Be The Change
As I prepare for my third year at IAAHPC, the veterinary hospice conference, I’ve taken pause to reflect on this journey and how it affects the way I view veterinary medicine. Personally, I have only euthanized a personal pet in a clinic (versus at home) one time.
It was Nuke, my vet school coonhound, and he was diagnosed with hemangiosarcoma just a month after I graduated and came back home. The veterinarian was lovely and did as great a job as one can do in that situation, but so many memories still stick in my head:
-They asked me to come in at the end of the day, ostensibly to make it easier for me. It meant I had to wait all day and then sit, sobbing, in rush hour traffic. It wasn’t what I preferred, but I was too tired and sad to realize I should have asked for what I needed.
-They took him in the back to place a catheter. I get it, I did the same thing throughout my entire clinic career. It’s definitely easier for the staff. I would have preferred to be with him the whole time. After doing it by myself in people’s homes with no backup- yes, it is perfectly possible.
-After I left, they took his body and placed it in a black garbage bag in the freezer until the aftercare place arrives on their weekly rounds. I know, because we all do this. Every clinic I have worked at does it this way. It is just the way it is done.
But does it have to be?
I know that the answer is no. I know that there are options out there that so many people want, so many ways we can better respect the dignity of our patients and clients before and after death, and we owe it to you all to let you know they are possible. Veterinarians have many reasons for not offering them, and they are not invalid concerns:
- They are more expensive
- They take more time to organize
- Most people do not want them
While many if not most clients are fine with the process the way it is, it hurts me to no end to know that so many people are still unaware of the myriad additional options out there to help your pet at end of life and to ease your pain as a family through the process. You may have to advocate for yourself, prepare, and find these options on your own- trust me, after having to advocate for my mother to get into hospice when it wasn’t offered as an option, this is kind of a universal problem.
To that end, I’d like to share with you my End of Life Bill of Rights- the things that you as an owner have a right to ask for and, after having worked with so many like minded colleagues now for several years- I can tell you that someone out there is equipped to provide you with:
The Right to Refuse Treatment. If your pet is suffering from a terminal disease, you have the right to say no to chemo, or surgery, or radiation. I believe in my heart that most veterinarians out there support clients in that, but there seems to be a lost-in-translation moment where so many owners feel pressured into heroic measures they were not prepared to take, emotionally or financially. This does not mean I am advocating to neglect an ill pet in suffering- quite the contrary, I am advocating for aggressive and patient focused comfort care.
The Right to Pursue Treatment. On the flip side, if you want to take your pet to the best of the best and do everything in the book possible to change things, it’s your call, not ours. We can offer you guidance and advice, but our job is to help you make an informed decision about realistic outcomes.
The Right to Have Your Family Involved. Unfortunately, some veterinarians still actively discourage families from having children present during euthanasia in the clinic. The emotion makes them uncomfortable and is disruptive. It is a clinic-focused way of thinking that is not focused on family needs. This is a once in a lifetime transition, and you need to do what you need to do. Many clients do not want their children present, which is fine- especially for kids under 5 who don’t understand what is happening- but it should be your choice. What your children see and hear- or don’t see- will live with them forever. If you don’t know how to approach the conversation- there are many, many professionals who do, and they have excellent resources to help.
The Right to Impeccably Respectful Aftercare. Most people don’t want to know what we do with a pet’s body afterwards. If they ask, I would tell them, and assure them we are as respectful as we can be. I believe in transparency. Nonetheless it is a disturbing image to many, myself included. If we can’t be honest without feeling like there’s a need to cushion the blow, why not change it? Especially when it’s such an easy thing to do?
More recently I have worked with a local business that doesn’t use bags or hold pets onsite; pets are wrapped in a clean white sheet and transported directly to the crematory facility, with the family knowing that the position their pet was last placed in is how they will remain. Yes, it costs more. And yes, many people are happy to pay it for that peace of mind. Some clients of mine transport their pet directly to an aftercare facility themselves, or have a trusted friend do it, because that chain of custody is important to them. These are all valid options.
The Right to Die at Home. The first time I went to a hospice conference, it changed everything for me. We can do so much better by our clients. In-home hospice and euthanasia veterinarians are changing the landscape of the profession, and providers exist all over the world. We are trained to offer not only medical support, but we are able to direct your family to the compassionate emotional support you may need, through chaplains, grief counselors, and support groups. We can offer palliative care options when medical treatment is discontinued- as in humans, we have a wide array of comfort care support that goes far beyond a pain pill here and there that can ease the discomfort of end of life.
And when the time comes, you will be at home, in a safe place, with those around you that you need. I bring blankets, candles, music- things that might not be practical in a busy clinic but, in a time of grief, provide small but vital bits of calm through all the senses. For those who experience euthanasia in a clinic, you also have the right to take the time you need, to make the environment what you need it to be for you. It matters. Your bond matters, too.
With love, Dr. V
The phone rings, and I answer it with an admittedly impatient voice since someone sold my phone number to a marketer and I’ve been getting deluged with spam calls all week. I have the phone in one hand and Brody’s tail in the other, as he chewed up his bandage when I wasn’t looking and now I have to re-wrap the whole thing.
