The End From The Beginning

 ....what if we all started everything here?

The End.

...let's start every decision, every big life event, every meaningful intention-led action by imagining ourselves at the end,,

and then march yourself back.. 

by living the life you want to end at.

Me, I want to close this book of my life with one single thing as my legacy.

I was always my patients best friend,

biggest advocate,

fiercest warrior,

and most adoring fan.

Nothing more mattered enough to change these..

The End begins, begins again, and will always be here.

mic drop

Fresh Meat

You Don't Know What You Don't Know..

Penny. One of our dearest friends and a local rescue

The staff have notified me that you are headed to a nearby practice that has just sold to corporate. I want to respectfully and sincerely share my experience and insight on this decision. And apologize for the tone. 

I spoke to the seller, (a veterinarian I have known for the 20 years I have been a veterinarian), about two weeks ago. She told me that she sold to corporate, (a corporate company I also know), and I told her that I understood why people do it, I just could not understand her doing it. She was the last and only other practice owner besides myself who I believed would never imagine selling corp. 

Here’s what I don’t think you know. You are young. Just starting,  In debt yes, but you still have your heart, compassion and integrity. Your sign on bonus and contract are going to challenge that. Corporate companies have no interest in patients unless they have deep pockets. You will be expected to turn away or euthanize treatable pets because they are not inline with their profits. Period. They don’t care about anything unless there is a profit driven reason. They only care about you because you have a license and a contract. Without them they don’t care about you either. I could put you in touch with a dozen former corp vets who worked for them. They would all verify this.

If you think being in debt is the worst part of your current position it’s not. Being burnt out and turned into an indifferent person who doesn’t love vetmed is. Even worse, becoming a part of the statistic that is so shameful we bury it. We can talk about all of the myriad of reasons that veterinarians choose suicide, but, losing ourselves in the process of trying to care for others is at the forefront. 

Corporate medicine is so insidious in our profession that they now start recruiting the most debt-ridden students, (it is not a coincidence they start here), in their first or second year of vet school. By third year they have "signed." They are receiving "pay" in the way of stipends and expected to take their internships at their corporate run practices. They are constantly groomed and persuaded to pay back the favors enticed by large (always secret) sign on bonuses and long restrictive contracts. The contracts are the most horrific parts of this recruitment trade. I don't know if anyone on the university side has these graduates interests on their job description, but I know that when I was in vet school I at least had a professional advisor on campus. A recent new grad was sharing the details of the contract they had signed. $160,000 for 60 hours of appointments. Sixty hours is twice what any of the vets at my practice carry. The state average is about $130,000. This is endangerment labor. I strongly challenge the viability of anyone being able to learn effectively, care for patients effectively and then being locked in for 5 years!? An internship and residency last 5 years and when they are completed the expected salary triples. What is going to happen to this student? She is going to want her life back. Or, she is going to quit vetmed feeling like toast.

I never require a contract with new vet’s because I never want them to feel obligated or pressured to be anything other than who they are. If you aren’t happy here I want you to find the place you are. You cannot give your heart and soul and feel purposeful and good about yourself if you are contracted to anyone. 

I know this is not what you want to hear. But, I want you to know I am here for you. 

A veterinarian who sells their practice to corporate is asked to stay around for awhile. Help it look like the transition is gradual and under their guidance and acceptance. Maintain a facade as the new regime takes hold. It is all a part of keeping the most profitable plan by the new owners. In exchange for a whole lot of money the departing practice owner has to give up all that they built and all of his decades of building something amazing to vultures. They will always know that they profited from this sale and their staff clients and patients will pay for that. 

I hope that you find a place that you love. And love vet med as much in 5,10, and 20 years down the road. Never ever let anyone take away your passion or compassion.

I wish you well. I hope I am wrong about the direction that the clinic is headed for. The seller thinks it will remain the place she built and is proud of. I hope she is right too.

 Krista. 

