My Christmas Wish

Some people are just building a body of work. The getting up day after day to repeat the same tasks for the same boss. Punching the same clock. A small cog in a bigger wheel that they cannot identify their own importance, or the meaning of it, within. Day, after day. Weeks on end, until at some point you realize that the novel within you lacks a central character you can relate to, or, even root for. There is that someday where you realize that there is more behind you than in front, and you are at the intersection of what's left to do, vs., what is left that you want to do?

Others are just trying to find work. Find someplace to pay the bills and disregard the purpose, the passion, the place of belonging that maybe a job can bring. 

Sadie.
The most influential patient of my veterinary career.

Then there’s me; plodding along trying to build an empire. Filling my days with little wet-nosed lives that have already given so much. Filling my life with the people of Jarrettsville Vet who share this passion and purpose and expanding upon them, so that it touches everybody in our community from its core. I am also trying to convince the rest of my profession to feel the power and the addiction in the purpose we all came here seeking. Ask yourself if you became the Ebenezer when not so long ago you just wanted to help the Tiny Tim?

Every year at this time my husband asks me what I want for Christmas. I'm 5 decades into this passage, and I can say with 100% honesty that it's not wishing or wanting more. I simply feel so grateful and lucky for what I already have. Right here and now, this is it. I worked my whole life to get here. I am not waiting until retirement to live. Or go out and live. It's within everyday already. As far as the season of giving,, well, I just tell him; I don't want one more thing, that is a thing.  Nothing. Not one smidgen of a particle of an article that was intended to be gifted. Not one more thing to dust, to pass on, to leave behind, or, wonder how much of a carbon footprint it carries?

The wealth of love

This year the wish is to pay everything forward. All of the intangible things that spread peace, joy and kindness. Veterinarians, the whole lot of us in vetmed, forget, overlook, under appreciate how impactful and meaningful the power of kindness and compassion is. These don't cost any of us anything. These change lives exponentially. They hold more power than our diagnostics, injections, and medications. These save more lives than all of the tools in our medicine locker do. 

Now, I am not a person who lives in a tiny, shabby, debilitated make-shift hut. I have not come to the place where I shun all belongings. Meditate in a trance-like chant to find a higher inner awareness seeking permission elsewhere. I have traveled the world and seen far too many families suffering in poverty, corruption, greed and desperation. Living in a home constructed out of piled wooden shipping crates. Or, an assemblages of tarps. Rooms partitioned by shower curtains. Dirt floors, no provisions to allow for windows utilizing a portable camping stove with its assigned two pots forced to feed 5 or more mouths. Homes that wouldn't pass for junk are required to be the shelter for the heart of its inhabitants. I have heat, insulation, cable tv, food in the fridge, a pool, and the happiest, spoiled, blissfully unaware pets. There are rugs underfoot. Artwork on every wall. Bins of rotating holiday decor to embellish the upholstered furniture. It is a rich life. There is excess here. I admit it, and I am eternally grateful. For as long as it might last. Wealth, all of it, in all of its many forms, is fleeting and fragile. Wealth that is tangible, liquid, asset-based, is transient.

River, who is as excited to see me as I am her.
She, and her mom, are some of my dearest friends.

Yesterday on the NYC subway a middle aged heavily sweat-shirted man broadcasted that this year he was asking for generosity. He had lost family in the 911 massacre. He had served in the Army. He was suffering from PTSD, on the streets, and begging for food. A man next to him quietly and shyly handed him a burger-sized, wax paper wrapped sandwich. "My wife made this for me. I hope it helps." That simple, impromptu, two second exchange made everyone on the train smile. It was accepted with gratitude and a firm handshake of "thank-you Man." The train stopped not one second later and we all got off feeling like a little bit of the holiday season happened with all of us to witness. 

That is my wish. Pass on a small act of kindness. Avoid the door-busters. The stocking stuffers. The swag, and the stuff, and the things. Take great joy in what is already around you. The life you have built. The people you share it with. Think about how rich you already are. Want for nothing more than the possibility of this being all there is left to do and still being the most blessed person you could ever be. 

Autumn and I stealing a snuggle and a kiss with Otis.
He was at the clinic for his first puppy visit.
How many others do this on routine appointments? Why not?

This year I hope that I can refuse all the gifts. My hope is that I can convince others that there is nothing more to accumulate. I want nothing other than paying it forward. Is it possible to keep paying it forward until there is no one left who still can't recognize the treasures underfoot. I hope that they still give of themselves to enrich someone else's life and that they feel that the gesture pays back 10 fold over in return. Wealth in the truest form of pandemic proportions.

This year, as one fades into a new, Jarrettsville Vet is going to take on a new challenge. We are going to empower ourselves, every staff member, to find that sense of financial freedom and the independence it brings so that maybe by the time they all hit the same number of tree rings that I have they feel just satiated gratitude irrespective of Santa denoting you naughty or nice. You never have freedom unless you have this. It doesn't have to be millions. It only has to be enough to keep you from making choices based on the influence of need. It is why I feel so strongly that the debt we carry denies us the ethical integrity to put our patients first in every decision we make.

Sadie. Captivated by the temptation of another treat.

Nothing matters more than having the freedom to make your own choices. The sense of being healthy enough to pick your own path. Even if no one else wants to emulate or follow. The passion of your purpose to make other lives better, and the financial freedom to never feel you have to sacrifice any of these to etch out your own survival. Veterinarians forget that they hold such power. The power to bend lives, influence, albeit determine survival and outcomes of the lives those companions hold together. I never lose sight of this. I never deny hope, or miracles, or chances, or financial freedom for this to determine fate almost more than any other influence. Of all of the callings that going to vet school answered for me, it was this one reason more than any of the others. I think that lots of vets go to vet school because of the impenetrable bond we have with animals. Me, well, I was never going to surrender the power of protecting my beloved pets to not being able to afford to get them well, or at least try. I was never going to be stuck, trapped, tortured in not being able to keep them safe, healthy, and pain-free. Some women stay in relationships for all sorts of victimizable reasons. Me, I can give up everything else in this world, but, I will never lose the peace of mind that I never have to let go unless there is nothing else that can be done. That is power. That is what being rich beyond compare brings you. That is a Christmas wish that has nothing to do with things. That's the gift I want to give back. That is when you change lives.