It’s Chaplain Gary this time, calling as he does, every few months, to see how I am doing.
I met him once, when he came to the house to talk to the kids when my mom was sick and give them a book. They sat looking at their hands, not sure what they were supposed to say to the stranger who was trying to get them to open up about their fears.
“We’re fine,” they say, because that is what they see me say. It is what all New Englanders learn to do from a young age, saying they’re fine even when their house is on fire, their leg has fallen off and one eyeball is hanging by a stalk. “Fine fine, under control, it’s fine.”
“I just was wondering how you guys were doing with the anniversary coming up,” he says. Ah yes, Easter, the last holiday we shared together as a family, the week before my mom’s seizure changed everything and brought our charmed existence to a screeching halt.
“Fine,” I say, “We’re hanging in.” Brody forgets his distress over his tail and puts his head in my lap, sensing the tension in my voice.
The chaplain calls because it is his job, and I am grateful he is there, but he’s not the one I want to talk to. He cares, but he doesn’t know me. When I see a butterfly zip by out of the corner of my eye and I’m hit with a wave of sadness, I want to talk to my sister. When I wake up from a dream where I’ve been out with my mom doing the little mundane things we always used to do- grabbing a Starbucks, pawing through the racks at Marshalls for a deal, I want my husband to hold me when I explain why I woke up crying. When I greet my Dad on Sundays and we both look at each other a little lost, I want Brody to come up and bully him into giving him treats, because that’s one of the few consistent ways to get a smile.
Grief is a family affair, and we’ve completely forgotten how to do that as a society.
Loss: The elephant in the room
When I started with Paws into Grace, I thought it was such a great boon to offer people a comprehensive list of pet loss support groups, counselors, social workers, psychiatrists. Don’t get me wrong, it is a good thing, but I was naively surprised when people almost universally declined to use their services. They are there to fill the void of a support system we no longer have and to help those in crisis, but it doesn’t replace our innate desire to turn inward during these times, to those close to us.
I gave a talk last year at a hospice conference about grief around the world, and one universal commonality was the ritual of community, surrounding families like a cocoon as they healed, giving structure and a safe place surrounded by friends to fall apart and, slowly, rebuild. Most important of all, the cocoon, the safe space, comes to the family- not the other way around. It takes a lot of energy to be sad, and who wants to do that in a strange place like a church basement, surrounded by other strangers, when you could be at home in a Snuggie close to the coffee pot and your dog.
I was at Western Vet Conference this week, and I ran into my friend Bill, who even in a rush to get to his upcoming afternoon of talks took a moment to say, “I’ve been thinking of you.” That meant more to me than 50 calls from the stranger chaplain. This is how it’s supposed to work, right?
When someone near to us loses a loved one, it seems these days that our instinct is to run away instead of to them. It is, I think, because we’re scared, we don’t know what to do, and no one has taught us how to scrape someone off the pavement. We don’t want them to know we’ve seen them upset.
We’ve made grief pathological, something ‘wrong’ that needs to be fixed by a professional, implying that we are somehow broken for having felt it. We’re so removed from this part of living that we can’t even manage the basics of grieving, needing booklets and chaplains and groups to manage even the simple things like, “am I normal to feel sad.”
As always, I keep trying to file these tidbits away into something useful for my own work, and in this case it’s dawned on me that it’s not the person who lost a pet who needs the guidance, but their family and friends. It’s a work in progress but it feels right, just as it’s a reminder to me how to be a better friend. I know 3 friends who lost a parent this year, and countless more who lost other beloved pets and family members. One little note from a friend, a Facebook message or a mailed card, means more than 50 calls from a stranger.
This is something we can all do well to remember.
There’s something happening in the animal world, something sticky and kind of ugly, and we need to talk about it.
You learn to spot patterns when you’ve been around long enough, trends that start in one area but quickly pick up steam in your own neck of the woods. And that, my friends, is what I’m bringing up today: the emerging trend of the Social Justice Warrior, and how that relates to people in pet care.
I think it’s pretty clear that I am a big proponent of animal advocacy, from the first blogathons to my work with hospice and this very site, which I’ve written for seven years now in an attempt to keep an open dialogue on important pet topics. I am a huge fan of people who work so very hard and selflessly to make a difference, and this is not who I am speaking of today.
I have also seen a less pleasant side of people, those who use their issue of choice as a shield to build up their own ego and bludgeon others, often at the expense of those very people who are trying to improve the world for others, while tarnishing their own cause by association.
What is an animal social justice warrior, exactly?
While the term “social justice warrior” started gaining momentum with the Gamergate brouhaha specifically in reference to progressive views and speech, the prevailing wisdom is that the term has evolved to encompass a wide array of armchair activists who care less about outcomes and more about dogpiles. No one has specifically defined what it means in our sphere, so I’m just going to go ahead and do it right here.
It matters to us, as animal welfare advocates, healthcare providers, and educators, because we’re often the ones being targeted. Here’s what I’ve observed, over and over:
- It starts from a good place.
Most of the time, people start on a course of advocacy for an issue they truly believe in: maybe it’s ear cropping, or vaccine safety, or feral cat rescue. Good topics that good people can get behind, which is why it is so hard to call them out. But then something goes sideways.
