The Measure

The measure, (of really anything right?), is too often based on "success". But who gets to decide what that is? Who decides that measuring stick has increments other than dollar signs? Why is our society so fixated, obsessed, with money? The success measured by profits and the magnitude of the beast that the business is based upon. So often I wonder if people are really happy behind that? So often I wonder if the whole damned world needs a smack in the face about success with respect to where success, and hence, happiness lies?

At some point enough is more than you need and the result is finding meaning within the days after financial security.

The clinic has become so busy that I have to repeatedly stop, look for, and find myself. Days become so chaotic, hectic, and fervor-ed that I have to remind myself to breathe. Step away, take a breath, maybe even take a sip of water, and, ask myself if I have peed yet today? I have to do this... actually consciously tell myself to STOP. I have to repeatedly ask myself if I still remember why I am here? I have to force myself to take pause,,, Re-center, refocus, and renew the hopes, dreams, and aspirations that got me to right here. In the chaos.

Kitten pile.
5 of the 54 we helped re-home from a dire hoarding situation.

Here is a veterinarian. Here is a 7 day a week veterinary clinic with a heart so big people travel from miles away to be a part of our mission. The marrow of our purpose. Here is 12 hour days packed with more cases than the day can contain. If I can't help them they too often don't get help. There are industry wide whispers about seeking and maintaining a "work-life balance" but the reality is that the advice easier to dish from afar than it is to swallow. The reality that I hoped for this. I got exactly what I asked for.

I got here because I love pets more than my compassion for humans could convince me to study medicine for the sheer bliss of helping a human who already had a death wish provided. People are complicated. They like complicated. Pets, animals in every species, are easy. Life, liberty, freedom, and no false bravado or pretense for personal gain at your expense. The simplicity of their lives, as little and seemingly insignificant as they seem, are splendidly beautiful in their quest to live in the moments they are given. Their fears are only in their losses, never their greedy gains. Humans make life hard, painful, burdensome. There are angles, trust issues, and acquisition/preservation of gains to contemplate. Pets, no they never steal your heart and break it for less than you were willing to invest. They fill it without asking what's in it for them. They define, and eternally exemplify, unconditional love.

There is an endless sea of veterinary need. For those of us who take personal pride in the feeling of being needed, even desired or sought after in the professional sphere the ego boost can be invigorating. The problem lies within the minutes between the chaos. I get lost here too often. I can't find my footing and with that I lose my compass.

One of the Motel 5, 2022edition of the Good Sam rescues

So many days, (I would say the vast majority), go like this: 

I start the day driving to work heart pounding. Cortisol surging through my veins. Every inch of them. Heart beating out of my chest. The drumbeat reminder that the day looms before me. Taking deep slow breaths and trying to replace my current overwhelmingly dismal mindset with some podcast of light jovial banter. Half of my days are filled with surgeries. These are the days that cause the deepest despairing and yearning. "Lord, just let them all live through the day and be better off for my scalpels precision." I absolutely say something this corny and pathetic. I obsess over these patients. Their predicaments. Their necessary, life changing surgical interventions at my hand. The cases that only have me as their only life saving options. The much heavier burdens to bear; the routine spays that can bleed out behind your back after you thought they were sewed up nicely and left to warm up and revive. The routines will break you. The adverse outcomes you never saw coming. Never mind the pet parents who debate, doubt, and despair over these "routine surgeries" and whether the risk of anesthesia is worth the lack of heat cycles they will have to endure. People worry about their pets in degrees that I both identify with, and break my back over fearful burden with. For all of those clients that fret, I promise I fret with you. I am hiding in the bushes these days. Passing cases anytime I can to a boarded surgeon, internist, cardio specialist. I pass the buck at every chance possible in the hopes that these patients are better served elsewhere. The measure of success is in outcomes, not deposit slips.

For these days, these fearful-filled stress like you cannot imagine, days, I know every patient that I will see. I compartmentalize them. If hope and well-wishes could motivate fate I expect I am blessed and flush. It also makes the weight of the elephant on my shoulders mammoth sized. Remember the days when pets were just "pets"? The kind that lived in a box outside? On a chain. Yeah, I don't either. I know the pets that have names as endearing as the well thought out collar and matching onesie they had custom made for them. I know these pets, my patients, and I know that they are just exactly like my own. Family. Irreplaceable. The most important part of our human days are the pets we share them with. They don't just fill our home space, they define our happiness, well-being, and place of belonging. It is the kind of clientele I attracted. Hoped for. Wished into existence and fought for. Heart on my sleeve, berating the profession that so vehemently wants to protect the "pets = property" legal designation as they promote their personal professions of "pets = family" worthy of kidney transplants, chemo and costs of care tipping the bar of elaborate weddings and lifesavings. Smiling out both sides of our faces.

