This has been an almost unbearably terrible week for those in the veterinary profession, and those who love animals. First the awful news that Dr. Sophia Yin had passed away, and then not one day later, we learned of the passing of another tremendous voice and educator, Dr. Lorie Huston.
Like many of you I considered Dr. Huston a friend. She was extremely well regarded for her work online as the Voice of Pet Care with the Pet Healthcare Gazette, her many contributions to various publications, and most recently her position as president of the Cat Writer’s Association. But I think even more than her fantastic work, she was admired for her kindness.
Her gentle manner and empathy were unrivaled, and a shining example of the compassion that veterinarians so often extend to animals but sometimes struggle to extend to each other. She never had an unkind word for anyone. I don’t know how she did it. She made me want to be more like her.
As a denizen of the online community, I have nothing tangible to offer in condolences, no casseroles to deliver, no walls to place a white flower upon. All I have are words, those intangible, ethereal ideas that seem so unremarkable in the face of such sadness, and my attempt to express them in the hopes that in some small way they help someone else understand what Dr. Lorie was all about. And because I cannot bear to cry any more today, I want to instead share a story that will maybe make those of you who knew her smile a little through your tears.
The Marble Room Incident
A couple of years ago, the AVMA national convention was in San Diego. I touched base with Dr. Huston and learned she would be attending, and made plans to meet up with her at the Winn Feline Foundation booth, where Dr. Huston was sharing the work the foundation is doing to advance the health and well-being of cats. Dr. Huston had six cats, six well-loved, adored felines.
“Shall we go get dinner?” I asked, and she said she thought that would be a good idea. We walked a little bit through the Gaslamp district, and as I was starting to get tired I saw the name of a restaurant I had been to before and said, “How about the Marble Room? They’re great.” Lorie agreed.
I had been to the Marble Room with my husband shortly after it opened, a throwback steak house type place with amazing truffle fries. That was how I remembered it. No one told me they had changed ownership.
We sat outside since it was a pleasant evening, which in retrospect was an error since had I gone in I would have seen the new theme: old timey bordello masquerading as a saloon. Within a minute, what I thought was a streetwalker but was instead an embarrassed-looking server in a too-tight corset and can-can skirt asked us what we would like to drink.
“Iced tea,” Lorie said with a pleasant smile, as I sat horrified. “Me too,” I squeaked out. “Are these uniforms new?”
The server nodded with a frown, trying not to catch the edge of the menus on her fishnets.
A quick Google search would have helped immensely in this situation.
So Lorie and I shared a pleasant meal of not-quite-as good as I remember truffle fries while we talked about the role social media played in the evolution of veterinary medicine.
As always happened when we spoke, I was blown away by how sharp she was- never mind her calm and quiet demeanor, her brain was always churning away a million miles an hour about what the next big step was in improving the human-animal bond. Her greatest gift, as many of you know, was in explaining these complicated health concepts in concise and clear language. She made medicine accessible, and to those like me who knew medicine, she made social media accessible too.
Midway though dinner, she excused herself to find the ladies room. When she returned, she assured me that she located it just fine. When I followed suit a moment later, wedging between red leather banquettes towards the back, I saw that the hall leading to the ladies room was hard to miss as it was covered in, uh, tasteful I guess, nudes. I paused a moment to dab my forehead with cold water, mortified that I took poor, sweet Dr. Lorie to the world’s tackiest themed restaurant for subpar potatoes.
Seriously, naked people everywhere.
When I returned, Lorie was talking to the server and quite kindly ignoring her attempts to hold her top up as she cleared the plates. “I am so sorry,” I said. “This is not the place I remember.”
“Oh no, it was delicious,” she said kindly, ignoring the rest of the situation. “The truffle fries were excellent. Thank you.”
And that was Dr. Lorie, always. Gracious to a fault. She was generous with her friendship, advice, and compliments, even when they were not deserved, even when her friend subjected her to an awkward, PG-13 rated evening out after a long day at the conference booth.
She will be missed.
When I was in school, I accumulated a lot of textbooks. Books from the titans, the Nelsons and the Feldmans and the Fossums. I stood in line at the bookstore with these heavy tomes weighing me down, and noticed every other person in line with a tiny mahogany text balanced on top of their piles.
“What’s that?” I asked.
“The Nerdbook,” they said. “I heard you can’t make it through vet school without it.”
I had an earlier edition, because I’m old.
They were right. I spent many hours in rounds with my Nerdbook balanced on my lap, trying to look up answers to questions before the clinican called on me. It was unlike any other book I ever owned: concise, easy to navigate, organized by clinical signs to be completely usable. I heard it was written by a veterinary student, which made sense because it was so perfect for the way we used it, but also made no sense because who had time to write a book in vet school?
