Jennifer Shepherd, DVM

I lost a patient today, a sweet little critter who was very well loved by his family. He was an older rabbit who died during surgery. I knew he was a poor anesthetic candidate. Rabbits don’t tolerate anesthesia well, especially when they are geriatric. In spite of this, I did the procedure anyway. I felt the only options were to either perform the surgery and hope all went perfectly or euthanize the bunny. His family wanted to give him a chance, so I agreed to take the rabbit to surgery.

Halfway through the surgery, my technician said “I think we lost the heartbeat.” We performed CPR, but it was too late, my patient was gone. As soon as I realized this, the negative self-talk started. I killed him. Was it my anesthetic protocol? I should have performed the surgery quicker. I shouldn’t have waited so long to do the surgery. Had I squeezed the surgery in over my lunch break when I first saw the bunny, he would have been stronger. Why did I even think I could do this surgery? I should have pushed harder for a referral. I leaned over my deceased patient and whispered “I’m sorry!” as a tear rolled down my cheek and into his fur. I failed my patient and my clients.

All these negative thoughts went through my head as I made my way to my desk to make the dreaded phone call. Prior to surgery, the clients and I had discussed the risks at length. They made an informed decision when they signed the surgical consent form, but it was still a phone call I did not want to make. I could tell by how they answered the phone, they knew my call wasn’t good news. I braced myself for crying, anger, and regret.

My news was met with sadness, but to my surprise, it was also met with something else: kind words and encouragement. My clients sweetly said “Thank you for trying. I am sorry for you that you lost him. I know what a gentle heart you have and this must have been very hard for you.” We talked a little more and agreed that we were glad we at least gave the little bunny a chance. He had died peacefully under anesthesia and did not suffer.

I hung up the phone with a lump in my throat. I was sad that I had lost a patient, but I also had a feeling of contentment. I had treated my patient to the best of my ability. I had done what was best for him and for my clients. They had wanted their beloved bunny to come home with them at the end of the day. But what they needed was to know they had done all they could for their bunny, to know he was in the hands of someone who cared and could help him. It was not the outcome any of us wanted, but it was an outcome we all accepted without anger or blame.

I realized my negative self-talk was wrong. I hadn’t failed my patient and my client when the bunny died. My clients were happy their needs were met – I had given their bunny a chance. I had treated him with compassion and offered him the best I could. They saw this and were grateful for the care I had provided. So even though my patient died, maybe I did something right.

I think a lot of veterinarians are like me. When a patient dies, our first thought is “what did I do wrong?” and we blame ourselves.  Our goal is to heal the patient, to be there hero. Not every story can have a happy ending, especially when the odds are against our patient from the beginning. Instead of beating ourselves up when the outcome is not what we want, we need to look at how we handled the case. Did we meet the needs of the patient? In this case, the bunny needed surgery or to be euthanized. He could not continue in his current condition.

Did we meet the needs of the client? My clients needed to know they did all they could within their means and to know their vet cared about them and their pet. As veterinarians, we need to stop beating ourselves up when we aren’t the hero. We have to learn to accept the outcomes, good or bad, and be content with knowing we offered the best care we could and treated the patient with compassion. If we can do that, we are doing something right.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

First, let me start by saying that I love my dad. When asked who I admire most, my dad is the first person who comes to mind.  However, sometimes my dad forgets I am not his little girl anymore and doesn’t always listen to my advice, especially about what to feed a dog. He thinks honey nut cereal rings are the perfect dog treat and never goes anywhere without a bag of them in his pocket.  All the dogs sit under him at the dinner table giving him sad begging eyes. He slips them food, then firmly says “don’t you ever beg again!” I still have not completely forgiven him for taking the advice of his MD friend (who is a non-practicing doctor who does research in Croatia) who told him to feed the dog dry toast and oatmeal for a week after she threw up once.

