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 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.
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.
I was always trying to get there. That other place. The place just on the other side of the fence. The end of the rainbow along the road I hadn't yet gone down. The woods on the other side of ours. Another state maybe? What about a country? I suppose I should start practicing their language now? You know just so I could find the loo should the need arise.
I was that kid. The kid not settled on here and now. There was no value in it; The present. This place I am already. It isn't a terribly detrimental character trait for a kid, but, these kids should try to grow out of it for fear of being trapped in 'never good-enough-land'. No one wants to grow old feeling like a foreigner. A nomad without a home to call your own. This feeling of not belonging in a world already full of coldness.
Frippie. Our morning wake up ritual.
But reality is that I was always this kid. I keep, and always have kept her alive inside of me. Albeit quiet. No one wants to build a relationship with a gypsy.
Stealing a kiss before surgery. Maybe after too?
Well, almost no one. For me, then, now, always, the companions who left me feeling grounded, belonging, were just my animals. Named or not, they kept me at a constant. They provided the only place that I wasn't feeling alone.
I never let her grow up into any other kid. The kid who had relationships so deep that you grow deep like the roots of a Sequoia. Strong, formidable, permanent, present. It was never that I didn't value fortitude, strength, and mightiness, it was that I could never decide if here was where I belonged. If the exchange for staying-a-while was worth the potential of not being able to go again. What if staying here meant I had to forego the greener grass elsewhere? Was I ever ready to take such a gamble?
Looking back I don't know why I was so unsettled. It wasn't so much the loss, or absence of what I didn't have, it was a longing for always somethingmore. More in the way of experiences, places, people and all of the stories that they brought. It was the stories. Making them, finding them, living them and amassing them. More in the way of options, freedoms, liberty, and self-reliance.
Elvis. One of the 54 cats we helped rehome from a hoarding case. He was brought to us with 4 littermates, 3 had died over the weekend the owner was away. The previous owner had no idea how many cats she had, or how many were spayed/neutered and she begged us to allow her to keep him, "because he was the healthiest." He would have died like his siblings had he not been taken away. We spent months trying to keep them all alive. We did. He was here to be neutered marking the end of his kitten struggle saga. After this litter we realized that the problem was far bigger than our clinic could manage and we called Animal Control. They have removed dozens of additional cats from her property.
There were very few constants in this life of meandering. There was a dream, a goal, and, a constant companion beside me. Those pets were my guide as much as they were my inspiration to keep moving forward. It was the pets. As a young girl who only wanted to be surrounded by animals all pets held a place of great importance, but very specifically, my pets were of paramount importance. They were my constant. My grounding, the reason for understanding who I was and wanted to become. The sense of belonging in this world I never fit into that provided meaning and substance. They were everything in my world that I saw as just passing by.
My parents, more accurately, my mother, decided to leave Long Island, New York when I was very young. They moved to the country for all of the imaginary wonders and miracles that they believed a country life afforded, and were not attainable in the city. Grass, trees, land to get lost in, and peaceful discussions about days lacking agendas and human bustling. For me it felt more like being removed. I was being removed from some place with lots of lives, to a place without humans lives to interact with. It was the first time I ever felt lonely and alone. Lost and taken away. It was the beginning for me, and I think my mom too, that there was a world we were without within.
Autumn, one of our technicians, and the lead for the 54 cat rescue, kept Oaken. He was one of the 54 cats we helped from a hoarding case 2020.
My mom countered the cricket cacophony and automobile silence by amassing pets. Her little farmette crawled slowly with the menagerie to make it look like a legitimate country living poem. There were two dogs, three cats, a pony of my very own, and a sheep she bought unknowingly at the county fair. The little cottage-cape in the country my parents had purchased came with shabby two car garage and a field, but, no barn for the livestock to cohabitate. They never fully planned much of the jumping into they did. They tended to jump, best intentions in hand, and land wherever the free-fall dropped them. The barn, or lack thereof, was a very good example. The idea that you would purchase a horse and a sheep and not have a barn for them to be safe in snowy-laden New Hampshire is ludicrous. And yet that is what happened. My parents converted the well house, a wooden structure about 8 feet by 10 feet into a barn-ette for their newly Christened farmette. Few creatures are born into immediately having to flee the nest and wander alone the rest of their days. How would one survive if they awoken from delivery, set off swimming, and hoped for the luck of the draw to magically and successfully make it to a ripe old age? Unless you are a single-celled organism you need a buddy to help walk you through the perils of life. For all of the alone-ness I felt, there was a togetherness that these pets supplemented to dispel the solitude. We weren't put together to remind each other of the holes we had as individuals. We came together for the friendship of each other, Maybe the sheep, her name was Lambie (as original as the thought process in acquiring her had been), or Memory,, the pony that my parents helped me purchase,, a lifetime of savings for the gift I wanted more than anything I could have ever imagined. Memory was $500. Five hundred dollars to a ten year old girl in 1980. Memory, was short for Sweet Memory, and that she still holds firmly.
