What Am I Supposed To Do?

The question plays on repeat. Over, and over. And, over again.

It is inescapable. Perplexing, vexxing, and excruciating. All of these and sticky beyond excision. 

Nana, broken leg, ER advice; "surgery 10k, or euthanize"
my advice; "cage rest" 
she is alive and doing well today because her dad refused to have only two options for her

There are fixable veterinary problems all around me. In my effort to provide exposure to these treatable and yet often ignored veterinary issues, encouragement to face and fix them, I seem to have made myself the wailing post. I have become the beacon for hope and last place for help when there is none to be found at the footsteps of present veterinary provider. 

My question isn't why I have become this person, my question is how do I keep from becoming the only vet who cares enough to put the patient before the profits and the fear?

And all of those blocked cats..

I have spent a great deal of  time asking me how I got here? Why I feel so alone here, and what the hell I do about it? 

I have spent so much time in the problem that I cannot walk away. I cannot shutter it, suffocate it, stow it, or sacrifice it. I am in it, wholly and without reserve. 

What would you do if you knew there were answers, some of them ridiculously easy to solve,  answers that would save lives, save human hearts from being crushed, and right a wrong that just grows more egregious as it  consumes the caring around it.

What do I do?

And all of those PU surgeries

Today it was another desperate plea. A question on the Pawbly, the pet care site asking for help. They are always the same. 

"I love my pet. They are my whole world. They have this problem..... I have been to so many vets, no one cares. I saw your video. Is there anyway you can help me?" .. and there is always a photo. A photo of the pet. So sweet, innocent, and fragile and in desperate need. How do I turn away from those faces?  How do I stay in this profession if I sacrifice my ability to have compassion so strong it compels?

Babybear

Veterinary medicine is about taking care of animals. Somewhere along the day to day grind this got lost. It became about money, and egos, and trying to be bigger than our britches. We became distant from our purpose, and divided from our clients. When it was not profitable, or easy, or worth our time we blamed them, the clients, the people who make all of this possible. We used cruelty to remind pet parents that this illness, this unforeseen accident, disaster, (albeit treatable), isn't worth us intervening if they can't pay us handsomely for it. The cost of care has skyrocketed, the treatment for all of the ailments remains what it was decades ago when everything was a few  hundred dollars, or less. 

.. and so I remain here. Asking myself the same question and dedicated to finding, exposing, and disrupting the same problem.

Want to see what I am talking about?

See my YouTube channel 

or Pawbly.com 

The Tipping Point. When There Is More Behind You Than In Front.

The tipping point.

There is a place, a moment, a collection of revelations, where you realize, bring to your own attention, that you are looking back, (horrifically in some cases even attempting to relive, revive and recollect the exact details of what was before), more than looking forward. 

That place where there is more behind you than in front of you, and not only is that the truth, but worse, your preference defers to back versus ahead.

Gracie. Just rescued. Her mouth was soo diseased the smell would knock you over.
All of her teeth had to be removed. This is her waking up.
She was a different (soo much happier) cat 24 hours later.
The degree of neglect she came to us with was pitiful and compelling.

In the misery of many a childhood moment I would sit, close my eyes and imagine the magic that lay ahead. Too often the allure of what might be. What I could salivate over. Some lustful moment. A momentous accomplishment dreamt of but yet to be fulfilled. A far away land with all of its exotic flavors. I got by, (a theme song from my favorite Grateful Dead anthem), because I projected forward. Those invisible carrots of motivation lay just at the tip of my tongue. Propelled me forward through what turned out to be some pretty traumatizing growing up. 

At 50ish I have realized that the carrot has shape shifted. It no longer hovers above calling. It lays beside me waiting. The small dirt-dusted, blunted, jaundiced nut in a collection resembling a sickened nest of eggs to ride out the Winter. 

The snowdrops and the crocus.
They remind me to believe in beginnings,, even after all of the endings.

Unbeknownst to me the tipping point hasn't evolved into a concession, rather a gentle acceptance that the To-Do list, my collective life accomplishments still yet ephemerous, need to be fast-tracked. That list cannot be allowed to outlive me, good intentions, or fate deciding.

Perhaps other people spend their autumnal time reflecting on the amassed possessions as some aging dragon in her liar of pillaged treasures? Perhaps not having children to leave a better life to isn't the motivation to dying with assets left behind? Or, perhaps even more disturbingly I recognize my stash will outlive me. I will not be able/chose not to, exhaust it before the timeline draws to a close. Perhaps this is the tipping point? that place where your efforts tip to giving back versus gaining more? Perhaps that's what aging, retirement, exhaustion and a worn out body brings to your peace of mind as the collective cacophony of a chaotic world swirls around you?

