It's The Courage That Matters. Garfield the kitten and his broken jaw.

 The real joy in medicine is not the repetition of doing what you already have mastered, it's the courage it takes to trudge into unchartered territory with nothing to lose and a life in the balance.

...at least that is what I am trying to convince myself to believe these days.

Garfield, 24 hours post op

I get these cases more and more frequently as the garden of availability for care shrinks to a place of abysmal, if not completely absent viable options. It seems all too frequently the pool of practitioners would rather swim in the waters of comfort and ease doing vaccines and avoid the whole messy territory of risk critical care for the common people. With its potential for failure and lack of the obligatory at the ready/disposable $10k we are becoming a profession so pigeon-holed we are petrified to challenge ourselves out of our own comfort zones. Human medicine made this leap many decades ago. They parceled out the person into parts, made a specialty for each of those parts and consciously decided to ignore the whole for the rest. Those specialists now demand high dollars and police the gate of admission based on your anility to pay the entrance fee. You may hope to be seen as the sum of your parts, but in medicine you are just that piece-meal-parts. Vetmed used to do it all, and try to do it all for the sake of our patients. Now we just refer. Regardless of whether that works for anyone else but ourselves.

Yesterday was one of those days. Seems the more I call out the ER's for ditching treatable cases when they don't meet the non-negotiable deposit required, the more calls I get to take the cases with the worst traumas and the lowest budgets. Me and my big mouth.

Yesterday it was Garfield. A speck of a puff of orange fluff with his big green eyes and his cock-eyed jaw. It was obvious he had met some sort of trauma. A 2-pound kitten with a dare devil perspective and a primitive naive sense of caution. His dad cuddled him in the exam room nervously. He had come home from work last night and found him this way. Garfield would attempt to open his mouth and scream. He was in pain, his mouth wouldn't close properly, it was fairly obvious the dilemma lay here. Dad did what all of would. He headed to the ER, screaming kitten in tow.

As dad relayed the story my mind wandered off to my beloved Seraphina. The kitten who came to me so many years ago. She had been found in the middle of the road, another tiny speck, grey and mangled. Her chin hanging from her jaw bone, a pitiful meow to landmark the site. She had been the same dilemma; a very broken kitten, and no training to pull from vet school on how to treat her. She, unlike Garfield, had been a found, unwanted kitten. She was so broken that no one would have claimed her. If you don't have the love of a human who has already bonded to you it is very hard to instill a strong enough sense of empathy to pay for the couple thousand dollars a broken kitten of her magnitude that it required. With this she became ours. Our pet project to offer a chance to, fight like hell for, and find a way to solidify her perfect presence within. She remains to this day, perfect. She is the one being I find myself seeking when the Garfield days find me. As the veterinarian who never goes looking for her next companion she will remain the most beautiful, elegant, super model caliber pet I will ever call my own. She adores me as only a once-ago-lost soul can. 

Seraphina

Her story can be found below, just in case you don't know her already.

Seraphina, Lip Avulsion

Seraphina, The Why In Who I Am

Garfield's dad told me that his girlfriend had gotten a kitten, but they had broken up some time ago, she took the cat and left, and he just missed the cat. So, he had found a fluffy orange tabby of his own, and named him Garfield. The two had only been together for a few days, but he was already smitten with his kitten. Garfield was loved and his dad wanted him back to better with whatever means he had to do it. For as long as I have been a veterinarian this is all it takes for me. If a pet parent wants their pet better, if they are truly willing to move mountains to get them the help I will move the mountain with them. This is where the joy lies for me. It isn't in the assets and the accolades. It isn't the work-life-balance and the easy living of being the apex edification-aficionado in a profession you will never master fully. It is the little endeavors where we all put our heart and passion together to make the meaning of life humanity. Give me this a million times over and you can keep your yacht and Birkin bag.

The ER visit was a brief one. At two pounds, and with obvious fractures/dislocation of the jaw, this kitten needed a surgeon. They, kindly, gave a free exam, a bombshell of a projected treatment plan, and sent them on their way, with a comment that "Jarrettsville Vet takes these kinds of cases if you can't get help anywhere else." 

..and so the next morning, as my first emergency appointment of my already booked day, I met little Garfield and his worried dad.

A very brief exam later and I reiterated the same advice; Garfield is really small. Our options for treating this were limited. To make the dilemma even more precarious, I had to be really certain I knew what was wrong before I go jumping in all "damn the torpedoes" to render interventional aid. I had to know whether this was a broken jaw or a dislocated jaw. To diagnose a bone problem we rely on an x-ray. To take a picture of anything in a 2 pound kitten is fraught with impossibilities, They are too small to hold still. There's that. There is no way to not have your hands in the shot.. and the bones of a kitten are more mush than formidable. We tried three times to lay him in different positions to get a head x-ray. None were diagnostic quality. I went back to the exam room to lay it all out. It went something like this;

• Garfield is really small.
• Garfield is in pain and therefore does not want anyone to hold him anywhere near his head. (Where else can I hold a two pound anything?)
• Garfield should see a surgeon for his best chance at a life long functional mouth. 
• I don't think surgeons wake up in the morning and do anything for less than $2,000. If it is a fractured anything that number starts at $4,000. 
• I don't think I can get a diagnosis of what exactly his problem is without sedation. I have not sedated a two pound anything, ever.
• If I can manage the sedation I will need to intubate him to take an x-ray, and figure out what to do to try to treat him. I don't know if I have a tube small enough to intubate him.
• If I can get the above done I still don't know if I can fix it.

(Way to be all Debby-downer Krista)...Want to try?

They took a few minutes to talk about it. 

I returned to the exam room and they agreed the specialists were too expensive, (preach to the choir, and can I have an "amen!" brother).

"So, we would like you to try."

I am sure I muttered something sarcastic like; "thanks" and, "if this works you owe me a big gin and tonic." I tried to keep it light and I hated myself for offering. I don't know how to fix this? I don't even know what this is.

I walked back to the treatment area with an angry, screaming in pain Garfield. I had every justifiable reason to punt this case. It was 12 pm, I was booked solid with appointments until 7 pm, and I, have I said this yet?, did not know what I was doing.

I asked the techs to help. If I never have anything more than the support and kindness of the staff I am still the luckiest veterinarian on the planet. For every crazy, sad, lacking in the hope department case I take on they always jump in to help. "Damn the torpedoes" is our company huddle song. They won't abandon me, or these patients, and we are as close as any military unit I have ever fox-holed up with. This is the marrow of veterinary team building. 

I pulled up the smallest dose the smallest syringe we have and jabbed Garfield in his non-existent thigh muscle. He screamed, I was hopeful that maybe this was an indication the medication had hit its mark.

A few minutes later we masked him with a little aerosol of isoflurane to get him quiet enough to try to place a tube down his trachea. Anesthesia for neonates, sure I remember that lecture, (there is no lecture).