Spencer, always shy and skeptical.
A local rescue

This is the letter I sent to a former employee who is started work at a corporately owned practice upon graduation. He has a big heart and he has worked hard to get into and out of vet school. He is like so many students who are lured by corporate reps who promise all sorts of things to get them to enlist. I spoke to one student who was given a big sign-on (about their first years salary ($140,000) for a 5 year commitment and a 60 hour a week appointment schedule. This leaves them to make phone calls,, review blood work/diagnostics and write up their cases on their own time outside of that. I would expect that will leave them working 80 hours a week. They are now earning $33/hour, and miserable.

What you don't know, you don't know. Maybe the first person who approaches you with the shiny objects and the impressive dollars doesn't have your best interests in mind? Maybe it's time the vet schools take a stance on predatory practices if they aren't already one themselves?

Maybe it's time we start asking some hard questions as consumers and start whistleblowing for the sake of our patients, our emotional bonds with them, and the people we entrust with their care. (More on this to follow).

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The Venom In The Terminology

A message came to me from a colleague about a post on LinkedIn drawing some attention. 

The post centered around what we (the veterinary profession) calls "futility of care." 

It was hard for me to read. Hard for me to internalize. Hard for the words to carry so much gravity and deliver so little of what our clients need from us. 

I don't know when it exactly happened. When that pivot point was. But somewhere along the way our message about treating out veterinary patients like family became treating them in the way we allowed.

I want the profession to start to pay attention to their words. I plea for the profession to also pay attention to their intentions. The gravity of the judgement within them;

Here are some of the most offensive;

"Pets are a privilege, not a right." Why would poor people deserve something to adore them? Someone to make you feel loved back.

"Futility of care." We decide when you stop caring, and, therefore,, stop looking for hope. Some pet parents struggle with grief and loss on a level veterinarians have refused to comprehend. People should be allowed to feel as they feel. Our job, well, that is to provide them the tools to do so. Hope is as integral in medicine as vaccines. Hospice is absolutely an acceptable avenue in medicine. Every kind of medicine. We, the veterinary profession, want to follow in the footsteps of our human counterparts and offer every billable option to our patients, so, why is it then that we also won’t offer hospice? Why are we so intent on being morally superior and yet still not empathetic to those we are here to serve? 

PS futility care is most often seen as cold and uncompassionate. Why would we ever use that term? Small animal medicine is about taking care of family members. Nothing is futile here right?

"Economic euthanasia" The fact that the profession has increased the cost of care so staggeringly fast that this is the last vestige of care we will permit, affordably. You cannot advocate for your patients to be treated like family and then decide they aren't worth options that work for the rest of the family. In 20 years of practicing medicine I have (hopefully) never denied care because it didn't work for me. It has taken me time to understand how different we all are. There have been clients who don't value their pets in a way congruent with care. 

"Replacement value" There are people who see pets much like food animals. They have a value that is defined by "replacement value." That dollar figure where it is cheaper to replace them than to fix them. Ask me to expose my soft vulnerable underbelly and help your pet out of a difficult situation and I will jump in. There isn't one person at the vet hospital who wouldn't jump in with me. But, don't ask me to look into that disposable pet and see them as replaceable. 

Elsa.. recently rescued and adopted

This blog comes from a post from a fellow veterinarian who started the post with;

"Today I had a client for which I refused treatment." The veterinarian went on to describe an elderly patient at the end of their disease. The pet parent bringing that pet is was back at their vet hospital, again, seeking help. The parent did not see the pet in the same light, the same degree of dying, that the veterinarian did. The pet parent wanted help. With that plea for help, with nothing more to offer that was feasible in helping the pet get better, with only euthanasia left, the vet posted that they were refusing treatment because watching this pet show up at the clinic was stressful for the staff. Like so many other instances this is a veterinarian who refuses to see the pet in the light we make such financial gains from and meet them where they need us to be. The parent wants to feel hope. They are aren't ready for the passing of their family member. Futility or not, there is absent compassion here for what the pet parent needs. We are turning our back on them when they need us most. Why can't anyone say, "what can I do to help?" When is declining a hand of empathy abandoning our responsibility?

I replied; "Today you decided to stop being a doctor."

For more on my veterinary hospital please follow us on our Facebook page; Jarrettsville Veterinary Center.

YouTube channel here.

