Patient Ownership Amongst The Veterinarians

There is a secret to medicine that you only learn with decades of passage. The secret is to remain vulnerable. Remain hopeful, kind, and adoring to the companions that fill your life with gentle inclusion. Look into their eyes and feel what is reflected back. Be compassionate as the guide to healing both them, and yourself. The patients will never let you down, therefore, keep reinvesting in them. 

These patients that I am entrusted with, the small, the weak, the voiceless, they are my WHY.

Honey's Story Here

There are a multitude of reasons why vets stay at one practice for decades, or, their lifetime. I can tell you that with 20 years in, I will never leave JVC because my roots are so deep in my patients/clients lives that I can no longer dissect one from the other. These patients and families are my glue. They are my roadmap, compass, and cadence. They are my time, my waking moments, my daily guide and my nightly whispers. They are the first thing I check before bed. The first thing I wake up to, and the delightful fluff of the middle. My pets are an extension of who I am as much as everyone else's pets remind me how important they are to their family.

Last night I sat with a mid-20's guy who cried buckets of uncontrollable tears over the loss of his 6 year old cat. It was raw, and tragic, and gut-wrenching to be a part of. It was also the best example of a real moment of this life I am so honored and privileged to be a part of. It is a perfect reminder that all of us need to spend more time within. If you cannot feel empathy for a loss, as insignificant as others might think a cat's life is, then you are missing the only WHY that will ever give your life true color and beauty. 

Snoops Story Here

The WHY in medicine has to be more than the paycheck and the initials before or after your name tag. The WHY in medicine has to be so powerful that it gets you through the long, exhausting and grueling days. It has to be so powerful that you willingly and knowingly give up the yearning for beaches, and fast cars, and possessions as a way to remind others that you have achieved something envious. It has to be enough to be almost everything. Medicine is that way. The trick is to outwit it with willingness to accept its terms on your own. The trick is to adore it for all of its glory and ugly.

The WHY is all that matters when everything else is breaking your heart.

When the WHY takes the form of a fluffy kitten, a bouncing puppy, the client that you wait excitedly to see in your daily roster, or the cat that you spent months trying to save their leg and/or life, you get invested so deeply that you risk the green-eyed-monster of jealousy. Maybe we shouldn't admit this, and maybe, (in rare cases), we only mean it half-heartedly, but, veterinarians absolutely take ownership of their clients and patients. 

When you tread on that WHY we get seriously protective.

Dexters Story Here

You will a hear robust, boisterous, outcry if one of the other vets walks back holding a patient that another one of us has grown fond of. You will almost see bodily harm if we perceive that the pet parent is forming new bonds with another vet. Fistfights, or the bitter air of plotting passive-aggressive vengeance comes next. There have been occasions where (mysteriously?) one patient's appointment is switched with another's so that the vet can see the one they know and adore, versus the one they do not. It is a game of barter and bribe when one vet won't release possession of the others patient. You can almost get a day off if its the right patient on an otherwise difficult day. Our patients, and clients bring so much to our days that we bicker over them. We absolutely take it personally when one client chooses another provider, or, worse yet, refuses to see you. 

Sure, we take our jobs seriously, and our patient claims vehemently, but, there is a lot to this job, so don't infringe upon our own emotional needs. We need to feel like we have purpose. That our patients rely on us. We need to feel needed. With that comes ownership. It is impossible to not be personally invested and not jealous when the care falls into another camp. That our cup o'WHY is kept topped off.

Me and Goose.
I adore him as much as his family..
They are my WHY just as much as Goose is

Too often clients who say to me, "I know you are busy. I wanted to see you, but, I didn't want to ask for special treatment." This is most often because they have some need to be seen within the next few days or hours, and I am almost always booked weeks in advance. We have pets who we saw for all of their puppy visits. The cats who needed multiple urinary unblockings. The dogs who swallow socks; repeatedly. The cat with the leg that took 3 months of time, love, and dedicated worrying ourselves to pieces of harrowed existence, but is now walking on that leg that everyone else said to "just amputate." We take our little victories, our previous challenges, and we hold them near and dear.  These patients become our obsessive labors of love. If you went into small animal veterinary medicine you did it because dogs and cats compel some little piece of your soul which is meant to care for them. It is the best part of everyday to be with them. I live for these cases. I throw myself into them. When we win our war against their ailment we regale! We never forget these patients. As an extension of these cases we bond to the pets parents. We all go through this together. I feel for them as they feel for their pet, and maybe, just a little bit, for me. Don't all teachers, doctors, caregivers, hair stylists, manicurists, everyone who has to provide care or a service face to face with someone repeatedly, don't we all feel some sense of friendship past the business transaction? 

Allie, who is always this happy to see me.

I know I do. It's only human to get your feelings into the work you are passionate about.

"You can't add days to your life,

but you can add life to your days."

