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I think some relationships come along to teach us a deeper lesson.
Riley Grace was a wonderful golden retriever. When she came to see me she always wanted two things. First, a cookie...then once she snapped up the cookie, I was to pay full attention to her. She pranced with her leash in her mouth and she never turned down a thorough physical exam. That actually worked out for her, because throughout her years, she presented me many medical challenges.
She came to me already diagnosed with hypothyroidism. She had a heart murmur.
Under my care we expanded her problem list. I found several lumps and removed them. One was an aggressive cancer in a gland in her chest. Quite a few were just fatty lumps.
Her 'mom' was dedicated and loved her. She also spoiled the heck out of her. Again, it worked out well for Riley Grace because when I diagnosed the cancer, she went to a specialist to have chemotherapy. At the time I had few patients who had been treated with cisplatin. I knew it was tricky to use and I knew it was expensive. But Riley was less than 5 years old and that follow up ended up giving her another 8 years. In those 8 years her owner went through a bitter divorce. She licked her tears. She gave her solace and made her feel needed and loved.
She always made me smile, but without knowing it she gave me a gift that I share in my approach to my practice. A few years ago Riley came to me with some non-specific signs. She wasn't eating well. She was very crabby. I hospitalized her for a more indepth workup. She was a little dehydrated, her white blood cell count was elevated. Her Xray revealed a tumor in the front of her abdomen. From the radiographs I wasn't sure if it was her liver or her spleen. I went to palpate her to see if I could feel the difference. She bit me.
I knew something was wrong.
Follow up radiographs showed that her tumor was on a single lobe of the liver. The good news was that you can surgically remove up to 60% of the liver and it will regenerate if everything else is working well.
In fact, that regeneration can occur within a few weeks. The bad news was that most liver tumors in older dogs are cancerous. I prepared her for surgery. I told the staff we had a late night ahead. I called my wife and told her I would be late.
When I did surgery that afternoon I was faced with a very large liver tumor. But it involved only one liver lobe. I removed the entire lobe and controlled the bleeding. We gave her a transfusion from Gizmo. Her vitals were up and down throughout the surgery. Several times I thought she was in trouble, but she stabilized each time.
I decided to bring her home to watch her.
The team checked her IV, gave her antibiotics and pain medication and I packed her into my Honda. I put the IV bag on the hook made for dry cleaned shirts.
She was comfortable as we drove home. We live on the second level and so I carried her up the stairs when I got home. Mary prepared Riley a bed in our walk-in closet/ICU. Mary had heated up dinner and encouraged me to sit down and eat. I adjusted Riley's fluids and sat down to grab a bite. As I did though, I heard Riley Grace breathing more heavily.
I got up to check on her and as I did she looked up at me and took her last breath.
I tried CPR. No response.
I knelt beside her with her head on my knees, totally spent.
The inevitable second guessing began. Should I have sent her to the emergency clinic? Should I have recommended that Riley Grace have the surgery in Portland or Boston where a boarded surgeon might have had a better outcome?
How would I muster the emotional energy to tell her 'mom', who would surely be devastated?
I sat down for what seemed like a very long time.
I picked up the phone and called her owner. She was, as predicted, devastated. But she was also concerned about how I was taking it. I had worked with Riley and her mom for years now. I felt like I was part of the grief, part of the story, part of the support system. She wanted to see her and pay her respects before we had her cremated. I explained the situation to Mary.
.
I met Riley's mom at the clinic. We talked and cried for almost 2 hours. She had found a wonderful new man that had brought her and whom she later married. We all helped each other that night. I was grateful for the part of human relationships that can be healing during a significant loss. Somehow going through it together can be better that experiencing it alone.
So here is where the crossroads came for me. Several months later I was sharing this story with a therapist. Quick disclosure here, I have had several mental health professionals make sure my head is screwed on right as I go through my career and through my life. They have their work cut out for them.
As I downloaded all of the information, I shared with her all of my usual concerns. Was I getting too involved? Was I respecting my professional boundaries? How do I help other's heal in a time like this? How do I handle the fallout to myself, to my marriage, to my personal health, to my relationship with my children?
She asked me a very simple question. "Mark, is this the way you want to practice?"
I considered the conflicting responses going through my head. I knew it wasn't always healthy for me to get so involved. My wife, a nurse practitioner with a tremendous heart had often been concerned about how much it affected me when I lost a patient or something did not turn out well. She saw how I took it all to heart.
But on the other hand...isn't this what we are here for? Not just as a vet, but as a person? Didn't the same recognition of the importance of the human animal bond mean that I had to give it everything I had?
I responded almost surprisingly with a single word.
"Yes"
She responded clearly and without any judgment. " Mark, if this is the type of vet that you want to be, then you have to keep some energy on hand for when you need it. Take care of yourself on a consistent basis. Put limits on who you see. Take time for your personal relationships. Nourish your soul outside of your practice as well as in it. Do these things Mark... so that when you need to be there 110% for a patient and its owner.... that you will have it to give"
So if you wonder why I have closed to new clients 3 times since we've opened.
Its because of Riley Grace
If you wonder why I take off the last week in July every year, and I don't bring my cell phone
Its because of Riley Grace
If you wonder why I totally trust Jim and the team to help all of you on Friday with love and compassion
Its because of Riley Grace
And if you wonder why when I run through town trying to beat my last time when training for the Boston Marathon and I ignore you
Its because of Riley Grace
OK, I made up the marathon one.
Honestly, I'm not that great at taking off enough time. I plan to get better as I get older. But next week (July 26-30th) I am running away and enjoying the summer in Maine. You are in the competent hands of Jim and the staff.
Last year we had an essay contest, and if you want to know why I didn't judge it
Its because of Riley Grace.
I will be taking a break from the email list for the next two weeks. I promise to come back renewed and enthusiastic.
In the meantime, two things.
First, I got a call from Bangor's Best last week and we were voted Bangor's Best Veterinary Practice for 2010!!
Thank all of you who voted.
Second, I've been thinking alot about the feral cat thing and I think that if we had a way to come to the feral cat colony that the project would be more successful. It is for that reason, I am looking for an old VW Westfalia to set up as a mobile surgical unit.
Seriously....
Can you see it? Friends of Kindred Spirits? Peace signs? Spaymobile? Anesthesia unit next to the fake wood formica??
Maybe I do need a vacation.
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