Life as a Veterinarian, Pet Care, Veterinary Health Topics

The Worst

Even though you prepare for the worst outcome, can you really ever be prepared. I feel like I jinxed it or cursed her recovery by sharing enthusiasm in her progress. Abby was doing so well and just like that nature reminds us we have no control, no cure. She started seizuring last night and the difficult decision to let her go was made this morning.

 

IMG_1137 Abby

“Miss me but let me go, for this is the journey we all must take and each must go alone. It’s all part of the Master’s Plan, a step on the road to home.”

 

 

Goodbye sweet little dog….

 

“Grief is the last act of love we have to give to those we loved. Where there is deep grief, there was great love.”

 

IMG_1134 Abby

 

How blessed we are to share our lives with these creatures that don’t speak our words yet can so powerfully bond with us, forever capturing a piece of our hearts.

 

IMG_1133 Abby

Life as a Veterinarian, Pet Care, Veterinary Health Topics

Preparing for the Worst, Hoping for the Best…Making Tough Decisions in Patient Care

I heard the cries and screaming vocalization in the background with my own mother’s voice on the phone saying

“Abby’s in real pain. I can’t even touch her without her biting. What should I do?”

There is always a desperation in the call for help but when it is your own mother you can hear the unspoken words, the anguish in seeing her beloved little dog so painful she would bite in opposition to handling.

Abby is a senior Dachshund and had fallen from the couch earlier that week and had been a bit sore. I recommended some pain meds and rest. With a Dachshund it is always their back until proven otherwise. I had years before stood on the other side of the exam table with their other Dachshund, Harley, when he had back pain secondary to intervertebral disc disease, and progressive paralysis.  There comes a point in this disease when it progresses fast enough or far enough that surgery or a humane goodbye become the two options.

I saw the bottle of euthanasia out of the corner of my eye while we discussed the options. My father hadn’t handled it well and was reliving goodbyes from years ago and was essentially distant from any reasonable discussion and my mother held the weight of the decision on her shoulders. While Harley’s body was failing him his brain was very much intact and aware of his distraught owners. They had elected to drive all night for imaging and surgery. Harley walked again but now how has neurologic deficits and was never 100% normal again. Now it was Abby, their other Dachshund. They had been down this heartbreaking and difficult road before.

“I knew the discussion would come…wait and see, referral for imaging and surgery…or euthanasia.”

It was decided that we could try what we could here but the option of referral and surgery just wouldn’t be available. Abby had been on a variety of pain medications including a Fentanyl patch but nothing was touching her pain. She was even sedated for radiographs and bit me as I was trying to touch her. The happy little dog at your feet just waiting for a crumb to drop had transformed into a screaming painful feral creature.

“Her radiographs showed intervertebral disc disease.”

We breed these lovable little dogs for their long backs but with that comes the risk of instability of the discs between the vertebrae. They can bulge and burst, pushing on the spine or nerves, causing unbearable pain or even complete paralysis.

IMG_0427 Abby
Abby’s acupuncture treatment

I started a morphine/lidocaine/ketamine continuous rate infusion and intermittently just sedated her to facilitate her pain. I brought her home and kept her by my bed in a tote. The Kiddo peeked into the tote and with concerned eyes asked if she would need to go to puppy heaven. My heart ached.

It had been two days and I couldn’t touch her without the screaming and biting and she had progressed with motor loss on her left hind. The bulging vertebral disc was pushing on spinal nerves and her spinal cord, causing pain and loss of function. First it is conscious proprioception…knowing where your feet are…then paralysis…then superficial pain…and then at the end there is no pain sensation left at all.

We made the decision to pick up the  “supplies” that would be needed to end it all…the strong sedation and thick blue syrup that would stop all her earthly pain, but open up a pain for those that knew and loved her.

“With our animal companions, I have seen the struggle to know “when”. Do we allow a day’s worth of suffering so they may enjoy a lifetime without? Do we allow no suffering at all?”

It is emotionally tasking to watch pain in an animal knowing they can’t communicate if it is all too much or they are willing to keep going. I had stopped her MLK drip, continuing her other pain meds,  with the decision that if she couldn’t maintain comfort without it, it was unfair to continue.

I continued her therapy exercises, hoping and praying those little neural pathways would be stimulated, that the unstable disc would stop its pathway to paralysis. I stimulated her toes, did bicycle motions, stretches, massages, even took a electric toothbrush to her toes to stimulate her nervous system.

