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.

The Problem and The Compulsion

I have had this conversation a thousand times before.

A thousand times I have explained the same problem, the same outcomes, the current state of our profession, and the same desperate passionate plea to provide better for the sake of all living things.

With each plea for help, pitch for the solution, and nodding heads of understanding, the problem remains here at my feet grinning. 

The problem sits, consumes and grows.

Problems this big, the kind of big that swallows lives and breaks hearts, can define a life. 

I may have come to vetmed to save pets lives, but this profession is more than practicing medicine, it is about protecting and saving lives. When I can't do this it's a big problem. This problem has gripped my life's work and taken it into a place I never thought I would become so compelled and stuck within.

What do you do with a problem that allows suffering, denies culpability and consumes as it festers? Well, I guess if I am me I dig in. 

I am now companions with my problem. My problem has become my compulsion. As compelled as I was to become an adult and leave the shadows of a small existence in an even smaller northern town. Compelled to be unburdened by the confines of a family fleeing a city that left them feeling monitored and microscopic. To the girl who I once was compelled to find a bigger life with a chance at freedom to the cost of a uniform. To be compelled to go to sea for a decade to buy your second chance elsewhere. Compelled to fight and outlast the years it took to get into veterinary school and quench that little girls soul still alive inside her and be the Herriott she heralded. I am compelled to do this too. Shake the ground so hard that the tallest tress tremble and the smallest beings benefit. Just like all of these before I will not stop until this to is notched in my belt and a little piece of kindness is given back to those who never formed the language to ask.

Here's the pitch, (for the one-thousandth-plus time), in small bites;

"The house is ALWAYS stacked against you." Whatever veterinary clinic you walk into, (and for my analogy: any casino), they have the upper hand, almost all of the control, and very little, (if not intentionally absent), motivation to provide you all of the options available to you and your pet and no upfront transparency to allow you to be prepared, informed or flexible once you walk in their door. I used to hope that moral fortitude, ethical foundations, and our own soul-filled desire to make a difference within the profession we were all so passionate about might motivate a righting of the compass, but it appears the gap grows ever wider and the despair ever deeper. 

"There are so few governing rules in veterinary medicine that it has allowed the single minded behemoths to eat up the landscape for profits without limitations." If you work in a profession that is being acquired by venture capitalists there is a dollar figure so alluring you take notice. Why is it happening so quickly in veterinary medicine? Money. Just money. We are perfectly positioned to be so lucrative the vultures are eating us up in record numbers in record time. Here's the facts that allow vetmed to be so profitable. For many people our pets are our reasons for everything. Price is not set by, nor limited, nor overseen, nor fixed, nor ceilinged, for anything from anyone at anytime. We, the profession, the individual and the facility, can charge anything we want for anything you need/want. The reason; well pets are property, and the market will bear what costs are, until it's 2 am and your pet is dying and you have no other options, AND, no one publishes their prices. Consumers don't ask, don't know, and don't have the ability to query costs before, nor, negotiate during a pet visit. You are a victim to an establishment that now has you hostage, and we know it. How does that feel when your pet is dying, sick, and you are both at the mercy of someone just out to make money? The house is ALWAYS stacked against you. And no, you shouldn't trust us. We don't work for us, or you, or pets anymore.

What is the price you put on your pets head? Maybe its not a question you have ever had to ask yourself but be warned it is the only question the VC's in this arena care about. If they think you will spend $20,000 for a pyometra that's what they ask. How many of you have access to that at 2 am? How many of you couldn't afford this and will have only one other option given to you; euthanasia. 

The system is getting worse as the money gets fatter cats, fatter. Ask your vet if they work for a corporately owned VC? Ask them if they received a sign-on bonus? What if that sign-on bonus was $250,000? Who do you think is going to pay for that? How much is the price on your pets head worth? How else can those sign-on bonuses be paid? I promise it isn't coming out of the fat-cat at the top of the food chain who owns the place, and btw has zero interest, nor experience, nor knowledge of any aspect of vetmed other than its profitability.

So, now that you understand the money, let's talk about the other thing the house has on its side; liability.

Liability is managed in CYA documentation. We are very good at this. We are, after all now owned by the fat-cats with the fat-cat lawyers. Although the single veterinary practitioners liability insurance hasn't met any other kind of human medical malpractice comparison, we pay hundreds, they pay tens of thousands, when we start to ask $20,000 for a pyo, (remember pets are property, we only need to provide "replacement" value) it might be time to change the valuation of our culpability. 

