Everyone Is NOT Welcome Here. When Do I Close The Door To Bad Clients?

While I recognize that this is prejudice, I also recognize my own limitations. 

I mean isn't that fair? Didn't the Supreme Court decide who could, or, didn't have to, bake cakes? Why not have my cake, and eat it too? (The degree to which cake defines acceptable social tolerance is alarming, isn't it?).

Seraphina. She is adamant that you will hold her.

I would like to believe that I am the person who accepts all; lovingly, unconditionally, and without the harsh judgement that divides, alienates, and perpetuates. BUT, it turns out I am after all the person who yields death, AND, therefore, I feel I deserve reprieve and definition to my latitudes.

No one enters my realm unless they love their pet. in itself this offers a huge range of persons. those that love so much they cannot bear goodbye. those that love so blindly that cannot see the path of despair they reap. those that love so much they will not permit one ounce of struggle...the list goes on.

My Charleston. Second chemo session.
passed away 10/21/21

If you aren't sure what I am referring too, let me explain the polar end of loving so much..

The woman with the elderly cat with the facial mass. She found me after visiting a dozen other vets. Two of them specialty clinics with all of the options available for every disease and ailment imaginable. These are the pinnacles of exceptional care and treatment options. She had been told by every single person before meeting me. They all told her that the mass on the face of her cat was so advanced that it was no longer curable. There were no surgeries, no medications, and unfortunately this cat was so debilitated that not even oncology had any suggestions. Cancer is often like this. It can cause such devastation that at some point we should seek merciful end of days, versus, fighting for an ending that leaves no hope for any quality of life. What was best for this cat? Simply helping this woman understand what lay ahead for both of them. She refused to see what all of the rest of us were telling her. She refused so vehemently she became angry. Argumentative, accusatory, and nasty. I kept repeating to her that I was on her side. Her cats side. They are not, or at least did not, have to be separate sides. She couldn't see it. She did not believe us. Any of us. None of us should have to suffer. This cat was comatose and suffering. Now for all of you who are as incensed by this as I was, there were measures in play to help. Animal Control was on her case before she came to me. Another vet before me had reported her. It is incredibly difficult to force euthanasia on anyone seeking care for their pet. Hospice is an option for all of us. But, just like all of us it requires acceptance of dying. My mom couldn't see her own cancer killing her. I get it.

The woman with the mass that took the life of the patient. What about the client who brings in the happy, active dog with the softball sized mass that is bleeding, necrotic and seriously problematic for both his quality of life and his family. Bandages cannot contain masses of this size and severity. They only go away when taken off. Nothing (alright, to be honest, almost, nothing hurts my heart like euthanizing a mass because I don't have a chance to save the patient from it. (Veterinary pearl of advice; don't wait to do surgery on a mass that will never go away without surgical intervention. Take it off  asap!) Ask me how many old dogs with yucky masses I have taken off and had them live years, yes, years, after. See Spencer's story).

The hoarder who loves kittens so much she cannot spay. Ugh. This one drives you to question humanity at its core. The most egregious hoarders that I have tried to help have been compassionate enough to see the respiratory infections, the lethargy, the signs of illness, but, they are resistant to spaying and neutering the whole colony. Why? Well, they don't want to admit it, but, the core of the hoarding is the feeling of purpose and feeling needed. (Every veterinary professional can identify. It is why we are all here.) If there are kittens you are needed. If the cats are sick you are needed. It is an impossible cycle to stop. They will go adopt new kittens if the colony is sterilized. It makes you crazy to see the cycle of dying, disease and suffering be promulgated due to mental illness. Cats need to have kennel licenses required by law. It is the only way to curb the tide for this situation.

The old man with the lifeless chihuahua who cannot put him down,, even as he is agonal. The times when an elderly, (it has happened twice, and always been very elderly), man cradling his dying dog and refusing to let go. There is obvious suffering, and still, they cannot let go. Who do I advocate for? Who do I work/serve? There are times I do not know.

....at least there is some salvation with them,, some bedrock of a foundation that helps me justify the end,, at least they were loved..

