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.

The Little Luxury Of Time Off.

 

My back porch with Magpie

Time off

Luxuries in my world have become sparse, and hence, heavily scrutinized. I just get too little time off to allow for idle luxuries anymore. They are now pre-planned and weighted. I am also now humbled to be notified by my withering infrastructure to have to allocate ‘recovery’ time into the sparse luxury free time category. For the bulk of my 2022 summer the days started at 6 am. I have had to forego my treasured morning runs so I can arrive at the clinic by 930 am. I work until 8 pm every day. I come home most nights after 9 pm, so worn out and hungry that I internally argue about which needs to be resolved first, or, even if at all. I typically eat dinner at about 930 so fast that I cannot recall what it tasted like. I land in bed 15 minutes later. I would guess I consume 3,000 calories after 9 pm, and less than 500 before. I go to bed with a stomach left on the night shift and a vision of gastric reflux with all its secondary consequences to haunt my comatose sleep. I used to wake up at 2 am to flounder for an hour or so. It was the couple hours of needed slumber that gave way to the demons of the day that could no longer be kept quiet, or silenced. 2 am, eyes open, mind charging, and the little lurking nagging oversights take hold. It's the time I am captured by my unconsciousness and awoken to address the needs of all the patients and clients from the day I just slipped away from. Awoken to face their elusive illnesses and diseases as my own incapacities. Now I wake up at 7 am arguing that the sun must still be up from the night before. Some all-night bender that altered its rhythm? It can’t possibly have been 8 hours from when my eyes slammed shut? There is no longer a slumber with its quiet pre-slumber conversational interlude with my husband. There is the parking the car, walking inside the house and a fog until I question whether my cell phone has been locked out of knowing the correct time. I best describe it as feeling like a professional athlete who is stuck in their Olympic trials’ day after day. An endless loop of running your best time. Swimming your fastest lap, and clearing the endless set of hurdles. I leave my soul on that field, on my veterinary clinic epoxy floors, every single day.

Kirby kisses... the best part of the job, hands down.

Now I realize many will see this as venting/complaining. A complaint for the life I have chosen. It isn’t. I know I can say no. I understand that I have options. The thing is that all of those options aren’t things I think I can live with. For every friend with a pet related emergency that calls, texts, or show up I feel needed. There is immense power, I would argue it is far more powerful than money, fame, and restful toes in the sand (or sleep). I cannot dismiss a plea for help. I cannot excuse it as ‘inconvenient’ or ‘poorly timed’ or ignore it. I just dig deeply, plow my nose into the ground harder and deeper, and hope my absent happy game face isn’t too obvious. The issue is the consequence for the need. The exhaustion for the hours and days that run into each other and drain the engine in the process.

Abby never has a day she doesn't go googly-eyed-happy over.

I was reading a post about the life inside vetmed as of late. For many of us COVID came on like a veiled and sinister mysterious uninvited house guest.  We had no idea of what we were in for. Absent clients stuck in their homes with their (hopefully) very happy and healthy pets just watching the days of monotonous a quarantine drag on? Would it be a repetitive cycle of wash, rinse, repeat, stay inside and pray your pet doesn't get sick. Or, would we all hide and survive, or chose to work and die? I made an internal promise that my vet clinic was going to stay open, be there for our patients, and weather this storm as we have the previous 80 years of storms, even if it meant I did it alone. My pets are the most important part of my life. I know that I am not alone in saying that, and I am going to be there for them, and all of the rest of those who are for their parents what mine are to me. Two years later and we have made it through. Unbelievably we were slow for a few weeks of COVID and then a scant few weeks later the sky-rocketing demand for everything pet related blew up. It has been unyielding and unprecedented. I have never known such need. We have never heard from so many people so desperate for help. We have dozens of new clients seeking care for their pets because the ER has a 24 or more hour wait. Or they tell clients that they can only make time to see them if their pet is imminently dying. Who can wait for that? 

Allie, our amazing technician and our resident cat Saffie

I didn't come here to have a life of routine rabies vaccines and spays/neuters. I came here to be the place you go when your pets aren't healthy. 

It has become a storm. An unparalleled time and consequences that I cannot accept even at the expense of the machine that attempts to answer the call.

I say all this knowing that along with the incredible demand for help there is immense gratitude and new life-long friends we have gained. The other side of a pandemic is the lives that aren't so inclined to be a little nicer, a little more compassionate, and a little more grateful that we are all still alive. It has been really hard to still want to help the mean people. The people who are mean to the staff and sweet as pie to the vets. The people who are soo ridiculous they don’t think my staff tells me. We know. It’s a small family. We take care of our own.