Two of the 54 from last years Good Sam endeavor.

My patients, the ones who land on my surgery day, they are much more than a name, an age, a species and a problem. They are my lifeblood. My responsibility. My only obligation for that period the anesthesia is running and the heartbeat is defining the rhythm of the moments. They are my mammoth to carry to the other side safely.

The measure for me is really simple. Your pet is one of the greatest gifts ever given to us. A personal treasure beyond weight, or measure. That value is unmeasurable. Hence, my mammoth, and my dilemma. 

You see my challenge. How do I stay true to my belief that every pet is someone's bedrock, and, not let that become a mammoth that puts so much pressure on me I hyperventilate on the drive into the office?

Clarke.

I am successful. Profitable, but yet still so burdened. I wonder if they are inseparable? Does one only come without the other? 

Yes. I think so. For me. For my measuring stick. For the kind of success that I am interested in. 

Oaken. May they all be as beloved as he.

Maybe I need to be asking myself about contentment. If that is measurable? 

Related blogs;

New Beginnings and Old Responsibilities. The building of my legacy.

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

This is a blog about the journey. There is not a destination. Nor, is there a typical audience. Just a diary into the ethos to cast out the inner musings and  hope they find a place to settle outside of my soul.

Each entry is a step to a place that like every other will have an ending. Its the little fragments of time I steal away to peel myself from the arduous work that is my life's joy and legacy.

My crew, Storm, Frippie, Charleston

Good Commercials Are Sold With A Smile You Never See

 Did you know the secret to selling something with only audio is to be smiling as you record?

Did you know that a smile can be heard?

Have you tried it? That smile is transcendent. It influences. Motivates. Sells.

Don't we all have to pitch ourselves every single day to someone?

Veterinary medicine is no different.

Simba. One of the 54 cats we helped last year from one home.

My job is to understand and translate my mute patient and sell their needs to their parents. Smiling while I sell, albeit the way a ventriloquist does, is the art behind the successful veterinary care sell.

I more appropriately I call it the 'building of trust to the point where the pitch is simplified to a permission versus a negotiation'. 

Basil One of 5 cats we took after the owners were evicted from a motel.,
He is safe with us now, but looking for a home.

I am a terrible salesperson. All that nonsense of fluff, fake veneers, and smoky mirrors is exhausting. I am a failure as a phony. I know this. I have had to rely on my genuine compassion to build a clientele willing to entrust their pets care in my hands. Just be me and try to remember to smile every so often. Not too much teeth or arm twisting. Keep the common goal in mind. We all have to be here with the same agenda and the same endpoint. Not an easy task or small hopeful wish.

It's not just lip service. I back it up with skin in the game. I make deals. If needed I will make deals that the house loses on.

Sadie. The most influential patient in my career.
She was my defining moment. My pivot point.

I give stuff away daily. It's the glitter in my vanilla day. It is the thing I love, take greatest delight in, every single day.

Sound crazy? Counter intuitive? Maybe its the easiest way to sell my genuine belief in always putting the patient first.

Saffie. Clinic cat.
Adopted and returned 3 times.
And still loved.

Here's an example.

Miss Phillips was elderly. Small, demure, crumpled and lacking any color in her dense weighty coat. Grey stringy hair, grey overstuffed winter coat, and grey sweatpants. She was seated on the long wide wooden bench in the exam room. Composed, quiet and clutching her coat sleeves enveloping her oversized market bag I think she used as a purse. She was quiet, withdrawn and weathered. She struggled with the weight of the 7 decades she had been alive. She needed help getting into our building. The staff led her into the exam room as they carried her petite dog-sized cat carrier for her. She was soft spoken and easily overlooked. She was a new client with a cat to be seen for a spay. This is the information I am given as I walk into the exam room. "New client, new patient. Cat needs to be spayed." No other information available. Blank slate. Not my favorite place to begin.

Seraphina.
Queen of everything

I say "hello" and start collecting pieces to finish the canvas. "This is Lilly. She is about a year old. She is not spayed." That's all I have. I look up at Ms Phillips. She has no emotion. She doesn't move an inch on the bench. Nestled into her winter coat seemingly swallowing her in its over abundant quilting.