The people who give up at the first sign of hardship to spare suffering.. . There are cases that wag, wiggle, and delight into the clinic. Most are here for routine examinations. Every blue (black?) moon these patients are attached to clients who perceive something I do not. They feel their pet is unhappy. Struggling in some unidentifiable fashion, and, therefore needs to be put down. I reel on these cases. I offer free everything: diagnostics, exams, drugs, every pain medication in the arsenal, even taking custody of him. These, yes, absolutely these cases are what ruin me. I have had two clients, both men mid 40's, yell at me. Threaten me, and yes, even charge my via the State Board, that "I work for them." Get so angry and unhinged you fear for your safety. They, (my perception) seem more about the control of it all. The embarrassment of being challenged. Called out. Questioned. That they resort to anger, outrage and threats. One I will never forget is Chuck the dachshund. When Chuck walked into the clinic he bounded toward the treat jar at the front desk. He sat, waited patiently with the drool running down the sides of his mouth, and gulped up three treats the receptionists gleefully delivered. He was euthanized because they were going to have it so even if it meant dropping off at the shelter to have it done by someone who primarily euthanizes via a cardiac stick and doesn't know him. He would be afraid there. He was loved here. I hugged him, cuddled him in my arms, and cried. I made it as full of love as I ever did for my own pets. He was mine in that moment. He was the most beloved dog who ever lived. They weren't going to watch. They told me so as a weapon to remind me that they were so hurt by the loss they couldn't watch. I can't put into words the hate that burned inside of me at that moment. I whispered in his ear as he fell asleep that I loved him, and I hope he returns to pee on them every day of the rest of their lives. Let Chuck be the karma I couldn't deliver in person. 

Did I have to do this? Put Chuck down? No, of course I could have declined. I have done so only to have the Sheriff be called out to witness the dog being shot in the backyard tied to a tree. 

(Middle finger salute to that idiot who ever said "what ever doesn't kill you makes you stronger.")

Like it or not, the minute you threaten me is the same second my claws come out. Yesterday I screamed back into the phone to a woman who was insistent to tell me that "she has friends who do not like me!" It was a dagger she thought would hurt me. She wanted to hurt me because I was forcing her to wear a mask in the clinic. I very loudly told her that "I truly didn't care what anyone thought of me." I am over that manipulative crap. These two guys, gone for good. Hip-hip.. I definitely don't work for them.

Jitterbug. My beloved cat. Passed away September 2021

The wise old veterinarians before me would tell me that it is not my place to judge. While at the macroscopic this might be best for mankind, it is not the reality of the world I am trying to stay alive within. 

Diedra, always a smile.
Me, claws at the ready, yet still looking for the next adventure/challenge

Can you love too much? No, I don't think so, but, you can love so much that you are blind to the other person/soul/being/dependent in the relationship. You can love so much that it is destructive to the others around you. You can love so much that there is no other perspective to influence decisions. If that includes your health care provider they cannot do their job with the best interests of the patient first. I also cannot survive with a compassionate spirit to guide me. 

End Note;

This blog is about the lives I meet and the struggles I face as a veterinarian. It's about the endless questions that I grapple with everyday as I try to find my way. I can say that I am trying to stay true to who I am, and why I chose this profession. But in reality I am just trying to keep that little girl who always dreamed she would grow up be a veterinarian, in the face of the harsh realities the adult me has to manage, alive.

The Mistakes Veterinarians Live that Make Us Paranoid. Or Kill Us.

There are reasons most competent veterinarians are paranoid. Now, I don't use "paranoia" as a compliment, but, I do say it is aptly fitting.

At some point in your veterinary career you accept your quirks and embrace them as the fabric that made you whole.

I am paranoid about a yards long list of things at work. Why would I be paranoid at work? and, why would I accept this as unchangeable? Because, the consequences of not being paranoid are too frightening.

Me and my girl Madeline

In the  last week I have seen real-life reasons why I know I am both supposed to, and, dead right to be, paranoid. Shit happens, really, really bad shit in the day to day real-life world of being a veterinarian.