Hamilton. Our newest act of kindness and the reason we are who we are.

There are lessons we are all going to learn in the hardest of days. These are the people we will be remembered as. 

Remember the people who make you feel good about who you are, and why you are here.. here's to a few (of the many) people who I rely on everyday.

Thank you to all of you who help JVC be the place where miracles happen, and help nudge them along their path with your big hearts and your endless smiles.

Walking Away. Can Empty Handed Be More Painful Than Heavy Hearted?

Walking away. 

For those of us who choose to travel abroad with the hope of helping, do something meaningful, and, influence an unjust reality, it is deeply painful to have to walk away empty handed. 

I wanted, upon my return home, to feel as if I had done more. Make a more meaningful impact.  I quite honestly want to take them ALL away. Pack up every little face I saw, all of those fearful eyes, bowed defeated heads, and hungry souls, and stuff them into my carry-on luggage and just head west. Cross the landscapes of the safe Nato countries skirting the western borders. Hop that big pond with our own 747 and fly the coop Big-time-America style. Just bust outta Ukraine and be done. Dust on our heels, blue skies ahead. It’s the only real tangible hope for them. The only way I can stop the suffering and save their lives. And I can’t. I don’t accept inability nor denial. It is not in my vocabulary. I didn’t go so far away to just bear witness. I went to change fates. Move trajectories make happy endings from a war. It didn’t happen. I feel defeated and guilty for departing. For leaving them behind. Abandoned and in the same predicament I found them. 

I hadn't traveled this far, 5,000 miles from home, with three days of traveling into Ukraine to see Droog shelters massively overcrowded 500 head count, and just witness the problems there. No, I came to influence them. Surely I couldn't solve many, maybe a tiny pet on a tiny scale, but, I wanted to try. Me and my ever present operative word, TRY. It just doesn't feel like enough right now. Isn't always enough,, but, it is sometimes all you have.

Two Ukrainian rescued dogs out for the evening walk.
I miss them every single day.

For more on the Ukraine trip please see my previous blogs.

Investing Too Much. When, and Where Do You Draw The Line?

Perhaps I went into this for all of the wrong reason(s)?

Maybe not the wrong reasons, but, perhaps the expectations were unrealistic? Maybe there was too much of me in this endeavor for others? Maybe it's the other way around?

These are the questions I ask myself as I muck through the maze of my daily life as a veterinarian in general practice.

One of the many delightful faces of my vet life day

Yesterday I spent a long time, (to be honest 20-30 minutes), with a sobbing client as she dropped off her dog, Brunswick, for a forelimb amputation. She was, (as every single other amputation pet parent has ever been), reluctant to consent to this surgery. Of all the procedures that we do, and, for all of the many indications this procedure is recommend for, there is no other life-saving, pain alleviating surgery that is met with such pet parent reluctance and resistance. In my clinic over the last 15 years that I have been practicing, I would say that only about 1/4 of the pets who need this procedure, and, I believe would benefit immensely from, actually get it. Most pet parents will sacrifice the pet to spare the removal of a limb. There is this incredibly difficult and deeply rooted mental block on consenting to limb removal as a treatment option. We were at this place; sitting in the front office, debating whether to consent to cutting off the leg of her otherwise perfectly healthy and happy pup.

Brunswick is a timid 7 year old, 50 pound, mixed breed dog. She is a tawny brown with big erect triangular ears, a wide faced and her soft white body is liver spotted from neck to tail. She has a history of a mass removal from this leg that yielded a diagnosis of "lipoma" many years ago. That mass has returned, slowly growing within the armpit of her front leg. It is now pushing the limb out and away from her torso. It has gotten so large that it has exceeded her skins ability to further contain it. The underside of the arm was red, raw and ulcerating. The mass that has been slowly growing for years now is outgrowing her. The cold cruel eventuality of Brunswick's leg was lose the leg or lose her as she would soon have an open wound that would never heal but instead continue to erode her leg, cause her increasing pain, and chew its way up her neck and across her sternum. 

Brunswick walks front legged short stepped, cowboy style. It manifests as a limp. The mass is hidden from obvious view by her bushy hair. The dappled coat hides the magnitude of the mass until you pet her. The diameter of the upper part of her left front leg is easily twice that of her slender athletic right leg. Her demeanor is always stand-offish for a few moments, but, if you are patient, quiet, and gentle in allowing those few moments to pass she will warm up to you to flounder flop on her "good" side for a full belly reveal. It is her not so subtle invitation to focus your affectionate rubs on the tender fleshy part of her belly. She is easy to fall in love with. Her handicap simply reinforces her charm. Her mom adores her. She will tell you that "Brunswick is her first child." 