"So, she has never been to the vet before?" I ask.

"No." Volley and serve and still no emotion to guide me on where this is going to end up.

"She is here to start her vaccines and be spayed. Correct?" I repeat. Ms Phillips is not giving me any information willingly. This is going to be a Q&A discussion. I slow down. Mirror her pace and attitude as much as I am able. 

I take a minute to look at her again. Switch gears from Lilly to her. "Did you drive here?"

"No, I don't drive." 

"Oh," I reply. A sigh of relief washes over me. "Who brought you?"

"My friend drives me."

"Do you have other pets?"

"No."

"No other cats?" Part of my job is sizing people up. Finding common ground whilst understanding the degree to which they invite these pets into their lives. That, and I just had a sense of "cat lady" lingering. Building a relationship to help a pet for their entire life and not this one and done visit. I try to remember to smile inside my inquiries. Add a smile, slow my pace, she seems very nice. I can see myself, someday, in her.

"There is a cat. (long pause).... She is not mine. I let her inside when it is cold. I just had her at the ER over the weekend. She had a respiratory infection. It cost me $300, so now I cannot afford to much for todays exam. I am not allowed to have more than one cat."

And there it was. The shell was cracked. She spilled the beans in just a few sentences and a change of perspective. 

We spoke for a few more minutes. She told me that she was renting her house. She was not allowed pets, but her landlords were going to let her keep Lilly as long as she was spayed and vetted. She was here, at my clinic, because we were the most affordable outside of the rescues and non-profits that had a 6 month plus spay/neuter wait time. 

"You let this other cat into your home where she sleeps at night. You feed her and now you pay for her to go to a vet clinic, and yet she isn't yours?"

All of a sudden one cat that she couldn't afford was two.

"What is going to happen when she has kittens?"

And with this question the look on Ms. Phillips face fell to the ground. It hadn't occurred to her. This reality where her good deeds put her in a predicament she couldn't manage.

We decided together that she would leave Lilly with us at the clinic. Her friend graciously ok'd bringing her back tomorrow with the other cat, Kitty. I would spay both the next day, and she could pay me back as she could. To save financial resources that she truly didn't have we would cut out the optional items like pre-op blood work. The exchange and change of plans had taken almost 20 minutes of our allotted 30. It had included being honest with who we are. It also included asking for help from the driving friend via a flip phone she dialed to her friend parked in the lot outside, too far for Ms. Phillips to walk again.

The next day I met Kitty. Small, slender, matted and peppered with grit in her coat from the flea dirt. Underweight, under muscled, overlooked and discarded like soo many cats in our community. She was gentle, confident, and melted with any small inkling of affection. She was so grateful for a warm place and a kind heart that she surrendered and collapsed into your arms soaking it all in.

Ms Phillips called later in the day checking on how the two cats did with their spay surgeries. "Fine," I replied. I had estimated Kitty to be about 4-6 years old. She was too sweet to be overlooked anymore. I asked her if she would like us to try to find her a home of her own. I never know if I can persuade others to see the kindness in an all black cat who isn't a kitten, but, she was not a feral cat and she needed a break. Ms. Phillips agreed once again that she couldn't have two cats at her home.

Over the phone (no car to drive and sign papers, remember), she authorized Kitty to stay with us as we tried to find her a home.

You know what happened? Another miracle. Seems so crazy the way miracles find us when we give more than we have to, and offer more than the house makes money on. Ms. Phillips got brave! She went to her landlords and put her cards on the table. She told them that she loved these two cats! That with a little help she was going to take care of them and she asked for permission to have TWO!

They said YES!

She called us back. Told us she wanted her Kitty back. 

Turns out happy endings just need a little faith and genuine compassion to make miracles happen.

....and with a smile we made the ending meet the intentions of everyone a reality everyone benefits from.

Wren. Night time ritual.
I tell her she is the most beautiful girl in the world and she reaffirms it.

Related blogs;

Wren: The Sickest Kitten Of Them All

Seraphina; The Futility of it ALL and Meet Seraphina

Sadie; Sadie's Story.

The Hardest Part Of This Job

Give Back. 

No one should ever have to choose. When we, the practice owners, cover the cost of care for employee pets.

I was on a veterinary hospital owners FB page the other day. While there a veterinarian practice owner posed a question to the group. It was essentially a long drawn out description about an employee with a specific patient ailment which led to the question; 

When should the veterinary practice help a staff member with the care of their own personal pet?