Storm. Rescue,, a dobie with ears and a tail!
She is the cutest!

What is your holiday wish this year? What are your New Year goals? How much of them just rely on giving vs getting, and why?

Oh, and let's not forget,,, go adopt a life. Start 2024 with the most incredible way to pay anything forward. Go save someone. Foster, adopt, read a book to the shelter animals. Take them for a walk. Come to Jarrettsville Vet with your whole heart on your sleeve and just give. 

Critical Mass

Critical mass. 

I am fixated with the concept of where that fulcrum lies between viable critical mass and the surrendering of life. In medicine, vetmed very specifically, we are trained to inspect and dissect down to the point of recognition of this place of fate. We learn to listen to a patients history. We perform a thorough examination and then recommend the appropriate diagnostics to solidify our presumptive diagnosis. All of this from a patient who cannot speak and often doesn't want you poking/prodding/palpating them. We have to be the doctor of every department and we have to stay on a budget. How any times am I expected to diagnose and identify without any of the diagnostics I need to be more certain? How many times can I beg and plea for mercy for the patient to be given some small chance at recovery when all their owners want to know is where is that critical mass point and will it be cheap enough and easy enough to allow passage of better days ahead? It will make you mad if you let it. It is why there is this protective parable preached to us about not being judgmental, and, not caring about your patient more than the owner does. Not recognizing the face for more than a number in a day of many. It is why we band together like refugees in a village of emotionally fueled hostiles. There is not one day where we aren't vividly reminded why life is so slippery and precious as why it is so wretchedly, painfully hard.

Rudy. Rescued from Texas. So absolutely, adorably perfect.

It is the fated search of critical mass in a life of fearful brevity.

There is a place in all lives where that one cell too many costs the whole. One atom too few, one tiny piece of sand hits the pile below and all of fate is doomed. The fulcrum, the pivot point and the place where you cannot force, intervene, and bend the will of the ghost that comes calling you home. In vetmed I look for this place with endless relentless persistence always hoping I can outsmart and out will the critical mass headed toward my efforts being futile.

My beloved Raffles.
Rescued as a kitten, forced to serve a 4 month quarantine for rabies.
We will never love all cats fully enough to permit even the most basic vaccine.

This place, the tiniest of differences between that one moment soon enough, and the next, where it is too late, is where I stay stuck in my cause. The place where I seem to hyperfocus, stare down, and too often get stuck. The place I think I owe in recognition to both my clients and my patients. The place I fear I will both not recognize, nor admonish. In vetmed we are expected to intuitively know this place when we arrive, articulate its magnitude, and spare all parties involved the futility, the suffering and the premonition to save both dollars and disappointments. We are expected to know it all, and then dictate a fate that fits the hands that pay the invoice.

How many times have I overstepped this place? Tripped over the threshold and found myself falling into the end before I knew it?

Minnie. One of my WHY's

For my mom I knew we had lost her battle for her life, and all that that carried, when she was lifted from her wheelchair to the scale at her oncologists office and the numbers read 74. 74 pounds was not recoverable. She could not come back from here. She would not be able to regain her body mass. She would never walk again. The ability to stand up, blaze her trail to independence and freedom from all of the decisions that would soon follow was gone. Extinct. She was destined for death and there was no point in hoping, praying, wishing or cajoling anything further.

Me and mom.

For my best friend Havah it was 31. The day she called me as I was driving to work. The one place we shared everything our veterinary lives brought us. The one place that solidified us as sisters, the fairytale of vet med and all the magical moments, and this was our road sign to never being together again. She was going in one direction that I couldn’t accompany her. She had yet another mri the day before and her headache culprit lay in 31 metastatic  lesions within her skull. This conversion was the place everything collapsed around. For five years she had never wavered in her conviction to win her breast cancer battle. This was her Normandy. Her foxhole was exposed and her enemy was mounting its last attack to claim its host. It was the first time her voice cracked and her fire diminished to a spark of planning a legacy she could no longer add a chapter to. 31 was the count we knew we had lost each other and all of the many things we depended on each other to carry. We had to go the rest alone. I had to try to imagine being a veterinarian without her. She was the soulmate to my passion and the guard to my heart being safely nestled in some semblance of sanity simply because we both knew what it took to survive this profession and neither one of us would ever leave the other wounded soldier behind. She was my Forrest and I her Bette Midler Beaches. I had always banked on us going out like Thelma and Louise and now here we were having to decide how one could finalize a life still with so much left to write while I, the other, the one being left behind, knew it would never be happy ever after.

Havah and my mom. Halloween, maybe 1999.

The cases at the clinic walk in like a revolving cattle drive. Every 30 minutes the door deposits another sick, helpless cat or dog at my feet. I have 30 minutes to find that pivot point. Identify the underlying triangle that permits one side to slip into the abyss and recognize it for its power, while the other allows me to flex my medical prowess and save this life. The scant 30 minutes to identify which side of the fulcrum we are resting upon. How many of those once in a lifetime lives, those irreplaceable companions can I sleuth into being classified as savable before that last determining grain of sand slips into terminal. Can I see it for its critical mass of yet to be undetermined in its fate and push the tide back to sea? Where is that place of my endeavors can still matter and fate has claimed its next hostage for keeping.

Grizzly and Bear. Two patients I adore.

I play this game in my head with every life I see.

You don’t know you are strategically laying out your chess pieces until you try to pause from the game. Until you try to push yourself out of your chair so you can look at the board from above. How little your pieces influence the greater part of the landscape. How many pieces you can lose to protect the king as the queen does all the heavy lifting. Where is that moment that the game tips?

You don’t realize how much the tiny shuffles of all those pawns in front of you influence the outcome until the critical mass of your life’s work sit beside someone else on the opposite side of the table.

You don’t realize how much you’ve lost until you have to contemplate surrendering the whole endeavor.

Vetmed tries to measure loss in inches of acceptable intestinal resection as a way of predicting functional abilities. How many abdominal exploraties have I opened up to see lengths of black gut leaching into both sides of healthy adjacent tissue? How many times have I had to call a parent to guess, propose and confess the critical mass being lost already? That game. This duel of sizing up my opponent to try to mercifully protect my patient is the battle I obsess over.