“Some gunner student a few years back,” I was told. “She was brilliant.” The author? Sophia Yin.
It was the only book I brought to the teaching hospital each and every day, taking it with me the following year into clinical practice: highlighted, scribbed on, well-loved. One time, I made a diagnosis that my clinician, a man who had been in practice for 167 years, said was impossible. “How did you know to put that on your differential diagnosis list?” he asked, before telling me I would be an amazing internal medicine resident. “Oh you know,” I said, but the answer was it was in the Nerdbook. Dr. Yin told me. The Nerdbook was everything. My techs used to hide it from me sometimes just to watch me panic for a few minutes.
Dr. Yin’s name popped up again soon after I began work, this time as a behavior expert. When she got into practice, she again sensed a void: a need for reasoned, science-based behavior approaches that would keep pets in homes and out of shelters. It’s hard to imagine now, but in the early 2000′s behavior was held in lower regard than specialties like neurology or internal medicine, a fluffball elective. “Nothing in life is free”, the foundation of positive reward based training, was in its infancy. Alpha rolling was still the norm in many circles, and training programs based on shock collars were being franchised left and right.
She helped lay the groundwork for what we now view as the best science-based approach to training, one of the most fundamental paradigm changes in our field in the last decade. Dr. Yin became a world-renowned behavior expert and fierce advocate for positive training, an amazing communicator whose lectures were always overflowing into the halls by an audience who finally recognized that her advice, when passed onto clients, was saving lives.
Though she was often known as a dog behaviorist, I remember her most for a series of cat lectures I attended at Western around the time Apollo was marking in the house. My husband was about to lock him permanently in the garage. In one hour, she gave me enough actionable tips to fix the problem, for me, and later on for clients and blog readers. Those tips keep animals out of shelters and in homes.
Dr. Sophia Yin- you are missed.
Dr. Yin’s latest work is, again, revolutionary. As a board member for Dr. Marty Becker’s Fear Free Practice movement, she is one of the key figures teaching us low-stress restraint techniques that change the way we practice medicine. It makes sense, right? Why do we just accept the fact that pets hate the vet? Why do we not try to make it better? Just this week I used a technique of hers I watched on video to help bring a frightened cat out from under the bed; he was already ill and the last thing he needed was more terror. Dr. Yin’s reach and her influence is everywhere, her touch felt every day in the way we practice modern medicine with compassion.
Dr. Yin was the best of what veterinary medicine is all about, a passionate veterinarian, a dedicated revolutionary, a person whose accomplishments knew no bounds, an inspirer of colleagues. Her unexpected passing has left so many saddened; I hope her family and friends know just how much she was beloved by so many people. Thank you Dr. Yin for everything. You will be sorely missed.
My first year of practice, I was talking to an owner in an exam room when I saw her eyes go wide and she yelled, “SPIDER!”
I looked down and saw a large arachnid crawling across the table towards her poodle. Without missing a beat, I grabbed a large drug compendium and put an end to the assault. The lady looked up, cocked her head, and said, “I guess you don’t love all the animals, then.”
I felt terrible, actually. My grandmother would not have approved. She would capture daddy longlegs in little glasses and transport them outside, or just as frequently, leave them alone. “They eat bugs,” she said. “It’s bad luck to kill them,” she said.
But I didn’t live with my grandmother, my dad’s mother. I lived with my mom, who learned from her mom that the best way to deal with a spider was a Dr. Scholl’s sandal, the one with the big wooden sole.
I think about that day, and how I would have to make up for it lest I be followed through my life by angry hordes of spiders. As you are about to see, I think I’m still paying.
Yesterday, the kids called me in to assess a spider situation in the guest bedroom. It was, they claimed, a huge spider, which could mean anything from “dime sized” on up. I went in, and yes, it was actually a huge spider. Probably an inch or two across, I didn’t get too close.
The good news was, it wasn’t a black widow or a recluse, and in the interest of being good to my grandmother’s memory I told the kids, “let’s just shoo it under the armoire. See? It’s as scared of you as you are of it.” I did not notice the tiny peals of laughter from the spider as it ran away. I did not realize she was simply approaching us with a familial sense of pride to show off her brood.
A couple of minutes later, my son came out again. “There’s a bunch more,” he said.
“What?” I asked. “Spiders?”
“Yes,” he said. “Like, 8.”
I went back into the office, a sense of disquiet taking over me. “Where?”
“On the bed,” he said.
And there, crawling all over the guest bed, was an army of teensy tiny baby spiders, which had apparently just hatched from whatever hellspawn was hiding under my armoire.
No. I do not love all the animals. This I can say now with great certainty.