Cali. Here for a knee injury repair. Always smiling!
I think that there are a lot of small animal vets by default. We start out as a little seedling intent on animals, but most specifically it is the horses. The vast majority of little girls love horses. We love them so much we want to fill our lives, every minute of them, with more horses. As kids we might grow up with dogs and cats in our homes. Closer to them in proximity, but, there is some allure to horses. Little girls love the idea of the smell of the hay. The aroma of the flat coat that can be brushed for days and still never luster. Horses are big, yet gentle. Soft muzzles always inquiring for a peppermint snack. It is a feeling of belonging that horses give to little girls. Solid, strong, yet soft and safe. You can wrap your arms around their necks. Breathe in the musty, earthy, perfume of their massiveness and still cuddle up near them as they graze contentedly by your side. Horses capture and transport. It is the glitter of every little girls dreams.
It was that horse, Memory that started it all. The cement of a relationship that I hadn't yet ever figured out started with her. A horse vet was born from the days on that farm that was so far away from everything I thought I needed to have more.
Dexter waits for me to come visit. Here for his annual exam and a hug, of course.
The isolation that moving to the country also brought me a kindled a purpose. I learned from a very young age that where these pets brought me the only true friendship I had known. But this friendship came at a price of being vulnerable that I was not prepared to accept. A farm animal, and to this designation my parents cast a wide net (all pets, i.e. all animals, were pets for as long as they were healthy and free of trouble) when a medical need, or a behavioral nuisance presented their stature on the ladder of importance fell to below my parents being designated as responsible for. I joke about it now, twenty years into being a veterinarian myself... that my parents had to be the worst pet parents my poor childhood vet, and lifelong mentor, ever had. They were the clients who called him at home at 2 am to notify him that our dogs had just returned from their all day expedition with a face, and frontal chest-full of porcupine quills. The dogs were muddy, bloody and keeping my parents from being able to get back to sleep. My dad asked if he "could drop the dogs off now (at his clinic conveniently located downstairs from where he and his family slept each night) so they could try to get a few more hours of rest before work the next day?" That saint of a veterinarian, said "ok." I remember listening from the top of the stairs, (these were the days of one corded to the wall phone per household), and feeling so relieved that the dogs were A) going to get veterinary help, and, B) they weren't going to have to suffer with a face, chest, and mouth (yes they were in the mouth and tongue) of sharp quills. I know now that Dr. Barsanti opened the door at 230 am, pajamas and robe on, took the dogs by their leashes. Placed them in the dog cages in the back of the main floor kennel area and immediately aced the dogs into a few hours long nap to face the task of pulling them out one-by-one the next morning. It is what I would do now. Who starts a 3 hour quill removal surgery at 2 am? Heck, who answers a phone, and their door at 2 am? Not me. (Damn, I hope he charged my parents out the nose for that one. I'm sure he didn't my dad would have never paid for it if he had tried).
Jenn is the office manager in her office. Never alone with our clinic house cat; Seraphina, and my pup Storm.
I have written about it before. The pivotal place where my childhood trauma of feeling like my most beloved, and often only friends, were continually at the mercy of another humans decisions transitioned into an adult obsessional determination to find that the place where my destiny rested was in protecting these, and all others, pets. I would never be left sobbing in the corner while someone else decided who was, or was not, worth the effort, or expense, to heal them. It would become only mine to decide. That place where no animal in my purview would be denied care based on anything other than fate, and even she would be dealt blows to humble her if not frighten her away for at least a few more moments. If I had to give up, travel on, and never have left a footprint behind, then so be it. Is there isolation when there is purpose? I think I learned very early on that to have my dream of becoming a veterinarian to come true I had to have dedication and determination to a level that no one else possessed. I had to make sacrifices and decisions based on the long game. Always the long game. Every relationship I had was based on that premise. There was a here and now but I was not going to get stuck in it. Not for longer than that semester allowed. I lived my life for many years, a decades worth, in semester blocks. One at school trying to maintain straight A’s to dilute the Academies implicit bias and baseless defamation via the measure of academic and excellence. And the other at sea, working as a deck officer aboard a cable laying ship to fund the quest into its next chapter. There is very little chance at life, its tapestry of relationships on a schedule built like this. Going to sea for a decade was the most challenging, and even lonelier existence than moving to rural NH brought. No pets out there. Not much of anything except hard work and too much time to self reflect.
It had to happen. A relationship had to evolve from a lonely girl who lived for the tomorrows she lived to see and she wished the present day away.
My kitty Magpie. A cuddle in the sunshine.