For more information on the non-profit work we are doing to help save pets from economic euthanasia please follow us on the Pet Good Samaritan Fund page.

Pawbly.com for pet questions and pet care cases with cost of care included.

When The Veterinarian Decides Who Is Worth Care

"I need to talk to you privately."

It is the beginning of another chaotically busy day and this is my least favorite preamble to start it off with. I tell myself to stop what I am doing and just go face the discussion head on. Rip that band-aid off and then return to GO. It is the only way I will get to the end of the day intact.

Magpie

She is the vet hospital floor manager. She has been here for about 9 months. (New to us by the law of averages that the rest of the staff holds. Most have been here for over 5 years). She is the Sergeant who keeps the cadence. Monitors the staff and doctors to stay on time. Ensures the blood tubes are labeled and the diagnostic table stays organized and orderly. She fills in to hold a patient, address a problem with a client to keep the vets on schedule. Picks up the phone to answer the random, often completely inane question. (Like yesterday's; "my dog ate a treat toy. What do I do?" No idea of size of dog, size of treat toy, what said treat toy was made of, or how well their dog chews before swallowing). She is on her feet, in everyone's business, and still keeps a smile on her face and an optimistic cheer in her stride. She used to manage race horses. She is ideally qualified for this crew of, (authors note; I wanted to use the analogy about 'busy as a beavers' but it just might be construed aberrantly.. ;-) ),, let's say ants... yes, or bees, or thoroughbreds, they all substitute to make my point. 

Storm, morning naptime

The conversation centered around one of our oldest clients. Old in both age and years with our practice, (must be about 70, as he is about 85). His family has farmed the lands in this county for over a hundred years. He is known by every person who has lived here for more than a few months. He is an indelible character. Always a farmers baseball cap atop his head, (which I have never seen naked). Always a pair of pants missing fabric in key places. And, always a long tale about some physical ailment of his unrelated to the cat he has brought. And, yes, always a cat. He used to have dogs, farm dogs, (of course), but cats, he has  decided are far easier to care for, and he far prefers their company. He lives in an equally old, equally worn out, farm house. Every room of his home has been converted into a cat dormitory. Every room is sectioned by feline family. All of his cats, 40-something in total, are related. He is as old school rural farmer as they come. He absolutely, unequivocally loves his cats. They are his family. 

"I don't understand why you didn't tell him that he had to put the cat down?" She is referring to his cat that we saw late yesterday. His cat was pitiful. Dying, and in horrific shape. He was matted, foul-smelling from feces that had caked on his back end, and emaciated. He was also sweet, gentle, purred the whole time, and knew only love from a human. His cat needed help, he knew it, and he was here looking to us to provide it. We are, after all, doctors. This is, afterall, a hospital.

Her question is so heavy you can reduce to a few minutes and a clock that ticks impatiently. 

I know that I have to try to answer this for her. Find some analytical reasoning in her black and white perception. I also know that her question comes from a place of respect that she trusts me, and concern that she is a part of a patients suffering she doesn't feel right about. 

The answer to this question is seated in the ethos of who you are. It comes down to this; who are you here? Specifically, who are you in veterinary medicine. 

The successful small animal veterinarian is able to keep their business open because they understand every pet parent sees parenting differently. Veterinary medicine exists in a place of whim and will. Every pet in every home is there as a guest in the eyes of the law. While they may have some basic rights in a few states they are still considered property. Pets are the reason veterinarians worked so hard to attain a degree. They are our purpose. They influence us. When you are so deeply invested in something it becomes painfully purposeful. It becomes ingrained in who you are. This is a curse as much as a blessing. Understanding the emotional seat of pets is imperative. 

Frippie. Also morning naptime

If my purpose is to help pets I have to provide it within the confines of what works for their family and caregivers. Veterinary medicine is forgetting this. We are getting judgemental and restrictive as we become more profitable. We have influence tied to our preferences and our gate-keeping for their health. It leaves people like this farmer in a place where he now will not go to the ER, and he will not go to other veterinarians. They have judged him, lectured him, reported him, and he will not share his life and the dearest individuals he adores. His cats are his family. He will protect them as such. 