It is the battle to not feel to pessimistic to the power of hope. It is the battle to not be so egocentrically dictated that I presume failure while dismissing miraculous chances. It is the most egregious aspect of vetmed. This insidiously absurd power that one life can be replaced. It’s mark left to be rewritten by another. Vetmed needs a slap in the face to wake up its indifference for another patient to follow. We need to see each individual as its own unique and meaningful life. So influential in its existence that it enriches our own beyond replaceable measure. We need to be ever vigilant in our inspection of mass that we seek purpose in saving and protecting rather than measuring and abandoning.

500 dogs. 500 dogs kept in 80 cages. Broog shelter in Ukraine was a war camp. A place where all were trapped in a hell that lived smack dab in the middle of a country under siege trapped by a war none could flee from. This is my ptsd. The place I go back to as a yarn of tangled intentions to distract from the weights and measure of assigning critical mass. The place of chaos to remind me that my decisions, as honorable as they may be are still just wished cast to the clouds as I grip the grass below. Yet we all still wake up to another day of discovery and hope the compassion can out weigh the mass. That the tiny grains of moments collect into magic wishes of perpetuity for the next generations to reminisce about.

The dogs from Droog, The group in one of the open spaces

I am beginning to recognize that I cannot stay focused on the end. The place where there is less, and it is slipping away. I can only stay grateful in the present, and all of the joy here, the rest will find me, someday, regardless.

The profitability of Asclepius

I recognize that my veterinary clinic; Jarrettsville Vet, is succeeding because we are not following in the ever increasing footsteps of the rest of the parade of hospitals around us. I recognize that as we remain independent and committed to our patients and the people who call them family, others, in ever growing numbers, are becoming financially focused institutions. Under their guise of care people are being targeted for manipulation as they are held emotionally hostage for their pets care as the commodity. It is obvious that as so many other veterinary clinics fall into corporate, conglomerate hands, focused solely and singularly on profits, the wave of supportive leadership to make this happen is the keeping of the guards to allow passage of currency. The veterinarians are the backbone of every veterinary practice. The engine that keeps the machine allowed to run. They hold such power, permit the profession to promulgate, and, now more than ever before in our history, they are in such short supply that we are begging for more of them to find our unanswered want ads. 

Given away at just a few days old someone took mercy.
Often the littlest lives need the most compassion.

With any great demand comes innovation, competition and incentives. The ability to find a veterinarian in any of the traditional ways has become impossible. You cannot place an ad in the local, state, or country publications and get even one response. You can try to recruit from the veterinary colleges, but you will be met by large corporately run HR banks with their platoon of jesters who now recruit students at the freshman level as "ambassadors" who are paid to promote their hospitals and essentially own the student upon graduation. As with all choke hold demand there is great profit in finding that unicorn. So gives rise to recruiters. 

 Today I received an email from one. Here's how that exchange unfolded.

Good afternoon Dr. Magnifico, 

I am sorry you have not had good luck with recruiters in the past. I try very hard to be transparent and have never been accused of being unethical. I have been a veterinary recruiter for 30 years and love the industry and what I do.

I have attached the document that explains how we work and associated fees.

Looking forward to hearing back from you.

Gwen

The contract is as follows;

Contingency Retained Recruiting

Off-site identifying, sourcing, and recruiting

Off-site telephone interviewing

One year replacement guarantee

Fee: 33.5% of first year annual compensation of each candidate hired. To begin process, sign agreement

and pay retainer of $3,900.00. Retainer is deducted from invoice of candidate placed. Only one retainer is

required per year, regardless of how many open positions we are recruiting for at the same time.

Fee is calculated at offer and acceptance of candidate chosen and is due in full within 5 (five) days of receipt of

invoice. Payment is due upon verbal offer and acceptance. If payment is not made on time as agreed, billing

fees, interest, and late fees can be incurred.

Retainer

Retainer is non-refundable. In the event Client hires someone outside of VetProCentral services, the

retainer is available to use on any placement within one year from date we are notified that the original position

has been filled.

Details – fine print is always necessary!

Signed contract and retainer are required to begin the search. Retainer is non-refundable. Signed contract

and retainer are required to begin the search. Retainer is non-refundable. In today’s market, we strive to offer a

superb candidate experience as well as meeting client’s expectations. With that, a streamlined hiring process is

essential when entertaining the best candidates available. We have adopted the 2/5/5 premise to achieve those

goals. What does that mean? With permission from the candidate, we will present them to you for consideration

after the initial phone interview with a VetProCentral team member. To follow, we expect a decision from our

client to either move forward with a candidate or pass within two days of submission. Thereafter, an interview

via zoom or on-site is to be scheduled within five days. Following a decision within five days of the on-site or

zoom interview, a second interview is to be scheduled or an offer will be extended. This hiring tactic is used to

give you a competitive edge against other practices. Our goal is not to rush our clients to an offer, but simply to

move the interview process forward and ensure we do not miss out on excellent candidates as they wait in the

interview pipeline.

Replacement Guarantee

Each Candidate placement is guaranteed. In the event a recruited and subsequently hired candidate is

terminated for cause during the first year of employment, VetProCentral will replace candidate at no charge to

Client. Guarantee follows title of person placed and location. The guarantee set forth in this paragraph will be

void in the following circumstances: (a) Client chooses not to replace the candidate; (b) Client decides to

promote from within to replace the candidate; (c) candidate is under contract for one year, and the contract is

determined not to be renewable by either party, prior to year-end or (d) the candidate is moved from one Client

location to another.

My response;

Jesus Christ. I would have to euthanize half of my patients to increase fees enough in the other half to pay for this. 

Insane. 

When you hear about the cost of care for veterinary care going up and the subsequent loss of access to care because of this, and, all of the pet adoring parents who will never get another pet again because they cannot afford to, please recognize your part in the landscape that vetmed has turned into. 

I just think it’s super important that we all share that responsibility. 

You are either a part of the solution or a part of the problem. 

May there someday be empathy for compassionate care again. 

This is disgusting. 

Krista. 

Earl, one of our rescues on his last day with us. He was adopted by one of our most beloved friends.
Here's to living the best life ever!