- Facts become less important than emotion as time goes on and the ‘army’ grows.
As momentum builds with a social justice warrior’s campaign, enemies are identified and the followers are called upon to ‘take them down’ on social media, which can be annoying for a large pharmaceutical company but devastating for a small business owner or individual. Sometimes it’s very hard to dispute the ugliness of the original offense (like the guy who killed Cecil the Lion), but other times the dogpile results in something far worse than the original problem: people losing jobs, people erroneously identified as child predators. By the time the error is identified, the damage has been done.
- Methods are as important as ideas.
When a social justice warrior really gets going, they often work to recruit others to the cause. Sometimes those people demur, not because they disagree with the original idea, but because the seek and destroy tactics make them uncomfortable. They become the enemy. There is no allowance to exist in parallel.
- There is no room for discussion.
This is when you know the game is over, so to speak. Are you allowed to point out an erroneous fact? No. Question a topic? No. At this point, the social justice warrior’s ego has become more important than the actual topic at hand, and no amount of reasoning will change their mind. In fact, it only makes them dig their heels in more. You’ve just given them one more ‘enemy’ to bounce off of.
What does this mean for you, the pet lovers of the world?
If you’re the owner of a small business, rescue, or work with an organization, you may find yourself in the crosshairs for some or other perceived wrong. I’ll talk about what does and doesn’t seem to help in another post, because it’s happening more and more.
How to Spot an Animal Social Justice Warrior
But even you, the general audience out there on the web, has a role to play in this. Before joining a cause or supporting an advocate, ask yourself this:
- How do they respond to constructive criticism? With acknowledgment, or anger?
- Do they have a revolving door of bullies who they claim are always trying to silence them? Do they ever talk to someone with an opposing view in a respectful dialogue?
- How do they encourage action? Do they link to legitimate organizations doing real world work, or is it limited to online petitions, reviews, and Facebook arguments?
- What emotions are they playing to? When you look at their page, do you feel empowered to make a positive difference, or just angry at the world?
If you think this is about one person, you’re wrong. I can’t even point to any one in particular because the truth is, there are too many to list. People like this don’t help the causes, they hurt them. They make animal advocates look bad, incapable of compromise, cooperation, and nuance. Be aware, and ask yourself what the real goals are before liking, sharing, or sending money. Real advocacy exists, but this isn’t it.
We still have lots of work to do, but this isn’t the way to do it.
I’ve spent a lot of time the past few weeks thinking about gratitude, and what it means to me. I was worried that this, the first holiday season without the person who defines it for me, would be horrible and that I would have no interest in celebrating anything. Which is a valid response for sure, but I was hoping I could dredge up enough energy to participate for my kids’ sake.
And then a funny thing happened. I totally was into the whole gratitude thing.
Although my life has had its ups and downs, I would say I’ve been pretty darn lucky, and I’m the first to admit that. This is the first year I’ve had what I consider a truly devastating event, and even that- well, this is part of the human condition. Love and loss, one of the great lessons we learn as humans, one of the great moments for which pets prepare us.
I am grateful for that. I am grateful that my work prepared me for life to the point which I could address loss head on. Sorrow? Yes. Regret? Nope.
I never could have imagined when I started this little blog so many years ago that the people who would show up have turned out to be the most amazing group I have ever met. You have supported me through low points and high (many of which you never even heard about, but trust me, they were there), given me love and encouraged me to fulfill a lifelong dream, allowed me to walk into that bookstore and see my name on a shelf.
I am grateful for readers who, despite a world full of cynics and narcissists, recognize that we are all on the same side. Even when we don’t always agree on the finer points, we all know that hey, we all love animals and do our best in the best way we know how.
Do you realize how amazing that is? How many people spend their lives in anger, drumming up fury over things just because they need something to fill their lives?
We don’t need to do that, because we have all we need. And that frees us up to experience life in all its beauty, pain, and love. Your support and encouragement has in turn given me even more compassion for the people I meet every day, and that is such a gift.
This is the lesson our pets give us every day, and we carry it with us out of our homes and into our interactions with everyone around us.
It is a beautiful thing.
And I am thankful.
The fire came in the night, a storm without warning.
At his home in Middletown, a small town of 1900 just north of California’s idyllic wine country, veterinarian Jeff Smith ventured outside after the worst had passed to find only 8 of the 20 homes in his neighborhood survived the firestorm. With communication centers down, there was no way to determine when help was coming.
He had no way of knowing what he was up against, or the fact that by this time only 40% of the structures in town would still be standing. All he knew was that his community was leveled. So Dr. Smith hopped in his truck and went to work.
The Middletown Animal Clinic, surrounded by gravel that resists catching fire, was miraculously intact. Dr. Smith pulled bales of hay from his feed storage and small buckets to place in his truck, dumping bales of hay and water wherever he could find live animals. The fencing was all gone, burned along with everything else.
Severe wildfires can create their own wind system, creating fingers of flame twirling up to the sky and blowing gales of cinders across roads to catch entire neighborhoods aflame. Dr. Grant Miller, another local veterinarian who serves as Unit Director of the California Veterinary Medical Reserve Corps, was finally allowed in to Middletown the following morning.
