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Life With Clients

My Greatest Service Was Sending You Away

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When we met, you were dying. Not in the existential ‘a little every day’ or a slow fade of light, but in the ‘Poo is hitting the fan, move. Now.’ kind of way.

I quickly went to work. Your eyes were screaming for help, and you let us. Thank you for letting us, I know it was scary.

I was able to find out what wasn’t going on: you weren’t bleeding out, your heart wasn’t failing. You were, I would later learn, crashing in septic shock.

Then I met your dad. His eyes were screaming even louder than yours. I ran him through everything I knew, and what I felt to be true. That elbow, the shock, a chance.

I saw my technicians getting your catheter in over your dad’s shoulder while I talked. One of them made eye contact with me, a silent conversation between us about what you needed, she nodded, and pushed two bags, steady, and calm. My other technician kept his hands on you the whole time. He talked you through the plan I was discussing with your dad, and what was going to be asked of you.

I had minutes to convince your dad to trust me, and then to take you and run. What you needed, I couldn’t give. I wasn’t sure anyone could in that moment, and I told him that.  You deserved a chance.

A friend came at that moment, listened, and took the helm. She said to load both of you in her car, she was driving, she would pay, they could be at the ICU in under an hour if they left now, you deserved the chance.

You spent the next week in the ICU. My whole clinic read your SOAPs every day. Dad started a crowd funding page and the whole town chipped in. You kept going.

It would be months of recovery. Anonymous donations kept showing up on your account. You were in our clinic every other day. Your dad would talk to every person that was in the lobby about how I saved you.

It’s hard for me to own that. I sent you down the road, your dad was really doing the work with your oral meds, my technicians were doing laser on you.

Maybe there’s a lesson about knowing when we can’t help. My skills didn’t save you, my treatments bought you the hour you needed to go somewhere else. My greatest service was sending you away. You deserved to be saved and I couldn’t do it.

A few weeks ago your dad came in with wrapped presents. One for each person in the clinic. Thank you, each of you. Paw print charms, some on necklaces, some on earrings, a bracelet. Every single person put one on. Not because we all have the same taste, far from it, but because every single person cares about you.

I wear one on a necklace with one other charm, the ashes of my own dog. I couldn’t save him.  But every time I see the charm on someone else, I’m reminded that we can win, and I want them to see that in me. I want every animal to listen to that silent conversation we had when I first looked in your screaming eyes, “I’m here to help”.  I wear it to remind myself every time I look in the mirror, “This is why I practice”.

When we enter medicine we know, at some level, that we will never fully win. The greatest doctors of all time have never kept a patient alive forever. But we keep showing up, not to win the war, but to fight for ever small victory.

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.

About the Author

Dr. Hammond is a graduate of Ross University. She practices integrated small animal medicine in Gloucester, MA. When she’s not in the clinic she spends time traveling with her husband, on the ocean, or getting lost in the woods with her dogs.

When Relinquishment Punishes Everyone

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It happened again. A family could not afford the care of their pet and the veterinarian offered relinquishment instead of having to euthanize the animal. It should be a feel-good story. It should make you say, “Wow that veterinarian is so nice to do that for that animal instead of euthanizing.” But instead, people get angry. People start harassing the veterinarian. People start spreading misinformation. And then the family gets their pet back at no charge because the public has made a spectacle of it all and forced the veterinarian to work for free.

Misinformation continues to fuel these situations.  I’ve written about this before. People get wrapped up in the title and read very little details regarding the situation and then just click that share button. And then it’s shared… and shared… and shared.  Suddenly we are dealing with a misinformation mess.  Let’s go over what really happens in these situations to try to get some facts straight before this trend continues.

In most of these stories, a pet is brought in for a major issue such as parvovirus or a surgical issue or even just a really sick dog or cat.  Typically the owners cannot afford treatment, even the bare bones estimates. The veterinarian sees this sweet animal suffering and usually has to bring up euthanasia as a treatment option but doesn’t like discussing that when the animal could be saved. So we discuss relinquishment.

Relinquishment means that we will take on the cost of the treatment but the animal now belongs to the clinic. Here is where the story always takes a turn.  The owners will always ask if they can have the animal back once it is better or sometimes will harass the clinic for updates on who is the new owner so they can guilt those people into giving the animal back. Or sometimes you see social media get involved and random people will scream at the clinic saying “If you are doing the work for free why not just give the animal back to the owner.” So let’s discuss those misconceptions.