A practitioner who wants to stay in the community they live, work, and practice in, needs to meet our clients where they are, not where we want them to be. This is the key difference that specialty medicine is lacking. You cannot be a part of someone's story without being embedded within it.

His cats are crowded. He has too many. He knows this. He spends all day everyday cleaning for them. Feeding them. He treats them the way the rest of the world treats the animals they eat. Crowded and housed like they cannot have freedom to pursue free-will. Why do cats and dogs deserve different standards of care? Different living standards? Why if you think they are more deserving of minimum standards of care and yet not deserving of end of life care like humans are? Every hoarded started with love and good intentions. Every pet under their care still deserves care.

This is what she didn't recognize yet.

The view from my kitchen window

For every client that I see who doesn't want to euthanize their pet because they do not feel it is their place, their right, their duty, their decision to make, the profession has to be respectful of this. Hospice is their right as much as it any other aspect of dying is. This farmer has never put a cat down in my clinic. Whether or not I can do the same with my beloved pets is not relevant to his decision. He loves them. He cares for them. He dedicates his life to them. Do his cats love him back? Yes? Is he wealthy, influential, hold some power over others that can afford him a different set of rules or standards? Is this the country we live in now?  Is this yet another instance of inequity deciding who is or isn't worth empathy? How many cats are looking for homes in my county? (Hundreds). Do these facts influence our compassion?

A decade ago we had a long, hard conversation about his colony. It took me years to convince him to spay and neuter. It has been a decade of no kittens, which was very difficult for him to give up. It was what his cats needed. It took him a while to see their world from this perspective. There has been a huge decline in respiratory infection, illness, and death outside of old age from this. He needed to see the colony from this vantage point before he could give up the joy of having kittens. This is medicine. This is the emotional glue trap that having pets causes. This is the life every veterinarian chose even if we couldn't see, or comprehend it during the early years or vet school.

For more on veterinary care, my diary entries, and the current state of vetmed please follow this blog, see me on YouTube, Instagram, BlueSky, and our Jarrettsville Veterinary Facebook page. 

Pawbly.com for pet care questions and cost of care cases.

We also just started our non-profit Pet Good Samaritan Fund. See our stories of helping pets in critical need there.

They Will Break Your Heart.

The months within the abyss never clarified the question. Was the sense of abandonment worse than the sense of loss?

Twenty five years later I still can't find the answer. All those many years ago, when I was the new bride with the husband asking for divorce I couldn't answer this question for myself. Would it have been better/easier if I had been grieving over his casket. Widowed, alone, and yet everyone would know my story without me actually having to mutter the words aloud. Sparing me the humiliation that his truth held. I could have had a life again. Someday. Sure, I would have lived in the shadow of our wedded life contracting so fast. Being so fresh and small then wiped away cleanly. The nuptials of a black holed loss. Our life together compressed with so much into so little. A proverb of a marriage story. Just a few sentences; we came, we tied the knot, we died. The End. But, nope. Me, my marriage, this story, had to have mystery. Intrigue. Substantial tabloid worthy dirt to smear with shame, horror, judges and public notices. Mine had to have an arrest. A secret charge for child endangerment. A pregnant teenager. A mother of same said pregnant teenager who called our house aghast at the thought her daughter was capable of complicit consent. 

He had left before. But, he always came back. When he left for good I realized he had only come back as some sense of pity. Imagine that. He pitied me, and I was the one with the clean record. Nothing more than guilt kept him. After a few weeks not even that was enough. That's a slap in the face with a reminder to listen the next time. Listen to what people tell you. Not only to what you want to believe you hear. I hadn't heard him the first time. I hadn't wanted to. 

While you watch other married couples around you treat their spouses far worse than you know you ever treated your ex the truth remains that they never left each other and yours did. Yours did it in everyway to make it feel soo atrocious you lost your own identity in the mire.

All these decades later I am not grateful for the time my ex-husband and I had together. I am still fuming from the way he left. What shit came out of that departure. My dogs and cats, the dozen plus little lives that I have lost within this same time frame, well,  I am still searching my insides for those little pieces they took with them from the weight of their loss. I miss every precious moment of everyday I had with each of them.

