The Journey, The Missed Pit Stops and The Pile Of Regret Souvenirs

There were a litany of advantages to calling this blog a diary. It gives a considerable degree of artistic latitude and an avalanche of protection to the scrutiny of the squawkers so willing to judge and cast doubt.

Life lately is at a tipping point. That place where life changes indelibly and irrevocably. It is death lurking. The ominous threat has found my mom. She is 74, (everyone always asks me that, so, I will answer it from the git go).

She has breast cancer, no big thrill of the exotic here. Thing is it wasn't the most usual of presentations. It is a real example of how medicine and our options, lessons learned and advancements have influenced us.

Maize Quest Corn Maze October 19, 2019

My mom had a unilateral (one sided) mastectomy 23 years ago. At that time I was away sailing on big ships at sea. Pretty much out of reach for anything other than a fax, or satellite call which no one ever (ever!) made of short of, and singularly for one thing, and one alone; death. If you got called to take a satellite call you knew it was bad. You knew it was going to be really, really bad. Knowing this most family members spare you the notification until the ship hits the shore. No sense fretting alone for the rest for the months long voyage. I wasn't in the picture for her day to day life 23 years ago. She found a lump, went to her doctor and they had a small chat. She elected, (as she did this time too), to be as aggressive as possible. It was removed with very large margins that included the entire organ. The lump went with the breast. It is exactly what we do in vet med. (Except of course women like to have their boobs back after they are taken, so in human medicine there is this branch called "reconstructive." No such stuff in vet med). My mom is tiny, like really tiny. No one would ever know anything happened. She wore the same clothes and never missed a beat. Nothing was done for follow up, or clean up. Things have changed for oncology two decades later..

23 years went by,, and in mid 2019 she found another lump. It generated a quick call to her general practitioner, who sent her to dermatology under the suspicion of being an ingrown "something". The dermatologist sent her to a plastic surgeon who sent her to oncology. Took four months for this table tennis match to play out. Four wasted months with her prior history being dished out at each appointment and loads of passing the buck..

A fine needle aspirate at the oncologists led to a "high degree of suspicion" that her cancer was back. She elected for a matching mastectomy. It was done within a few weeks.

She stayed one night in the hospital post op. Went home with drains, but feeling pretty good.

Four days later she started with back pain. Over the next few weeks it got to the point she couldn't walk. Four doctors over four weeks and finally it was so bad she was admitted to the hospital for "pain management." Now I am not a human physician, and no one likes a back seat driver, and yes, hindsight is always 2020, blah, blah, but the fact that she, or anyone would have to go through so many weeks of being given driveled aliquots of escalating pain medications is something that NEVER happens at my practice. EVER. If a pet is brought to us in pain we provide lots of pain options. We don't start at skimpy and let pets suffer. If the client declines them I provide them for free. Pain under my care is not acceptable.

Over eight weeks of trickled paltry doses of every medication imaginable and available, some of which were included in her week plus hospital stay and the medications were still not enough to manage her pain. She, to this day, is still unable to leave her bedroom. Its heartbreaking to think you might end up spending your last days bed ridden from incurable, unmanageable intractable pain.

September 16, 2019, my house cook-out.

Early on, like right as the biopsy was delivered I sat her down to talk about what I know her doctors won't, we talked about ALL of the options.

"Mom, once you decide you are sort of committed to the journey that they have planned out for you. That is about six months of chemo and radiation. It should be something that you want to do so that you can have the best chance at the best outcome. It will be a long, hard, tiresome and toilsome  journey, but you have to have the long game in mind when you start that race. Or, you can sell everything you own, lock up shop, and just not get on that bus. Move to Paris, drink wine, enjoy whatever it is, wherever you want. It's your choice."

Things changed before the wait began at the bus stop.

After 5 days in the pain management hospital stay, and her tenth diagnostic proved still yet unfruitful, and me being there daily, we called another all hands meeting.

"My mom has been here for 5 days. She is on, or has been on, every possible pain medication including opioids. She has morphine given intravenously every 4 hours, and she is still in pain. This isn't soft tissue. This is something more insidious. We all know that,,, right?"

Quiet faces replied.

"What modality is left to find the answer? What haven't we done, or, need to do again?"

"A bone scan." Her doctor replied.

"Ok, can we get one?"

It was ordered and done a few hours later. That night all of her doctors met in private in the basement, which is apparently where the diagnostic machinery is housed. That night they broke the news to her. I wasn't present but it was reported back to me as, "it's really bad."

Didn't we all already know that? I asked myself. I had given up pushing her to do anything other than find an answer and not over exert herself which only brought on more pain than she could bear at week two.

