Live...today.

I am afraid the end is near.  He is going to die soon.

I said that twice today.

What terrible news to deliver. 

He is going to die.


The first couple to whom I said this had done the right thing.  When their handsome little dog began losing blood, I was able to tell them that it was from his bowels, but not where.  They went in debt to take him to the internal medicine specialist, where a battery of tests were run.  No significant finding after thousands of dollars and all the appropriate tests.  They treated the dog for a stomach ulcer and anemia.  He seemed to improve for a few months.  When I saw him back last month, we were back at square one.  Frustrated, I contacted the referral center and they were eager to recheck him.  The note I got back advised me that there was significant concern of a greater pathological process, but now these owners could no longer afford the diagnostics.  So again we treated for stomach ulcer and anemia.  Sadly, today my beautiful little friend was pale and passing out.  We had the difficult discussion.  The options are few.  Return to the specialist for all the tests again,  transfuse and perform exploratory at my hospital in hopes of finding the problem, give in to the disease and allow it carry away this beloved boy, or euthanize. 

I heard myself saying to the owner, "if you can't do the tests or surgeries, then you can take him and enjoy the life he as until he no longer enjoys it."  He is going to die, so take him home and live for a while.  Until you feel he suffers, living is an option.

Live

In the afternoon I had a similar conversation.  Those who follow the blog may remember a previous piece, Litany for Memories, which was inspired by a dog with heart cancer.  In late December of last year, this beautiful and outgoing dog was sent to the cardiologist to evaluate his heart.  He came home with the devastating diagnosis of hemangiosarcoma and a prognosis of two weeks to live.  It has since been eight months since those words were spoken.   We made some necessary diet changes and tried some medicines that I hoped would maximize his quality of life while it remained.  Only a month ago, I heard the owners express their doubt.  Could the cardiologist have been wrong?  You do think there is a tumor in there, right?  Indeed, I believe it.  Yet, I had no reasonable explanation for how this amazing dog was surviving. 

Today, he developed a symptom that I can no longer help him manage.  Today we had a difficult conversation of what to expect and how we must prevent his suffering.  Today I put a number on how long I think this amazing dog will live.  We talked about digging a grave.  But, just as important, we talked about living.  We talked about living, all the while knowing he is dying. 

My thoughts go back to those first conversations following the bad news.  Why do I think this dog has lived so long with cancer in his heart.  I know it because the owners did not give up on him.  They did all that I have asked them to do.  I believe it is, at least in part, because they allowed him to live.  I believe that they snuggled, petted and played ball.  I believe that he was loved and allowed his daily routine.  I believe that they heard the words, "let him do what he wants and can do, and stop him only if he doesn't understand his own limitations," and did just that. 

Live

When I got home after work today, I found a card given to me by a dear friend yesterday that I had yet to open.  I met this friend first as a client.   I grew to know her better when she began to volunteer at a place where I work.  As I got to know both her and her husband, I began to hear the stories of their life.  One of the stories is about her diagnosis of cancer over 11 years ago.  I have heard her speak of the burn of radiation and the nausea of chemotherapy.  Of the permanent neuropathies and reconstructive surgeries.  I remember our discussion of how long she had been cancer free and the smile on her face as she said it. 

Last year on her birthday and after 10 years of freedom from cancer, my dear friend was told she would die.  Her cancer had come back and was inoperable and late stage.  In the following weeks, she was told the same by two more doctors at specialty centers in different states. 

Yet, every week since then, I have had the pleasure of working along side her and seeing the love and compassion she shows to the animals for whom she cares for at the surgery center.  Her desire to learn more and help has not been changed.  I have heard her laugh at my dinner table and on the phone.  She and her husband recently renewed their vows.  They bought an RV to make seeing the children and grandchildren easier. 

Last week, my friend celebrated her birthday and the year anniversary of hearing she would die.

I stood today in my kitchen and opened a card that made me again realize the important option that is always available to us all. 

"Thank you so much for the birthday cupcakes.  I have decided to celebrate each one from now on...."

Live

Today I was angered by my own frustrations. 

I have realized over the past three months that I am again suffering from burn out.  The euphemism in veterinary medicine is compassion fatigue.  This is the second time I have battled this since veterinary school.  It is a common problem among veterinarians.  Interestingly there has been much talk about and great examples of the reasons for burn out in the veterinary blog world lately.  It seems that this post by The Homeless Parrot inspired this post by Can't Spell, DVM.  While A Vet's Guide To Life posted about the high depression rates among veterinary students.  I spoke to a veterinarian today who attributed his divorce and a failed business to the problem.  I worry that burn out contributes to high suicide rates among veterinarians (see these articles at CNN, Medical News Today.  I am not aware of an American study to date.)  Sadly I know of two veterinary suicides in a nearby towns and I wonder if my colleagues have heard similar stories. 

When I burn out, leaving veterinary medicine is my arbitrary choice, but I toss around all the options: try a different practice, open a practice, try a different field, specialize, military, food inspection,  or government inspection.  Yet I know in my gut that there must be a way to be happy working in a practice helping these dogs and cats.  I tell myself that I could be much happier at a desk job or even pushing a broom or waiting tables.  Still I know I would miss using my gift.  So I return to scenarios of the different small animal practice options in my head and the consequences of each and soon I am tangled in a web of despair and frustration. 

I was blessed recently by a client who nominated me for leadership recognition.  I received a telephone call that said, "Congratulations!  You've been selected for this honor.  We'd like you to come in for an interview ."  Imagine my sorrow when the interviewer asked me what I love about being a veterinarian.  The only truth that I could muster was the very truth itself.  "I love these cats and dogs...and I'm good at this."   I sat in my truck in the parking lot after that interview wondering if I should go back in and ask them to give this recognition to someone who knew for sure they would be staying in their leadership role.  My own uncertainty at the time was so great. 

Somewhere along these last three months, I allowed this burn out to creep in and take away something that is very important to us all.

I realized today when I read that card....that I am not living. 

Daily I have been giving this amazing and healthy option to my clients....prescribing it as medicine even, if you will.  I have spent a year watching a dear friend lead by example, yet I have not been doing so myself.  I have come home angry and sad, been short with my wife and children, rejected the healing touch of the affection of my own pets.  I have walked through my door with the singular intention of getting through the rest of the day so that I can crawl in bed and pray tomorrow will be better.  And while I have reached out for help in the necessary ways to get through this difficult time, I still have not been living. 

I have not hugged, played ball, or loved enough.  I have not celebrated, learned, or laughed enough.  I have not lived! 

My job is not my life.  How did I allow it to stop me from living? 

I continue to sort through the details to find my happiness in the veterinary world.  Dear friends, I ask you to bear with me as I begin to live again.  I will not be answering your veterinary calls during dinner or responding to your facebook emergencies when I should be reading bedtime stories.  I will be leaving my work in a veterinary hospital where it belongs.  I will be responding to your emails during the time I get paid to do just that.  Please understand that I still care for your pet just the same.  But I have chosen to live, because I have realized that I am dying.

Today, I will be listening to and hugging my children.  Today I will be holding the beautiful hand that has been reaching out to comfort me in my distress.  Today I will playing ball and taking naps with two special dogs who seem to know when I need them the most.

God and friends, help me to remember tomorrow....that I must live today.