I was a little taken back by the responses. Most, (I am sure they are classified as "well managed" aka the varsity letter for "highly profitable"), clinics had some long verbose lawyer-ey written up explanation for what discounts staff get and when these apply. It was all very cut-dry-to-the-letter. It was sadly indifferent and cold. In essence there was an algorithm set up in advance to "assist" with very anemic access. A discount is given, but a yearly cap was also applied. In essence, for most veterinary hospital employees who can barely cover their own housing and food costs it would never be enough to help in a bad case of any pets ailments.

Bica gets a hug of reassurance.

I read the feed, chewed on it all night, and the next day replied with the following;

"Why do we set our staff up to fail? What the hell is this "accountability over compassion" crap. The culture breeds indifference and neglect and yet we spend every professional moment trying to harbor the exact opposite with our clients? We know what we pay our staff and we know they cant afford the care we expect our clients to bestow upon their own pets and it is incongruous." (,,and I wonder why other vets don't like me,, ugh, Krista. Shut up more often, or, at least try).

Every staff member at my clinic JVC is treated like family. Yes, we are dysfunctional, and, yes, we are imperfect, but when I take you on as a staff member I help you take care of your own family. In return we all collectively take care of the patients in need within our sphere of influence. 

Kissing my Seraphina goodnight.

If your staff can't afford to care for their pets at your practice I challenge you to think about whether you are a part of the problem that separates the ultra rich from who you are? Telling me that you cannot afford to pay them what they need to to protect and care for their family indicates that you either take too  much off the till, don't charge enough for your goods and services, or, you have lost your way in a profession built upon an oath to serve.

And as soon as I had finished this article I make the mistake of perusing Facebook;

Here's what I found one of my family-staff-members had posted.

..to which multiple other staff members; (you know the same ones I just called "family" above write the following;

"very true"

"I feel this"

"Yes! That's why I'm broke and happy. lol. No more pushing myself too hard." (she quit a few months ago.

"truth"

...and I wonder why so many other vets sell to corporate? Why not cash in and dump your family? 

Rio. I live, and, live for this smile!

I am almost two decades into this profession. It has not been an easy road. But, I think that above all else is the fact that no matter how hard you try, how much you invest of yourselves, people look out for themselves first. I am at peace with this, even as I try everyday to convince them to help those who need us desperately, without judgement for the sake of being true to our purpose and mission. As I try to unite them in one small walk of faith into a place of putting others always before ourselves.

My end of Summer 2021 family photo

I wrote a truly pathetic self-pity blog a few weeks ago about how tender my feelings have become. I believe that the more I convince myself to hold onto this somewhat delusional dream of being a practice owner who still cares much more than she profits, that I could inspire a whole team to do the same. That is the hardest pill to swallow... that it might be contagious for a short time, the desperate case of the day timeframe, but, it might not have legs long enough and strong enough to endure. it wont be the heartbreak of losing cases that I turned away, or declined to help, I never did that, it was the investment in others that never got returned. its the fair weathered friends who will always see you as just their boss. The person who is the unwanted guest at the party. The enemy. The person who makes more money than you do, who profits from the labors and yet cant ever be one of the group. That's the hardest part. Just being lonely and still trying to stay the course of what you think is the right thing to do.

This profession, this place that I hold, leaves me constantly questioning. Who am I? What do I want to be remembered as? And, how can I shape the world, and my little community in a positive way? Even if it isn't always sunshine, rainbows and easily recognized?

If anyone, truly, anyone comes and asks for help we need to remember the following;

First, that is is our calling. Our chosen profession. The place where being needed is also being depended upon. You can't have one without the other.

Instead of being annoyed at the pet parent, the situation, the road to however they got here, we just remember there is a soul in need. We focus on that. 

We offer help in all of its forms. medically, emotionally and, yes, in some cases financially.

As it always is we start at, and end at compassion. The value resides here, and very often the cost of care can be managed adequately so that we all feel we didn't fail our pets from there.

And lastly, it is imperative to every human who loves a pet companion for them to feel hope. If we take away this whether it be in the form of excess cost, lack of access, or apparent indifference to their plight, we lose our ability to keep the staff who keeps us viable and capable. 

Give more than you have to and expect nothing in return is a good motto to live by.

The good life as modeled by my dog Storm

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.

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.

Leave Funds Available For Euthanasia. The things vets say to each other that would appall the pet parents they serve.