My parents never understood my chosen path to get to vet school. They never accounted for veterinarian in the same light as lawyer, doctor, politician. My mom loved animals, to be sure, but she never wanted me to have to deal with the clients the likes of my dad. Too much heartbreak in vet med she thought. Animals might die, (she didn't waste time on the ins-and-outs of why, how or by who's hand), they died, it was sad. I should avoid sad, and poor. My dad knew the kind of people he was to his vet and he thought I would be far happier being far wealthier and steered me away from vet med at every chance he got. He got about 3 decades of chancing me out of this profession. In the end I was always more determined than he to not live the life he wished for me. It has made all things possible. And an even lonelier girl on the other side of it.
I think it is a deal many vets make. I am not alone. My story is not unique. So many veterinarians left humankind to stay firmly grounded in the pet loving world. We left our souls tied to the hearts of the pets who never live long enough, never hurt your sense of not belonging, and never question your life choices even when you aren't quite sure of them yourselves.
There are secrets we all hold. For me, and the little girl still living quietly by herself inside of me, the secrets are in the days, years and lifetime that I shared with the creatures who always mattered more than everything else could.
Seraphina. She loves me, and more importantly, we need each other.
I think that while I recognize now the cost of the sacrifices I made to make this dream my profession, I am not sure it was an even exchange. So many of us forego relationships, friendships, two legged children and even our too compassionate souls for this profession. We die, or at least sacrifice so much along the way to help others who will never enunciate a human "thank you." All for the power of this purpose. It is the secret so many of us share, and one of the many cracks that remains us we are all too human and ever fragile.
This is a blog about my life. A place to put the feelings, experiences, troubles, and many of the great successes of the lives we share with our patients, and furried family members. It isn't a testimony, a plea for help, or a call out to the profession that struggles so much. It is a diary. An open love letter to the life I live and the choices made to stay alive and happy here. It is about purpose and contentment, and these often feel mutually exclusive while you serve the human public who "own" pets.
The measure, (of really anything right?), is too often based on "success". But who gets to decide what that is? Who decides that measuring stick has increments other than dollar signs? Why is our society so fixated, obsessed, with money? The success measured by profits and the magnitude of the beast that the business is based upon. So often I wonder if people are really happy behind that? So often I wonder if the whole damned world needs a smack in the face about success with respect to where success, and hence, happiness lies?
At some point enough is more than you need and the result is finding meaning within the days after financial security.
The clinic has become so busy that I have to repeatedly stop, look for, and find myself. Days become so chaotic, hectic, and fervor-ed that I have to remind myself to breathe. Step away, take a breath, maybe even take a sip of water, and, ask myself if I have peed yet today? I have to do this... actually consciously tell myself to STOP. I have to repeatedly ask myself if I still remember why I am here? I have to force myself to take pause,,, Re-center, refocus, and renew the hopes, dreams, and aspirations that got me to right here. In the chaos.
Kitten pile. 5 of the 54 we helped re-home from a dire hoarding situation.
Here is a veterinarian. Here is a 7 day a week veterinary clinic with a heart so big people travel from miles away to be a part of our mission. The marrow of our purpose. Here is 12 hour days packed with more cases than the day can contain. If I can't help them they too often don't get help. There are industry wide whispers about seeking and maintaining a "work-life balance" but the reality is that the advice easier to dish from afar than it is to swallow. The reality that I hoped for this. I got exactly what I asked for.
I got here because I love pets more than my compassion for humans could convince me to study medicine for the sheer bliss of helping a human who already had a death wish provided. People are complicated. They like complicated. Pets, animals in every species, are easy. Life, liberty, freedom, and no false bravado or pretense for personal gain at your expense. The simplicity of their lives, as little and seemingly insignificant as they seem, are splendidly beautiful in their quest to live in the moments they are given. Their fears are only in their losses, never their greedy gains. Humans make life hard, painful, burdensome. There are angles, trust issues, and acquisition/preservation of gains to contemplate. Pets, no they never steal your heart and break it for less than you were willing to invest. They fill it without asking what's in it for them. They define, and eternally exemplify, unconditional love.
There is an endless sea of veterinary need. For those of us who take personal pride in the feeling of being needed, even desired or sought after in the professional sphere the ego boost can be invigorating. The problem lies within the minutes between the chaos. I get lost here too often. I can't find my footing and with that I lose my compass.
