Care

Every dog is unique, but some special dogs become cornerstones as we build our lives. These companions accompany us as we grow into who we are and become part of our most treasured and sacred memories.

Phoenix came into my life long before I went to veterinary school. In fact, he was a big reason I became a veterinarian. Through him, I learned just how much dogs can mean to people, and how it feels to have an animal at the center of your life. Without him, I’d probably have chosen a different path.

He was the first dog who was ever truly mine. I schemed with him on how I’d ask my now-wife to marry me. (He was very excited.) I took him with me to veterinary school, where he volunteered to be studied, palpated, examined, poked, and probed for 4 years. (He was delighted by the attention.) I introduced him to our first human child (he was wary, but welcoming), and then our second. Phoenix saw my wife and I through starting our first, second, and third jobs. He lived in eight houses over nearly 16 years and saw more of the eastern United States than most humans.

When I put him to sleep last month, he was deaf and nearly blind. He wore a diaper when no one was home to let him out, and his hind legs were so weak they slid out from under him when he wasn’t walking on carpet. At the end, he was no longer able to get up into his favorite chair. He would cry until someone came to help him. He enjoyed his walks until the end, and that was the last thing we did together. It was time.

I know Phoenix wasn’t a perfect dog. He was anxious, couldn’t resist wallowing in puddles, would drive everyone nuts if he didn’t get exercise, and couldn’t be trusted around lunch meat. Still, I loved him so much. When the time came to put him to sleep, I couldn’t do it myself.

For a veterinarian, I don’t know if there’s any higher praise than being asked by another vet to help his dear pet pass from this earth. I called one of my most trusted colleagues and asked for her assistance because of my deep belief in her skill, compassion, and willingness not tell everyone how much I cried.

For weeks after Phoenix passed, I was depressed. At first, that surprised me. I thought the sadness would come in flashes, that I would come crashing down when I saw his water bowl or when we got his favorite chair steam-cleaned after years of constant use. In reality, I was just sad all the time.

You might think that prolonged sadness sounds awful, but strangely, I was fine with it. Really. I accepted that grief because I know it’s part of the process. It’s the cost of admission.

While I worked through the painful period after his death, I drew a lot of comfort from the Buddhist belief that life is suffering. I know that sounds morbid, but I found it to be a beautiful and liberating concept. The general idea is that we will always struggle, because that’s what it means to be alive. Only by accepting that life is hard can we be happy in it. By this reasoning, the best thing we can do if we want to be happy is stop struggling against the presence of suffering in our lives. We just have to make a choice about which kind of suffering we want to endure.

Think about it. You will suffer in this life — so how do you want to do it? Do you want to deal with the headaches of being married or with the headaches of being single? With the realities of having children or the realities of not having them? With the crappy parts of having a job or with the crappy parts of being unemployed? There is no right answer to any of these questions. All we can do is make our choices, own them, and be happy that we get to make these decisions at all.

That’s how I think of dog ownership. At some point, it will mean suffering. There is suffering in losing one shoe in every pair to a teething puppy. There is suffering in sacrificing financially to pay for pet care. There is suffering in grieving the loss of a furry best friend. But I would rather have this sea of sadness now than the tiny drops of emptiness every day if I’d chosen not to have a dog in my life. When I think about what life would be like without a dog — all the times I would have come home to silence, jogged alone, or had no one to listen to my live commentary on Game of Thrones — the choice is obvious. Give me the pain at the end.

When it comes to our relationships with dogs, grief is the price of admission. We should all know it when we take a dog into our families and our hearts. I hope we can remember it when the pain comes, because we signed up for it. I chose this pain. I have no regrets. I will do it all again.

My daughter and I have chronic illnesses that took a long time and many doctors to diagnose. We’ve met some outstanding doctors and others that have frustrated us and dismissed our suffering.