On a Facebook page for vets to assist other vets I saw this comment. It stopped me in my tracks. It also made me question where this profession is at, and, whether we want to change our collective persona. It was also another reminder that the veterinary world that I live and work in is a far cry from what others do. 

Storm in his holiday cheer

There are numerous Facebook groups dedicated to vets helping other vets with difficult cases, and, of course the clients that come along with them. It is our international social media network for vetmed advice. This particular post, like many of them, was about a perplexing case with a client who had limited resources, or as we like to coin it, "financial constraints" aka no money. Most of these cases have the typical presenting facts; dog, age, breed, spayed/neutered, pertinent history, along with presenting owner concerns, and, veterinarians physical exam findings. This particular case involved a cat who was having trouble breathing. Scant details about patients history, (and/or details the vet thought the client was withholding to look better; think marijuana, drugs, illegal ingestion or access to stuff), and therefore vet really only had that and their physical exam findings to go on. This is an all too common scenario. People show up with a very sick animal and little-to-no details about how, when, why, or even last time the pet saw a vet. Think; umm? don't know how long the pet has been like this? Don't know when, or if ever, it saw a vet? Don't know if they could have gotten into something (like weed or toxins)? Don't know when they last ate, or, went to the bathroom? Or any tiny tidbit of relevant helpful information to assist in this case. Turns out the vet thought the chest sounded too quiet, (indicating there might be fluid in the chest making breathing harder, and hence, breath sounds absent). When a client without any money for things like x-rays, or a chest tap (to try to remove the suffocating chest fluid) the patient has little help of getting help because the clients didn't have enough money to allow for the most basic of diagnostics. It happens with almost every case. We make do with little diagnostic dough on a daily basis. It is almost impossible for me to try to explain how hard practicing medicine is when you don't have the liberty to run tests.. like any tests. Even the most basic/cheap diagnostic tests. Try to analyze a sick, almost lifeless non-verbal being with just your eyes, ears, hands, and nose. We do it all day every day. We also get convinced to guess so much that it too often makes us believe that we are truly very good guessers. I dare say we are too often cocky with our presumptive diagnoses as there is no one to prove us wrong. The clairvoyant diagnostician with no data to ever prove us a charlatan.  

What was most shocking to me about this particular post wasn't that people weren't giving the advice I give my vets (which is listed below), but, worst of all that one vets advice was to; 

"not spend all of the clients money so that they could no longer afford euthanasia." 

I suppose I am deeply and ethically perplexed that this is valid advice. I also wonder how many of us veterinarians live here in this place where mercy only comes with a price tag? And, why would we want to? Aren't we being both neglectful and hypocritical if so? Aren't we both absent in our compassion towards our patients (and no, I did not say client,, because we all know that we love to punish them), but also hypocritical in our own advice of "it's neglect if people get a pet that they cannot afford?" Can we really be so cold and cruel to allow suffering if it doesn't make us money? Don't we dish that judgmental sputum daily? Blame the pet parents when their pet gets sick because they couldn't prevent the preventable? And then deny them a compassionate end when they run out if resources to permit it? Aren't we complicit in promoting negligence that perpetuates suffering because we do not offer affordable euthanasia's? I know of some places that charge $400-600 for euthanasia. (It is $125 here at my clinic). If you cannot afford it, AND, (big and here!) if we truly believe that it is in the pets best interest to be euthanized, should we then be doing it for free? Are we really reminding each other that we should spare the $600 to help save the pet so that we can euthanize them profitably? 

Holy Crap where has this profession gone?

I don't (and won't ever) add the cost of a euthanasia into the cost of a patients care. I also don't list it as a treatment option. It's an option, as it should be for every living being that suffers in dying, but lets not elevate it to a "treatment". It is not the last line item in the long list of charges for both goods and services that I feel the patient will need to get better. After all isn't that our primary goal? Getting patients better? Aren't we all collectively responsible for helping pets get and feel better? No veterinarian should withhold euthanasia due to cost. And yet it seems we do? I have never even considered adding/budgeting/listing this on an invoice when a patient is at the clinic asking for care. As if the tally of the 'total cost of care' needs to include this? Is euthanasia part of our "care" package? I am not arguing that it isn't, but, I am asking why we make room for this at the expense of doing what we all came here to do? Am I asking for too much room? Too much compassion? (Yes, probably). I am asking for a sliding scale of care. You know the kind that gives you a "freebie" euthanasia when financially warranted after a client has exhausted the meaningful list of possible curative treatment options. A rewards program of sorts so that we can care for pets by making them better versus incentivizing euthanasia. How many times do we send animals home to suffer while they die because we used up all of the funds beforehand? Doesn't that sound cruel? How can we preach being ethical and responsible and then send pets home suffering for our economic gain. Let one vet get charged with intentionally cruelty when they deny affordable euthanasia. Then maybe our collective conscious would outweigh our judgmental pragmatism. How sad that it might come to this?

