Dandelions in a meadow outside Thunder Bay, ON

Dandelions in a meadow outside Thunder Bay, ON

Saturday, January 17, 2015

How I Nearly Died, And What I'm Probably Supposed to Learn from This.

This post, albeit mostly about me, has direct relevance to my practice of veterinary medicine. Please bear with me.

Last September, on the day following my birthday, I was driving to Vancouver to work along the Sea to Sky highway. After a few weeks of draught (sic! in the Pacific Northwest) it was raining for the first time. I lost control of my car, slid across the oncoming lane, and plowed through the ditch with a towering rockface to my left and inches away. I still don’t understand how I didn’t crash into the rock. By Hollywood movie standards I felt embarrassingly, disappointingly little. My life did not flash before my eyes, because that’s complete and total bullshit. Do you realize how much time it would take for your life to "flash" before your eyes? I'm guessing no less than ten minutes, by a very generous estimate of an average life. Here is what did happen. The picture of the world ahead of me, what small piece of it I needed to see, became blurred as from a very quick and very close zoom-in, with no time to sharpen the focus. Through a slight haze I saw the rockface coming at me, and I expected to hit it. There was no fear; I guess there was no time for that, and no room. My thoughts were blurred just like my vision; there was so little I needed to think about, but that too was magnified, almost as if the letters of those wordless words were bigger than usual. And this is what they read: Everything Has Changed. I was equally ready to live or to die or to get crushed and mutilated but remain alive; I deserved either of these in equal measure, and nothing depended on me any more. And when I found myself not only alive but utterly unharmed inside a dead and mutilated car that had rolled out of the ditch back onto the highway and had come to a stop at a perfect 90 degree angle to traffic, I was not surprised, because nothing was surprising, and anything was fair game. I remember the smell and spatter of coffee on everything, and I remember feeling embarrassed that people would find me in this pitiful and slovenly state. Before anyone arrived, I already felt squeamish on their behalf. I will never again sneer at a person who asks for a nail trim for their dying dog or cat. These priorities get fucked up for a good reason. We cannot fathom death any more than we can fathom the infinity of the universe. In the presence of death, the only recourse available to us is the ritual and decorum of living, nail trims and all.

Days later, when I crept in my new used car past that cursed turn and studied it, I was surprised to see a signpost only two or three metres across the ditch from the rockface; I don’t remember seeing it as I hurtled through that ditch and have no idea how I avoided crashing into it as I was trying avoid the rock. I say “trying” because I’m guessing that my body was taking measures: my hands must have been steering the wheel, my right foot must have been braking, or staying the hell away from the brake - I’ll never know which one. My body knew what to do. Maybe my eyes did see the signpost and told my hands and feet to avoid it. My left hand was holding a cup of Timmie’s coffee as I went into that turn and lost control, and the hand must have thrown the cup away from me to grab the wheel because that cup ended up on a soaked jumble of papers and a sweater at the foot of the passenger seat. I don’t remember doing any of this, and never will. It’s none of the mind’s business what the body does in such moments. Presence of mind, my ass. If my jittery and meddlesome little mind were allowed to be present, I am quite sure I would be dead.

