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

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

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

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

Me and my girl Madeline

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The healing powers of Serafina

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

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


More information on tail vaccines here.

AAFP,  American Association of Feline Practitioners Vaccine Guidelines here.

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

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

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

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

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

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

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

Hear about Dr Shane Cotes Suicide Story. YouTube

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

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

For more on this please see my other blogs;

Find What Breaks Your Heart And Change It.

Ethical Fatigue and the Crossroads Of Vet Med

The Problem In Vet Med and the Great Divide

Serafina.. The WHY in Who I AM

Don't Forget To Put Your Heart Into Every Euthanasia

More about Dr Magnifico and her mission here;

My clinic is Jarrettsville Veterinary Center in Jarrettsville Maryland.

My YouTube channel.

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

Best Veterinary Facebook Page ever; Jarrettsville Vet

My pups Frippie and Storm

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

Human Vs Veterinary Medicine: Real-Life Case Meets the Dueling Ring. Who's Better and Why?

Growing old is the luxury of your ancestors mastering a wealth of tools. Modern medicine has become so highly specialized and advanced that it has extended life spans to triple what they were a hundred years ago. Technology has helped enable us to get real time information and share it almost anywhere in the world in the blink of an eye. We have medical innovations for every conceivable problem, and agricultural advancements guaranteeing us access to an abundance of food. A bazillion tiny steps in  our species history, a few millenniums later, and we now have an excellent chance of living past our thirties. We should all feel so blessed. We really do have it easy compared to three, (or more), generations before us.

my Frippie and one of her sacred socks.

When life presents us humans with a stumbling block in our health we have so many avenues available to ponder. We live in a country where access is available to miraculous options. If you have insurance the sky is almost the limit, and, you can be carried and cared for through the halls of medicine without ever being told "there is no hope," and/or, "there is nothing more we can do." If you don't have financial resources or health insurance you can walk into any ER and the hospital is still required to help you. On the contrary, in vet med although we can (should) at least be empathetic enough to always grant and garner hope, (although I fear we are not and do not), should you not be fortunate enough to be independently financially secure, or, have insurance that pays at time of service, or, a wealthy animal loving friend, or, good and available credit, when and if it comes to lacking funds for your pet care the doors to help for them unanimously and almost immediately close. Veterinarians are happy to help if you can pay for it with a full deposit to be left with your pet. If you cannot, we have decided to chorus our voices in unison to the anthem of finger pointing blame and deflection with chants about "pets being a privilege, not a right!" (What does this serve other than to humiliate a pet parents breaking heart being forced to part with love due to insolvent ability)? When same clowder of  veterinarians do have the opportunity (consent and financial stability) to treat our patients we are expected, and, have to do more, with less. Less available avenues, less access to needed specialists, and less insurance options to allow those necessary diagnostics to uncover correct treatment options, never mind pay for those miraculous medicines. We vets have to be everything to everyone who needs us right here and right now.  Never mind the too frequent impatient snarky comments like; "and, if you could be snappy about it I have other things to do with my day, and my time is valuable too." (Hint, hint, this is the wrong thing to say to your vet trying to tick all those possible boxes while flying solo). As you can see, being a veterinarian with the same hopes, fears, and often expectations to take care of your four-legged kids as your two legged kids, is a big ask, with a big bunch of obstacles.

As a veterinarian providing health care options for pets for over 15 years I can testify that we are far more skilled and versed in seeing cases through from start to finish than our human medical counterparts are. We have to. The patients that walk through our front door with a presenting complaint are cared for by us to the completion of care. We are expected to figure out the problem and provide the answer in one visit, and do so based on your budget for it. We are there as the guide for the whole journey. It makes us Sherpa's with invisible tool chests of unparalleled excellence.

We veterinarians have to be a "Jack of all medical trades" as we try to be the one stop medical shop.

I guess I always knew this, but this week I lived this.

This week my life has been a true display of the stark contrasts of veterinary versus human medicine.  Lack of full oversight, disjointed as it is too focused on specialized care and passing the buck was found ubiquitously on the human medicine side. This week, in one tumultuous day actually, I took my mom to one ER at 8 am for debilitating pain that left her incapacitated and bed ridden to come home at 2 pm to find my dad having trouble breathing. This led to another trip, with a brief visit to Patient First (different one in a different state), that kicked off an almost immediate transfer to the ER  for immediate admission.

Frippie and her shadow Jitterbug

Let's start with my moms story.

On Monday December 16, 2019 my mom had surgery. She had elected to do this after a newly discovered mass came back "suspicious" from a needle aspirate. Within days she was given numerous options. She decided to be as aggressive as possible. She is a 23 year previous cancer survivor. She had been aggressive in her treatment and care options decades ago and it had served her well. Her new oncology surgeon was her guide. She, like every other aspect of  my moms care came to her with the best medical training, a breadth of experience, and a gentle, compassionate hand. My mom believed she was very lucky to have her.

Surgery went very well. Her surgeon, as is the protocol, looked at the local lymph nodes and decided to take them all as they looked abnormal and she didn't want to leave anything she knew might be dangerous behind. Two days after her surgery my mom came home with a few drains, a new scar but a feeling of relief that this was once again behind her.

Fourteen of the sixteen lymph nodes came back positive for cancer. Her mass was also now able to be definitively labeled.

For this care she was seen by 10 doctors over 4 months, and 6 separate doctor visits. Cumulatively it accrued to about four full 24 hour days.

Magpie protector of the lair

If she had been my patient with the same condition and the same treatment plan it would have been two visits. Here's the breakdown of a veterinary practice patient flow for this;

The first visit would have been to discuss the history, examine the patient and the mass. From here we discuss a few things.

Important key and critical discussions need to include;

1. Here is what I think we are dealing with.
2. Here is what I think we should do about it.
3. What are the goals for the patient?

Every successful client-patient discussion should stay and be focused within these.

For all patients the discussion of where to go next is usually centered on;

What are the options?

A. Religious Bliss is usually option Number One; I refer to this as; Ignore it and hope. While there are some masses that might appear relatively benign, if you don't have a piece of it, and, if it isn't examined by a credible trained person it is always a "guess and hope" scenario. Some cancers give clear early obvious warning signs. My moms was one of those.