No, the owners cannot have the animal back once the clinic has saved it unless they come up with the money to pay for treatment. Unfortunately, animal clinics are businesses and we need payment to keep afloat. If we gave back every animal that was relinquished without payment we would no longer be in service.  This also creates a vicious cycle because now those owners think any time their pet is in trouble they can get work done “for free.”

That brings up the second part. We are not doing the work for free. We still have to pay for those medications, anesthesia, and time that had been put into saving the animal.  Several animals that I have saved due to relinquishment or abandonment were charged to my account and I happily paid them since I became the new owner of said animal.  None of the work is for free. Now maybe the clinic will discount some of the services or write them off but that doesn’t mean that any random pet owner should be able to cheat the system and not have to pay.

Relinquishment doesn’t have to be a bad thing. Sometimes animals get into situations that clients cannot afford.  If a veterinarian offers relinquishment that means that they care enough to try to give the animal a chance. But if the public continues to act like veterinarians are just money-hungry people wanting to take everyone’s dogs for profit then a lot fewer veterinarians will be willing to allow relinquishment which means a lot more unnecessary euthanasia.

You don’t have to be rich to own an animal but you do need to take responsibility for that animal. Relinquishing an animal is the responsible route to take if you cannot afford treatment.  You are allowing that pet to live another day. We need to stop punishing both the owners and the veterinarians in these situations. We all want to help the suffering animal and that should be the endgame.

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.

5 Lessons I Learned From Losing My Own Pet

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I’ve been working in the veterinary field since I was 15 years old. I witnessed my first euthanasia just two hours into the job.  It struck me in that moment, even at my tender age, that this would be the most important aspect of my job.  And it is.  Saving lives is wonderfully satisfying, and new puppy kisses are amazing, but helping a pet transition through this world is a sacred thing.

I’ve cried alongside pet parents, I’ve laughed at their funny stories, I’ve stood solemnly in the corner out of the way, and I’ve been thankful I was able to lighten the burden of their loss, even if just a little. But despite the countless euthanasias I’ve witnessed and performed, I was ill-prepared for the death of my own pet.

Your first dog as an adult holds a special place in your heart. Mine certainly did.  Countless moves, different jobs, different countries, new partners and friends – you flounder through life and they’re with you through it all – your beacon in the storm.

At the age of 16, when renal disease progressed past being manageable my first love my Border Collie, Brae, told me it was time for him to go.  I listened.  I had countless people supporting me, many words of wisdom, words I’ve even said myself.  I had the comfort and support of compassionate family, understanding co-workers and loving friends.  Brae left this world surrounded by friends and family under a huge walnut tree on a warm summer day, blanketed in the serenity of our farm.  It couldn’t have been more perfect.

But what happens then?

Sometimes the best decisions you will make will also be the hardest.

To say I was devastated by his loss would be a gross understatement.  I couldn’t go to work for a week.  Please note I said couldn’t.  I physically couldn’t face those new puppies, aging seniors or worst of all, pets on the same road he had been on. I was a mess.  Although I wasn’t depressed, I was deeply, deeply sad.

Even though I’m not an overly emotional person, the smallest thing would cause rivers of tears.  I was fine one moment, and a pile of bawling, snotting jelly the next.  I found myself frequently wondering how people get through this.  I’d helped people with the process of euthanasia countless times, but the “what now” was uncharted territory.

The world around me was continuing to move, but I had ground to a stop.  I bounced back and forth on whether I had made the right decision for him.  What if I had waited one more day?  What if we had tried something else?   I’ve told countless clients over the years that your companion animals tell you when it’s time, and he did.  I knew I had made the right decision for him, but that didn’t stop my mind from exploring the possibilities I knew didn’t exist.

Grief is intensely personal.

It took just about two months for me to get my sadness and secret sob-fests under control, crying in the shower is strangely cathartic.  That’s not to say I was “over it”, not by a long shot.  About six months after Brae had passed, a medication he had been on came up in an exam room and the doctor I was working with asked me what his dose was.

I had to excuse myself and go dab my eyes in the bathroom.  How could I be so broken?  How could the mere mention of a Zyrtec dose send me spiraling?