And, now,,, here we are. Sobbing. Crippled with fear and doubt, and stuck about what to do with it all.

Many conversations get to this point. That critical pivot point where biology, disease and prognosis has met the timetable of limited options. That juncture in a pets life where you have to choose? Are you a proactive parent seeking to gain as much time with your pet as medicine is able to provide? Or, do belong to the crowd that does not believe in surgical procedures for pets? Do you choose to invest multiple thousands of dollars, hours, and caregiving requirements to gain the precious commodity of more time with your companion. Do you value your pet as a member of your family? Are they one of your kids? Can anyone possibly speculate all of the twists and turns that lie ahead if you do, or don't, take action? 

Most pre-op surgical discussions go like this. 

In Brunswick's case we had already done multiple examinations. Two with me, one with the surgeon. At each time we (the "professionals") agreed the best resolution to this tumor was to remove the leg. There were about a dozen emails back and forth to discuss every possible question and concern. And,, yet,, here we were, crying at drop off. 

I sat with her and said; "I know how hard this is. Please do what you think is right. Not what anyone else tells you to do." I firmly believe that this needs to be said to every parent. The road ahead is too full of twists, turns, and potentially even life-threatening landmines. I should add the cost of care, but, for me it is not a part of the equation I will let decide options. If we believe a treatment option is needed we will find a way to make it accessible. (Note: we use multiple payment plan options to help people not let the financial burden be the deciding factor).

I try to ask myself who will benefit from these decisions? Who am I looking after? These are huge weighty decisions with dire consequences. I try to be unbiased, neutral, indifferent. I try to present facts, argue all sides. I soo often feel that I fail miserably at this. I am not ever able to remain indifferent. I am not on anyone's team outside of my patients and their family. It is the dark force that grips my soul surrenders my conscious heart at midnight.

Brunswick post op

Here's where the muck meets the sole. Brunswick needs this operation. She will die within a year from the mass if she doesn't have it. How do I advocate for that? A: I just have to be honest. Then I have to accept the consequences. But, I know Brunswick is loved and I know her mom is making this decision based on that. Seems silly to some, maybe? But that is always enough for me. I am not the vet for indifferent people who don't value pets. That I cannot do. That would kill me.

My pups; Frippie and Storm

These are the elephants I carry on my back all day every day. They remain cumbersome, consuming and catabolic even after I get home at night.

I didn't sleep much after midnight. That mystical witching hour.  My typical work day has me arriving home after 9 pm, a 12 hour day of work without breaks, meals or niceties logged in the record books.  My shear exhaustion leads me to literally passing out on a pillow having foregone the obligatory teeth brushing, face washing, moisturizing and evening medical supplement regimen. They are all tossed out the window for the sake of sparing my legs the 80 paces they would require. There are loads of nights like this. Wrung out dry. I enter home as this zombie-eyed shell. I sleep for 3 hours and the death cipher lets go her grip for the anxiety ridden stressed-out-Suzie to take claim. Its always this exchange of custody each night between the hours of midnight and 2 am. A shared custody battle as the sun sleeps. 

My Frippie always brings me a gift

Why does the day weigh so hard? Brunswick is one example.. this is another. This one happens too often these days. COVID has created a huge demand for puppies. None of them are being socialized appropriately and for some (often breed specific) it is causing potentially disastrous consequences.

The other emotional dilemma of my day was an 11 month old German Shepherd, (let's call her GS), who visited for a pre-spay exam with bloodwork. Her mom had brought her inside the clinic vestibule on a one foot leash to a tight prong collar. Even with moms double fisted grip she could not get GS to remain with four feet on the floor nor have any kind of focus. She had no control of her adolescent puppy, and, she knew it. She told me that she "doubted I would be able to get her blood." She passed my technician the one foot lead and watched us all as we struggled to lead her to the treatment area. All GS needed was a 5 minute physical exam and 30 seconds to pull a blood sample. These appointments are not charged for as they should only take 6 minutes to complete. That didn't happen.

GS was a happy, outgoing 75 pound determined to party firecracker. She was elated to be around people, and in absolute resolve in not sitting for longer than one split second for anything. She knew commands, and she knew how to decide to avoid them. She surged, jumped, boxed, and thrashed. She twisted arms, crashed heads, and started to lunge and bite to have her demands heard.