Frippie in the poppies. (Poppies seem appropriate, right?)

At a continuing education conference a few years ago. Three of us sat cross-legged on the carpeted floor, all hoping that it didn't have as many germs as we knew it likely did, eating our bagged lunches. I, always the oldest of the group of my vet school classmates, had by this time, owned my own vet clinic for about 17 years. They, they were 10 years younger and about 14 years shy of my ownership anniversary. New to the game, still optimistic in making all of the pieces fit, sat and talked about motherhood, toddlers and juniors of their own, and finding that elusive balance to it all. Me, I ate. I know better than to offer unwanted, pessimistic advice or lessons. They had loads of questions about bookkeeping, scheduling of staff, adequate staff to veterinarian ratios, payrates. Marketing, websites, inventory buying power, and cases that seemed too odd to be real. Their questions required minimal time to answer. They were most inquisitive about our internal slush fund, its use and my unwaivering dedication to treating every patient who crossed our threshold. They asked many questions. The one that I had learned and they had yet to feel first hand was that one lesson that time makes truest. 

"What's the hardest thing you have been through so far in owning your clinic?"

"Heartbreak. The cases can be difficult. The acceptance of life just not being fair. But, the hardest part above all, without question, is the staff. They will break your heart. You won't see it coming. You won't be prepared for it when it happens to you. You will question everything."

Its bereavement in shades of grey. 

Frippie, cold Sunday at home.

The stickiness of this, my own veterinary clinic, is the same glue trap of my existence. There is such great emotional depth here that it is impossible for it to not bleed into every other moment of our lives. It is the same canvas that paints a families portrait. Dysfunctional, adoptive, ugly with infighting at times, yet still all coming together in times of disaster, trauma, and need. We are that bunch. Proud as I am to have them all home for supper, each with children of their own. This clinic, our veterinary hospital, has weathered storms. Tragic deaths. Departures from unforeseen epidemics. Boyfriends, babies, and ambulances. Waves of changing tides, yet still trying to stay the same course. I have to be the one to leave this time. Abandon the web in the hopes it doesn't force exodus to those that remain behind. If I can logically see myself as the common denominator to all of this then maybe the problems solution remains in the crossing out, cancelling of the common thread? Afterall, excision is curative in so many other cases.

Storm, also never sure of much.

"What do you want to do?" My husband sat quietly across from me. Worried about not being there for me as much as saying the wrong thing.

"I just want to be a veterinarian, and still have a little time left for the rest of the life we amassed." Our house, now finally done. The cats and dogs all healthy enough to not leave me counting days, and pills and obsessing over calories in, weight loss out, and the pennies in the 'good day' versus 'bad day' jar to help measure the quality of life scale.  

"What are you most worried about?" He loves to live here. In the doubting-Thomas shoes. The red spiked tail and pitchfork always at the ready in his back pocket. 

"I am always to blame." You cannot feel anything other than this. The imposter friend. The imposter boss. Never truly a part of the group. Never in on the inside scoop. The pulse of the practice. Always aloft in the crows nest looking for a speck of dry land, or, the iceberg. Sure both are there re-plotting their courses to intercept yours. The sweeping line leading to the bullseye dead-center on your radar screen. Game Over. You know you will go down with the ship. They won't save a seat on the lifeboat for you. They never even counted you into the articles. 

I left the conversation with my business partner/spouse/wise old owl that he is, with this. "I understand now why Dr S and Dr L just walked away from their practices. They had no other way out. They hadn't become different people. They just couldn't stay trapped within their own prison any longer." I am not sure he heard me. It wasn't a nugget of information for him anyway.

In the end you will find yourself alone. Life will remind you periodically to get comfortable with this. It will remind you to be at home in your own heart. That people will tell you who they are. It's up to you to listen. They will come, and go, and try to come back again. You might not be the same person the second time around. It's up to them to listen to that person too.