It will come to a place where this is really all, and only, about the money. Where only the rich can have pets, and only the richer care for them. There is a tipping point, a continent of opportunity for those with an entrepreneurial spirit to propel them, and a whole devastatingly destructive tidal wave of culpability to follow. If independently run veterinary practices continue to sell out to corporately managed investors at the rate they are the price for care, the salaries paid to do their bidding, and the death toll of those treatable cases will continue to rise. Who among us doesn't want to be paid more? Who among us wants to work harder, see more cases, and try to hold the line for ethical care at affordable prices against a wave that grows bigger, hungrier and more powerful? 

My adorable Seraphina. My muse, my salutation salvation, and my Why.

There is a cost for each decision all of us in vetmed make? I am bombarded by it every day. Today a person drove 11 hours to see me. He was afraid to go anywhere. Afraid his cat is going to die from a treatable disease that no one else wants to help him with. Eleven hours away I had to tell him that his cat was not treatable, savable, and that all he feared was about to unfold. I told him this for $500. The cost of an exam, blood work, xrays, radiologist reviewed, fluids, appetite stimulant, antibiotic, and a steroid as our last Hail Mary attempt to make whatever time she has left as pain free and peaceful as able.

I know he drove by hundreds of clinics who would have given him the same advice, for about the same price. I also know he drove by hundreds of ER's who would have told him he needed $4,000 to get started on his journey of futility and not been honest with him. He would have felt shamed in not being able to afford the list of recommended line items to punt his cats diagnosis to a specialist, in network, of course. 

Daisy. Getting ready for her dental.

I wonder if my end in vetmed will be left with me as the only DVM name on our shingle? 

There is a price for high wages. A cost to only providing care to the elite, the wealthy and the expected annual salary of $200,000 per vet and the 33% of that it would cost to be able to procure a vet from this agency. Veterinarians out in the world looking for employment hold great leverage and power. They expect sign on bonuses of over $50,000, annual pay of over $150,000, and every other benefit imaginable. While I recognize the great healing powers of all veterinarians, I also recognize that no where in any recruiter flyer, corporate descriptor, and "about us" website section is only about quality of care, work-life balance and income. There is not one single word, inuendo, or iota of responsibility with regard to the reason we all came here. There is no hint of caring, compassion, or the incredible magnetic force that is caring for these pets who hold our hearts, and now wallets hostage to the web of greed that we are engulfed within. There is no mention of how fulfilling, inspiring, and impactful it is  to save the life of a companion that ties another human to wanting to stay within humanity. The gift that I receive day in and day out in saving the savable lives, showing compassion to those I cannot, and never denying that there is hope for each one of us in even the darkest of days is the elixir to all of our collective miseries.

When will vetmed, and the powers who hold them in check, become honest about transparency with these influences? What I will call cost of culpability, be called out? When will moral integrity with all things that fall within the net of vetmed reign supreme again? When will the tipping points of treatable tip back from profitable? When will we all wake up from this catastrophic speeding train and recognize we burned every bridge as we transited to indifference?

From Wikipedia; culpability;

The concept of culpability is intimately tied up with notions of agency, freedom, and free will. All are commonly held to be necessary, but not sufficient, conditions for culpability.

A person is culpable if they cause a negative event and
(1) the act was intentional;
(2) the act and its consequences could have been controlled (i.e., the agent knew the likely consequences, the agent was not coerced, and the agent overcame hurdles to make the event happen); and
(3) the person provided no excuse or justification for the actions.^[2]

Every decision that I make as a veterinarian, a practice owner, and a human being, has influences on others. The meekest being the most obviously influenced. If I even entertained the idea of signing this contract with this, or any of the other recruiters, I have to pass on the expense to the patients I came here to care for. Period. The idea that the profits of the clinic not being passed down to the staff as unpaid wages is not present at this clinic where we post our prices, wear our hearts on our sleeves, and never shame based on financial limitations. We also are not afraid to try to save a life, even when we need to cut diagnostics to do so. We are honest in our mission, purpose, and compassion. It is not a tagline to infer trust that we simply break when you are not profitable to our business.

It is wonderful to have the newest, brightest, shiniest, fanciest, modern pieces of equipment, but if you can only utilize on a tiny segment of the patients who need them it is a detrimental restrictive asset. It is a choice to be the Bower bird and not the Asclepius we were trained to be.

Rio. My heart lies here. In the stories of these lives and the memories of a life rich beyond the measure of societies currency.

It's time to be honest again about why we are here. If you are a product of a sign-on bonus that compelled you to have to turn treatable patients away, and you told yourself that pets are a privilege, and that these patients with their treatable ailments, are "not your problem" because the CFO at your employers office will not permit you to try to find an affordable answer, then the issue with integrity lies at your feet. We are all responsible to help the animals who come to us in every capacity we are able.

One of the four blind puppies we have helped to rescue.
These are the reason we came here. Why this profession will always be more than a recruiters ability to sell, market and negotiate.

For more on this please follow this blog. Please find the real-life cases on my YouTube channel and follow along with us in our day-to-day lives on our Facebook page.

Remember we are all here together. We all came into vetmed for the same reasons. None of us will grow rich on saying no, denying chances, and killing for the profits that bankrolled the guys who never have to get their hands dirty. Who's side are you on? 

Goodnight Gwen. God bless all those tiny creatures who are still out there in need, and the souls who still find their lives valuable enough to see the miracles in the chances of just being kind without a balance sheet.

The Right Question

Perhaps I had it all wrong all those years ago? Perhaps my perception of the distant, reserved indifference that I saw on my older, wiser, decades in the trenches, weathered predecessors faces was the quiet contemplation of whether or not to ask the question? More specifically, the right question. At the right time. Maybe that is the whole secret to life and all of its layers? Maybe the enthusiasm of the young vibrant newbie vet got confused by the quiet contemplation?

This little one is one of the many we have tried to save along the way.

It is the maturing in medicine that has brought me to this pondering on the mountain. The question for the ancient one that is the singular question I will be allowed to ask?