One of the Motel 5, 2022edition of the Good Sam rescues
So many days, (I would say the vast majority), go like this:
I start the day driving to work heart pounding. Cortisol surging through my veins. Every inch of them. Heart beating out of my chest. The drumbeat reminder that the day looms before me. Taking deep slow breaths and trying to replace my current overwhelmingly dismal mindset with some podcast of light jovial banter. Half of my days are filled with surgeries. These are the days that cause the deepest despairing and yearning. "Lord, just let them all live through the day and be better off for my scalpels precision." I absolutely say something this corny and pathetic. I obsess over these patients. Their predicaments. Their necessary, life changing surgical interventions at my hand. The cases that only have me as their only life saving options. The much heavier burdens to bear; the routine spays that can bleed out behind your back after you thought they were sewed up nicely and left to warm up and revive. The routines will break you. The adverse outcomes you never saw coming. Never mind the pet parents who debate, doubt, and despair over these "routine surgeries" and whether the risk of anesthesia is worth the lack of heat cycles they will have to endure. People worry about their pets in degrees that I both identify with, and break my back over fearful burden with. For all of those clients that fret, I promise I fret with you. I am hiding in the bushes these days. Passing cases anytime I can to a boarded surgeon, internist, cardio specialist. I pass the buck at every chance possible in the hopes that these patients are better served elsewhere. The measure of success is in outcomes, not deposit slips.
For these days, these fearful-filled stress like you cannot imagine, days, I know every patient that I will see. I compartmentalize them. If hope and well-wishes could motivate fate I expect I am blessed and flush. It also makes the weight of the elephant on my shoulders mammoth sized. Remember the days when pets were just "pets"? The kind that lived in a box outside? On a chain. Yeah, I don't either. I know the pets that have names as endearing as the well thought out collar and matching onesie they had custom made for them. I know these pets, my patients, and I know that they are just exactly like my own. Family. Irreplaceable. The most important part of our human days are the pets we share them with. They don't just fill our home space, they define our happiness, well-being, and place of belonging. It is the kind of clientele I attracted. Hoped for. Wished into existence and fought for. Heart on my sleeve, berating the profession that so vehemently wants to protect the "pets = property" legal designation as they promote their personal professions of "pets = family" worthy of kidney transplants, chemo and costs of care tipping the bar of elaborate weddings and lifesavings. Smiling out both sides of our faces.
Two of the 54 from last years Good Sam endeavor.
My patients, the ones who land on my surgery day, they are much more than a name, an age, a species and a problem. They are my lifeblood. My responsibility. My only obligation for that period the anesthesia is running and the heartbeat is defining the rhythm of the moments. They are my mammoth to carry to the other side safely.
The measure for me is really simple. Your pet is one of the greatest gifts ever given to us. A personal treasure beyond weight, or measure. That value is unmeasurable. Hence, my mammoth, and my dilemma.
You see my challenge. How do I stay true to my belief that every pet is someone's bedrock, and, not let that become a mammoth that puts so much pressure on me I hyperventilate on the drive into the office?
Clarke.
I am successful. Profitable, but yet still so burdened. I wonder if they are inseparable? Does one only come without the other?
Yes. I think so. For me. For my measuring stick. For the kind of success that I am interested in.
Oaken. May they all be as beloved as he.
Maybe I need to be asking myself about contentment. If that is measurable?
This is a blog about the journey. There is not a destination. Nor, is there a typical audience. Just a diary into the ethos to cast out the inner musings and hope they find a place to settle outside of my soul.
Each entry is a step to a place that like every other will have an ending. Its the little fragments of time I steal away to peel myself from the arduous work that is my life's joy and legacy.
While I recognize that this is prejudice, I also recognize my own limitations.
I mean isn't that fair? Didn't the Supreme Court decide who could, or, didn't have to, bake cakes? Why not have my cake, and eat it too? (The degree to which cake defines acceptable social tolerance is alarming, isn't it?).
Seraphina. She is adamant that you will hold her.
I would like to believe that I am the person who accepts all; lovingly, unconditionally, and without the harsh judgement that divides, alienates, and perpetuates. BUT, it turns out I am after all the person who yields death, AND, therefore, I feel I deserve reprieve and definition to my latitudes.
No one enters my realm unless they love their pet. in itself this offers a huge range of persons. those that love so much they cannot bear goodbye. those that love so blindly that cannot see the path of despair they reap. those that love so much they will not permit one ounce of struggle...the list goes on.
My Charleston. Second chemo session. passed away 10/21/21
If you aren't sure what I am referring too, let me explain the polar end of loving so much..