B. Fearful Sleeper; AKA Tiny Lil Poke, FNA., What we call a "fine needle aspirate." Quick, easy, no anesthesia required. I refrain from saying "cheap" because sending that slide of cells to a pathologist is the same price as sending a far more diagnostic large piece of tissue. Pathologists like big, (the bigger the better), pieces of tissue if they have to make a diagnosis and potentially change the life of the person who provided it. FNA's are problematic for multiple reasons. First, you have to poke the correct piece of tissue. Ever try to poke accurately repeatedly and perfectly an awake unhappily to be restrained dog who weighs as much as you do? And, you have to pass that needle through skin, fat, and then a mass covered in multiple layers of tissue? You get artifact along the way to the money shot. I tell clients that you can rely on that slide smear of that aspirate about 70% of the time. In many cases the pathologist has to say "non-diagnostic sample." And there goes your $200. If it comes back as "consistent" with xxx(scary)xxx. We have to recommend a biopsy to confirm, or, a surgery to remove.

C. One Shot Answer. Go for the best chance of getting your diagnosis now and go for the biopsy. If you chose this, and based on loads of factors I always vote to start here, please, oh goodness, please go for a one kill surgery. At my clinic, for my patients I always want "one and done!" One surgery to remove the mass,, diagnose the mass and be done with the mass. In rare cases this is not possible.. all of those cases are cases where people waited too long, or, its a tumor we had little hope of slaying to begin with.

But, lets go back to our heroine. My mom. Human medicine is about hoops... and liability. It would be inaccurate to not point out that these are wonderfully intelligent saviors working in a midst of corporate medically and ethically guided steps, but still slow and cumbersome. My mom had a pretty clear problem, with a very high indication of cancer suspicion. She also had a history to match her fears. She was the duck who looked, walked, and quacked. She also was ready, willing and able to be aggressive. She wasn't the ostrich with her head in the sand.

Storm. All adoration, very little calculation.

Here's where I would argue vet  med has it's incredible advantages.

If I think I have a patient that I fear has a cancer that needs tending to ASAP I can talk to you about it on the first visit. I can then discuss all of the options. We can then start down that road on day one visit one. Want an aspirate? BOOM! same day, (just give me 10 minutes to set up). Three days later = answer. Not sure you are ready for the road ahead? Let me take a chest x-ray and try to tell you if the Gods are in your favor? (Why because statistically IF there are "mets" (metastatic lesions which are an indication of the mass having spread to the lungs) the prognosis for surgery is the same as without surgery.

Now, lets stop here and take a second. What human medicine provides us and makes me cringe at as I am trying to be the expert of too many things to be anything other than the Queen of The Jack of all trades' is that we guess A -WHOLE-HECK of A LOT! Remember how we got here? We made a guess that this was cancer, and that this was a bad kind of cancer. Educated guess, sure, but we are guessing.

I suppose we should all take a second and reflect that if it is new and abnormal lets just assume it doesn't belong there and evict it. Right?

After the FNA is discussed and either returned as "inconclusive" or, "indicative of cancer" we then discuss getting that bigger piece of tissue. This is where my whole spiel about "anesthesia always has risks, and, a cost. Therefore we weigh the risk versus the benefit" happens. Biopsies need general anesthesia. This is not a decision we make blindly. The average veterinary FNA is about $300, the average biopsy is about $500-800, maybe more if I am going to be aggressive and attempt to remove cleanly. Which is always my goal, (and always should be yours too!).

If we follow my moms example we are now at the place where we have done our exam, done our FNA and now need surgery to confirm the FNA and remove the suspected cancerous mass.
My mom and my patients (almost all (wink-wink) of them) have pre-op blood work. You, me, us, the whole patient list, should have pre-op blood work. No sense going under anesthesia if we fear you won't wake up. (Next asterisk here: a GREAT vet provides help even if corners might be cut. I have done lots of  "no other viable choice" surgeries without any pre op diagnostics. I have done these surgeries with all invested parties knowing, thinking, fearing, believing that if we don't do this surgery the only other option is humane euthanasia. So, what do we have to lose? (Maybe the cost of a surgery that ends without a patient walking home? (Has happened maybe (?) once in 15 years of fear-free-trying.)). (See Spencer's Stories here). (Personal plea here, since I started shouldering the possibility of free last chance surgeries I have become full-happy-purpose driven. The more I give away, the more optimism and compassion I give the more I know this is the only way to practice medicine healthy and content). Try, always try. Encourage your clients to try. Be honest. Be a pet parent next to them. It's not about money, or privilege. It's about honoring life and all the desire we all have to keep living it with one more day in the sunshine.

Here's where I would have taken my mom on a different route. I would have looked for mets before scheduling, or doing surgery. The cost for three view chest x-rays at my clinic is $150. It is so helpful to know this. I also have to explain costs, (lucky MDs get to dodge this sticky step). Asking a client to spend likely $800 to $1500 for the mass removal binds me (my ethical opinion) to being completely open and honest.

My pups waiting for dinner

My mom had her surgery based on an FNA without anything else. Surgery, radical excision surgery was next.

She did great. It was the right choice.

A few days later she developed pain in her back. The pain over 4 days caused her to become bed ridden. I got a phone call at 8 am, "mom can't walk, she wants to talk to you," my dad sputtered.. He handed her the phone, inaudible crying... sputtered words. "Mom, call 911 or go to the ER."

Instead they called the office of their surgeon who suggested they go for an x-ray. My dad elected to go to an independent office that he had used before. He called to notify me. "WHAT! why would you go there?" stammered silence.

"Listen dad, medicine is all about preparing for worst case scenario  as you uncover the clues to your situation. Go where her doctor is. (An hour and a half in the opposite direction of his choice). What happens if her xray indicates a serious problem? (Yep, on your way there now aren't you? Or, she gets admitted to a place they don't know anything about her."

He turned around and headed to more recent, although less familiar territory.

Her xray was difficult to definitively diagnose. No broken bones, no abnormal chest patterns, more good news than bad, but, alas also, no answer.