“It’s apocalyptic,” Miller said. “It dissolved the entire town of Middletown. The things we saw on the way in…” he pauses. “I can’t even tell you.” With the arrival of a generator and supplies, Smith opened the doors to his clinic and vowed to treat any animal who needed it, for free.
With hundreds of miles of power lines down and roads closed to all but essential emergency personnel for days, the animals were initially left to fend for themselves. Smith treated the many burned and injured animals brought to him, but with the arrival of more veterinary volunteers, teams were able to venture into the area to look for more.
With the small reprieve of rain one day, Miller is convinced it saved the lives of many animals the teams had yet to find. “By God’s good grace it rained an entire inch, and provided some water to these stranded animals. When they’re burned they have insensible losses through their skin. I am in awe of these animals.”
Eight days after the flames, “we’re still pulling animals in,” said Miller. “At first it was a lot of sheep and goats, then steady numbers of dogs and cats. Now we’re finding horses and cows. They’re still finding cats alive in melted cars.”
Teams from the nearby University of California Davis School of Veterinary Medicine assisted with the treatment and are taking the most severely injured animals in. “UC Davis has taken in over 70 burned animals- mostly cats,” Miller said. “They are functioning as a referral center. I just arranged transport for a puppy. They’ve been amazing.”
The Valley Fire now ranks in the top 3 worst fires in California history; at last tally, almost 2000 structures were destroyed. Lake County is California’s poorest county, says Miller, with an average income of about $35,000. “They were economically depressed to begin with,” Miller says, “and now they’ve lost everything.”
In the face of this disaster, Smith vowed to treat all these animals without cost for as long as their injuries require, an estimated 4-6 months.
“Burns are not easy injuries to manage,” says Miller. “His clinic is going to be the last option when everything else is gone.” When the camera crews leave and immediate disaster response withdraws, this community still will need all the support they can get.
Miller pauses again to reflect on the long road ahead, or maybe just from the exhaustion of four hours of sleep every night for a week. “You look at these animals, and you know how much they have suffered. You just want so badly to turn things around for them, and you would move heaven and earth to make it happen.”
A GoFundMe has been set up for donations to sustain the Middletown Animal Hospital during this period. In addition, Wells Fargo is accepting donations at any location nationwide to Wells Fargo Account, #2872526005.
All photos courtesy Dr. Grant Miller. Used with permission.
Dr. Jeff Smith, Middletown Animal Hospital
Some photos may be disturbing to sensitive viewers.
A mobile home reduced to rubble.
Trucks with much needed hay languish on the side of the highway due to road closure
With little fencing remaining, surviving animals were left to fend for themselves.
Middletown Veterinary Hospital treats all animals.
Our hero SuperBrode has been enjoying the relative peace and quiet of Muttropolis, lounging in semi-retirement.
However, evil was afoot! The Malevolent Mast Cell Maniac was on the loose, wreaking havoc on SuperBrode and the good citizens of Muttropolis!
When we last left our hero, he was recovering from their last vicious battle…
SuperBrode survived, but it cost him dearly. Or should I say….D’Early?
Nonetheless, he was well on the road to recovery-
Something seemed….different. Without his Super Fluffy Ears of Wonder working in concert, he felt a little deflated. Or just cold, maybe. So he put his sidekick Tenacious V to work on a Super Secret Project. He thought it was just a hat, but she had other ideas.
When he put it on, his Super Senses were heightened! Treats were falling from the sky!
And even crazier than that, his Bionic Ear seemed to lend certain…powers.
Can it be? Does his Hawaiian ear actually bring to others the spirit of…
He certainly seems to be spreading sunshine wherever he goes.
Tenacious V has built a prototype hat with interchangeable Bionic Ears. Who knows what the future will bring for Bionic Brode?
Perhaps you are the magnanimous sort. “Dr. V,” you say, “I ordered the book but I don’t need the free Halo or Sleepypod stuff or PetHub tag or Dog + Bone collars or Groom Genie or any of those items you are giving away, not even the awesome little activity book with coloring pages and a word search featuring ANALGLANDS and DEMODEX.” You are an ascetic. You don’t have a pet. You’re decluttering. OK, I get that.
But surely you aren’t opposed to a donation in your name, right? I have a treat for you.
Newflands is a New Zealand company, started by a veterinary nurse (don’t give me a hard time, that is what they are called in New Zealand) who was looking for an ethically sourced, sustainable brand of fish oil for her dogs. With none to be found, Fiona started her own brand, and Newflands Hoki Oil was born.
We all know that fish oil is a well-utilized and effective essential fatty acid supplement, with a high ratio of omega 3 to omega 6 fatty acids. Hoki is a fish native to the waters off the coast of New Zealand, but starting this summer it will be available in the United States through Newflands.
Newflands founder Fiona Robertson wanted to support my book campaign with a donation that would also give back to the community, so she suggested a donation of Hoki oil products to a US Charity. We selected Vets’ Pets, a program run by Angels for Animal Rights NYC helping veterans with low cost pet food, supplies, medicine, and deployment support. For every preorder Charity Treat, Newflands will donate a bottle of Hoki Oil to Vets’ Pets to support this wonderful program.