Since I can’t find my flamethrower, I was stuck with simply tossing the entire set of bedding out into the courtyard with a scream and spending the next two hours vacuuming every nook and cranny in the room, stopping only long enough to call my husband on his work trip and freak out into the receiver. The mother spider, of course, was now nowhere to be found. Her work was done. For now, at least.
I was up until three in the morning startling at every shift of the bedsheet. If anyone can recommend a good pest control service in San Diego, I need one out stat. *shudder*
I remember this about September 11, 2001: I felt very lonely.
It was my senior year of veterinary school. My husband, who had only been my husband for about 2 months, was far away in San Diego. My mother was the one who called me, waking me up to tell me to turn on the news. She was alone too, as my father was on a rare business trip in Texas, one he ended up having to drive home from. We held the phones to our ears together until there was nothing more to do, so I said, well, I guess I ought to go to school.
I was doing a rotation in a lab that week, spending my day alone in a dark basement underneath the medical school looking at slides. Every few minutes I’d wander upstairs where I could get radio reception, and the other lab denizens would join me for a few minutes before we retreated back down to our holes.
Later that afternoon, after I returned home, there was a knock on the door. It was two nicely dressed missionaries. “How are you?” they asked.
“Not so great,” I said.
“Why?” they asked, genuinely concerned. “Do you want to talk about it?”
“Do you have any idea what’s going on?” I asked. They shook their heads in confusion. I shut the door.
Behind me, Nuke gently pressed his head into my hip. I had adopted him the year before, thanks to my friend Dan. “I want a dog,” I had said. “A Golden, maybe, or a pug.”
“I have just the dog!” he said, before referring me to the radiology department and the 10 year old coonhound who had been getting irradiated on a weekly basis as the vet students learned how to take films.
“He’s not housebroken and doesn’t know what outside is, so he’s a little addled. If it doesn’t work out, it’s ok,” said the tech. “They were going to euthanize him so I figured, I’d give it a shot.” No pressure.
He was a little addled. He was the dumbest dog I’ve ever had. He was neurotic and howled if he was outside for more than 2 minutes because he was scared of open spaces. He refused to learn ‘sit’. I loved him.
In those long and sad days after September 11, he was my greatest comfort. He died of cancer shortly after I graduated the following year. I miss him.
This Sunday marks National Pet Memorial Day. I hope you’ll join me in thinking of those we lost, or sharing a memory below. They leave this earth but they never leave our hearts.
A week ago, I called my husband on a business trip in China for the urgent assistance in locating my DVD of Aladdin.
“Why do you need it this very second?” he asked. “You haven’t watched that in like 15 years.”
“I know,” I said, “But our daughter is singing a song from Aladdin in summer camp this week and she really, really needs to see this movie.” She’d seen it once before, years prior; my son hadn’t seen it ever. It was an unforgivable omission, one I felt an almost irresistible need to fix.
So we sat down and watched it, this movie that came out when I was still in high school, and I marvelled. The computer animation looked so dated now, the pop culture references flying over the kids’ head like a magic carpet. But it worked. It still worked, and it was all because of Robin Williams’ genius.
He wasn’t a person who had been in my thoughts much in recent times, though he was a fixture of my childhood from Mork and Mindy through Good Will Hunting, Patch Adams, Good Morning Vietnam. Watching Aladdin rekindled my interest in his unique body of work and I’ve been on a Robin Williams binge this last week- Aladdin followed by The Birdcage, Good Morning Vietnam, and Mrs. Doubtfire scheduled for later this week. Robin had, in addition to his brilliant improvisation and manic energy, an exquisite ability to layer melancholy and sweet, delving into the deepest pains of humanity in a way that made you hopeful despite its ugliness, a compassion that balanced the sometimes cruel realities of being alive. He inhabited those characters in a way few others could. Williams and Alan Alda, the actors that defined the genre for me.
That level of perception and intuition about the human condition, often begets a certain creative brilliance. Comedy relies on it. It also, as we all too well know, often drags along behind it a heavy dragline of depression. It is the contrast upon which such artistry must be laid in order to make it pop. It takes an awful lot of mental energy to wield the two simultaneously, I suspect. No one described it better than, well, himself:
Phenomenal cosmic power!
iity bitty living space.
Depression is not a fight that can be won, a demon vanquished. It’s simply there, a weight people carry around and manage the best they can. Robin wrought his depression like a kettlebell, swinging up and down and up and down and in the process put out the energy that was-is- his legacy. I can only imagine how exhausting it must have been, but he did it, over and over, though his life. He made it work for him.
He was a dog lover, you know. Of course he was, right? When you live with that kind of pressure and expectation from those around you to be on all the time- why aren’t you saying something funny?- the presence of an unconditionally accepting creature is a comfort and a joy.