My Raffles kitten. She was given up on because her sibling came up positive for rabies.
Four months of quarantine and she is mine.
Life for me works like this. These needful souls find me.
I am as much grateful for them as I am for the fate that brings them to me.

Maybe that's why I am so much happier in the looking back than the drive to accelerate forward?

Oh, that's right, today is Tuesday. I must get dressed and go fight those diseases and dragons for another good day of deeds in the small animal vetmed trenches. I'll rest tomorrow and save a carrot for the slumber another day. 

Raffles watches as Birdie wakes up from her spay surgery.

Tipping points too often get me confused between tipping and pivoting. I don't know if I can recognize one versus the other any longer.

There is a real-life plight in vetmed these days. Those of us who grew up in the trenches, took on a place of our own, led or our community practice for a few decades, sunk our whole lives into. We are at a place now where we have to decide how to exit. Do we take the big cash out from the guys who might as well have a Hamburgler face on. Their shifty eyes, smooth talking and thick gravid unexplained check books? Or, do we try to find some new grad willing to take the reigns and care for the next generation of pets the way our previous generations of vets did? Is that even possible?

Hamburgler holding the American icon hostage

Me, I am at a place where the box has to be rethought, reinvented and repurposed for the greater good and not the singular cash out retirement/burnout plan. Me, I'm pivoting before the tip pulls me under.

Saving The Soul Of Veterinary Medicine by Mark Helfat

 Saving the soul of veterinary medicine

An appeal to practitioners to sustain small, independent clinic ownership

February 15, 2023 (published)

By Mark Helfat

Photo by Scott Nolen

The author, Dr. Mark Helfat, snuggles his dog, Simply Irresistible Giselle.

Last June, I attended my veterinary college reunion (45th!) in Ithaca, New York. Over three days of perfect weather, old memories and old acquaintances were revisited and renewed in all their youth and splendor.

Before, during and since that glorious weekend, I have enjoyed ample opportunity to ponder my veterinary career with all its twists and turns, what-ifs and why-nots. I have spent many moments reflecting on our profession — where it started for me and where I see it now.

It saddens me to conclude that veterinary medicine is quickly losing its soul. I choose this word "soul" because, for me, it denotes a life-sustaining spirit, an inner force of sustenance, a vibrant, glowing core.

For four decades plus, I have viewed veterinary medicine as a singular profession. As practitioners, we treat animals and care for owners. Yes, "we care for owners." Our patients do not arrive on their own. The hand of a human is at the end of a leash or upon the handle of a carrier. Our veterinary-client-patient relationship, our VCPR, relies as much upon the C as it does upon the P. And the C and P don't have a chance of finding fulfillment and the finest care with the V unless a sound foundation of trust has been established.

I rarely encounter the word "trust" when studying veterinary journals, webinars and lectures. How do we establish this fundamental condition as we navigate daily examinations, treatments and client interactions? In my opinion, the sine qua non for gaining trust is forging a personal relationship — a one-on-one, caring, empathetic, honest and human touch.

Where would I look first to discover this foundation of trust; this genuine outreach of caring? With certainty, the answer is the independently owned, smaller-sized, community-based veterinary practice. The life and blood and soul of veterinary medicine lies in the long-established, solo-owner, hometown animal clinic.

So I'm sad to see that these clinics are disappearing, as corporate ownership, investment venture capital and super-sized juggernauts consume and dominate the present and future of our profession.

If you have never worked in a smaller clinic such as mine, allow me to draw a picture:

• The receptionists greet each client and pet by name — because they know their names.
• Clients never wait more than 48 hours for an appointment.
• Emergencies are seen that day.
• Appointment requests for specific veterinarians are gladly accommodated.
• There is frequent conversation in the exam room regarding family and all the accompanying health updates and milestones. There is no shortage of bad and sad news; however, we find the time and we have the concern.

More examples of characteristics from my practice that define the soul:

• The veterinary staff and non-veterinary staff have negligible turnover, with tenures averaging 10 years. More than half of the staff has been in place for 20 years.
• Financial concerns and limits are addressed case-by-case, allowing for discounted care when the pet needs immediate attention. If we know the client, late payments may be arranged.
• We see our patients from youth to euthanasia.
• We see our clients age as children to adults, and then we see their children.
• While appointments are scheduled at 15-minute intervals, they often go over — and we do not mind.
• Callbacks are made the next day for every surgery and for most visits involving sick patients.