The best part of my job is all of the feelies. It isn't easy living a life based upon, and within them. Propelled, compulsed, and revolving around them. But, it is the heart/soul/integrity of medicine/rescue/life, so, you might as well embrace it and dive full on into it.

Anna Mollie.
A visit from her newly adoptive mom, many years ago,
 started a friendship that has become the one I treasure most.

Every great pet parent wants to have a veterinarian who knows what their WHY is. One who makes that WHY visible, palpable, obvious. The sticky-feely-WHY also makes us more human, more capable of being the companion our companions inspire us to be. 

Pippa. Whose family has become a part of my own.

P.S. I want to add that we have abandoned the ability to decline providers in an emergency. We all live within the same WHY here at JVC. None of us is here to diminish or infringe upon it. We are a team of equally emotionally burdened powerhouses. If there are open options for picking and choosing a vet, for example, we have multiple openings available with different vets, you can choose who you prefer to see. But, if you are in need of a same day appointment and you want to try to cherry pick providers when only one is offering to see you, you are out of luck. We have collectively decided to support each other and not permit the hard feelings declining a provider brings. 

The Dilemma. What do you do when you don't think it's time to euthanize?

 

There was still a tag attached.

That’s what I remember most vividly. There was still a big cardboard tag, the kind that keeps you from being able to fit the merchandise in your pocket as a theft deterrent device, still attached to the obviously brand new toy she held so proudly in her mouth. It was the kind of tag that allows it to be hung on a rack for easy display whilst also providing the descriptor that announces the features of the toy that your pup might find most exciting and enjoyable. The colorful cardboard backing to allow plastic ties to prop up mouthpiece rope from the stuffed animal body and prohibit easy pilfering. That tag was hanging out of one side of her mouth as she clung to the beloved toy that dangled from the other. Toy and tag in tandem swinging from one end of her while the other wagged tail so hard it made her bony hips hula.

Her name was so endearing it made me stop to smile. Her name, a blossom in springtime, a flower in the glimmer of an eye, the baby of a movie star who wanted to be cool and still maintain cute. I’ll call her Honey. She was bright-eyed, exuberant, bubbly, bounding and exploding with joy to be around people. She is the lab pup every Labrador-lover dreamt of. She is pure love and kisses in your face the minute she gets close enough to steal your cheek unguarded. She is the reason I became a veterinarian. She is the reason every pet loving person grieves for decades when they lose their beloved pet. She is perfect. BUT, she is also old. 11 years old to be exact. She has not been to the vet in many years and her very dapperly dressed dad is sitting quietly in his designer loafers without laces, cross-legged in pressed, creased herringbone tweed pants. Where Honey is outgoing and energetic, he is stoic and reserved.

There is a foot of snow on the ground outside and every inch of landscape is slush and snow. I look at his buff-tan-kidskin leather loafers and wonder how he got from his car to our exam room on this yacht shoes missing soles. I look for an assistant who must have carried him in, knowing Honey wouldn’t have permitted an easy passage and yet he shows no sign of snow or wet.

I sit on the floor next to Honey and she cuddles up in my lap immediately. 

I am here in this room with them both, on the floor embracing Honey and delivering the hardest conversation I ever have to be present for.

This is Biscuit.. she reminds me of Honey.
I adore this girl,, and she knows it

I look at Honeys overdressed dad and say, “I’m sorry but the veterinarian doesn’t feel right about this.” He is quiet, his eyes narrowing and his composure tightening. He is waiting for me to dig in, and I see him returning the favor.

You see Honey is here, brand new toy in tow, wagging, happy and excited to be with us, to be euthanized. Her dad is here, holding her tight on a short leash, stoic, reserved and yet determined to make this a one way trip for her.

I go on to say; “We have a terrible problem with burnout, suicide and mental health. I do not force anyone to do anything they don’t feel right about.” I let the words fall around him hoping they landed softly enough to allow a crack in the façade to let the light in just a little bit?

I waited. I stroked Honey’s head and whispered a mental “I love you,” knowing I would likely never see her again.

These are the moments of the days of my veterinary life I despise. The moments that remind me to be brave and stay true to my heart,, even if I am alone in this.

I was the fourth person to enter this room with Honey today. The first had been our vet tech who had placed both in the Comfort Room as his appointment with Honey had been scheduled as a “QOL” exam, short for quality of life. We do not book euthanasia appointments with out a veterinarians prior consent. This is not a slaughterhouse. You do not drop off to pick up remains later. We are a family who loves pets as our own family. We take this request as a discussion and a decision not lightly agreed upon. If pets are truly property there is no conscious of grief to surrender yourself to. But we all know pets are so much more than this to all of us. We know that they are our truest friend. Our most adoring confidant, our reason for early wake-ups and long walks. When everything else in life seems questionable and unreliable your pets will remind you they are your constant. We don’t need much more than the belonging they inherently give us.