 

With clients there are lots of words and discussion, the knowing when, the hows, the questions. With my own family I found it harder to find the words. When someone has know you your entire life, they can read your face, your ticks, your eyes, and hear the words unsaid. So much of the discussion wasn’t a discussion at all but a knowing. I wanted to make the right decision for Abby.

The bag of “supplies” lie on my vehicle’s floor board and as we drove home my mind spun, dreading the moment, trying to push the details out of my mind. I felt frustrated that it had come to this. Should I have ended the pain sooner? Should I hold on for a miracle?

I peeked into the tote and Abby was bright, alert, more upbeat than I had seen her. The test would be could I pick her up without the screaming. I could and she even wanted to eat something. Could 5 hours have brought a miracle, a turning point? I knew the drugs would affect her and cause her to be dysphoric but I hadn’t expected her pain to be controlled without them.

I texted an update and said let’s give her more time. Thru the weekend she was able to start moving, placing her left hind leg that previously was worthless. I did her sessions at least 3 times a day…stretching, massaging, stimulating, hoping. A new day came and her appetite improved, her attitude improved, her function improved. Had the suffering she endured been worth it to get to this point?

IMG_1048 Abby
Doggles eye protection for laser therapy
IMG_1052 Abby
Laser therapy

We added acupuncture and continued laser treatments and she went home with my parents yesterday. Is she out of the clear…I don’t know. Will she ever be 100% normal…I don’t know. She has chronic changes that will probably always be a risk…and lead to a relapse. But at least we have hope, though prepared for what may be.

“How do we define the end? We all share so much earthly emotional and physical suffering that we want none of it for our animal companions.”

Was her suffering selfish? Maybe. Was her suffering worth it if she can recover to enjoy another day? I look back and say yes now.

This isn’t the first time I was disheartened, preparing for the worst, wondering if we humans were selfishly keeping a patient alive for our own purposes, only to be amazed at the recovery that can be made. I have literally had the euthanasia solution in hand walking to the exam room when the owner cried out the door “He tried to walk!!!” The paralyzed HBC (hit by car) dog had pulled himself to his unsteady feet after no improvement while hospitalized and there were simply no more financial resources to continue the effort. He made that first step and didn’t look back making a near full recovery. As a new vet it was a powerful lesson about making that decision for our pets which we do from a place of love and concern for their suffering, but sometimes they decide it just isn’t time and want to keep fighting. I am forever amazed at the healing and recovery possible.

“As a veterinarian, the struggle comes with trying to predict that recovery, only having the info available at that moment, with no magic ball to guide decisions.”

*Update on Abby. She had some regressions with her rehab and became a somewhat difficult patient. She has since been staying with me to continue her exercises and monitor her recovery. She is still periodically weak in the back end and mis-steps occasional. While she may never be 100%, we are hopefully she will recover to enjoy more quality time, with her pain controlled. Her spirit is definitely back.

 

Pet Care, Veterinary Health Topics

Pet Dental Care: Why the Resistance?

Pet dental care is so much more than white teeth and great smelling breath. 85% of dogs over the age of 3 will have some degree of periodontal disease. Periodontal disease not only leads to unsightly tarter and bad breath, but causes infection, bone loss, and chronic pain when left untreated.

Dental disease is one of the most common diagnoses in the exam room yet brushing and regular maintenance is hard. For puppies and kittens, we send home dental kits with the hopes of acclimating them to a lifetime of brushing and at-home dental care. We hope for regular, routine dental care throughout the pet’s lifetime with the intention of avoiding infection and pain and that one monumental dental experience as a senior pet where a lifetime of inattention results in dental extractions.

Adult-dogs-infogprahic dental

How do we define neglect? What if I showed you this picture of a dog’s mouth and told you she was a puppy mill survivor forced to have a litter every year, living in a tiny cage with matted fur, with no dental care (not even a dental treat in her lifetime). Is this neglect?

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Pom puppy mill

Now what if I told you these were the teeth of a very beloved 10 year old Pomeranian who lived in the lap of luxury with a well tended hair coat and wardrobe accessories. She had complete adoration and attention to all of her medical needs….except dental care. What if I told you while her owner loved her very much it was that very love that prevented her from tending to her pet’s dental issues? What if I told you her person’s fear of anesthesia forced her to live with chronic pain, infection, and rotting bone. Is it neglect now? (*For the record, this is not a client photo but some random internet PetMD image).