I cannot view an episode of All Creatures Great and Small without breaking into tears. Silly, right? But the life depicted in the series — which you probably know is based on books by James Herriot, pen name of a 20th-century British animal doctor — is exactly what our profession is losing. These vignettes of a practice that is a family point straight to the profession's soul.

I do not have a Mrs. Hall who answers the office phone 24/7 and cooks all of our meals but I have loyal employees who genuinely know many of the clients as not just pet owners but as friends. The staff is not just staff. We are a family. Having known each other for so long, we truly care for each other.

Don't get me wrong. A large corporate practice will certainly check some of the boxes above, and I applaud them. However, it is my firm belief that the small, independent practice will check more — if not all — of the boxes.

Beyond the trend of large corporations buying up practices is a newer, and in some ways more terrible, trend: Many baby boomers who own solo, independent, small-town practices are reaching retirement. For various reasons, some younger practice owners also are looking to exit. But they cannot find a buyer for their established, vibrant, profitable practices. I speak to such veterinarians weekly who are now contemplating closing the doors and simply walking away.

I am talking about practices that annually gross $500,000 to $900,000. These practices have for years provided incomes that have purchased homes, paid bills, put kids through college, funded substantial IRAs and 401Ks, paid off student loans and provided a comfortable, happy existence.

At one time, these practices would be in demand. They would have associates eager to buy in. The owners might run an ad, and soon, the phone would ring. Simple word of mouth would send someone inquiring. No longer. Why? There are many theories and many new forces at work, but that is a topic for someone else. As these practices serving both small and large animals close, the impact is widespread and devastating:

• Veterinarians lose funds they had counted on for retirement.
• Longtime staff are left jobless.
• Towns lose a clinic, and the next nearest animal hospital may be far away.
• Clients are forced to start over with a new facility where wait times may be much longer.
• A community loses a pillar.
• Veterinary medicine loses another fiber of its soul.

Disclosure: I am among the veterinarians frustrated in trying to sell my practice. But my individual situation is not the problem. The issue is that this phenomenon is affecting a broad swath of clinics.

Please spare me the discussions of EBITDA, no-load and cash flow. I speak to veterinarians who have great numbers but because of proximity to another clinic, the mood of the broker, the high payroll percentage and a million other excuses, they cannot attract even a serious broker.

Is it too late? I say no!

Organized veterinary medicine has a habit of looking at other medical professions for ideas and answers. On occasion, the dental profession has been inspiring. Regarding this very topic, it lends some hope. Dentists have done a remarkable job of maintaining the noncorporate, smaller-sized, traditional community practice. In fact, they are quite successful at passing on facilities to associates and other buyers as they move into profitable retirement.

Where veterinary medicine now approaches 25% corporate ownership and is projected to rise, dentists in recent years have come in much lower, around 15%, judging from a 2021 article in Dental Products Report.

To drill down further (sorry): The American Dental Association — dentistry's counterpart to our American Veterinary Medical Association — has a formal initiative called ADA Practice Transitions (ADAPT) that addresses preserving the independent and smaller dental office. The program has a step-by-step process by which buyers and sellers are connected. Advisers are provided to facilitate the transitions. Simply put, the ADA has decided to play an active role in preserving the soul of their profession.

Perhaps our AVMA would consider a detailed study of the dental profession's trials and errors with ADAPT. Might such a program be of value for the veterinary profession? The AVMA has 400-plus volunteers from every corner of expertise, a professional staff that is surpassed by none, an Economics Division and even a Veterinary Economics Strategy Committee. I would hope that if our association studied this dental initiative and plugged in the unique characteristics of veterinary medicine, we might, in fact, construct our own program.