Frippie, sock thief.

When veterinarians wonder why the state if the profession has come to this place where we can boast of our astronomical suicide rates, or, having made the worst return on investment possible by profession decision, or, the fallen trust status we used to boastfully proclaim, it is no wonder that we struggle and suffer to the degree we do. We created it. We are responsible for it, and now we wonder how to repair it? 

To my fellow veterinarians out there.. (whom I suspect will be pissed at me for my publicly stating this viewpoint) argue with me all you want.. and, then ask yourself whose side you are on? Who do you serve? If you said yourself, then ask yourself how she thinks that is compassionate care giving to be proud of.. ?

Zeba and Honeybrook waking up from surgery. Kept in kind oversight by Michele.

The following is the list, (long, short, detailed, and just silly I suppose) that I wish my mentor had given me before I started practicing vetmed. This profession is too reliant on learning hard lessons. Trial by fire, and thrown in to see if you can swim. For a profession too settled upon self doubt in the face of loads of guessing prognoses, not to mention our imposter syndrome frailties alongside the suicide factor it isn’t appropriate any longer. We can, and need, to do better.

Home at the end of a long adventure in the park.

The vet practice I bought has had a 17 year history of this sort of practice owner advice. My advice to the vets who follow. I keep the list growing. Accumulating pearls of practice to pay forward. A playbook for the other doctors and our staff. It consists of permission slips, warnings, and some basic ground rules as we all try to live within this landmine filled landscape full of wet noses, heartbeats and heartbreak trying to keep healthy the most important lives in other humans lives. We are just like them. Us, the veterinarians and staff, and them, our clients. We love our pets as the lifeblood to our souls in need of companionship, purpose and joy. It is imperative to always remember this.

My Frippie sleeping guard over our tree.

To the veterinarians and staff of Jarrettsville Vet, I ask you to ponder these;

I would like to start by saying one thing that I hope you hold true and tight to your heart. You have to be brave enough to be vulnerable and courageous enough to fail. Too many of us let our fear apprehend us. Too many lives slip away because of this. Jump in! Challenge yourself and be both proud and hungry for the next. Invest yourself into every patient every single time. Sometimes you will walk away with only that. And that is always enough. The rest is short loved transient and holds little value.

Likability matters. In medicine it is the single first influence to motivate your success. Smile. Engage. Offer more than you have to, and, more than the rest do. You can risk vulnerability but the reward more than makes up for the soft spot exposure.

The secret to the report card (the summary of the pets visit that we send home from every examination); it is the measure of your time with your patient. Let it reflect it accurately and definitively. People need a tangible piece of the experience. It is also the ticket to the next stop in many cases. Let it be the road map for where you came from, where you are and where to go next.

I summarize the report card as having the following key pieces in each;

