Leave No Patient Behind

George is a 9 year old indoor domestic short haired cat who visited us about a month ago for straining to urinate in the litter box, and producing only small amounts of urine. 

He presented again to us yesterday; unable to urinate. George is now a "blocked cat" or, UO cat (for urinary obstructed) cat. 

He found us, like they all do, with a little bit of luck, and a parent with limited resources. 

When he arrived on Saturday morning at the vet clinic we suspected that he was blocked. We also hoped that his parents had a rainy day account of immediately accessible funds so we could send him where he needed to be; the ER. The ER these days require a $4,000 deposit for this. It is beyond my comprehension what they do with that $4k, but it seems ubiquitous enough amongst the lot of them so it must be accountable in some list of line items. 

Within 20 minutes of Georges arrival at my clinic my phone rang.

"Sorry to bother you, (I was away for the Thanksgiving holiday), but, we have a blocked cat here." 

"Is anyone there willing to unblock him?" I asked.

"Yes."

"Ok, then we will figure out how to pay for it later. Have the owner go through our emergency sheet. Have someone else in the room with them to serve as a witness. And, make sure she is ok with us sharing the story and photos. Call me if you need anything."

"Ok. What would happen if we didn't help these cats?"

"They would die at home a miserable death, or be euthanized. Just like all of the rest of the cats. You know that." I replied.

My office manager agreed to go over everything with George's mom. She was working from home, on her day off because that's what George needed from us. George is a perfect example of who we are. He is deserves to be cared for. He is why I went into veterinary school. He is my WHY as much as any of the regularly paying customers are. Maybe more so.

George, the morning he arrived at JVC.

Here is the Facebook post we put up that morning; Georges first FB post here

"This is George.  He has found himself in a hopeless situation today.  He is blocked, and his mom only has $400 available to help him.  At our practice unblocking runs $800 - $1,000.  Despite the lack of funds we’ve agreed to help him, because we know without help George will die.  George and his mom could use some help financially with the cost of his care and treatment over the next couple of days.  Donations can be called in or made in person directly to George’s account.   Donations can also be sent via PayPal to jarrettsvillevet@gmail.com, please note that your donation is for George.

A big thank you to our kind hearted Dr. Ahrens who agreed to stay late to help George today.  ❤️"

A few hours later we posted an update;

Waking up from surgery.

"George is out of surgery and resting!  Thank you to all who have donated.  Please know any funds raised in excess of what is needed for George will be used to help another pet in a predicament like George. 

We truly couldn’t do this without the kindness and generosity of those who support us in our mission to help pets like George."

Two hours after the first post was put up we had raised $1900 for George. 

I posted a video on his story. Find it here; Inspire an army to save lives video here.

George update

One day post op. Looking good George

He is feeling SO much better with the help of our rockstar Saturday staff. He is getting his sq fluids currently (he is awesome at it) & taking his meds like a good boy.

So, George is a miracle, right? I mean its an incredible thing to be able to be given the treatment you need at a price your client can afford? Why doesn't every veterinarian do what we do? 

Well, because they think they can't. I hope to set an example of how this can be done. And remind everyone how good it feels to help save these lives.

We take a can-do approach to these cases. We take a leap of faith that we can save these pets first of all. We only offer payment plans, pro bono, take a risk on non-payment for cases that we think will survive and have a good return to a quality of life. We do not offer this to patients used for breeding purposes, people who are abusive, unkind to the staff, and who we do not believe will continue to provide routine preventative future care. For all of the cases we do not offer pro bono, or potentially not pay us back, we do offer to have the pet parents the option of signing over their pets to us. We will find a home for them, or keep them as our own for the rest of their lives. While this might sound cruel or unkind there are situations where pet parents realize they cannot provide the care their pets need, and they put this above all else. These are the people we want to over extend ourselves for. Sadly, almost everyone would rather their pet suffer, remain without treatment, and ultimately die than give them up. There was a case of a 4 year old dog who swallowed a corn cob who died recently after the owners declined the offer to give lifesaving surgical intervention. They watched her die over 4 days while they tried to raise the $3500 the ER required as a deposit versus signing her over to the rescue who offered to take her and get her the surgery she needed. 

Here is the document we use for these cases. We ask the pet parent to initial each line and then give them a copy for their records. If people would come to me and say "I love my pet so much that I would rather have her treated and alive with someone else than dead with me." I would do everything to save them. I don't think I am alone with this. 

For more information on this please see our website; Jarrettsvillevet.com see the tabs for Financial Assistance and Immediate Help.