All of this has been a cascade of events without enough time to really put our feet on the ground to make any sort of plans or decisions. It is a tornado of shit and no umbrella will shield you.

The prognosis is, they say, (they being her tiny oncologist who is unwavering, exceedingly smiley and abundantly optimistic, after all how else do you be, get,, stay this way, in this field? Or, she's really new to this?), one to three years.

This sentence, her stay of her own bodies execution, is also a really big terminal exclamation point. No subtly, no chance of a get out of jail card. It's like a done deal.

September 24, 2019, at JVC.

Now it is natural to presume that you know your parents fairly, if not exceeding, well. I would be so bold as to say that I know my mom better than anyone, her husband included. This whole new twist in our lives has me having to rethink those words. I am perplexed, perhaps even shocked and peeved, about her reaction to all of this. All of the doctors, all of the tests, all of the pokes, prods, probing inquisitive conversations, the constant turnstile of nurses, social workers, therapists, scars, bruises, drains and pill bottles, never mind the hidden emotional and mental anguish without a destination to dump them at. This is a journey of destructive accumulation not liberty, peace, or freedom. She will lose all of that if it hasn't already been willingly surrendered to this disease taking them, one by one. As they slip from her fingers she retreats deeper into her home. Her world shrinks to a place without public view. There is no plan for ticking off the Bucket List of life. No anger, no list of experiences to dive full-on cannonball dive into. No making the biggest splash to fully immerse and drown yourself in, damn the torpedoes! I'm having the greatest difficulty here. Feeling like fighting, arguing, and challenging every one, their expertise, their opinions. Why isn't she doing what I would do? Just living on my terms, my way, to the last breath,, And yet, maybe that's what she is doing, just not in the way I would wish for her?

August 25, 2019. My last photo of Jekyll. He died the next day.

It has been months but she has her medical answers. She has their recommended treatment plan. It's just not the plan I want for her. It's not the fireworks fanfare that a finale should have. She wants to stay home. Exist within her three rooms she has handicapped access to and be visited as often as possible.

Don't we all want to exit with the fat lady singing some crescendo to a lifetime worth reminiscing over?

And so for all the things she can't do, didn't do, and has't yet experienced, I find myself filling buckets of lists of experiences I can't live this life AND NOT DO! I can't accept having lived without having also nicked more notches into my belt. There are so many places yet to go. Things to see. Blogs to write. Videos to make. Things to eat on sun setting shores that span the globe. Hands to hold, pups to belly rub upside down, and cats to purr on my shoulder as we bid another long day of hard work I am immensely proud to be asked to participate in. I only have this lifetime to try to fit all of these into. I just don't know when to start. I don't know how to be my moms caregiver companion as I remind my own wanderlust to sit quietly, as it has for the decade of sea, the decade of clinic ownership, the decade of giving to the patients I so adore and the cement it barnacles in between my toes as she whispers her beckoned calls to stay with her, just a little longer.

Easter egg hunt 2019

Thank you to all who ask, who offer help, words of encouragement, concern and love. I am genuinely grateful.

To the girl I feel obliged to fill and conquer a Bucket List, I hear you too. We will go, soon enough, try to be patient a little longer.

Related story;

Human Vs Veterinary Medicine: Real-Life Case Meets the Dueling Ring. Who's Better and Why?

For the me inside still serving the greater good of the companions in our community I am here in the following spaces;

YouTube channel

Facebook Page for Jarrettsville Veterinary Center

Jarrettsville Veterinary Center website (with our price list)

Pawbly.com is the place for those who don't visit me at the clinic to help with their pets care, And it's
FREE!

The Skeletons You Can't Take With You

We all have baggage. Those little skeletons we try to keep hidden away under subconscious lock and key in the desperate hope that no one uncovers our secrets.

For every veterinarians proverbial medical bag there is an unseen dumpster full of regret, self-doubt, and lost cases. I suppose that at some point we either get so busy that we don't have time to sit and reflect on these, we decide we in fact have no idea of what we are doing, or we try to remind ourselves softly, kindly and gently that we are indeed human, we do not know everything, and that sometimes fate decides for you, in spite of you, and without consulting with you. Boy is that frustrating.

If you truly can forgive yourself and keep plodding through the day to day life of cases you learn to get better at recognizing the subtle clues a pet gives you. If you trip and march on long enough you can occasionally give fate the finger and save a pet from following in the footsteps of a case that got you screwed in check mate before. Boy is that liberating.

