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.