The wisdom of the animals whose lives I strive to prolong and often carry the burden and honour of ending, is in living by their senses. They are not tormented by the knowledge that they have this disease or that, and as long as they are free from pain and able to enjoy their food and repose, they are happy. We the oh-so fortunate sons and daughters of Western Civilization have been taught by Socrates to despise this unexamined life. But might it not be time to revise that cumbersome and complicated lesson, to learn from our animal companions how to be grateful for the mere absence of pain? Because it takes so little, so wonderfully little to take pleasure in life. After my accident on the highway I have felt the duty to derive some sort of learning from it, but I have yet to figure out what it is I'm supposed to learn. I am fairly certain that an animal would not "think" twice about such an experience, because for them dodging death is business as usual. But I cannot claim the simplicity and innocence of an animal. For a short while it pleased me to think that providence (or God) had spared me so I could go on to achieve something or other. But my temperament is not well suited to religion. In these past weeks I have often felt as if I'm watching a movie about someone who lived and loved and worked and was happy, but is now dead. That someone is, of course, myself. Lately, after years of peaceful sleep, I have found it hard to sleep through the night. It feels exactly like jet lag because that is exactly what it is. I have been catapulted through time to the final moments of my life, and I have felt them without seeing them. I have been released on parole, but the sentence stands. At any moment I can be summoned to finish serving that sentence of mortality. Up until that accident I had lived the naive and blissful illusion that my life would never end. The shattering of that illusion has marked the beginning of the second half of my life. In chronological terms I do not know how long that second "half" will be, but every morning I still enjoy my coffee and I am happy to resume my place among the living. It is not my intention to wallow in maudlin sentimentality but to move past it to a new appreciation of life that no longer rests on the illusion of immortality. A few minutes before the end of 2014 my partner asked me to marry him. I was blissfully happy, and I remain so every day. Every day it is still a wonder to me that another life out there has noticed me and found me to be singificant. This is nothing to sneeze at, because evolution has not prepared us for this. In terms of evolution, one person and all their aspirations mean nothing. But if only one other person in this crazy world of ours thinks we amount to a hill of beans, that is quite something, that is reason enough to celebrate. While I cannot claim the simplicity and innocence of animals, I have experienced the miracle of lighting up the life of other humans. I am amazed that people thank me for nothing more than relating lab results for their ailing cats and suggesting a plan of action. I am amazed and slightly embarrassed by how little it really takes to make a difference in someone's life. All it takes is listening and a kind word, I kid you not. I owe it to my fiancé, to myself, and to the world around me to take my life seriously, and with time I shall find a way to do so.

Sunday, November 23, 2014

Fundraiser for Canadian Animal Assistance Team

It's getting ever so slightly chilly for an ice bucket challenge, but you can still make a priceless gift as you read by the fireplace. This holiday season I am sending all proceeds from the sale of my e-books on Amazon to the Canadian Animal Assistance Team for which I have been honoured to volunteer as a veterinarian. Information about this charity is here: www.caat-canada.org The Team was born in foggy Vancouver, BC and a few days later baptized in the floods lefts behind by hurricane Katrina, on its first relief mission. My own experience has been on First Nations reserves in British Columbia, and has inspired a chapter of my novel.

The link to my books with their descriptions and free browsing samples is here: www.amazon.com/Valerie-Albemarle/e/B005ITWSEY

Thank you for your support, and may the season bring you joy

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Sunday, November 9, 2014

State of the Non-Union

I had an interesting two visits to my family doctor recently. During the initial appointment, the wait was forty minutes and the visit lasted about forty seconds. That is not necessarily a problem. The doctor knows his stuff, and forty seconds was all it took him to make an educated guess about why my eyelids had swollen up like red balloons (making for a very embarrassing forty-minute wait among people with less obvious problems). Off I went, with a prescription for two medications and directions to come back in a week. In a week things were better, but not better enough. So, another forty-minute wait, another visit with the good doctor. This time I got five minutes of his time because he was training a new graduate. So, it was not what he'd initially thought; it was something else, and it would get better if I kept using the steroid cream. That was fair enough. Uncertainty is the foundation of medical decisions, and sometimes the only way to know if this is condition A is to see if it gets better with medicine B. None of this was a surprise or a disappointment to me. Here's what was: at the end of the appointment he said, "Sorry to have wasted your time." I was too surprised to ask what he meant. Did he mean he knew the wait was too long? Or that I should have ignored his instructions to come back and just kept using the cream, since things were getting better? Although I don't think any less of his medical expertise, I thought his remark was lame; maybe he was too tired and busy to express himself more clearly. One day I might shoehorn this into a short story.

