Hello 2022, Whatcha Got Up Your Sleeve?

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

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

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

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

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

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

Here's the dilemma..

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

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

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

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

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

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

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

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

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

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

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

We were so lucky.

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

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

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

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

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

The Fortress You Retreat Within

 The house at the end of the lane is mine.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 The veterinary plague in the pandemic.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 unprecedented times of veterinary medicine and the pandemic.

It is the middle of August 2020. We are 5 months into full on COVID-19 pandemic mode. Within my professional life as a veterinarian the ripple effects of this have reached places I never saw coming.

We are a 7 day a week, 5 doctor veterinary clinic about 45 minutes north of Baltimore, MD and we could not have imagined, never mind prepared for, what COVID has delivered. I have been a veterinarian, and practice owner for 15 years, and although there have been numerous rough spots along this journey there has never been a time where I more question my stamina, and fret for my patients, than now. The current state of our profession has become an ever growing chasm of unmet needs meets unparalleled exhaustion on all fronts. There is also no discernible end to this "new normal." The degree of personal stress, emotional questioning for well-being, and the public's visceral anger and ugliness has us all at a boiling point of which I fear great personal, professional and accessible losses will result.

Here is a break down of where we, my little vet clinic is, and, how we got here. Jarrettsville Vet used to be the routine general small animal veterinary clinic where doctors saw appointments with pet parents holding their pets on their laps, or on a leash, all the while going over important patient points. It was a calmer exchange where personal time was fostered. I have always been honored to be a part of a pets care, and, to a great extent also their parents life. Feeling needed an appreciated is the purpose so many of us strive for. In clinic personal care was delivered in real-time with multiple options given for treatment care and an all-for-one team approach. We have always taken pride in being transparent with affordable prices for a huge range of pet ailments. We do not turn away care for anyone who needs it. We have stayed true to our values and we have been in business for over 8 decades.  With this pandemic a few things have altered our approach on delivering this care. We have to wear masks, we have to stay distant, and, we still have to hold onto what makes this personal emotionally enriched care genuine. 

We began curbside services, thereby keeping the public out of the clinic because we could not provide adequate or acceptable social distancing, began in April. We split into teams to try to insulate at least half of the staff if a positive staff member would cause us to have to quarantine, or even shut down. We did everything we could to stay viable while also trying to stay safe. It has not been easy to lose the personal connections, most notably for the terminal, the dying, and the euthanasia's, as we tried to stay open with some semblance of doing the best we could in meeting our patients needs. We have had to rush dying patients into the clinic and witness them die without their families who were outside in uncontrollable hysterics. It is not who we were, nor ever wanting to be. 

With all of this change it has also brought along a never ending list of unmet expectations and needs. We are not unlike many, if not most, of the veterinary clinics in the U.S. right now. The current state of this pandemic has left us saying we cannot help, and, we cannot keep up. We also are afraid more then we ever have been. It is a mounting storm without ceasing winds to calm. 

What's the cause to our current patient care dilemmas?

Demand has over run supply.

There is an increasing demand for care, as there has been an increase in pet care ownership, and, a decrease in vet staff availability.

As of this week my clinic, we are booked about two weeks out for routine care. This has never happened to us before. We are now having to place blocked appointment slots into each doctors schedule for every shift to try to manage the same day requests for urgent cases. There has rarely, if ever, been a time before where we couldn't fit someone in within 24 to 48 hours for an exam. Almost all emergency cases were provided a spot within the same 4-8 hours. We  are a small town, deeply rooted within the community, practice and we know that long term relationships built us. To abandon our clients in their time of need only undermines the trust and reliability we have worked so hard for so many decades to establish. For most of the clinics around me they are booked days, weeks, or even months out. When they are and they get an urgent call the client is told to "call around," or, "go to the ER." No one wants to be told that. But, it is the reality across the board for all vet clinics. We are seeing more cases than ever. Why would we be immune to a pandemic, or, even over burdened with patients within it? 