Stubbornly blind determination can be a good tool to help you get through those dark days. Your good clients will be grateful for it, and your bad cases might actually live to see another day. It is the flip side to ignorance is bliss, but the only way that you can walk away with a clear conscious should fate decide to throw you a fastball.

For all of my most painful cases this one trait has gotten me through the darkest of days.

Saying goodbye, losing a case, and the feeling that fate stole another soul from my clutches is a difficult task that never gets easier. But for every face whose eyes have stared back at mine begging for a release from the pain and suffering I always say the same thing, "I am sorry, I am trying, and I am on your side."

There is great humanity in humane euthanasia. There is great grief in not understanding how fate can keep you at the poker table, bluff you, break you, and keep trying to bankrupt you. And yet we stay at the table, deal another hand, and tell ourselves "maybe I can win this one?"

If you have a pet question, need, concern or a desire to help other pet people please visit us on Pawbly.com. We are a free open online community dedicated to helping pet people by exchanging information to better pets lives.

You can also find me at the clinic, Jarrettsville Vet, in beautiful Harford County, MD, or on Twitter @FreePetAdvice. 

The Skeletons You Can't Take With You

We all have baggage. Those little skeletons we try to keep hidden away under subconscious lock and key in the desperate hope that no one uncovers our secrets.

For every veterinarians proverbial medical bag there is an unseen dumpster full of regret, self-doubt, and lost cases. I suppose that at some point we either get so busy that we don't have time to sit and reflect on these, we decide we in fact have no idea of what we are doing, or we try to remind ourselves softly, kindly and gently that we are indeed human, we do not know everything, and that sometimes fate decides for you, in spite of you, and without consulting with you. Boy is that frustrating.

If you truly can forgive yourself and keep plodding through the day to day life of cases you learn to get better at recognizing the subtle clues a pet gives you. If you trip and march on long enough you can occasionally give fate the finger and save a pet from following in the footsteps of a case that got you screwed in check mate before. Boy is that liberating.

Stubbornly blind determination can be a good tool to help you get through those dark days. Your good clients will be grateful for it, and your bad cases might actually live to see another day. It is the flip side to ignorance is bliss, but the only way that you can walk away with a clear conscious should fate decide to throw you a fastball.

For all of my most painful cases this one trait has gotten me through the darkest of days.

Saying goodbye, losing a case, and the feeling that fate stole another soul from my clutches is a difficult task that never gets easier. But for every face whose eyes have stared back at mine begging for a release from the pain and suffering I always say the same thing, "I am sorry, I am trying, and I am on your side."

There is great humanity in humane euthanasia. There is great grief in not understanding how fate can keep you at the poker table, bluff you, break you, and keep trying to bankrupt you. And yet we stay at the table, deal another hand, and tell ourselves "maybe I can win this one?"

If you have a pet question, need, concern or a desire to help other pet people please visit us on Pawbly.com. We are a free open online community dedicated to helping pet people by exchanging information to better pets lives.

You can also find me at the clinic, Jarrettsville Vet, in beautiful Harford County, MD, or on Twitter @FreePetAdvice. 

The Ones I Left Behind, My Regrets

I know that I am one of the few people that can truly say out loud and with full confidence that I get to do what I love. Being a veterinarian fulfills me and my sense of purpose.

I have so many friends who go to work every day because they feel like they have to. Because they have people who depend on them to keep a roof over their heads and food on their tables. But they all work because they have to. The endless grueling cycle of; wake up go to work, punch a clock and wait for the end of the day whistle to blow.

I go to work every day knowing that I will be faced with challenges, meet new faces, and touch a life. Sometimes it is a life that will never speak a thank-you, sometimes it is staff member going through their own life trial, and sometime it is just the opportunity to take my own dogs to work and spend the whole day with them. I am lucky and blessed on many levels. It took me a long time to get here and I am savoring every moment.

I met with a drug rep the other day. They stop by (usually without an appointment) with the hopes of stealing your ear for a few minutes. I am one of the few vets who let them in, spend time discussing their newest products, and their personal stories. As we sat down she asked me the routine questions, like, “How’s business?, the family? etc..” All were replied with a simple “Good.” 

The conversation migrated to asking me about “How long I wanted to own JVC?” I told her that “I still love veterinary medicine and owning a practice, that I am immensely proud of the work we do here, the dedication of my staff to saving pets, and to being so devoted and compassionate to our cause, and that quite frankly I know myself well enough to know that I don’t want other partners.” 

She then surprised me when she said that she “doesn't know many other female practice owners who feel this way. That most of them can’t wait to sell and get away from the pains of ownership.” I then confessed and told her that “I wasn't done with veterinary medicine yet. That I wanted to do more, to help more lives because there is so much need out there. So I am not done yet.”

