Hello 2022, Whatcha Got Up Your Sleeve?

It's the dawning of a New Year, and, hope springs eternal, again!

(yada, yada).. as we all try to shake loose of this pandemic. Time to look back as I plan ahead. 

Or, as I feel is more realistic.., what couldn't go right from here?

So, here it goes,, pen to paper, heart on my sleeve, best attempt at optimism to carry me through another year. (Roaring 20's comin' round again?)

I want to open this new year full of old hopes and new dreams.... 

This year I am making some lofty goals. It's a combination of feeling obligated to make resolutions for a brighter future, and, be reminded about the bleak recent past.

Here's the dilemma..

I have this nagging lingering insecurity that I am going to find my dear friend Havahs' fate. She died in 2020 at 47. She was also a veterinarian, and a veterinary practice owner. She had two kids under 10. Or, my mom who died at 74 thinking she still had another 74 years left to get her dress rehearsal right. They both died too young. They both thought they had more time. Turns out life will hand you a shit sandwich and then watch you die trying to accept it. I prefer to not have any of this nonsense. I much prefer to die old, tired, contented and meeting that new book of the afterlife with a smile of gratitude and the look of the cat who swallowed the canary glee on my face. I hope to get away with everything as I accomplish more than imaginable. Maybe that’s not relatable to anyone? Maybe, in your opinion 47, and 74, are ripe old ages and there are too many people on this planet anyway? But, if COVID has driven home one thing it is that life is short, fleeting, unpredictable, and disposable. A bug/virus can rule the world and keep us hostage while it permeates every corner of every human life. Fear shouldn’t be the only motivator, but it makes a damn good coach.

There isn't much that my life is without. I seem to have so much that I wonder where it all belongs at times? It's a comfortable nest of fluff and fodder that I made for myself. Just enough dogs (two, and they are inseparably happy together), three house cats (and they have found a way of avoiding each other just enough to no longer have cat fights), my two clinic cats (Seraphina, she's famous, (see my Jarrettsville Vet Facebook page if you don't believe me) and Oreo, her ever devoted side-kick), and, the amazing group of people who keep the inner soul of the vet clinic burning bright. I seriously fear that way too many vet hospital owners claim success based on the thunderous magic of their worker bees who keep their practices alive. It's tragic and pervasive. I don't subscribe to it. I might pick the paint colors, and pay the mortgage but JVC is the magical kingdom of hope and miracles because of it's people. I have just enough, and yet there is this relentless nagging that I can do more. Maybe not for me, but others. That place where inner calling supersedes personal preferences to the laurels and my nest they lie upon.

I was talking to an old friend who now hosts a podcast on "successful veterinary practices" (of which JVC seemed to qualify based on metrics that remain mysterious to me). He asked me how the pandemic had changed the way I manage the clinic? I told him that I will never be the same on the other side of it. Early on, when the world was closing down to a hide-away halt, I told myself that no matter how bad this pandemic got I was not going to be the person who failed JVC. I am the third owner of a place that has survived and served its community for over 80 years. I have their legacy to carry and preserve. If that meant I would have to sleep on a cot, work any hour of the day needed, answer every call for help regardless of its severity, I would. I was prepared to be the vet of one against the pandemic of all. Whatever it required I would not let this clinic fall or fail. I was not going to succumb to the fear. The virus might claim me, and I might be one of those little ones in the litter of parvo pups where you are the single one who will survive. I had seen infectious disease wipe out populations before. I knew this villain, but, I wasn't hiding and surrendering. At this same time my mother was bedridden at her home battling a demon of her own. She lost her battle to cancer quickly in the beginning months of this world wide quarantine and fear. Her fear wasn't all she had to shoulder, she focused on the worlds of panic, tucked herself away, and gave up without ever fighting. It was the darkest hours of my life, without question.

Through that loss the clinic chugged along. In the beginning we lost some staff due to personal preferences about exposure and family obligations. As our numbers dwindled so to did the demands for routine care. It was a symbiotic relationship that made life manageable. But through these early days I had this burdened heart that was unshakable. Fear. Dread. Despair lurking. I got through it reminding myself that "to each beginning there is an end." One step, one day at a time. Breathe. Be brave. It's all I could do. 2020 took two lives very close to me. 2021 was the mourning dark veil of a still life still frozen in COVID paralysis.

At a vet conference mid Summer 2021, mid pandemic, I met with other female practice owners. We were all grateful for a get-away, and, we were all exhausted. Most of us qualified as 'burnt out,' I was charred. What I wasn't expecting was how much their attitudes about their practices had changed because of COVID. All, and I do mean all, were once (pre-COVID) worried about how the new corporate ownership would affect their staff. Two years prior I would have said that this was the biggest and most significant factor swaying practice owners to not sell to corporate. That concern had evaporated. Their viewpoint now was exactly what the corporate acquisitioners wanted to hear; "I'm too tired, too broken, and too frustrated/fed up to care anymore about anyone else. I just want out."

I never got there, but, I understand how others did. Had I been forced to run the clinic solo I am not sure I wouldn't have crumbled. I know of one veterinarian who lost 9 of her 11 vets in the first few months of COVID. They left for many reasons, but, they also left her largely incapable of meeting the demand. When I asked her how she did it she replied that the techs did everything. She stayed in surgical scrubs all day and the techs did everything else. It was now 9 months later and she was selling. Her team had abandoned her in her darkest hours of need. 

