The Venom In The Terminology

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

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

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

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

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

Here are some of the most offensive;

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

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

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

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

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

Elsa.. recently rescued and adopted

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

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

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

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

YouTube channel here.

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

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

When The Veterinarian Decides Who Is Worth Care

"I need to talk to you privately."

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

Magpie

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

Storm, morning naptime

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

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

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

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

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

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

Frippie. Also morning naptime

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

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

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

This is what she didn't recognize yet.

The view from my kitchen window

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

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

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

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

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

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