I looked up at the foster mom who had brought her in. She was so hopeful that I could hold a cure, a witch’s brew to turn the tide. The kind of hope that lies in miracles, abandoned by medicine.

I unwrapped the towel. She didn’t move. Made no acknowledgement of the stranger I was, and the new place she was in. Elouise was perfectly captured by her name. So apt in her gentle, shy, peaceful demeanor. The kind of name that accompanies a bicycle, a French beret, a windswept skirt, and a song you catch yourself whistling on a clear summer day. The name of the heroine in a children’s book, small curly white dog as the sidekick. A name as intentional as a romantically fraught fairy tale heroine. As gently as possible I picked her up and placed Elouise on the exam table. As it is too many times the harshness of a stainless-steel exam table meets the wispy goodbye of a life taken too soon. It is not lost upon me that these rooms are asked to absorb too much and be a vigilante to too much sadness. One of the first places a veterinarian starts with an examination is basic standing ability. She was a crumpled speck of jutting angles of bones and fur. “Has her back leg ever been normal?”

“No, she has never been able to use it.” It stuck to her underbelly like a contracted, lifeless, muscle-less chicken-wing bought by the dozen for less than a buck. Her pelvis was tucked, her other back leg attempting to extend, but also lacking the muscle mass to support anything past behind her. Her mom told me about the time she had been with her which had been less than 2 weeks ago. "She came to us able to run and play. But, that had stopped days ago. 

Elouise's story with me had started as an email in our hospital inbox a week ago. She was in the care of the rescue, who had just been granted permission to take her after the rest of her siblings had died. The foster mom was inquiring about a surgery to correct Elouise’s inverted rib cage. A condition we call ‘pectus excavatum’. Elouise was born with a ribcage so narrow it impacts her ability to breathe normally. There are multiple ways to fix it, in kittens who are still soft and pliable we place a cast around the chest to try to mold it back into the shape it belongs. She is a rescue, and like all of them that I see I have to be creative and thrifty. It is why I am so disappointed in where vetmed has fallen. These cases, the millions who preceded them, over the hundreds of years that we have been influencing animals outcomes without tech and stock holders margins. She didn’t need a surgery, she needed merciful grace. She came to see me not because I am a wizard at unusual congenital birth defect corrections, but instead because I am wiling to try before I require a 3-plus-thousand-dollar deposit. Elouise had two women in her corner who see her as more than a replaceable, over populated compilation of carbon.

Elouise couldn’t stand, she couldn’t react to physical exam queries, and her gums were white. She was utilizing every ounce of whatever marginal strength that she had left just to breathe. It was all she could muster the energy for. She was dying and her mom, the person who had had her for only a few days, was crying on the other side of the exam table.

“I knew that you would tell me the truth. I am just not ready for this.”

We are never ready. That purr will convince you to hold on even when life is being stolen away before your eyes.

Elouise was purring in my hands and she stopped, extended her head back and thrust her front legs forward.

“She keeps doing that. Every so often.”

“I think it’s a seizure.”

“Oh.” It put another layer of despair onto her already bleak pile.

“We can send her home with opioids if you aren’t ready yet.” Try to give her a passing in hospice care. Truth was that Elouise had been here, this place where dying is overtaking the mitotic cataclysm of living for her whole short three-week long life. She is, as medicine would have labeled her “unviable” from the moment she was born. Luck and love had gotten Elouise this far, but there was nothing left to bargain.

“No, it’s the right thing to do. She doesn’t need to suffer any longer.”

I knew it to. And so she came home in a little box in the back of my car, to be with all of the other pets who had made my life as their mom, their vet and my life’s collected book of stories so meaningful, purposeful and richly rewarded.

“What do I owe you for today’s visit?”

“I am not charging you for Elouise. She is a gift to both of us. You cared enough to give her a chance and love her despite knowing she needed more than you could provide, (how many of us are willing to do that?), and I needed a reminder as to why I am here. She is my WHY. The reminder that this is, was, and always needs to remain more than a practiced profession.

Slater. Brought to us for vomiting.
His mom had rescued him from her son after he passed away. She struggled with homelessness, surrendered Slater to the shelter, saw him a year later featured as "pet of the month" and went back to adopt him. He was up to date on vaccines and preventatives and when he started vomiting she called her vet. They wouldn't even give him an exam without an $800 deposit, which she didn't have. He came to us. We worked with the shelter to give him a chance. His mom stated that she would surrender him back to the shelter if it meant giving him a chance again. An exploratory surgery revealed a large tumor on his kidney that was inoperable. He was put down next to his mom who knew there was nothing left to do for him. 