Animals, especially dogs and cats, hold such privileged positions in our households.  They’re privy to every aspect of our lives.  They’re there when you wake up, there when you go to bed, there for every highlight, and every sad time.  They have become our constant cheerleaders, our furry therapists.  There is nothing as therapeutic as crying or smiling into a furry neck.  Studies have shown that for many people the loss of a companion animal often takes a greater emotional toll than the loss of a human family member.

My dogs are so much more than companion animals, they’re like a piece of me, and I know I’m not alone in this thinking.  Losing one is like losing a limb.

I had a distinct moment of clarity when a friend (who is now an ex-friend) said to me, “It’s been six months, you need to get over this, he was just a dog.”  Harsher words have never been spoken, at least not to me.  But this lead me to think, when will I get over this?  Will I ever?  And he was so much more than just a dog.

Your timeline is yours alone.

It’s been five years since I said goodbye to my boy, and I think I may have the answer as to when my grief will end.  Never.  I will never get over his loss.  True, I don’t openly weep each day, but I do still choke up and get misty-eyed when I think of him, or speak about him sometimes.  I’m fairly certain that’s just my new normal, and that’s okay too.  It’s no longer a place of deep sorrow, but of quiet smiling introspective and a kind of happy wistfulness.  I’ll be honest while writing this I pulled out some photos of him and had a little weep, and it’s been five years.  YEARS.

Don’t cry because it’s over, smile because it happened.

His collar still hangs on my car’s rear-view mirror, and his spark will be forever engrained in my heart.  With distance, I’m able to focus more on the good times we had, the happy memories, instead of fixating on his loss – and that’s a gift, but it’s also taken time, more than I ever thought it would.

I look back at him now more often with smiles than tears, and his legacy of love lives on in my other dogs.  They will never be him, but I love them just a fiercely, all three in very different ways.  I’m also able to enjoy each day with my dogs now, instead of focusing on the “what ifs”.  As Brae aged, I spent a lot of time wondering about the future, and mourning him before he was even gone.  He taught me just to live in the now, to enjoy each day, and not worry about the future.

They say there’s never a love quite like your first love, and I guess that’s true, but that doesn’t mean love doesn’t go on.  It does, taking paths you didn’t know existed.

I’ve learned along the way that grief is a deeply personal thing.  There is no timeline.  There are no right answers.  Dogs are such amazing gifts, such unfiltered, unbiased, pure joy.  To me, they are love embodied, like tiny points of light. If someone tells you they don’t understand because “it’s just a dog”, please feel free to tell them, from me, that they can’t possibly understand because “they’re just a human.”

My life is so enriched by my three dogs, and the animals I get to interact with each day in my occupation.  Sure, it would hurt less to not endure the losses, but my life would be so hollow without them in it. 

Losing love is hard.  So is allowing yourself to find it again. 

A lot of my struggle with Brae’s loss was trying to justify my feelings to the world, if only from inside my head.  I know now that I didn’t have to. My loss and my reaction to it were mine alone, they were separate from my husband, my family, and each person I have helped walked down this road.

Some people just won’t understand the pain of your loss, and that’s fine too. Just know that there are people out there who understand.  We get it, even if no one else does.

ABOUT THE AUTHOR

Kimberley Beldam-Saylor is a veterinary technician and lifelong equestrian.  Kimberley is the Technical Director at Shiloh Veterinary Hospital, a two practice, nine doctor hospital in York, PA and Dover, PA.  Originally from Kingston, Ontario, Kimberley now lives in Dover PA with her three dogs (Border collies Vimy and Wynn and Aussie Cross Jelly), and her three Cheval Canadians, Patriote, Xcellence and Wish.  A previous FEI level dressage rider/trainer Kimberley now competes in the fast-growing sport of Mounted Archery.

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.

That One Time You Needed Me and I Wasn’t There

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Remember that time that you needed me to help out you and your pet and I didn’t do it? I remember that too. I think about it from time to time, and not just when I see you on the street or I’m looking at reviews on Yelp.

I think about it whenever I feel that dark urge to find something to beat myself up about. I remember it when I’m tired and things aren’t going well and I decide to really punish myself by mentally reviewing all the times I just couldn’t pull out a win.

You were really upset. You said if I cared about pets, I’d keep the clinic open late and I wouldn’t charge so much money. I did everything I could to get the care your pet needed as affordably as possible, but I told you I couldn’t do what you were asking for this time. So you told me — and others, whoever would listen — that I’m greedy and that I hurt your faith in humanity.