See? Win-win. A book for you, a donation for them. What could be easier?
1. Preorder 2 copies of All Dogs Go to Kevin (if you want them signed, get them from Warwicks)
2. Head over to the Treats Page and select “Shiny Happy Charity Treat”
3. Follow the instructions, including proof of purchase for 2 books
4. We’ll follow up in the coming weeks to confirm the order!
I know I’ve been remiss in posting, and I wish very much I could say it’s because I’ve been so busy creating amazing and exciting book campaigns and creating a plan to hit the NY Times Bestseller List in July. I still want to, don’t get me wrong, and I still plan to at least give it ago. But that’s not why I’ve been quiet.
I guess you could say I’ve been doing nothing. Nothing. Let me explain.
I’ve said to many people when I started working with as a hospice veterinarian two years ago it was like my career and work finally made sense. I liked working in a clinic, I liked the day-to-day stuff, but only two jobs in life ever touched my soul and felt as close as one could come to a calling: writing, and veterinary hospice. Stepping into hospice work was like buying a new pair of leather shoes and finding them already perfectly worn in.
Something deep in my gut implored me to proclaim our work far and wide. I began speaking on the topic at various Ignite talks, the first one being in January this year at NAVC:
Then later, in San Diego in February:
Putting those two talks together forced me to really dig into why I thought this work was so important- first, I realized, we can do a lot to help people understand the process of grieving a pet.
Then, I realized losing a pet is in itself a really important lesson in how to lose a person, or more importantly, how to help them gracefully experience the end-of-life process.
I remember a lot of things about that night at Ignite San Diego, namely about how I said that all people should hire me so their kids wouldn’t stick them in a nursing home later in life because they were too scared to deal with them. I pointed at my parents, sitting proudly in the second row, and said, “See? Aren’t you glad I made this promise to you guys in front of like, 200 people?” And they laughed, because we knew they were young and healthy and that was all a long time away.
It’s funny how that works.
It all happened very suddenly: the fall, the seizure, the diagnosis of my mother’s inoperable brain tumor. One day, my life was filled with the usual concerns, getting annoyed with pseudoscience on the net, figuring out Teacher Appreciation Week. The next day, I forgot everything except this: My mom, still young, beautiful, and full of life, looking at the same diagnosis that made Brittany Maynard a household name last November. It is perhaps one of my worst fears, this particular beast, and now it has invaded someone I love more than words can adequately express. The person who, in any other circumstance, would be the one I called for support.
Now she was looking to me, and then it all made sense, this need to understand the importance of hospice and advocacy and learning to let go gracefully. I wasn’t meant to help other people understand the difference between living poorly and dying well. I was doing all of this preparation, whether I knew it or not at the time, for my own mother.
In the space of two weeks, I moved my parents into my house, earned frequent parking points at the hospital, and had to dig deep into everything I ever stood up for and ask myself if I really meant it when I said I thought people should change how they dealt with illness and end of life in their families:
- Would I help someone honor their own wishes to say no when everyone in an authority position was pushing for treatment? It seems like oftentimes it is easier to do all the treatment than to say no and risk upsetting loved ones who want you to try it.
- Would I be honest with my children in an age-appropriate way or just kind of try to avoid it for a while? Use the old la-la-la-everything’s-fine approach our family has relied on for generations?
- Could I bring this whole experience into my house, ask my husband and my children to take on this really intense experience, when it would be a lot easier on them- in the short term at least- to keep my parents at arm’s distance, in their own home, in skilled care?
The two weeks during the diagnosis phase was an unending slog up and down the linoelum floors of the hospital, trudging from one cramped waiting area to another: CT. Neurooncology. Neuroradiology. Neurosurgery. Each appointment took an emotional toll that far compounded the physical one, leaving mom too pooped by the end of the day to do more than go to sleep. Waiting rooms filled with other seriously ill people nervously picking at the fraying vinyl upholstery, doctors too aware of the gravity of the diagnosis to be able to offer a smile.
My mother was so upset at the prospect of poorly effective radiotherapy she didn’t want that she could barely speak after the appointment with the radiologist. He had recommended six weeks of daily radiation and chemo, tied to those halls and the stale air. Glioblastoma, a poorly researched and dreaded cancer- even in the world of oncology, it’s a bad one- has had few treatment advancements in 25 years. Treatment doesn’t cure the disease, just kind of kicks it down the line a little.
“And if we choose not to do the radiation?” I asked.
“You could do nothing,” he said, baffled, “But I don’t recommend it.” No one did, but nonetheless that was exactly what Mom wanted.
So we did it anyway, leaving through the doors of the hospital one last time into the cool evening breeze of the evening marine layer rolling over, before calling in the ‘Nothing’ that is hospice. So far, Nothing has included the following:
- Watching hot air balloons fly by in their sunset flights
- Getting through all the Harry Potter movies
- A comprehensive plan for managing every symptom, every discomfort
- Greeting the children every morning and tucking them in every night
- Trying every flavor of macaron at the local French bakery (lemon = best)
- Getting our nails done
- Going through old photo albums
- Driving to the beach
Brody, exhibiting that strange instinct most dogs seem to possess, hasn’t left my parents’ side. He’s been so protective, in fact, that he came barreling out of their room last night to bark at me when I got up at 2 am for some water.