Having so recently been drawn back into his life and his work and his bright eyes that never entirely belied the stormy grey beneath, I was so enjoying re-experiencing the creative rush of his work, immersed in how much he gave of himself to make others smile. Today was a shock, in many ways.
And I guess that is why so many of us are so insanely devastated, at least I know I am. He always made his depression work for him, turning the swirling rivulets of thought and extremes in his brain and transforming them into art. I see in the world the same sort of wide eyed despair that followed Kurt Cobain’s death, that sense of hope snuffed out. I think a lot of people looked up to them both. They were proof positive of the transformative power of creative will, but while Kurt succumbed at a young age, Robin managed to persevere, and that made him even more infallible in our eyes.
I thought he had it figured out. With all his success and fortune and mastery of substance abuse, he was a tick mark on the list of success stories with this particular type of chronic disease. I thought he had won the battle. I was wrong.
We are reminded today, yet again, that depression is a fire that never gets put out completely, a smolder you can never turn your back on. Never, ever.
We’ll never know why this time was different, why today was insurmountable when every other day was a day to soldier on, but the world is all the dimmer with the Genie flown back home to the Cave of Wonders, beyond the horizon and beyond our grasp. All we can do now is celebrate the shimmer he left in his wake.
Look out for one another, friends, help one another. It’s a rough world out there, and we need all the joy we can get. We need each other. Tolkien said it best: “Despair is only for those who see the end beyond all doubt. We do not.” We do not.
RIP Robin, kind sir. Thank you.
In the olden days, people used to turn to carnival medicine men or the back pages of Look Magazine for the latest way to solve all of their problems. People don’t change, just the technology. Now we have the internet to turn to. If the web is to be believed, and it always is for some reason, there is a new cure for all the world’s ills. That cure is coconut oil.
It’s good for your hair, your skin, your GI tract, your dog, your mental health, and your aura. It’s anti-inflammation and pro-synergy. You can rub it on your scalp, then scrape it off and use it to cook, or sit on the leather couch and make it more supple. I don’t think there is a single malady out there that someone has not suggested coconut oil can fix:
Dry skin? Coconut oil.
Dry face? Coconut oil.
Yeast infection? You guessed it.
Alzheimer’s? Eat up.
Athlete’s foot, acne, depression, hemorrhoids, anxiety, UTI, weight loss, heartburn, autism. I guess what I’m saying is you could nuke your local CVS and be just fine as long as there was a Whole Foods next door, because coconut oil’s got you covered.
I’ve done a Whole 30 challenge, which is a no-processed food crossed with a tinge of Paleo, so I’m no stranger to coconut oil. I’ve cooked brussels sprouts in it, stirred it in my coffee, used it to make paleo pancakes. They were good.
Sadly, at the end of a jar I have to say my life has not substantially changed. Everything broken in me before is still broken. Coconut oil, while delicious and no doubt healthier than, say, margarine, has not eliminated my need for my allergy inhaler. I asked my doctor if I could try shoving coconut oil up my nose instead, just for a little while. It’s way cheaper than Dymista. She didn’t think much of the idea. When I told her I was just joking, then she sighed and said, “I get that question a lot.”
While coconut oil is unsurprisingly gaining steam in veterinary medicine, we have an equivalent that already enjoys legendary status in the home remedy category: pumpkin.
Long treated as the pet pepto-bismol, pumpkin is the go-to far various GI maladies spanning the range from constipation to diarrhea. It’s a great thing for the colon. It’s a great source of fiber and most pets will eat it. Pumpkin is Metamucil in a more holistic package.
What pumpkin is not is everything else, like an anti-emetic or anti-inflammatory or something that will teach your dog to talk. Like, it’s no coconut oil or anything.
On a friend’s Facebook page, she recently asked if it was possible for a pet to develop an allergic reaction to a food they’ve been eating for years.
10 people chimed in (correctly) that yes, this happens. Then someone said, “Why do you ask?”
“Because my dog’s been throwing up every time he eats all of a sudden.”
As a veterinarian, my mind immediately collates a list of the differentials when I hear something like this. 3 year old pit bull, history of being a destructive chewer, clearly the problem is “pumpkin deficiency.”
Which is exactly where the comment thread went.
“OMG! You need to give your dog some pumpkin.”
“Seriously! My dog loves it.”
“Pumpkin cured my dog’s farts.”
“Pumpkin is a great source of electrolytes.” And so on and so forth.
Don’t get me wrong, I like pumpkin. As far as advice on the internet goes, it’s one of the more benign things I’ve read and unlikely to cause harm. My only concern is that people recommend this in lieu of something that might actually work, such as starting with a correct diagnosis. Fortunately this person has multiple veterinary professionals on the thread, and somewhere in between pumpkin recommendations she got some solid advice.
