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. 

Permission in Veterinary Medicine. When Is It Not In The Best Interest Of The Patient, and Why Not?

 

The start of today's NYC 10k

Permission is one of those words that come seasoned with disdain. It’s a word spiced with hierarchy. Flavored with rank, status, and inherently poised to provide unwritten, un-equivocated submission to being less than, therefore in need of,,, permission.

It’s a silent caste admission. A way to assert while it sentences subservience. 

Hamilton. One of our best examples of compassion and not needing permission.
When you are unwanted its not relevant or pertinent,, at least to me.

Permission in medicine, the human variety, occurs at almost every level of care. Today I was running a race and right in front of me a fellow runner was broadsided by a bicyclist going about 40 mph. He hit her so hard that she was sent flying and landed like dead weight on the asphalt. She was unconscious for 20 minutes. In that time three doctors rushed to her aid (2 md's and a veterinarian from N Maryland). Without any consent her clothes were cut off and she was hooked to a defibrillator. We held her hand, kept our fingertips on her pulses and called an ambulance. Passerbyers flocked quickly and everyone was directed to keep clear. We placed her in a neck brace, slipped in an i.v. and began collecting vitals. It took 5 minutes to get an EMT and 20 for an ambulance. She was still barely conscious as she was transported into the ambulance to be brought to the hospital.  This is how we would all want to be treated. Right? A freak accident occurred, people immediately jumped in to help, and life saving care was not given one second to allow for a poor outcome. This is how it should always be, right? There are things we can do to help with pain, disease, and even immediate emergencies and we help? Well, let me tell you about vetmed. Vetmed is all about consent from the first second to the last. Consent requires permission. Permission is the crown wielding the fate.

Permission is where fate meets traffic signage.

Permission in my experience rests on spousal influence. I wish I could feel that permission rested on ethics, soul designation, and the inherent irreplaceable value that is the truest level of devotion and companionship any of us will truly have,,, but it isn't. It is so often about control. There are broad sweeping generalizations I could pepper in here, (most apply spot on), and much makes reminds me daily to be so grateful I have financial independence. Control/permission, the lot is an ageless reminder to women that their voice carries a 2/3 vote. It’s the acceptance that the purse-strings are provided with a budget in mind. It’s that one thing that drove me to not becoming my mother. Permission is that one last vestige of inequality that manifests at the vets office. Permission is as venomous to me and a chastity belt and a maiden name. I have given up asking for permission. It places me back, mentally and emotionally, into a time and place where skirts were too tight and white gloves were fashionable. Permission implies ownership, deference, and allowance for others that is far too generous.

Permission was something my mother needed too much of. She was resentful because of it. And I learned to never want to be in her shoes. It is quite simply the reason I went to vet school. I see it a lot, (too much quite honestly) in my day-to-day vet med life. It makes me seethe inside. It breaks me, daily. Why, why do so many of us need permission?

I have been married for decades. I know the difference between conversation and negotiation and compromise and permission. Permission denotes control. When it comes to pets, their lives, and the precarious place they hold value, permission turns into earnest negotiation and pleas for mercy.

..end of the 10k. Frippie and Storm are happy to see me!

It’s a high wire act founded upon compassion and rooted in property replacement values. Very rarely does permission for care hinge on sparing from pain. Occasionally permission to treat manifests around a lunatic discussion of perceived appropriate care. Last week it was the trapped barn cat caught on the vet clinics property. Small, frail, afraid to blink, or move a muscle and the neighbor who believes he is a wild animal and therefore does not deserve veterinary care. He will either be eaten by a predator, injured by a rabid animal, get and possibly infect other cats with FIV, or continue to live his life full of fear outside. They feed him by the way. They refused to give me permission to vaccinate, neuter and provide flea prevention. I am reminded of the saying about “good fences” although how many of these are cat proof?

Jeezy,, he loves me,, he loves me not,, it kinds goes like this with him.