Our dinnertime excitement

I always stop here...... The three of us; myself, my technician, and GS. We all looked at each other. What to do now? Take a breath? Try a different tactic? All of the above? We took breaks. We tried treats. We tried calm quietness. I tried a large muzzle, just to see if that would settle her. Fifteen minutes into the endeavor and one thing was clear; Nothing worked. We were at the place where one of three things was going to happen;

    1. I lose my patience and I hog tie, muzzle and we pig-pile on her to attempt to bruticaine (brute-force-paralysis vet lingo), and see if she is so shocked by this she gives in.  I just turn into a cold hearted drill sergeant. Bark orders. Intimidate. Force her to be what I want her to be. Force her to hold this command until I feel she has learned who is in charge. Quickly restrain GS and get it done. Get the blood. Skip the exam. Smile and return her to mom. After all what she doesn't know isn't my problem. She can't claim naivete when she already admitted unruliness. Make friends with the owners, even if it  is at the patients expense. A lot of vets have learned this trick. Two faced. Sweet to people, not so much to patients. A bite will likely follow at some point. What the real consequence of this is; To hell with the next guy who has to deal with her.  Might work for some dogs, never works for shepherds. Shepherds are too intelligent, they cement resentment like dolphins. If I do this to her she will never again come happily into our doors.. She will start every future interaction with fear and aggression. A bite will follow at some point soon.

    2. I give up knowing the short game loss is worth the long term gain and we have a family meeting to try to find a way to make her appointments more enjoyable and productive. Her mom had already expected that today wouldn't go well. We come up with a plan for next time. This should include training at home with the family to allow others to handle her. Working with a trainer to help her focus on commands and execution of them with focus and safety. And medications to help bridge the gap as we work on training. 

    3. I just get bitten. No chance to compromise, or convince her that we are not trying to hurt her. She just explodes and bites as fast as she  can. She is done with us and she will remind us she is in charge. 

What happens when a "bite" happens? Paperwork, fear, and almost always the pet parents compounds the tragedy by isolating their dogs in an attempt to avoid future potential bite provocations. Muzzles, prong collars, yelling, over protecting orders and mounting anxiety across all fronts. It's a snowball. Attempt to avoid situations leads to a lowering of estimation of the pets perceived threats. They used to like everyone. They were puppies meeting a world of new sights, sounds and smells. Now they are guardians that bark at the door knocking, or, strangers. You can't take them out in public anymore because now they bark at everyone. Everyone is a perceived threat. They are 100 pounds and you cannot restrain that amount of determined muscle. They become isolated. We reinforce the idea that everyone is a stranger. I used to see them every two to three weeks. We had fun visits. Now I am the stranger. I ask for unreasonable acts of discipline and focus. They don't know me and they certainly can't see a reason to obey me. Hence the bruticaine and indifference. 

Buster

Who's fault is a bite? Well, for the huge majority of clients vets see daily they would say it is our fault. For every time I have handed back a shepherd to say "we need a different plan to make this visit enjoyable." I almost always get, "well, you don't know how to hold her. She is fine with me." Oh, how I long to reply; "Ok then you do the bloodwork and  the spay. I like my fingers and face." Or, "she would never bite me, therefore, you are the problem." 

Here's my advice; it is the advice that every seasoned pet care professional will give you. Train your dog to accept a muzzle. It is NOT a reflection of a persons failure. Nor the pets. It is a tool to provide assistance as we transition out of anxiety based fear laden actions and reactions. Every pet parent should openly and provide permission for a muzzle to be used if deemed necessary. Man-handling, bruticaine, that is not permissible.. ever (unless a pet is endangering another's life). How do we insure this? Trust. If you don't trust your pet care professionals ask to be present for all possible procedures. Ask, demand, insist that pre-anxiety medications be given. Set ground rules for care. Resistance is a flag for scrutiny. Leaving a practice because a person intervenes on your pets behalf is only going to hurt your pet. 

About 30 minutes after I aborted pushing GS any further I sent her home with a training plan and sedatives to try at the next vet visit. I chose to not push her, not exacerbate a bite, and not make it impossible for the next time. Here's what I got for that, a call from the husband saying "they had a bad experience with us and they are going elsewhere." I doubt I will ever see GS again. There is pride before a fall. There are Shepherds relinquished everyday because no one intervened on their behalf at this critical development time. And, worst of fall there are vets who get court orders to put animals down after a "bite" history deems them a danger to the public. Will the next vet push her so hard she bites? Or becomes passive aggressive? Or fears people so much she reacts with defensive aggression to everyone outside of her family? In my opinion she needs help. Will she  get it? It's one of the reasons I awaken at midnight with elephants.

Tex. His first puppy visit. My goal is to have every patients visit look like this.