Jitterbug admires himself

Two days later, after a prescription for ibuprofen (which sarcastic slightly annoyed me will remind you all is NOT a prescription) and she was screaming for help. Again.

This time they (over the phone) decided a CT might be a better diagnostic tool to assess her spine.. their next guess. (Pssst,, mom,, yeah, its me your vet daughter, tell them you need better pain meds. Ask for tramadol and robaxin? (cause, ya, know every doctor loves a back seat driver).

Four days later no answers, no referrals, this time they suggested she could "try the oxycodone she had post op and never took). Oh, and yes, she can have some tramadol.. (squeaky wheels get some relief).

Two days later, Friday morning (yes, yesterday Friday) after basically living at her house and not being able to ease any of her pain we decided at 4 am to go to the hospitals Urgent Care facility for orthopedics. At 8 am, the minute they opened we were there. She needed a wheelchair to get in the door. She could not sit up long enough to finish her paperwork. She was exhausted, beaten into accepting she might  never feel better, and so fragile I began to see the world as a matriarch that we weren't leaving without answers I accepted. They were about to meet me litmus test. (I went to a military academy, I am feared, I make no apologies for this. Fair, feared, ferocious, F*%$# 'em.).
Within a few minutes we had a doctor to see her. We went over her history, as garbled and complicated as it was. We all collectively answered questions, provided insight, and started chipping away at her problem instead of punting for diagnostics, waiting for experts, and getting worse.

Dr Dan did an exam with her laying on her back the only place where she was comfortable, and within 10 minutes of that we ruled out her worst case scenarios. She had severe muscle pain based on her history of spinal issues, her surgery past and present and her inability to respond to palpation of her spine. She had muscle pain!" WAIT? WHAT! We were preparing for spine surgery.

"Mom, did anyone examine you the last two times (everything previously had been without me present)?

"No, they just sent me for tests."

In my head, and I am sure a few words slipped out audibly, I thought, "Are you f'ing kidding me? No one touched you? It's been over a week of crying in excruciating pain in bed, and no one touched you. You would have had your answer immediately if someone had touched your spine versus your muscles on other side  of it!" In veterinary medicine if your pet sees a vet or any kind, shape, or flavor there is ALWAYS an exam,,, every,,, single,, time! It is malpractice if they do not.

We left with Robaxin and a steroid. She has been slowly improving since.

How can human medicines obsession with diagnostics to achieve a diagnosis be so blind to the  basics. On my side of the fence this is "malpractice."

Want to be a skilled doctor, start by being a good listener, a thorough diagnostician, use the tools that trained you (head, ears, nose, hands, and  yes, gut), and then tell your mute patients that you can figure it out on BOTH a budget AND without words.

I know pet care can be expensive, but, human care is waay more corporate profit based, waaay more inefficient, and waaay crazy pass the buck hot potato than vet med is.

Chemo is a whole different discussion. My mom has an excellent prognosis because she has a specialist to guide her. A few million previous victors to both benefit from their lessons learned, and outcomes favored, and a militia of determined men and women who all want to see the sunshine on their faces for many more days to come.

Ya know what, vet med has the same. Ya know whats even more amazing, as the  mom of two oncology patients they do far better with the treatments than humans do. I would never use the all too common excuse,"I don't want to put them through chemo." If they can benefit from it, live longer lives, see more sunny days, they will probably do far better with it than you think they will." That's dogs and cats. No fear, no apologies. Living today and loving the people they spend it with.

P.S. My mother waxed and waned in pain for four weeks. Four weeks, one of which was as an inpatient hospitalized patient until she had another MRI, and then a bone scan. The bone scan 6 weeks after her surgery revealed metastatic cancer in almost every bone in her body.

Want to know how much I know vet med surpasses human medicine?

Think it might have helped if every doctor she had met had examined her as they listened to her?

Think maybe that cancer in a 23 year post cancer patient wasn't on the top of the "feared" list every time she spoke to a medical professional?

Think that pain care options are doled out in pathetically paltry pieces? (It took 2 weeks to get access to an opioid, and 6 weeks to any kind of meaningful pain relief as every doctor discussed side effects and dependency. Turns out those opioids are her only hope at life long partial relief).

Think that I couldn't have and hadn't already known what she knew about a week after a surgery she sailed through? This was bad, really bad. It is the worst. Took the human MD's 6 weeks to figure it out.

Where is the silver lining in human care versus vet care. She has a better chance at some good time than most vets can offer advanced cancer patients in her same shoes.

There is frustration, of course, but she has a diagnosis now, and options, and yes,, she has what we all universally need, hope.

For more on vet med please see my other blogs. For information on my veterinary clinic see our Facebook Page, or, website JarrettsvilleVet.com.

For more help from me on your pets care please go to Pawbly.com and ask me. It is free to use.

For educational veterinary medicine videos see my YouTube channel here.

My video on her care and the maze of human medicine here;

Brave Enough. Words To Live By,, My Edited Version,, Of Course

I have this terrible affliction.. It's a bibliophile thing... like obsessive. There is the smell,, the musty, powdery ashen parchment.. it's intoxicating just a tactile feast. Then you get the extra added bonus of that wealth of adventure, knowledge, and escaping story desire and it's euphoria I cannot resist.

When it comes to the challenging moments of my life, those little bumps along the way that cause me to trudge and shuffle, I turn to the poetry flavored feminist written chorus columnist-seasoned manifestos.

This is my new go-to;

This little green wonder is my hard copy to Gloria Gaynors anthem,,, you know the one; "I will survive," every jilted girls hashtag for getting over being disposed of. But, as with all personal rites of passage you customize a little. Accessorize, monogram, throw in a few extra expletives, drop an F-U to the waning fist pumping moments, spare a tissue drop a threat and a promise save yourself a wrinkle and rehydration requirements.Salt stains after all.

So, I buy a book I think can add a bit of stiffness to my tired bowing back, and then I spice it up.. just to taste,, as a former sailor I find starching, corner creases, a gigline, and a potty mouth help immensely.