And so I come back to my question. The right question. It isn’t about how wealthy we are, it is about how enriched we become along the way. 

The System Is Rigged In The Houses Favor. The hidden costs that keep rising because the public has no access to transparent pricing models.

The system, i.e., the whole profession of veterinary medicine and all of its affiliates, is rigged in the houses favor. It's a harsh reality for the ever growing mob of pet parents who feel betrayed by the system they rely on for their pets well-being. The vet, the vet hospital, and the profession as a whole, has all of the power. Power can come in many forms, with many faces, but, the most powerful will always remain with those who control the emotional, mental, physical, and financial survival of those who do not. Power of that kind is totalitarian. Power like that has collapsed civilizations. Made extinction a reality. Power like that is dangerous beyond measure. 

Serafina. My daily reminder of my WHY.

Whilst some would say the house of vetmed has always has been rigged, I would add that is was, at one time not too long ago, centered on providing care that was utilitarian/agrarian based, not emotionally based. When that shift to companion based pet vs. food/livelihood based animals happened, and our four legged friends became bedfellows, the whole construct of vetmed shifted with it. Vetmed promoted, marketed, and richly profited from the elevation in pets status to highly valued family members. For an ever increasingly large section of humans our pets are truly the only thing we consider to be our children. We brought our critters inside our homes, gave them their own beds, and now we buy them their own gourmet food, sold by tv personalities, whose nutritional content often surpasses our chik-burger-plastic-wrapper-fast food convenient daily meals. Our pets have social media pages, monogrammed Christmas stockings, and matching family holiday outfits. We do not hide the fact that we spoil, spend and love them. We hug, kiss and fret over their happiness and health. We do not see them as property any longer. We see them as individuals we protect and advocate for. This whole pet based relationship has swung from livelihood based to heartfelt. This relationship with our pets, well, it became deeply, personally, and life-changingly, emotional. 

Pets are, in many of my clients lives, (mine being no exception), the cornerstone to the joy in their day to day lives. We are so emotionally anchored to our pets that we will do anything to maintain their health as a reflection of the happiness they bring to us. There is no doubt that the loss of a pet hurts as much, and in many cases more than, the loss of many of the humans in our lives. We depend on them this much. As society grows more open via our handheld phone based computers and the endless flow of social content, we have become less social with humans and more satiated with our pets presence. Many of us went into vetmed, pet hoarding, animal rights/rescue/advocacy, back yard farming, and the like, to seek refuge from the harshness of people. Many of us just like animals better than people. People are painfully messy, and awkwardly sticky creatures whilst pets are perfectly ours.

The relationship we have with our pets is hugely impactful and elaborately delicate. This deeply adoring relationship has lead to a pet care market with ballooning revenues. Over the past two decades pet care based services have doubled to reach 5.8 billion dollars annually in the USA. This degree of growth has spawned a hailstorm of erupting opportunistic pet centered ventures.  It has led to financial gains of which we have never witnessed before. When vetmed transitioned from veterinarians in muck boots over green coveralls with its after 2 am $50 field calls to look at downed cows in far off fields, to multi-million dollar practice owners working for shareholders dividends. With this the emotional well-being of patients and their people morphed into economically driven profit-mongering options. When money like this influences lives there are few exceptions to compassionate driven care. The practice will make money on your pet even if it is just in euthanizing them, again for a healthy profit. Lives are disposable, replaceable, property. Lives, no matter how impactful to the people anchoring the other end of the leash, are collateral damages. Vetmed has been reduced into heartbreaking too often economically based treatment decisions to protect profits. Pet care has gotten itself so profitable that the cloying underbelly has grown greedy, ugly and insatiable. As the cost of care continues to skyrocket upwards, (be mindful they are not done yet), it will continue to shatter countless more lives along the way. 

Teddy.. and her dad,, who adores her

The once single doctor practices have grown into large multi-doctor hospitals. It used to be that your vets face was the face of the mission and purpose of the practice. You knew them and they were approachable and accountable for your pets care. Today, many practices are owned by someone, or a board of someone's, you will never meet, nor even be told about. Today practices are sold in the dead of night to people who live in bank accounts of billionaires. Today your pet is an asset in someone else's portfolio to be traded, sold, or squeezed at their discretion. This is what property bears. 