The backside of this pandemic has left me feeling relieved of a burdened heart that couldn't have taken much more. Where early on the demand for services was so great we were stretched thin to meet them, now we are anxious for its departure. COVID vaccines are available to anyone who wants them. Where I had feared people would be putting themselves at significant risk to stay employed with us, they now had options to protect themselves more than the mask and PPE's, (which make medicine inherently more difficult to patients who cannot talk to you), could. If a staff member had gotten exposed at work, brought that home and infected others, and anyone had died along the way the guilt would have crippled me. I was out of that self-imposed fearful scenario by end of 2021. The burden was now solely and singularly on them.  I could go back to being grateful for their help and not burdened by the fear of their presence.

Maybe being able to forge your path from the end is a good way to not be hesitant or afraid of the now? Maybe as I live everyday with such a constant reminder of what we are all going to lose from living through this, is a way to be more free to make huge mistakes, take huge risks, and live without caring about what others judge, call, label or even think about me.

I can say with a full belly of castigation that almost everyone who is anyone in vet med thinks I am an awful person. From the vet side my colleagues hate me. Yep, hate. Such a cruel word. I am not on twitter anymore and I cannot use the Facebook peer pages without at least one veterinarian trying to berate, bully and intimidate me into hiding in shame. I am outspoken. I remain this way. And it compels my every move in vet med. We, this profession, have failed so many pet parents whose lives revolve around their companions. The prices, expectations, and yes, our own interactions with pet parents is decaying. Vets don't seem to care as much as we believe we portray ourselves to the public. Too often in this, my own clinic, if I try to be vegetarian I am faced with the same shaming and ridicule. As if this life choice is insignificant and banal. And this is from people I actually care about. As I try to be kind to all animals I have staff members insulting me and mocking me. That hurts. I remind myself of this as I try, (operative word), try, to be respectful that others have different opinions. Even opinions on COVID vaccinations. I have had to accept that they may get sick, or even die, and it was their choice. I can almost accept this, except for one small thing, that person could infect another person who might not survive. So I try to be respectful of civil liberties and freedoms in the face of vulnerable defenselessness and yet I struggle to elevate them to the place of pride and dependency they hold.

I have done all I can do as a leader in a small town with a vet clinic that has no equal. We are the sum of all of our parts and yet we are still here facing another year of undoubted challenges with unknown obstacles and a big heart on our sleeve which I will be the first to say is our biggest strength for our greatest chances at success.

We survived the pandemic. What has it done to me? I suppose it will take 2022 to see? 

We were so lucky.

That fact has brought me back to being able to set goals. Make wishes. Be at peace.

What had gotten us here? I think it was just being true to who we are. Not being reluctant to be genuine. And staying there for them in both of our darkest hours.

How do these fit into this book of my life? My singular narrative?

I am left with feeling that they are the root of everything in life. 

Here's to all of us finding a new dawn in a new year, and the hopes that dreams are still possible on the other side of gratitude that we are all still here.

The Fortress You Retreat Within

 The house at the end of the lane is mine.

She's a little fortress of stone straddling a bank that tumults into a pond. She is a formidable villa whose skirts used to encompass all the land around her. She has been settled here for over two hundred years. Long enough to have seen dozens of families transition from new hope to old death. She has secrets. Mysterious hidden passages. Root cellars, caves, and an ominous presence fortuitous in its reassurances. 

I met her twenty years ago. She was a speck on the edge off a map. Her criteria fit; old, stone house with land, relatively untouched. There were peepers and Lily of the Valleys in Spring. Deer and abundant wildlife in Winter. Her location did not. She was alone on the edges of a place no one sought outside of being born there. Her charm was what stole me. She was as exact in her integrity as she was simple in her merits. She would also require a lifetime of devotion. Old houses are like that. They will you into bowing to their needs and enslave you in their necessities. It wasn't me so much that I was worried about, it was my city slicker husband. He had no idea what he was in for.

We bought this place with the single goal of never leaving. We were going to die here. Our final stop. I wonder how many others before me meandered down this lane and felt the same way? 

A fortress can serve as a refuge, or, it can become your enslayer. Perhaps a matter of perspective. Perhaps a toothless grin from wicked grandmother waving an apple.

COVID has found us. Arrived quietly in the night. Tickled my throat. Ended up swallowing us whole. A python of paralysis that inches you into their gut. It has been 14 days of isolation. The house and the virus suffocating us from all sides. And yet there is no answer elsewhere. No place to go and find better shelter. No welcoming relief awaiting us where the drive meets the world. We stay. Hidden. Quietly suffering watching the hope slip into snow falls, and simpler lists for the tasks of the day. 

In two weeks I have watched my husband erode. He is distant, vacant, empty. He resists everything. The bed calls him like a tomb. The worry has melted into anger. He is giving up. Letting the leeches in his blood suck away his resistance. I ask him "how he feels?" a mind numbing hundred times a day. I search for any sign of forceful intent. It is not there. We just lie together. All day every day as it melts unrecognizable into the next. A delirium of attempts to know what day it is, and how many we have  been here? 

It was our custom to ask each other at the end of everyday "what the best part of the day was?" I attempted to carry it into COVID. A last sense of routine to hold us together within. I had to abandon it a week ago. There is not one remarkable thing within these 24 hour loops, save for breathing. We are still breathing.

I check his pulse ox, his temperature, heart rate, rhythm, rate of breathing. His degree of dysphoria. I am certain that I can feel this bug worming a way in my brain. "Eating into my cribiform plates" as I rip the scalp from my head to wave off the headaches causing my blinding agony. He keeps repeating, "umm, ok, uh-huh." Some statement to a villain I cannot see beside him. An affirmation we are alone here save for the thief within us. 