The woman with the elderly cat with the facial mass. She found me after visiting a dozen other vets. Two of them specialty clinics with all of the options available for every disease and ailment imaginable. These are the pinnacles of exceptional care and treatment options. She had been told by every single person before meeting me. They all told her that the mass on the face of her cat was so advanced that it was no longer curable. There were no surgeries, no medications, and unfortunately this cat was so debilitated that not even oncology had any suggestions. Cancer is often like this. It can cause such devastation that at some point we should seek merciful end of days, versus, fighting for an ending that leaves no hope for any quality of life. What was best for this cat? Simply helping this woman understand what lay ahead for both of them. She refused to see what all of the rest of us were telling her. She refused so vehemently she became angry. Argumentative, accusatory, and nasty. I kept repeating to her that I was on her side. Her cats side. They are not, or at least did not, have to be separate sides. She couldn't see it. She did not believe us. Any of us. None of us should have to suffer. This cat was comatose and suffering. Now for all of you who are as incensed by this as I was, there were measures in play to help. Animal Control was on her case before she came to me. Another vet before me had reported her. It is incredibly difficult to force euthanasia on anyone seeking care for their pet. Hospice is an option for all of us. But, just like all of us it requires acceptance of dying. My mom couldn't see her own cancer killing her. I get it.
The woman with the mass that took the life of the patient. What about the client who brings in the happy, active dog with the softball sized mass that is bleeding, necrotic and seriously problematic for both his quality of life and his family. Bandages cannot contain masses of this size and severity. They only go away when taken off. Nothing (alright, to be honest, almost, nothing hurts my heart like euthanizing a mass because I don't have a chance to save the patient from it. (Veterinary pearl of advice; don't wait to do surgery on a mass that will never go away without surgical intervention. Take it off asap!) Ask me how many old dogs with yucky masses I have taken off and had them live years, yes, years, after. See Spencer's story).
The hoarder who loves kittens so much she cannot spay. Ugh. This one drives you to question humanity at its core. The most egregious hoarders that I have tried to help have been compassionate enough to see the respiratory infections, the lethargy, the signs of illness, but, they are resistant to spaying and neutering the whole colony. Why? Well, they don't want to admit it, but, the core of the hoarding is the feeling of purpose and feeling needed. (Every veterinary professional can identify. It is why we are all here.) If there are kittens you are needed. If the cats are sick you are needed. It is an impossible cycle to stop. They will go adopt new kittens if the colony is sterilized. It makes you crazy to see the cycle of dying, disease and suffering be promulgated due to mental illness. Cats need to have kennel licenses required by law. It is the only way to curb the tide for this situation.
The old man with the lifeless chihuahua who cannot put him down,, even as he is agonal. The times when an elderly, (it has happened twice, and always been very elderly), man cradling his dying dog and refusing to let go. There is obvious suffering, and still, they cannot let go. Who do I advocate for? Who do I work/serve? There are times I do not know.
....at least there is some salvation with them,, some bedrock of a foundation that helps me justify the end,, at least they were loved..
The people who give up at the first sign of hardship to spare suffering.. . There are cases that wag, wiggle, and delight into the clinic. Most are here for routine examinations. Every blue (black?) moon these patients are attached to clients who perceive something I do not. They feel their pet is unhappy. Struggling in some unidentifiable fashion, and, therefore needs to be put down. I reel on these cases. I offer free everything: diagnostics, exams, drugs, every pain medication in the arsenal, even taking custody of him. These, yes, absolutely these cases are what ruin me. I have had two clients, both men mid 40's, yell at me. Threaten me, and yes, even charge my via the State Board, that "I work for them." Get so angry and unhinged you fear for your safety. They, (my perception) seem more about the control of it all. The embarrassment of being challenged. Called out. Questioned. That they resort to anger, outrage and threats. One I will never forget is Chuck the dachshund. When Chuck walked into the clinic he bounded toward the treat jar at the front desk. He sat, waited patiently with the drool running down the sides of his mouth, and gulped up three treats the receptionists gleefully delivered. He was euthanized because they were going to have it so even if it meant dropping off at the shelter to have it done by someone who primarily euthanizes via a cardiac stick and doesn't know him. He would be afraid there. He was loved here. I hugged him, cuddled him in my arms, and cried. I made it as full of love as I ever did for my own pets. He was mine in that moment. He was the most beloved dog who ever lived. They weren't going to watch. They told me so as a weapon to remind me that they were so hurt by the loss they couldn't watch. I can't put into words the hate that burned inside of me at that moment. I whispered in his ear as he fell asleep that I loved him, and I hope he returns to pee on them every day of the rest of their lives. Let Chuck be the karma I couldn't deliver in person.
Did I have to do this? Put Chuck down? No, of course I could have declined. I have done so only to have the Sheriff be called out to witness the dog being shot in the backyard tied to a tree.
(Middle finger salute to that idiot who ever said "what ever doesn't kill you makes you stronger.")
Like it or not, the minute you threaten me is the same second my claws come out. Yesterday I screamed back into the phone to a woman who was insistent to tell me that "she has friends who do not like me!" It was a dagger she thought would hurt me. She wanted to hurt me because I was forcing her to wear a mask in the clinic. I very loudly told her that "I truly didn't care what anyone thought of me." I am over that manipulative crap. These two guys, gone for good. Hip-hip.. I definitely don't work for them.