My mother has chosen to die well instead of living poorly. But really, I can’t call what she’s doing right now dying. The walls of the hospital, filled with fear and extended wait times and the ever-looming spectre of illness, feels more about dying. She is living. Each moment, each breath of spring air, each hug, is imbued with a gratitude and a joy it wouldn’t have had in a different situation.
I don’t believe one person’s tragedy is any greater or less than anyone else’s, no story more worthy of being told. But I do hope that in sharing this one I might reach someone who is struggling with a similar situation or just looking to understand why a loved one may have made the same choice.
We’re terrified, but we’re ok. We’re devastated, but happy. I have an incredibly high tolerance for stress right now but Rubio’s running out of pico de gallo leaves me in tears. We are doing what we can and continuing what routines we are able to do. We are together, and that matters most.
We are doing nothing but living, and that is enough. It is, in fact, everything. And when all of this is said and done, I regret—nothing.
I always assumed my experience as a veterinarian would serve me at some point when I needed to navigate the human healthcare system. The similarities between veterinary training and medical training, after all, lend themselves to a good number of similarities: how to read scientific articles critically. How to read an MRI. When to call the office and say, this prescription doesn’t seem quite right, is this what you wanted?
The similarities are all well and good, but I never understood, in the marrow of my bones, until recently that what would serve me best was our differences.
We MDs and DVMs are both given an ethical mandate to ‘do no harm’, which we as communities hold dear. Our duties to our patients are guided by this overarching principle; we look to it for direction in complicated cases, fall back on it when we feel conflicted about a request, and hold it like a flashlight when we shine a light into the cave of an uncertain future, looking for direction.
But oh, do those lights shine in very different spectrums.
Recently, a man in Russia volunteered to become the subject of the very first head transplant, an idea that leaves most of the world recoiling in horror. “There are some things worse than death,” said many of the neurosurgeons commenting on the piece.
As a veterinarian, I agree. We veterinarians occupy a strange place in the medical field in that most of us view it as not only an option but often a moral imperative to ease the pain of a traumatic death process through pharmacologic means. We are precise in our process, with the goal of minimizing stress and pain. We view it not as causing death, but as easing an uncurable pain. In this, we view our fulfillment to do no harm.
But in the human medical field, the prevailing attitude is by and large that hastening death is, indeed, harm, and anything we do to prolong a life is conversely fulfilling their requirement to do no harm, no matter what it does to a person or family in the process.
Even if it is multiple craniotomies.
Months of chemotherapy.
Daily radiation therapy with a bevy of ill effects. And you have to get screwed down to the table wearing one of these while they shoot brain shrivelling radiation beams at your head:
Not to cure a disease, but to make a patient breathe one more day, for better or for worse. It is the second most common utterance to me in my hospice work: we do better with our pets than we do our people when it comes to end-of-life decisions, and truly, friends, we really do.
I was recently-by invitation- listening to a doctor outline just such a series of events and possibilities to a patient who didn’t want to partake in them, who has been looking- without success- for someone to say, it’s ok to say no to months of hospital visits and yes to fewer days filled with this:
Plenty of people do want everything we have to throw at disease, and more power to them all. Thank God for modern medicine. But when did it become not only an unthinkable mistake, but an outright affront to the medical community to say, “thanks but no thanks”?
Searching for information on hospice and palliative care has been as challenging as getting bootleg rum during prohibition, furtive conversations in hallways and whispered hints at such necessary things as family support and respite care, secondary concerns far down the to-do list after scheduling yet another CT. I never knew how much of an afterthought the emotional wellbeing of the patient truly is in many medical decision making processes.
“So what if they don’t want to do this?” I asked.
“Well, this is the standard of care,” the resident responded.
“And if they choose not to do this?” I asked again.
“Why wouldn’t you?” he said, dumbfounded. He never did give me an answer.
Do no harm.
In the early days of the Puritan settlements, colonial Massachusetts was gripped by fear. Between the British and French warring over colonial dominance, smallpox, and potential attacks from Native American tribes, the residents of Salem Village lived in a constant state of anxiety and worry for their safety. In addition to these real concerns, an overlying and persistent worry that some people possessed supernatural powers tickled away in their psyche.
When two young girls began exhibiting strange symptoms of fits and screaming (now believed to be caused by fungal contamination of grain stores), the local doctor diagnosed ‘bewitchment’, because why not. The first to be accused were a family slave, a homeless beggar, and an elderly woman- but they weren’t to be the last.
As the hysteria spread and some of the accused confessed in an attempt to save their own skins, others took note: accusing someone you don’t like of witchcraft is an effective way to get them out of your hair while also setting yourself apart as someone virtuous enough to be worthy of bewitchment. Rivalry, desire for power, fear and suspicion, ego- pretty much everything except reality itself seemed to play a role in the accusations.
All you had to do was point your finger and yell “witch!” and out came the pitchforks.