Permission to provide pain management post operatively was a battle for the first few years of practice. I had to absorb it into the cost of the surgery to make it appear as if it wasn’t a line item that was negotiable. Permission for analgesia? Yeah, not under my scalpel. Permission is the most precarious part of vetmed. It may not seem so obvious but it is. Permission to help is often used as a wedge to drive price points. I admit I do this too often. Where I am strong in my ability to not show, ask, or desire permission my deference to advocating for a patient’s well-being lies in my willingness to negotiate anything for my desire to obtain permission. I will wheel and deal more cunningly than a used car salesman. I will wager the house to heal. I do it daily. I have amassed coffers of contributions so large there isn’t anything I can’t give away for free. I have turned my disdain for seeking permission into a black and white disclaimer of empathy. Still with this there are those who won’t provide care regardless of whether or not they have to pay for it. That’s the ultimate control. The ultimate heartbreak, and the ultimate reason I am not a veterinarian to all, in spite of all who need one.

Peggy. Allie's rescued kitten

Personal Note; please remember what the title of my blog is. It is my diary. The place I put everything I try to sort, package, and categorize when it lays bubbling under the surface of a profession I feel so passionate about and the lives of the patients who cross the threshold of my small town vet practice and eat away at my heart for the plights they face. I have come to be paranoid about euthanasia requests. Not because I don't feel they are warranted in so many cases, but, because they are also totally unwarranted in far too many. I have come to despise permission and the inherent control it inflicts.

The Little Luxury Of Time Off.

 

My back porch with Magpie

Time off

Luxuries in my world have become sparse, and hence, heavily scrutinized. I just get too little time off to allow for idle luxuries anymore. They are now pre-planned and weighted. I am also now humbled to be notified by my withering infrastructure to have to allocate ‘recovery’ time into the sparse luxury free time category. For the bulk of my 2022 summer the days started at 6 am. I have had to forego my treasured morning runs so I can arrive at the clinic by 930 am. I work until 8 pm every day. I come home most nights after 9 pm, so worn out and hungry that I internally argue about which needs to be resolved first, or, even if at all. I typically eat dinner at about 930 so fast that I cannot recall what it tasted like. I land in bed 15 minutes later. I would guess I consume 3,000 calories after 9 pm, and less than 500 before. I go to bed with a stomach left on the night shift and a vision of gastric reflux with all its secondary consequences to haunt my comatose sleep. I used to wake up at 2 am to flounder for an hour or so. It was the couple hours of needed slumber that gave way to the demons of the day that could no longer be kept quiet, or silenced. 2 am, eyes open, mind charging, and the little lurking nagging oversights take hold. It's the time I am captured by my unconsciousness and awoken to address the needs of all the patients and clients from the day I just slipped away from. Awoken to face their elusive illnesses and diseases as my own incapacities. Now I wake up at 7 am arguing that the sun must still be up from the night before. Some all-night bender that altered its rhythm? It can’t possibly have been 8 hours from when my eyes slammed shut? There is no longer a slumber with its quiet pre-slumber conversational interlude with my husband. There is the parking the car, walking inside the house and a fog until I question whether my cell phone has been locked out of knowing the correct time. I best describe it as feeling like a professional athlete who is stuck in their Olympic trials’ day after day. An endless loop of running your best time. Swimming your fastest lap, and clearing the endless set of hurdles. I leave my soul on that field, on my veterinary clinic epoxy floors, every single day.

Kirby kisses... the best part of the job, hands down.

Now I realize many will see this as venting/complaining. A complaint for the life I have chosen. It isn’t. I know I can say no. I understand that I have options. The thing is that all of those options aren’t things I think I can live with. For every friend with a pet related emergency that calls, texts, or show up I feel needed. There is immense power, I would argue it is far more powerful than money, fame, and restful toes in the sand (or sleep). I cannot dismiss a plea for help. I cannot excuse it as ‘inconvenient’ or ‘poorly timed’ or ignore it. I just dig deeply, plow my nose into the ground harder and deeper, and hope my absent happy game face isn’t too obvious. The issue is the consequence for the need. The exhaustion for the hours and days that run into each other and drain the engine in the process.