Jitterbug. My beloved cat. Passed away September 2021
The wise old veterinarians before me would tell me that it is not my place to judge. While at the macroscopic this might be best for mankind, it is not the reality of the world I am trying to stay alive within.
Diedra, always a smile. Me, claws at the ready, yet still looking for the next adventure/challenge
Can you love too much? No, I don't think so, but, you can love so much that you are blind to the other person/soul/being/dependent in the relationship. You can love so much that it is destructive to the others around you. You can love so much that there is no other perspective to influence decisions. If that includes your health care provider they cannot do their job with the best interests of the patient first. I also cannot survive with a compassionate spirit to guide me.
End Note;
This blog is about the lives I meet and the struggles I face as a veterinarian. It's about the endless questions that I grapple with everyday as I try to find my way. I can say that I am trying to stay true to who I am, and why I chose this profession. But in reality I am just trying to keep that little girl who always dreamed she would grow up be a veterinarian, in the face of the harsh realities the adult me has to manage, alive.
"I have such great news! .... My mom found a home for the cats!"
It is a tough ask; pitching two adult cats to anyone. People adopt babies. Cute fluffy new babies. Teenagers, well, teenagers are a hard tough sell. And yet it happens; life, and it's unforeseeable twists and turns leaves us in a place with pets we are not sure we can care for any longer. None of us want to feel as if our own life is so fragile, so uncontrollable, or, so unpredictable that we are one bad decision, or, phone call away from bankruptcy, homelessness, etc.. But, these things can, and do, happen. People get a twist in the road of life that derails them. They find this place where they are no longer able, or willing (in some cases), to support their pets. What happens to them, our companions we brought into our lives, should we ever find ourselves here? In my life, and this line of work these stories end up as preludes to these dilemmas too often.
A few years ago a house fire threatened to leave a client and his 42 cats looking for new living arrangement options. (Yes, 42!). He began collecting cats as a rescue effort. One or two here or there, a litter became four litters, and 7 years later his 4 bedroom home included 10 to 20 cats in each bedroom. The litter box management alone left everyone smelling like sewage. The house couldn't be kept up. Random pieces of appliances began to fail and he feared letting anyone in to fix anything as the cats would literally be out of the bag. He began using a hot plate, and a kitchen fire happened. Thankfully no one was hurt, but he realized his cats were almost public knowledge, and if this happened he knew his whole life would come under county scrutiny.
This is a man who loves his cats.. Like many hoarders he has more than he can care for and he also believes that surrendering any of them places them at a far greater risk then their current situation where they are overcrowded, underfed, and lacking in basic medical care.
He fears the public more than he can see his participation in the denial of the affection and health to his cats that they so obviously needed. He always believed that his life was managing fine, and his cats are happy because he loved them.
After years of trying to help him and his cats with multiple attempts to spay and neuter everyone (which never happened because the few we couldn't catch were too feral to trap), I realized he didn't really want a population neutral home. He wanted more cats. Kittens to be precise. Kittens made him feel needed. They were so small, vulnerable and often so sick. They needed him to nurse them back to health (because they all were after all unhealthy and always sick), he had concoctions for every ailment. He began to resist spaying the girls because he wanted "to focus on the boys," and, "most were related and they wouldn't mate if they are related, so I didn't have to worry." I spent years begging and pleading him to start considering adopting out some by letting us find homes for the youngest, the friendliest, the ones we knew other families would adopt. But, he would never even consider letting even one go. Not one kitten. Not one feral adult. They all had names given to them as soon as they were born. He knew who was whose grandparents, siblings, aunts, and uncles, etc. This was his family. He loved them more than he could see what that love was costing them.
After 10 years of seeing bad decline into criminally negligent and mentally incompetent I was broken to resolve that I was merely a spectator watching his cats die more tragic deaths than the parents before them had. The problem over the years had gotten bigger, and more alarming and he just wasn't seeing it. A few timid cats turned into 40 plus (although I suspect the number is 70 plus) indoor cats with severe emaciation, respiratory failures, illnesses that can only be explained due to massive overcrowding, inability to manage basic sanitation, and starvation due to dental disease that left the cats unable to eat and dying to in the process. I gave up my ability to believe that I could make his cats lives better. I realized I was just flaming the fires of an inferno and watching cats die more excruciating deaths than I could intervene on. My last straw was a dozen plus cats who starved to death from stomatitis. A cat with stomatitis has inflamed gums that causes such severe mouth pain they can't eat although they are desperately hungry. One emaciated fire mouthed cat after another showed up. Each so sick they couldn't fight the stranger they knew everyone to be. So weak and yet afraid to eat they gave up and willingly died in a corner of a cage that offered no reprieve.
Any person who hoards is already a difficult person to relate to. There is always a lack of trust, there is always a degree of denial that often turns into defensive denial coated anger, and there is always a helpless life hanging in between.