As I look forward I am also looking back on where I have been. I am left thinking about some of the pets I have left behind. I feel as if I have failed some of them. I bear the burden of that failure every day, and I move forward with more conviction, dedication, and determination because of them.

My first scarring failure occurred when I was still sailing. I was house sitting for a friend who lived in a cute renovated row home in Fells Point Maryland. One early morning headed out her front door to go to work I saw a little 10 pound, 6 week old brindled Pit Bull puppy just walking down the sidewalk. He was only a few feet from the very busy road full of cars rushing off to work. I froze in my tracks. I felt so sure that within a second someone would come rushing down the sidewalk frantically looking for this little puppy. After about 30 seconds I couldn't sit by any longer. I couldn't sit by and watch this pup get hit by a car so I picked him up and sat on the front steps of her house with him and waited. I waited 20 minutes, and no one came. I now officially late for work so I put him inside her bathroom with newspaper, food, water and said a little internal “sorry” to both her, him, and my boss.

I rushed home at 4 pm and was greeted by a happy hungry puppy. I spent the entire evening walking around her neighborhood trying to find his owner. Three days of this went by. No posters, no missing dog report at the shelters, no owner. That afternoon he started acting really lethargic. He wouldn't eat, and he wasn't playful. Later that evening the vomiting and diarrhea started. It didn’t stop all night. At 4 am I drove him to the emergency clinic. As my luck, and fate would have it, I only had 2 more days on the ship and then I was done and could drive the 5 hours back to my house in Blacksburg, VA.

I presented my very sick puppy to a very cold, very matter of fact veterinarian. She told me that he had parvo. And she told me that he needed to be hospitalized, on i.v. fluids, and antibiotics, and that his prognosis was not good. I explained my situation to her, she offered to keep him for the next two days and then transfer him to a vet down by my home. She gave me an estimate of about a thousand dollars, and a poor prognosis. I remember sitting in that white linoleum waiting area trying to sort out my thoughts and figure out what I should do.

I told the Vet that I couldn’t afford to provide his treatment, and that he wasn’t really my puppy, (which is what I said, but not what I felt). So I had him put to sleep.

I have carried the guilt of giving up on him to this day. If the same thing happened now I wouldn’t make the same decision. And when someone walks in with a pet that they can’t afford to treat I offer them to transfer the pet to JVC and our pet rescue takes over the pets care. That day defined what kind of vet I was to become and what kind of person I wanted to be.

Three years ago I was working the evening shift. One of my receptionists came to me and said that she had just taken a call from one of our clients who told her that their dog had been run over by their lawn mower. They arrived a few minutes later with their 2 year old female boxer. Both its front and back left feet were taped and wrapped in blood soaked towels. I very quickly looked at the dog, and then gave her a much needed dose of morphine for the pain and to sedate her. I wasn’t going to take off her taped on towels until she calmed down. She was also going into shock so I need to replace her fluid loss with i.v. fluids. The whole time her parents stayed by her side, (not an ideal way to treat a patient, but I didn’t think she was going to make it so I wanted them to be there with her). Within a few minutes she was sedated and I needed to investigate what lay under those towels. The owners had told me that they thought the “front leg was minor but that the back leg was bad.” I also was told the story of how the accident had occurred.

It seemed that their 12 year old son was being tasked with taking over the lawn mowing. He did not want to use the riding mower because he was afraid. His dad then admitted that he had forced him to get on and start mowing. At some point he lost control of the mower and ran over the dog. Oh god, how could this get worse? A two year old dog that I knew very well, because I had done all of her puppy shots and spayed her, a young boy who was hysterical about injuring his dog, and a family that would now have to deal with the trauma of all of this. I started with the front leg because I wanted some good news. I took the towel off and the whole paw was gone. It was not salvageable at all. I took the other towel off and the foot was gone from the ankle down. I replaced the towels and added a tourniquet to each foot to try to control the bleeding. I then put their dog under anesthesia and I took the owners aside. I told them that a three legged dog can adjust and do well, but a two legged dog needed a prosthetic. I told them that their dog needed surgery now, and then probably more surgeries later, and multiple trips to a specialist for a prosthetic. I knew the cost of these treatments would be in the thousands.

They discussed their concerns and decided to put her down. I wish I had pushed harder, and tried to convince them, that their pet, and their child, would be impacted by this. I wish I had had them sign their Boxer over to us. I still think I could have configured some sort of “peg” leg for her, and she was so young, I wish I had given her a chance.