Medicine is built around questions. To be specific, the contemplation of the right questions, and the internal pondering of the dialogue it manifests. This is the place I feel we have strayed the most at the cost of our patients’ outcomes. We don’t talk to each other anymore. We don’t share information for the chance it might be mutually beneficial. We don’t pause for reflective answers. And we don’t invest in each other’s experiences nor heartfelt desires as the mortar to each other’s foundational awareness. We don’t seem to care enough about each other to extend a moment of contemplation. Without this, everything that medicine has to offer is reduced to a tiny spark of its true power.

This is what sets the people of Jarrettsville Vet apart. We aren’t just a face in a time slot. We are a person with an investment of ourselves into each patient.

Last night, as with every night before it, I texted my husband to tell him I was leaving the clinic and headed home. We are three years post COVID and he has become the stay-at-home-dad to our 5 cats and 2 dogs. It was after 8 pm, he had already inquired, hours earlier, if “I needed food?” (Don’t I always? I replied to myself). I told him I would “love a glass of wine,” (don’t I always?) and, that I was “bringing home a big box in the back of the car of the party lights,” I had forgotten for weeks at the clinic, and a “little box with a kitten to bury.”

There was no text reply back. Clearly, I would have to clarify that this wasn’t an autocorrect mishap upon my arrival.

What happens at JVC when a breeder brings in her litter of blind puppies and their mom and tells us they will all be surrendered to the shelter? They stay with us.
(P.S. they are all still looking for homes, see Black Dogs and Company for information on them).

“What's up with the kitten in the car?” he said as I handed the tiny box to him as he helped me carry the days fodder inside our home. He wasn’t upset, nor surprised, but he knew there was a story. This is how we end each day. He meets me at the car as I drive in, glass of wine in hand, the other to help carry the days endeavors. The end of the work day summary is a quilt of crazy colored stories shared over a quick dinner and 30 minutes of taped tv. I came here, to vetmed, for the allure of the stories. The Herriott stories. The place where others who adored their pets as much as I do, would share their journey together. I have a place that I belong here in these  stories. It is what keeps me from retiring to greener pastures with sun filled vistas to nap upon.

"Her name was Elouise," I began. She was a rescue. The family whom she was born into had forgotten to spay and neuter their cats who were brother and sister. She was the last survivor. She was as doomed as her siblings. I had known that from the second I set eyes upon her.

Elouise arrived at the clinic swaddled in a small towel. Tenderly carried in, too quiet to be healthy. If you pay attention long enough you learn that the neediest patients in your clinic are the silenced. The ones too weak to protest, too near the verge of death to allow their survival instincts to protect them any longer. Only her tiny face was visible. A mottled face the size of a tangerine, and oddly the same dimensions. A broad face with wide set eyes. In the 18^th century she would have been called a Mongoloid. A horrible description of a skull that was burgeoning from within. Her eyes were unresponsive and resting laterally (the left eye was turned outward to the left, and the right faced far to the West). She was not present mentally. She did however still possess the one magical power to keep us human’s captive in fighting for her; she purred the moment a hand met her head. She purred, and purred and purred. A trans-like rhythm that pulls an emotional compulsion to continue to care when the biology has stolen the chance.

Gracie, found with severe wounds, covered in fleas and ticks, and microchipped.
It allowed us to find her home but she wasn't able to return. We have loved her everyday since.

I looked up at the foster mom who had brought her in. She was so hopeful that I could hold a cure, a witch’s brew to turn the tide. The kind of hope that lies in miracles, abandoned by medicine.

I unwrapped the towel. She didn’t move. Made no acknowledgement of the stranger I was, and the new place she was in. Elouise was perfectly captured by her name. So apt in her gentle, shy, peaceful demeanor. The kind of name that accompanies a bicycle, a French beret, a windswept skirt, and a song you catch yourself whistling on a clear summer day. The name of the heroine in a children’s book, small curly white dog as the sidekick. A name as intentional as a romantically fraught fairy tale heroine. As gently as possible I picked her up and placed Elouise on the exam table. As it is too many times the harshness of a stainless-steel exam table meets the wispy goodbye of a life taken too soon. It is not lost upon me that these rooms are asked to absorb too much and be a vigilante to too much sadness. One of the first places a veterinarian starts with an examination is basic standing ability. She was a crumpled speck of jutting angles of bones and fur. “Has her back leg ever been normal?”

“No, she has never been able to use it.” It stuck to her underbelly like a contracted, lifeless, muscle-less chicken-wing bought by the dozen for less than a buck. Her pelvis was tucked, her other back leg attempting to extend, but also lacking the muscle mass to support anything past behind her. Her mom told me about the time she had been with her which had been less than 2 weeks ago. "She came to us able to run and play. But, that had stopped days ago. 

Elouise's story with me had started as an email in our hospital inbox a week ago. She was in the care of the rescue, who had just been granted permission to take her after the rest of her siblings had died. The foster mom was inquiring about a surgery to correct Elouise’s inverted rib cage. A condition we call ‘pectus excavatum’. Elouise was born with a ribcage so narrow it impacts her ability to breathe normally. There are multiple ways to fix it, in kittens who are still soft and pliable we place a cast around the chest to try to mold it back into the shape it belongs. She is a rescue, and like all of them that I see I have to be creative and thrifty. It is why I am so disappointed in where vetmed has fallen. These cases, the millions who preceded them, over the hundreds of years that we have been influencing animals outcomes without tech and stock holders margins. She didn’t need a surgery, she needed merciful grace. She came to see me not because I am a wizard at unusual congenital birth defect corrections, but instead because I am wiling to try before I require a 3-plus-thousand-dollar deposit. Elouise had two women in her corner who see her as more than a replaceable, over populated compilation of carbon.

Elouise couldn’t stand, she couldn’t react to physical exam queries, and her gums were white. She was utilizing every ounce of whatever marginal strength that she had left just to breathe. It was all she could muster the energy for. She was dying and her mom, the person who had had her for only a few days, was crying on the other side of the exam table.

“I knew that you would tell me the truth. I am just not ready for this.”

We are never ready. That purr will convince you to hold on even when life is being stolen away before your eyes.

Elouise was purring in my hands and she stopped, extended her head back and thrust her front legs forward.

“She keeps doing that. Every so often.”

“I think it’s a seizure.”