I am a veterinarian. Trained and skilled at assessing my patients who cannot speak. Who cannot point or articulate the source of their dismay. I am certain that if a disease of this magnitude hit our pets as hard as this has hit us that (save for a few outliers)The  all of my clients would be ending suffering long before day 14. 

People don't survive this. Seems silly to those of you not in the midst of it. Or, those young enough to allow resiliency to shape the path. The elderly are sitting ducks. Incapable of escaping the life it steals as you are too tired to fight. 

The snow has covered the ground. Seasoned the salt and pepper to all white with a few remaining black trunks to jab the gravid sky. 

The dogs are so bored they have become bad. Annoyances with too much energy to direct in a manageable fashion. I used to tell clients about the many advantages pets breath into life. The stable regimen they adhere you to. The life their antics breathe. The optimism they shed. The youth they bind us to remain within. A pandemic magnified this. Everyone got pets. Everyone found their isolation someone in a wag and a purr. For as much as I have lost all sense of any kind of humanity holed up here away from the world they have brought me back every day. Perhaps just for a peek, perhaps for just a vivid moment, but, they have been all I had, and dare I say all I needed. A life line of a wet nose nuzzled under the covers of eternal slumber housebound in a snowstorm sobbing alongside a pandemic.

Pandemic Induced Decision Making Catalepsy

The Queen of the clinic Seraphina

I am at the point within this pandemic that I have decision making catalepsy. I am paralyzed by each new decision. The dilemma lies within being almost empty on identifying right versus wrong, or, bad versus worse, or even when to intervene any more. I am at heart a pragmatic decisive democratic leader. I got here from spending four years at a federal military academy, and then a decade serving in uniform in the private sector where rank determines everything from where and when you sleep, to where and when, you eat. I have for most of my life been embroiled in leadership roles. I am also a veterinarian. I am wired to care more about those less fortunate than I am my fellow human beings. This pandemic has forced me to reconsider, and, perhaps even abandon, each previous decision making argument as I attempt to decide how to navigate these ever emerging uncharted waters. The entanglement of my decision making process has become the angles of individual alliances and personal motivations that have been so unprecedented I almost can't tell myself where to settle my soul of indecision and burgeoning heart of consumed worry.

Remy. A little nervous at first, a marshmallow at "hello."

This COVID decision-making jungle began in March. The forced closure of most businesses left us with a simple question? Do we dare deem ourselves "essential" enough to stay open? Put the staff at risk of, well, ventilator dependent coma or even death? Am I that arrogant to consider my job that necessary? Is the pride going to come before the fall? I dug deep. Initially I opened the decision making process in true democrat fashion with querying the entire staff. We offered free passes with an indefinite leave of absence to any and every staff member who wanted it. They could play it safe. Stay home. Insulate themselves with their families. The safest maneuver possible. All were promised full acceptance and support to whatever decision they felt best suited them. I pledged to keep their position open until they deemed themselves ready to return. I secretly prepared myself for a skeleton crew. Endless days of paltry appointments from only the most dire cases to be shuttled in by their masked, socially distanced pet parents. We would sacrifice our bread and butter routine spays, neuters, vaccines, well visits, and, just buckle down for the most darkened days of our 80 plus year existence. Even at this bleak unknown place I believed we would get through this. Perhaps scarred, scathed, nearing bankruptcy, whatever may come, I would not let this ship be lost on my watch. If I could keep myself off that COVID causing ventilator I could go on, even alone if need be. I truly went there. Imagined myself in this place. Alone and yet still having my neon sign burning as an "open" beacon to the rest of the world huddled within their isolated and hidden homes.

The decision to stay open, with the Governors blessing, turned into a weeks long hysteria about whether our pets could contract, or even transmitting, the bug. The paranoia that this brought to each phone call was unsettling. The pictures of people in the COVID birthplace throwing pets out of high rise windows to eliminate the baby with the bathwater. That lecture of quelling paranoia was left to my previous 15 years of dealing with zoonotic disease. I wasn't going to fall into that rabbit hole of fear. I knew my enemy well enough to not placate to personal paralysis because it was simply a novel pandemic. I know corona. It's been around my office forever.

My Jitterbug. Always on duty, never under command.

The first round of COVID forced decisions left us down about 25% of our staff. Which was about the amount of business we saw decline.

March 2020 also coincidentally delivered us the ability to start our long awaited hospital expansion. It had been ten years in the making and waiting. A decade of hoops to jump through. A decade of personal saving and planning to allow us to grow into the clinic we had outgrown 15 years ago. A building permit was finally granted. The clock to begin, and complete, the project started ticking as the personal promissory bond was deposited. I had voted to wait the construction out and let the pandemic pass. In doing this we were risking a rare chance to do what we had been told over the last 10 years that we could not. We took a big chance, dropped a million dollars we had spent my whole career saving for, and jumped in. It has made me sick with worry every single day since. Every nail and every excruciating decision. I didn't know what the future held and yet here I am putting all my chips in the game. To this day, mid January 2021, I still think/fear, that I just put a bigger anchor around my exhausted neck to sink into the abyss of bankruptcy both deeper and faster. The dizzying list of decisions that a huge construction project brings are daunting. Some I made by the bottle, others I made by coin flipping. Most were whatever the builder wanted. I couldn't focus on them, so, I didn't. Not the way to spend a million.