Considering the present disaster of our disappearing practices, I imagine that an AVMA counterpart of ADAPT could offer significant incentives to encourage and attract reluctant prospective buyers. Among such incentives, I'd suggest including the following:

• discounted sale prices (would a retiring practice owner jump at receiving 80% of practice value compared with nothing?)
• the option of a personal loan carried by the seller, with a minimal required down payment
• providing a list of reputable lenders willing to consider providing the necessary financing
• no commissions for either party (but presumably some type of service fee collected for the association)
• advisers for both parties
• a discussion with the seller of practice management options
• a program in which a prospective buyer first works at the practice alongside the owner and later buys in, either over a period of time or in whole

I would be foolish not to admit that there are impressive benefits that accompany employment at a large corporate facility:

• flexible schedule
• good pay
• health insurance
• paid vacation
• ample continuing education
• mentoring
• human resources support
• fancy, state-of-the-art equipment (read "MRI")

But all of these are standard fare for a practice owner, with the exception of the MRI. Do we all need the MRI?

Here are the benefits of independent ownership:

• being your own boss
• running a profitable business
• holding a recession-proof job
• more wealth
• paying down student debt more quickly
• creating tangible equity
• choosing your own schedule
• hiring family
• amassing a sizable IRA/401K
• becoming a community partner
• mental well-being derived from personal stability and achievement
• saving the soul of veterinary medicine

I was an associate veterinarian for six years. I have been an owner for four decades. I am much happier being an owner! I wonder how many years I would have stayed full-time in the profession had I remained an associate. Certainly not more than 20 or 25 years. And would I have found the success, stability and well-being that I now enjoy?

We are all different, and others' answers to this question will vary. However, I am not alone in lauding the advantages of ownership.

When will veterinary medicine reach its tipping point with regard to corporate ownership? If our profession continues on its present course, we may never see small private ownership again. Without new blood, our soul will slip away, never to be seen again. Just look at our friends in human medicine and their overwhelming corporatization. I contend that they lost their soul a long, long time ago.

One question to which I have no definitive answer is, "How many associate veterinarians have ever seriously considered practice ownership?" If one considers that the AVMA boasts 100,000 members, let's say that 75% are in general practice. That would give us approximately 75,000 veterinarians in general practice. If just 10% are youthful associates who have considered practice ownership, that is a sizable population that we must encourage and support.

Here is my elevator speech to our future, the saviors of our soul:

• Talk to your accountant/financial adviser about practice ownership and its benefits for you.
• Talk to some practice owners, classmates and friends in practice about the benefits of practice ownership.
• If you work at a noncorporate practice, consult the owner about the possibility of buying in.
• Reach out to the "maturing" veterinarians in your town, in your county, in your state. Ask what their exit plan might be. Don't be shy. You might gain some new friends fast.
• Attend your local and state veterinary medical association meetings and spread the word that ownership is in your future planning.
• Don't forget the drug reps as a source for who is looking to sell. They know everyone.

When I finished 15 years of volunteer service on the AVMA House of Delegates and Board of Directors, I promised myself two projects on behalf of the profession: First, write an inspiring book for veterinarians of all ages. That was easy. Within a year, I scribbled down The Happy Veterinarian. Second, and a whole lot more difficult, start a nonprofit that serves to save the soul of veterinary medicine. I founded Veterinary Practice Transition in 2020.

The mission of the organization is to encourage younger veterinarians to consider practice ownership while providing the older generation an option for selling their practice. The nonprofit offers personal loans with low interest rates, a 10% reduction/discount in the sale price, and no commissions for either seller or buyer. The effort is a work in progress. I cannot succeed alone. The profession as a whole needs to address the impending doom.

In closing, let me return to my reunion. As my classmates of '77 gathered and regaled each other with tales of conquest, I saw the immense, reflected energy of careers that served them all so well, but even more, careers that served so many others with compassion and empathy. What I also observed were veterinarians who reached out as family and friend, fostering the trust that defines the soul of our profession.

Mark P. Helfat graduated from Cornell University College of Veterinary Medicine in 1977. He owns and practices at Larchmont Animal Hospital in Mt. Laurel, New Jersey. He has volunteered for veterinary organizations and institutions for most of his career (New Jersey Veterinary Medical Association, American Veterinary Medical Association, Cornell University College of Veterinary Medicine, Virginia-Maryland College of Veterinary Medicine). Mark and his wife, Mendy, commissioned the sculpture "Shilo" that howls on the Virginia-Maryland College of Veterinary Medicine campus. The couple share their home with four beagles and many cats.

Cheers to you Dr Helfat. Here's to the rest of us working so hard to preserve the many souls vetmed is built upon.

The Other Lives I Could Have Lived.

Do you ever wonder which path you would take if the whole book of your life had been refreshed? Sent back to that first word on page one. What if your whole life's narrative suddenly all went blank? You got to do it all over again. Restart. Relive. Redo.