Vet med is this crazy offshoot of a profession trying to live up to ridiculously lofty expectations we placed upon ourselves, whilst, trying to fit into the glass slipper-shoes and manifest the same medical miracles as our human counterparts do. Except, and this is like the biggest blaring Vegas-style neon asterisk ever, we get very little support from anyone else. Veterinarians don't have the ability to ask for a specialist to "pop-in for a looksie" and help guide a case. We haven't had years of a residency to help white glove us into the world that awaits us. We also, (in almost every single case), have some narrow, if not non-existent, budget to adhere to. No time, no money, and no calling a friend. Humans in their white coats have it so easy.. They have their shit together. They have to. They are watched. Part of a pack. They have insurance guidelines and protocols. We, well, we veterinarians are the equivalent of fortune seeking gypsies toting our wares across the plains to those who don't know better than to hope our elixir can "cure all that ails ya!"

SO, if this were your life complete with its bills, internal conflicts of ineptness and imposter-syndrome meanwhile attempting to maintain a neck abreast of the Jones's next door, you would learn what we have learned. If you are asked to do more with less you get creative. We do wacky shit like fill the appointment slots in 15 minutes versus 30,, (heck, simple math). Double your profits half your time allowance. What could go wrong here,,? Or, make room for time you don't have by offering services that seem "convenient." Like drop-offs, Owner Not Present services (and provide them cheaper. Wait?? what? See this story here). Owner Declines All .... (whatever,, people decline shit you cannot imagine they would.. like; pain meds.. what!?). Yep! happens.. I actually had to make pain meds for surgeries free so people wouldn't decline them. (If they did, I still give them away for free). It's the right thing to do do for your patients who you KNOW feel pain. (Just because you don't wanna pay for it doesn't mean it ain't there people!).

On top of my inherent paranoia for things like getting behind on my appointment schedule (with the White Rabbit muttering "I'm late! I'm late!" on repeat in my brain), is under estimating a surgery price. No matter how hard I  to be a clairvoyant who knows without being able to actually see how many rotten teeth are actually in that snarling mouth of garbage-smelling decay. Or, the paranoia  of having a client get bitten by their own pet because they refuse to stop getting in the way of their already nervous afraid pet who we know is going to bite first chance they get. Want to imagine what my insurance carrier says to me when a client is bitten because they were doing a technicians job. Not pleasant. I need my insurance, and clients need to understand this. Or, how to decline profanities when the client who has bled you for two grand can suddenly find the money for that private cremation, but, not have enough to pay their bill for trying to save their life. Or, having a lost pet be found with a microchip (all together now sing "hallelujah!") to find out we never registered it so we still don't know who they belong to. Or, you do knee surgery on the wrong knee, or mass removal on the wrong mass, or forget to pay attention to the patient alerts and your patient almost dies in front of you because you didn't. (I swear this is just the list from today, this list goes on and on!).

Here's the list of the paranoia building headline of this week.

Cat accidentally gets euthanized during vet visit.  A Houston-area woman is at a loss for words after she says her 8-year old cat, Sophie, was accidentally euthanized at Suburbia North Animal Hospital in Spring. "Every time I close my eyes, I see that look on her face and I just can't get it out of my head," Michelle Olson said. Olson and her husband had just picked up Sophie after taking her in for a routine checkup and to get a rabies vaccine when she got a call from the hospital. "It was the doctor herself calling saying, 'Please get Sophie back here immediately, we gave her euthanasia instead of a rabies vaccine,'" Olson recalled.
They quickly took Sophie back to the vet.

You think that this can't possibly happen? Well, it did. Want to know how? (Or at least how I see it could have happened).

So far I guess I should feel lucky. Up until today I hadn't even considered confusing euthanasia solution with a rabies vaccine on my paranoia list.

How could this happen??!! Well, let's discuss.