Here is my edited version of an almost perfect book from the start;

Medicine, veterinary medicine especially is fraught with insecurity, imposter syndrome paralysis, fear, suicide, and getting through the day, never mind safely to retirement takes grit, courage, dedication and a strong overwhelming sense of purpose. For me it has been a series of challenges so incredibly devastating I have learned to fight for what I believe in every single case every single day. I also stay true to one thing above all else, my own path. So, if you need a little bolster of conviction buy yourself the outline of the story you are walking (or stumbling and trudging) toward your journeys happy ever after add indelible adjectives and your own sparkle, whatever it takes to get out alive and still like you best of all on the other side.

That's Brave Enough for us all.

If you like content that is animal centered and medicine flavored visit me at my other social media stops;

Pawbly.com the place for free pet healthcare advice. We share stories, experiences and open access to a worldwide pet community.

Jarrettsville Vet, my clinic, where miracles and hope are alive and never based on a price tag.

Our Jarrettsville Vet Facebook page is full of the faces of the smile of each day and the people who make the magic real.

If you are looking for case based examples of the medical and surgical cases of my day to day veterinary life see my YouTube channel.

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Don't Forget To Put Your Heart Into EVERY Euthanasia.

Hello Erin,
As a veterinary practice owner I want to sincerely apologize for this. I cannot say that I know, or even remotely understand this?, but, I am sorry that you left feeling penalized and punished at one of the saddest moments of any pet parents life. If I can help I am here. Again, I am so sorry for your loss and frustration. Sincerely Krista.

Nashville

Starting a conversation with an apology is about as common for me as "hello." A few years ago there was an outpouring of articles all proclaiming how over used and detrimental apologies were especially passing from the lips of females. It was heavily marketed that apologies as a preamble masked submission, leading to shame, and that women in all places and positions, especially those in leadership positions, were being throttled to abandon.  I spent years pouring over these articles, catching myself constantly to pull those three little words back in each time they slipped out, while beating myself up for the deference apologizing for everything brought me.  And yet, I still apologize often. Way too often.

The opening paragraph above is a private message I left Erin, on Nextdoor.com just a few days ago. Sad as it is, it is true that I am so prolific in apologies I even send them to strangers. Stranger or not, with this apology I meant every word I was delivering.

Apologies fall like confetti daily in my veterinary life. I apologize for the small and insignificant just as much as I do the grand,, and everything in between. Failures of the staff, the facility, the limits of human abilities, the boundaries of my soul-sucking emotional requests, the anger every so often a person seems to need to explosively purge at the clinic, as they are, after all my responsibility and I take ownership of them even if they don't recognize them. For me, as a veterinarian, and especially the veterinary practice owner, there are a boat load of fully justifiable reasons to extend a word of apology as ubiquitously as raindrops.

"I'm sorry we were running late today. I appreciate your patience."

"I'm sorry that I don't have better news," always the case of providing some death sentence diagnosis to a parent unprepared for the bombshell I just provided.

"I'm sorry but we don't provide walk-in euthanasia services." (Cause ya know, everyone should be able to decide last minute that "it's time" without the assistance of a doctor to consult. Which always elicits hostile accusations of us "not caring that their pet is suffering!" Somehow that is our fault too. These are only pets we haven't seen in years, or, pets we have never seen. I always want to reply, "would you call your pediatrician and request; "Hey! my kids suffering, it's time for goodbye" and NOT expect to be questioned?). (where is that fire headed emoji?).

"I'm sorry but I cannot take the 4 kittens you just found in your backyard." (Personal note the clinic has 5 cats in need of homes presently, and, we used to take in kittens to help adopt to homes and in the last year 4 were "returned",,, what the &@*&!).

"I'm sorry but we don't have overnight staffing to keep your critically sick, eminently dying pet, you WILL have to go to the ER, or take them home." (people you cannot leave your pet here to die alone, right?).

"I'm sorry but your dog is so frightened by restraint we cannot safely hold them. We will need to reschedule another time when we can provide pre-examination sedation." Also usually met with incredulous judgmental angst, as if we were the party who failed to provide the conditioning needed to do a nail trim safely? Odd how so many clients know they cannot trim their own GSD's nails at home, and yet get angry that we can't either. Even more disturbing is how many people prefer the staff be injured as long as the nails can be trimmed, right now!.

As  you can see from the examples the apologies range from introductory opening statements to help shoulder the burden of the disappointment about to follow,, "I'm sorry, but, I can't..." To the "I'm sorry, but, I won't." To the most common; "I'm sorry for your loss." It is a Santa-sized sack of apologies to be plated and served daily.

They all work, even if their pallor and place varies so enormously. What other prelude would be appropriate?

But let's get back to my apology to the stranger, Erin.

Social media reaches into the tiniest corners of every community. It is undeniably powerful and in a matter of seconds a social media post can reach millions of people and cause lives to change irreversibly. If you own a business it can be the death of you. Literally.

I am a champion of social media. I have (albeit unforeseeable) found overnight notoriety through the power of an emotionally charged video that struck a nerve with not just me, but bitter burnt pet parents the world (although lets be honest, overwhelmingly just the USA). Instant fame has been found by many a social media post, some good, much otherwise.

One of the burgeoning eruptive social media sources of the last few years is Nextdoor.com. Nextdoor groups people based on location. There are multiple daily posts by my local community members  looking for advice on all sort of things, like services. For instance "nanny needed," a newly diagnosed patient in need of a need of "orthopedic surgeon recommendations for hip surgery," or, notifications like "hound dog loose" replete with photos, times, and pet descriptions. It has also been the place for bad services experiences to be vented publicly, back yard crier style. If you own a small community based business Nextdoor is a potential hotbed of agony.

Here is the original post from Erin, to whom all of my apologizing to a stranger was about;
"New Vet Wanted"

We had to put our sweet boy down last month... pancreatic cancer.  We spent a few thousand at XXX XXXX Animal Hospital during his treatment.  The day we Euthanized him.... our original quote was $330 which was euthanasia and private cremation.  Once they realized that we wanted to stay with our dog during euthanasia... they upped the charge to $390,  They actually charge $60 more for you to be present while your dog is being put to sleep!!!!  I have NEVER been more disgusted in my life.  Our receipt actually says “Euthanasia—owner present”.  Their prices are exorbitant almost extortion like.... I stayed with the practice while  our Nashville was being treated there but I will never use that practice again now that he is gone.  Looking for a reasonably priced, non price gouging bc of “ the neighborhood” compassionate veterinary practice.