Abby never has a day she doesn't go googly-eyed-happy over.

I was reading a post about the life inside vetmed as of late. For many of us COVID came on like a veiled and sinister mysterious uninvited house guest.  We had no idea of what we were in for. Absent clients stuck in their homes with their (hopefully) very happy and healthy pets just watching the days of monotonous a quarantine drag on? Would it be a repetitive cycle of wash, rinse, repeat, stay inside and pray your pet doesn't get sick. Or, would we all hide and survive, or chose to work and die? I made an internal promise that my vet clinic was going to stay open, be there for our patients, and weather this storm as we have the previous 80 years of storms, even if it meant I did it alone. My pets are the most important part of my life. I know that I am not alone in saying that, and I am going to be there for them, and all of the rest of those who are for their parents what mine are to me. Two years later and we have made it through. Unbelievably we were slow for a few weeks of COVID and then a scant few weeks later the sky-rocketing demand for everything pet related blew up. It has been unyielding and unprecedented. I have never known such need. We have never heard from so many people so desperate for help. We have dozens of new clients seeking care for their pets because the ER has a 24 or more hour wait. Or they tell clients that they can only make time to see them if their pet is imminently dying. Who can wait for that? 

Allie, our amazing technician and our resident cat Saffie

I didn't come here to have a life of routine rabies vaccines and spays/neuters. I came here to be the place you go when your pets aren't healthy. 

It has become a storm. An unparalleled time and consequences that I cannot accept even at the expense of the machine that attempts to answer the call.

I say all this knowing that along with the incredible demand for help there is immense gratitude and new life-long friends we have gained. The other side of a pandemic is the lives that aren't so inclined to be a little nicer, a little more compassionate, and a little more grateful that we are all still alive. It has been really hard to still want to help the mean people. The people who are mean to the staff and sweet as pie to the vets. The people who are soo ridiculous they don’t think my staff tells me. We know. It’s a small family. We take care of our own.

Hamilton. Our newest act of kindness and the reason we are who we are.

There are lessons we are all going to learn in the hardest of days. These are the people we will be remembered as. 

Remember the people who make you feel good about who you are, and why you are here.. here's to a few (of the many) people who I rely on everyday.

Thank you to all of you who help JVC be the place where miracles happen, and help nudge them along their path with your big hearts and your endless smiles.

Weathering The Heartbreak Within The Purpose

 

Saffie, our (one of ours) clinic cat.
She is no help, but always a shoulder to lean on and laugh over.

I sit here surrounded by fodder. Aberrant news clippings, half read magazines, a pile that represents time to do what my heart finds joy in, and not a second to do any of it. My life is a serious of tiny snippets, all left over from a place before, where I had hoped I would find time later. It is all elusive now. I cannot amass the hopeful day to make it a quiet time for me to enjoy. I have given up almost everything to be here. Everything save for the one thing that is the most important; the feeling of being a veterinarian who rises each day to stem the tide that manifests into a tidal wave that just grows, and looms larger with each circadian revolution. I have become the 2022 version of all of those I knew before me. None of them had much of a life outside of their work. All of them made choices of neglect to answer their call of duty. All of them did it silently, with their actions, their blunted birthday celebrations, too tired to make it vacations happen, and holding on to their practice until they were too withered to walk away productively and do anything else. Retirement is a short stay and no vet dies broke at the end of it. It is a calling as much as it, (I’ll admit to more), than it is a sacrifice or a curse. As exhausted as I am, my tattered, disheveled home to prove it, my aching legs and stress fractured feet now abandoning my morning runs, I am meant to be here. It is the place I belong. How fortunate am I to have that? How many others work in factory assembly lines, toll ticket booths, or check out lines with angry faced clients and fell this way? How many walk this journey of life never feeling that they gave more than they received and feel purposeful because of it?