As COVID was settling in with her 24/7 news coverage of bodies being amassed like war torn canvas clad victims housed in portable freezers, March also brought the news that my mom was now terminal with breast cancer. Fear took her over, the cancer ate away the rest. I had to choose between seeing her, assisting her with trying to function at any kind of basic level, and the exposure my job left me open to bringing back home to her. I took time off. I decided the little time I had to advocate for her was not worth the limited appointments the other vets could see without me. Of all the decisions I have faced within the last year this was the easiest. For three months we faced COVID and her debilitating disease that stole everything she had and left. We all faced decisions that left only two options with every decision. She was either sent away to die in some patchworked mandatory isolation from us, or, suffer at home as cancer insidiously pilfered the rest of her. Trying to find in home care options in the early days of a pandemic was impossible. No one would help us. I moved in to live at my parents house. It was quickly apparent that she needed more than this one human could manage. Three times we had to send her away to try to save her a few more months of time. Each was excruciating to debate, and final in its potential consequences. Every time she was taken anywhere we knew it might be the last time we might see her. How do you weigh that? In May 2020 my mom died in hospice hidden away, and still very much afraid, at home with her family. We have never had any closure after her final breath. I'm not sure we ever will. It's dull and faded and blanketed in an anger I still can't resolve. So many of the decisions I faced outside of taking time off for her were fraught with coffin calling cards. I have no idea if any of them were right? But we made them. Twisting her arm to get in an ambulance as C-diff ripped her guts out in a bedpan her frailty wouldn't permit her to get to. She fought the interventions and surrendered to the terminal.

Three months in, June, 2020, and the phone began to scream incessantly. The holed away humans began adopting pets in record numbers. These humans also began to place a much higher value on their pets who were at home with them and now their only source of companionship in keeping them company. The business surged and the risks of contracting COVID followed. As the novelty wore off the fears abated a little into monotony. Life was soo busy we couldn't watch the news with the same fervor. A sliver of silver lining found us.

Six months in, September 2020 and the staff, and world began to grow restless. You can only stay quiet for so long. People started traveling. Families began to scatter. By this point we had at least a half dozen self-quarantine 2 week hiatuses to disrupt the scheduling obstacles. We had at least 2 dozen people pending tests, some of which took almost two weeks to return. We had dozens of near misses. We were due, and our numbers were too big to insulate us from the bug forever. We split into teams to try to lessen the contact of the blow when our luck faltered. December advent delivered our first COVID positive staff member. The rest of the team went home with quarantine induced fear and chaos. The fear led to real-life mortality concerns. It was the harsh slap in the face that reminded us we were still vulnerable regardless of the masks, hand washing and curb-side service.

I had to decide what to do about a positive employee? I took the safest route I thought possible. We sent everyone who had been in contact with them home to isolate and hopefully contain the spread. We paid everyone, as we had done before. We calculated how many more home stays we could afford? We called the health department, our legal counsel and scoured the CDC for guidance. The NY Times had just run a section long special eulogizing the huge number of landmark businesses across the country who fell to the pandemics passing. Was I going to follow?

Where has paralysis cornered me? Here;

The vaccine is now eminently at our doorstep and another series of questions that need to be asked. How do I handle vaccinations? Silly, stupid me thought this one would be easy? We are all medical professionals? Aren't we? Isn't that our pitch to stay open as we call ourselves "essential"? Don't we all want to get out of this fearful place where a virus still has us by the neck? We are the vaccine giving kings of the world. Right?

Turns out a significant portion of the staff doesn't want to be vaccinated.

So,, do I take my personal opinion and force it upon others? Do I stay true to the devote liberal I am and let you do with your body what you want to? Isn't that what I stand for?, (well, as long as it doesn't hurt others. Isn't that caveat pertinent? And doesn't it apply?).

Every decision up to this point has been based on others over self. My mom, the staff preferences to stay working or not, making sure they are financially secure for whatever time off they might need, the multitude of ways the business might suffer at the expense of treasuring and coveting life. And, here I am now. I can force vaccination to be a condition of employment and risk losing people I deeply care about as I force my firm belief that we have an obligation to eradicate disease with all measures available. Stop the spread of disease by the same means and manner we do, pitch, force, and testify to being effective to the staff who doles it out to our clients and patients. What if there are pregnant staff members who should not be vaccinated among us. What do i, we, owe them? What about the conspiracy theory staff who don't believe the virus is real. Is that a religious pass?

Here is my list of pro's and cons. The forces pulling me one way versus another. The network of squabbling synapses causing my current COVID catalepsy;

I find a few things odd and unreasonable. How can we be a group of doctors and medical professionals and not believe in science backed preventative care? How can we be the single greatest distributors of vaccines to others and not participate in being vaccinated ourselves? How can we not call ourselves hypocrites and cowards? How can I possibly protect the staff if the staff isn’t willing to protect themselves? I certainly can’t take the ostrich in the sand approach. Just not look, not ask, and not care, if this virus hits is like wildfire and mows out everyone it meets. 

When all else fails in medicine we often defer to what's the “worst case scenario”. Shouldn’t we always be talking about and prepared for that? Isn't it both helpful and insightful when stuck at a crossroads of indecision and perplexity? 

So, let's go there.