In the very exhaustive list of things that you just don't do in veterinary medicine screwing up a euthanasia is at the top of my list. Think you can't possibly screw this up? Let me give you my resume of them.
1. You put the wrong tag on the wrong body. Yep, not requesting the proper cremation (say the parents wanted the ashes back and you didn't tag it appropriately. Yep! really really bad).
2. The process doesn't go smoothly. Yep! happens. Death is not an easy ask most often. Our bodies are wired to keep breathing, and beating no matter how much drugs you provide. Or, they gasp for air as their bodies fight to give up. Not the last impression you want a family to have.
3. It is a busy, frantic day at the clinic and you (hard as you try) cannot get into the family waiting for you to be calm, patient and generous, as you secretly worry about the pet you are trying to save from death next door. I often think we need to have "euthanasia only" hours to avoid the chaos our general practice life throws us into.
4. People are people. Some know what to expect and know you, so there is not so much chit-chat to exchange. Others think they know what they need for their pet and then lose it last minute. (I once had a parent start CPR on their dog as I was injecting the euthanasia solution).

If you mess up a euthanasia the 10 previous years of anything you ever did for that pet gets flushed. Along with that scar you leave on your (previous) clients heart goes the devastating word of mouth they will share with every loved one they know.

So to every well intentioned Fortune 500 seeking femme fatale out there attempting to ascend that ice sheer under that omnipresent glass ceiling i apologize for my prolific apologies. I woefully fear (apology again), that I have set us back a few centuries..

For my place in vet med empathy is about apologizing for fate that few can outwit and outplay. I cannot undue the fact that all of my patients will die. Many of them too soon despite the best of care, the most adoring of parents and the miracles of modern medicine, but, I can apologize for the failures of not being able to spare them the grief of loss. I never surrender anything here, just remind them that kindness comes in many forms and a bow clad apology is one.

Where did this  practice go so wrong? They forgot that giving an estimate over the phone sets you up for big problems. Every case is case based, and an estimate is "estimating." Although less is always met without fued, more is a set up for angry torches at your front door. I try very hard to not provide estimates. For the cases of pay in advance euthanasia services they pay up front (if they want to) and I eat the overages if it happens.. (avoid the torches whenever possible).

You also never forget, no matter how crazy busy the rest of the clinic is at the time, that these last few moments of a life you cared for matter just as much, maybe even more, than all of the rest. Stop, embrace, say you are sorry for their loss, and be empathetic!

Erin's response;
Wow... thank you so so so very much for such a kind and beautiful message.  I knew that I was paying exorbitant prices at XXXX during his treatment but I was committed to just staying with them till the end.  If I had known that would have happened, I would have switched earlier.  It’s shameful that it happened and they seemed to have lost touch with human and animal compassion and are just about money.  One person commented that it’s about staffing and that is why they charge extra but in my opinion when it’s an end of life situation, money should not play a part , only compassion.  What practice do you own?  Thank you again for taking the time in your busy schedule to reach out to me.  It is most appreciated and speaks volumes. 


Here is Erin's description of why the price was different because she was present;
My daughter called them after the fact and was told it was for the catheter that was placed.  Owner present.... catheter placed.  No owner present... no catheter placed.  I was a tech for 10 years.  The vet that I worked for never placed a catheter because it’s unnecessary.  You can give the dog an IM shot of Acepromazine.  That will take about 10 minutes to make them sleepy and gives the family private time to say goodbye and then the vet comes in and gives the final euthanasia injection.  I asked for sedation from the tech first who questioned my request then when the vet came in, I had to ask her again.  They were actually going to give a wide awake dog the euthanasia injection through the IV!  I had to ask the vet (a second time) for sedation.  She obliged but then gave him the sedation IV.  He went from wide awake to dropping like a sack of potatoes in front of my distraught family.  The vet then said “I’ll give you some time now”.  I looked at her and said “Well you might as well give him the final injection now”.  I feel like that peaceful 10 minutes to say goodbye to him was stolen from us.  I have called several hospitals (like 5 or 6) to discuss their euthanasia policies and all have said that charging for owner present is disgusting.  Some said placing a catheter is unnecessary, some said that they place a catheter but do an IM sedation injection first.  The whole situation was horrible and completely in poor taste.
If the reason they place a catheter is because they want to make sure they get the vein then why don’t they do it if you are not present for Euthanasia.  That says to me that they are more concerned about getting the vein while in front of the family and not for the sake of the dog.  If you are not present , no catheter is placed.  That says to me that it is not about the comfort of the dog but for the comfort of the vet trying to find a vein in front of the owners.  Plus , they still take your dog “in the back” to place the catheter... it should be done with the family present.  Going “in the back” is scary for the dog... they still have to shave him and stick him with a needle to place the catheter.  What if you could not afford that additional $60 but WANT to be present?  Is that an “oh well, sucks for you” situation??!!  And what happens to the dog?  Does a sick, scared dog go in a kennel until they have time to euthanize?  Do they just jam a needle with euthanasia solution into your wide awake dog?  I’m thoroughly disgusted.

As a practice owner I understand that time is money. BUT, as a human being driven by the love of a pet I would never think of performing a euthanasia in a different manner because the owner is present. Why would there be a difference in how you handle the euthanasia? I know the answer I know why most vets place a catheter before. I know why vets act one way in front of clients, and hence practice differently in front of clients, but, for me, there is no difference. You could be a fly on the wall of any part of my clinic and the treatment is the same. I will tell you that " I am sorry," and that you "were loved." In some cases it is an animal that was never granted "pet" or "owned" status, but that doesn't mean they weren't loved, if only by me, for that moment in time we were together. How do you work for? Me, its the pets, my patients, 24/7/365.

Here is the story that Erin wanted me to share.
This was sent to me today.  I teared up.   😢 Pls excuse the cuss words...