A couple of weeks ago, my neighbor came over with her adorable 6 month old Golden Retriever. She hopped back and forth on her toes before asking me if I had any thoughts about her dog’s diarrhea.
“How long has it been going on?” I asked.
“Go to the vet.”
“We’re going tomorrow,” she said, “but in the meantime……do you have any pumpkin I can borrow?”
I did. It’s on the shelf next to the coconut oil. Hope springs eternal.
PS The dog improved dramatically … once the vet diagnosed Giardia and started Flagyl.
I am training for a half marathon.
I thought about training for a full marathon, but then the reality what that was like the last time I attempted it kicked in and I remembered that oh yeah, I don’t like to run. I think you can do a full marathon once when you don’t like to run, just to say you did (Rock n Roll 2001 for me), but after than there’s really nothing to prove other than, “oh yeah, this hurts.”
A half marathon though, is doable. Still not fun, but manageable. I have decided, along with my friend from the gym who I kind of hate because she keeps inviting me to things such as “Summer Boot Camp!” and “Half marathon! It’ll be fun!” and I keep saying yes, that should we complete this without killing ourselves, maybe, just maybe, we will try and tackle a triathlon before our 40th birthdays.
Do they let people leisurely triathlon these days? All my competitiveness gets used up in my professional life so I have none left over for this.
Anyway, the point is I am doing this and it’s a grind, but I keep remembering that health is a gift and blah blah blah; I’m training with a group because it’s the only way I will drag myself out of bed at 6 am for the long Saturday runs.
Brody doesn’t come with me on those. He can manage shorter distances, but he’s made it clear he’s not yet ready for anything over 3 miles, tops, despite his summer cut. I appreciate that.
This Saturday I ran (‘ran’?) 9 miles, which sounds alternatively fantastic and psssshaw depending on where on the running spectrum you fall. To me, this is the longest distance I’ve done in a single day since I staggered off Mt Meru a few years ago, and that was because I had to since there was no oxygen up at the top.
I’m hunched over because I couldn’t straighten up, not because I voluntarily felt like standing that way. Teri is hanging on for dear life.
So after 9 miles, at the end of which I realized my entire body was numb from the waist down, I came home and sat on the floor to stretch. Soon enough I was laying on the floor, like one of those crime scene outlines.
020 0120 7141 023 0123 7173 Small is Beautiful Floor Black Still Life, by Steve James on Flicker
I began to appreciate why dogs do this, this splat sort of positioning. The wood was cool. Soon I melted and became one with the floor. Why don’t I do this more often? I wondered, and when my daughter asked me why I was doing that I realized it was not really possible for me to make it onto the couch at that particular moment.
Brody was excited I was in his domain, plopping down nose to nose and looking at me like, “Hey! What are you doing here?” He stared at me for a while, and then I decided I needed to stretch if I ever was to have hope of standing up again.
It went about as well as you’d expect.
Dogs don’t understand why we would come into their territory for any purposes other than play, and Brody was having none of it. He laid on my foot, licked me in downward dog, and dumped a soggy tennis ball on my stomach when I tried to stretch out my hip. It’s clear I’m not alone in this.
Dogs are awesome at many things, but sitting quietly by while you sit on the floor and bend into weird shapes is not one of them. If you’re going to goof off, they figure, might as well let me in on the fun.
Anyone else have a dog who simply won’t let you on the floor by yourself?
When I took my son in for his first routine eye exam, I had no idea he needed glasses. Neither did he. He seemed fine, wasn’t running into things, was reading fine in school, but nonetheless the optometrist suggested glasses. OK, I said, let’s give it a shot.
One week later, his glasses arrived and we went into the office to pick them up. He picked them up dubiously, slid them over the bridge of his nose, and stood there for a moment, blinking as the refracted light hit his retina in new and improved ways.
He spun, slowly, taking it all in. His lips twitched, burbling with something important. When he could no longer hold it in, he opened his mouth and shouted, “I CAN SEEEEEE!!!!”
Boy did I feel like a horrible mom as the assorted clients turned to see this blind boy get his sight back.
Later that week I was sharing this story with a friend. As we were talking, her daughter picked up my kid’s glasses and put them on just for fun to see how weird things looked.
She came over and tugged on her mom’s sleeves. “Hey mom. Things look pretty good with these things on. I think I can’t see too well.” Then I felt less bad. It happens to us all.
We thought things were fine, my kid thought things were fine, and then someone with tools I didn’t have access to and the ability to evaluate things said, “Actually, life can be even better.” And it was.