Tiniest tube in the rack, you know the one I have never used before. Yep, let's see how that goes. What do I do if it doesn't fit? We wing it? (We are already winging it).

2.5 endotracheal tube slips into the trachea like Cinderella's slipper. (I say a quiet prayer of gratitude).

Lowest setting for the anesthesia machine? Well, if he stays asleep we got that right. (He did).

Now thay the endotracheal tube in place that we saw the blood in the back of his mouth.
 This is the site of his fracture.
This was the clue we needed to focus the x-ray on.

Now it was time for the magic to happen. That place every veterinarian inherently learns by being a mental ninja of anatomy. Experience and the miracles our fore-parents instilled into us when there wasn't a textbook to follow. (Did I mention I had my Emergency and Critical Care Manual on the surgery table with me?).

Three technicians jumped in to help. There was a Fossi-fanfare of hands circling Garfield's little body.

Our dental expert took the time to take/retake and keep taking all of the dental x-rays until we finally got the picture we needed to confirm our diagnosis. There was a fracture in the mandible on the left side right next to the ramus, or angle of the mandible. (I know I swore here). There are ways to fix this, (did I mention I haven't done them myself), but you need bone on either side of the fracture site to stabilize it for the whatever many weeks it takes to heal a broken bone. It's also super helpful to have had 4 years of residency training in dental surgery.

Ok, check off numbers 1,2,3 we have a diagnosis.,,, and now what. A diagnosis isn't where this kitten needs to be. He needs help in the way of a treatment plan so he can get up and go live another 20 years fully and functionally.

 My dear friend Dave broke his jaw playing baseball in our senior year of college. He was pitching, his face got in the way of a slugger headed low and hard for center field. His jaw cracked upon impact. We were all there. He spent the next 8 weeks with his jaw wired shut after the surgeons put the pieces if it back together. Senior year at the Academy is called our First Class year. You show up, take your exams, pass your license test and drink to oblivion in between all of it. Four years of that pressure cooker and drinking (along with swearing) is your rite of passage. Dave wasn't going to miss out on any of this. To insure his airway could remain open if he ever got sick he carried around a wire cutter necklace. "In the event of vomiting cut wire" in bold letters. Safety first. We are trained merchant mariners who live everyday knowing the sea will claim your life if it deems appropriate. 

"Sure, I just wire his jaw shut."

I walked back into the exam room with the news. Want to keep going? Don't know what I'm doing but I will keep trying?

They nodded yes. 

Ok, if I wire the jaw to get the bone to heal how will he eat?

Let's place a feeding tube. I have actually done this but it was in a 10 pound cat. (Size matters).

Open Emergency Care Manual and read-re-read instructions.

An 8 French red rubber was placed. Three full body x-rays later, and a few minor adjustments and it was in. 

7th inning stretch and recap; pt is under general anesthesia with breathing tube in. HUGE accomplishment! Patient has feeding tube in, Second standing ovation! Patient have jaw closed with canine teeth lined up perfectly, YAY! But, how do I keep it this way? 

The dental/oral surgeons use a quick drying epoxy to lock the teeth together. I am not a surgeon therefore I do not need, or have, locking putty. I do however have suture. So I use what I have. "Damn the torpedoes!" I close Garfield's mouth with his canine teeth lined up as they should be. Put the anatomy back where it belongs and place stabilizing material to hold. I take a big bite of the inside of his upper lip with my suture and loop it down to the same place on the inside of his lower lip. Then I tie a knot. I remember Dave had just enough room to open his mouth to allow a straw. We blended every meal for him for 8 weeks. Steak, pasta, beer. Beer with NY bagels and cream cheese. Dessert, every kind of ice cream imaginable with more beer. Initially it was a great, albeit drastic, weight loss plan. It wasn't always palatable but we were young and resourceful.

..and so I used my dear friend Dave's treatment plan as I concocted Garfield's. He had just enough room to open his mouth, extend his tongue through his canine teeth, but, the canine teeth remained in their correct position because he couldn't open wide enough the unlock them.

Now, all he had to do was wake up well enough that I could remove his breathing tube. He had to be breathing, calm and stay this way, because I had just sealed our fate in NOT being able to re-intubate him. (This requires opening the mouth wide to see the hole for the trachea). This is where the courage lies. All of these things, most I had never done before had to work. They just had to.

I was not going to euthanize a kitten without throwing my butt in the very hot, very unchartered territory seat, I haven't done it in 20 years and I am not starting today.

I placed a pink turtleneck over his neck to secure the feeding tube as he was waking up.

Garfield needed to be held for the next two hours or he would caterwaul a cry that only a desperately afraid kitten can produce.

A few doses of gabapentin, buprenorphine and a Zorbium later and he was sleeping.

After all of this, everything going so perfectly, I just didn't feel right about sending him home with two grateful parents who still had no idea of what they were doing. Can't lose the race in the last few yards.

As I carried him back to his dad I asked if he would be ok if I kept him for the next few days. The site of Garfield with a neck bandage, black suture ends sticking out his his clenched mouth, and a long orange tube extending like an antenna from between his ears did all of the persuading.

Garfield stayed with me for the next few days. In my attempts to not over fill his stomach via the syringe I forced the gruel into his stomach with I had induced a hunger strong enough to convince him to lap up the blended kitten food with vigor. In 24 hours Garfield was eating on his own feeding tube still in place, jaw sutured closed, and yet he marched on. The biggest victory for his recovery I could have hoped for. 

It's smooth sailing from here kiddo! I told him at our next 4 am check in.

Garfield's YouTube video

Never, ever, ever give up on a kitten. They are braver, fiercer, and more stubborn than even the saltiest of the most weathered magicians we call veterinarians.

Garfield went home with his dad on Monday 5/20/24. He had been with me for 4 days. He had survived a traumatic event strong enough to break his jaw, sedation, general anesthesia, a feeding tube, and having his jaw sutured closed. He is a survivor. A little life with so much desire to thrive that nothing will hold him back. He is resilient, determined, and joyful no matter what he is faced with. 

His dad was so excited to see him again. To hold and to hug him. He was a smile and a thank you that we too often neglect to share with one another. I was full of pride, joy and purpose to have helped them both. There is no nobler profession and no greater gift to be given that we can give back so fully. Vet med has so much power within its humble existence. You just need to look for and acknowledge those tiny specks of fiery courage to let the spark build an inferno of love.

For Garfield's story and the cost of his care with Jarrettsville Veterinary Center please go to Pawbly.com storylines and search Garfield Broken Jaw

Gentle Persuasion

The essence of meaningful change is best sought in the gentlest of approaches.

Everyone of the littles is adorable.
Thank you to Grace and Britt for helping

I have found this to be true with every patient that I encounter and every endeavor in medicine I stumble upon. There is very little too gain with brute force. Nature punishes unwilling interventions. She is the only one of us that is permitted disastrous force with unmerciful annihilation and no apologies for her unexpected wrath.

