Greed, Gouging and Your Legacy in Veterinary Medicine

I am just a few months away from having twenty years as a veterinarian are under my belt. It is a benchmark I was sure I would attain, and yet, I really never thought about my life, or this journey, past it. You get caught up in the pace. The one foot after the other. Keep moving. Don't stop to look back, or, forward. Trek away, day after day, after day. Never ask yourself; what's next? What does the journey on the other side of this mountain look like? You get so consumed with the cases. The lives. The challenges both internal and around you that you are tormented by the expectations to cure them that you never give yourself time to plan, or prepare for the later. The next phase. The thing before you hang up your stethoscope and slip into crossword puzzles to stem your time. I am this place now. It is daunting. This summit atop the professional expedition I spent my whole life living for. 

Unlike my first forty years, where I struggled for acceptance and worth within this profession of over achievers, I am finally at peace with where I am and how I got here. But the after this part, that I don't have an answer for.

This life quest began when I was 8. I was a child of Long Island, N.Y., which lay at Manhattans suburban outskirts. We had just moved to N.H. from the melting pot of the culturally diverse neighborhoods abutting NYC because my parents chose to chase the Tasha Tudor temptations of a life surrounded by  animals and homesteading. My mom was a woman in juxtapositions. She loved the outdoors, the wildlife in our front yard, but she disliked the hoops of attaining resident status in a place that was adverse to any changes of any sort. We were transplants from a city they wanted no parts of. I never felt at home in the bucolic mountains, lakes and entomologists cornucopia of N.H. It was with this feeling of isolation that I re-invested all that I was, all that I hoped to escape from, and, all that I ever wanted to feel needed within, into the newly amassed farm of my soulmates. At 10 I earned my horse as a prize of patiently accruing babysitting and farm chores money. She was a pony by stature named Sweet Memory. I called her Morie for short. We were the stuff of tween dreams. I can still smell her fluffy-downy coat full of dander and hay. I remember brushing her for hours in the cold just to have some place, some thing, to feel connected to. Our life together was a mish-mash of leather parts to make a happenstance riding rig just secure enough to carry a young skinny girl away into the 50 acres of woods that lay behind our white clapboard farm house. She was sturdy and rugged and never afraid to go roaming with just a bridle and a saddle pad. Her sidekick in our tiny barn was Lambie. She was a whim of an auctioneers mallet at the local country fair once my mom realized the show animals had no other purpose but to be consumed after the ribbon ceremonies concluded. My mom convinced my dad to bid on her tiny white newly shaved military buzz-cut as she was being forcefully coerced to enter the middle of a dirt floored circular show ring under the big top flags. Little spindled legs reluctant to walk, scared and screaming for mercy. Her "baaaahhhhhh!" cries broke my mom and cracked the weak spot that was my moms empathy for animals outside of her dinner plate. She was about 4 months old when we packed her up in the luggage area of our woodie-sided station wagon for the ride home. Over the decades that were their lives in our back field the vet only needed to be called out twice for Lambie. Once when my mom couldn't figure out what kind of strange ailment had acutely caused her to not be able to stand or walk in the dead of winter. This turned out to be an overnight affliction of her over grown woolen onesie to the frozen tundra that cemented the under carriage of her. An emergency shearing of her over grown, albeit incredibly warm and cozy fleece wool, to the clutches of the frigid ground she took refuge upon cured her. For the rest of the approaching spring you could see her forensic woolen outline marking her preferred sunny spot in her paddock. The second time was for another poor husbandry charge. Every veterinarian learns early on that one of our primary diagnostic tools is our nose. One warm summer day my nose told me something afoul was about. There was a wet spot near Lambie's backside with a terribly foul odor. Upon inspection the skin of her wool could be lifted from its tissued-foundation revealing an entree sized dish plate matrix of  wiggling naked worms. Maggots had found her and she was too rotund and Rubenesque to bother with them. These were my indoctrination to large animal medicine. I was hooked. Enamored. Smitten. Called. The more gross and gritty the more I wanted to be a part of it. That and my parents were miserly with their willingness to make financial investments into our livestock lawn decor.

My parents moved to N.H. with one dog. They, like all true homesteading farmers, quickly, quietly, and unintentionally amassed multiple cats from the fringes of unwanted free-to-a-good-home classifieds. Within a few years of our farming life we had 2 dogs, 4 cats, Morie, and, Lambie the Southdown. 