The reason I found this curious is the contrast it provides with the veterinary standard of client care. In my line of work it would be unthinkable to make such a careless if innocent remark. We simply cannot afford a potential misunderstanding or offense. If a client has been waiting for forty minutes (as they sometimes do, because of emergencies and routine appointments turning out to be not so routine), they get an apology. No exam lasts less than ten minutes; twenty- to thirty-minute appointments are becoming the norm. Of course not all of this time is spent examining the pet; a large part of it is devoted to a conversation with the client - about medicine, and about money. Does money make all the difference between human and veterinary medical standards of customer care? Money makes an enormous difference, but not because it is absent in human medical care: it is present but for the most part invisible, while perception is everything. (Despite what many of my fellow Canadians think, medical care is not free, although our taxes pay for a very small part of it with the rest being heavily subsidized by Fort McMurray oil; but that's a story for a different day). Maybe veterinarians are trained to walk on eggshells because they work with a much more vulnerable type of patient, the kind that can't speak for itself - but then, so do pediatricians. So neither money nor the fragile status of our patients explains why MDs are free to practice medicine while DVMs must practice customer service that offers medicine as its commodity.

I think this is because veterinarians are on a crossroads of social, economic and emotional demands that make for an impossible situation. How else to explain why we constantly second-guess our medical decisions, beat ourselves up over the most trivial of things, why the rate of suicide among veterinarians is painfully high, and why, for all this, the public perceives us as heartless merchants who only care about money, or at best as glorified janitors whose purpose is to end the life of an animal at the owner's request?

Our profession evolved from caring for food animals and transportation/working animals (horses). For most of our history, our work was essential to society and its health, and our successes and mistakes were often a matter of life and death. From our history we have inherited a sense of the utmost importance of our work, and the self-imposed requirement to excel. Then came a sea change that resulted in veterinarians being service providers in a sentimentally important but largely non-essential sector. Caring for house pets is a very recent development in the evolution of veterinary medicine, but in first-world countries this is now the bulk of what veterinarians do. Here is the sad and sobering truth at the heart of the matter: with the exception of service animals, pets are a luxury and not a necessity. Companionship is a necessity; getting an animal to provide that companionship is a luxury, and while other humans may not be everyone's first choice of companions, the choice is there. And no matter how many times we call our pets babies and family members or how sincerely we feel about this, there is no guaranteed safety net for them in case of accidents or major illness. They are at the mercy of their owners' financial decisions and of their veterinarian's readiness and ability to give away services for free. For all the failings of the human medical care system, there is the fundamental understanding that a human life is precious and that no person will be allowed to die simply for lack of money. There is no such promise made to animals by society and the government. The nation (i.e. government, taxpayers, laws and regulations) does not regard pets as its children the way it does human children. Yet there is the expectation that animals be treated in the same way as humans when it comes to emergency situations.

Veterinarians carry the emotional burden of responsibility for other people's fur babies, and they are held morally accountable when owners cannot come up with the funds necessary to treat their pets. We strive to offer the very best medicine (which not everybody wants, and which is not always in the patient's best interests) and spend countless hours arguing among ourselves about the best way to do this or that procedure. We are incredibly skilled at blaming ourselves when something goes wrong, even when this something is not even remotely our fault. Despite knowing very well that this is no longer true, we behave as if the customer is always right. There is a huge disconnect between what we offer and believe is good for the pet, and what the owner wants for their pet (and this may have nothing to do with what they can afford). Is this because we are nerds with our heads in the clouds, while the owners often have no idea of how their pet's bodies work, and may not really want to know? (Again and again I realize how many people have no idea of how their own bodies work, and how many do not want to know.) Is this because veterinarians have somehow inspired the image of suckers who love animals and *should* save them at all costs to themselves? Or because in our society people do not always know the difference between entitlements and responsibilities? Is it also because pet ownership has come to be viewed as proof of a happy family and good moral character, and people often acquire pets not simply without due forethought but without even really, truly wanting them? These are not warm and fuzzy questions, but it's time to start asking them.

Sunday, October 21, 2012

Friends and Family.