Serfina

Me, well, the animals, the pets I adore, the places I always invested my whole heart within, well, they never broke me. They might have stolen my heart. Sent me into grieving as violently as anything else ever dared to, but they never broke my heart in a text message or email. Humans, they are the glue trap you will chew your own arm off to get away from. They are the ones you have to become at home with indifference over.  There are people who come and go. They don't have a calling card to notify. They have a history of half hearted attempts. Broken wings. Fledglings who keep flying to a different nest, but, never set up a home. Well wishes and bon voyage. What else can you do?

 It has taken me forever to learn this. I am never the person to leave. There are cobwebs on every facet of my existence. I don't know if I am the wiser or the poorer for this. I just know I am still here. Roots, legacy and epitaph intact.

Waggle Partnership Letter

 Hello,

I am a practice owner who is a veterinarian with a big heart first, and a superhero ethos to save pets lives second. From this perspective, (and the current ethos of corporate take-overs in the vet sector), the burden of helping more in dire need by offering affordable care has become overwhelming. It was with all of this at our doorstep that we created our own 501c3 about a year ago. The Pet Good Samaritan Fund purpose is to encourage other vet clinics to offer more affordable treatment options to pets in dire need of interventional care. We did this because we know pet parents need help, and we also know pet providers need a safety net to reduce financial loss and risk.  

Sephora

My veterinary clinic, Jarrettsville Veterinary Center, is a small animal private practice that has always been committed to helping the pets in our community. We never deny care and we move mountains to make miracles happen. This is a daily endeavor at JVC. Yesterday was our first case that we utilized your platform through. In the past we have done all of our fundraising through our own social media outlets. While I cannot always defeat disease, fate, and the inevitability of death, we have never lost a case from having to resort to economic euthanasia. My whole existence as a human and veterinarian is committed to ending this widely accepted, (and almost unanimously approved vet med community), option. The thought that a deceased disease afflicted/beloved family member is better off dead than taking a financial risk/offer to be compassionate and fulfill our veterinary oath by actually treating the patient, is archaic, cruel, and unjust. I am as vocal about this personally as I am publicly. This profession has strayed from who we wanted to be, and why we are here, and the pet parenting public knows it. Our veterinary suicide rate, the massive buying of hospitals for coroporate profits, and the skyrocketing cost of care prove this. I believe that with key partnerships we can help pets, their families, and veterinary care providers. We can minimize financial risk to providers, and we can all feel good about caring, (and actually practicing medicine), again. It is merely a challenge to think outside of the capitalistic goals shareholders place and start offering palatable, beneficial, meaningful care that everyone can feel good about. I also know that the rest of the veterinary decision making practices need a template and examples of how it can work. Our non-profit and for profit vet hospital have made countless examples of how we can be both doing good and doing well.

Yesterday we saved Sephoras life because of two things; first, her family advocated for her, second we have the ability to do so. The rest of the happy ending outcome was a little bit of trying, asking, finding you, and having the other key factors in place. We have been here before. I am not afraid to try, and I am determined to leave vet med better than I came into it.

Surgery prep

I am hoping to connect with you and make more miracles happen by extending the ask to not just the public at large, but to the gatekeepers; the veterinarians who don't know what tools to access to be a part of a worldwide movement back to compassionate care that really saves lives. The lives of all of us who need our pets as the vital part of our wellbeing and the pets themselves. I truly believe that a big part of the answer to all of the unrest, unhappiness and fear in the world can be solved by protecting the place pets have in our lives.

Thank you for your time and your platform,

Sincerely,

Krista Magnifico, DVM

owner Jarrettsville Veterinary Center

Founder Pawbly.com

Founder Pet Good Samaritan Fund

pet parent, exhausted practice owner, and total-bad-ass pet savior in residence..

PS Sephora's pyometra surgery took me 30 minutes to do. It was the most rewarding, (easiest) surgery of  my day. Her moms gratitude was inspiring. This life I live (while exhausting) is so rewarding I wouldn't exchange it for anything. Not a yacht, or a villa, or a tiara. Who else gets to feel this good about 30 minutes of their day? The more you give the more you get back. 

We did not do any diagnostics outside of a 1 view lateral xray. We declined everything to put all of our efforts, and resources to her treatment plan. We take risks, there is great reward, and all of us feel good about trying. This is life. You jump in. You give yourself to others. That is medicine at its most powerful.