How your vet sees euthanasia.....
So, you bring me this puppy - she kisses my face, devours the cookies I offer, and our friendship starts. 
Several visits later, he starts to learn where all the cookie jars are in the clinic, and that lady in the white coat, well she’s okay....
Fast forward many visits later, now I am in love with your dog and your whole family because, well, you are just really really good people and I have not only watched that pup turn into a really sweet family member, but I got to watch the kids grow every year and be a very small part of your journey. 
Remember that time she ate your teenage daughter’s thong underwear?  😝😝😝 yeah we all had a good laugh over that once surgery was done and she was recovered. Your daughter probably never forgave me for bagging that up and showing the whole fam-jam when they came to pick her up from the clinic. 
So many adventures, so little time.....
And here we are, fifteen or so odd years later, having to say goodbye. 
He’s got heart disease and I can’t fix it anymore. She’s got cancer and there is no cure.  He has arthritis and the meds just aren’t working.  I want her to live forever for you. I want that so badly it hurts.  I feel like I have failed him and you when I have run out of options to keep them, and you, comfortable and happy.  
So now it’s time, and I am supposed to be professional.  Objective. I am the doctor. Calm. Cool. Collected. Always under control. 
*&$# that. 
I have known you and her for a third of my life, and most of my professional career. 
But I keep it together.  My superhuman amazing technicians have put the catheter in. My support staff from reception to assistants have done all the paperwork. Trust me they may not show it but their hearts are breaking for you. They have been there.  They know. And they know you and care about you too. 
And I have the needle in the pocket of my white coat. The same pocket that was always full of treats for him.  I take a deep yoga breath and come into the room. Gotta stay strong now.......
She’s giving me that sweet look she always does, the one that is followed by puppy kisses and a glance at the cookie jar.  But she is too weak now. She is ready. You are not. I am not. But this shit has to happen because we love her too much to let her suffer.
She would keep going as long as we asked her too.  But we can’t ask her to anymore. It’s not fair to her.  I wish our human hearts could be so giving all the time. I wish I could be the person my dog thinks I am. I wish I wish i wish I could find a way for them to live forever.  But I don’t have those magical powers. I am just a vet. 
So we kiss him back, not much left of his body that still works, but that old tail wags, just enough that I lose my shit on the inside but I try not to cry.  Gotta stay strong. 
Her body relaxes, she is in your arms and your are sobbing.  Another family has lost one of its most cherished members. I put my stethoscope to her heart to make sure it has stopped but she is held so tight to your chest that maybe that is your heart I hear pounding or maybe it’s mine and all the blood rushing through my ears as I try so so so hard not to turn into a blubbering mess. 
Confirmed, he has passed. You lay him gently on the table and we hug tightly as you go to leave. 
The door closes behind you and I don’t know if you hear this, but I sob hysterically into your pets ear.  She is gone, he will be missed, and you have to face what I know will be one of the hardest parts of today. 
Entering that house and they are not there to greet you. 
Please know that I know how you feel. As you leave the clinic I just wish with every fibre of my being that you never had to face that.  I wish they could live forever. 
And please know, I am so grateful that I was a small part of your journey.
Love always,   Your vet.

We all want to be this veterinarian. It costs us something to be her. Vulnerable, fragile, and emotional. It is not a big ask, but, remember in the same breathe, at the same moment for one person that we are expected to be this person, in the next room over there is a person with a cat they say they only feed, "it's not theirs" who has a very treatable condition and wants you to treat for free because if you don't "you're a cold hearted bitch." Do you know which one you are supposed to be for which room? There are many reasons the suicide rate in medicine is what it is.

This blog is dedicated to Nashville,,, and Erin.

Erin's story and Nashville's photos are posted with her permission.

Why Women Apologize and Should Stop, NY Times.

It's Time for Women To Stop Apologizing So Much

Suicides Among Veterinarians Becoming A Growing Problem. Washington Post

Taking A Stand And Facing Consequences. What Would You Do If You Were Asked To Euthanize A Pet You Didn't Believe Was Ready to Die? How often do you think it happens? I know most vets euthanize anytime asked. Why? Because if you dont you get labeled as "uncaring."

Compassion Fatigue. Lessons on avoiding the lure of veterinary suicide.

More on Jarrettsville Veterinary Center here.. JVC is a place where compassion comes first. Compassion towards our patients is paramount. We are kind, generous, and never allow financial constraints to dictate access to care.

If you would like to know more about the topics I discuss here please find me on Pawbly.com. It is free to use and open to everyone who loves pets. Pawbly.com is designed to help educate, inform and inspire pet people everywhere. We have just added our "storylines" section to help people share their own pets experiences and to help others learn from them. Please also consider joining if you have experiences to share and pet support to lend.

If you would like to learn more about me at the clinic please visit our Facebook page at Jarrettsville Vet.
For my YouTube channel please visit here.

For more information on my veterinary clinics services, including prices for care please see our Jarrettsville Vet website.

Hoarders, Surrender, and the Worst Fate of All

"I have such great news! .... My mom found a home for the cats!" 

It is a tough ask; pitching two adult cats to anyone. People adopt babies. Cute fluffy new babies. Teenagers, well, teenagers are a hard tough sell. And yet it happens; life, and it's unforeseeable twists and turns leaves us in a place with pets we are not sure we can care for any longer. None of us want to feel as if our own life is so fragile, so uncontrollable, or, so unpredictable that we are one bad decision, or, phone call away from bankruptcy, homelessness, etc.. But, these things can, and do, happen. People get a twist in the road of life that derails them. They find this place where they are no longer able, or willing (in some cases), to support their pets. What happens to them, our companions we brought into our lives, should we ever find ourselves here? In my life, and this line of work these stories end up as preludes to these dilemmas too often.