The truth is that people pine as much as I do, if not more, on what to do for their companions. What is the right/best/safest/compassionate course of action to take? What will consequences for that looks like? Will I hate/berate/beat up/chastise myself for the action, or lack there of, I take? I have been in these shoes. At every moment of my professional life I remind myself that I am still that devoted pet parent who is in turmoil about what to do? Do I trust my own judgement? Do I have enough pertinent information to base my judgements upon? Is there trust here. Maybe GS's parents lack that? They just don't trust my call? The reality is that she is being set up to fail, not flourish, and her "bite" won't be on my account of failing her. 

Brunswick. One week post-op forelimb amputation

What these two cases have in common is that I did my best to make decisions, present options that were in the  best interest of my patients. period. I can fall asleep knowing that. The rest, the worry, the grief, the elephant on my shoulders that I failed them, their parents, or the relationships we have is the midnight hour that clutches my throat and drags me into the abyss of self-doubt of avenues from that first decision to "do no harm."

Magpie helps me motivate for another morning.

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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.

For more information on Jarrettsville Veterinary Center please visit our Facebook page, or website; JarrettsvilleVet.com

I am also posting lots of informative videos at my YouTube channel here.

The hardest part is looking into the eyes of the patients who want to live and knowing you can't do anything to save them.

There are tougher parts to this job than most people think. These are the eternal forces that pull you into and out of the ability to care. The profession calls it “compassion fatigue,” I call it surrendering your purpose. It is a fight I have every day. It is a fight I expect to have everyday as I continue to practice vet med with the public paying my way.

“I don’t know how you do it.”

“I always wanted to be a vet, until I realized I would have to do this.”

“I couldn’t do it.”

“This must be the hardest part of your job?”

I hear these weekly, and, on the really bad days, I hear them daily. The small talk, the dropped one-liners that are delivered to me as I am sending another life into the after life. They are the common conversation fillers from clients as I humanely euthanize their pet. They are the reminders of how dismal this job can be. How emotionally and mentally taxing the price is for pet care at this level as your chosen path. We tell ourselves it isn't our fault. That this task is our final act of compassion, but, the truth is we have to tell ourselves something to stomach the acrid taste of being the designated henchmen. 

For the majority of clients that I see, saying good bye to their pets is a kind way to spare their loved ones further suffering and the passing is marked by overwhelming grief. For for a smaller group of people it is the only way out of a situation they can no longer manage. In either case I am always sure that this act is based on love. I have spent decades insulating myself from the other scenarios that bring euthanasia to the resolution of a pets treatment care plan. The cases who can no longer afford further care even when the condition is treatable, or, believe that the road to recovery may be too long and arduous to attempt. The disposable pets who are more affordably replaced versus ‘fixed’. The cruelty cases, the court mandated cases, the "found but don’t want cases," and the weak/dying/debilitated/desperate cases. I have somehow figured out a way out of  being simply the euthanasia mother to these. It has taken stern warnings to the staff, repeated pleas to the receptionists, and a no-exception scheduling of walk-in euthanasia's. It has taken courage to stand this ground. I have been called terrible names. I have lost clients. I have been brought to the medical board, punished and chastised, and, yet I still stand firm on my position. I will not euthanize a treatable pet without offering every option imaginable, and extending myself further than is ever expected. I will not go to my retirement with blood on my hands. If, and when, I leave this profession, as I lie in my own grave I will at least like myself for standing up for my patients. It is not the path of my fore-fathers. The men who began this profession to serve the needs of their community. Veterinary medicine has changed over the last 100 years, most remarkably within the last 20. The place of our pets within our families has evolved. The desire to value our pets as family members has driven the wealth in the vet med profession and lucrative lifestyles we veterinarians can lead because of this, and, it should follow that our perspectives on these patients who allow us this should also evolve. There is a sphere of hypocrisy among our colleagues and within the leaders of the profession. The belief that we should not judge, and that we cannot maintain a healthy client base if we don't answer all of the client requests, (almost regardless of the basis of said request). These tenets have shaped us into appearing "indifferent" as we deny care to those who are financially constrained and yet also the exemplification of absolutely devoted to their pets, while we "humanely" euthanize the cases we feel are better off dead than neglected of the care we deem "most appropriate". All judgement calls. We readily, and, almost universally shirk emotional investment as we consistently and almost without exception buffer our own personal financial risk. We do so with the legal backing of the state veterinary boards and the national leadership. We un-apologetically (my least favorite over used axiom in the profession), deny based on any desire we choose. Veterinarians are emotionally scraping the bottom of an all too empty well, as we blame poor financial decisions of our creation, (if you cannot afford to go to vet school, and you cannot financially recover from that decision based on your current or projected salary whose fault is that), as we at the same time blame poor decision making on clients financial limitations whom we remind all too often need only have that pet based on responsibility versus rights. (My second least favorite vet med saying). It is an impossible game to play. I have learned this the hard way too. I hate myself for being the middle man between clients who don't value their pets as worthy of love, and the investment that this responsibility requires, and, then I hate myself most when I consider turning my back on a case I believe I can assist. I often sit trying to chose between which scenario I will hate myself less for. It is all about choices, and, getting out of this alive.