I got to the point where I knew I wasn't helping anyone. I was just prolonging and participating in their and my own suffering. I didn't want to continue to be an accomplice to his feral cat breeding side show circus any longer. I explained that the conditions had gotten to a point where they were no longer manageable, that I felt as if I was complicit in this, all of the death, the disease, the perpetual continuum of it all, and I couldn't live with it any longer. I tried again, and in vain, one last time to be the advocate for his cats who he dedicated every minute of his life to.
At the end of my attempt to open his eyes to the state of despair his cats were living in I landed the ultimatum. Either he got help, or I would report him to the county animal control officers.
Helpless is a place for the meek to hide in. Helpless and hog tied as a bystander is torture beyond forgiveness. I was the enabler watching disaster strike over and over again.
I never saw him again.
Over the next few months the local shelter received 5 hoarding cases. Each case had between 20 to 80 cats. All were thin, sick, and covered in fleas and feces. I would estimate that less than 5% of these ever found a home. Most were too wild to be adopted. Some ended up in barn colonies. Others just died of fear.
It is impossible for me to tell you the worst way to die? It is impossible for me to say there is anyway for a happy ending in these cases. It is also impossible for me to understand people. Veterinarians seek animals to fulfill our healing purpose, people we distrust amongst our dislike.
I grapple with the fact that I ever made anything better for these cats who deserved a life of so much more. I still ask myself if they were better off with quick death from someone who doesn't care about them, versus the slow death they got from someone who does? There was no happy ending, I just got out, and, even in this I wonder if it was the right thing to do?
"I have such great news! .... My mom found a home for the cats!" Jenn, my office manager, relayed the seconds ago phone call as she came bounding into my office.
The excitement in her face was obvious. The relief was inflected in her tearfully bubbly words.
We had spent much of that morning, and previous few mornings, discussing this dilemma of the impending eviction. The eminent need for a home for two older cats whose long time clients were moving to a smaller apartment and not taking them. We, the collective of us who manage the vet practice, had decided many many years ago that if we wanted to run a family-oriented veterinary clinic then we had to stick to our words. Be more than a trademark tag-line and actually stand by it. We aren't going to say that we "treat your pets like family" and then not really treat them like our family. So, we do. We offer payment options, free boarding, intervention care and emergency care to our patients when the pet parents need it. In the past this has included; emergency boarding for family emergencies, the automobile accidents heart attacks, deaths and even domestic abuse and inclement weather needs. If needed we even do it pro bono. We have never put profits above compassion, nor, pitted purses against pet care. We stand by our patients at their best AND worst days and most dire times of need.
We had also learned the very hard learned lesson that if you give someone an easy out they never truly take responsibility, and they hardly ever follow through with their end of the bargain. People who abandon/surrender pets already have an emotional disconnect, or, they are so far removed from financial ability that follow through won't matter. In 15 years I have only had one surrender I ever felt right about. (See Cole's story here). The rest were clients who had a history of disposable lives the unloaded (often obviously un-remorsefully and un-apathetically onto anyone else who would take them. Once you surrender in (many places) you are forever blacklisted from adopting again. Shelters, rescues, and yes, even us, won't adopt out to you again. Ever. (How can we?)
This particular family were losing their home. It was something we had known was likely for months. We had been in constant contact with the family to get as much social media saturation as possible. Just that morning Jenn had told me that she was scheduled to visit the home to take an in home video of the cats (as one of them was very shy and wouldn't film well at the clinic). She had planned her weekend around this home visit. We all know how hard it is to place adult cats, especially shy reluctant cats. When I asked how the visit had gone she told me that they had cancelled it.
"Don't they understand how hard this is going to be? How we really need to find them homes before bringing them here to live at the clinic."
We have taken two other pairs of cats into the vet clinic over this last year. Our current number of in clinic cats stands at 6. All older, all tough sells to find homes for. One pair came from a family who had developed allergies. The other from a family who just didn't want them any longer then the 10 years they had already had them. One of these cats had gotten so depressed, fearful and withdrawn that we feared he would die from the stress and anxiety our busy chaotic clinic landed him within. I had almost gone as far as placing a feeding tube to force feed him. Cats bond very closely to their owners. Even if they aren't a lovey-dovey lap cat they know who their caretakers are and they adapt to their home with a dependence not seen in other species. When their world changes many of them cannot handle the insecurity. They withdraw, they stop eating, they stop grooming, their depression can kill them. Even when they don't appear to love and need human companionship they die without their people.
"No, she cancelled over the weekend, and that was before her mom had called her to say that she had found a home for them."
"Do you know her mom?" I asked.
"No,"
"Call the shelter. I will bet you a thousand dollars she is just going to bring them there."