I am currently bottle feeding three 3 week old kittens that my sister rescued.  They are tiny balls of fluff with only two preferences; eat and sleep. They are helpless, fragile, and adorable. If there is a core of all of humanity for such innocence it is spawned from the twitching of ears, the rhythmic kneading of open paws and the purr of suckle on a bottle. If mankind has one central weakness it is the precious life that littles elicit. These three kittens as tiny, meek and vulnerable that they are, were also born with some primitive, compulsion to survive. The first time I offered a bottle they were angry. They wanted what they knew, what was working just fine for them in the past, and, they were reluctant, resistant, (no, that's not the right word),,, they were pissed to change. The bottle is hard, plastic, chewy rubber nipple and there's me anchored to all of it. Not very tempting save for the desperation that hunger induces. It took two days of gentle persuasion to convince them to abandon the old fleshy-furry-momma they once knew and adored. Problem was that momma was feral. She was ferrying her babies form one shelter to the next to avoid incarceration from the good intentioned onlookers providing her free room and board. We captured these three as she attempted to once again avoid intrusion. These three boys were lost from the home they knew and the mom who has thus far been everything they needed. Who wouldn't be disgruntled about this turn of events?

We have a very well-qualified technician we are interested in hiring. Her credentials and work history are impressive and it would be so nice to have someone just slip into our work schedule who didn't need a year of training who then discovers they want to be a cosmetologist, or nurse, or tattoo artist. She interviewed, gave us a high dollar start figure ultimatum and then requested a shadow work day to see us in action. She left that shadowing day feeling as if we were incapable of the changes she felt we needed to make to fit her work style and standards. In a polite decline she made us feel like we were below her standard of care. While I appreciate knowing who you are and maintaining a bar you are not interested in negotiating I found it poetic that the staff felt much the same about her. Her obvious insinuations that there was room for improvement put them on the defensive. They felt she wouldn't fit in because she had little interest in trying. I explained to them, all strong, very talented, experienced technicians that I was pretty sure they would do the same if they were transplanted into a different clinic. What remains at the core of each of us is, needs to be, the same nidus of inspiration. We all have to be here with a common goal. Perhaps we need to be reminded, or inquired as to what that is, and then ask ourselves if we are capable of gentle persuasion to work together for this instead of competing for who gets there more efficiently? Also, maybe the carrot, and the warm bottle are not our preferred substitute but we can learn to tolerate it, maybe even embrace the change that is inevitable.

Maybe the whole world, every interaction, every moment needs to be centered on gentle persuasion when the life around us reminds us there is a wrath of consequences awaiting.

For more pet care tips, veterinary medicine cases, and all of the stories that make up my WHY please follow me on my Jarrettsville Veterinary Center Facebook page, or, my YouTube channel, my free pet centered advisory company Pawbly.com, or Instagram.

Greed, Gouging and Your Legacy in Veterinary Medicine

I am just a few months away from having twenty years as a veterinarian are under my belt. It is a benchmark I was sure I would attain, and yet, I really never thought about my life, or this journey, past it. You get caught up in the pace. The one foot after the other. Keep moving. Don't stop to look back, or, forward. Trek away, day after day, after day. Never ask yourself; what's next? What does the journey on the other side of this mountain look like? You get so consumed with the cases. The lives. The challenges both internal and around you that you are tormented by the expectations to cure them that you never give yourself time to plan, or prepare for the later. The next phase. The thing before you hang up your stethoscope and slip into crossword puzzles to stem your time. I am this place now. It is daunting. This summit atop the professional expedition I spent my whole life living for. 

Unlike my first forty years, where I struggled for acceptance and worth within this profession of over achievers, I am finally at peace with where I am and how I got here. But the after this part, that I don't have an answer for.

This life quest began when I was 8. I was a child of Long Island, N.Y., which lay at Manhattans suburban outskirts. We had just moved to N.H. from the melting pot of the culturally diverse neighborhoods abutting NYC because my parents chose to chase the Tasha Tudor temptations of a life surrounded by  animals and homesteading. My mom was a woman in juxtapositions. She loved the outdoors, the wildlife in our front yard, but she disliked the hoops of attaining resident status in a place that was adverse to any changes of any sort. We were transplants from a city they wanted no parts of. I never felt at home in the bucolic mountains, lakes and entomologists cornucopia of N.H. It was with this feeling of isolation that I re-invested all that I was, all that I hoped to escape from, and, all that I ever wanted to feel needed within, into the newly amassed farm of my soulmates. At 10 I earned my horse as a prize of patiently accruing babysitting and farm chores money. She was a pony by stature named Sweet Memory. I called her Morie for short. We were the stuff of tween dreams. I can still smell her fluffy-downy coat full of dander and hay. I remember brushing her for hours in the cold just to have some place, some thing, to feel connected to. Our life together was a mish-mash of leather parts to make a happenstance riding rig just secure enough to carry a young skinny girl away into the 50 acres of woods that lay behind our white clapboard farm house. She was sturdy and rugged and never afraid to go roaming with just a bridle and a saddle pad. Her sidekick in our tiny barn was Lambie. She was a whim of an auctioneers mallet at the local country fair once my mom realized the show animals had no other purpose but to be consumed after the ribbon ceremonies concluded. My mom convinced my dad to bid on her tiny white newly shaved military buzz-cut as she was being forcefully coerced to enter the middle of a dirt floored circular show ring under the big top flags. Little spindled legs reluctant to walk, scared and screaming for mercy. Her "baaaahhhhhh!" cries broke my mom and cracked the weak spot that was my moms empathy for animals outside of her dinner plate. She was about 4 months old when we packed her up in the luggage area of our woodie-sided station wagon for the ride home. Over the decades that were their lives in our back field the vet only needed to be called out twice for Lambie. Once when my mom couldn't figure out what kind of strange ailment had acutely caused her to not be able to stand or walk in the dead of winter. This turned out to be an overnight affliction of her over grown woolen onesie to the frozen tundra that cemented the under carriage of her. An emergency shearing of her over grown, albeit incredibly warm and cozy fleece wool, to the clutches of the frigid ground she took refuge upon cured her. For the rest of the approaching spring you could see her forensic woolen outline marking her preferred sunny spot in her paddock. The second time was for another poor husbandry charge. Every veterinarian learns early on that one of our primary diagnostic tools is our nose. One warm summer day my nose told me something afoul was about. There was a wet spot near Lambie's backside with a terribly foul odor. Upon inspection the skin of her wool could be lifted from its tissued-foundation revealing an entree sized dish plate matrix of  wiggling naked worms. Maggots had found her and she was too rotund and Rubenesque to bother with them. These were my indoctrination to large animal medicine. I was hooked. Enamored. Smitten. Called. The more gross and gritty the more I wanted to be a part of it. That and my parents were miserly with their willingness to make financial investments into our livestock lawn decor.

My parents moved to N.H. with one dog. They, like all true homesteading farmers, quickly, quietly, and unintentionally amassed multiple cats from the fringes of unwanted free-to-a-good-home classifieds. Within a few years of our farming life we had 2 dogs, 4 cats, Morie, and, Lambie the Southdown. 