I am too often left with trying to discern what the hardest part of this for profession for me? I will admit it has changed over time. It has transitioned along with my courage to stay viable. Early on the hardest part was the angry and demanding owners who tried to remind me that; “I work for them, and, therefore it is my duty to fulfill their wishes to kill their pet/declaw the pet/etc.” I have bid them all adieu. I am financially secure enough to have this luxury. Truth is I have decided I could not go on like that so the financial loss was apparent either way. As I was figuring out who I was, I was realizing they didn't fit my perspective professional path. I, along with the rest of us, cannot be everything to everyone. 

Then there was the period where I knew I was being tested to see if I could maintain my own choosing between doing the kind thing for my patient who had just been hit by a truck puppy and the manipulative demanding owner who wanted everything for free and then to have their puppy back. I wasn't sending her back to them. They had withheld lifesaving care I gave them for free the last time , an old yellow lab who died the most horrific death of denial of care, and it had left me heartbroken like no other case has before or since. I should have reported them, another lesson I have learned, and I hadn't fired them in time to avoid this (their new puppy to replace the dead previous lab) puppy and the truck, which the state board so firmly reminded me, that “euthanasia is a required to be offered option for every, (yes, they used the word “every”), condition.” I suspected I was going to pay for this decision when I was making it. My pocket paid a fine, but my heart did not. I still know it was the kind decision for Sadie, even if it wasn't the right decision in the state boards eyes.  Sadie is alive and well almost 10 years later with a different family, (the original family tried to get the board to force me to relinquish ownership after they surrendered her due to lack of any funds to treat her. After I paid to have her fixed they sued me. The board offered to drop charges if I returned. I didn’t. They charged ahead for not offering euthanasia). You have to pick sides in life. Make hard choices. Decide whose integrity you care about most. 

The hardest part for me after I earned and tested my titanium britches was the cruelty. It is the single undeniable force that breaks vets. Cruelty comes from only one side of our equation; our clients. It is the people who kill you. Chip away at your ability to remain centered on your patients and the care they need. Indifference is the dark side. The force that whispers in your ear over and over to just stop caring so much that the vulnerability leaves you marching to the fatigue that compassion can cost you.

How do I get around the cruelty? I use the tools I have at hand. I simply don’t tolerate it. I don’t turn a blind eye and I don’t ignore it. If it crosses my path, and it does, I take photos, I have frank conversations about what I am seeing, how I am documenting it and what needs to happen to keep me from reporting it. Doesn’t it seem odd that society has anti cruelty laws and yet you can euthanize for anything? I call out Animal Control to bear witness. I leave the judgement of inadequate care, neglect, cruelty in their hands. It is the job they signed up for. I am now the messenger, albeit hypervigilant, but that is part of my purpose to protect the pets I still call the love of my life. 

The hardest part for me these days is the looking into their eyes, these patients who I have elevated to be the answers to cause and consequence, and asking the hard, deeply moving, philosophically governing questions. There are patients who are suffering and desperate to get better and there are others who are suffering, dying and don’t want to go on. Here is where I am finding my latest cross to bear. The part that is chipping away at my inner purpose and conviction to course. 

When I can see the difference in their eyes and not be able to do anything to change it.

I will never let myself be any other kind of veterinarian than the one who shows up for her patients. Although our clients are an integral part of our ability to keep our pets healthy my love and my loyalties lie in the preservation of life and health of the cats, dogs, kittens, and puppies I pledged to serve. Not putting them first, in everything I do, is answering to the indifference that has plagued too many lives already. I entered vet med with the same single belief the rest of us do, we love animals.

 If you take the time to look into their eyes they will tell you everything you need to know. I, as the practitioner also have to listen as I gaze. I have to believe what my heart and soul tell me, what so many of us know already, that they have a place in our hearts because they have a heart of their own. Isn't that everything in this lifetime worth fighting for?

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.

For more information on Jarrettsville Veterinary Center please visit our Facebook page, or website; JarrettsvilleVet.com

I am also posting lots of informative videos at my YouTube channel here.