My parents have a little schnauzer, Miss Molly, who commonly gets skin infections. A couple of years ago, I finally convinced my parents to feed a higher quality sensitive skin dog food with of fatty acids. The dog did well on the food and did not have any more skin problems.  However, about a year ago, they were driving to their winter home in Florida and ran out of dog food on the way. The gas station they stopped at only had a lower quality brand with lots of colors and fillers, let’s call it Grocery Store Brand X, which they purchased for her. The next time I talked to my dad he asked what I thought of continuing to feed Miss Molly on Grocery Store Brand X because it’s less expensive and she really likes it. I told him I did not recommend it because of her skin problems and that the other food I had recommended would be better for her.

Fast forward ten months. My parents took the train to visit my brother for Thanksgiving and left Miss Mollie at my house for two weeks. I mentally rolled my eyes but didn’t say anything when my dad handed me her food – an open bag of Grocery Store Brand X. Once again, my dad doesn’t listen to me, I thought. There was no point in arguing so I fed her the food he brought and she happily gobbled it up.

The dog did well during her stay with me and did not have any skin problems so I thought maybe it was ok she was getting Grocery Store Brand X. After about a week at my house, she was starting to run out of food. I now had a dilemma – do I go out and purchase more of Grocery Store Brand X, even though I don’t recommend it, or do I buy her the sensitive skin food I recommend, knowing that a sudden diet change may give her diarrhea. I thought about this for a couple of days and tried to stretch out her food, but when her food was almost gone, I knew I had to make a decision.

Although I love Miss Molly, she was quickly wearing out her welcome with my husband. I realized my husband would not appreciate it if she developed diarrhea from a sudden food change so I decided to buy her a bag of Grocery Store Brand X. I went to Target and slipped the bag into my cart, hoping I wouldn’t run into any clients at the store. That night, I finished the old bag, threw it in the garbage and opened the new bag of dog food to top off her dish. The kibbles I added didn’t look anything like what was in the dish. Hmmmm , maybe I bought the wrong flavor?

I dug the old bag out of the garbage. It was the same brand and same flavor. I searched the new bag for any sign of “new shapes” or “new formula” but there wasn’t any. The two bags were identical. They even had pictures of the kibble on the front. Then I realized, the kibble pictured on both bags was in a variety of shapes and colors, Miss Molly’s food was just brown cylinders, nothing like the kibble pictured.

I sent my dad a text: “what kind of food do you feed Miss Molly?” He rapidly responded “The sensitive skin formula diet, just like you told me I should!”. “Then why do we have a bag of Grocery Store Brand X?” “Oh, we bought that last year on our way to Florida and used it all up a long time ago. I just use that bag to put the food in when we travel.”

I realized two things that day: that my dad actually does listen to me and I have the perfect Christmas gift for him – a small plastic dog food container for traveling.

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The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

A couple of years ago, I heard about an alternative to the New Year’s Resolution.  Instead of making a list of resolutions that will likely be broken by February (something I am very guilty of), you decide on just one word to focus on for the year. The plan is called “One Word that will Change Your Life” by Dan Britton and Jimmy Page.  I decided to try this. I thought about it and prayed about it for a few days and let the word come to me.

I was surprised when I realized my word for the year was JOY. I was content in life – I had the career I had dreamed of since I was five, three children who can always make me laugh, a loving husband, and a few very close friends.  But if joy was my word for the year, maybe contentment wasn’t enough.   I decided to focus my thoughts on being joyful, which sounded easy enough.  Little did I know my plan to be joyful would be quickly put to the test at the place where I spent most of my time my small animal veterinary hospital.

The first three months of 2016 was the most anxiety-ridden and stressful period of my career so far. I found myself dreading going to work and hating every minute I was there. When I wasn’t at work, I was still thinking it. I couldn’t sleep and when I finally did fall asleep, I would wake up in the middle of the night with my heart racing.  At one point, I remembered my word for the year – JOY. How could I be filled with joy when I was so stressed out and miserable that I didn’t even like myself?