If necessity is the mother of invention my ah-ha moment came when the second unplanned pregnancy occurred in our also-bored-with-the-country Border Collie Bonnie. For all of the preaching I do about avoiding pyometras my parents dog never lived long enough to worry about this disease as the accidental breeding's kept her lady parts from making bad decisions and getting all life-threatening infected. 

Life on a farm is hard work. For my parents the utility of farm hands fell squarely on the humans. The pets were, well, pets. None had a purpose outside of emotional company, so none had a value worth investment. People in N.H. are frugal, rugged, and independent. Pets were never meant for this. The cats got the worst of it. They always do. The second generation of farm dogs turned into Jack Russell Terriers. In the trade we call them 'Jack Russell Terrorists'. The name is fitting. They terrorized the cats to no end other than death by cornering, or death by poor timing. I knew they wouldn't be fixed unless fate took mercy upon them. It was this spectator helplessness that compelled the quest I now find myself on the descent from my professional mountain from.

My mom, RFD #1 New Durham, NH 03855
circa 1984

I have done what I came here to do. I am no longer the unprepared, incapable pet parent, companion colleague I was. There hasn't been one pet who crossed my professional path that wasn't cared for in the same manner I wanted someone to care for my childhood pets. I am the spitting image of the veterinarian my parents called upon all of those decades ago. A little bit of farm-raised ingenuity, a smidge of humble boot-strap sensibility, and a bitter swallow of knowing these people I serve decide my legacy, (not the other way around). 

In twenty years of practicing I have saved thousands of pets like my parents pets needed. I have found new second chances for hundreds of lost, forgotten, abandoned, over looked and always under appreciated dogs, cats, kittens and puppies. I have done pro bono work so extensively the local ER's, rescues, clients, and community all hail my name as the place to ask for help when no one else is interested. I used to worry about this lot in life I have cast for myself. I now recognize it as the fostering of that little girl I was, am, remain. 

You can find yourself in the oddest of places but it usually is a reflection of the path you were always on. I guess I will just put up a road sign, a billboard, and an empowered concession flag for peace in the place my feet have found me and hope that this journey bolstered my crossword puzzle prowess.

December 2019, our last Christmas

P.S. I wrote this after reading the commentary to a post about the NY Times inquiring readers to submit their stories about being "gouged" at the vet office. It has stirred a lot of intense emotional outcries on both sides of the leash. I use the word "emotional" because this is exactly what small animal veterinary medicine is about. All of the marketing adjectives and verbs we use in describing the importance of our craft is 100% emotion based. We exist because people, our clients, need us. They need us as we need to be accessible, empathetic, and skilled in caring for the beloved members of their family. I wrote the story above to reflect two things; one I needed, and still need, my pets every day of my life. When the clouds congregate above, and the days seem too dark to warrant me stepping foot into them, the pets in my life, heck, the patients in my life, remind me that I have a purpose far greater than the fears, insecurities and apprehensions of this moment. Losing a pet, as we all must face, is grief-riddled enough to not feel that I lost them because I couldn't afford, or find access to help to provide them. The impetus of why I am who I am was that little girl on the farm who wanted to do more for the things, the companions, the souls, I loved most. The veterinarian who was my mentor never, ever, ever made our pets care about the money. Now I know my current collection of colleagues would excuse, or even disparage him for this, but, he was a legend. He left behind a legacy. Me, well I have every intention of doing the same. Can I be financially comfortable over the next 20 years from the fruits of my labors because of the last 20 years. You betcha. I simply choose to walk this path with nothing more as my guide. 

As for the NY Times article, here is my opinion. The words we use, the actions we take, and the intentions we put forth into the world matter. "Gouging" is happening in vetmed. It is happening because enough veterinarians have decided that they can seek refuge in the collective defensive banter that permits economic euthanasia, one sided conversations about the spectrum of care we are willing to offer, and simple plain old vilifying of the emotional empathy that this profession is built upon.

There is a cost effective treatment plan for every single condition we are faced with. We just have to be willing to lower ourselves to seeing these patients as the pinnacle of purpose our companion pets represent.

If you have to defend so angrily, and cannot see the hurtful impact your actions have upon others it might be time to ask yourself if you are a part of the problem, or, if your legacy reflects the person you came here to climb that mountain.

The Advice I Wish I Had Been Given. New Grads in Veterinary Medicine

 

We are at an unprecedented time in veterinary medicine. Never before has the demand for veterinary care been so great, and never before has the availability of veterinarians to take care of animals been so thin. It is very important for new grads to understand this. We are also at a place where the ethics and intentions behind every decision being made within vetmed has serious long-term consequences. Never before have you had to start making life changing, and life influencing decisions so soon out of the gate.

No one from the other side is going to tell you this. They won’t tell you because they need you and they need you to remain new enough to be green and naive. No good, strong, lasting meaningful relationship starts with this as the premise.

When I graduated from VT I was looking primarily for two things; mentorship and long term stability where the fruits of my labors would reward me with a piece of the pie that I had helped establish. It took me a few months, and a few practices, to find this place, but once I did, I stayed. What I didn’t recognize as truly important was the people that I shared my professional life with. I had been too self-absorbed in trying to become a great practitioner to understand the importance of a place of belonging. When all else was turning into a catastrophe soup (and yes, these days are ahead regardless of where you go), I had a group of people who supported, cared for and saved me.

I have always been a veterinarian. From my earliest thoughts and actions, I was meant to be a part of this profession. I suspect most of us are this way. I was all passion, some training, and dedication in limitless bundles. What I learned is that patients come and go, your place in their lives, (albeit incredibly important) is also transient. What is not transient, what grows and motivates, and moves you into legendary, is the impact you have on those around you. What has defined legacies of the veterinarians before you, (and perhaps the veterinarians who helped get you here), is the other stuff vet med brings to your life.

Your perfect place is out there. It will grow with you, evolve because of you and be better because you are a part of it. Finding that place out of the gate will take some self-introspection, some questions you may not be able to answer fully yet, and courage.

Here are some of the insider employer secrets;

1.       If it is all about the money you will leave vetmed heartbroken/bankrupt. There are sharks among us who are here because of the money. VC’s are circling and capturing veterinarians in record numbers. You are a cog in their money-making machine. You can justify a small, transient existence among them, but you will sacrifice something along the way you will regret. Money does that. There are limitless lucrative possibilities here, but know who’s terms you are making them upon.

2.       A contract always benefits the house. Don’t sign anything. You don’t have to, and it doesn’t protect you outside of a short period of time. Everything in life is negotiable.  No one has any business influencing your heart and soul. Walk away. You need to learn this lesson early. It is ok to say no. You have a voice and a responsibility to yourself, your patients, and clients (occasionally). A non-compete, and/or gag-order are hard NO’s IMO for me. Period.