It was quite effective- after all, how can you prove you aren’t a witch? After all was said and done, 19 people were hanged that year before everyone came to their senses.
The evidence that sent them to the gallows? Dreams and visions; and of course, some very self-assured charlatans.
Nowadays, we scratch our heads at how this could happen, how people could go so easily down the road of hysteria and gullibility. Or do we?
In 1998, a medical researcher named Andrew Wakefield published a now discredited study linking the MMR vaccine and autism. Young parents, petrified at the increasing incidence of autism in children and worrying that their own choices could play a role, began delaying or declining vaccines altogether.
In first world countries where preventable diseases were being, well, prevented, parents felt the risk of a vaccine injury was now greater than the risk of the disease itself. There’s only one problem: it wasn’t true.
As the research proved Wakefield a fraud and everyone came to their senses, the medical community assumed that people would go back to business as usual. But, people are funny creatures, and sometimes we don’t really evolve. It only took the people of Salem a year to come around, but a strange thing happened at the turn of the millennium.
The “all natural lifestyle” turned out to be a very lucrative phenomenon, tapping into all our current fears: corporate conglomerates controlling the food chain. Large pharmaceutical companies more interested in lining their pockets than curing disease. Money over health. Go back to nature, they proclaim, and the world will be a better place.
The era of social media. There was a time where in order to be heard, you had to earn a spot at the podium through having something worthwhile to say. Now, you just have to get there first and have the loudest megaphone. Also: be a babe.
On the sidelines of the ‘nature vs chemicals’ battleground, people with no stake in either the pharmaceutical industry or the coconut oil industry shook their heads. “But look!” they said, holding up science papers. “That’s not how it works! GMOs aren’t causing cancer, vaccines aren’t causing autism, and pet food doesn’t contain dead cats!
“I appreciate your desire for transparency in consumer goods,” they continued, completely misconstruing the authenticity of those with the pitchforks, “but do we have to say things like airplanes should contain 100% oxygen and a bleach enemas cure autism? Surely we can be reasonable here.”
They smiled, holding their papers in front of them with their palms up, waiting for the coconut salesmen to welcome them with open arms.
The coconut salesmen, who had just celebrated their millionth Facebook fan and launched a new website selling crystals, lowered their pitchforks. They looked at the people with the papers, pointed their fingers, and in a clear, loud, voice they yelled-
And the pitchforks came out, because how can you prove you aren’t?
A word from the stake
Whenever I speak on the worrisome outcomes of the current trend of science illiteracy, people say to me, “but don’t you agree that pet food should be transparently sourced? And that companies should tell you where their food comes from?” I imagine them saying this as they hold a match to the pile of wood underneath my feet, shaking their heads sadly.
And to those well-meaning but nonetheless about to burn me people I say, “Yes, but I don’t understand how you can make the leap from ‘I’d like more information about my food’ to ‘Subway contains yoga mats’ and ‘vanilla ice cream contains beaver butts.’ ”
Industrialized society is a double-edged sword. There are great benefits and some pitfalls, worthy of trying to improve. But why bother with such nuanced debates? It’s much easier and faster to call someone a shill. Next!
Toxins are today’s sorcery. Shills are the modern day witch. I take pride in being put to the stake, because I know history will vindicate me. And the only reason I’m not laughing at the absurdity is because while we sit here and have these nonsensical fights, children are dying. And there’s nothing funny about that.
I have an idea. Let’s make this a week where we all walk away with at least one new idea, one way to make things better for the animals we work with and/or love.
ETA: I’m actually going to pause and take a little more time with this idea, and hopefully get more ideas and more people involved! Stay tuned!!
Today, I want to remind everyone of the best way to approach a nervous dog, featuring a short clip from Dr. Yin:
I chose this for a few reasons:
1. I don’t know any people who teach their kids to do this;
2. I don’t know any vet offices who teach their staff to do this;
3. I don’t do this (that will change)
It’s no wonder that pets who routinely come to the clinic to get stared at head-on, tackled and/or pinned for a nail trim and then get their temperature taken have no interest in coming back. I am so glad my OB/GYN doesn’t take that approach; there’s really no reason we can’t make some changes for our pets too.
A simple change in body positioning can make all the difference to a nervous dog, which is better for the dog and better for you. If you work with animals, make a promise to try it this week and report back. And if you don’t, make a promise to try it with a pet you meet out and about, or teach your kids to try it out. Please, please teach your kids to try it out, if they are of the “I love and want to meet all dogs” variety.
For all you Instagrammers, I propose a #lowstress tag this week where you post a picture of a good low stress handling technique. There may be prizes. Let’s make this a good week, what do you say?
This is not about Sophia Yin.
I feel the need to say that before launching into a discussion about suicide and depression in the animal community, because the horrible news that she took her own life and the ripples it is causing in the veterinary world is the reason I’m talking about it today. But it’s not about her or her situation, which none of us will ever really know; Dr. Yin’s legacy is the work she did during her life, and it should remain that way. This is not about one person.