I realized that just because my word was joy, I wasn’t just going to suddenly be joyful. Joy was something I had to find.  So every day, as I drove to work dreading what lay ahead of me, I told myself “find the joy”. When I started to feel anxious, I repeated “find the joy” to myself throughout the day.  It wasn’t easy, but eventually I began to find the joy at work.

Joy wasn’t obvious, standing out big and bold like I expected; it was in the little things.  When I was able to get a cystocentesis sample on a patient on my first try, I heard a little “dun da da da!” anthem in my head. Getting a blood sample on a wiggly patient when everyone else failed involved a small little victory dance when no one was looking. I celebrated when my patient’s blood tests improved and did a Tiger Woods fist pump when a histology report came back as benign. Instead of quickly leaving the exam room after puppy exams, I took a few extra minutes to play with the puppy. I started taking pictures of cute kittens to post on the clinic Facebook page.

After a while of focusing on myself to find joy, I decided to focus on others. I made it my goal to sincerely compliment my patients, finding something positive to say beyond the pet’s medical state. I was surprised that saying things like “I love the collar you put on Buddy” or “Look at that adorable spot pattern on Baby’s back” helped me bond and connect with clients. I extended the compliments to my veterinary technicians and receptionists when they did their job well, again I focusing on little things, like “that is a great paw print you made. Lucy’s family is really going to appreciate it!” and “thank you for going over those instructions with Mrs. Jones so thoroughly.”

As 2016 came to a close and I reflected on the past twelve months, I saw what a journey it has been and how far I have come. I still have my anxious moments and there are days when I find myself counting the minutes until the clinic closes and I get to go home. My team will tell you that I have my times when I am crabby and not fun to work with. Being a very reserved person who doesn’t let my emotions show on the outside, I’m sure no one would say “she is bursting with joy”.  But overall, I feel I am a better person. My thoughts are more positive, I find myself focusing on others rather than my own feelings, and I notice the little things around me. I don’t have to tell myself “find the joy” as much anymore because it has become part of who I am.

I learned that joy can be found anywhere if you look hard enough. I wonder what my next word will be……

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

I have been a small animal veterinarian for over sixteen years. In all those years, I have had a lot of successful cases. Along the way, I have also had my fair share of cases I would consider failures. However, there is one case that stands out to me as the greatest success story of my career. What may be surprising, is that some people may consider this case a failure.

It was a Thursday afternoon in August 2011 when Annie presented to me as an ADR. She was a twelve year old female intact mixed breed dog.  It didn’t take much of a physical exam to see that Annie had a pyometra.  The pyometra was open, but had been going on for at least a week and Annie was sick. The prognosis was guarded with surgery and grave without it.  Annie’s mom was devastated with the news, but what was even harder, was that Annie’s mom didn’t have enough money to pay for surgery.

It had taken her a few days just to scrape together the money for the office call. I discussed the seriousness of Annie’s condition and told her surgery was the only option to try save Annie. I wanted to help them so I explored all the options – she couldn’t afford emergency surgery at my clinic so I called the low cost spay neuter clinic. They said they would only perform surgery on Annie once she was stable. Annie’s mom was not ready to euthanize but could not afford hospitalization so I advised oral antibiotics as an option, knowing that oral antibiotics alone were unlikely to stabilize her enough for surgery, but it was worth a try. Annie’s mom didn’t have money for antibiotics that day but said she would do what she could to get the money. I gave her two Clavamox tablets, one to give that night and another to give in the morning along with a price quote for a week of antibiotics.

Annie’s mom came back Friday morning with the money for a week of Clavamox. Again we discussed Annie’s condition and that immediate surgery was the best option.  Annie was still not stable enough to have surgery performed at the low cost spay neuter clinic so I gave her an estimate for surgery at our clinic, cutting the cost down as much as I could. I discussed the case with my husband, the business manager, and he agreed to let me perform the procedure only if they could come up with a deposit of $150 – enough to cover our supplies and anesthesia – and a payment plan for the rest, knowing that we may never see the rest of the money.