Many of the larger vetcare centers are being bought up by venture capitalists who now own much of the ER's and specialty clinics, (the really big money makers), which has created the foundation for a monopoly, (and been prosecuted for such), and escalated the cost of care in the process. The profession has lost its clients trust. We have lost the ability to communicate between the conflicts of property vs morality. And, we are unapologetic about our contributions to these dilemmas we have gotten ourselves into. Veterinarians are seeking never before conceived of compensation packages and being lured with multiple hundreds of thousands of dollars sign-on bonuses. We do so this a bravado that justifies as being "long overdue" without reflection on how this impacts our patients. To pay for these sign-on bonuses AND the formidable huge dividends the share holders require, the cost of everything they haven't conceded already has escalated to compensate. The latest, and not at all surprising escalation, is happening in the lab services department. Lab services is another way we can hide and escalate a cost and you won't know the difference, or be able to price shop elsewhere. The house is hungry, and the house needs more cash to keep the belly of the beast quiet. Lab services is that ever growing line items list after your pet is examined and before they are treated. Lab services in my veterinary hospital is the fat I trim to treat a patient before the finances are exhausted and economic euthanasia is the only affordable option left. Lab services is the BS the profession utilizes as "standard of care" to make our pockets deeper and your shame as a failed pet parent suffocating. 

The new found profits of vetmed has led to advancements of diagnostic and treatment options. These benefit our clients and patients immensely. While we all share much of the same biology and physiological functions, we now share the same human based treatment options. There are truly no boundaries to what we can treat, or do, when it comes to our beloved pets. While this is miraculous to the desperate pet parent seeking novel care options it is an ethical black hole of queries conjured previously only for sci-fi movie plots. (Go watch Altered Carbon, Jurassic Park, The Island, or Google Top Clone Movies). Unfortunately, this fact has also gotten lost in the quest for profits. We don't talk to our clients to understand who they are, and what their pet means to them. We are medical centers of unbiased, automatons who deliver estimates on paper two and three pages long. We don't start at the clients wishes and hopes, we start at our most profitable. We do not practice best medicine, we practice stockholder strategies. We take people at their most vulnerable and we shame them into spending more than most of them can, without regard to all of the myriad of ways we can both help heal and give clients a way to afford the minimum diagnostics to make the treatable affordable. The whole premise for providing people assistance in navigating a medical dilemma is rigged and stacked in our favor. We know it, we refuse to admit it, and we profit egregiously from it. It is power than euthanizes without hesitation nor culpability. 

Pocket. All two pounds of her. Her mom is protective
and gushingly devoted.

There isn't one veterinarian who wasn't taught to practice medicine via an understanding of a minimum database, and yet we are all collectively mute as a consortium so as to not tilt someone else's profitable apple cart as they try to make every patient visit as lucrative as possible. All in the name of "best practice." If our best practice is letting treatable pets die because we conveniently forgot to have open honest discussions at the collection of history and examination time, and not the long pregnant expectant pause of seeing if the client bites at the first (and let's be honest, always highest) estimate, then we are the problem regardless of how treatable the solution is. We must own this. In my opinion this is the fact that is killing us.

The house has you because you have nowhere else to go. The house also gets you at your most vulnerable for the most painful of all of the decisions you will have to make. Oh, and yes, we know you are out of your area of expertise, at the mercy of our prices, and without options to argue or negotiate (or at least you feel you are). I hear this over, and over, and over.

Birdie. My kitten who had to be quarantined for 4 months after her sibling tested positive for rabies.
How many of us would quarantine two kittens for four months while worrying about rabies?
The story here.

"It was midnight. My vet wasn't open. I didn't know what was wrong with my dog and I couldn't let her suffer until they opened the next morning. They took my dog to the back. They came out and gave me a paper with a dollar figure I was afraid might be the only way to save my pet. My head was spinning. I couldn't understand any of what they were saying. There seemed like no other options. I love my dog." 

My YouTube channel here. 

You can hear this example repeated by the thousands via the people who post on my YouTube channel, blog, or reach out to me directly. I know there are thousands more who have had the same experience. The house has you. You feel it, and you are so emotionally conflicted you cannot make sound decisions.