Back home from a two-week assignment in the lovely Fraser Valley, I'm basking in the attention of my two cats trying to climb on my lap from each side and confused about the laptop I've chosen instead. Maybe they just appreciate body heat now that it's cold and dreary, and maybe they do love me in some non-anthropomorphic way we'll never be able to fathom. They can't correct me even if I'm full of - something, so an animal's love is the easiest thing to assume and go on assuming. That's okay, because we're all human, or all animals, hence pretty weak and vulnerable, and we're going to insist we're loved even when someone in their meanness tells us otherwise. The anthropomorphism isn't going anywhere any time soon. So as a wise man once said, It's All Good.

What bothers me a bit is when a grown person says with perfect seriousness that their dog is their best friend. It's supposed to be a noble sentiment, right? It suggests this person is honest, pure, has had it with all the bullshit that exchanges hands between humans, and has turned to an honest and pure creature for companionship. The person becomes more noble by a sort of osmosis. (I was interested to find out that the phrase man's best friend was coined by George Graham Vest, a Confederate statesman and lawyer whose keen sense of justice as well as historical circumstances probably made him thoroughly disgusted with humans. The phrase was first used in Vest's courtroom argument that the killing of his client's hunting dog Old Drum constituted the loss of a true friend besides mere property damages.) I agree that dogs can often do a much better job at being people and that humans often suck at this, but I also think it's kind of a copout on our part to turn up our noses at fellow humans and pretend we're as honest and pure as dogs. But enough about us. Back to this alleged friendship, what's in it for the dog? Does the dog also think of the person as their best friend? Are we living up to our end of the unspoken bargain?

It's a huge act of arrogance to take a pack animal that thrives among its companions and put it among foreigners who don't speak the language, or speak a very broken version with a strong accent. It's just as arrogant as doing surgery. But you don't cut into a living body without meticulous preparation and taking precautions for healing afterwards, so why is it acceptable to throw a dog among humans and expect it to know what to do instinctively? It simply doesn't; it needs to be taught, and some teachers are much better than others. I've met rare and amazing pups who are very calm and dignified by nature, with the wisdom and near-indifference of grown wolves even at six weeks of age. They are deceptively low-maintenance because they don't yap or follow people around, but they need training and socialization just as much as any other pup. And most pups are not like this; most are exuberant, do not know what's expected of them, and will push the envelope to find out where they belong in the pack. Without training they get stuck in a groove of anxious and overactive childhood for the rest of their lives. In my perfect world it would be illegal to separate pups from each other and their mom until they are at least three months old, when they've had a chance to be educated as dogs through playing together and guidance from mom. In a less perfect world where consumerism rules and people insist on scooping up a pup as young as six weeks and raising it themselves, I'd make it a requirement to take that pup to dog kindergarten where it can at least observe other pups at play and learn the fine art of bite inhibition as well as getting the companionship of its own species. No offense, people, but we'll never do as good a job as the pup's own family. Training a dog can be a real bitch, so why not leave it to the real bitch, the dog's own mother and siblings? Back in the real world where veterinarians are often glorified janitors cleaning up genetic and behavioural messes we have no legal power to prevent, I do the best I can. I'm shamelessly over the top in my praise of owners who take their pups to kindergarten, or who have waited patiently and unselfishly for their new pup to grow with its own family before it was sold to them. I gently encourage breeders to make this a rule. It's a great joy to see a happy, well-trained dog whose owners have taken the trouble to learn its language and to speak it. Then I see a plethora of dogs for whom it may be too late because they've been smothered in completely misguided sentimentality, treated truly like the little fur people they are not. Some of these dogs cling in terror to their owners and cannot bear to be touched by anyone else; not only are they perpetual children, but perpetually unhappy and anxious children. There is hope for them if the owner realizes this is no way for a dog to be. But if they dote on the extreme dependence their dog has developed and see it as cute, there's not much to be done.

As I wrote this the sun started seeping through the fog, and I'm watching clouds being made on the slopes of Tantalus Range. The cats are asleep, exhausted by the effort of sitting and looking at each other across the keyboard. For now I will content myself with their companionship. Because although I would love the friendship of a dog, I'm not in a position to take one into my life at this time: I need to be much better prepared.

Saturday, April 2, 2011

Looking for meaning where there may be none.