3.       Never sell yourself short. We are all growing and learning and there is beauty and strength in this.

4.       Promise yourself you will be honest from minute one day one. You can admit to anything and be ok. I promise that.

5.       Always remind yourself of your WHY. Know WHY you are here and never stray. You know what it took to get here, and never abandon that person.

6.       Have fun every single day. Nothing is more valuable than joy. (Purpose is a close second).

7.       Remember that mentoring is so much more than medicine. It is also mentoring for success in every avenue that makes you YOU.

If you truly find an advocate, they care about you without caring about how it benefits them. Vetmed was founded on this.

If any part of this resonates with you, or if you want to learn more about how we practice you can find me anytime at my email, or our social media sites. kmagnifico12@gmail.com or Jarrettsville Veterinary Center, Jarrettsville Maryland. New grads, interns, wanderers, curiosity seekers, surgery exposure, or good-deed-doers are always welcome. We have housing, no contracts, no emergency calls, zero tolerance, and hard-won cases that heal every bad day in great abundance. We never practice economic euthanasia and we never break hearts, hope, or good intentions.

Jarrettsville Veterinary Center

more on us here; Jarrettsville Veterinary Center Facebook

Jarrettsville Veterinary website, here

Reflection's In The Sea Glass

Morning writing time with Birdie

The sunshine beaming in my windows delivers just enough warmth to remind me that Spring is right around the corner. I am at home in Southern Pa., close to the Maryland border. It is the last week of February. The tail end of Winter's quiet. The peaceful transition from snowy, sleepy, slumber to the bright burgeoning of the colorful explosion of Spring  life. There are a few birds congregating outside my window at the feeder I fill daily. They sing songs of cheerful excitement, catching up on free pickings as if prepping the internal organs for the demand ahead that perpetuating a new generation demands. They skip quickly from the evergreen branches to the feeder weary of a hawk that stands guard above. Even she has an internal clock that ticks and gnaws for the fledglings she must soon create and cultivate. The grass on our lawn sprawls widely on each side with its cropped-tight, still silver-grey veiled surface. Below its feet lies a vibrant spring-greenery hidden safely by the frozen ground soaking up this sunshine while gathering momentum for the weeks that lay just ahead. These are the days between the seasons. The days I run to a warmer place, for just a few days, to avoid the clutches of the Winter doldrums that living in the north forces us to endure.

We arrived home very late last night after a long day of travel from abroad. The five of us; my husband Joe, sister Diedra, and her two boys; Cody and Anthony, went on our second end-of-February trip together to Grand Bahama Island. Grand Bahama Island is a small speck of land, (or atoll as Joe would correct me), that lies just off of the southern tip of Florida. Grand Bahama is replete with sand skirts and coral outcroppings yet oddly quiet all day everyday that the cruise ships aren't berthed to her. Grand Bahama is close, but the travel to and from isn't ever easy, nor, effortlessly quick. The total air time amounted to a scant 3 hours, but our travel time encompassed more than 16. We all got up early to leave our villa by 8 am. Packing took up most of the night before. After a week at the beach our rooms looked like a teenage summer away with clothes, snacks, wrappers, billowing attempts to air dry bathing suits and a cascade of make-shift dive gear strewn between two adjoining rooms. We had booked the rooms with a shared door to allow for the adults to awaken early and the boys to sleep in as per their preferred daybreak sunlight avoidance preferences. 

Seven days of expeditions upon sand and we were left with a massive collection of seashells and sea glass to discern/decide, divvy up and divide. Suitcases were repurposed to stow coral encrusted fans and sea-bitten detritus home. The yearly challenge to jettison the unvalued in exchange for the newly found, albeit decades old treasures the sea coughed up for us. We travel here, for this bounty. It is inevitably always the most enjoyable moments of our time there.

The adult section of this entourage wakes up for each sunrise, makes our own percolator coffee, (which we make room for in the packing process to also include our preferred variety of oat milk and miniature grater for fresh cinnamon and nutmeg), always packing enough for the allotted days abroad. Every morning is the same. Up for sunrise, fresh hot cup of coffee in hand, open door to beach to pepper the unmarked sand with our foot prints. We never have to share the beach, or wish another human a "good morning" greeting. We are always alone, and, always plotting the rest of our day ahead. We may have a resident feline with us, and, we welcome their company with great enthusiasm. There are always four or five resident cats here. They appear early in the morning looking for a kind hand of affection, or late in the afternoon seeking a hand-out from the snack hut patrons. They are always young, in early stages of pregnancy, and always bearing the shaved back-ends from over aggressive grooming to keep the fleas at bay. We stop behind the tiki hut bar to make sure the food we scavenged from the previous day, and left before we went to bed, has been taken by the stray dogs that live in the woods behind the abandoned (due to lack of business), HR trailer. Everyday is a copy of the one before; wake, sunrise, grind beans, brew coffee, grate cinnamon and nutmeg, sip, stroll, plan. After the coffee is emptied we dress to go for a run, or to bike to the beach. We always pack a mesh bag to stow whatever treasures we find. 

The resort is a gated beach of rambling pastel colored villas scattered across a massive, mostly forgotten, landscape. This place has a long history of chances, intentions, allure, and lost dreams. There are miles and miles of empty beaches. Running along them are paved roads with overgrown, unkempt, planted palm trees, lamp posts (most missing their globes), stop signs, traffic directives, and gutted electric boxes, sewer plates and four buildings. Ten skeletons of homes remain standing. All strewn about the 600 acres of land that stretches from one shore to the other. It is so mind boggling how so much could be built, at such great expense, and have so little to last to show for it. There is an infrastructure of cut canals, golf course, club house and one single home about 80% complete surrounded by nothing. A cemetery of dreams built by a wealth of intentions that fell so tragically hard it is impossible to believe. We wander these roads, these beaches and we reflect on how immense a mistake this was. A billion dollar debacle 4 decades old. These beaches are awash with glass, ceramics and parts of machinery almost unrecognizable. Whole train engines are buried under sand with piston pock marks left as their only identifiable feature. Over 10 years I have collected suitcases of these beaches lore. Many still bear the names of the developers initials, or the resorts names. Some are almost 100 years old. There are so many stories washing up here and I collect them with a curiosity that compels. This is what beaches beckon to me for. A stroll and a collection of trinkets some man made and others sea borne. All with a story unto themselves. They are my treasure, but they began as someone else's dreams.

The point is that I travel far away to rummage through the decades old of castaways of lost, shattered hopes, and massive work efforts gone debunk. Curiously, (and let's be honest concerningly), I am not sure what I am building, or, if any of it will stand the test of time? Maybe all of my efforts will be left to fall into the sea only to be washed up to find some curious fingers in 2074? Perhaps this is all just fodder for reflective pondering of the hopes of one person among the tides of challenges that is inevitably a lifetime of intentions and a hope of longevity? Maybe all of this hard work, exhaustive effort that leads me to run away to far away islands is all futility in the end? Maybe even the biggest dreams, with the loftiest of intentions will end up as trinkets with soft edges, barely recognizable from the original pieces of remains the sea spills over and over onto the shores of harsh, inescapable mortality.