Two of the 54 we saved and found homes for.

How many vets work so devotedly to getting into vet school only to leave a few years later? I saw Karmen, a 3-year-old German Shepherd, yesterday who had become lethargic just the day before. She is the dog of my surgery technicians, Autumn. Karmen was fine one moment and distressed the next. It was early Sunday morning. Within two text messages and a master key to allow access to the clinic 24/7, my tech had her on her way to getting vet help. We got her into the ER with one phone call. Something unheard of these days where waiting to be seen can take days. Days pets die from. Karmen was immediately hospitalized at the ER to have her blood work done, x-rays completed, and barium administered. Less than 24 hours later she came to me, yesterday morning, (a 6 am Monday morning transfer to our vet clinic, the place she had been vaccinated, spayed, our patient coming home to the place her mom works at), and I knew the moment I saw her that she was unlikely to make it through surgery. It is a gut feeling that only comes from decades of being in practice. I just knew. I tried to break it gently, (there is no such thing) to Autumn. She is the kindest, hardest working 22-year-old me, and just like me she feels too much, and devotes her life to her pets. I adore her. I feel like her mom most days, encouraging her to not put limitations on herself, being her support system for all of the adventures and misadventures she attempts. She saves every unwanted critter that steps into our clinic. One year she found homes for 54 cats from a hoarding home. This year she adopted Hamilton, the kitten brought to us after I suspect having been thrown out of a car, who has a broken back yielding him paralyzed from the waist down. Through her Hamilton has amassed a following on social media exceeding 6 million views. She did this. She has no idea how influential and inspiring her actions are. And here we were, me the aging seen too much to not be realistic vet, and her, still trying to save everything, looking at Karmen together. Karmen needed emergency surgery now, probably last night at dinnertime, but we are here and now with decisions to make. We put Karmen on the OR table within minutes of getting to the clinic. The clinic transforms into a quiet vacuum on these occasions. I.v catheters running, monitors beeping too fast and too loud, people shuffling back and forth hyper-focused on the task in front of us. These are many of the too numerous to count clues that things were at disaster status and Karmen was barely holding on. Autumn stood beside us as we opened her up. It is a rare thing to be able to separate yourself enough to let the body be a body.. the soul to be levitated over the shell it is housed within. It is the gift, or curse, I am never sure which, that allows magic and miracles, and quite honestly closure to occur. We spent two hours doing a surgery I had never done before. A surgery I know has horrible chances at a good outcome, and yet it was the only hand we had to play short of euthanasia on the table and waking the dog up to die a day later in still constant intractable pain. We tried. I place so much emphasis on this. These two words govern all my days. All my efforts. I just want to try. How immensely lucky am I to be able to have the freedom to try?

Karmen

Karmen died on the table as I was suturing up the incision that ran the length of her abdomen. Medicine is like this cruel to the place of pondering fate and our futility in considering ourselves influential in its whims. Karmen died from a colonic torsion. I have only seen it one other time in 20 years. The other vets at the practice, four of them, had never seen it before. Karmen was fine one day, Saturday, in the ER Sunday and deceased Monday, and she had the immensely, (not even the right word to describe the magnitude) fortune to have a mom who knew she was in need of immediate care, access to the ER, and a surgeon at the ready. Nothing would have been more advantageous for her. I am quietly whispering to my inner self that I should have just done the surgery immediately on Sunday an not have waited for her to stabilize, rehydrate, get antibiotics. And yet my 20 years tells my aggravated mom self that it doesn’t always fall this way. Forcing the hand, cursing the cards, and dictating the outcomes. She is the third patient I have lost under anesthesia. Shockingly the two others were my sisters feral cat, and my former groomers kitten. Two grey cats with unknown histories and unknown underlying issues. Three in 20 years. I remember their faces. I will always carry them with me. Thousands of successes and the few indelibly scar. Even with this haunting I feel grateful. The glass half full must always be the lens we utilize when the mess around us reminds us of all the work left to do, and all the joys left to be had, someday.