You know, it hurts to see someone telling one side of an emotional story without being able to add the other side. Especially online, people can be quick to offer support to someone they perceive as a victim of injustice. They grab their pitchforks and head to their keyboards to exact revenge, oblivious to the full truth of the situation.

I’m not here to give you excuses for why I couldn’t do what you wanted, or to try to convince you to change your emotions. I’m genuinely sorry that you and your innocent pet were ever in a situation where you needed to ask for help. Please know I wouldn’t judge anyone in that position, and I understand how hard things can get. My heart breaks for the fear and stress you felt when I explained what I could and couldn’t do to help. It always breaks.

I could give you an endless list of all the times I’ve sacrificed my time, money, health and relationships with friends and family to go as far as I could to help all those I could. I could cry trying to explain how much I care about my patients and how painful it is not to have endless power and resources to fix all that’s wrong with them.

I could walk you through all the costs involved in keeping our clinic open and making payroll for the people who work here — arguably underpaid for what they do — giving it all they have. I can lament the fact that, unlike in hospitals for humans, there are no government programs to support medical care for pets when their families can’t pay the bill.

You might have heard that my profession has a serious problem with depression, compassion fatigue, and burnout. You might even know that veterinarians are more likely to commit suicide than almost any other group. I know that doesn’t change the frustration you feel, but maybe it helps make clear how hard these ethical decisions are for most of us, and how seriously we take what we do.

There’s a long list of reasons that I couldn’t do what you wanted me to do that time. The one that matters most is that I need to help as many families as I can, and that means sustaining myself and those who work with me.

You needed me one time. Just this once! It’s the only time in your life your pet has needed an expensive surgery or ongoing medication or intensive care. It was only one time, and I couldn’t make it happen.

The miserable truth is that it’s not one time for me or for the people I work with. It’s several times every day. Daily, we are begged to take exceptional measures for a pet in need. Daily, we have to make choices about how we can and can’t help the endless tide of animals who come in without the money or time needed to care for them. Daily, the animals come, and we do what we can for them and the people who bring them, whether they’re from the shelter, the farm, the college dorm or beside the highway.

But there is no magical, endless well from which veterinarians can draw. We can’t be a bottomless source of time and discounted or free care. No one can.

I don’t plan to stop trying to help people and pets. So if I’m going to keep this up, there will have to be times when I have to draw a line. I can’t help pets if my clinic goes out of business (and yes, we’d go out of business in a matter of days if we said yes to everyone’s “just this once”).

I can’t be compassionate when I’m depressed and my soul is threadbare. I can’t feed others when my cupboard is bare, and I can’t give them water when my own cup is empty.

I’m going to help as many as I can, as best I can. That means there will be some times when I have to step away so that I can keep moving forward. I’m sorry that I couldn’t help you the one time you needed me, but as I prepare to head back to a job that I still find reward in and have resolve to do, I can’t regret my decision.

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.

My Mistake Killed My Cat

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Last week I experienced the worst day of my career. Actually, it rivals the worst day of my life.

It was my first week back from vacation. My old kitty, Meow Meow, had been in boarding during the holidays. When I got her home, she didn’t seem quite right. She wasn’t eating or drinking very well for a couple of days, and she was weirdly clingy. Although I chalked it up to stress, I decided to bring her into the hospital for blood work and IV fluids.

It was an unusually slow morning. Technicians and assistants were puttering around, chatting. There was only one extensive dental procedure lined up, so I decided to get the ball rolling with Meow Meow. I examined her, drew blood, collected urine, and placed an IV catheter. I asked one of our technicians to prepare a bag of LRS. She hung up the bag, and proceeded to get a cage ready. I looked up to see a full bag of LRS, with fluid sitting in the drip chamber, all ready to go; or so I thought. I grabbed the line which had been draped over the hook, connected it to her port, and opened the crank. Something wasn’t right about the way it dripped; I looked at the technician holding Meow Meow and we realized simultaneously, the line wasn’t primed. She swiftly pulled it out, but it was too late. Meow Meow got a line full of air. She died. Almost instantly. CPR failed. Her tiny little body couldn’t survive that.