What’s worst case scenario for us? The collective group of jvc? My thoughts on this question is not that someone will get sick and have life threatening or even life ending complications. That’s what it was before we had a vaccine option. Mine now is that someone at jvc will get sick or pass on illness to someone else and that transmission will affect others. I now worry more about not the individuals who made a selfie choice, because they now have a choice, but the collateral damage to letting the choice be made. We have multiple staff members (3) who are pregnant. What would I feel like if I didn’t get vaccinated (and let’s be honest the only people who don’t here are doing so out of selfish fears) and then it affects the mom's fetus? I’m not living with that. Part of being in a society, a family, a group as tight as we are, is agreeing to go along with what is best for that society. So for as much as I too worry about the first generation of a population receiving a vaccine I worry more about it others than myself. I will be vaccinated because I care about my husband and you all more than my business and myself. This for me is yet another incredibly difficult decision in a years long list of the same and I am not putting me or the business first. I’m putting you all first. You can choose what you feel is right for you. But abandoning science and the best interests of each other is not how I vote. 

Do I split us up into “vaccinated” vs unvaccinated teams? Leave the expecting moms in the most vulnerable place? Just take the "don’t ask don’t tell" approach. 'Cause that never benefited anyone? Just keep hoping? Praying? 'Cause that didn’t work with breast cancer in 2020. I am not sure. What I do know is that not making a decision leaves everyone vulnerable. And like every other medical issue we face with our clients ignoring it doesn’t make it go away. It just leaves you a prisoner to fate. What good is any medical knowledge if that's your approach  to disease? 

So who is liable? Me the person who let the unvaccinated work with the vaccinated? Let the pregnant employees work with the unvaccinated? 

Do I give monetary incentives? What does that say about us all? Are we at that place in society where baksheesh is the only way to get selfishness to take a back seat to population protection? Have we completely abandoned the notion that the sum is a product of the courage of the parts?

My obligation to this place where so much good happens, so much love exists, and so much healing is given so unselfishly is probably where I need to focus my answer. The answer is that this, like all the rest of the decisions behind me, is just another test to see if I can adult harder? Can I salvage my liberal democracy where people can be confident in living their authentic life and not see it as the selfish, myopic, obsession with individual-above-all in America?

Take a minor risk, get the vaccine, require the staff to unless they have a valid medical exemption.

And yet I sit here torn. Catatonic to Covid.

For more information on anything and everything pet related please ask us for free at Pawbly.com.

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The Blacktop Divide. How Vet Med was redefined in a pandemic.

 Nine months in and I still haven’t figured out the knocking on windows etiquette. 

I spend an inordinate amount of time these days amidst the middle (maybe? Hopefully? Dare I even hope?), of this pandemic in my veterinary clinic parking lot knocking on windows. I am not comfortable here. Too many people pulling in 5 minutes late (or more) for their appointments, going too fast, and congestion at every corner. The struggle to talk through masks, after I pound on the window to release them from their cell phone meets carbon dioxide trance, is real. I am also repeatedly finding myself in too many arguments about even putting the mask on. It has gotten so bad we have put laminated warning signs on the back of our patient record clipboards. 

The protocol is that if you walk up to a car, or client, without a mask on you just raise the clipboard up to your face so they can read the “mask required.” (It has very small (almost invisible) emojis adjacent with a poop face and a finger for staff motivation). 

The real fear of the black topped front office is losing a pet in the transfer to the staff. (Because we all know that if something awful can happen it will.) We have had this happen multiple times. One escapee had us spending three long desperate days and nights searching woods, roads and back yards fearing the whole time that they would be hit by a car in the interim. The other had the entire staff running down our busy two-lane road (where the speed limit is always pressed at 50 mph) to persuade a full on running dog to come back to the rioted crowds chasing it. I wasn’t sure which I was more petrified to see happen, the dog flattened, the staff tossed like road kill salad, or the owners meltdown within the whole endeavor. Or,, that even within the confines of our parking lot, entrance, and exit, that a pet will be run over, bitten, attacked or misplaced in the clutter of chaos as we do more and more outside. The parking lot has become our catch-all. The check-in and check-out point. The collection of pet information and the (thankfully dissipating) point of hostility contact place for the non-mask wearing amendment protestors. I had no previous emotional designation for my parking lot, and, yet, now within this pandemic year it has become an extension of my profit-making square footage assessment. I have invested as much into it this year it as I have my front lobby in years past. It is my first impression, my (by far) most dangerous spot on the property, and the new battlefield for healthcare provisions. Truth be told my hate for the asphalt grows daily as this pandemic grinds on.

The parking lot has been upgraded; glossed over, restriped, labeled by parking spot number to help identify where to find our patients, and as the months drag into winter we are adding portable heaters. I am proposing to also add check-in microphones, the sort of modern-day drive-in movie theatre comms system. All we seem to be missing is the jovial spirit of short skirts, knee-high tube socks and the roller skates. 

We have benches outside that allows for a change of scenery as people to wait to be seen, albeit used based on weather permitting. It allows some refuge from the confines of a car that can last a few hours at our busiest times. We also have a considered how to more easily implement the check in and out procedure. Phone lines are blowing up at record breaking unprecedented numbers. Our call volume is about 1800 calls a day. Which is up from about 300. It is significantly more than two receptionists can handle over 12 hours. The attempts to remain a place where people feel welcomed and well cared for is immensely more challenging while trying to maintain social distancing and public isolation. Removing the in-person examinations where the pet parent and veterinarian, and veterinary staff can exchange patient concerns in real time and together is nothing but detrimental to the overall patient care. As I have lost the ability to share my examination findings together, like showing a parent their pet’s degree of dental disease, eye issues, body and muscle condition changes, every little detail my eyes have been trained to look for and identify, is lost. It becomes reduced to a bullet list of items lacking the relative personal expression of invested concerns on a report card sent back out to the parking lot. Or, a summary phone call.