A few years ago a house fire threatened to leave a client and his 42 cats looking for new living arrangement options. (Yes, 42!). He began collecting cats as a rescue effort. One or two here or there, a litter became four litters, and 7 years later his 4 bedroom home included 10 to 20 cats in each bedroom. The litter box management alone left everyone smelling like sewage. The house couldn't be kept up. Random pieces of appliances began to fail and he feared letting anyone in to fix anything as the cats would literally be out of the bag. He began using a hot plate, and a kitchen fire happened. Thankfully no one was hurt, but he realized his cats were almost public knowledge, and if this happened he knew his whole life would come under county scrutiny.

This is a man who loves his cats.. Like many hoarders he has more than he can care for and he also believes that surrendering any of them places them at a far greater risk then their current situation where they are overcrowded, underfed, and lacking in basic medical care.

He fears the public more than he can see his participation in the denial of the affection and health to his cats that they so obviously needed. He always believed that his life was managing fine, and his cats are happy because he loved them.

After years of trying to help him and his cats with multiple attempts to spay and neuter everyone (which never happened because the few we couldn't catch were too feral to trap), I realized he didn't really want a population neutral home. He wanted more cats. Kittens to be precise. Kittens made him feel needed. They were so small, vulnerable and often so sick. They needed him to nurse them back to health (because they all were after all unhealthy and always sick), he had concoctions for every ailment. He began to resist spaying the girls because he wanted "to focus on the boys," and, "most were related and they wouldn't mate if they are related, so I didn't have to worry." I spent years begging and pleading him to start considering adopting out some by letting us find homes for the youngest, the friendliest, the ones we knew other families would adopt. But, he would never even consider letting even one go. Not one kitten. Not one feral adult. They all had names given to them as soon as they were born. He knew who was whose grandparents, siblings, aunts, and uncles, etc. This was his family. He loved them more than he could see what that love was costing them.

After 10 years of seeing bad decline into criminally negligent and mentally incompetent I was broken to resolve that I was merely a spectator watching his cats die more tragic deaths than the parents before them had. The problem over the years had gotten bigger, and more alarming and he just wasn't seeing it. A few timid cats turned into 40 plus (although I suspect the number is 70 plus) indoor cats with severe emaciation, respiratory failures, illnesses that can only be explained due to massive overcrowding, inability to manage basic sanitation, and starvation due to dental disease that left the cats unable to eat and dying to in the process. I gave up my ability to believe that I could make his cats lives better. I realized I was just flaming the fires of an inferno and watching cats die more excruciating deaths than I could intervene on. My last straw was a dozen plus cats who starved to death from stomatitis. A cat with stomatitis has inflamed gums that causes such severe mouth pain they can't eat although they are desperately hungry. One emaciated fire mouthed cat after another showed up. Each so sick they couldn't fight the stranger they knew everyone to be. So weak and yet afraid to eat they gave up and willingly died in a corner of a cage that offered no reprieve.

Any person who hoards is already a difficult person to relate to. There is always a lack of trust, there is always a degree of denial that often turns into defensive denial coated anger, and there is always a helpless life hanging in between.

I got to the point where I knew I wasn't helping anyone. I was just prolonging and participating in their and my own suffering. I didn't want to continue to be an accomplice to his feral cat breeding side show circus any longer. I explained that the conditions had gotten to a point where they were no longer manageable, that I felt as if I was complicit in this, all of  the death, the disease, the perpetual continuum of it all, and I couldn't live with it any longer. I tried again, and in vain, one last time to be the advocate for his cats who he dedicated every minute of his life to.

At the end of my attempt to open his eyes to the state of despair his cats were living in I landed the ultimatum. Either he got help, or I would report him to the county animal control officers.
Helpless is a place for the meek to hide in. Helpless and hog tied as a bystander is torture beyond forgiveness. I was the enabler watching disaster strike over and over again.

I never saw him again.

Over the next few months the local shelter received 5 hoarding cases. Each case had between 20 to 80 cats. All were thin, sick, and covered in fleas and feces. I would estimate that less than 5% of these ever found a home. Most were too wild to be adopted. Some ended up in barn colonies. Others just died of fear.

It is impossible for me to tell you the worst way to die? It is impossible for me to say there is anyway for a happy ending in these cases. It is also impossible for me to understand people. Veterinarians seek animals to fulfill our healing purpose, people we distrust amongst our dislike.

I grapple with the fact that I ever made anything better for these cats who deserved a life of so much more. I still ask myself if they were better off with quick death from someone who doesn't care about them, versus the slow death they got from someone who does? There was no happy ending, I just got out, and, even in this I wonder if it was the right thing to do?

"I have such great news! .... My mom found a home for the cats!" Jenn, my office manager, relayed the seconds ago phone call as she came bounding into my office.

The excitement in her face was obvious. The relief was inflected in her tearfully bubbly words.

We had spent much of that morning, and previous few mornings, discussing this dilemma of the impending eviction. The eminent need for a home for two older cats whose long time clients were moving to a smaller apartment and not taking them. We, the collective of us who manage the vet practice, had decided many many years ago that if we wanted to run a family-oriented veterinary clinic then we had to stick to our words. Be more than a trademark tag-line and actually stand by it. We aren't going to say that we "treat your pets like family" and then not really treat them like our family. So, we do. We offer payment options, free boarding, intervention care and emergency care to our patients when the pet parents need it. In the past this has included; emergency boarding for family emergencies, the automobile accidents heart attacks, deaths and even domestic abuse and inclement weather needs. If needed we even do it pro bono. We have never  put profits above compassion, nor, pitted purses against pet care. We stand by our patients at their best AND worst days and most dire times of need.

We had also learned the very hard learned lesson that if you give someone an easy out they never truly take responsibility, and they hardly ever follow through with their end of the bargain. People who abandon/surrender pets already have an emotional disconnect, or, they are so far removed from financial ability that follow through won't matter. In 15 years I have only had one surrender I ever felt right about. (See Cole's story here). The rest were clients who had a history of disposable lives the unloaded (often obviously un-remorsefully and un-apathetically onto anyone else who would take them. Once you surrender in (many places) you are forever blacklisted from adopting again. Shelters, rescues, and yes, even us, won't adopt out to you again. Ever. (How can we?)