Jack Tarr, or jt

With each return home I am so grateful to be back in my own bed. I am so fortunate to have healthy cats who aren't licking/chewing/scratching to the point of balding on their bellies and backsides. Struggling to have another litter to support whilst scrounging for scraps from the tourists at the tiki bar. In the Bahamas there is an odd twist of fate. The dogs are largely roaming vermin and the cats are more likely to find a kind hand of offerings. Few dogs have a place within the home. A little more so are tied to a pole in the yard, but, the vast majority roam the side streets and stores flea infested, trailing pot-bellied worm gravid bellies and sad bleak faces of indifference based compassion. These souls break me. A constant reminder of how fortunate we are in this country in the vast places I live and frequent. Spaying and neutering is an inconceivable concept there. A way to deny freedom versus protect the high mortality that life on the streets presents. 

One of the resident cats staking claim to the sunny spot on the bed

As we arrived on the island a storm erupting above us. We landed in turbulent cross winds that jarred the small plane like dice on a craps table. There were audible outbursts of muffled screams from the passengers caught off guard. We were relieved to have landed safely, but the adventure of reaching our destination was still laying ahead. Our efforts to secure our rental car in the torrential down pour left us soaked through within seconds. The ride from the airport was a constant reminder to "STAY LEFT" while traversing unmarked streets with absent signage. Had it not been for our phone maps we would have never made it outside of the airport parking lot. The downpours left us navigating overflowing unlit streets to find detours from the one road that headed to our end of the island. One 20 foot detour off of the main strip led us to a mixed litter of bobbing puppies and a pack of their parents intent on reminding us that we were not welcome here. Diedra and I decided we would rather risk drowning in the street puddle than traversing this motley angry gang. There was a heated argument on whether we could even safely turn around without running over a straggling starving puppy. 

Life is like that in this part of the world. While blessed with beaches they are poor with interventional actions for the other inhabitants of the paradise isle. 

As the off-mainland veterinary colleges sprout up in record numbers in adjacent islands the standard of living for the cats and dogs in their neighborhood improves markedly as they begin to receive out reach support for the vet students training purposes. Ask any vet school student from these institutions how many are brought home each year and the numbers will speak for themselves. Why are so many colleges being built? Two reasons; there is a desperate shortage of veterinarians, and, they are highly, (much easier to get accredited and more lucrative than the human doctor factories), profitable. Kids will go into astounding, unrecoverable debt to go to vet school. We are hounds to a bone with blind oblivion to the consequences.

My vacation time was spent unplugged. I intentionally kept my cellular roaming capability off. If I don't begin to take time off I will pay for it in blood pressure statins and botox. The reality of my professional life is that I am not feeling my cup as full anymore. Too many tiny holes in the mainframe to allow a full tank. I repeatedly ask myself if this is more than exhaustion? Perhaps a bit of lacking in the enthusiasm department when the gauge reads within the eligibility for retirement age. 

There are benchmarks that mark your life. The calendar being our primary measuring tool. Mine is in the place where most of my peers have paid for the kids colleges and weddings and now find themselves free from allowances to dependents. I am at the place we never believed we would actually find; debt-free. My last loan to the 20 year purchase agreement for the clinic is due in under 60 days. How did that happen? How did the sun actually circumscribe the heavens enough times to reach the maturity date on that loan? Two decades ago, as a brand new graduate veterinarian that number was so mammoth in its zero's that I just assumed I would expire before it did. Who works this long in one place? 

What I didn't realize was that as that sun was doing its donuts around my best of intentions a village was being built. Passionate efforts day after day, week after week, for years on end got me to this place. Intentions manifested into a lifetime of stories that involved wet noses and wags. There is a proud assertion of power that comes from standing on the top of the mountain you created. A sense of accomplishment to assuage your aches. A quiet sense of reflection for the lives you made stronger, happier, more inclined to nap than have to fret about the litter you cannot support. The choices you had the luxury of deciding. The knowledge that yours are free from the streets, the unmet pleas for empathy, and the heart songs of the moments of the life you got to share. For every dream a veterinarian ponders there is this life I paid for in hopes and got reimbursed for in reflections I don't want to escape from. I am so lucky,, maybe even as lucky as these pets I call my kids.

I remember that first day of vet school so vividly. My starched white jacket, my green nametag, that symbol of the snake and the cross, so ancient Roman impressive in its unpronounceable title, and me,,, wondering how I had gotten here after so much determination and grit, and an interminable 4 years ahead to try to keep that determination burning despite the challenges I knew I would face. Twenty years after graduation I have done vet school 5 times over. Who stays this long at anything, and why? To put those numbers into perspective I joined vet school after a ten year stint at sea. My second career is twice as long as my first, granted I adore this one and found great challenge in even attempting to like the first (no dogs or cats, or anything even remotely feminine at sea).

I can travel to get away from myself, but I always find out that I am happier with what I have built than what I want to get away from. That's the only kind of reflection that I should make time for at this point. Isn't it?

Maybe all of this effort will only amount to a cascade of colors with softened edges and hazy opacities. Maybe everything with even the best of intentions ends of rolling itself up on the shores of another lifetime as either detirtus or treasure? Maybe its only a matter of being the eye of the beholder and not wanting anything more than gratitude for the adventure given to us all?

For any of you interested in the history of this resort here goes. Enjoy,, I loved running down this rabbit hole. Finding the back story behind these fragments found in the tidal vomitus.

Butlin's West End Grand Bahama Island Debacle, care of the Grand Bahama Island Museum

Butlin's current resort options here

Jack  Tar Village Grand Bahama West End here

I AM NOT AN E.R. The Story Of Sophie. Baclofen Toxicity

It has been a week since I last flossed. It seems like a confessional to the internal self to seek a pardon, and once again, promise to do better. It seems I seek a peaceful acceptance of all of my inadequacies within my inabilities too often.

This week was exactly like this… a series of internal confessions with a humble begging for forgiveness to a self that doesn’t take disappointment, or failure, easily.

This day, this Wednesday evening, within this moment, was about Mollie, Genie, Maxi, Taylor, and Sophie. They were all in some degree of desperate dying. Each patient was supported by at least two technicians, all wondering the same thing as I; how could so many catastrophes happen at once?, and, which one would start to crash/die on us first?

“We are not an E.R.” I hear myself produce these words almost daily these days. I am not sure why I even try to explain, or, perhaps more realistically, excuse myself. For every 100 times I recommend to a client that they transfer to the ER, 1 actually consents and goes. People just don’t/can’t/won't/refuse to go. For some of these cases they have already tried to get in. They have called, been directed to sign in via the online portal, and been notified that there is a 10 to 24 hour waiting period. People who are desperately worried for their pet’s life are not going to wait 10 hours. So, they drive to us. Many just show up. Arrive unannounced. Crash a party and hope that the door is open and the staff is welcoming. Depending on the degree of the emergency they may have called us. May have spoken to our Charge Tech to plea their case, which gets parlayed to a vet, and almost always given permission to “come up, be patient, and we will do our best.” I try with each case to set the stage for the reality that we are “not an ER” and may have to transfer them to one should it be in the best interest of the patient to do so. I know that even with this preface, this CYA blanket statement, that I invite the chaos, and hence, I internally beg for forgiveness yet again when I get myself too deep in the shit pile.