Are you beginning to believe that the house has this gig rigged yet?

Let's talk about signing documents? Are we the only profession in the world that has customers sign something AND NOT GIVE THEM A COPY IMMEDIATELY? Why is that? And why can't clients turn the table on this practice? Why aren't we providing guidance to save lives instead of practicing a professional skill to avoid liability while we with hold access and options? (More on this via Pawbly.com soon).

Here are some of the stories I get sent every day. (Find all of them on my YouTube channel and Pawbly.com)

From my friend;

"My cat was a diabetic. He was having some kind of crisis and needed emergency surgery? Our $5,000 walk-in deposit went to $10,000 within a few hours. We didn't have the $5,000 and we certainly couldn't pay the $10,000." I knew what was coming next. Yes, they euthanized."

What the actual,,,, I have never had a emergent diabetic case that needed surgery. And every, (yes people EVERY) case has options. Like, let's start with insulin and fluids. Basic medicine every vet was taught. We don't practice affordable care because it is not maximum-profits care.

The practice owner I met last week at the veterinary career fair summed it up perfectly. "It is our job to offer best practice care (i.e. most profitable) and if they cannot afford that, then we offer other options." Sounds kind of unfair to you, the consumer, doesn't it? 

To the weekly requests I receive to unblock a cat, look for a nasopharyngeal polyp, or save a pyometra (all of these cases are given with real-life pets on my YouTube channel) for a tiny fraction of the costs being given elsewhere, I have to remind myself that I am not alone. I cannot fight for all of these pets, provide all of these services alone. And so my war with the current state of vetmed wages on. 

Unblock cat here.

Cat with polyp case here. And here.

Pyometra here.

For those of you who don't care, maybe you think you are sheltered? Some of you are. Some of you have a great vet who you know and care about, and, who you believe cares about you too. Some of us are still out here working for ourselves. Putting our own reputation and shingle on the line. We are affordable because we care about you AND your pet. We value what we always have; being a trusted part of our community. We care about lives, legacies, and ethical traditional vetmed values. But what will happen when we leave, or retire, or die? What will happen to you and your pet when we have to decide what the future holds for our clinics? What happens when its 2 am, we are closed and you need help from someone else?  What do you think your vet will do for you when you are at the front door of the fat-cat clinic? Ask them? Don't wait until you find out in real-time with a real emergency.

Go back to rule number 1. The house always wins. When your pet needs something, critically needs something you will very quickly be reminded that pets are now a luxury for the rich. No longer the middle class, but the rich. Rich people seek other rich people to get richer,, they don't apologize for this. When I started in vetmed in the 80's an exploratory surgery, let's say for a corncob stuck in the intestines, was about $300. Ten years ago it climbed to about $1,000 to $1,500. Five years ago $4,000. Today, at almost every specialty, and some ER's it is $10,000. How many people can afford this? What happens when a corn cob isn't removed? Your pet dies. Dying of a treatable condition used to be far less common because veterinarians had obligations they took personal responsibility. We had our own practice to protect. We were a part of our community and word would get around fast if we failed to help, failed to provide care, or even worse if we failed to provide an affordable service. 

the easiest thing for you to do, and the way the house insures its victory, is by you giving up. Once you sign that euthanasia form, it is over. You have conceded all and given permission. I know, and I do believe that there is no greater gift then ending suffering kindly, but, how many pets are given up on because vet med has made any other outcome impossible? There is a war coming to vetmed. There will be enough people forced to abandon the one being they love more than anything this world holds and the war will be for them. There is a class action lawsuit that will follow, and with this a littany of others will follow. People will have their voices heard and this profession will have the first righting forced upon them after never have had one before. 

Property. As the legal liberties are awarded, and the price points become both transparent, publicly provided, and openly traded services will provide some degree of stability and fairness. Does the profession want to lose the legal status of pets being property? No. With this definition there is a limit to liability we face when clients seek compensation for damages. But, the classification of property 

ways to escape being a victim;

independent practices. find, meet and ask the owner what you can do, or need to do, to be cared for. P.S. "get insurance" should not be, and cannot be, the only answer.