Karmen going home after her spay.

Karmen at home

For more information on Hamilton please follow the Jarrettsville Vet Facebook page. 

Thank you to Autumn for letting me share her story.

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?

Consequence Medicine. Does Knowing What Lies Ahead Influence The Course Taken?

I've been spending a lot of time immersed in the other side of medicine. The human side. It's been a very enlightening vacation from the dirty, gritty, completely un-glamorous life of dingy scrubs full of cat & dog hair and wipeable shoes caked in excrement from all imaginable canine and feline places. It's been an interesting, albeit eye-opening foray into what I might have been if I liked people half as much as I like furri-ed beings. The differences between these two species,, me and the MD's, is stark and vivid in contrast. I did a little informal study of the attire in human medicine. They are an excellent example of how different the life of an MD is versus a DVM.

Here was my attire for yesterday: layered short sleeve shirts, short sleeved scrub top (a motif of mugs of coffee of every color floating in haphazard directions against a charcoal background... one of my favorite shirts purchased within the last decade), scrub pants, (ill-fitting, baggie, completely unflattering, which is how most of us live our entire careers), and plastic covered flowered Danskos. God are these shoes durable and professionally forgiving, but fashion vomit. And, yet, I have dozens of pairs in every shade, season, and style. There's only one style, it's that bleak. Ponytail, trademark and omni present. No time for pretty hair you are just going to get ear wax puss, or anal gland spooge in. Is there? I dress for a power wash decontamination day, well, every day. No false pretense here. I aim to serve and be peed on,, it's a crap shoot I expect.

Here was how my moms oncologist (I met her just yesterday) was dressed: Silk dress jacquard print black floral cream background. Heavy duty, almost bullet proof leggings, and heeled ankle boots black. Immaculate white, nun inspired bleached, starched, pressed, cursive embroidered multi-lined, almost paragraph form, blue lettered, lab coat. I wouldn't be surprised it if has it's own glass box it is kept in off duty. She sported a double back pony tail. Pony tail start, flip up to sky ends. I liked her for her effort. The jealousy lies in the silk and jacquard.

It's a wide divide. Want to know how wide? Well, let's measure it in this. My humble wardrobe. It keeps me smiling more than I need to. And with that I get to show off the braces, (second attempt since puberty attempt at alignment failed many decades ago), which are also a reminder that I live and work amongst the mere mortals. It's real-life at ground level. I am dressed and ready for medical detective sleuthing and slaying. She, well she talks too much and never touches her patients in any meaningful medical way.. She dresses for luncheons at country clubs. My mom is dying in the dark corner of her small room and I am prepared to clean up any mess it might make, and then still see another patient 20 minutes after. Down, dirty, real-life messes that I can diagnose, treat, and sweep up the crumbs.

My mom is back in the hospital. Again. This time it was a quick three week stay at home after a week of intensive trials to find her pain management for her stage 4 metastatic breast cancer. I have to say it like that, seems more ominous. I try to lower my bravado, enunciate like I'm introducing the sporting class entrants at Westminster, "Sir Lancelot Cumberbund of Landsley, 4 year old male Bishon. He likes long walks, and peanut butter laced Kongs".. kinda drawl. Add flavor if you can't add humor, and we all need to try to add both lately. It was a long hard discussion about where to go from the discharge instructions out of the hospital the first time. My mom chose home. In retrospect I am fairly certain she was feeding me a line of BS not even she believed. It was what she wanted, not what she needed. She needed to go to the rehab hospital to have the full time staff inflict a regiment of tasks upon her to rebuild her. She needed post hospital boot camp. She got furlough. It cost her and the consequences were realized within a month.

Among the very different way we doctors dress, (yes, grant me the use of "doctor', even if vet med precedes it), is the way we dish out the dirt. For me, in my daily practice it is 100 % honest with very little chance at a thick file full of data filled diagnostics to support it.