At 7 pm I was standing, circling and losing my mind amid the evenings vetmed emergency offerings I had unintentionally invited to my own misery party. I looked into the surgery room. On the table to the left was an 8-month-old puppy. I’ll call her Sophie. She was intubated, on oxygen, and poorly to absently responsive. Under her head sat a bucket of vomit with specks of white pills. To the right of her was Taylor. A five-month-old tabby with fluid in his chest. He was sleeping in a clear plastic box full of life saving, life giving super saturated 100% oxygen. He was happy and loving his time with us, thanks to the oxygen. Just outside the doors to the surgery in a little stainless-steel cage sat Mollie. She was barely visible behind her cluttered cage door with its two fluid pumps, iv fluid bags, (also two), and a clipboard holding checklist of her too numerous medications. You couldn't see her adorable face with its white fluff mane that surrounded her blunted nose and omni present wide mouthed grin framed within the haloed plastic e-collar. She was sitting up on her front feet but straining and posturing her back legs. She had spent the last week like this. Trying in vain to push out a stone that was lodged so deep down her urethra it was only permitting a drop of urine at a time to pass. In the cage beneath Mollie was Genie. A sweet, slow, aged Dobie who had been vomiting for four days. She came in as a mystery ailment and she remained the same until the next day when the 4-year-old in her family confessed to feeding her a whole box of chewy milk-bones. She was in critical condition and not able to move, except for the vomiting that just spilled out of her mouth as she lacked the strength to pick up her head. Skip a few feet to the left and there was Tigger. I.v. catheter running saline into his veins in the hopes we could flush out the grit in his bladder and dodge the need to place a urinary catheter. He had arrived 3 days earlier just about to block. We mounted the most aggressive defensive plan we could to spare him a urinary catheter and his mom the price tag it came with.

Gastric lavage

Within these moments time stands still. I have to suspend it. It is the only way I can muster all of the senses to attention to compute the vulnerabilities and re-assign staff to guard the weak points. I know, I know deep in the seat of my gut, that at least 2, maybe even four of these guys are going to die in front of me. Probably in the next few minutes to hours. “I am not an E.R.” I remind only myself this time.

This is one of the best examples I can give of where vetmed is now. We have burnt so many people they don’t trust, or don’t want to be sent to an ER. For all of the many reasons the ER’s have gotten themselves in the predicament our clients see them as, it doesn’t change the reality that accidents, illnesses and yes, even death comes to find us.

I see my husband for about 15 minutes daily. 15 minutes when I get home, typically around 9 pm, starving and exhausted. He has a meal waiting, typically two hours old, as I never get my ETA correct. I do not recollect any of the meals from the last week. Only that I inhaled them, and that the portions were too large. We go to bed with me feeling like a bloated corpse, and him angry that I cannot ever say “no.” He reminds me of my limitations and the power of “NO.” I remind him that there are few options in these scenarios that I can live with. I remind him that I am reminded that if I don’t help, I don’t know if anyone else will. If martyrdom was a pageant, I could have a crown to sit upon. Think I am being foolish? Well, lets talk about each of these cases in a little more detail. Wonder why I don’t floss? Well, I don’t do anything in this state. I fall asleep as soon as I hit my bed. Surrendering to the exhaustion like the coma that claims me. I repeat this Monday-Tuesday-Wednesday and Thursday. I fall off to sleep worried for the patients I saw. Fearful for those I failed, and afraid for those I will see. I cannot say “No” to these either. They find me in my dreams.  Even here, as I try to rest I see them. I worry and react for them. I send them treatments, and apologies. A figment of a life preserver even here, when they aren’t near me. 

The routine day

On the night before a dog arrived with much the same scenario; "ER has a 10 hour wait. Patient is bleeding everywhere from a dog fight." We explain to the caller that we will do our best to help, but, if sedation or anesthesia is needed they will have to head to the ER. When they arrived it was after 6 pm. I was told that he was "bleeding everywhere" so I rushed in to see him. There was blood splatter on every wall in the exam room. He had been there for less than 5 minutes. The wounds to his left ear were so significant that I was not able to fully assess whether ear needed reconstructive surgery. The ear was not being held up at a normal (or symmetrical) angle on head. There were about a dozen (maybe more) wounds to the top of his head that included both puncture wounds and lacerations. Some appeared to have pocketing and underlying muscle damage. Again too bloody and painful to assess. Wounds appeared to go over to right ear, base of ear and included the neck. As with all wounds of this severity he was too painful to assess fully without pain meds and sedation, and most probably required general anesthesia. I advised them to go to ER. When I mentioned the ER the owner became volatile. She shouted and became angered. She would not to go to ER! she yelled, so I offered analgesics and antibiotics as initial treatment option but again warned that wounds may need clean up to check for degree of soft damage, and tissue damage. I told the owner I was also concerned about pain, bleeding, and high infection rates with dog bite wounds. Owner declined again to go to the ER, and take any medications. The owner went on to say that "this dog had cancer and she would not wait 10 hours at ER to be told he doesn't need anything." I attempted to diffuse her and offered pain management and antibiotics again. She stated that I was being rude. The owner got up, took her dog by the neck and began to leave exam room. She kept yelling, repeating that I was rude, and she was not going to ER. As she was leaving I told her to not return to us, nor treat staff this way. When I said this she turned around and charged at me with a hand in my face and the words "I'm going to beat your face." 

That's what advising someone to go to the ER can get you. She was served with banning papers from the Sherriff the next day. Yet another gem to add to my Wednesday fiasco.

My Storm,, his happy place.

Sophie is 8 months old. She is a wire-haired terrier just fostered and adopted by an older couple who adore her. For all of the mischievousness of a terrier, (vets tongue-in-cheek refer to them as “terrorists”). They find her antics, her strong opinions, and fierce compulsions, adorable. (I can relate, my parents felt the same about theirs. I grew up with 5 generations of Jack Russell Terrorists. They killed our cats. They killed any small thing that scurried). Sophie has a boxy face, tan highlights to a brown face and inquisitive soft intelligent eyes. Her ears stand with a little bow at the tips and she is formidable in a compact package of taught muscles and youthful velvet softness. Sophie was carried into the clinic in her mom’s arms as she burst in the front doors like a hurricane. I was alerted to their arrival by my receptionist who quickly came rushing into the treatment area yelling, “EMERGENCY! WE HAVE AN EMERGENCY!” arms flailing above as if waving down a passing car. I walked to the front and her sobbing mom attempted to pass over her lifeless puppy to me and asked myself, “why does this place feel like a firehouse on some days?” 