• Summarize the exam findings. 
• Provide your presumptive diagnosis, or worst case scenario. State them both. It is our responsibility to hope for the best and prepare for the worst. This is life, both happen.
• List the diagnostics or measures to confirm this. i.e. “our next step is blood work, xray, u/s. Etc”
• Provide guidance as to what to do next, i.e. “if this, then that.” I tell every client what I expect and when I expect it by. I also leave a timeline. i.e. “if the coughing isn’t better in 48 hours call me. If the coughing leads to open mouth breathing, or is intractable, go immediately to the ER.”
• Give estimates for the suggestions you make. Use the support tools provided to generate this estimate. 
• Talk about payment options. We all too often just assume people have excessive disposal income. 
• Help people understand the journey. Be the guide and the sherpa.
• Lay out the plan but keep the focus on the needed steps to getting their pets quality of life back. I.e. do not exhaust resources so that treatment is out of reach. It sounds scary I know, but, if you think a pet is dying and needs surgical intervention, or, medication to survive and resources are tight, skip whatever diagnostics you have to to allow curative treatment to occur. 
• Never paint a picture you can't back up if the case ends up being the worst possible scenario. Being caught off guard, or, letting a pet suffer because you didn't educate the client in what to look for is negligence and makes us complicit in that patients suffering. 
• CYA every day and every interaction. We are dealing with disease. Potentially deadly diseases where many can be passed onto humans. We also have this sticky situation of having to protect the people around our patients. Dangerous dogs, feral cats, zoonotic vectors, and human limitations to the "ideal at home treatment" plans. 
• Always be honest. It's ok to apologize. It is always right to make it right. In some cases I just say that, “what do you think I need to do to make it right?” There is a drought of admission of responsibility in vet med. This too must change. We aren't fallible humans when we cannot be honest and culpable. 
• Pro bono is allowed. Anytime or place that you want to help a patient (or even client) for the sake of helping we will support you. Take a free radiograph to look for pulmonary edema vs a met lesion if it means you can sleep better at night. There is a serious mental health issue in vet med... don't let the few scant dollars it takes to help you feel better about what you are doing here preclude you from resting just a little easier at night. These cases follow us.. the dark shadow. The grim reaper at 2 am, is there a price for these? Yes, but don't let a few give-away diagnostics be the culprit. I promise that what you give away comes back 10 times over. You can tell the appreciative and needy from the rest. And to be honest there aren't many who will take advantage of you when they know that you are here because you care about their pet with them.

Here’s where we fail people. We don’t explain enough. Talk.. talk,, talk… but try to be clear and concise.

Two of the 52 cats we helped to save in our most recent pro bono endeavor.

• Take good care of the staff, they will return it in spades. You may be in that white coat at the head of the line but there is an Army behind you.
• Clean up after yourself. You look like a jerk if you are too good to get dirty, or, think that you are above it. 
• Ask for help. It is available everywhere. Us (the other vets), our broad network of specialists and referrals. (Hey, psst,, did you know that there is a whole enormous group of specialists out there that can give your vet free advice? So, if they tell you they don't know what's going on, or, need help figuring it out ask them if they asked for help from the vet team that supports them. i.e. referral lab, online specialists, Facebook groups. The vets who invest and care will utilize these for the benefit of their patients. If your vet isn't one of these move).
• Don’t send out a referral without a head up as to what they should expect once they get there. Most often this is the price tag, but, it might also include diagnostics which they might be unaware of. Explain as much as possible. Call for estimates, then tell them they are welcome to come back to us if the options from the specialists don't meet their needs. 

Clarke. One of the many faces that I find purpose in this cause.

• Everything is offered a referral. Everything. If they don’t trust us, if they are worried to "don't know what to do paralysis", or, if the molehill looks like it might have a mountain of ugly behind it, CYA and refer. I have a "three times I try and then I punt" rule. If I can't figure it out within three visits I punt to a specialist. Or, I at least strongly encourage/offer. Everyone's time is precious. Further (brace yourself) we are not always such impressive/perfect guessors.

I hope this list grows. I hope that others add to it. Maybe we can all learn from each other and we don’t need to trip so often to remind ourselves who we are or what we are capable of.

Most of all I hope that we remember how powerful the love of a pet in our lives is. That we hold it sacred and feel honored to be caring for each other and giving as much, if not more, than we receive with the spirit of our pets unconditional love to guide us and serve as the inspiration for us to follow.

Jennifer, the Office Manager and our beloved clinic cat Seraphina.
For more on Seraphina read her story here.

If you are a pet parent struggling I am here to help. You can find me at my veterinary clinic Jarrettsville Veterinary Center in Northern Maryland, or, for free pet advice meet me at Pawbly.com.

References;

What is the ROI of your college degree?

Professions With Highest Suicide Rates

How Much Does It Cost To Euthanize A Pet.

Eluding The Arrow. When Life Narrowly Escapes Death. If Only By A Few Days

I have been repeating the following to myself routinely throughout the past days;

"There is nothing more precious than this day...."

I play this on a loop because my breath can't catch my fears for long enough.

Every moment of each recent day has been an egg-shelled goosestep frenzy. A holding of my breath as I cross my fingers and mutter a silent prayer for a reprieve,,, if only for another day. All the while knowing that my luck, and the mercy from above, is on short supply from an endless demand. Fate always wins. The house always calls its players home from rehearsal. I am not fooling anyone, surely not myself. The one who witnesses, awaits, and too often yields that fateful blow. No, surely I will not be provided mercy from deaths ever tightening grip. 