Pom happy

There are many resistances to pet dental care. I believe strongly in the benefit of routine dental care. I have heard too many testimonials to not believe it matters to our pets quality of life. If we wait until our pets have stopped eating or cry in pain, we have simply waited too long. Remember these are animals that survive because of their ability to withstand pain and disease without drawing attention.

Your coworker may complain of a tooth abscess but still eat his lunch and show up at work day after day, just dealing with the chronic pain until one day that infection becomes so bad he lands himself at the ER with injectable antibiotics. Our pets are no different at hiding that pain.

Common Points of Resistance to Dental Care

Fear of anesthesia.

I love my pets and have those same feelings of concern and fear but I know the benefits will out way the risks. I also know that all precautions including a balanced anesthetic approach, careful and detailed monitoring with a designated trained technician, IV fluid support, thermal support, and pain control will be part of the anesthesia event to minimize risks.  I can’t take away the fear… as your veterinarian I can only assure you that we do everything in our power to minimize the risks to hopefully relieve your fears. Many owners may have had a terrible experience a decade ago. We are always striving to improve your pet’s anesthetic experience, using the newest research and medications to allow the best experience possible.

The cost.

Truth. Pet dental are is expensive, especially if we are undoing years of inattention. Personally we cap our dental estimates because we believe very strongly that the pets NEED this service. It is unfair to leave behind painful or infected teeth and wish to reward the owner taking the steps to care for their pet.

Too Young or Too Old.

I always got a little squeamish when I saw the 14 year old dog with a mouth of pus, mobile teeth, and a risk of a jaw fracture secondary to that infection knowing I needed to say the words, “Your pets needs a comprehensive dental assessment and treatment”.  It all felt like too much too late.

There were probably many years of dental recommendations and now the teeth were in desperate need of attention. Or if they new clients to us they may have heard for 5 years “Their pet was simply too old for anesthesia or dental care.” But then I treated the 12 year old dog, and then the 14 year old dog, and then the 15 year old dog or the 16 year old cat and I couldn’t deny how much better they felt afterwards.  Owners would report “I had no idea but now they feel like a puppy or kitten again!”  My oldest dental patients are usually 15-16 years of age and I love the reports of how much better life is after. “Where there risks?” “Yes” but they were calculated in the hopes the benefits would outweigh them. Does quality of life matter more than quantity?

Save all the teeth! Fear of tooth loss.

My job as your pet’s veterinarian is simple…to give him a pain free, disease free mouth so it is a disservice to leave any compromised or infected teeth behind just to “save a tooth”. The reality is these teeth are worthless and most pets eat better without them. Also pets use their teeth very differently than we do. They have fewer molars and don’t do a lot of “grinding” and since we don’t make them hunt for their food, many don’t slow down a bit with eating or playing even when we take every single tooth. For those worried about how their pet could possibly eat without the teeth, many actually eat much better without mobile or painful infected teeth.

But do they really need it or is this just some great upsale?

I am not a sales person but I do have a passion for dental care. There are too many times to count when a tooth “looked” just fine and the pet didn’t complain only to find a problem and have the pet feel so much better. I tell clients “Our pets can’t tell us where it hurts so it is my job is to find the problem and fix it.” An exam under anesthesia and with dental radiographs tells the story. Just like eat food and brush everyday we are still advised to have our teeth cleaned regularly. Relying on just eating a kibble or dental chews is often not enough.

Some breeds are very prone to developing dental disease (smushy faced breeds, smaller or toy breeds, those with crowding). Researching the breed and preparing for the dental care necessary in the pet’ s lifetime is big step in responsible pet ownership.

So here is my big secret…I don’t brush everyone of my pet’s teeth every SINGLE day. I barely get my kids to brush the necessary times per day. I try! Regular dental assessments, cleanings, and appropriate treatment are a priority though. We are all human, just doing the best we can for those we love and care about, including our pets!

If your pet has had a dental treatment recommended and you have stalled, resisted, or just ignored the recommendation I urge you to really think about the reason why. As a veterinarian, it is my job to help pets and their owners enjoy a great quality of life and effective communication must be part of the equation. Don’t hide those fears or concerns! Tell us and we may have ideas or solutions to those hurdles holding you back from getting those teeth the attention they need. 

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Source: Making the Case for Dentistry. Paul Q. Mitchell, DVM, DAVDC

Pet Care, Veterinary Health Topics

Pet Health Insurance… Is it worth it for you and your pet?