I do. 

Hamilton

I seem to imagine these avenues where I find myself lost in the other things my life takes light within. The other things I could have been. The lives I could have lived. I live them now and again, in tiny moments, but, as a spectator. Set away and apart, at a distance. Able to enjoy but not influence. Absorb but not immerse. Be, but not be included within. I wonder if I would have been happier there? Would have had a different outcome? Would have been a fuller person? Lived another life in the same canvas with a whole different set of trimmings to set the stage and act the part.

Color and music. I would have done a whole lot more with these two. Maybe a fashion designer? Draping sumptuous silks in jewel tones with operatic bellows to inspire me as I work. Sopranos to swallow me into.

I could have left the bleach washed walls a hospital requires and have been a street artist. Playing a harmonica in the subway watching the world rush by to their cubicles and plastic potted plants. Making money by predicting the tides and hedging the cortisol surges of a gambler playing with other peoples monopoly money as stock broker on the floors of ticker-tape scribbles. All adrenaline and dollar signs as the carrot promising a life of caviar dreams and champagne stained yachts.

A humanitarian rushing off to a foreign land to protest human rights violations and expose the cruelty no one wants to acknowledge. The Audrey Hepburn/Lady Di cupping starving faces in their coiffed manicured hands with smiles of false optimism for a more stable and safe tomorrow.

Droog Shelter in Alexandria Ukraine. April 2022

A gardener praying to a seedling with the umbrella-like healing palms over the verdant shine of the two cotyledons who carry so much promise in their two tiny appendages reaching upward for the sun. The caretaker to natures bounty among the war for food by all the other beings who seek to profit from the seeds sown by others. Find my place in the balance of sharing resources and not taking more than the earth can balance. A silent partner to the provisions the seasons dictate. Spend every moment of everyday the observer. The Cicada listener. The observer to the flashing color of the hummingbirds, the butterflies, and the flowers they dance between. The deep breathes of the grass as I walk on her carpet of cosmic energy. The goddess of all that is green in a forest that emits only the crickets and the buzzing of the beings far smaller than I and yet so massive they drown the rest of the world away.

Wren in our rock garden

Is it possible to live all of these lives in a profession that requires all of the time that my eyes are open within? That I don't know. I live in snippets. The opportunities between the sick calls. The place where I can steal a few minutes to walk outside. The seconds between lunch (I never eat) and the next scheduled appointment to hold Seraphina and press her into my face. She is a muted galaxy of greys and gold. A tangible downy gosling of fluff emitting a halo of feathery hair. She is my time out in the middle of the endless chaos that is a work day. Hamilton, the paralyzed ginger kitten who belongs to Autumn now. The kitten thrown from a moving car window thrown away like a piece of trash. Brought here for a chance at mercy and now one of ours. He is so perfect in his purpose. He simply wants to be held while he purrs into my chest. Alters the rhythm of the blood coursing through his symphonic blissful lullaby. I painted the vet clinic staff bathroom hot pink/fuchsia. The one place the door can be closed and the color can envelope me whole, half naked to the world that exists on this side of the tsunami treatment door. I put up 1930's advertising prints. Who else has $150 artwork in their work bathroom? I also added a mirrored make-up table and a crystal chandelier. it's handicap accessible per MD state law and glammed to my alter-ego. 

Hamilton

I struggle to fit fashion into a workplace graffitied with urine, feces and anal glands on an every-single-day-of-my-work-day-existence. It might just be a pair of bright cartooney socks. Or some vibrantly-glittered Begdorf eye shadow to add a hint of glimmer to the disposable day scrubs.

But the reality is that I chose this one. This life, This path where the road is not full of whimsy, trends, public performances, and striving to be a house of notoriety in this label conscious crowd. I am a small town vet working my ass into a dust trying to save this most recent disposed of kitten who without us would face a world intent on consumption. I am the force of nature determined to hold back the raging bull wearing expensive shoes in the phone booth, and I couldn't be anything else. No matter which door I had chosen to open; pick the hidden prize behind, I would have ended up here. The heroine in my own set of Herriot novels. Still sweating under urine soaked scrubs with turquoise socks stenciled with cats in Santa hats feeling like I make a difference even when there is no audience to applaud, and no orchestra to bow to. 

Recognition, Resolution, and Restitution

 

One of the few rescues who got out. We brought her to Romania.
She has since found a home.