We are fortunate enough to have a little house that accompanies the veterinary clinic, grooming and boarding facility, and, the 5 acres of land it all resides on. The house has never been used as a part of our veterinary services. It has for the last 50 plus years just been a domicile for rent. This year it has become an integral part of the personal approach to the care we used to pride ourselves for having given each case. In this oddly distancing time of self-protective warnings the house has given us two things many other practices don’t have; a indoor bathroom, and, a place for quiet peaceful passage. My septic system for the small family it was built to support now holds a reservoir for dozens of people a day. I have fingers crossed every day that it can manage the load, same as the rest of us. And, I wonder how do I renovate it to resemble the facility at Ravens stadium? The house has also served as our last tiny vestige of compassionate centered care for the euthanasia’s. Since the beginning of the curbside COVID service discussions I knew that I could not remove this last piece of humanitarian kindness. How others justified, (and perhaps my bottom has not been met yet and I will have to eat these words?), and permit only drop off services for euthanasia’s I don’t know? I have been that person so consumed in grief, while desperate to hold on for every last second as I say goodbye to my family member. Doing that as a ‘drop off’ service, well, I could never forgive myself for that. Nor could I ever look that person in the eye again and proclaim myself as compassionate. The clinic house is our one last sanctuary for providing the intimate care we all came to this place for. The most meaningful moments of my vet life during a pandemic have been there. Taking that last good-bye, those final moments, and reducing it to a drop off service puts us all in a place that undermines all we have collectively prided ourselves as. This pandemic has already taken so much; it can’t take this. Even if I have to gown up in hazmat gear to be there, I will. I can’t surrender this last place of empathy.

I find it jarring how much the place I practice has changed within the world around us changing. That piece of ever engulfing black top has been the divide between the clinic still bustling with activity and yet absent from the people I share these patients with, and that little house where we say goodbye and still remain human.

People are tired, worried, and fed up. I am with them. Everything is thought out, measured, weighed on a risk-based analysis, and the duration that feels omnipresent along with annually recurring in its resplendence. 

I wake up every morning wishing this looming veil of fear would be eradicated. Yet, I know disease doesn’t work like that. It does what it wants. It takes it’s time on a calendar that is intangible, mysterious and elusive. That’s the single thing driving me the closest to the brink of breaking. The unknown. Looming over me day to day and unending in its grip. 

My closed clinic doors. My masked face, and my painful hesitance to hug the client crying beside me as they say goodbye to another loved one in a time where companionship is scarce and fleeting. 

Yesterday I had to help a 2 pound kitten into the only peace she has available after her previous 4 months of struggling to survive. She was one of those few neophyte patients who has failed to thrive. Her mom has dedicated the last 4 months and thousands and thousands of dollars to multiple specialists across the eastern seaboard to help her get over her too many ailments. She passed away in her mom’s sobbing arms, desperate to fight another moment with a poking prodding vet who hurts. We cried together. The injustice of it all. The finality to a time with so many already to mark its passing. That kitten, (her name was Honey), fought so hard. She was destined to fail by some minute failure of her tiny bodies’ creation, or lack thereof. All I could do was say how sorry I was. What I wanted to do was hug her and her mom as firmly and re-assuredly as she was being held and cry together over the loss that was so painful and unfair. That, this personal grief met by self-protective perimeter defense is carried every day. It is an elephant that is dying on top of me. The degree of suffering is transcending every moment of everyone’s life. Like it or not. Deny it or not. 

The parking lot is just my tangible, dangerous reminder of how much distance we have lost in our taking care of each other during this pandemic. 

While I am not going to attempt to list all of the challenges COVID has brought to us as a veterinary clinic I would like to remind everyone that we are all in this storm together. Paddling in the dark, not sure which direction to go, desperate to hold on as the weather unpredictably rages around us. And, yet we aren’t really truly alone. It just feels like it amid the isolation of a parking lot which seems to feel like the best way to stay safely afloat. Being kind isn’t an act of exclusion., The challenge is maintaining it as inclusion amid the chaos of the unknowing. 

If you would like to learn more about veterinary medicine you can follow me here, at my blog KMDVM.blogspot.com, or my clinics website JarrettsvilleVet.com, or, our Facebook page Jarrettsville Vet Center.

I also have a YouTube channel, and the best place for free pet centered advice at Pawbly.com.

The veterinarians life in the grips of the pandemic of COVID-19.

 The veterinary plague in the pandemic.

That's exactly how I have felt for the last 5 (plus) months.

These are unprecedented times. No one can argue that. It is a time none of us have ever seen. The layers and the ripple effects are worldwide and life changing. None of us could have guessed all of the layers of impact it would have upon us all.

When the whispers of a blazingly fast deadly virulent disease began in the late Winter of 2019 the science lover within me was steeped with curiosity. Infectious disease, population dynamics and the decisions that arise from these are the fodder we live everyday in veterinary medicine, and, to a much greater extent than human medicine gets to participate in. Over in vet med we deal with death from poor vaccine management, viruses, and transmission from multi-species hosts daily. Think about parvovirus for a moment. For every sick puppy I see I have to pine over poor, if not often absent, vaccine records, question interactions, clinical signs and scant hard to accurately elucidate human observations. I also know I have to test sooner versus later to get our best chance of survival as care needs to be aggressive and early for the best prognosis. I see upwards of 2-5 puppies a day in our current pandemic case load. In one day I saw 10. For every sick puppy I start with parvo and hope for anything else. Want to make the scenario even more bleak? Add lack of emotional bonding (new after all implies, haven't bonded with yet), and, almost unmanageable costs (average estimate for care, and btw should be at the 24/7 ER, about $3-6,000 USD) which almost no one can afford. 