“Oh.” It put another layer of despair onto her already bleak pile.

“We can send her home with opioids if you aren’t ready yet.” Try to give her a passing in hospice care. Truth was that Elouise had been here, this place where dying is overtaking the mitotic cataclysm of living for her whole short three-week long life. She is, as medicine would have labeled her “unviable” from the moment she was born. Luck and love had gotten Elouise this far, but there was nothing left to bargain.

“No, it’s the right thing to do. She doesn’t need to suffer any longer.”

I knew it to. And so she came home in a little box in the back of my car, to be with all of the other pets who had made my life as their mom, their vet and my life’s collected book of stories so meaningful, purposeful and richly rewarded.

“What do I owe you for today’s visit?”

“I am not charging you for Elouise. She is a gift to both of us. You cared enough to give her a chance and love her despite knowing she needed more than you could provide, (how many of us are willing to do that?), and I needed a reminder as to why I am here. She is my WHY. The reminder that this is, was, and always needs to remain more than a practiced profession.

Slater. Brought to us for vomiting.
His mom had rescued him from her son after he passed away. She struggled with homelessness, surrendered Slater to the shelter, saw him a year later featured as "pet of the month" and went back to adopt him. He was up to date on vaccines and preventatives and when he started vomiting she called her vet. They wouldn't even give him an exam without an $800 deposit, which she didn't have. He came to us. We worked with the shelter to give him a chance. His mom stated that she would surrender him back to the shelter if it meant giving him a chance again. An exploratory surgery revealed a large tumor on his kidney that was inoperable. He was put down next to his mom who knew there was nothing left to do for him. 

And so I come back to my question. The right question. It isn’t about how wealthy we are, it is about how enriched we become along the way. 

The System Is Rigged In The Houses Favor. The hidden costs that keep rising because the public has no access to transparent pricing models.

The system, i.e., the whole profession of veterinary medicine and all of its affiliates, is rigged in the houses favor. It's a harsh reality for the ever growing mob of pet parents who feel betrayed by the system they rely on for their pets well-being. The vet, the vet hospital, and the profession as a whole, has all of the power. Power can come in many forms, with many faces, but, the most powerful will always remain with those who control the emotional, mental, physical, and financial survival of those who do not. Power of that kind is totalitarian. Power like that has collapsed civilizations. Made extinction a reality. Power like that is dangerous beyond measure. 

Serafina. My daily reminder of my WHY.

Whilst some would say the house of vetmed has always has been rigged, I would add that is was, at one time not too long ago, centered on providing care that was utilitarian/agrarian based, not emotionally based. When that shift to companion based pet vs. food/livelihood based animals happened, and our four legged friends became bedfellows, the whole construct of vetmed shifted with it. Vetmed promoted, marketed, and richly profited from the elevation in pets status to highly valued family members. For an ever increasingly large section of humans our pets are truly the only thing we consider to be our children. We brought our critters inside our homes, gave them their own beds, and now we buy them their own gourmet food, sold by tv personalities, whose nutritional content often surpasses our chik-burger-plastic-wrapper-fast food convenient daily meals. Our pets have social media pages, monogrammed Christmas stockings, and matching family holiday outfits. We do not hide the fact that we spoil, spend and love them. We hug, kiss and fret over their happiness and health. We do not see them as property any longer. We see them as individuals we protect and advocate for. This whole pet based relationship has swung from livelihood based to heartfelt. This relationship with our pets, well, it became deeply, personally, and life-changingly, emotional. 

Pets are, in many of my clients lives, (mine being no exception), the cornerstone to the joy in their day to day lives. We are so emotionally anchored to our pets that we will do anything to maintain their health as a reflection of the happiness they bring to us. There is no doubt that the loss of a pet hurts as much, and in many cases more than, the loss of many of the humans in our lives. We depend on them this much. As society grows more open via our handheld phone based computers and the endless flow of social content, we have become less social with humans and more satiated with our pets presence. Many of us went into vetmed, pet hoarding, animal rights/rescue/advocacy, back yard farming, and the like, to seek refuge from the harshness of people. Many of us just like animals better than people. People are painfully messy, and awkwardly sticky creatures whilst pets are perfectly ours.

The relationship we have with our pets is hugely impactful and elaborately delicate. This deeply adoring relationship has lead to a pet care market with ballooning revenues. Over the past two decades pet care based services have doubled to reach 5.8 billion dollars annually in the USA. This degree of growth has spawned a hailstorm of erupting opportunistic pet centered ventures.  It has led to financial gains of which we have never witnessed before. When vetmed transitioned from veterinarians in muck boots over green coveralls with its after 2 am $50 field calls to look at downed cows in far off fields, to multi-million dollar practice owners working for shareholders dividends. With this the emotional well-being of patients and their people morphed into economically driven profit-mongering options. When money like this influences lives there are few exceptions to compassionate driven care. The practice will make money on your pet even if it is just in euthanizing them, again for a healthy profit. Lives are disposable, replaceable, property. Lives, no matter how impactful to the people anchoring the other end of the leash, are collateral damages. Vetmed has been reduced into heartbreaking too often economically based treatment decisions to protect profits. Pet care has gotten itself so profitable that the cloying underbelly has grown greedy, ugly and insatiable. As the cost of care continues to skyrocket upwards, (be mindful they are not done yet), it will continue to shatter countless more lives along the way. 

Teddy.. and her dad,, who adores her

The once single doctor practices have grown into large multi-doctor hospitals. It used to be that your vets face was the face of the mission and purpose of the practice. You knew them and they were approachable and accountable for your pets care. Today, many practices are owned by someone, or a board of someone's, you will never meet, nor even be told about. Today practices are sold in the dead of night to people who live in bank accounts of billionaires. Today your pet is an asset in someone else's portfolio to be traded, sold, or squeezed at their discretion. This is what property bears. 