A very pregnant cat came to our SPCA hospital from the shelter yesterday, and according to protocol she could be either euthanized or spayed. Nice and simple choice, kind of like choosing a plan for your wireless phone. The veterinarian doing surgeries was able to fit her in. Any vet I know, including myself, would find a way to get her spayed if the alternative was euthanasia. The logic behind this is seemingly clear-cut: the mother cat is already the subject of a life, but the kittens' lives have not yet begun. I know, many would argue that the kittens are in fact already alive, or at least viable, if the pregnancy is advanced enough. Never mind cats - the question of when a human life begins has still not been settled to everyone's satisfaction, and there's no need to repeat the debate here. In veterinary medicine in a shelter setting we of necessity simplify things: an animal that has already started its life and lived some of it, usually takes precedence over an animal whose life - growing, learning, playing, experiences - has not yet begun. I have no intention of pondering what's right and wrong here. There is no right and wrong, only consequences - and I can't even lay claim to this great saying. The consequences in question are the number of lives that require homes, and that are in danger if these homes aren't found. Fewer lives mean less potential for suffering in our cat-unfriendly world, and lives that have not yet started (in the simple, non-convoluted sense) should not be encouraged to start. Simple math, and no need for moral agonizing.

But consider the other official shelter choice - euthanizing both mother and unborn kittens. The mere fact that it exists is interesting. Even more interesting is the fact that some veterinarians avail themselves of this choice. Think about it: a cat who has not yet become pregnant is entitled to spay and subsequent life, but one who is pregnant has somehow lost these wonderful privileges conferred by humans. Why is that? I doubt it's because the non-pregnant cat is considered healthy whereas the expectant mother is somehow an anesthetic and surgical risk. Spaying a pregnant cat is more involved than spaying an immature one, but it's still a fairly simple surgery (compared to dog spays) with little or no health threat to the mother. So, why would a pregnancy even theoretically threaten a cat's right to be spayed and to continue living?

Saturday, March 19, 2011

Brachial plexus injury, and a big spot of doubt.

Last Saturday I had the honour of meeting a young marmalade cat who'd been hit by a car and found his way home a couple of days later (judging by the dried blood on his chin and the degree of dehydration). He had a broken lower jaw, a broken upper canine tooth (fang), and an injury of the front leg that made it impossible for him to use it. A fracture would have been much better, medically speaking. But this cat had a brachial plexus avulsion (torn or badly stretched nerves that run through the armpit to the front leg) which happens when the arm is suddenly and violently thrown sideways. With this injury there is almost no hope of meaningful recovery. In the best case scenario, the animal 1. is a dog, 2. has a calm and patient temperament, and 3. has undamaged nerves running from the back to the muscles above the elbow. Then they may learn to throw their leg forward to unfold the wrist onto the ground. If they are not so fortunate, the wrist buckles under and is dragged along, making it necessary to amputate the leg. Either way, they are unable to actively move the wrist and position the foot. This cat had two major disadvantages going against him: his injury was bad, making amputation necessary, and he was an inveterate outdoor cat.

I explained the injuries to the owners and said that physically the cat would recover just fine after a leg amputation - he was a robust young cat with the will to live, and ate a whole plate of food after the painkillers had kicked in. (He would also have needed dental surgery to remove the root of the broken fang and to wire the lower jaw together.) I told them that he would have to be an indoor cat for the rest of his life, as it is not safe to let a three-legged cat outdoors - he can neither run fast enough nor climb to get out of harm's way. Then I asked the owner about this cat's day - what he does, what he likes to do. The answer I got told me he was a dedicated outdoorsman, and would probably be miserable if confined. Unless he was frightened off the outdoors by his experience. My broaching of the subject, and asking the owner about his lifestyle, may have sealed his fate. Because an hour later, after we'd given the owners a financial estimate of the surgeries and hospital stay, they called back to tell us they'd made the decision to euthanize.