Rabies is the other viral monster with even more devastating reaches. There are still multiple patients walking in every day who have never (I saw a 10 year old with this presentation) been to a vet before. Or, have only been for sick visits, and, hence were never been fully vaccinated. Pouring over sketchy, to non-existent, medical records takes time I never have at hand. How can this be more devastating than parvo? Rabies kills humans. People can, and do, get rabies from cats and dogs. With every case I have to make sure I am protecting the public by monitoring for rabies.

The case load for my 7 day a week, five doctor practice has been steadily increasing over the last decade. Growing on trend with the industry standards. We have our typical seasonal quiet season, February through March, and, our busiest time of year May through October, with one little blip in business at Thanksgiving to Christmas. With the pandemic getting more news attention, the growing number of cases spreading through Europe and mounting pressure to begin government mandates to promote slowing the spread, we faced March with huge uncertainty trailing fear for both our own lives and the viability of our business. 

When it became increasingly obvious that the virus had reached our shores and invaded our inhabitants I knew we had to do some hard talking and face some quick decisions. We had to face yet another outbreak in our clinic, except this time the victims might be us.

The first action I took at the clinic took was to ask each employee privately what they felt comfortable with? Who wanted to shelter in place, versus continue to work. Self isolating was being instituted in adjacent states and we knew we were not far behind. Each employee was given a letter to state our dedication to them in supporting their decision with whatever choices they made. If they chose to stay home we would promise to hold their positions. We would assist in unemployment benefits or exhaust benefit packages for as long as possible.While other veterinary clinics around us mandated employees remain working, I was not going to take worst case scenarios and force anyone to do anything. If that meant that I was going to be running the clinic alone, with my husband as the only receptionist and technician available, I was going to do it. If I had to open 24/7 and live there I was prepared to. 

I was preparing myself for worst case scenario. This is the typical approach to everything in medicine. Personal and professional life are one in the same. I was preparing myself to stay at the clinic for endless hours melting into endless days. Man the caseload alone, or, enlist the help of my family, and work 24/7 to keep both the lights on, i.e. keep the business alive, and, keep the patients of my community cared for. If other vet clinics closed I was determined to not lose a patients life due to inaccessibility. Summoning the troops to see who was with me was where I started. Much to my surprise most of the staff wanted to stay working. The reasons varied from employment security, maintaining an income, age based health security (not that this came from my personal disease preference viewpoint), to boredom associated isolation avoidance. Personally I felt I had an ethical obligation to the pets JVC had taken care of for decades that have almost accumulated into a centennial. "This ship wasn't going down on my watch," once again rang in my head.

As the commotion of human hospitals reaching maximum capacities almost overnight in our surrounding states ballooned the realities of our potential doom motivated action. Within a few weeks of the diseases arrival half way around the world the state governor ordered a very quick mandate to self isolate. A list of "essential businesses" was circulated and our importance to world health became endorsed. Veterinarians were expected to stay open. How we were to do this safely was open to scantly provided guidelines and interpretation. 

The world around us slowed to a snails pace of cleared roads, hysteria based grocery shopping (none of us will ever look at toilet paper the same will we?), and, solitude like we have never seen outside of a few days of a previous weather catastrophe. The news was buzzing with charts, graphs, daily tallies and "curve flattening" chants. Masks became a commodity I felt oddly out of place wearing in public. My work life of disposable clothing, replaceable and disposable was now the new normal. Coming and going to work included placards for the car announcing my place of importance in the pandemic saturated society. Working was a risk we were all volunteering for. Would there even be a reason to show up? Would there even be clients brave enough to go out into the infected world around them to get their pets care? We didn't know how bad this would be, or, how bad it would get, never mind the collateral damage we would invite ourselves into. What if I went to work and brought the virus home unknowingly? I had a very sick mom to care for. A husband who fit the age based "high-risk" classification. Me, well, I was comfortable with steam cleaning clothes I changed out of at the office. I was fine breathing in a mask, wearing gloves to work, and washing my hands like death was colonizing with complacency. Me, well, I was ok with me facing a ventilator, but being the fomite who brought it to others, nope, no blood on these hands please.

What happened was a 20% decrease year over year for the first month, March. Then a steady April. Business was running its (almost) normal course and people went to and from 2 week quarantines if they felt sick, or were told to do so by their physician as the tests took weeks to process. Temperature monitoring, letters of CDC guidance on what to look for, when to play it safe and stay home, and the myriad of vague clinical signs to alert oneself to possible COVID exposure/illness were circulated, signed and kept on file. 

There were weeks of one, two, and, even three staff members being out for quarantine at a time. Managing the staffing schedule was a best attempt daily. The teams further isolated us, and magnified the difficulties of scheduling appropriately for the days case loads. We didn't know if we would be able to manage with either our own staff being too short to function, or, the clients being too cautious to take their not-going-to-wait-for-the-pandemic to abate pets. Would we lose a whole generation of puppies to distemper (which we have never seen before because our clients are too sensible and savvy) to have been susceptible too? Would we see a huge influx of rabies cases as people avoided vaccinating? What about pregnancies when spays and neuters (aka "elective surgeries") were ordered to be postponed to save valuable short supply medical equipment for the front line workers? SO many questions and no guidebook to assist in assuaging the fears. Would those staff members who were out at home come back to us as "positives" and throw the whole rest of the apple cart into hysteria? Would I lose people I cared about and feel responsible for that for the rest of my days? When I asked myself the really hard questions I couldn't come to terms with the idea I might be swapping one life for another. Was my efforts to save my four-legged patients going to cost me any of my two-legged colleagues? Was it a trade off I could ever justify? Deep down I strongly considered closing the clinic. Shuttering the windows and leaving a "gone fishing" sing without a due back date. I would prefer belly-up versus 6 ft under.