I had hoped I would be at a different place then here. And yet I am not. I am still stuck. Mucking and muddling through the aftermath of a trip I was so compelled to journey upon. I was hoping to make a difference. Assist a place so fraught with injustice. Throw a fist in the air to provide a whisper of defiance to a place I have never been before, for a people I do not know.

The Ukraine story, my story within theirs, still nags and gnaws on inside of me.

Here’s where I am, and here’s what I didn’t know I needed to start to try get away from it all.

Sandbags and steel barricades. They are everywhere.

Validation. I needed this. It might be shameful to admit. (Heck, if it is I am ok with that). I needed to not feel so alone. It came from two voices today. One, Dr. Sarah, who felt as desperate to go and help as I did. And two, Dr. David who arrived at the group I was with a week after I left, and described it, his experience with them, (not even the Ukraine war debacle) as; “the worst experience of my life.” He has been a veterinarian for 37 years. I found myself apologizing to him. Sorry for what he had been through. Sorry that I couldn’t have helped discourage him from being there. I can feel his weighty regret. He, like me, wanted to go more than our due diligence in trusting commandos with nothing to lose brought us. He, just like I, was content to clean the kennels of the dogs that the egomaniacs who had retrieved them would not do. Silly how we were so easily and eagerly recruited to came care for the animals because there was no one with any veterinary training there to help, only to be trusted with kennel duty. For me, I was more intent on being useful than being disposed. It seemed from day one of my arrival in Ukraine that my two options for being a part of the ramshackle team was clean cages/walk dogs/try to lay low, or, be headed with the engine crew to drive all over Ukraine on a rescue mission. He, like me, feels misappropriated, cheated, and deceived to have come so far to clean kennels, while watching them die of disease and isolation in dark cramped cages. I feel most closely connected to the animals I was so intent upon helping because of the solitary time I spent with them. Regardless of my medical prowess my contentment, despair, and painful burdened heart lies most solely upon walking away from those animals. I am bitter, burdened and speaking out for them. I will not be able to find my answers to the nagging puzzle still in pieces around me, but, now I can share my story with the others who passed through after me. Revenge for the eyes of those needful, displaced souls I can no longer be walking near.

Jeffery. One of the few to get out.

Resolve. There is none of that here. So, I fall back into recognition. I keep finding myself chewing on the days, the quiet with a dog on a leash, walking, walking, walking. And the faces I will never see again. The eyes of those faces that I dream of. Want for, and beckon to.

Mischa, the compound kitty. I loved her, she needed us. I needed her.
I spent much of my days just holding her. 

Today I found a community. It was the first time I could talk about my trip and have it resonate with someone else. I can say that I needed them, and feel great comfort in them also needing me. A community of more than a singular being who still tries to settle for the dust that won’t fall. I have found three other people, (maybe four? Or, even five?) who went just to be helpful. Just like me. They put their lives into a precarious place for the pure humanitarian effort that is so desperately needed. Just like me. Three other people who went because we were silly enough to believe that we were needed just because we were told so. We all asked for references, a call from the one before us to help settle the voices within that we were doing the right thing with the people who shared our view on this preposterous invasion and had the gumption to not only say so, but to do. All of us received the same response. None of us were given each other’s contact info beforehand. We found each other afterwards. After we left. Came home. All of us struggling to come to terms with our time there. All still reeling from the experiences we had. All ostracized by the group we put our lives in the hands of. I can’t express how consoling having this community is. There is something inexplicably horrible about loneliness. Loneliness with a secret no one can digest. A rumination of fear-based failures from a faraway place that isn’t relatable, nor comparable. War is the most atrocious act of mankind. War upon fellow humans just because you believe your might is more than their spines can withstand is unforgivable. The weak, poor and defenseless who get caught in between, that, well that is enough to motivate foreigners to your shores. And yet there is this survivors remorse, this silent pain of abandonment, and the futility that seemed to have come from risking so much.

My husband doesn’t understand. I can’t share this with him. It is still too raw, and my actions too selfish for him to make room for empathy on what that trip cost me, never mind him. He thought it foolish from the start. Empathy with a fool is permission to repeat. He wants me to see the experience in valuations from the economist’s eye. The weight of one life and the cost it requires. “Is one dog from Ukraine worth the thousands of dollars it cost you to care for them? Is it worth it when they still cannot get out? When 25 out of the 30 puppies that were brought to the compound died of parvo simply because they were rounded up, caged together and never vaccinated?” No, the answer is no. I wasn’t brought there to practice 30 years of medicine that I was armed with. I was brought there to be a pawn in a delusionist's collection. I was pled to so that I could be a talking point for more social media fuel. The lives can’t be counted as not valuable, not risk-worthy, not my problem to solve.