The answers lie across our spectrum. 

Where did the increase in pets come from? This is the results of a multi-factorial burgeoning of demand.

• increase in adoptions/purchasing of pets.
• clearing of shelters.
• people have at home and personal time they never had before.

The shelters were placed on indefinite closure as they had to keep the public out. If they cannot allow the potential adopters in to help advertise their adoptable pets then the outflow was going to come to a halt. To avoid this many shelters offered free, if not significantly discounted adoption fees, to try to clear them before the next shoe dropped, (i.e. staff gets sick and no one is available to feed, water, clean and house). 

Pets have been adopted/purchased at record rates. Along with the increase in demand for adoptables has been an increase in now-full-time stay at home workers to have the pet they never had time for before. People hit the internet looking for a companion as they socially distanced from the rest of the human world. 

Dwindling supply for pet healthcare caregivers;

• vets and vet staff who are home self-isolating.
• staff were hard to find before the pandemic.

Just like a swath of the population, there are veterinarians, and veterinary staff who do not want to expose themselves, or their families to infection from a disease they are at high-risk for. I have staff members with elderly parents they are caring for. The risk is too great for them, and hence, they are on an extended undefined leave of absence. at any given time 10-20 % of my staff is out due to COVID influences. We started this pandemic short on staff. COVID has exacerbated it.

The stress of a trying to be everything to everyone and not knowing if any decision is right.

• the difficulty of managing a practice through ever evolving,and changing, information.
• the strategic planning needed to try to stay open and safe.
• the ripple effect of bad practices now magnified by a greater need.
• the poor planning of not being able to catch up as you try to prognosticate ahead.

The allegiance and the pressure to meet all the demands across all spectrum's of personal, professional and ethical standards. Feeling like I am expected to meet every need of every soul under this practice is overwhelming on our best days, add the stress of non-stop phone calls for help, and knowing my own physical limits are at the brink has me thinking that maybe the vets sending all the excess elsewhere are serving best by serving self first? 

The fear/anxiety/and division while trying to keep ourselves safe and alive.

We all feel it, don't we? The anger/fear/and degree of stress we have never before experienced, and now it's daily, worldwide, and on a magnitude we cannot comprehend by any previous experience. People are stressed in a way we cannot ignore as real, and, they take, are taking out, this anxiety out on us. Add the emotional element to the package and the boiling point lowers. If you fail to serve them they can, and have, opened a wrath that leaves you with bad reviews, crying staff, and yet another reason to not work when pay is available elsewhere regardless.

Burnout. The staff, outside of the doctors, and hospital administrator, are all on hourly pay.  I have to keep this in place, even though we need them all at almost every breathing moment, to force down time. They stay longer than needed. Ask repeatedly about leaving us, and whether we will be "ok?" And, yet I have to tell them to just walk away. There is not an end to the day past the automatic shut off of the phones. 

I leave everyday with an unsurpassed list of things being left undone, and a chorus of faces I worry about overnight. Will they be ok throughout the night? Will their families stay safe and healthy to provide them the oversight they need for their own survival? Can they reach me if needed?

The vets, we are maxed out. We feel compelled to help. To answer every call. It is what we are cut from, and yet, we cannot work enough hours to meet the demand. 

The place we have found ourselves.

Emergency veterinary clinics are seeing the cumulative effects to the greatest degree. Many of these new pet parents cannot establish a veterinary clinic based relationship. They are not finding a clinic who will see them in the time sensitive manner all new pets are ideally seen within. (I say three to seven days max!). 

Where do people go? they have been turned away at the vets office, the ER was already too expensive for many, and, now the wait is, and can be, from 4-24 hours. Puppies with worms, and/or, who are sick are being told by their vet that the wait to be seen is weeks. They don't have weeks to wait. So, parents head to the ER to be told the wait might be 24 hours. Am I responsible for this puppy? What about if I know that minutes matter for survival? What would you do?