Many of the larger vetcare centers are being bought up by venture capitalists who now own much of the ER's and specialty clinics, (the really big money makers), which has created the foundation for a monopoly, (and been prosecuted for such), and escalated the cost of care in the process. The profession has lost its clients trust. We have lost the ability to communicate between the conflicts of property vs morality. And, we are unapologetic about our contributions to these dilemmas we have gotten ourselves into. Veterinarians are seeking never before conceived of compensation packages and being lured with multiple hundreds of thousands of dollars sign-on bonuses. We do so this a bravado that justifies as being "long overdue" without reflection on how this impacts our patients. To pay for these sign-on bonuses AND the formidable huge dividends the share holders require, the cost of everything they haven't conceded already has escalated to compensate. The latest, and not at all surprising escalation, is happening in the lab services department. Lab services is another way we can hide and escalate a cost and you won't know the difference, or be able to price shop elsewhere. The house is hungry, and the house needs more cash to keep the belly of the beast quiet. Lab services is that ever growing line items list after your pet is examined and before they are treated. Lab services in my veterinary hospital is the fat I trim to treat a patient before the finances are exhausted and economic euthanasia is the only affordable option left. Lab services is the BS the profession utilizes as "standard of care" to make our pockets deeper and your shame as a failed pet parent suffocating. 

The new found profits of vetmed has led to advancements of diagnostic and treatment options. These benefit our clients and patients immensely. While we all share much of the same biology and physiological functions, we now share the same human based treatment options. There are truly no boundaries to what we can treat, or do, when it comes to our beloved pets. While this is miraculous to the desperate pet parent seeking novel care options it is an ethical black hole of queries conjured previously only for sci-fi movie plots. (Go watch Altered Carbon, Jurassic Park, The Island, or Google Top Clone Movies). Unfortunately, this fact has also gotten lost in the quest for profits. We don't talk to our clients to understand who they are, and what their pet means to them. We are medical centers of unbiased, automatons who deliver estimates on paper two and three pages long. We don't start at the clients wishes and hopes, we start at our most profitable. We do not practice best medicine, we practice stockholder strategies. We take people at their most vulnerable and we shame them into spending more than most of them can, without regard to all of the myriad of ways we can both help heal and give clients a way to afford the minimum diagnostics to make the treatable affordable. The whole premise for providing people assistance in navigating a medical dilemma is rigged and stacked in our favor. We know it, we refuse to admit it, and we profit egregiously from it. It is power than euthanizes without hesitation nor culpability. 

Pocket. All two pounds of her. Her mom is protective
and gushingly devoted.

There isn't one veterinarian who wasn't taught to practice medicine via an understanding of a minimum database, and yet we are all collectively mute as a consortium so as to not tilt someone else's profitable apple cart as they try to make every patient visit as lucrative as possible. All in the name of "best practice." If our best practice is letting treatable pets die because we conveniently forgot to have open honest discussions at the collection of history and examination time, and not the long pregnant expectant pause of seeing if the client bites at the first (and let's be honest, always highest) estimate, then we are the problem regardless of how treatable the solution is. We must own this. In my opinion this is the fact that is killing us.

The house has you because you have nowhere else to go. The house also gets you at your most vulnerable for the most painful of all of the decisions you will have to make. Oh, and yes, we know you are out of your area of expertise, at the mercy of our prices, and without options to argue or negotiate (or at least you feel you are). I hear this over, and over, and over.

Birdie. My kitten who had to be quarantined for 4 months after her sibling tested positive for rabies.
How many of us would quarantine two kittens for four months while worrying about rabies?
The story here.

"It was midnight. My vet wasn't open. I didn't know what was wrong with my dog and I couldn't let her suffer until they opened the next morning. They took my dog to the back. They came out and gave me a paper with a dollar figure I was afraid might be the only way to save my pet. My head was spinning. I couldn't understand any of what they were saying. There seemed like no other options. I love my dog." 

My YouTube channel here. 

You can hear this example repeated by the thousands via the people who post on my YouTube channel, blog, or reach out to me directly. I know there are thousands more who have had the same experience. The house has you. You feel it, and you are so emotionally conflicted you cannot make sound decisions.

For all of these scenarios I ask two things; who did you talk to, and what did you sign? (More on this topic to come).

We, the collection of veterinarians who guard the gate to your pets access to veterinary care, will not permit passage without a price of admission that we see as suitable for the access to our healing hands. The house has the power. Your pets are still considered "property" under the law, and now that VC's are collecting record breaking revenues it's not going to concede or have a conscious awakening until the public forces their hands, challenges their intentions, or just plain old innovates a way out. It is the fundamental crux of every problem our patients suffer and die from. The house needs to start working in the patients favor, and that alone will be our collective salvation. 

Mavis and her mom. Didn't every vet go into vetmed because we were this kind of kid?

While the rest of the fringes of our profession taut insurance, third party billing, pet care wellness plans, low cost spay-neuter-vaccine clinics, and the transition of for profit to no profit as being the answer I will stand here firmly on my 20 years of private practice ownership and tell you that every time you think you alleviate one part of the dilemma another part shifts away from affordable while it drags accessibility with it. The system is rigged. It will remain this way as long as three things remain in place;

1. Pets are considered property. 

2. Pet care does not need to be open or transparent in its pricing. This is protected by every state veterinary medical board. What they fail to protect consumers in is their availability to be given options outside of the ER at 2 am. Someone should be addressing this.. see Pawbly.com

3. People in society continue to be as hateful, divisive and uncompassionate as we have become. The greater the divide in our empathy for one another the more we will turn to our pets for emotional refuge. We all are pet loving people. It is time to remind ourselves this.

This girl was the first girl who required a whole lifetime of my courage to intervene on her behalf.
Courage only matters when the cost calculation requires you to put someone else first.
Here's to all of the other Sadie's out there who never get what they need because a veterinarian isn't brave enough to put there license where their mouth is.

While I will not argue that vaccinations and spaying/neutering are not vital to preserving your pets health, I need to remind you that the care you receive in a well, young healthy state are not the things that are likely to cause you to be forced to chose euthanasia as the only economically feasible treatment option available to you at 2 am. As the cost of care climbs into the stratosphere where only private billionaire rockets can take you there will only be three options left;

1. People elect euthanasia because it seems the only affordable option available and we need to feel good about giving up by labeling it "ending suffering". (Please see my article on the Power Of Consent below).

2. As the vetmed sector grows profitable it attracts investors. Investors are about one thing, profits. When you tilt the service of care into profits there is shrinking margins for compassion. Where one revenue stream drives up (pharmacy, food, preventatives) another is exploited, today lab services, tomorrow surgical intervention/specialties. 