I was in veterinary school when I acquired my first pet as an actual adult, a little Chocolate Lab puppy. Then I quickly learned as a I went thru my veterinary school courses of all the things that could go wrong or accidents that could happen in this puppy’s lifetime. Then I became a hypochondriac and with each new disease I learned about, I was convinced my dog had “IT”. Gagged once= probably Physaloptera sp. esophageal worms. My mind was frantically planning for the esophageal endoscopy. When he misstepped across the yard my mind rushed to the diagnosis of debilitating hip dysplasia that would certainly need a total hip replacement. The good news is he coming 11 years old now and really hasn’t had all those rare and not so rare diseases I had learned of.

hypochondriac

I also learned there were more and more options for my pet’s health care and with those options and expertise came expense. Pet health care is expensive.  This puppy was family and if needed care to save his life or give him the best quality of life I wanted to have that option, even though my pocket book as veterinary student was pretty devoid of means of doing so. I remember the dogs I had growing up and the extent of their veterinary care and expense. We hauled them to City Hall once a year for “shots” and treated the random ear infection or rash. Veterinary medicine had changed a bit since.

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“The times they are a changing!” Courtesy The Animal Pet Doctor

 

We were active in DockDogs, a community of dog competitors and athletes and Embrace Pet Insurance was offered at a discount to participants and many raved about the benefits of health insurance so I signed up. When clients ask me about whether insurance would be a good idea also my single biggest question is:

“If money were no object, what would you do for your pet?”

Dockdogs

My former canine athlete Brody

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Brody loved this activity but as a vet student I saw a ruptured cruciate, iliopsoas injury, or fracture, etc just waiting to happen!

In veterinary school I learned about the many advanced care options available including imaging, cancer treatment, critical care/ICU stays, or complex surgical or dental procedures. These wonderful options could quickly deflate a savings account. Not to mention the pets we treated with chronic illnesses such as allergies, where the costs added up more slowly but steadily. If money was no object, would I want these options for my pet? The answer was “Yes!”.

“Could I have set aside funds every month for the emergency or severe illness I dreaded?” Sure.

But I also knew care could be in the thousands. At $20-30/month my pet was covered for the worst…which could cost thousands of dollars. At that same rate of savings it would take my 150 months, or 12.5 years to save $3000 as an emergency fund. I could have played the odds that my pets would be healthy and have no issues in their lifetime but as a veterinarian I knew the reality. Over 50% of dogs over the age of 10 will develop cancer. And how many puppy owners I saw that had just dropped down a sum of money for their new pup, collar, kennel, and food only to struggle to find the $1000 it would need when that same clumsy puppy tripped up the stairs and broke its leg.

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I have sat with clients that had no money but had all the want and willingness to help their pets and there is NO worse feeling. I have worked for free, had the pets relinquished, or found resources or rescue groups to help but there are only so many dollars available. No one expects bad things to happen to them and so that is where insurance may be worth the money.

So I got pet health insurance and paid my monthly premium and thought about the money I was “wasting” and how I should be investing it in retirement. We had actually talked about dropping it. Why would a vet have health insurance…it seemed most things to fix where within our budget and manageable.

Then I felt a firm boney mass near my soul-dog’s ear, arising from his skull. My Newfoundland had bone cancer. As a veterinarian I knew I could do nothing and he would be gone in months or I could seek care and hope for better. There were just a few places that offered the treatment options we needed, including Flint Animal Cancer Center in Fort Collins, CO. So we loaded up as a family including my 2 week old newborn and traveled for stereotactic radiation.

The price tag was about ~$10,000. No way, no how could I have justified that expense with the costs of a newborn, student loans, and life. I would have been limited to the option of pain meds and waiting. But my Embrace Plan, the same one I had contemplated cancelling months before, paid 90%.

Cancer treatment 5
His CT Scan showing the boney tumor…osteosarcoma
Cancer treatment
Computer-generated 3-D Model for use in radiation treatment planning

$10,000 may be crazy to spend on a dog…any dog… soul mate or otherwise but I figured a bargin compared to the cost of that same technology applied in human health care. When owners complain about the costs of veterinary care being more than human health care it highlights the misunderstanding. The same supplies, drugs, education, equipment sits in our veterinary hospitals but as pet owners we pay out of pocket and feel every single penny leave our wallet. I have received statements and bills from hospitals and half the time I have no idea what was charged to the insurance company (in my mind it reads: $40 million dollar IV catheter. You own $1.47! So someone, somewhere paid or negotiated the difference).