All clients who cannot afford the estimate for needed care at Jarrettsville Vet must agree to and sign the following;

___ I understand this is an emergency.

___ I understand my pet would be best served at an ER, ICU, referral center.

___ The only reason that I am NOT at the ER/referral center/ICU is that I cannot afford it.

____ I understand that my pets current condition is (we fill in our differential diagnosis here).

____ I understand that I may not fully understand the extent and severity of this condition without a referral or additional financial resources

____ I have been given an estimate for care;

I can   ______        or    _____       cannot afford this estimate.

____ I understand that the estimate may change as my pets status changes. We will offer a payment plan if we go over your estimate.

If I cannot pay the estimated deposit for care I will;

1.       Sign a letter of collateral. If the invoice is not paid in 90 days the collateral will be transferred to JVC at my cost and the item will be sold for payment. Collateral item is; ______________

2.       Allow my case to be shared on any social media platform of JVC’s choosing to try to raise funds for my pet and awareness for their condition. This will help pay knowledge forward and maybe spare another pet from this condition.

3.       Follow all suggestions to include full story write up, starting a Go-Fund Me, sharing the fundraising efforts of JVC, and assisting with future fund raising projects at JVC

4.       Volunteer at other non-profits to pay it forward.

____ I allow JVC to share photos, videos and pertinent patient info for an indefinite period of time at their choosing.

____ I allow JVC, Dr Magnifico have full access and rights to my pets story. Past, present, future,

___ I will provide updates as asked and allow JVC, Dr Magnifico, the GSF, TPGSF, to share my pets story.

___ I understand that JVC has offered to help me care for my pet as an extension of compassion, kindness and shared goals to help end suffering and provide care regardless of financial constraints. It is with this in mind that I will be kind, compassionate, and generous with the actions and comments about my pets care.

___ We reserve the right to refer care back to an ER/ICU/specialist at any time.

 

Our Immediate Need Policy and Expectations for Non Clients are as follows: 

· We strive to offer affordable options for pet owners.

We usually require a full deposit at the time of intake for any emergency services. Our team will go over an estimate for your pet’s care once your pet is assessed. 

Please visit our website for additional resources to help with paying the balance. 

CareCredit may be utilized. You can apply for CareCredit via their website - https://www.carecredit.com/applyo Payment plans will be offered only to existing clients who have applied for or exhausted CareCredit. Payment plans are provided via Vet Billing

· Any financial concerns must be discussed at the time of receiving an estimate. 

· If you cannot afford the exam fee, the estimate for diagnostics and the treatment plan we will ask what is feasible for you financially, emotionally and physically to care for your pet long term. You are asking us to put your pet above the cost of running a veterinary facility, paying our staff and the emotional burden we take on with these cases.  

You will receive a copy of our Client Rights and Responsibilities and be expected to abide by it. We will not tolerate abrasive behavior directed to our staff. We are here to help you and your pet and expect to be treated with kindness. 

We will work together as part of a team for what is in the best interest of your pet. 

In working within the confines of financial concerns we may discuss with you waiving some diagnostics to keep the estimate within your budget. 

If it is determined that it not feasible for you to care for your pet long term, or if you pet is in need of immediate emergency care and we can not come up with a reasonable financial plan we may discuss surrendering your pet to one of the rescues we work with so that may receive the lifesaving care they need. 

· Jarrettsville Vet is a small animal general practice, we do not have staff in the building overnight. In most cases you will be expected to pick your pet up before we close. 

· We are working your pet in as an emergency. This means that the veterinarian may defer update calls to the support staff. Please rest assured that if your pet’s condition worsens you will receive a call. 

· It is our policy that if your pet is in need of emergency surgery and is intact, they will be spayed or neutered at the time of surgery. This is non-negotiable, if you are not agreeable to this clause please seek services elsewhere. All patients will also be vaccinated for rabies and given a microchip with Jarrettsville Vet listed as the contact for the life of this pet.

· You will allow us to share your pet’s story on Pawbly.com and social media at the discretion of the veterinarian. 

· If you receive funds from our Good Samaritan Fund you will participate in JVC or Good Samaritan Fund fundraising or volunteering and agree to the terms and conditions of our Good Samaritan Fund Recipient Policy. By signing below, you are indicating that you have read and understand our Emergency Services Policy.

Hoarders, Surrender, and the Worst Fate of All

"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;

If you would like to know more about the topics I discuss here please find me on Pawbly.com. It is free to use and open to everyone who loves pets. Please also consider joining if you have experiences to share and pet support to lend.

If you would like to learn more about me at the clinic please visit our Facebook page at Jarrettsville Vet.

For my YouTube channel please visit here.

For more information on my veterinary clinics services, including prices for care please see our Jarrettsville Vet website.

Thank you for being kind..