The first euthanasia I had in Ukraine. Heart failure.

If grief is part of this recovery I am past the heartbreak of not being able to bring the dogs and cats I helped smuggle into Romania. I am in anger. Anger that I wasted my time, watched those dogs die from sheltering, caging, and followers. Angry that this is the only place I have left to put the pieces. It’s not good enough that the wolf and the grizzly bear are safe and out of Ukraine. It’s not good enough that I came home safely. There is not a place I can shelve this and go on.

Can I continue to carry the stories of the faces I left behind? Can I find the will to put the pieces back into some assemblage of peaceful acceptance, or, am I at the place where restitution is the only resolution?  

Coughing all night. He just coughed all night. Antibiotics, sedation and a full grooming shave down. He was brought to Romania. In a shelter now.

I said once to a fellow, equally fried veterinary colleague, "yeah, I get it. I am so exhausted by the sheer volume of need, and the frustration of my inability to meet the demand that I went off to a war to try to feel better about myself, and my current place within vetmed." Maybe the muck is my own to own, and accept? Maybe there isn't such a thing as a peaceful recognition, nor resolve. And, then again, maybe the restitution only exists within?

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.

Blame The Other Guy. Where Fault In Vet Med Costs Us All

We all want to point the finger.. It is natural when we are smacked in the face with something so devastating we can't find the place to put our feet back on the ground. We point, blame, and spew angry hateful things when life sends us reeling for safer waters. It is so insanely common we do it in almost every aspect of our lives.

My cat Wren,, basking on the warmest spot in the house.

We are living in a time and place where people are struggling. Struggling to stay afloat as they yearn to get ahead, and, dare perhaps to even get ahead. We are also struggling to find a place where we are loved for some semblance of a peaceful respite in the all too chaotic world we wander within.

I live it. I live it every single day. I see the most needful in this world, and, I see it in the most compassionate of us all. Also, and this is vitally important to remember, I see it in the voiceless, meekest, and most vulnerable. I see it in the eyes that no one else looks into.

Have you ever tried to extinguish the life of a tiny creature still fighting to live? Do you know how soul crushing that can be? Do you know what the price for this act is?

Do you have to look into the eyes of the small, meek, suffering, struggling, and fighting to live anyway and ask yourself the really hard questions? How do you reason with your own internal understanding of ability without advocacy? Or, how about the person, your client, who is so devoted to their beloved pet that they can't see reason in anything? What if you don't have the resources or knowledge base to help manage this medical and emotional debacle? It's a mess at all sides and all levels. How to avoid all of this messy stuff? Just disengage? Turn yourself off and walk away. There is a lot of this going on in our society.

We live in a place and time where medicine can provide miraculous cures. We also live in a place where fewer and fewer people help their fellow man at a sacrifice to themselves. This is a time where costs of care are skyrocketing and indifference about who is responsible for this is thriving.

The tiniest creatures cross my threshold every single day. And with each face (and they all have a face, and a voice, and a personality and a huge list of needs), I have to ask myself what I am going to do about it? What am I going to do about meeting their needs as I try to remain within my own? How do I find the place where both can be met? How do I place a value, a price, a conciliatory explanation on finding the answer, within the confines of need, for a life that costs me, emotionally and financially when neither are secure, nor, established within mine? Who do I place first in line for a feast of rations?

I could concoct a million excuses. Find a bazillion reasons,, wouldn't you? Wouldn't you rather make her little needy desperate face someone else's problem? Let them figure it out. Just turn a blind eye, make an excuse, who cares? Right? Isn't that the point? Does anyone really care if no one else knows her plight? If no one else hears her heart stop in this wood, did it ever beat to begin with?

This is a blog about blame. The safest place to retreat to when you lack the conviction to do anything more.

So, lets talk about blame.

Veterinary care is too expensive. I mean isn't it? Five thousand for knee surgery. Ten thousand for hips to be replaced. Hit by car with multiple fractures, a few days, maybe a  week in the specialty clinic and you are looking at maybe twelve grand? Maybe more?