Here's my full on paranoid list of possible causes for euthanizing a cat who was just supposed to get a rabies vaccine;

1. The pet parent left the cat behind for treatment. I know lots of practices that plan their whole day around drop off appointments. You think, "It's just a simple rabies vaccine. Why wait for that? Let's hit up Target for detergent and pick up Fluffy after. Time is precious, detergent level is almost critical." Let's go back to the "creative" tactics of above. Ever think about how much time we could save if we didn't have to chat with you about you, or, Fluffy? LOTS! We don't get paid by the hour like lawyers do... (huh, possible hack for bucks). Would you leave your toddler at the doctors office for an exam and ya know, whatever else? NO! You wouldn't! Why? Because your kid needs you to watch over them. I used to, (like yesterday used to), let the techs pull up the vaccines. But, now I am adding this to my list of "no longer trusted to do" paranoia. If there is going to be a mistake Lord let it be mine to own).

2. The color of a rabies vaccine looks a lot like the color of beuthanasia. Red-vs-pink, it's the same color scale. Syringe next to syringe and most vets might not blink with query.

3. Volume. The volume of euthanasia solution to euthanize a cat is 1 ml, which is the same for inoculating for rabies. Oops! grabbed the wrong syringe in my rush to get the simple vaccine done!

4. How does a rabies vaccine differ from euthanasia solution? Other than what I have stated previously the delivery is very different. A rabies vaccine is given under the skin. What we call subcutaneously. A tiny pinch of the skin to find the space between haired outside and on top of the muscles space, draw back, make sure there is not a bloody "flash-back" and deliver. If you are me, I deliver a cats rabies vaccine in the tail. It's still SQ, (takes practice), but its the recommended site as published by the AAFP. But, euthanizing a patient is almost always done by delivery the overdose of the barbiturate into a vein. Quick, efficient, and reliable. Trying to kill a patient by the same means we give a rabies vaccine?Not quick, not effective (guessing here), and surely not reliable.

5. Trying to do too much in a cramped time frame. Oh, if I could get people/clients to understand this. How can I be everything to everyone at the same instant? People have set appointments, God forbid I get behind in appointments, people get pissed, or, God forbid you come home to find your beloved pup having trouble breathing, on the brink of expiring. Who do you call? Me, probably me, who is already drowning in appointments, and you need to be seen NOW! and really you prefer to be here with the people you know and trust than at that ER that overcharged you last time for a broken toenail. Paranoid? Yes, I am paranoid that you will come here, and, need to be there on oxygen and monitored for a day,, or more. And, I do not have the ability to provide oxygen 24/7 as I lack the 24 part.

Mistakes, this mishap of epic proportions which is both tragic and irreparable beyond imagination was a human error. Completely human. I promise that the drug companies making euthanasia solution did not mislabel it "rabies".

My big question is, I get that this was probably a similarly colored syringe with the exact amount of euthanasia solution indicated, but, how did it get in the wrong place? At my clinic we keep that bottle of pink death under lock and key, yes, 24/7. it is not left out. It is not to be drawn up by idle hands. It is not a paranoia I apologize for.

Whats the most troubling part of this story as a person who lives the motto "your worst fear will happen." We vets euthanize so many pets so often that the delivery and the process is as routine as a rabies vaccine. The same expectations for clients apply. Don't make us wait, don't ignore the emotional gravity of the situation, but, yes, be prepared to see the happy 4 month old new penny puppy next door, 30 seconds from now. And, then the guy who argues about why you are late, as you tried to squeeze a few more minutes in with the heartbroken tear-laden family you just left behind who has to go home without their child they love so much it has slept in bed with t hem every night since they adopted in a dozen years ago.

The healing powers of Serafina

Paranoia and personal strife sit with my conscious every waking moment of my working life.

Could this happen to me? Oh, Jeez I cannot answer honestly for fear it might drive me to hole up at home and just seek use of my license as an acupuncturist or peaceful passage parson.. the kind of vets who leave vet med with some form of PTSD that leaves us not taking chances with life and death and all the tiny tip-toes of minefields that lie there. Mistakes in medicine are well documented and accepted. Add the stress of timetables, ridiculous expectations to be every kind of doctor to every kind of pet parent with every imaginable budget and the mistakes are bound to happen with increased frequency and consequences.


More information on tail vaccines here.

AAFP,  American Association of Feline Practitioners Vaccine Guidelines here.