The Futility Of It All. How Futility Fuels Empathetic Activism.

Serafina. Her story here 

The futility of it all is ubiquitous if you sit and think about any of it for longer than a moment. This appears to be true because just about everything imaginable can fall into the futility category. Just take a minute and think about a few examples.. You might  have to take a few steps back,, narrow, or widen, the focus, but, it's true.

Or, so I fear most days.

You will die,,, there's a big one. What the heck does it all matter if that is the final thought? Eat more cake. Watch more t.v.. Buy that expensive purse. Live larger, or, live longer,,, (which is it?). Can you do both? Isn't it all futile if a nuke lands in your back yard tomorrow?

It's futile to deny it.. All of it will end. Someday.

But, wait a minute, what about our pets? Those little delightful beings that drive us to do almost everything we so willingly have to do. Like waking  up early on those precious few days off, cleaning (yes, this includes diarrhea and vomit on the living room rug at 2 am, and, hair in every corner of every room). And, don't have to do.. like putting on a pretty dress for our eat-in dinner date together. I swear that my home lives by the motto: "I work hard so my cat doesn't have to." But, is all of this futile? My precious short time with them? My deep adoration toward them? Am I alone in this singular thought that NO! It isn't! They are my life,, certainly that can't be futile? Can it?

Pawbly is the place I chose to put my excess futile efforts outside of my too often also arguably already futile vet practice. (Futility meets its maker on an even larger scale. Yipppeee!). I can't follow any current vet practice ownership model. They have all become too calculating on how to make more money, how to lure more client visits, manage your practice better so it is more efficient AND more profitable. Listen to the experts, embrace the real facts that some people just shouldn't have a pet if they cannot afford them.. we after all are vets, we know everything,,, we should decide who lives and dies and who deserves companionship... yeah, I'm not this person... it's futile for me to try.

Poe. His story here.

There are endless debates about the futility of vet medicine. It is jarring to think about how futile that whole long four years of vet school is as the foundation of ice cream is to its banana creme sundae of my daily futile veterinary life. At least that's what it feels like in this profession on some days. Do you know how many times a day that I have to plead for a patient because I am certain that their treatment will NOT be futile? Or, how many times I have to look at an animal knowing I cannot alter the path they are on already because life as they know it is futile at this juncture. Never mind the even more futile and heart crushing cases that I can intervene on behalf of and SAVE but aren't given the chance to! Yes, I feel like my life, whole veterinary existence, is futile far too often.

For many clients the futility of their pets medical options might be financial constraints, personal issues that preclude ability to preform the treatment or an intervention task needed, or, the awful reality that life is replaceable, expendable, an economic equation, perhaps not just the current status of their health but perhaps their entire existence, and the utter lack of seeing our life as a reflection of others. That's when futility makes this veterinary life almost impossible to bear any longer.

Fripp and Storm. My puppies. Their story here.

The problem as I see it is that whatever I might know, or want to utilize to assist or intervene on behalf of, dish and dole to those who find me, and the importance of life as I see it, is futile when that patients care, or ability to access it is decided by someone lacking the ability to see their life as anything more than, well you know already; futile.

Can you see the dilemma?

The face. The cases you never forget.

It's not the ending of a life at its end from some debilitating destructively devastating disease that rips you to shreds. It's the ending a life at its most vulnerable time of needing me, the vet, to intervene for them and being unable to that makes it all feel futile. Hence, Pawbly. Try to offer more help to more people and deliver it to them for free, (which by the way it most certainly isn't).

Storm. His first appearance here.

It hits me pretty hard on occasion. This dance between navigating selfish decisions, suffering, economics, and easy street to avoid feeling anything. Then the smack in the face of futility wakes me. Pets are at the mercy of people too often. People are governed by motives I cannot always alter. People don't want to be decided for, and far too often they can't see their pets, their dilemmas and their place in altering courses like I can. Futile to try to convince, futile to push, plead, beg, and not permitted to coerce,,, futile.

Serafina.. futility at its best.