A blocked cat starts at fifteen hundred. A puppy with a sock stuck in his gut will set you back three grand,,, to start, complications, which can happen, will cause that to increase. And, remember these are all treatable. Maybe not accessible, maybe not affordable to the masses, but treatable doesn't change the fact we can help them.

So decide.. Take a chance, everything in health care is a chance, cough up a few thousand dollars.

Who pays if no one cares? What about if someone cares but no one can produce viable accessible options? Well I hope we all know the answer. The most obvious victim is the patient. They all too commonly pay for the blame with their lives. Why let them suffer any longer? There is after all no guarantee that they will recover? Why not just save your pennies from the risk of losing them, and your pet, and just blame the vet?

Your vet thinks that the blame is all yours, and, yours alone. Here's why;

• You waited too long. 
• You never got the preventative care to avoid this mess. 
• You weren't prepared for the bumps that are inevitable in every living things life.
• You should have had an emergency fund available.
• You shouldn't have spent two grand on this dog when it was a puppy and not be willing to invest 500 bucks in them at age 10 of never having spent a nickel the last decade short of dry crappy kibble.
• You should have saved your pennies for the pet you claim to so deeply love instead of getting your nails done, your tattoos done, your new car, your new phone, your boob-job. 

Your poor choices are not mine to bail out.

The venom knows no bounds.

Always observant. My pups Storm and Fripp.

We live in a country where we can't care enough to provide humans health care, or, hungry kids school meals. Or decent housing that is affordable at minimum wage.

You want to place blame? Go ahead it won't get us anywhere. But you can feel better about yourself can't you?

So here we are,,, living in a place where people want monthly wellness plans. They think they are getting a good deal. I mean aren't they? Well, maybe in the short run you are, but, ask yourself, better yet ask your vet at that corporate practice how much it is going to be for these;

If you have a male cat.. How much will it cost to unblock them? What if it happens at 2 pm on a Wednesday? Or 2 am on a Saturday? Are you prepared for these? Will they even help you if it does happen? Many, dare I say, most, will send you to the ER. Starts at about $1500. I know someone who spent $9,000. Can you afford that Wellness Plan now?

If you have a 3 year old Lab who ate 5 tampons and is now lethargic, vomiting and can't keep anything down?

What if you have a cat who likes to play with thread/string?

What about the German Shepherd with the basketball distended abdomen?

Or the dog fight dog who has multiple bleeding lacerations?

I know people who have spent $400 on a broken toenail. Want to place blame on exorbitant care costs? This seems like an easy target to start with.

If you are cold enough to look at these faces and not see a life worth fighting for then you will never understand why the blame is cousin to the hateful accusations you are going to get.

People love their pets. We veterinarians love our pets. If we don't love them anymore there is a blame based excuse at the crux of our armored indifference?

We are all choosing to live a life of blame based justification. It's safer here. No vulnerability, no guilt, no shame. No one cares after all, do they? Do you?

At this time and place the last local ER is closing its doors. For good. It was the last place I could send people at 2 am to have that sock, tampon, urinary stone, twisted gut, broken nail, etc.. to go. Now the only choices are two corporately owned clinics. They are bright, shiny, well-staffed and making some group of middle aged venture capitalists driving very nice cars, with very nice clothes and very cushy vacation homes in places we have never been. Want to live their life? Own a forty-thousand dollar bag that the K's tote their laundry in? Well, it's easy. It will only cost  you every other pet with a face you cannot see beyond the doe-eyes for. Just turn them away, kill them as a resolution to their ailment. You don't care do you? You love your stuff more. Its not your fault is it?

You have bills to pay. Vet school bills, a mortgage, kids to put through college, a car loan, and you need your car so you can get  to work. And those poor vet techs. If we don't pay them a decent wage we can't possible help the pets who need us. And if I don't buy the most expensive x-ray machine out there, and have loads of licensed techs I can't attract a decent vet to help me stay open all of the hours that my clients need me to.

Always adorable,, really innocent. Fripp.

So who's fault is it?

Maybe we all need to care more? Care about the choices you make? The businesses you support? The long term acute and emergent choices you make? Maybe the blame is so evenly distributed that one small change can start an avalanche of infectious cures? Maybe you are not prepared? Maybe you love your pets like children? And, maybe on some dark Saturday night at 2 am you will be living this nightmare that is called economic euthanasia so some corporate shark can drive a convertible in a snappy zip code? He doesn't care about you, or your pet? And, really, let's be honest, you don't care about him either.

Charleston. My senior, a local Humane Society find.

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.