3. People get their hearts shattered by the system that holds their emotional glue together and in its grip, and they never get another pet again. The damage has been done to the point of extinction.

There are often numerous low cost options for the lowest hanging fruit at affordable and even accessible costs, (spay/neuter clinics and vaccine clinics.. all high volume and therefore competition based low cost), but you pay for that with the loss of something you will need far more down the line like that emergency 2 am pyometra surgery. That cost has gone from expensive ($1500-$2,500 a decade ago to $18,000 at one clinic I saw).

Tilly after her spay. She was surrendered because she had four blind puppies.
Her breeder gave her up when she was no longer profitable.
She deserves better, she will get it. We will make sure of that.

In the last decade the veterinarians have lost two key pieces of our revenue pie. We lost our solitary foothold on in clinic prescription medications and preventatives to the likes of 1-800-online and then food to chew-on-me and I'll send you a painting when your pet dies, who can provide these at lower cost and still never have to go to vet school. Vets conceded an easy 30% of our revenue stream to innovators outside of our profession. Over this time a cascade of vet care specialists blossomed. For the benefit of our patients many once in clinic services are now farmed out to vet specialists; think cardiology, neurology, surgery, dermatology, and general practitioners have lost another big money piece of the pie. 

There is a lot of self-justifying puling these days on the vet forums. They all too often are intended for the clients we have failed, and, therefore are likely falling on deaf ears. We have tried to seek empathy for our suicide statistics. Others beg for understanding wrt our over crowded exam rooms and appointment scheduling access. A few spew a banter to remind parents that "pets are a responsibility/privilege, not a right." Which is my personal favorite. I feel it is quite likely the most obnoxiously hateful based arrogance ever muttered. We love animals as much as our clients do. Why would we ever use that as fuel? Now there is an article being circulated to compare the cost of a human knee surgery to a dogs. Can we reiterate the cost of medical liability, lifespan, and macrophagic greed going on with our counterparts on the human side? Why are we so intent on justifying costs when we have boatloads of data that support the fact that if you want to call property "property" (i.e. limited liability and we can all dispose of our pets anytime we want to, which vets will defend until their dying breath). It is not a valid comparison for so many reasons I feel we are ever obvious entitled morons to share it.  If any of us can remember that we are all here to "solemnly swear to use my scientific knowledge and skills for the benefit of society, through the protection of animal health and welfare, the prevention and relief of animal suffering," then why has it all become about how much money we make and not how can we help each other. They are not ever going to be anything but mutually vital for the other half to survive.

Holy crap the degree to which I can pick this apart.. 🙄

Here's what you can do to have some tipping of the cards in your favor; 

Know who owns the practice. This includes your primary care provider, your local ER, and the specialists you are sent to. If the same group owns the whole lot you should be very concerned about how much you are paying for everything you are recommended. Do you routinely get sent somewhere else for services, especially surgeries? It is not an uncommon practice to have your vaccines and the other most very basic services done at the primary care facility and everything else referred. What is the cost difference for a simple mass removal (and the majority are very simple) done at a private practices office and one been done at a specialty referral surgical facility (hint; about $2,000, or more). If every single pet loving parent walked out of the corporate owned practices the landscape would shift dramatically. For every pet parent who says "I stayed because I like my vet," I need you to ask them what they can do for you when the cost of your emergency care, mass removal care, enucleation, splenectomy, etc is soo astronomically high you have to euthanize your pet. If they say get pet insurance because I like my sign-on bonus more than I like saving savable lives, leave. Being loyal shouldn't mean having your heart broken when you realize your vet isn't on your pets side when it really counts. 

Wellness plans are also stacked in the houses favor. Ask about a Pet Savings Plan that is yours to use where you want it. My clinic offers one through VetBilling.com. Its yours for your pets care, I don't care where you need it.

Three years after the original 52 cats from the hoarding situation we helped with we still have reminders of what giving more than anyone expects can bring you.
More on this here.

I truly believe that good veterinary medicine is about saving lives, not making economic decisions because our student debt is so high and our sign-on bonuses were so grand. The problem does not reside in lack of insurance, lack of empathy for our off shore private vet school debt, our knee surgery costs comparisons, or our lacking reciprocal empathy for how hard our lives are while making shareholders millions of dollars in dividends, but simply in not reducing a treatable life to a replacement value chattel. We are the house. The house owes its residents the oath we took so many years ago.

I am so proud of who we are, and how much we give back.
We are a culture, a mission and we do well by doing good.
We are the heart of vetmed.

P.S. If you would like to have a better understanding of the cost of common lab services please see Pawbly Storylines section. Go to Pawbly.com Storylines.

Jasmine gets a hug after her spay.
Every pet here at JVC is family.

Upcoming topics to discuss: 

• Social workers in vetmed. When the emotional turmoil is so high you don't know what to do. When the emotions get soo overwhelming your adrenaline kicks in. When the system that is supposed to care doesn't you need a friend/ally on the inside to help you. For this reason some hospitals have started to follow the human hospital infrastructure plan and employ a social worker. Someone to help guide your emotional journey without the medical or financial interference and influence. 
• The spawning of "Zero Tolerance" has grown into our new veterinary fight song. Seems everywhere we go in the world these days there is friction. Animosity is borne of broken hopes and unrealized promises.
• What are some of the costs of veterinary care in my private practice?
• What are some of the items you need to ask your vet at your next visit?

What are your thoughts? I would love to hear them. Email me at krista@pawbly.com

P.S. because every time I post one of these I need to add a disclaimer. All comments are posted after approval, and all hate mail posts get posted, or reported. 

If you are a veterinary professional and you don't understand how big the divide is, and how harmful our actions have become please read the comments on my YouTube channel. I have been practicing for almost 20 years. I have never denied care based on cost. While I stand a very strong line on serving my patients above all else I do so with 100% transparency and all options on the table at every single visit. I also do not allow any unkind behaviors towards anyone; patients, staff, clients. This is the ranking in which we serve. Please see my other blogs,, and P.S.S. this blog is appropriately titled. I am an open book,, its not always picture-perfect.