Whenever a tragedy like this happens, I see the same posts over and over: “Shocking. Tragic. Hold your loved ones close and tell them you love them. If someone seems to be suffering ask if they are OK.” And so it goes for a day or two, as we hug our kids and our spouse and our dog and then go back to work and assiduously ignore the suffering of those around us. Not that we recognize it most of the time anyway, but I’ll get to that in a moment.
One of the biggest misconceptions people seem to have about stress, burnout, and depression is that it is inevitably obvious to those around the person. I blame Zoloft ads for making us think all depressed people walk around weeping with little clouds hanging over them.
I think a lot of depressed people look like this:
Totally fine, I’m fine, I’m fine.
You know how we always say cats walk around looking like a million bucks with BUN levels through the roof until one day, way past the point it was an issue, it’s finally too much but you never had a clue? A lot of depressed people look like that. So maybe this is a little more accurate:
They do just fine at work, and out amongst friends, and then come home and realize man I am not fine. But we’ve normalized stress in our lives to the point many of us don’t even necessarily recognize the signs of depression in others, and even in ourselves. I sat on the floor of the bathroom for four hours straight one day, when I was suffering from postpartum depression, and still had no idea that sitting on the floor of the bathroom unable to muster the energy to move two feet might be a sign something was wrong (protip: it is).
I don’t like talking about that time in my life, but I will because every time we censor ourselves from discussing these things we perpetuate the stigma that drives people away from seeking treatment. We are more scared of the consequences of admitting depression than we are the consequences of not being treated, and oh my god, how awful is that? I’m pretty sure the mental health professional community has been watching us in horror for years, waiting for us as a profession to finally say yeah, we could probably use some assists here.
So while asking someone if they are ok and offering virtual hugs is lovely and kind, I really think the time has come to try and do something a little more impactful. Open dialogue is a good place to start. So let me share some things that I have discovered over time, watching us wring our hands in despair over and over while we wonder what we could have done differently:
1. You would not believe how many other people out there are going through the same thing.
People at the top of their field, with lovely families and good jobs and beautiful dogs. People who seem to have it all together. And maybe they do, if they have good treatment.
2. I wish someone had told me about these things in vet school.
I thought I was the only person plagued by worry and self-doubt in school. In retrospect, ha! That was really not the case. Nonetheless, a little peer-to-peer support or support from people already out there would have been very reassuring. I believe we need to start letting people know at the start of their career, not at the middle or end, that stress/anxiety/depression/burnout are common, but solvable problems.
3. There’s support, although it’s hard to find.
Do you know what the hardest part was for me about getting through my depression? Figuring out who to call. My OB didn’t help, the psychiatrists she gave me the numbers for didn’t take on new cases, I wasn’t actively suicidal, and by the fourth call I was too tired to deal with it any more. So I laid on the bathroom floor for a few more days until I had the lightbulb idea to call my primary care physician, who was horrified and got me in that afternoon and life got a lot better after that.
I feel like our profession is still in the same place. Help should be very visible and easy to access, a rope already floating in the water instead of a life preserver someone has to yell for when they are drowning. Want to really do something to make our profession better? Help me figure out how to make that happen.
So you think you’re depressed/ burned out/ feeling off? Take a deep breath, you are in good company. You do not stop being a successful professional and accomplished person. Life can be good and you can still rock out and kick ass and laugh till your cheeks hurt. Here’s some places to start:
1. There is active peer support, through VIN, and on Facebook. A closed group has been started on Facebook for people dealing with these issues as well as their family and friends- to request membership, click here. Peer support is fundamental, though of course it is not a substitute for-
2. Calling your primary care physician, who if they cannot handle it themselves can at least get you where you need to go. I guarantee you every mental health professional out there is going “uh, of course,” at every thing I have said because they are experienced in these things, while we are not.
3. Stop googling. Seriously, all you will do is come out blaming yourself for not juicing enough and while it is a lovely way to get vitamins, it’s probably not going to be enough. Talk to a pro, just like we tell people to stop treating their dog’s ear infections with diluted alcohol that they read about on a yahoo group and go to the vet. Right?
4. VetGirl has offered their excellent webinar about suicide awareness available for free, for everyone. It is well worth the watch not for anyone who works in the field to help increase your understanding of the issue. You can find it here.
5. VIN is offering a webinar this Sunday at 9 pm PST to honor Dr. Yin and discuss “Dealing With You and Your Colleagues’ Stress and Depression.” My understanding is that this webinar will be made available to non-VIN members as well, so stay tuned as I get more information. Both webinars, by the way, are taught by mental health professionals who know their stuff.
I will be honest and admit I hate overly sentimental statements accompanied by soft-focus ocean pictures like “fall into my arms and I will catch you” and “the world is full of hugs if you just ask for them” and all that other stuff, so I will offer you my own personal unfiltered thoughts on this:
Depression sucks, and it’s real, a physiological crap storm of neurotransmitters, and if you are reading this experiencing a dawning sense of dread with unasked-for tears rolling down your face as you desperately say nonononononono I’m fine, you might not be. So call someone who can help so you can stop feeling miserable, ok? Do it today.
OK maybe one overly sentimental picture. But just one, and only because kittens. And with that, I demand some good news so we can get back to our regularly scheduled program of fur removal device discussions and derpy dog pics.
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