I’m a veterinarian, and during this journey I’ve learned many things from the physicians we’ve met that have helped me be a better doctor for my patients.  I’ve also thought a lot about how physicians can learn to be better doctors for their patients from veterinarians.  Here’s my advice to human doctors:

1. Listen to your patients (or their caregivers).

You have a huge advantage over veterinarians, since most of your patients are able to speak to you directly about their symptoms and concerns.  Yet, if you don’t listen to or dismiss your patients’ concerns, you lose this advantage.  A good history will get you to the diagnosis sooner, almost every time. Listening to your patients validates their experiences and instills trust in your care.  Veterinarians rely heavily on the observations of pet owners.

2. Don’t forget a comprehensive physical exam.

Yes, it’s admittedly more awkward to do a physical exam on a person than a pet, but it’s still important. Many times veterinarians find something highly significant on a physical exam that the pet owner had not noticed or not realized was a problem.

3. Think big picture.

Specialists in both human and veterinary medicine are becoming ever more abundant.  The knowledge they have in their disciplines is deep and remarkable.  However, many times it is helpful to step back and look at the whole patient, not just one or two body systems.  Veterinarians in general practice often care for our patients from 6 to 8 weeks of age to death, and that breadth of knowledge of our individual patients helps us tremendously when choosing diagnostic and treatment options.

4. Don’t rely exclusively on initial test results.

It’s fine to reassure your patients when the initial tests you’ve run are normal, but that doesn’t mean your patient isn’t sick, just that it will take more work to get to the diagnosis. Fewer than 5% of our patients are covered by insurance, so we often must stop after the initial round of testing due to the pet owners’ financial limitations.

Our lack of a diagnosis does not mean the pet’s clinical signs aren’t real or that the pet is not sick.  In these situations we empathize with our clients and help alleviate the pet’s clinical signs, which is much more compassionate than assuming patients’ undiagnosed illnesses are “all in their head”, as people with chronic illnesses have heard from their physicians far too often.

5. Learn to say, “I don’t know”.

The last line of the Veterinarian’s Oath is:  “I accept as a lifelong obligation the continual improvement of my professional knowledge and competence”.  This assumes we don’t know it all and we never will. Besides having to learn about multiple species of animals, veterinarians often don’t have access to the latest diagnostic tools or treatments, so saying “I don’t know” rolls off our tongues pretty easily.

I’ve found many physicians have a tough time saying, “I don’t know”, but I respect immensely the ones who do.  Even better is when a veterinarian or a physician follows “I don’t know” with “I’ll help you find out”.

6. What you see in the exam room is not the whole story.

Many pet owners apologize to us and are embarrassed when their pet’s limp disappears or the cough is non-existent in the exam room.  Yet, veterinarians know that the adrenaline rush pets experience when visiting us masks many of their clinical signs, and we reassure pet owners of that fact.

We encourage pet owners to video their pets at home when they are experiencing clinical signs so we get the full picture. Don’t discount what your patient is telling you because you don’t see evidence of it in the exam room.  Ask how the symptoms are impacting your patient’s daily life.  If your patient has a short video or picture, take the time to review it together.

7. Remember the zebras.

Yes, we’ve also heard the saying, “When you hear hoofbeats, think horses, not zebras” during our training.  Common diseases and conditions (horses) are more likely to explain patients’ symptoms than uncommon diseases and conditions (zebras).

Veterinarians could be called upon to treat any kind of animal, so we might be more open to “zebras” than physicians – if our patients can be so varied, surely the diseases and conditions they suffer from can be as varied.  You too could have a “zebra” come into your exam room one day – don’t miss it!

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.

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About the Author

Dr. Michaele M. Oberbroeckling received her DVM from the Iowa State University College of Veterinary Medicine in 1994. She is currently an associate veterinarian at VitalPet Kings Crossing Animal Hospital in Kingwood, Texas. Her daughter has a form of dysautonomia (Postural Orthostatic Tachycardia Syndrome). She also has dysautonomia, along with Sjogren’s Syndrome. These conditions are not actually rare, but can take months to years to diagnose. Learn more at: www.dysautonomiainternational.org and www.sjogrens.org.