It is exactly in this moment that I have to decide. I do not extend my arms. I do not rush to offer some act of heroism in a crucible of mercy. I have to make that split second decision as to who I am and who I want to be remembered as. It is in this second that your marrow matters. It is here that your consequences, your good deeds, your ethos, and every second of every tid-bit of training finds you. Your actions here will haunt you. I know this. This is the place where some vets will offer “humane euthanasia” while others will offer extremis estimates for a chance, and many will take a bad situation and make it hopeless. (To be honest I never quite know if I ever pick the right offering of an answer. More on this with Genie’s story to follow). What I wanted to do was ask her to remain there. Put her on a pause, holding her rag-like puppy and make a quick physical exam assessment and,,, punt. HARD. I did not want to be responsible for her. I did not want to be responsible for a hysterical mom feeling guilty about an accident I have seen so many times before. I did not want this dying puppy. I didn’t want any of the hers in front of me asking for help. Now I know this sounds cold and cruel, but the reality was that I had just finished a long morning of over booked surgeries. I had come in early, after getting home very late, to try to cram in all of the things that I had scheduled. There was not enough room for them, never mind the falling deaths from the skies. I know this. I know I am supposed to say "NO!" I looked at her puppy, I looked at her, the words slipped out softly, “I am not an ER.” I knew we didn’t have the manpower, the time, nor the facility to help a puppy in this state to the degree she needed. Sophie was purple, barely responsive and I was pretty sure she was dying in her moms arms, if not already dead, and would die on her way to the ER. I clumsily said as much. Mom begged me to “try” and I am a sucker for that word. It is my verbal kryptonite. No other word compels me. Mom was hysterical. Mom was not safe to drive. Mom was not going to make it to the ER with Sophie alive.

 

Sophie was in such a terrible state that I knew she had a very narrow window. I took her in my arms and we headed into the treatment area. Over the next few minutes the story of Sophie’s predicament unfolded. Her parents had left her at home for a few hours. When they came back she ran to greet them, same as always. Within a few minutes she had vomited and then they found the chewed up pill bottle. Scattered around the bottle were large white aspirin-powdered pills. Baclofen. The label was so chewed up that we had to use the pills and pharmacy information to identify them. The bottle was filled for a 30 count. 13 remained. As the technician called Pet Poison I debated her degree of consciousness and whether she was awake enough to induce vomiting. She was not. Sophie had dried bloody, thick, taffy-like saliva and vomit in her mouth. I tried to clear it. It was a sticky-spiderweb goo that left your hands incapable. Sophie was placed on the x-ray table. She had a huge distended stomach full of,,,, well, seemingly dog food and pills. We whisked her to the surgery table, quickly intubated her and provided oxygen to her purple lips and tongue. She was slipping into a coma. Four people, two of them veterinarians, swarmed around her tiny new body. We placed a stomach tube. We lavaged the stomach contents in a desperate effort to remove as much pill-peppered-ingesta from her stomach as we could. The clear plastic tube sucked out tan kibble speckled with white powdery-pieces of pills. She gagged once, whimpered once, and lay lifeless for the rest of it. I gave her intermittent breaths of oxygen and told her that I was sorry. I told her she was loved and I watched the staff so desperate to help and so foreign in this act of emergency procedures. Sophie gathered a crowd and I barked orders to try to turn a tide I knew we were all likely to drown within. I called the hospital manager down. I told her to call all of the rest of my evening appointments and tell them we were swamped with emergencies. “Offer to reschedule, (knowing this never works), and ask them to be patient if they don’t want to. Go in all of the exam rooms, (I knew all 7 were filled with people waiting for us), and tell them the same.” I put her on the reception desk and pulled the last two techs to the back treatment area. For three doctors we had 8 technicians scurrying. We also had 17 patients in our building, 7 wanted to crash and expire if you blinked.

I got on the phone with a veterinarian from the Pet Poison Helpline. He was slow spoken, jovial, and the calmness on his side of the line was re-assuring and yet vexingly annoying. “Baclofen is a common toxicity. Have you had one before?” There it came again, “No, I am not an ER.” ‘Don’t kill the messenger’ and ‘be nice.’ I said to myself. He is here to help me. (Does he know that I have 7 other animals trying to die around me?).

“Baclofen is a muscle relaxant,” (yeah, I can see that). “It has a very narrow index of safety in dogs” (Like 1 pill? How about 17?). “Unfortunately, (never want to hear a sentence start with this), most dogs, if they survive, (never want to hear this either), need supportive care for 72 hours to up to 6 days. Many need to go on a ventilator.” (Crap, who has a ventilator? Only the veterinary teaching hospitals, I thought). I kept going. We kept lavaging, hoping, and telling her that I loved her with a gentle pat to her head. I stroked her ears in between her oxygen bag compressions. If she was going to slip away it would not be without my whole heart and soul going with her.

Over the next hour we tried fluids and desperate attempts to stabilize. She was the last patient to leave the hospital that night. I called the local ER to refer. “No,” they had not had this toxicity either. “No,” they didn’t have a ventilator, but, “Yes” UPenn vet hospital does. They had sent a patient last week. Estimate given for this was $18,000 to $30,000. OMG Crap.

I look back on Sophie and I want to cry. I want to be upset about how many times pets get into things we think that they are smart enough to avoid. I want to put up billboards to say, “NO! crate training is not punishment. It is the safest place for your pets to be.” My pups are 4 years old. They are my children. My most beloved. They are also raccoons in autographed collars. They will get into everything if I turn my head for a second. They are trouble. I know that. They are crated when I am at work. They are in a cage at the clinic. They are in a crate in the bedroom when we go out the door. I don’t care if it is 5 minutes or 5 hours. They have been raised this way. Every pill bottle in this house is double locked. A bottle in a closed drawer. Never, ever is it out. Have you ever shaken a pill bottle next to a pet toy? It’s all the same inviting tune.

In a sea of crashing waves, tumultuous and treacherous, I will never forget Sophie’s face. I will never forget that yellow pill bottle with its perfectly intact child-resistant white top, labeled as such. Tattooed with its cursory; “push-down and turn” orange letters. Shrapnel-ed bottle, completely missing any recognizable bottom, or rounded edges. The label chewed, swallowed and obliterated in casual terrorist fashion.

Sophie was sent to the ER at 830 pm. She was transferred without her breathing tube. She coded overnight. She never regained consciousness.

I hope that she heard me. I hope that she knew she was always adored. I hope that she forgives as much as I hope I can forgive myself. Maybe I could have/should have used warmer water in her lavage? Maybe I should have done it just one more time?

My Raffles,, on our daily "dog" walk

Maybe forgiveness holds as much power as intentions? Maybe peaceful acceptance maintains the balance?

Maybe the other 6 will survive. Maybe I am an ER, if only in sheep’s clothing?

My Frippie and Storm