Going into every pet related situation as a veterinarian with my automatic assumption that my clients, (I say "my" because I do have invested ownership in them,, I know most other vets say 'the' (always pay attention to grammar,,, imperative of these is the choice of the noun. "Mine" is non-binary, we are all safe with "mine" ,,, use it, mean it, small soapbox diversion ended now),  is setting me up for problems, inevitably. There is this invisible line that seasoned vets learn to nimbly maneuver. Act like the patients best friend if the client can pay, send them to specialists, offer best practice medicine, charge premium for all of it, or, act like the bearer of compassionate euthanasia as their next best option if they can't. Appear to care, but decide who is worthy of our time and expertise based on financial ability first, deem the remaining as futility cases otherwise. Doesn't work for the patient all the time does it? What if I tried to always side with what was best for my patient? Albeit I might be biased, and, I might possess a more tempered professionally honed medical lens to decide who is and isn't likely to live a little longer. What if I just decided that I was my patients advocate and stuck to my guns about it regardless of the finances? Seems easier to tip-toe through this way with a client who might just think that medicine, my whole purpose is just futility dressed up in a white coat. Well, not so fast. I know many a financially sound client who uses a date, age, disease, length of  expected treatment plan, and even degree of personal involvement in said treatment plan, who opts to get another pet as this one doesn't meet their "acceptability" standard any longer. That argument, that plea to intervene on the patients behalf, leaves me with a patient of my own to try to rehome (which oddly has been easier than I assumed), or, a furious client because I am "not honoring their wishes." (Umm, does the pet have a wish? Can I ask? please?).

My Fripp. Found in a box on the side of the road.
If that almost didn't kill her a week in the shelter for her mandatory hold period almost did.

In a deep conversation with the smartest, most successful person I know, the topic of my pet project Pawbly came up. In one second of air sucking despair he gave it to me. The complete futility in the ridiculousness of a business that even a philanthropist would balk at as they dis-considered it. There it was, the perspective of extending compassionate for free care gone, evaporated, scoffed at. Futility Be Mine.

Futile efforts to herd the vacuum.

How interdependent are we all on each other? That's the question I often ask myself as the dog and cat mom to my family. Beauty, in all its intricate delicacy fades. Love herself is futile if you don't jump in and let yourself be brave enough to surrender to it. Be courageous enough to have your heart broken. Willingly. That's the aphrodisiac to futility. There is futility in caring. It will fall away from your fingertips. Leave you. And, yet I stand here stethoscope ready for the next set of futile feet to patter in or fall upon my compassionate driven threshold.

Poe

I wander in futility for the opportunity to be met by that every so often occasion where intervention matters, recognized or not. That one little soul who meanders in to my clinic, or, my website, and is able to depart better than they arrived. That one play that shifts the deck in their favor. The win in a sea of losses. The sheer joyful moment where what I have chosen to do with my life matters. The admission that this moment exists outside of every moment of every day where my beloved companions; Charlie, Storm, Fripp, Wren, Jitterbug, Oriole, and Magpie reside. That place where butterflies are air suspended floating winged fairies. Frogs are coins leaping in a fountain, and a new glorious sunrise is at the end of every nap. That omnipresent yearning where bellies are always anxiously awaiting the next treat in the many forms they find them, and nestling fur remains snuggled close the my laying legs with a reassuring resting fingertips to remind them they are safe here. It is the life I choose, futile amongst the otherwise.

Serafina

As for my largest futile effort, Pawbly, it still matters to me. This wanderlust idea that a place I created can transform a culture into acceptance that we got a few things wrong in our fear to protect our profitability. The futileness in believing that pets matter more then the dictionary portrays them as. That they are our beloved family. Our furred little ones. The idea that our lives are meaningful to each other, and worth the heartbreak the loss will cost us. That believing you can continue to try is worth the heart you wear on your white coated lapel. Profitable or not it's futile to try to take it with you.

The futility is in the trying to get through life without pain, disappointment, or solitude. The futility is denying  that empathy and love solves them all.

Anyone want a feral cat?
Sure,, meet Muffins, one of our JVC kitties.

Here's to endless practicing in futility! The bitter disappointment to futility's attempts to sway my little chips into its magnanimous suit of armor.

And proving myself wrong. That none of this is futile. It's futile to try.

Taking Frippie home.

Related Blogs;

Find What Breaks Your Heart. Why I do what I do in my veterinary practice.

Borrowing Battery Juice. How I utilize the lack of compassion I see too much of as a source of strength.

Affordable Options Are Everyone's Right. Difficult cases, expensive care and how I manage the tenuous cases that present.

The Turtle and the Unicorn. Entrepreneurialism in Veterinary Medicine. My way.

The Year of Year Around Care. Transparency in Jarrettsville Veterinary Center. How we changed the face of our practice to benefit our patients.

If you are interested in help for your pet and don't know where to go please find us here at Pawbly.com. It is a free online community dedicated to educating and inspiring pet people everywhere. It is free to use and open to everyone.

I can also be found at Jarrettsville Vet in Harford County Maryland. Visit our Facebook page here, or see our online Price Guide at our website jarrettsvillevet.com