This profession has wounds that run deep. We have apologies to be spoken, and we have a path that cannot continue at the pace and prices we are requesting.

I have been a veterinarian for almost 20 years. I have seen every kind of case with every kind of pet parent behind it. Very, very few are without hope nor options. I have also owned a practice for almost all of this time. Are the prices skyrocketing into exorbitant? Yes, they already have. Are there veterinarians and owners out there profiting without remorse? Absolutely. When you live in a place that loves money more than life, profits more than 

Be very careful what you wish for? Want to be the one-and-only decision maker for your pet? Then they are property. Want to have every treatment option available for the most beloved being in your life? Better have deep pockets and instant availability for those dollars. Want to be insulated from heartbreak because your love for your pet leaves you vulnerable? Just remember that the person who decides whether or not your pet gets the care they need has a limitless ceiling and you are at the ends of their strings. They give you care based on two things; your ability to pay, and their willingness to help you. Thats it. Feeling like a your pet is a pawn in a venture capitalists portfolio? They are. Welcome to my problem. I suggest you get pissed enough to do something about it before you get screwed and have your heart broken over the loss of your treatable companion.

And maybe think about the price on your pets head before it's 2 am and you have to consider it, and start demanding a change now. The divide between need and access is getting wider and the 

Here's what's ahead;

its time to put liability CYA paperwork in pet parents hands.

its time that pet parents be given all of the options, with written line item estimates, before a deposit is given.

its time for transparency;

its time to publish who owns the clinic you are at.

who was given a sign-on bonus that might have influenced the price on your pets head.

its time to publish average costs of care before a pet parent drives to your facility at 2 am.

its time for accountability outside of the faces of the veterinarians who are already emotionally bankrupt and emotionally unwell.

its time for the public to re-think the laws that dictate the unconditionally loving, uniquely beloved soul sleeping/purring next you in bed every night as disposable/replaceable property.

it's time to compel the house to meet your needs and standards and put them out of business before they bankrupt your ability to love your pet.

The Hardest Days.

The hardest days are lived in snapshots.

Frozen moments of the day that solidify, remain indelible, and scar. 

I have collected mountains of them. Held them in my arms like a clutch of kittens too fragile to walk away from and too demanding to dismiss. I know they are the villains to my story that makes the read worthwhile, but when away and alone I sit and wonder if I need to be so burdened by them. How can I extract the color without bleaching the meaning they must hold for me to carry them for so long?

The past few weeks have been vibrant and jarring. The color that propels heartrates into arrythmias.

I live within the proverb; intentions matter. I also suffocate screaming for merciful reprieve because these two words are so impactful. Within these intentions you are left to question motives at every movement. Veterinary medicine is a quagmire of bipolar extremes. Emotionally charged, diabolically opposing, with violently swinging requests of the pet care spectrum you often cannot foresee. What gives a family the gift of a graceful, peaceful passage, also leaves the other owner with a disposable/replaceable burden they simply want eradicated. The purveyor of these passings is too often  given a heavy burden. Or, what one family wants and will fight for another will dispose of without whim or wait. I have been bullied, berated and threatened for caring too much, and too little. Never have I euthanized a treatable pet without fighting to give them every chance, at no cost, which somehow vilified me even more. I have been dumped for an easier practitioner who works on an upfront-pay-and-I'll-remain-mute basis because I dared to open my mouth to attempt to defend a pets life. I have been threatened when I refused to be a part of a pets undoing unjustly. And with each I remind myself "that no good deed" often comes with punishment, however unintended, and unwarranted. I have also come to realize that a dignified end of life death is often a merciful act. But, dare I try to be the inspector of this intention, question the reason, and the tables will swiftly turn from humble request to angry accusations. How is it my place, my duty, and my obligation to question who dies and when? 

I am often asked if euthanasia's are the toughest part of my job, (I have written about this before), and no, when I am being asked this it is always at the hand of someone who loves so deeply they see beyond themselves. A euthanasia request for a pet that hasn't seen a vet in years and is suffering from a treatable condition they still don't want to try to treat, yeah, that's soul-sucking. A euthanasia request because it's cheaper to buy a new one than deal with the old one, yeah, that's a cancer you never recover from. This is my life. The one I chose. The one I fought so hard for.