A larger number of the clients going to the ER have no primary care vet. They are turned away at every vet clinic that they call. The ER is all they have left.

My clinic is open for walk-in appointments on Sundays. Sundays have turned into our receptacle for all the non-emergency cases I couldn't find time for during the week. I am taking Saturdays off to rest, because I have to. My core has to, and without being able to see the spill overs on Saturday they are told to come in on Sunday. Last Sunday for the walk-in hours of 1-3 pm, I saw 20 cases. All sick, all in need of care. I stay all day Monday through Thursday. I see everyone who is a client and calls. Fridays I go into work to catch up, to see the spill over. 

How am I coping? I am not sure I have a clear answer yet. I am desperate to keep the long game in focus. Remind myself that I carry the lives of my staff at my forethought, while reflecting on the legacy of the veterinarians who bore this clinics torch before me. Those who survived wars, depressions, and the plights of a rural community whose animals allowed them simple basic survival. Without the veterinarians who built this clinic I would not be here, nor, would my self-inflicted responsibility to carry on through whatever adversity facing us be so profound. We are deemed essential as we control the tide of zoonotic diseases, maintain a food supply, and protect the family members so many of us relegate our pets to. "Essential" adds a layer to this complicated bitter onion I never saw previously. With that I feel even more compelled to not lose my footing as I run this never to be seen horizon race. 

There are personal stories I have never shared. The clients who call needing immediate emergency care, or hiding within self-isolation and attempting to manage potentially life threatening cases via video calls. None of this is ideal for the patient, and yet I have made judgement calls I know I could be sanctioned for. I continue to practice medicine within a web of uncharted waters and a public as jarred as I am. 

Where I have seen this community come together and assist in ways I couldn't imagine outside of an invasion, I have also seen people react with vile vitriol I feel immeasurable to the insult at hand. The slightest, (seeming to me), insignificant annoyance reels people into fits of anger that leaves the staff fearing personal harm. I have forced clients in unprecedented numbers out of our practice in a desperate attempt to nix a fuse that I can only see more emotional trauma stemming from. We have had to add signs asking people to "wear masks and be patient," and, with these I still have people refusing. There are words coming out of my mouth that I feel will only add more vinegar to a wound surfacing before us. "This is private property that I own, it is my mandate that everyone wears a mask." To be met by spitting seething rebukes of "you cannot tell me what to do," and, "you cannot catch COVID outside." The point of helping a pet in need has soo often being overshadowed by an on-the-brink-of-breakdown of a human, and, too often I fear I am that human.

I am exhausted. More exhausted than I have ever been. This includes vet school training, working multiple day long shifts on the high seas, and the pains of being both a new grad and a new practice owner trying to shoulder a burden beyond my experience and expertise. The days I am working now start at 8 am and extend to, or even past, 9 pm. No bathroom breaks, no food, and so mentally stretched I have to tell the staff that I cannot safely handle another cases. For as much as I want to help, and cannot bear the idea of turning away a patient who may not get help otherwise, I have limits. If I push them any further I am going to make a mistake and it may hurt, injure, or even possibly kill someone. Fear, exhaustion, and pressure to be a vet, an employer to people I deeply care about, and keep the business alive when I feared for months I would not be able to, has me needing help I have never asked for previously. My village has become an interstate of traffic coming and going as friends leave food, walk my dogs when I cannot find time to, and help with laundry and household chores I cannot dream of returning to. I have had to say previously impossible "No's." "No, I cannot do a TNR." Or, "I cannot see that dying kitten," "I cannot take home that patient for overnight care as I fear I cannot get up if I fall asleep." No's I hate myself for uttering. No's that might cost me my personal legacy as I triage the others I am desperately trying to keep alive.