For all of these scenarios I ask two things; who did you talk to, and what did you sign? (More on this topic to come).

We, the collection of veterinarians who guard the gate to your pets access to veterinary care, will not permit passage without a price of admission that we see as suitable for the access to our healing hands. The house has the power. Your pets are still considered "property" under the law, and now that VC's are collecting record breaking revenues it's not going to concede or have a conscious awakening until the public forces their hands, challenges their intentions, or just plain old innovates a way out. It is the fundamental crux of every problem our patients suffer and die from. The house needs to start working in the patients favor, and that alone will be our collective salvation. 

Mavis and her mom. Didn't every vet go into vetmed because we were this kind of kid?

While the rest of the fringes of our profession taut insurance, third party billing, pet care wellness plans, low cost spay-neuter-vaccine clinics, and the transition of for profit to no profit as being the answer I will stand here firmly on my 20 years of private practice ownership and tell you that every time you think you alleviate one part of the dilemma another part shifts away from affordable while it drags accessibility with it. The system is rigged. It will remain this way as long as three things remain in place;

1. Pets are considered property. 

2. Pet care does not need to be open or transparent in its pricing. This is protected by every state veterinary medical board. What they fail to protect consumers in is their availability to be given options outside of the ER at 2 am. Someone should be addressing this.. see Pawbly.com

3. People in society continue to be as hateful, divisive and uncompassionate as we have become. The greater the divide in our empathy for one another the more we will turn to our pets for emotional refuge. We all are pet loving people. It is time to remind ourselves this.

This girl was the first girl who required a whole lifetime of my courage to intervene on her behalf.
Courage only matters when the cost calculation requires you to put someone else first.
Here's to all of the other Sadie's out there who never get what they need because a veterinarian isn't brave enough to put there license where their mouth is.

While I will not argue that vaccinations and spaying/neutering are not vital to preserving your pets health, I need to remind you that the care you receive in a well, young healthy state are not the things that are likely to cause you to be forced to chose euthanasia as the only economically feasible treatment option available to you at 2 am. As the cost of care climbs into the stratosphere where only private billionaire rockets can take you there will only be three options left;

1. People elect euthanasia because it seems the only affordable option available and we need to feel good about giving up by labeling it "ending suffering". (Please see my article on the Power Of Consent below).

2. As the vetmed sector grows profitable it attracts investors. Investors are about one thing, profits. When you tilt the service of care into profits there is shrinking margins for compassion. Where one revenue stream drives up (pharmacy, food, preventatives) another is exploited, today lab services, tomorrow surgical intervention/specialties. 

3. People get their hearts shattered by the system that holds their emotional glue together and in its grip, and they never get another pet again. The damage has been done to the point of extinction.

There are often numerous low cost options for the lowest hanging fruit at affordable and even accessible costs, (spay/neuter clinics and vaccine clinics.. all high volume and therefore competition based low cost), but you pay for that with the loss of something you will need far more down the line like that emergency 2 am pyometra surgery. That cost has gone from expensive ($1500-$2,500 a decade ago to $18,000 at one clinic I saw).

Tilly after her spay. She was surrendered because she had four blind puppies.
Her breeder gave her up when she was no longer profitable.
She deserves better, she will get it. We will make sure of that.

In the last decade the veterinarians have lost two key pieces of our revenue pie. We lost our solitary foothold on in clinic prescription medications and preventatives to the likes of 1-800-online and then food to chew-on-me and I'll send you a painting when your pet dies, who can provide these at lower cost and still never have to go to vet school. Vets conceded an easy 30% of our revenue stream to innovators outside of our profession. Over this time a cascade of vet care specialists blossomed. For the benefit of our patients many once in clinic services are now farmed out to vet specialists; think cardiology, neurology, surgery, dermatology, and general practitioners have lost another big money piece of the pie. 