If necessity is the mother of invention my ah-ha moment came when the second unplanned pregnancy occurred in our also-bored-with-the-country Border Collie Bonnie. For all of the preaching I do about avoiding pyometras my parents dog never lived long enough to worry about this disease as the accidental breeding's kept her lady parts from making bad decisions and getting all life-threatening infected. 

Life on a farm is hard work. For my parents the utility of farm hands fell squarely on the humans. The pets were, well, pets. None had a purpose outside of emotional company, so none had a value worth investment. People in N.H. are frugal, rugged, and independent. Pets were never meant for this. The cats got the worst of it. They always do. The second generation of farm dogs turned into Jack Russell Terriers. In the trade we call them 'Jack Russell Terrorists'. The name is fitting. They terrorized the cats to no end other than death by cornering, or death by poor timing. I knew they wouldn't be fixed unless fate took mercy upon them. It was this spectator helplessness that compelled the quest I now find myself on the descent from my professional mountain from.

My mom, RFD #1 New Durham, NH 03855
circa 1984

I have done what I came here to do. I am no longer the unprepared, incapable pet parent, companion colleague I was. There hasn't been one pet who crossed my professional path that wasn't cared for in the same manner I wanted someone to care for my childhood pets. I am the spitting image of the veterinarian my parents called upon all of those decades ago. A little bit of farm-raised ingenuity, a smidge of humble boot-strap sensibility, and a bitter swallow of knowing these people I serve decide my legacy, (not the other way around). 

In twenty years of practicing I have saved thousands of pets like my parents pets needed. I have found new second chances for hundreds of lost, forgotten, abandoned, over looked and always under appreciated dogs, cats, kittens and puppies. I have done pro bono work so extensively the local ER's, rescues, clients, and community all hail my name as the place to ask for help when no one else is interested. I used to worry about this lot in life I have cast for myself. I now recognize it as the fostering of that little girl I was, am, remain. 

You can find yourself in the oddest of places but it usually is a reflection of the path you were always on. I guess I will just put up a road sign, a billboard, and an empowered concession flag for peace in the place my feet have found me and hope that this journey bolstered my crossword puzzle prowess.

December 2019, our last Christmas

P.S. I wrote this after reading the commentary to a post about the NY Times inquiring readers to submit their stories about being "gouged" at the vet office. It has stirred a lot of intense emotional outcries on both sides of the leash. I use the word "emotional" because this is exactly what small animal veterinary medicine is about. All of the marketing adjectives and verbs we use in describing the importance of our craft is 100% emotion based. We exist because people, our clients, need us. They need us as we need to be accessible, empathetic, and skilled in caring for the beloved members of their family. I wrote the story above to reflect two things; one I needed, and still need, my pets every day of my life. When the clouds congregate above, and the days seem too dark to warrant me stepping foot into them, the pets in my life, heck, the patients in my life, remind me that I have a purpose far greater than the fears, insecurities and apprehensions of this moment. Losing a pet, as we all must face, is grief-riddled enough to not feel that I lost them because I couldn't afford, or find access to help to provide them. The impetus of why I am who I am was that little girl on the farm who wanted to do more for the things, the companions, the souls, I loved most. The veterinarian who was my mentor never, ever, ever made our pets care about the money. Now I know my current collection of colleagues would excuse, or even disparage him for this, but, he was a legend. He left behind a legacy. Me, well I have every intention of doing the same. Can I be financially comfortable over the next 20 years from the fruits of my labors because of the last 20 years. You betcha. I simply choose to walk this path with nothing more as my guide. 

As for the NY Times article, here is my opinion. The words we use, the actions we take, and the intentions we put forth into the world matter. "Gouging" is happening in vetmed. It is happening because enough veterinarians have decided that they can seek refuge in the collective defensive banter that permits economic euthanasia, one sided conversations about the spectrum of care we are willing to offer, and simple plain old vilifying of the emotional empathy that this profession is built upon.

There is a cost effective treatment plan for every single condition we are faced with. We just have to be willing to lower ourselves to seeing these patients as the pinnacle of purpose our companion pets represent.

If you have to defend so angrily, and cannot see the hurtful impact your actions have upon others it might be time to ask yourself if you are a part of the problem, or, if your legacy reflects the person you came here to climb that mountain.