Veterinarians have a few big challenges to face with every patient. It has been one of the big stark observations for my days living on the other side of the tracks. MD's ask a lot of open ended questions. Vets do this too, with our human clients, our patients we just can't get honest answers out of... BUT, we take all chatter at about 60% face value. We listen, we take notes, and we KNOW that about 50% percent of the time our clients are lying, embellishing, flat out oblivious unaware, or hiding something out of guilt, shame, or overwhelming personal blindness. Veterinarians KNOW to listen to our patients responses to our internal questions far more weighted than our speaking pet parents. Here is where MDs need to spend some time in our trenches to learn some valuable diagnostic skills. Let me give you an example,, or a few..

My mom has been under hospital care for weeks, cumulatively. The doctors, the nurses, the entire staff changes every 12 hours, like shuffling a Vegas deck. The house holds the upper hand, and the player is always likely to lose. Same applies here. There needs, really, desperately NEEDS to be some consistency. There is not personal investment if there isn't at least familiarity. So that's where family advocacy plays such a vital role. For the past few days my mom has been eating better. This little step alone is immeasurable. At the vet clinic every patient is monitored for food intake. We, the collective small consistent bunch of us, provide direct oversight. My mom, nope. They bring in food, clear food, always some cafeteria dressed orderly who says "hello" and flashes away. I am very certain she could go days without anyone knowing how many calories she is, or more aptly, isn't consuming. At the vet clinic we also weigh our patients DAILY. Examinations, done at least once, usually twice a day. My mom gets a "nurse assistant" who is always too indifferently distant to allow her four times daily numbers to interrupt her after work plans.

In three days in the hospital no one gave a thorough exam. Lots of specialists chatting, and no step back use your noggin deductive reasoning.

Back to meals: In the two days she has been attempting to eat a meal she has started to cough. The progression of her disease is so abrupt that she struggles to cough well enough to clear her food obstruction. I watch her and think, "crap, if she needs a Heimlich I am going to shatter her. If I try to slap her back I will likely send her into so much pain she will need a drug induced coma." So, I watch and wait. She hasn't needed emergency intervention yet,, but,,, it's probably coming.

She made mention to her nurse. "I get a tickle in my throat when I eat."

"Your lungs are still crackly, we will add a mucolytic." Essentially Robitussin to break up the chest congestion. She was after all admitted four days ago for pneumonia.

"She has dysphagia." I added. She is also on oxygen, lying in her bed for 23 hours a day, and not getting better.

Open eyes appeared.

We called the doctors in. After an hour of conferring I told them all of the observations I had made over the last two days.

She is oxygen dependent because she has lost so much muscle mass she can no longer inflate her lungs on her own. The same mechanism causing respiratory difficulty is causing swallow inability. She also needs to be told to sit up all waking hours, walk, and work on her internal muscle function as determinedly as her external muscle function. She has had three negative cultures for pneumonia. Therefore she does not have infectious pneumonia she has aspiration pneumonia, and atelectasis of her lungs. Her lungs are shrinking and shriveling inside her chest because she lacks the ability (whether that is pain, disease, etc.) to fully inflate them. Over time, weeks to months she is further failing to inflate them so they are shrinking inside of her, and now without forced 100% oxygen she cannot breathe."

The straws were taken away.
The bed is taken away.
The food has to be monitored. It needs to be small bites, liquid more than solid, and swallowed under supervision.
The nurses need to encourage her to walk and move. Even in bed exercises will help.

But what really hasn't been given to her, and what I find most contrasting in how I practice medicine is that there are no discussions of consequences. Lots of chatter about findings, the latest diagnostic results, but no talking about what will happen. What her course, her current path, where she is and how she has migrated within the spectrum of health, freedom, prognosis, life in general has come from, or gone to, or ending up.

Am I the only one who feels like every patient deserves that? Am I just a glutton for stark, cold hard reality so I can feel like I led a life of choice?

