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. 

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