For the pet owner (emphasis on owner for this is the only title that provides such privilege), the mere perception that I would ever question their intentions or motives can/has unleashed raw anger and threats of questioning your own compassionate humanity. On the flip side there are so many euthanasia's I have declined for fearing my thinly skinned heart could not bear witness, nor survivors remorse, from the act. I believe that for almost all of us veterinarians our internal parting words for excusing these acts, even when we cannot understand, nor agree with the motive(s), are; "if not us, who?" For within these requests there is always a pet, this piece of property, that will be/can be abandoned, tortured, hurt, or dropped to be surrendered at the shelter for the same request. If an owner wants it to be done, it will be done. Just as all property can be disposed of. No law, shame, or unjust reason will change this. So it happens, almost always, that these pets can leave by my hand with me telling them softly that they mattered and they are seen. I, in every goodbye, steal a moment for myself to say that they are everything that holds value and they are loved. I can at least always give them that. And then pardon myself in silent solidarity later. 

Euthanasia, in vetmed is the Medusa of intentions. I am the Master of my own acceptance that I am confident in my own intentions, I will never be everything to everyone. I have grown into an adult who rarely cares anymore if I am liked. I am not mute and I insist on this being married to my intentions.

This week brought us two families who tragically had to say goodbye to two pets within the same day, two days apart. When I admit that this has never happened before in my 18 years of practice I cannot believe it happened two days in a row. How is it that luck never translates to lottery tickets? I had been asked if I would do both dogs at the same visit? A way to condense the pain into a more efficient way to let one dog say goodbye to the other before we said goodbye to him? Thankfully we both agreed this would be too difficult on our hearts.

I have done double euthanasia's on two other occasions. Both were excruciating. After each I promised myself I wouldn't/couldn't do this again. The grief around these always leaves me reeling. I feel twisted in my intentions, and guilty in considering to deny it. How can I be a veterinarian who knows there needs to an end to a suffering we cannot avoid, and not feel a stab of feeling selfish within considering how to address and face this request. Euthanasia's however hard, can't ever be about me I reminded my inner gooey-yolk of a heart.

The first double euthanasia was two old black labs. They were 13 years old brothers, struggling to remain ambulatory. They had great difficulty getting up and walking more than a few steps without collapsing in pain. They lived on a sprawling, verdant bucolic farm and their quality of life was significantly impacted. The owner was not able to get one of them in the car, never mind two, so I agreed to come to the house. When I arrived they saw me approaching, and as if by some divine interventional miracle managed enough energy to get up from the front porch and run a half a mile in different directions. I followed the slower one to the west, sunset in my eyes, dragging my medical bag to the edge of the property to find him solo. I knew then that I had made a significant rookie mistake; coming alone, agreeing to do this in the first place and a massive miscalculation on time, ability to drag a deceased 80 pound dog back to the house and then repeat the process on the other. I too had not planned for how I was going to get them into my car. (Have we ever talked about the physics of dead weight being much heavier than alive? Someone has to have done a research paper on this?). The logistics, inability to walk so far, bring dogs back from so far and the emotional turmoil about how to make this horrible day less horrible for a pet parent who couldn't/wouldn't help me with this was traumatizing to all of us. Pets, all animals, all living beings, seem to sense goodbyes, and regardless of how warranted they are, they react. The reserve of adrenaline to preserve their life defies all diagnostics and prognostic indicators. The primitive call to get up and run even when you know you are no longer viable to evade allows bodies to defy biology and physiology. I can tell myself every moment of my professional, and personal life that I am here to relieve suffering, but yes, the desperate plea of those pitifully sad eyes looking at you as you send them away can hurt so bad you cannot find solace in the present, nor your intentions.

