Critical Mass

Critical mass. 

I am fixated with the concept of where that fulcrum lies between viable critical mass and the surrendering of life. In medicine, vetmed very specifically, we are trained to inspect and dissect down to the point of recognition of this place of fate. We learn to listen to a patients history. We perform a thorough examination and then recommend the appropriate diagnostics to solidify our presumptive diagnosis. All of this from a patient who cannot speak and often doesn't want you poking/prodding/palpating them. We have to be the doctor of every department and we have to stay on a budget. How any times am I expected to diagnose and identify without any of the diagnostics I need to be more certain? How many times can I beg and plea for mercy for the patient to be given some small chance at recovery when all their owners want to know is where is that critical mass point and will it be cheap enough and easy enough to allow passage of better days ahead? It will make you mad if you let it. It is why there is this protective parable preached to us about not being judgmental, and, not caring about your patient more than the owner does. Not recognizing the face for more than a number in a day of many. It is why we band together like refugees in a village of emotionally fueled hostiles. There is not one day where we aren't vividly reminded why life is so slippery and precious as why it is so wretchedly, painfully hard.

Rudy. Rescued from Texas. So absolutely, adorably perfect.

It is the fated search of critical mass in a life of fearful brevity.

There is a place in all lives where that one cell too many costs the whole. One atom too few, one tiny piece of sand hits the pile below and all of fate is doomed. The fulcrum, the pivot point and the place where you cannot force, intervene, and bend the will of the ghost that comes calling you home. In vetmed I look for this place with endless relentless persistence always hoping I can outsmart and out will the critical mass headed toward my efforts being futile.

My beloved Raffles.
Rescued as a kitten, forced to serve a 4 month quarantine for rabies.
We will never love all cats fully enough to permit even the most basic vaccine.

This place, the tiniest of differences between that one moment soon enough, and the next, where it is too late, is where I stay stuck in my cause. The place where I seem to hyperfocus, stare down, and too often get stuck. The place I think I owe in recognition to both my clients and my patients. The place I fear I will both not recognize, nor admonish. In vetmed we are expected to intuitively know this place when we arrive, articulate its magnitude, and spare all parties involved the futility, the suffering and the premonition to save both dollars and disappointments. We are expected to know it all, and then dictate a fate that fits the hands that pay the invoice.

How many times have I overstepped this place? Tripped over the threshold and found myself falling into the end before I knew it?

Minnie. One of my WHY's

For my mom I knew we had lost her battle for her life, and all that that carried, when she was lifted from her wheelchair to the scale at her oncologists office and the numbers read 74. 74 pounds was not recoverable. She could not come back from here. She would not be able to regain her body mass. She would never walk again. The ability to stand up, blaze her trail to independence and freedom from all of the decisions that would soon follow was gone. Extinct. She was destined for death and there was no point in hoping, praying, wishing or cajoling anything further.

Me and mom.

For my best friend Havah it was 31. The day she called me as I was driving to work. The one place we shared everything our veterinary lives brought us. The one place that solidified us as sisters, the fairytale of vet med and all the magical moments, and this was our road sign to never being together again. She was going in one direction that I couldn’t accompany her. She had yet another mri the day before and her headache culprit lay in 31 metastatic  lesions within her skull. This conversion was the place everything collapsed around. For five years she had never wavered in her conviction to win her breast cancer battle. This was her Normandy. Her foxhole was exposed and her enemy was mounting its last attack to claim its host. It was the first time her voice cracked and her fire diminished to a spark of planning a legacy she could no longer add a chapter to. 31 was the count we knew we had lost each other and all of the many things we depended on each other to carry. We had to go the rest alone. I had to try to imagine being a veterinarian without her. She was the soulmate to my passion and the guard to my heart being safely nestled in some semblance of sanity simply because we both knew what it took to survive this profession and neither one of us would ever leave the other wounded soldier behind. She was my Forrest and I her Bette Midler Beaches. I had always banked on us going out like Thelma and Louise and now here we were having to decide how one could finalize a life still with so much left to write while I, the other, the one being left behind, knew it would never be happy ever after.

Havah and my mom. Halloween, maybe 1999.

The cases at the clinic walk in like a revolving cattle drive. Every 30 minutes the door deposits another sick, helpless cat or dog at my feet. I have 30 minutes to find that pivot point. Identify the underlying triangle that permits one side to slip into the abyss and recognize it for its power, while the other allows me to flex my medical prowess and save this life. The scant 30 minutes to identify which side of the fulcrum we are resting upon. How many of those once in a lifetime lives, those irreplaceable companions can I sleuth into being classified as savable before that last determining grain of sand slips into terminal. Can I see it for its critical mass of yet to be undetermined in its fate and push the tide back to sea? Where is that place of my endeavors can still matter and fate has claimed its next hostage for keeping.

Grizzly and Bear. Two patients I adore.

I play this game in my head with every life I see.

You don’t know you are strategically laying out your chess pieces until you try to pause from the game. Until you try to push yourself out of your chair so you can look at the board from above. How little your pieces influence the greater part of the landscape. How many pieces you can lose to protect the king as the queen does all the heavy lifting. Where is that moment that the game tips?

You don’t realize how much the tiny shuffles of all those pawns in front of you influence the outcome until the critical mass of your life’s work sit beside someone else on the opposite side of the table.

You don’t realize how much you’ve lost until you have to contemplate surrendering the whole endeavor.

Vetmed tries to measure loss in inches of acceptable intestinal resection as a way of predicting functional abilities. How many abdominal exploraties have I opened up to see lengths of black gut leaching into both sides of healthy adjacent tissue? How many times have I had to call a parent to guess, propose and confess the critical mass being lost already? That game. This duel of sizing up my opponent to try to mercifully protect my patient is the battle I obsess over.

It is the battle to not feel to pessimistic to the power of hope. It is the battle to not be so egocentrically dictated that I presume failure while dismissing miraculous chances. It is the most egregious aspect of vetmed. This insidiously absurd power that one life can be replaced. It’s mark left to be rewritten by another. Vetmed needs a slap in the face to wake up its indifference for another patient to follow. We need to see each individual as its own unique and meaningful life. So influential in its existence that it enriches our own beyond replaceable measure. We need to be ever vigilant in our inspection of mass that we seek purpose in saving and protecting rather than measuring and abandoning.

500 dogs. 500 dogs kept in 80 cages. Broog shelter in Ukraine was a war camp. A place where all were trapped in a hell that lived smack dab in the middle of a country under siege trapped by a war none could flee from. This is my ptsd. The place I go back to as a yarn of tangled intentions to distract from the weights and measure of assigning critical mass. The place of chaos to remind me that my decisions, as honorable as they may be are still just wished cast to the clouds as I grip the grass below. Yet we all still wake up to another day of discovery and hope the compassion can out weigh the mass. That the tiny grains of moments collect into magic wishes of perpetuity for the next generations to reminisce about.

The dogs from Droog, The group in one of the open spaces

I am beginning to recognize that I cannot stay focused on the end. The place where there is less, and it is slipping away. I can only stay grateful in the present, and all of the joy here, the rest will find me, someday, regardless.