Although I wanted to do the surgery on Friday, Annie’s mom only had the exact amount of money needed for antibiotics.  Annie’s mom said she would do all she could to come up with $150 and would be back Monday morning, if she found the money. She was well aware of the risks of Annie’s condition worsening over the weekend and that she may not survive but was determined to give us a fair deposit for the surgery.

I honestly didn’t think I would see her again but the woman was there with Annie as soon as the doors opened Monday morning. She had sold her car and had $200 in cash. Annie’s condition had worsened over the weekend and she was very sick. I discussed with her that Annie was a very poor surgical candidate but she wanted me to try. We immediately started Annie on intravenous fluids and antibiotics. After a few hours of fluids, I took her to surgery.  Throughout surgery, her blood pressure was dangerously low.  I performed the surgery as fast as I could while still being careful – it was probably the fastest pyometra surgery I had ever done.

I wish I could tell you that Annie recovered and went on to live another few years. Unfortunately, that was not the case. Annie had stopped breathing on her own during the surgery and the anesthesia technician had been ventilating her throughout the procedure. Even with the gas off, she would not breathe on her own and her oxygen saturation continued to decline.  She developed ventricular tachycardia about an hour after surgery and we were not able to revive her despite aggressive CPR and emergency medications.

Even though Annie did not survive, her mom was extremely grateful that I had given Annie a chance. She thanked me with tears in her eyes when she picked up Annie’s body. She promised to pay the remainder of her bill with monthly payments.  The following month, we mailed her a statement with the balance on her account. I felt badly that she still owed money even though her dog had died and had little faith that we would ever see any more money from her. But a few days later, we received a check for $20. The $20 continued every month, with the exception of one missed payment. She called to apologize and explained that and unexpected emergency had come up. After about two years of $20 payments, her bill was paid in full.

Three years later, I walked into an exam room to examine a cat and saw a woman with a huge smile on her face. She said “Do you remember me, Dr. Shepherd? You did a pyometra surgery on my dog Annie. She died during surgery.  I just want to thank you for all you did!”  She went on to tell me her story. The reason she could not pay for Annie’s surgery the day she came in was because she had spent all of her money on drugs. She was a drug addict and did not have any faith in herself or others, Annie was all she had.

“You gave me and Annie a chance, and that chance changed my life” she explained.  “Because you trusted me, I realized I needed to do something with my life. I entered treatment, became sober, and got a job! I have been working hard ever since, supporting myself and paying my bills. You changed my life!”

My jaw dropped to the floor.  To be perfectly honest, I didn’t recognize her or remember her until I went back and read Annie’s record. At the time, she was just a distraught woman with a very sick dog and I wanted to try to help them. After the dog died, I grieved a little inside that my attempt to help them had failed, but, as we have to do to survive in veterinary medicine, I put the case behind me and went on to my next patient. Three years later, I learned what a big impact my little act of kindness had in her life.

Sometimes I have my doubts about my career choice. I hear stories of sick children and hurting people and wonder if I should be working in a field that would help them. How is treating a dog’s ear infection or a cat’s abscess making a difference in the world? Then I remember Annie’s mom. I treated her animal with compassion and I treated her with respect and those two acts made a huge difference in her life. It reminds me that, although I may not be changing the world, I am making a difference in someone’s little world, even if I may not realize it. My career choice is impacting people and animals in ways I don’t see and never know. Even the times when the animal dies and I feel like I failed, I may have had a positive impact on someone’s life and because of that, it was actually a success. And the successes are why I became a veterinarian.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

It was a Sunday afternoon in August 2002 and I was visiting my brother. He had just come home from a camping trip with his friends. On the camping trip, he was hit in the eye with a piece of firewood and was having vision problems in that eye. The emergency room referred him to the on-call ophthalmologist. I drove him to the office where a bright young ophthalmologist met us. Based on her age, I assumed she was a fairly new graduate. Because it was the weekend and the office was closed, she was the only person in the office.