I was shattered. I screamed and wailed over her dead body in the treatment room. How could this have happened? How could a bag have been spiked, a drip chamber filled, and the line not primed? Why didn’t I check it? Why MY cat? Why didn’t I get that bag ready myself, as I normally do? Why did I bring her in? I should have left her at home. She probably would have been fine.

My husband and I took her to the crematorium. I cried for a long while, clutching her wee body tightly in my arms. I apologized to her for allowing this mistake to happen, to take her life. I thanked her for all the joy she brought me through the years and hoped that she enjoyed her life with us.

I took a couple of days off work to grieve and lament. I requested the owners of the practice call a meeting to review protocol; to remind the team that careless medical practice is a recipe for disaster; to bring some justice for Meow Meow. I came back to find out that nothing was said or done. Instead, it was swept under the rug, like so many other things have been in the past. Oh, and Meow Meow’s test results were normal too.

Meow Meow died because of sloppy work. I wish I could tell you there was a reason this distraction occurred; that we were super busy and it happened in a moment of chaos. However, there is absolutely no excuse for it.

It is my hope that in sharing this story, I can remind those in the veterinary community that vigilance must always be practiced. Systems must be in place to prevent errors. We must always check each other’s work. We must constantly remind ourselves that this is serious work, as lives are hanging in the balance. We can do better. Some of us need this reminder more than others.

It is my hope that Meow Meow’s story will save a life.

Editor’s Note: This piece broke my heart, as a pet lover and as a colleague. The author’s admonition to learn from her mistakes is a loving testament to her beloved pet. I also hope as a community we know the importance of being gentle with ourselves when mistakes happen, which they, unfortunately, do to us all. 

These Are My Thoughts When I Lose a Patient

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Yesterday I lost a patient. I wasn’t even there.

It all started last week.  He came in for vomiting.  His x-rays were inconclusive. We decided to treat him symptomatically with IV fluids and repeat radiographs. They were still inconclusive, but the vomiting had stopped and he was eating and acting normally.  We sent him home.

The next day, he vomited again.  He came back in for an ultrasound. From ultrasound, he went to the OR.

He had adhesions from another surgery years ago—scar tissue—that had resulted in an obstruction. I couldn’t safely break them down, so I had to remove a section of intestine.  The two healthy ends of bowel came together nicely.  I checked the incision for leaks and finding none, I closed him up.

The next morning he was eating great and acting normally.  The day after that he was fine too.  On the third day, he wasn’t.

“We have to go back in,” I told his Dad.  “The incision could be leaking.”

I hoped I was wrong.  I wasn’t.

We removed more intestine and repaired the anastomoses.  We flushed his abdomen with sterile saline to try to clean out any bacteria or ingesta that had escaped the GI tract.  We loaded him up with antibiotics.  We crossed our fingers and prayed.

He made it through the night but the next morning he still couldn’t sit up and his protein levels had dropped dangerously low.  I wasn’t there, but I called my colleague to confer on the case.  He needed a plasma transfusion, we decided.

He never got it.  While the fresh frozen plasma was defrosting, he decompensated.  They did CPR, but he died anyway.

I’ve been through it a hundred different ways since that morning two days ago when it all went south.  What could I have done differently? Did I do something wrong?  Was it my fault?

14. That’s the percent of dogs undergoing this particular surgery that encounter this complication. Not the percent of my patients—just what the retrospective studies show.  And adhesions increase the risk.

This should make me feel better, but it doesn’t.  Because he’s still dead, and I’m still left wondering.  Was it fate, or was it me?

I know I did everything I could.  I know I’m a good surgeon.  I know this happens to the best surgeons.  But it doesn’t matter because I still can’t stop wondering.  Would he be alive if another doctor had done the surgery?  Was it my suturing technique?  Was it my choice of suture material?  Was it my tissue handling?  Was it me?

Clients often think euthanasia must be the hardest part of my job.  It’s not.  This is.  The ones we try to save.  The ones we give our all to.  The ones who have a chance but die anyway.  That’s the worst part of the job.  It makes us doubt ourselves.  It makes us feel helpless and useless.  It makes us feel like failures.  These are the cases that you never truly get over.

Sure, the wounds will heal, but they will leave scars.  Adhesions will form.  And you can never cut them out or break them down.  They will sit there for years, not really causing a problem, until one day something gets stuck in our tangled web of emotions and the old wounds feel fresh again.

We will heal for our patients who won’t, but we will never be whole.

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.