Cancer treatment 3
The medical equipment used to deliver steriotactic radiation therapy

Then Piper, our beloved GSP, developed Congestive Heart Failure. Echocardiograms and monitoring were doable without the worry of cost. I had considered stem cell treatment for her shoulder arthritis and had the $2000 cost approved through insurance before her heart condition worsened. Then that same puppy I acquired in vet school now with a gray face and aging body, developed a limp. I had done rads after rads with radiologists reviewing and though I suspected elbow arthritis, never got the answer I needed. A visit to Colorado State University and a CT scan provided the answer I needed to know.

So when we got a new puppy that was learning how to explore the world with its toxins and hazards and how to use its limbs without falling or tripping, it made complete sense he needed health insurance too. I couldn’t stomach the thought of not being able to offer him the care I knew was available just because money was the limiting factor.

Houses, boats, and cars…well they all have a set insurable value. But pets their value is determined by our connection to them. For some they may be totally replaceable but not in my world.

It may come down to priorities…what do you want to spend your hard earned dollars on. I value health care and realize the options and associated expense that comes with it. My pets are family and I want the best for them. I just don’t have unlimited funds to do that so insurance has helped offset the financial strain.

In addition to the question of “What is your pet worth to you?” I would consider “Are the odds in your favor?”.

The reality is certain breeds are more prone to medical issues such as cancer or orthopedic disease. General higher risk breeds may include the giant breeds such as the Newfoundland, Great Dane, or Mastiff and also Bulldogs (I once saw a bumper sticker that read “Support your veterinarian. Buy a Bulldog” and perhaps there is some truth in that).

Is your pet’s lifestyle such that an injury like a broken bone or athletic injury more likely to occur? This could include the canine athlete or working dog (hunting, ranch dog, or competitive dog) or the dog that runs at the family farm (with its associated risks of livestock, 4-wheelers/Quads, toxin, etc) on the weekends. Then insurance may be worth it.

No one gets home insurance planning for the day it burns but the reality is insurance is there if the worst should happen. Pet health insurance is largely designed to cover your pet’s accident and disease, not wellness care. 

There are several insurance options and resources to fit your unique needs and budget. The following companies are consistently well rated and recommended (Insurance Comparisons) : PetsBest, PetPlan, Embrace, and Healthy Paws.

My General Considerations are:

1) Does the policy cover hereditary or congenital diseases? If you have a Lab and they don’t cover cruciate disease surgery your plan won’t be very helpful to you. Research the diseases  must likely to affect your pet’s breed and read the fine print to ensure you are covered.

2) How are pre-existing conditions handled? This is still the world of insurance so if you pet has developed a disease such as allergies or hip dysplasia prior to acquiring your plan prepare for limitations in your coverage of the condition. The best way to get around pre-existing conditions is to get insurance early in your pet’s life.

3) What are the limits and deductible? Like all insurances, a higher deductible will mean a lower monthly premium. I personally have a higher deductible with the idea that my plan covers for the big and major. Some have no annual limits, others might.

4) How much and what do you want covered? Are prescription drugs covered? If you have an athletic dog such as a hunting dog which may be prone to injury you may want to make sure rehab services are covered.  You may need to tailor your plan if you wish to have routine vet care (vaccines, dental cleanings, heartworm testing, etc) covered.

5)How do they pay out? I prefer they pay a portion of my bill and not a set amount for the condition. Costs vary from location to location and this ensures I am not having to price shop. Most plans can be tailored to cover anywhere from 70-90+% of the treatment costs.

Pet health insurance isn’t for everyone. Only a small percent of the millions of pets in this country are insured but I am glad for the option and how it helped my family make decisions based on medicine and not money. Could my pet’s go their lifetime and I never get my money back? “Sure”. But their policy could also prevent heartbreak if the worst does happen.

Some additional resources:

2017 Canine Journal’s Top 3 Comparison

Pet Insurance as the Latest Work Perk

Consumer Reports: Is Pet Insurance Worth It?