I know this, and yet I, like everyone else, sit here pray-fully begging for another skipped turn. 

Just one more hour, a sunrise, a day, perhaps the upcoming holiday, to be given with my dear boy.

His name is Charleston. He's 13. All grey faced and creaky. Bones jutting from a spine that used to propel him like an antelope. Stiff gaited and slow. He wags a slow paddle when you gleam a big "hello!" and whisper into his silken silvered ears,  "I love you." He is still there. 100% mentally intact. Feeling all of his wants, his impatient protests, and the pull of a cancer that is slowly ingesting him from the inside. He moans and flops, and reminds me to beg harder. Plead more profoundly. And decide where that line is that I always propose to stop at. The veterinarians compass is full of tricks. Tools of the trade to barter with the invisible veil of fate calling him home.

Today was a night of sleepless worry. He did well yesterday. We enjoyed a full day at home, uninterrupted. Last night he paid the price for not sleeping the day away as is his usual when I work 12 hours. He tossed, turned, moaned, whimpered, and panted in small short blows to a chest that has been compressed by fluid from a tumor leaking inside his heart.

He sleeps at the foot of my bed. His dry, violent coughs jolt me out of half slumber to try to assuage the beast that rises and screams within his ribs. It was a night that brought an awakening that we couldn't do this another day. It was just too cruel to hear him pant so fast and furious and still not be able to catch a good breath. 

When my husband awoke we talked about the logistics of putting him to sleep on his bed. In just a few moments he could be at peace. I could give him that. For all the pain it brought to me. I cried to my husband hating this part of my toolbox as much as I do. I truly despise this one last act. It is the most difficult thing I force myself to do. 

Why do I euthanize my own? 

It comes down to them. My beloved pets knowing that they left with me confessing the depth of my gratitude into their ears, their being. That I loved them beyond measure and I wouldn't let anyone else tell them for me at this last moment together. It makes me nauseous. Physically ill. I cannot eat, or drink, or let myself be forgiven for my failure.

I draw imaginary lines to not cross. 

Today it was oxygen and thoracocentesis. I was not going to put him in a caged oxygen chamber, alone. Breathe better my boy, but do it surrounded by stainless steel and a plexiglass door fogged with panting pleas to be freed.

Chest tap. Drain the fluid compressing his lungs and let the air back in. Why when the tumor is just going to replace it? Maybe it will take days, or weeks (fingers crossed), but, it will come back.

Nope we were going to be grateful for our time together and say our goodbyes. 

The cancer is in his heart, his bladder and his spleen. Nasty invasive fucker holed up in the heart. The one place I can't put my surgically gloved finger on and cut out. Tentacled, maniacal, bastard.

The sun came up. The windows filled with light. The puppies made their morning ritual jump up into our bed and kissed our hands. They wag and wiggle and nuzzle into the pillows. It is their subtle "good morning!" cadence. Charlie usually starts to stir after the puppies pop in. A long exaggerated guttery yawn. A shaking of his head and church bell collar charm cockatoo. He then stretches cat-like on the carpet and trots to the bedroom door for his chaperoned walk outside.

This morning, after a full night of fitful moans he did just this.

Walked outside, peed on the holly and trotted for his morning stroll.

He walked into the kitchen, sat on his bed, and ate the steak left over from last nights green-mile dinner.

I smiled a tear-choked nod to my husband and said,

"I'm calling the troops at the clinic and we are trying different meds and a chest tap."

And so goes the line. Nudged to the corner. Redefined in another day.

The words rattle in my subconscious. The pearls passed down from the weathered vets who taught me to live by these words;

"Let no patient die without the benefit of steroids, analgesics, and an appetite stimulant."

That was the recipe for todays reprieve. And a jigger of chest tap muddler.

and to the wise words of my fellow vet friend,, because it is true that we lose our "doctor brain" when it is our own pet, sedate for sleep. We all need it, and, that mercy comes without a guilty hangover.

For those who understand. For those who still grieve with loss. And for those pet parents who have walked down this road before. You are not alone. You gave a soul a life I know they are blessed and grateful to have had. Every dog should be as lucky as Charlie is. He was loved, he remains loved eternally. What more could one ask for?

Parting wisdom; Saying goodbye never gets easier. What does make it survivable is only knowing that there are lives ahead of me to take care of, and a sense of knowing I can add his footsteps to mine on the other side of this. My life is infinitely richer for having shared the last 13 plus with him.

I will miss you Charlie, everyday.