And here is my quandary?

Does my mom want to know? Do I just sit quietly and give her quality time as it escalates to short time? DO I deny her the ability to know so she can understand what lies ahead?

My husband thinks that she just can't do what is needed. I can't possibly relegate her to "lost cause" on the assumption of can't. Can I?

The absolute torture for me is being able to see what lies ahead.. To be asked to sit quietly as doctors miss things while they lack the intuition to question their patients ability to accurately represent their condition. I can see her future and I am not sure I can sit sidelined and not yell in the warning of the linebacker about to sac her.

Mom, if you are out there you need to move, and eat, and yes, dare I say it, fight. It's almost too late to turn this game around. The coach, the vet, they all know the consequences. Aren't we here to remind you of them?

Alone in the Jungle

Alone in the jungle.. How often does everyone else feel like this? I suspect, (dare I say, hope?), that it is most. Otherwise I think that I might truly be all alone in this deserted jungle? (And how crappy would that be!)? Why do we, (or, at least me?), seek solace in knowing the rest of the boat is in the same boat with us?

Day One, USMMA plebe line-up. Second Company 1987

Maybe the grown up me just hasn't totally accepted the rest of me as "all I need?"

Why do so many of us feel so alone? And, with that, isn't that exactly why so many love their pets so intensely? If that presumption holds true then why do I feel so alone, and all alone, in my profession? I have somewhere along the way learned that I am less abandoned and more appreciated by my clients than my colleagues. (How many other vets feel this way?). I know there are vets out there sighing a sad despair-a-tive exhale with that admission. The vet profession has become a gaggle of cohorts all protecting each other from the demons lurking in the self prescribed pink juice. There are collectives who have your back regardless of your shortcomings, mistakes, or inadequacies. You just have to be a vet and they have your back. Right? Well, maybe for the other vets. But, for the small group of us not in the in-crowd it's an existence of cosmic outpost inhabitancy. You are really, really alone if you pick your clients side over your professions allegiance. What if you are the poor Schmuck who still likes your patients better than your clients and your colleagues,,, well, then you are totally fucked. What if on top of all of that you are a vegetarian,,, well, there isn't a category for that, fucked, alone, pariah. Great. 

Droog shelter, Alexandria Ukraine, 2022

That's me, totally unequivocally alone. And yet I still sit here in my dingy throwing out life preservers to the gulls passing by offering quiet applause and anonymous cheers. Last week I spoke to an internal medicine expert who said to me, "I wish you luck, this one is not going to be easy, or make you any friends." Thanks, just what I needed to hear. 

Storm, blissful in the buttercups

I wonder if my legacy will just become the Ralph Nader of the vet med profession? I wonder if I will take any kind of joy in that title? Can't anyone else see that our misery might just lie right next to our denial? Why aren't we all just on our patients side, if you know we need to pick a side? Why not them? I think it's because the us gets in the way of the them? Doesn't anyone but me see they are one in the same if you just open your lids a bit more? Who says you can't do everything for them, our patients, and not have it come back to you in spades? Or, I just have to convince myself that alone is ok, I'm not going to like myself if I try to make my colleagues like me. I'm not going to have patients that purr, wag, or cuddle me in those quiet places that we spend together. They look at me with enough gratitude to make up the chasm of difference that the profession can't fill. it is enough, it has always been enough.

Here's to being alone, saving every goddamn blocked cat and pyometra dog that my colleagues turn away. Those dogs and cats deserve a chance, a palliative nuance of possibility, and an advocate who's lonely. 

Always kiss the cat goodnight

Here's to intention having merit. Self-preservation being empowering, and lastly here's to all of the vets out there throwing stones and not able to look in the mirror at the faces of the skeletons in their own closets. 

Chief Mate CS Global Mariner, 4th of July cookout.

Here's to the Fourth of July meaning just a little bit more to us that feel alone, and a world of possibilities if we all start living a life of freedom instead of loneliness.