I think of this all the time when people say, “Oh, Buster’s doing fine, he doesn’t need an exam or meds or anything.” To a client’s eye, he is fine. His gait is the same it’s always been. But I can pick up things they don’t, that slight crunchy feeling in the knee, a stiffness when I extend the leg. It took some doing, but we convinced that lab’s owner to try some Rimadyl.
Or the dachshund who came in for a routine dental. “He’s fine,” the owner reported. “He eats kind of slow but he’s been that way since we adopted him two years ago.” When we opened his mouth, the fetid odor of eight rotting teeth hit my nostrils, teeth held in by tartar more than by tissue at that point. It took some doing, but we convinced the owner to let us remove them.
In both cases, we got a call about a week later to marvel about this new dog in the house. “He’s like a puppy again! I can’t believe his energy! Who IS this dog?” Like my son spinning around in the optometrist office, they had a problem they didn’t even realize existed lifted from their shoulders, and got to experience something better for the first time.
In the year since their last eye exam, both kids seem to be perfectly fine, but I took them in dutifully anyway. Both of them need new prescriptions. This time, I don’t feel so bad. Big things we notice- small ones? Not always.
It isn’t my job to evaluate such things in my kids, or to be able to recognize the more subtle signs of something needing help. All I need to do is get them to someone who can, on a regular basis. Next stop: orthodontist. Lord help us all.
Just a little reminder to everyone that there is a reason we recommend yearly (twice yearly, for older pets) checkups at the vet. We’ll probably find things you weren’t aware of, and that’s OK. That’s what we’re here for! Every pet deserves the revelation of improved health.
In the depth of my despair when Apollo was dying, the medical resident at the specialty hospital made a comment I will never forget.
He was dying of a blood clot, a sequelae of hyperthyroidism and heart disease. I was in shambles, having come home from the gym to find him immobile on the couch, and rushed in straightaway, sweaty and spandex-y. I scribbled his medical history as quickly as I could, which the resident pored over with her intern as I sat in the room planning to say goodbye. I knew at that point it was coming, I was just waiting for confirmation of the diagnosis.
I had checked ‘yes’ to allergies, in the interest of being thorough.
“What allergies?” the resident asked.
“Food allergies,” I said. “Chicken.”
She paused, and shared a knowing glance with the intern. “And how do you know this?”
I blinked. “I’m sorry?”
“How do you know he has food allergies? Did you just assume, or did you actually test him?”
“I….I did an elimination diet, 10 weeks…not the full 12…. but it was obvious by that point,” I stammered, though what I really wanted to say is “WHAT THE HECK (ok maybe another word) DOES THAT HAVE TO DO WITH THE PROBLEM AT HAND?? WHO CARES HOW HE WAS DIAGNOSED WITH AN UNRELATED MANAGED CHRONIC CONDITION A DECADE AGO??”
But you know, I just sat there because what are you going to do.
OK sure, let’s talk more about Hills z/d and then can you please get this cat some morphine?
Now, I understand that a teaching hospital is going to teach, but from the patient perspective I suppose I would appreciate the teaching being limited to the issue at hand instead of using an emergency cardiac event to make a point on dermatology. I don’t know if it was that, or the way she asked the question as if she were sure I was going to give the wrong answer, that rubbed me the wrong way. I also had to tell her not once but twice that I didn’t want to hospitalize him on the off chance his clot might dissolve enough to give us another month at home. We didn’t hit it off.
Fortunately I didn’t see her after that and was turned over to the lovely cardiologist who looked and talked like Oberyn Martell and understood when I said, “Please confirm my suspicion so I can give him a peaceful goodbye at home”, but it really reminded me, from the other side of the table, how hard it is to be a patient advocate for our pets. I knew what I was doing and I still had to push a little. It was a lonely experience.
It’s even worse in human medicine, as this ER physician who was hit by a car will attest to. Without someone who knows what’s going on to oversee the process and keep the focus on the overall wellbeing of the patient, things fall through the cracks. Flustered and underinformed family members get confused. Specialists focus on this problem or that problem and not the patient. How can we do better?
Um, no, actually.
In human medicine, many hospitals now have designated patient advocates who serve as an invaluable liaison between a family and a healthcare provider. In veterinary medicine, it’s not something I’ve ever heard of, so we’re stuck with ourselves, the vet clinic, or the internet to help us make sense of complicated issues, to understand why the vet wants to do this or that and to empower clients to make informed decisions, including “No.” It’s not the ideal system, clearly.
I wonder if people would benefit from a neutral third party patient advocate group in veterinary medicine. I think things are only going to get more complicated from here on out, and as both a patient and a vet I think that sort of thing could only help. Food for thought.
Have you ever felt confused and not sure how to proceed with your pet? Would it have been helpful to have a pet care advocate to serve as a liaison?