This particular family were losing their home. It was something we had known was likely for months. We had been in constant contact with the family to get as much social media saturation as possible. Just that morning Jenn had told me that she was scheduled to visit the home to take an in home video of the cats (as one of them was very shy and wouldn't film well at the clinic). She had planned her weekend around this home visit. We all know how hard it is to place adult cats, especially shy reluctant cats. When I asked how the visit had gone she told me that they had cancelled it.

"Don't they understand how hard this is going to be? How we really need to find them homes before bringing them here to live at the clinic."

We have taken two other pairs of cats into the vet clinic over this last year. Our current number of in clinic cats stands at 6. All older, all tough sells to find homes for. One pair came from a family who had developed allergies. The other from a family who just didn't want them any longer then the 10 years they had already had them. One of these cats had gotten so depressed, fearful and withdrawn that we feared he would die from the stress and anxiety our busy chaotic clinic landed him within. I had almost gone as far as placing a feeding tube to force feed him. Cats bond very closely to their owners. Even if they aren't a lovey-dovey lap cat they know who their caretakers are and they adapt to their home with a dependence not seen in other species. When their world changes many of them cannot handle the insecurity. They withdraw, they stop eating, they stop grooming, their depression can kill them. Even when they don't appear to love and need human companionship they die without their people.

"No, she cancelled over the weekend, and that was before her mom had called her to say that she had found a home for them."

"Do you know her mom?" I asked.

"No,"

"Call the shelter. I will bet you a thousand dollars she is just going to bring them there."

...."WHAT! Are you kidding!!??" Jubilation transitioned into shocked perplexity and angered pause.

"No, I'm not. I have never known her mom to be a nice person. She had a sweet cat named Feather, the only time or attention she ever gave that cat was letting her follow her to the mailbox every day. She was never allowed inside and she was never more than a cat., and she also never says anything nice about anyone, her daughter especially. Call the shelter, give them a heads up."

The next day the shelter called to say the cats had been picked up by Animal Control. The mom had requested they be euthanized. She had expressed that they were better off dead, something about being concerned that they would be "abused if adopted to the wrong people."

Now, I have to pause here. I have to stop here because as hard as it is to believe I hear this a lot. Too often. It bleeds into this paranoia, the same paranoia that precludes a person from finding homes for his 42 cats who are dying slow deaths around him, in his home. He firmly believes that all of his cats, whom he loves and will admit to repeatedly loving, are better off with him than anywhere else. He is blind to their suffering. Distrustful of everyone else in the world. Which also included me, the one vet who would allow him to drop off any sick cat at any inconvenient time, AND, not force him to pay when clearly he had no ability to afford anything.. Even I was  threat so intense that I had to be cut out. The same paranoia that allows people to believe death is a better place than chance when you dump them into societies mercy.

The lack of trust in medicine, in compassion, in humanity has been one of the hardest pills to swallow.

The shelter called to ask for medical records to be transferred to them for these two adult cats that we had just been told Mom had found a home for. I interrupted. I have such great news! .... My mom found a home for the cats!

"Who dropped them off?"

"Mrs. MOM did" they replied.

"Well, she isn't the owner!" I exclaimed. I was excited to have caught them before the euthanasia filled needle did. Before they were lost in an overcrowded shelter. Maybe, I thought, if I could show that these weren't the MOMs cats we could get them into a better place for their second chance?

The rest of the day included multiple phone calls to the shelter staff to promise me that they wouldn't euthanize the cats, the Animal Control Officer to explain the whole situation and urge him to go and speak to the cats real mom in person, and the vet clinic staff, just in case someone came packing and angry. We have had to go on lock down before, get restraining orders, and do emergency shelter recons before. You put everyone on alert when shit like this happens.

When I was on the phone with the Animal Control Officer I begged him to go to the cats home in person. "I'm afraid her mom lied to her. We have offered to help to find homes for the cats, give them a foster home, all so they wouldn't have to be surrendered, which was what she told us all along she feared the most. That sending them to the shelter where they could be euthanized if they were too scared to be adopted might be their fate. Please go! I just can't imagine she would do this, or knowingly let her mom do this? And, please give her my cell phone number. She can call me anytime. We will help her and her cats."

The next day the shelter called back requesting records. She, the cats real pet parent mom we have known so well,, hugged thousands of times, cried with over the loss of her pets, shared holiday cards with, loved more than any other person/client/friend/and even more than family had signed them over to the shelter. Their fates, as the shelter will openly admit to, are open, can be decided to be terminated at any time (because surrendering allows immediate euthanasia), and I am devastated beyond words.

I do not understand people.

Why would you not trust us more than the shelter that can/will/might kill your unadoptable/stressedout/abandoned-and-petrified cat?

It is impossible for me to tell you whats the worst way to die? It is impossible for me to say there is anyway for a happy ending. It is also impossible for me to understand people.

It is increasingly more impossible for me to not judge people as I try to dissect into the comprehensible these non-sensible pieces. I live in a profession where people decide their companions fates. I live in a world that I still willingly invest my heart and soul in, and I live in a world where even those pet parents who I think/feel/believe will fight and die for their pets don't.

And I'll be damned maybe, but, I sure don't understand them. The hoarders are killing their cats with selfish abusive neglect they cannot see, and, the disposers pass on a problem to let their guilt succumb to freedom knowing full well they can be, and often times are, euthanized. Because in the world of shelter medicine surrender allows anyone to decide at anytime whatever fate they want to deliver.

The pets, these defenseless deeply emotionally attached to us regardless of how atrociously we treat them, well, they deserve better.

I spent the night trying to figure out how I could be so wrong about her? Her obvious love for them?

Do I call her and try to unravel this? Do I secretly go get them and hope that I never see her again?

The next day Jenn called. "The Humane Society called. They are full, they want to know if we will take them?"

This is where the soul of every vet/every rescuer/every humane is decided. The little pieces. The incremental stories that your life gets entwined in and the facing of the fact that you do care more, you always have, and that's what makes you who you are. For me, the little fired-up vet who looks at every one of her patients as HER patient, HER family. I will never abandon you, or fight for you, without or without your parents.

"yes."

Here is the video of us picking up the cats. Meet our new JVC kitties;

Here's my video of how these cases affect me;

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Thank you for being kind..