The technician came back to the treatment area to report that Honey was walking well, seemed happy as a lark, was carrying a toy to show us how delighted she was to have it, and that she was deeply concerned that Honey looked A-OK. She couldn’t imagine what kind of quality her dad was in search of. Honey had bounced up to her, thrust her toy in her face, dropped it to the ground and planted a big wet kiss on her face. The technician was smitten with Honey.

The second person to enter the Comfort Room was the veterinarian. In less than a minute Honey had given her the same welcome, and after a brief exam it seemed that Honey had aging back legs and might benefit from an analgesic and NSAID. The veterinarian also offered to run some routine diagnostics and see if we could provide some options to help improve her quality and spare her life. A discussion ensued about cost, benefit, possible side effects, and after a few moments Honeys dad said, “the family has decided. We are ready to put her down.” It hit like a blow. The veterinarian countered. “Would you consider surrendering her?” He nodded, she left and the office manager entered.

In the bowels of the hospital the staff gathered to hear what the veterinarian recalled. “He’s going to sign Honey over to us. Call Heidi, see if she will come down and meet Honey.” We started to make plans to find Honey a new home, and we started to draft a list of diagnostics to run to make sure we knew what Honey had going on inside. The techs were excited, bustling and congratulating each other on their interventional good deed. There was a levity that spread, it was hope packaged in healing hands and warm hearts. It is the lifeblood that feeds the marrow of a place like this. It is the small miracles that fill our long days with purpose and stories and the passing of intentions into matters that build our souls and fill our sails. For a place like our veterinary clinic it is the small wins to help make the inevitable tragedies more palatable.

A few minutes later the office manager came into the treatment area. We all knew by her quiet entrance that the news was bad. “He won’t surrender her.” The girls begged for a “why!?” She replied; “He doesn’t want her to be with anyone else.”

None of us could accept it. They all argued with how the hopes had been dashed so quickly. Had she asked the wrong question? Had it been lost on him in translation between a vet and a manager? Should we send the vet back in?

The girls suggested alternatives to save her life, spare her from being disposed of so coldly and unconscionably, ..

“Can’t we just say we euthanized her? He doesn’t want to be with her anyway?” The first option they threw out.

“What if we only give a little bit of the solution?” Like adding a splash of water to the euthanasia solution might dilute it to the place where it wasn't effective.

Desperate pleas for a desperate place. 

There were no answers left to offer. We only had one choice left.

Honey's dad wasn't going to let her have any other option than the one he walked into our door deciding she deserved. These places, these cases, these are the ones that kill you. For some of us, literally and completely. They destroy lives that care and our ability to care again.

I looked at the other veterinarian. She looked back at me. We both didn’t want to be the other persons answer. The mirror of responsibility to the staff who always had their hearts on their sleeves and worked so hard to just be a kind heart to a pet in need. We didn’t want to put the other in a place of heart-wrenching decision making.

“I can’t do it,” she said. “I just can’t.”

I looked at the office manager. “He is not going to surrender her.”

That left me. Alone, and with a Honey of a problem to reconcile alone. 

I walked into the room with Honey. The fourth person she brought her new toy to. The fourth person she was as excited as the first. I sat on the floor, she flopped, toy in tow bouncing with its cardboard tag alongside her tongue into my lap.

I whispered silently to her longing eyes of love, “I love you.” 

Honey is not alone. She has me rooting for her. Alone in a quest to remind her father, her family, whoever, that there has to be compassion, even in times of mercy, and we have to remember how precious each day is and fight for our chance at seeing tomorrow with love, hope, and kindness in our hearts.

Honeys dad tried to argue our stance. He made phone calls, he stood fast in his decision. When I cam back into the room some minutes later I handed him two bottles of analgesic hope and a paper that said Honeys treatments had been on the house. I added that I hoped it help her feel better and that we were here if we could help her again.

I extended an olive branch of defiance. I stood by my staff who would have been balling and questioning my cruelty had I chosen Honeys  family’s side. I stood by being kind when it wasn’t the right thing for me to do for her family. I stand here now not knowing if it was the right thing for Honey, and why I should be asking about it being anything other than that.

Here's more on Honey's case;

..and so the question remains? What would you do?

I posted this story within a few days of it occurring. I had to find a place to put the heavy heart I was carrying. This job, this heart on your sleeve, and this degree of emotional investment has a cost.

Three months later (to the day) we got a phone call. Honey was still alive and her family wanted to surrender her to us. We were blown away, excited, and relieved. We just didn't know what condition she would be in. We knew that her dad had been back once to buy more analgesics for her. He also wanted to surrender the other dog she was with. (WHAT!? Another dog)? We said yes!

Honey with her new friend Emma, on her first day in rescue

After I posted this blog, and the follow up news, the local social media pages blew up with stories about these two dogs. Here are some of the excerpts;

Here is the place Honey spent most of her life. I have heard from multiple people that she was either locked up in the cage outside or in a crate in the garage.

I want to reiterate that it kindness to bring her to us. To surrender her took effort and compassion. I am going to hold onto this.