There is a lot of self-justifying puling these days on the vet forums. They all too often are intended for the clients we have failed, and, therefore are likely falling on deaf ears. We have tried to seek empathy for our suicide statistics. Others beg for understanding wrt our over crowded exam rooms and appointment scheduling access. A few spew a banter to remind parents that "pets are a responsibility/privilege, not a right." Which is my personal favorite. I feel it is quite likely the most obnoxiously hateful based arrogance ever muttered. We love animals as much as our clients do. Why would we ever use that as fuel? Now there is an article being circulated to compare the cost of a human knee surgery to a dogs. Can we reiterate the cost of medical liability, lifespan, and macrophagic greed going on with our counterparts on the human side? Why are we so intent on justifying costs when we have boatloads of data that support the fact that if you want to call property "property" (i.e. limited liability and we can all dispose of our pets anytime we want to, which vets will defend until their dying breath). It is not a valid comparison for so many reasons I feel we are ever obvious entitled morons to share it.  If any of us can remember that we are all here to "solemnly swear to use my scientific knowledge and skills for the benefit of society, through the protection of animal health and welfare, the prevention and relief of animal suffering," then why has it all become about how much money we make and not how can we help each other. They are not ever going to be anything but mutually vital for the other half to survive.

Holy crap the degree to which I can pick this apart.. 🙄

Here's what you can do to have some tipping of the cards in your favor; 

Know who owns the practice. This includes your primary care provider, your local ER, and the specialists you are sent to. If the same group owns the whole lot you should be very concerned about how much you are paying for everything you are recommended. Do you routinely get sent somewhere else for services, especially surgeries? It is not an uncommon practice to have your vaccines and the other most very basic services done at the primary care facility and everything else referred. What is the cost difference for a simple mass removal (and the majority are very simple) done at a private practices office and one been done at a specialty referral surgical facility (hint; about $2,000, or more). If every single pet loving parent walked out of the corporate owned practices the landscape would shift dramatically. For every pet parent who says "I stayed because I like my vet," I need you to ask them what they can do for you when the cost of your emergency care, mass removal care, enucleation, splenectomy, etc is soo astronomically high you have to euthanize your pet. If they say get pet insurance because I like my sign-on bonus more than I like saving savable lives, leave. Being loyal shouldn't mean having your heart broken when you realize your vet isn't on your pets side when it really counts. 

Wellness plans are also stacked in the houses favor. Ask about a Pet Savings Plan that is yours to use where you want it. My clinic offers one through VetBilling.com. Its yours for your pets care, I don't care where you need it.

Three years after the original 52 cats from the hoarding situation we helped with we still have reminders of what giving more than anyone expects can bring you.
More on this here.

I truly believe that good veterinary medicine is about saving lives, not making economic decisions because our student debt is so high and our sign-on bonuses were so grand. The problem does not reside in lack of insurance, lack of empathy for our off shore private vet school debt, our knee surgery costs comparisons, or our lacking reciprocal empathy for how hard our lives are while making shareholders millions of dollars in dividends, but simply in not reducing a treatable life to a replacement value chattel. We are the house. The house owes its residents the oath we took so many years ago.

I am so proud of who we are, and how much we give back.
We are a culture, a mission and we do well by doing good.
We are the heart of vetmed.

P.S. If you would like to have a better understanding of the cost of common lab services please see Pawbly Storylines section. Go to Pawbly.com Storylines.

Jasmine gets a hug after her spay.
Every pet here at JVC is family.

Upcoming topics to discuss: 

• Social workers in vetmed. When the emotional turmoil is so high you don't know what to do. When the emotions get soo overwhelming your adrenaline kicks in. When the system that is supposed to care doesn't you need a friend/ally on the inside to help you. For this reason some hospitals have started to follow the human hospital infrastructure plan and employ a social worker. Someone to help guide your emotional journey without the medical or financial interference and influence. 
• The spawning of "Zero Tolerance" has grown into our new veterinary fight song. Seems everywhere we go in the world these days there is friction. Animosity is borne of broken hopes and unrealized promises.
• What are some of the costs of veterinary care in my private practice?
• What are some of the items you need to ask your vet at your next visit?

What are your thoughts? I would love to hear them. Email me at krista@pawbly.com

P.S. because every time I post one of these I need to add a disclaimer. All comments are posted after approval, and all hate mail posts get posted, or reported. 

If you are a veterinary professional and you don't understand how big the divide is, and how harmful our actions have become please read the comments on my YouTube channel. I have been practicing for almost 20 years. I have never denied care based on cost. While I stand a very strong line on serving my patients above all else I do so with 100% transparency and all options on the table at every single visit. I also do not allow any unkind behaviors towards anyone; patients, staff, clients. This is the ranking in which we serve. Please see my other blogs,, and P.S.S. this blog is appropriately titled. I am an open book,, its not always picture-perfect.