Community, Life as a Veterinarian, Veterinary Health Topics

The Narrative of Veterinary Medicine

*Disclosure- I wrote this months ago and it sat…I was not quite ready for the world to read my thoughts. But I keep coming back to the purpose of story-telling in veterinary medicine. In our work, we gather and share hundreds of stories of our days working with patients and clients. *

Don’t we all just want to be heard?  I recently stumbled upon the topic of “Narrative Medicine”. It is a topic well recognized in human medicine and makings it entry into veterinary medicine. Narrative Medicine seeks to honor patient stories from a literary persepective. It goes beyond the medical interview and seeks to understand the psychosocial and spiritual perspective. In reviewing the whats and whys of Narrative Medicine I think it boils down to learning to listen…Doctor to Patient and Patient to Doctor.  In veterinary medicine it may be complicated by having a sentinent being with feelings of fear, pain, and happiness but no way to communicate in our language. So we rely on the stories of their caretakers.

Do you still remember the veterinarian you took your childhood pets to? You might still picture the waiting room or the smell of cleaning chemicals or pet odors. If you lived in a small town you likely had a relationship with your veterinary, pediatrician, and veterinarian. They knew our story and we knew theirs, for good or for bad. I still enjoy a small town feel and generally tight-knit community but veterinary medicine is changing as it evolves with increasing services and specialization. That connection and relationship has changed. The friendly, all knowing veterinarian down the street has changed.

Narrative medicine seeks to change that connection to a time of yesteryear where we knew each other beyond the exam room walls. So it goes that in our profession we complain about the numbness of repetition of vaccination after vaccination or the pain of compassion fatigue, the giving of yourself without thought for self-care and restoration. On an average full day I may talk to 20-30+ people in a day and some days I feel completely depleted and mentally gone.  My sanctuary is my home and my family and on those days of sanctuary I  prefer my days filled with casual togetherness and laughter, not words and demands. Those I converse with are carefully selected and the only outsider is the FedEx delivery man, delivering my mail order packages. The energy of the crowded stores, booming music, and bright lights can just be too much after a day of boisterous greetings, goodbyes, and the emotions of helping client’s pet thru disease and death. There is this balance of connection and relationship while maintaining a distance safe enough to prevent injury from the pains of the profession.


In our lives, we all seek meaning and to find our purpose. A wooden plaque with the words “If you love what you do, you’ll never work a day in your life” sits on my shelf as a reminder of finding passion and purpose. But some days are hard…it is hard to give another round of bad news, to share textbook of knowledge regarding a diagnosis starting slow then gaining momentum as the words spill out of my mouth. I see the facial expressions, some empty, sad, upset, angry, or just plain empty as the news hits their minds.

We celebrate the human-animal bond but what a gradient of affections. For some this pet right here, right now is all they have, their companion in life and for others it is as replaceable as the tires on their car and they grumble about the expense of doing so. For me to find purpose and enjoyment in this profession, I find myself needing to look past the signalment. Buddy is more than just a 2 year old neutered male, Golden Retriever. Buddy may well be the best friend to a 4 year old autistic boy and the one to whom it speaks. We celebrate that bond, the specialness of animals in our lives.


With narrative medicine, they look for words or phrases and don’t start with the checklist but ask the question “Why are you here today?”. It is a request to be invited into our patients or clients stories. For some clients I know the story of their pet followed over years, with chapters read here or there. The time they ate the garbage and had explosive diarrhea, the adjustment to the family when the new baby came. Each chapter strengthens the bond of the family and the pet. The most intimate invitation is often at the end of life.

At the end of life there is no longer a race against death, a need to win but an acceptance. For some it is just a dog or just a cat but for others I am one of the few that has read the story of this pet’s life, to understand its meaning and the bond that was shared. In that story, I have seen men fold over weeping for a pet when they didn’t shed a tear for a parent or the woman that holds her beloved pet lost to cancer and in that moment a flood of memories of the loss of her own mother too lost to cancer. I hold that invitation with great reverence.

So when you think of your childhood vet what do you remember? I sometimes ask myself how I want to be remembered. I can give a vaccine, diagnosis diabetes, or spay a cat but there is this deeper psychosocial aspect of veterinary medicine; that call to narrative medicine, where we understand the story behind the medicine.

As a helper and caretaker it can bring great frustration and even anger when I perceive I care more than the actual owner of a pet. In these moments narrative medicine calls for a more mindful detached compassion. One can quickly drown under the tidal waves of poor life choices, painful lives, or just plain indifference that some bring to the exam room.

So I ask “What brings you in today?” and realize mankind is this diverse, never fully understood complexity. We all bring our stories of youth, growth, adversity, sadness or joy when we meet in that exam room.

Narrative, story-telling…we are all connected by our stories. Story-telling and narrative has survived the centuries and though our world has changed, it all comes back to the connection and sharing of our stories.