The second double pet euthanasia was a long time client who battled a many-years long breast cancer battle. When she went into remission after a year of treatment she bought herself a Corgi puppy. She had set that as her accomplishment prize and she wanted to be well enough to take on another Corgi. Her original Corgi was about 3 years old by now. Young enough for a sibling and sweet enough to allow one without bitterness or jealousy. She wanted to be sure she would be well enough to care for both of them. Almost 8 years passed and her battle reappeared and raged again. In a matter of a few short months she lost all of her body weight, her hair and her spicy wit. When she elected hospice her last wish was for her dogs to be with her in her casket. She made an appointment with me to ask me if I would be there for her in this request as I had been there with her in all of the rest of her pets lives. I struggled with this request so deeply and profoundly that it almost broke me. Truly, it was the single most wrenching thing to be asked. I was this woman's trusted veterinarian for almost 12 years. She valued my compassionate care for her dogs, and knew that I cared for her as I cared for them.  We had been a team for all that was our lives with her most beloved companions and she had one more request for me to assist her with. She wanted the four of us to be together to say goodbye to her dogs that she could no longer take care of. I spent hours almost begging her to see if we could find them a place to go together. She was convinced that they would be neglected, mistreated, or unable to build a new life without her. She wanted to be present at their departure and she wanted them to be with her as she was laid to rest. It was one of the most emotionally gutting moments. How do I put all of my love, attention and energy into one euthanasia and then within moments try to muster it all genuinely for the other? I had flashbacks of being at the county shelter where the pets would be lined up as if in a genocide to clear the cages. One, after another, after another, Void of the dignity that ending a life turned into out right killing should be made of. It was the longest, most brutal, most conflicting experience. A few months later their mom passed away at home from metastatic breast cancer, I hope they are all together on a couch feeling like their family of love has enough belly rubs and wiggle-butt endearments to make the after life as magnificent as we all hope it to be.

These last weeks I have averaged about 3 euthanasia's a day. We joke that euthanasia requests always uptick in the days before major holidays, (Thanksgiving for the win), with all of the family arriving and the incontinent pet being the main incentive. Or the days before Summer vacation departure when you cannot come to terms with the emotional trauma of leaving a sick pet in someone else's care, or the inner turmoil of cancelling the trip because you expected they wouldn't have lived this long when you booked it 6-8 months ago. Or the back to school chaos and the days that you have to go back to work, the kids will be away all day and the luxury of constant care via Summers timetable. 

Last week a very old, very poorly looking lab came calling for help. She could barely walk or lift her head. She was labored, exhausted and sporting a severely distended belly of fluid. Within a few minutes I had confirmed what my fears told me. She was bleeding internally and there were only two options and a stopwatch timer to decide them within. She was dying in front of us and we either needed to get her on the surgery table immediately or euthanasize her now before she died imminently.

The response is universally the same. A tidal wave of tears, and a few moments to talk amongst the family to decide. They decided to let her go but only after they called the kids to come say goodbye. What ensued was two girls under age 6 bawling and screaming in agonal grief. The girls insisted on being present, a decision I feel very strongly is not theirs to decide, and subsequent hatred toward the veterinarian who was "killing" their dog. I was yelled at, thrown fists at, and made to feel like the most horrible human on the planet, which to this day, and likely every day of their lives I will be referred to as. How else can they process their heart break? How would I have been any different at their age? Why do we have to let our little kids see things that aren't going to be anything other than devastatingly painful?

And why do my shoulders have to be so broad as my heart grows so hypertrophied, thin, big and bulging with the responsibility I cannot always accept as kind?

Why if I am so convinced about the inherent holiness of my intentions do my convictions question my motives?

Ok, I know this one was a tough one,, so for all of us who need a reminder.,,, Here are some photos of my week and why I still love being who I am and doing what I do,, and how often one bleeds its color into the other,,, my ombre life.

Seraphina,, my beloved cat waiting for me to get back in my desk chair.

Winnie takes a quick nap while waiting for more treats during her puppy visit.

One of my favorite faces,, this is Goose. He always makes me feel like being a veterinarian is the highest honor possible.

Josie getting ready to go home after her spay.

These two are my giggles in my day., This is Lydia and Grace holding our beloved Hamilton.
If a clinic has a soul it is the reflection of the people who make all we do possible

Penny,, and her worried face. Beagles are my favorite breed but the lack the badge of courage,, which they make up for in adorable-ness. She was here for a 2 second visit and a hug from her mom.

The most challenging internal medicine case of my career is crowned by this little one. This is Snickers.. the most loved pup you will ever find. 

I write about the life I live. Complicated, conflicted and full of purpose. For more please search a topic and see what 10 years of blogging and 18 years of practice yields.

What Am I Supposed To Do?

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

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

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

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

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

And all of those blocked cats..

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

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

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

What do I do?

And all of those PU surgeries

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

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

Babybear

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

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

Want to see what I am talking about?

See my YouTube channel 

or Pawbly.com