I have my email posted in every corner of every client interaction. We use Facebook messages, personal phone numbers are given to any client in possible need of immediate return. I have socially distanced from everyone outside of work so that I can remain at work with the least amount of risk possible. All decisions have been made to protect the hive. Isn't that what I promised myself at the beginning of this Pandora's nightmare box?

In the end, and the whole point of the lessons we are learning within this pandemic is, that we have to get out alive. For some this is best believed achievable by sheltering in place until the world rights itself again, a year, or two from now. Just stay away from people, accept the risks associated, and, hope this bubble approach doesn't cost you a fatal delayed decision. For others, like me, I go to work, I diligently wear a mask, wash my hands, stay 6 feet away from clients, and only allow close proximity for euthanasia's which we do in a separate location. And for the non-believers, the people who haven't seen a death from a bug you never saw coming, I am reminded that negligence is too often the backbone of all medical professions. 

Like all inferno's this pandemic is alike in that it will end. Will there be a Jarrettsville Vet on the other side? Yes, of course. It is bigger than me. It has always been bigger than me. There is comfort in this as the small one doctor practices shutter when the quarantine forces their closure. But, will I be alright with my choices? I am not sure? I, like all of the rest of us paddling upstream to a place we have no knowledge of, all feel the same. We all have to get out alive.

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.

Triaged Medicine, The Veterinary Professions Answer to Who Gets What In Times Of Scarcity.

One of the hot topics on the human side of healthcare is how to manage limited resources in the face of an overwhelming need and critical shortages?

The scenarios range from anything like a massive flu pandemic where things like life saving medications or ventilators are in shorter supply than the demand requires.

Another would be oxygen in areas where natural disaster has hit. Think about a hurricane hitting an island and the power is lost. People need supplemental oxygen for surgery, respiratory disease, infection, burns, etc. What happens when the ability to provide supplemental oxygen is at a place of rationing?

What about food? Shelter? Medications? Or any kind of medical, health or supply that the masses need in a catastrophe? What about epinephrine pens that are now 800 times more expensive than it was a few years ago and needed in seconds to save lives? What about generic drugs that are no longer profitable (enough) to manufacturer but would be basic and life saving on a scale that hundreds of thousands of people might need immediately? Who would be given them if there wasn't enough for everyone?

Would you give it to the children first? The patient with the greatest chance of survival? The patient who provides the greatest contribution to society? Like the doctors? Nurses? Emergency response personnel? Yourself? Your family?

It is a tough thing to answer. It is also a real-life scenario in much of the world.

Does it happen in vet med? Of course. Every single day. Resources are limited. Access is limited. And not everyone gets the best of veterinary care even if it is available and accessible simply because they need it.

It is a common practice to utilize the skills, practice and lessons of another profession when trying to decide the best course of action in a current dilemma. So, why wouldn't human medicine follow our guidelines and protocols for the same set of scenario's?

The same scenarios apply in both human and veterinary medicine, BUT, the compassion is lacking on one side of the care giving side. Veterinarians provide care to those that pay for it. If it was free and available on the same scale to everyone who needed it we would face the same ethical decisions to deciding who gets what when they need it. But alas we don't. It is far simpler to ration based on economics. Cut and dry.

Should it be this way? I am not sure? I think that the reason we on the veterinary side don't provide everything we can to everyone who needs it being simply based on a case of economics limits our ability to understand more complex scenarios. It skews our reasoning skills, our preparation, our sacrifice for a common good. It reduces humanity to individually centered scenarios and decision making trees. It promulgates and promotes self preservation on an individual level. It is impossible to make life saving decisions in mass casualty scenarios when the individual is the source of the lack of compassion on a larger scale.

So the next time you need help ask not what you have access to, ask what you are willing to sacrifice to provide it. Maybe the abandonment of self is the salvation of all?

Resources and Inspiration;

NY Times article, Aug 21, 2016. Whose Lives Should Be Saved? Researchers Ask The Public.


More information on me, this blog, and who we are at Jarrettsville Vet can be found here:

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