Full cat death story here;
https://www.msn.com/en-us/news/us/cat-accidentally-gets-euthanized-during-vet-visit-family-says/ar-BBZ4ywh?ocid=spartanntp&fbclid=IwAR0P56Jt1yySrb8AQfHhhPpN3Y6-ep4JmkNknkdWn9ueXqoR5TpeaTseOr8

Up next in the paranoia cornucopia is the clinic who accidentally places the tag for "communal" cremation instead of "private" cremation on the pets body. And, ya know, you find this out when the pet parent calls inquiring about the remains that they have never been called to come and pick up because ya know, you see this one coming, there are no remains to be picked up. What kind of apology can you give them? Yep, that's happened to me.. reason number 6,251 that I am paranoid.

Or, just as gut-wrenching, is the client who requests, may or may not have paid for, and then successfully gets that little wooden box of their beloved family members ashes returned to us for pick up, but, never comes to actually take home.. What do you do with that box? How long would you hold onto it? Some of them didn't really want them back if there was a bill outstanding, and some of them just forget I think? Maybe?

Of course, because you are already paranoid, you hold onto it for two years, (isn't that the statue of limitations for most crimes?) and, you finally bury it at home with your own deceased pets to keep company in their eternal slumber spot. And YEP! 3 months later they come with some equally tear gutting story about how they couldn't get to us because Wilson their only friend while on that deserted island wouldn't let that little wooden box replace him.. Yep, happened to me.

Story of the broken but yet still irresistibly adorable kitten is saved by an innocent bystander who "has no money, but  isn't she cute as can be!" and your staff begs you to take on this little broken life,, because "if anyone can save her we can!" turns out to have rabies. turns out you figure this piece of zoonotic lethal shit after that Cujo possessed lightening bolt bites half the staff, including your most senior tech who is in her third trimester of her first childs life. Sure, there's tons of credible data on vaccinating for rabies while very very pregnant. That's safe? right? (kill me,,, really,,,how does this stuff happen to me)?

I am a veterinarian. I attract crazy. I live life and death. I literally, and very openly consciously tell myself every day as I drive into work that I simply have "to do the best I can, and come home alive and able to do it again tomorrow." This is my life. The one I chose. The one I always aspired to be. BUT, I am paying the price of this. I have been hurt, shunned, hated, sanctioned, and vilified. I stand alone knowing I did what I thought was right even if it was going to cost me financially or professionally. I can be paranoid to protect my patients, but, I am not going to be paranoid to protect my ego, my pride, nor my staff. I can go down liking who I am even if no one else does. I see the stuff you think is Twilight Zone material,,, and through it all, over the decades I still get up, grab those big girl panties by their ever expanding saggy bottomed waistband and adorn my equally unsexy disposable scrubs (that are only going to get soiled with fluids and excrements you havens even imagined exist in your own nether-regions,, or "tween" spaces, I go on. Paranoid.

Want to hear more about these topics? Here are some great videos on the life of a veterinarian;
Bernard Rollins Plight Of Veterinary Medicine. YouTube.

Hear about Dr Shane Cotes Suicide Story. YouTube

Please remember your vet is a human. Maybe a human dealing with more than you ever imagined possible.. Here are the statistics for vet med;
One in every six veterinarians have considered suicide. That’s three times the national average.

Maybe paranoia isn't suicide? And maybe its a small part of why this job costs so many so much?

For more on this please see my other blogs;

Find What Breaks Your Heart And Change It.

Ethical Fatigue and the Crossroads Of Vet Med

The Problem In Vet Med and the Great Divide

Serafina.. The WHY in Who I AM

Don't Forget To Put Your Heart Into Every Euthanasia

More about Dr Magnifico and her mission here;

My clinic is Jarrettsville Veterinary Center in Jarrettsville Maryland.

My YouTube channel.

My off site information exchange network which offers free veterinary advice and case based stories of my real-life cases. Pawbly.com.

Best Veterinary Facebook Page ever; Jarrettsville Vet

My pups Frippie and Storm

Be well everyone. And wish it to the others in your life.