The look on the doctor’s face was more bemused than annoyed as he tried to explain what happened to the centrifuge we were supposed to be bringing to Nicaragua for the clinic. The valuable piece of medical equipment had been confiscated by a leery customs official the day before, and the shifty eyed official wouldn’t release it to us without running it by his boss. Who would be in tomorrow.
Mañana, the official said. Come back mañana.
So a local veterinarian, who understands the language and the local culture, was dispatched the following day to the airport to convince the customs officials that there was nothing untoward about a centrifuge and to please give it back to us. He met with a different and no more accommodating Nicaraguan official, who thought about it for a while before saying, No, you can’t have it.
Well, the vet asked, when can I have it?
Mañana, he said, come back mañana. I never really got how this worked until this experience. The days stretching into the infinite, equipment locked up in an office to lord knows what end, mañana becoming less of a day and more of a concept.Sometime, just not now, and maybe not ever. It’s not so much tomorrow, it’s the idea of tomorrow perhaps being more conducive to our goals.
Frustrating as the experience was for all involved, it’s not a foreign concept to any human. We are experts at procrastination, at remembering things a day after the deadline, of holding onto that bottle of champagne for a *really* special occasion that never materializes, of planning that special trip in our heads if not on our calendars and only committing to it after the chance has gone by.
Anyone who has lived with animals, seen a life arc before you in all too short a time, knows how this works. It doesn’t matter. We still continue to do this to ourselves:
We spend our childhood dreaming of things we can’t do, because we’re too young.
Then we spend our adult lives dreaming of things we won’t do, because of work and kids and life. Mañana, we’ll do these grand things mañana.
And at some point, they again become things we can’t do, because now we’re too old.
(I know I wasn’t the only one cursing out Pixar through my ugly cry when Paradise Falls never materialized for Ellie.)
Somewhere in the middle, if we’re lucky, we can shake ourselves out of our certainty of tomorrow long enough to make mañana today. I’ve been doing this a lot more in the last few years, which I suppose is the natural progression of someone beyond the reckless optimism of youth and not quite ready to acknowledge that old is lurking right there in the wings.
It started with travel. It’s why I signed up for two weeks in Peru one year and another two weeks in Africa the next over the befuddled protests of my husband who wanted to know where I was going (somewhere interesting), with who (strangers that are now friends), and why (Why not?) Because at some point, I’ll know that I can’t.
It’s never the wrong time to go somewhere new and make a new friend.
And while I can’t commit to globetrotting nearly as often as I’d like to, on a smaller scale I’ve decided to take on one mañana a year. Back in 2008, I attempted to train for a marathon and dutifully attended every group run, but my knees gave out at the 18 mile training run and I had to drop out. I can still do a half marathon, I told myself. Later this year, I said.
That was six years ago. A friend from the gym who is at the same point in her life asked me last week if I wanted to join a running club with her to train for a half marathon in August, which seemed like a good goal but maybe for later this year. I’ll think about it, I said, and later that afternoon read this story. If ever there is a sign from the universe to get off your butt and go do something, it’s a 91 year old cancer survivor running a marathon in your backyard while you lament feeling old at a little more than half a century younger.
So I signed up.
We never did get that centrifuge. I learned this in a dusty Central American airport back room: mañana never comes. Today’s it, so do that 5K or learn to make real macarons or take opera lessons or whatever it is you’re sitting on for later. What’s your mañana?
It is one of the sad ironies of being a veterinarian in clinical practice that most of your clients are majorly unhappy to see you. (Retrievers don’t count, they’re always happy to see you.)
The reasons are obvious: vet clinics mean temperature taking, and shots, and cold tables. Trust me, I don’t much enjoy heading off to my doctor’s office either, nice as the staff is. Those awful half length hospital gowns they give you (ladies, you know the ones I’m referring to)- cold and humiliating. I’m here for something I’m not going to like.
While we vets are working on it through incorporating Fear Free Practice ideas into practice- thanks Dr. Becker!- we still have a long ways to go. Which brings me to today.
One of the most common things I hear from clients at a home euthanasia appointment is, “I just couldn’t bear to do this at the clinic. My last dog was shaking like a leaf when we went in for the appointment and I felt so terribly guilty afterwards.” And who can blame them for feeling guilty? Who wants their last memory of their dog or cat to be them cowering in a corner? How awful.
Not all pets feel this way about the vet, of course, but for those that do, it just adds another layer of emotional trauma to an already challenging time. Is this the pet signaling they don’t want to die? No. As pain management expert Dr. Robin Downing says, “Pets don’t fear death. They fear pain.” They are telling us they don’t like the vet, but of course we are only human and it’s hard not to extrapolate that to a bigger message that isn’t there.