I just got up everyday and went in. I left my husband at home with the animals. He was telecommuting and able to take over their care regardless of what my day might bring.

What happened was totally unexpected. Business exploded. It blossomed and burgeoned on record breaking. People fostered, adopted, paid attention in much greater detail and scrutiny to their pets and we struggled to meet the demand. We, for the first time ever, had to turn new clients needing emergency care away. It hurt me bitterly to do so. We received pleas form the local ER to help. They routinely had 4-24 hours wait times. I went into work exhausted and unable to catch up. I left the house at 8 am, arrived after 9 pm and the time in between was case after case of sick, dying, intensely managed patients. While the rest of the staff saw the routine vaccine appointments I saw the immediate need walk-ins. It was grueling and mentally so taxing I fell into bed every night wondering how I would manage the same day tomorrow. I started to fall apart physically, emotionally and internally. I understood why everyone else defaulted to their protective limitations, and, I wondered if I would get out of this wanting to be who I thought I was. Sleep became a fleeting precious and unreliable commodity.

The other side of the pandemic sword was anger. The quarantine brought out the best, and, the worst in us. We had to call the police to have people forcibly removed from the premises. We had to use strong language. Make ultimatums and have the courage to lose clients for them. We drew hard lines with harsh stern mandates behind them. We split the staff into teams with the hope that if illness ran through one team like wild fire the other would be safe. I did everything I could to minimize the villains reach, potentially deadly grip and keep the people I care about most safe and feeling secure at work. It was harder than I had imagined it would be, washing, cleaning and sanitizing after each day. Seeing one team lose more members than it could function without to stay at home orders. We were tired, worried and facing unknown client aggression every minute of every day.

We applied for loans we didn't know if we could meet, or get, or payback? The unknowns mounted to stress at unparalleled and nauseating levels. I remember telling myself everyday that I just had to breathe, go into work to try to help people and the pets I was so devoted to taking care of, and I had to tell myself that "this too will pass" as everything else behind me had. I had to remind myself that I know what disease looks like. It isn't personal, it isn't fully fatal, and there was a myopic meets universally pellucid lens that made it all relatable, comprehensible, and even purposeful. We have to remember we are a part of a whole. A tiny piece if a planet that is complex, self-regulating and unforgiving in its counterbalancing efforts. we are mortal. You get one life, one chance and you better be analyzing your place, your value and your compromises along the journey.

It is September. 2020 has cost me dearly. I lost my mom to cancer that COVID crippled, arrested and tortured her within. We had so few options for a deadly cancer that swept faster than most of the cancers I have dueled with. Cancer has plays. Definite steps it takes. Obvious signs it flags, and yet hers was just as swift, devastating and immobilizing as any I have ever witnessed. I have seen thousands of pets get, battle with, and eventually die from their neoplasia, but, my mom died and suffered more severely than any patient I was ever charged with. She suffered. Nothing should ever suffer to the extent she did. Medicine has better to pardon such pain. So many of us lost to this pandemic. Time, loved ones, events, experiences, vanished to trying to stay alive. There is still no normal to our newest evolution to the current pandemics plight. We are still not allowing clients into the hospital. Still providing mask enforced curbside service, and, I am still turning away non-clients so I can meet the fact that we are booked weeks in advance, while we receive requests for immediate care from our current the clients with their same day emergency requests. I have worked to the point of physically debilitating exhaustion, and then worked through that. It has been challenging and for someone who thrives on adrenaline based medicine I can say I cannot keep this up. I have to turn away people who I know need us because doing so will cost us a mistake we cannot forgive ourselves if we make. And yet through the worst of my veterinary journey I have been reminded that hope springs eternal. That little lives were saved, protected and spared because we showed up and did our best. Friends brought posters, cakes, wrote letters, and reminded us that we mattered. We made a difference, and we were appreciated. There were layers of kindness that were returned in waves more powerful than a disease can encroach upon. There are people whom I saw give the most incredible acts of compassion. Spread love and hope with generosity, kindness and for which I will never forget and never stop repaying.

So far I have lived to tell the story. We have all done such amazing things through the most troubling time of our collective lives. We have no end date, but, we do have the confidence of knowing what perseverance feels like and it's as good a guide as we will ever need.

I have learned that the foundation I am most assured of is that life is precious, short and fleeting, and at the same time it is invaluable and magnificently beautiful. I wouldn't trade one for the other. You cannot have one without the other. I also know that the more I give the more that comes back. It has to be genuine, but it is always enough to get through the worst of days.

Thank you to the clients who share their stories, photos, and lives with us. The photos above have no relation to the events or cases. They are snapshots of the days through this story. The loves that mold us, touch us and shape our views on crisis. They are reflections of what we can be if we chose to see value in sharing.

 For more information on anything and everything pet related please ask us for free at Pawbly.com.

If you are a pet care provider who is willing to help pets in need with your advice and compassionate words of kindness please consider joining us and adding your pet care experiences and thoughts at Pawbly.com. We are always in need of reputable professionals who can educate and inspire.

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