The doctor didn’t say much during her initial exam and, although she appeared smart and capable; I sensed that she was a little unsure of herself.  She put some drops in my brother’s eyes to dilate them and said she would be back in a few minutes. It seemed to me she was gone a long time, much longer than it took for my brother’s eye to dilate. When she came back, she was full of confidence and had a list of differentials and a definitive treatment plan.

When she left again to write his prescriptions, I smiled and asked my brother “Did you see what just happened? She wasn’t sure what was wrong, but while your eyes were dilating, she went into her office and looked up what could be wrong. She came back knowing exactly what to do.” My brother thought about it for a second and said “You’re right! How did you know that?” I laughed and said “Because I do it all the time. When I see an emergency and I’m not sure what I’m looking at or what to do, I find a reason to leave the room and search my reference books.”

At the time, I was less than a year and a half out of vet school. I had just finished an internship and was working at my first “real” veterinary job. I had lots of mentorship during the day, working with two very experienced vets, but I was on my own when I was on-call and seeing emergencies.  I felt like I needed to know all the answers, to always have a plan and never let the clients think I was in over my head. If I didn’t know what to do, the best way to handle it was to have a confident air, find an escape, and search for the answer. Basically I was faking it.

However, that trip to the ophthalmologist changed my perspective. Even though I could see right through the ophthalmologist’s initial act, I trusted that she had the resources to know how to treat this emergency.  I realized that it wouldn’t have bothered me or my brother if she had told us “I’m not sure exactly what is wrong with your eye, but I will find out.”

That was fourteen years ago. Since that day, when I see something unusual, I have confidently told clients, in one way or another “I don’t know what is wrong with your pet, but I will use my resources to do my best to find out.”  Sometimes that involves telling them I need to consult a reference book in my office and will be back in five minutes or that I will ask my colleague to come into the room to take a look at the pet. Other times I tell them I will post the case on VIN or email a specialist and call them in a few days with recommendations. Sometimes I have to tell them that I exhausted all my resources and I feel they need to be referred to a specialist. (Disclaimer: I always offer my clients the option of a referral but many times they decline on initial presentation)

Since graduating, I have gained more knowledge and experience, using past cases as part of my resources. However, there are still plenty of times I do not have the answers right at my fingertips and I am still telling clients “I don’t know what to do right now, but I know how to find out”.

Yesterday one of my favorite clients brought two of her pets in. She is a breeder (I know, it’s hard to believe that one of my favorite clients is a breeder, but she truly is an amazing pet owner!) and I have seen plenty of her dogs and many of them have unusual problems. Yesterday was no exception – she had questions that I couldn’t immediately answer. I told her I would consult a couple of specialists and get back to her with the answers. I laughed and said “Your dogs always keep me on my toes!” She responded “That’s what I like about you. If you don’t know the answer, you are always willing to dig to find out.”

Although most of my clients don’t verbalize it, I feel that they respect me more that I am honest with them and tell them I don’t have all the answers right now, but I know where to find them.  I think the honesty builds trust between the clients and myself. It has also made me a better doctor, helping me to build my knowledge base. I know many veterinarians, especially new graduates feel you need to “fake it until you make it”. But I have learned that you never really make it in veterinary medicine. You will never have all the answers or know what to do in every situation.

Medicine is constantly changing and evolving and every patient is different. That is why it is called “practicing medicine”. Our clients want to see a confident and competent doctor, but that doesn’t mean they expect us to have all the answers. They want us to do what is best for their pet, and sometimes that means telling them you don’t know what to do right now. We have a lot of resources available to us in veterinary medicine. Use those resources and don’t be afraid to tell the clients what your resources are. Trust me, they will respect you and trust you more knowing you took the time to find out the best way to treat their pet.

The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.