...."WHAT! Are you kidding!!??" Jubilation transitioned into shocked perplexity and angered pause.
"No, I'm not. I have never known her mom to be a nice person. She had a sweet cat named Feather, the only time or attention she ever gave that cat was letting her follow her to the mailbox every day. She was never allowed inside and she was never more than a cat., and she also never says anything nice about anyone, her daughter especially. Call the shelter, give them a heads up."
The next day the shelter called to say the cats had been picked up by Animal Control. The mom had requested they be euthanized. She had expressed that they were better off dead, something about being concerned that they would be "abused if adopted to the wrong people."
Now, I have to pause here. I have to stop here because as hard as it is to believe I hear this a lot. Too often. It bleeds into this paranoia, the same paranoia that precludes a person from finding homes for his 42 cats who are dying slow deaths around him, in his home. He firmly believes that all of his cats, whom he loves and will admit to repeatedly loving, are better off with him than anywhere else. He is blind to their suffering. Distrustful of everyone else in the world. Which also included me, the one vet who would allow him to drop off any sick cat at any inconvenient time, AND, not force him to pay when clearly he had no ability to afford anything.. Even I was threat so intense that I had to be cut out. The same paranoia that allows people to believe death is a better place than chance when you dump them into societies mercy.
The lack of trust in medicine, in compassion, in humanity has been one of the hardest pills to swallow.
The shelter called to ask for medical records to be transferred to them for these two adult cats that we had just been told Mom had found a home for. I interrupted. I have such great news! .... My mom found a home for the cats!
"Who dropped them off?"
"Mrs. MOM did" they replied.
"Well, she isn't the owner!" I exclaimed. I was excited to have caught them before the euthanasia filled needle did. Before they were lost in an overcrowded shelter. Maybe, I thought, if I could show that these weren't the MOMs cats we could get them into a better place for their second chance?
The rest of the day included multiple phone calls to the shelter staff to promise me that they wouldn't euthanize the cats, the Animal Control Officer to explain the whole situation and urge him to go and speak to the cats real mom in person, and the vet clinic staff, just in case someone came packing and angry. We have had to go on lock down before, get restraining orders, and do emergency shelter recons before. You put everyone on alert when shit like this happens.
When I was on the phone with the Animal Control Officer I begged him to go to the cats home in person. "I'm afraid her mom lied to her. We have offered to help to find homes for the cats, give them a foster home, all so they wouldn't have to be surrendered, which was what she told us all along she feared the most. That sending them to the shelter where they could be euthanized if they were too scared to be adopted might be their fate. Please go! I just can't imagine she would do this, or knowingly let her mom do this? And, please give her my cell phone number. She can call me anytime. We will help her and her cats."
The next day the shelter called back requesting records. She, the cats real pet parent mom we have known so well,, hugged thousands of times, cried with over the loss of her pets, shared holiday cards with, loved more than any other person/client/friend/and even more than family had signed them over to the shelter. Their fates, as the shelter will openly admit to, are open, can be decided to be terminated at any time (because surrendering allows immediate euthanasia), and I am devastated beyond words.
I do not understand people.
Why would you not trust us more than the shelter that can/will/might kill your unadoptable/stressedout/abandoned-and-petrified cat?
It is impossible for me to tell you whats the worst way to die? It is impossible for me to say there is anyway for a happy ending. It is also impossible for me to understand people.
It is increasingly more impossible for me to not judge people as I try to dissect into the comprehensible these non-sensible pieces. I live in a profession where people decide their companions fates. I live in a world that I still willingly invest my heart and soul in, and I live in a world where even those pet parents who I think/feel/believe will fight and die for their pets don't.
And I'll be damned maybe, but, I sure don't understand them. The hoarders are killing their cats with selfish abusive neglect they cannot see, and, the disposers pass on a problem to let their guilt succumb to freedom knowing full well they can be, and often times are, euthanized. Because in the world of shelter medicine surrender allows anyone to decide at anytime whatever fate they want to deliver.
The pets, these defenseless deeply emotionally attached to us regardless of how atrociously we treat them, well, they deserve better.
I spent the night trying to figure out how I could be so wrong about her? Her obvious love for them?
Do I call her and try to unravel this? Do I secretly go get them and hope that I never see her again?
The next day Jenn called. "The Humane Society called. They are full, they want to know if we will take them?"
This is where the soul of every vet/every rescuer/every humane is decided. The little pieces. The incremental stories that your life gets entwined in and the facing of the fact that you do care more, you always have, and that's what makes you who you are. For me, the little fired-up vet who looks at every one of her patients as HER patient, HER family. I will never abandon you, or fight for you, without or without your parents.
"yes."
Here is the video of us picking up the cats. Meet our new JVC kitties;
Here's my video of how these cases affect me;
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