So what happens in the absence of the clinic and the coat, when a pet meets me outside the office? A pleasant hello, usually. Even when I am there to help them transition. Especially when I am there to help them transition. I will be honest, I wasn’t expecting that.
I was reminded today of a lovely Golden I met last year, who was winding down a battle with cancer. When I came to the family home, their sweet girl was almost nonresponsive. As I knelt down by her side, she opened her beautiful brown eyes and gave me a huge, enthusiastic wag. We all stood there in shock, as she had not been able to do much of anything in the hours leading up to that moment. She did not fear death, or me.
In the absence of a preconceived assumption of vaccines and thermometers, pets are free to judge me based on whatever it is they perceive I am there to do. I cannot tell you the number of kisses, licks, wags, head bumps I get from pets who by all rights should be past caring who is sitting next to them. It means something.
It’s not, “Oh boy! THE DOCTOR IS HERE!”
It’s not, “That blond lady sure does smell good, like bacon.”
It’s simply this: I see you.
I know what a birdsong is.
And I am ready to hear it.
A few years ago I ran away from my job.
At least, that’s what I called it at the time, that is how I framed it in my head. I couldn’t hack it, I was a failure as a vet. My mind was wrecked, my physical health was wrecked, and my stomach curled up into knots every time I pulled into the parking lot. It wasn’t only me who suffered; I knew my heart was not where it needed to be for my patients. They deserved for me to want to be there. It was a bad place to be in.
With the gift of perspective, I know now I was dealing with some pretty significant burnout. I didn’t know that was what it was at the time; after all, don’t you have to be in it at least a couple of decades for that to kick in? Or be a practice owner? This is how it works, I was told. No one really talked about it, or it was code for ‘bad vet’, not for a defined type of stress reaction. Old Doc Johnson who treats everything with pen G and steroids needs to get put out to pasture, he’s old and burned out.
No matter the reason, I knew I needed to leave and take a breather. I am very fortunate that my husband was supportive of the decision, even without knowing how it would play out, or when I would be back. Although I saw it as a failure on my part at the time it was the best thing that could have happened to me.
I have learned to let go of a lot of destructive ideas in the past few years:
- that taking care of yourself is an indulgence;
- that saying ‘no, I can’t’ means you are a slacker;
- that being a veterinarian means you put your work above all other things.
I had to practice those sentences a couple years before I really truly believed them, but I do now. I listened to a wonderful VetGirl webinar today on the topic of veterinarians, depression and suicide and was kind of taken by surprise when our wonderful presenter said, “self care is an ethical obligation- to yourself and to your clients.” She’s right.
If you recall, one week ago today this happened in my neck of the woods:
A few days after the smoke had cleared, I had a girls’ weekend getaway that we had been planning for almost half a year. Girls weekends aren’t really something I’ve done much of- too busy, other priorities- but we randomly decided at a Christmas party that we should plan one. I didn’t know how much I would be needing it at the time, but man, I’m so glad it happened the way it did.
I flew far, far away from my blackened streets and up to the land of one of the world’s finest philosophers: Santa Rosa, home of Charles Schulz.
We ate, all weekend. Really, really good food.
We tasted some wine. Really, really good wine. Our personal favorite was a wine by Ehlers Estate, which was founded by a man with a deep philanthropic interest and is now owned by a trust that funnels all its profits into cardiovascular research. (I tell you this not to try and sell their wine, though if you ever get a chance you should absolutely try it, but because it ties into the rest of this story.)
The wine we sampled is called “One Twenty Over Eighty,” in honor of an ideal blood pressure. We liked it, so we bought a bottle to share that evening.
We all came on this journey with our own piles of stresses and stuff going on, and one of those things involved a friend taking a spot check blood pressure monitor, just to kind of keep an eye on things.
“I feel really relaxed,” she said later in the afternoon. “I’m going to check my blood pressure, just to see how it went today.”
She took it, looked at the numbers, shook her arm a little, and held up the monitor.
“One Twenty…Over Eighty.” OK, maybe closer to 125/82, but nonetheless, it was pretty darn good. Magic, almost.
On the last morning before we left, we bumped into Kenny G in a bistro. All I have for proof is a surreptitiously snapped picture of the back of his gloriously curled head, but it was confirmed that yes, we lunched with the G himself. Seriously, if ever you were waiting for a sign from the universe that you needed to kind of chill out for a few, there are few signs more blatant than running into the king of smooth jazz. This may top the time I ran into Weird Al at Disneyland (story for another time).
Good friends, laughter that makes you snort in the most unfeminine of ways, and maybe a sip of an exceptional wine if that’s your thing. It may not replace all the medicines in life you might need, but a little self care now and then does wonders, it really does.
Here’s to your One Twenty Over Eighty, whatever that might be. Cheers.
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