The things I've learned since starting in this career are the tip of the iceberg of what I want to know and be able to do. Yet one thing that came naturally (and perhaps too easily, given other veterinarians' typical reaction to the issue) was reluctance - or inability - to judge most people for life-and-death decisions relating to their animals. Of the things we do, passing judgment has to be one of the most exhausting procedures. I know this from the times when I was unable to resist. I'm actually quite easily annoyed by people, but this is different from feeling morally indignant at their choices. In this case, I did not feel the cat was being done a gross injustice. I needed to know his lifestyle, and I needed to tell the owners that the only safe life for a three-legged cat would be an indoor one. The God complex that afflicts many veterinarians made me feel responsible for the owners' decision - even now I can't help thinking the cat might still be alive if I hadn't stressed indoor lifestyle or if I'd been more forceful with the possibility that he might not even want to go outside from now on. Alive and recovering from a major surgery to see if his new life was livable to him as a cat as opposed to feline patient. He spent his last hours free of pain, ate a hearty meal, and dozed off slowly as the barbiturate I injected into his belly took effect. Then the receptionist told us that she got a vibe from the owner when he first brought the cat in that morning - he would not go ahead with any involved procedures. She has enough experience with people for this to be believable. And enough kindness to say things that would make us feel better. I still think I may have swayed their decision, but it must have been ready to be swayed.

Thursday, February 10, 2011

Free Lance (or would that be Free Scalpel?)

Since the beginning of January I am no longer gainfully employed by someone else. Business was slow and work a little too relaxed, and I'd started forgetting what it's like to be a doctor. By mutual agreement with my employer, we said our goodbyes. They tell you not to leave your current job until you have another one lined up (or is it - don't leave your current boyfriend unless you have a new one lined up? I get confused). I had nothing lined up expect for a few locum days at the SPCA hospital. Such perhaps unwise audacity was inspired by a trip to a First Nations reserve in November where a team of us volunteered at a spay-neuter clinic. Just like that, I was happy to be busy, to be run off my feet in a sustained adrenaline buzz. And no longer afraid of making a bad mistake, or of not being able to give people an answer as to what's the matter with their animal. Not that my skills and knowledge were significantly different from what they were a year back. It's just that I'd had time to take stock of what I knew, and cross some invisible barrier from rookie to doctor. Some people cross it sooner than that, and some start out as fully-fledged doctors on their first day of work. I envy them, but I'm old enough to know I'm not going to be someone else.

The few locum days at the SPCA hospital have been a blast. I've picked up more, and have made agreements with other hospitals in BC to work for short periods. There is no way I could have done this kind of work straight out of school. It takes the relatively sheltered cove of a permanent job with a mentor for reassurance if nothing else. Mine was very kind and easy-going but still buggered off on holiday two weeks after he hired me, and I remember being furious with him for having that kind of faith in me. I was particularly furious one night when I had to do a resection-anastomosis on a dog who'd impaled its abdomen on a sharp stick, with the stick tearing up a tuft of fur and driving it right through the jejeunum and out the other side. I felt dumped, abandoned, and somehow deeply wronged. I resented my boss for his failure to understand how hard it is for someone without his 20 years' experience. In hindsight I think he knew what he was doing: forcing me to do things I'd be too timid to undertake on my own initiative. I learned a heck of a lot. But I was scared a lot of the time. Most newbies tend to get scared in various new situations, and until that fear is overcome, it's probably not a good idea to take it with you to different work places where there are new people and new protocols to learn every time. Now that I finally have the same faith in myself as my boss had in me from the start, but no longer working there, I'm trying myself out as a locum. Or locust, as my sweetie likes to say. Hopping off on a new adventure each time.

The nerd knowledge I had on graduation is about 80% gone, by a generous estimate. I no longer remember what exactly happens at the proximal and the distal tubules of the nephron, what gets resorbed or dumped and by what mechanisms. I know where to look it up quickly when the need arises. The new things I learn are, and will remain, the tip of the iceberg of veterinary medical knowledge. I know how to go about the uncertainty without panicking, and how to talk to people without feeling personally responsible for their emotional state. And I also know how to select CE courses that will actually teach me something, now that I'm paying for them out of my own pocket ;-)