Compassion Fatigue? or Idiot Fatigue?

It's been a tough week at the ER clinic. I'm just coming off working five straight twelve-hour days, which is challenging enough. But if you consider two of those days were weekend days, and the final day was short-staffed with me as the only doctor? Well, you could've played a pizzicato on my nerves by the end of the day yesterday.

The "weekend" component is an interesting phenomenon experienced by ER clinics in particular, as our services are sought by families, already distressed by their pet's medical condition, who are now further aggravated by being forced to seek help from someone they don't know: "You aren't our REGULAR vet. He's a GOD!" -- Well, your god chooses to have weekends and evenings off, guy, so you're kinda stuck with us.

The winter season doesn't help, either. For some reason, the holidays seem to be a particularly deadly time of the year for pets, and there are a lot of pets who need to be put to sleep around the holidays. I can't explain it. A former mentor used to cynically remark that he thought it was because the humans are all trapped indoors, due to the cold weather, and they finally look at their pets and realize, "Oh, shit! Fido is sick!" when he's actually been sick for weeks. Or longer. Even more cynically, my mentor would also remark that "No one wants the old dying dog to ruin the Christmas photos." Ouch.

My own experience suggests nothing so coldhearted. The pets I've had to euthanize in the past few weeks have genuinely had conditions that simply weren't present two months ago, or even last week. Cancer is always reliable for a pop-up surprise of the worst kind. Had one of those yesterday. Nice dog with a limp. Bone cancer. -- I don't know why it's worse this time of year. Maybe in the summer ... well, I just don't want to think about it.

And of course, money is also stretched thin around the holidays. People are stressed about family and gifts and cookies and parties and travel, and then here I come with an estimate for a thousand dollars for care of their sick pet, another unplanned expense. 

And of course, it's winter. In Alaska. Dark. Cold. 

I understand all these things. I have empathy. I have beloved pets of my own, after all. -- And I understand the money thing. I grew up in a family that had about a half dozen cars in the driveway most of the time because we could never be sure which one (or two) wasn't going to start that day. I was told by my mother that I couldn't have a dog because we couldn't afford it. And we couldn't.

So, as a doctor, I get it. It's a crappy thing to get bad news about your pet, whether it's life-ending or just really expensive. All day long, I walk into rooms and give bad news. I listen to stories, hand over boxes of Kleenex, negotiate for what the family can afford. I've even been known to give a hug or two (You can ask anyone: I am not a hugger). 

It's an exhausting part of the job, but a necessary one.

However.

Mixed in with all these lovely families who are trying to do right by their little furry friends, are the following people, and this is where I truly struggle:

-- The Inconvenienced: I had a gentleman come in yesterday with a sickly sixteen year old dog (yep, sixteen), and his main concern was that he was leaving for vacation the next day and just really couldn't be bothered to have to deal with this, when, y'know, he's going on vacation! Like, tomorrow!! Can't I just give the dog a shot or something? I mean, they've already got a sitter arranged to come check on him once a day. The dog'll be OK, right? --  It's a nuisance, I sympathize. But some clients at least laugh about it, as they stroke their kitty's head and say, lovingly, "Kid, you've got amazing timing." And then they take proper care of their pet's needs. -- But these other folks are more worried about their tan than their cat's three week history of diarrhea and weight loss.

[I know what some of you kinder gentler readers are thinking. But I urge you to reserve judgment until you've read the closing comments.]

Next up:

-- The Breeder Cultists:  The client says, "Well, my breeder says....",  or "Can you call my breeder to discuss it?"... This is, of course, mostly a puppy phenomenon. I never know why people think breeders have more medical knowledge than doctors. I do know there are some good breeders out there, but it has to be said that the only requirement for being a "breeder," is that you put two pets in the same room together and allow them to mate and then successfully whelp at least one live offspring from that mating. Not terribly skilled or difficult. And if the breeder has been doing it for thirty years? That still doesn't give them medical credentials. The number of breeders I've encountered over the years who are merely bullshit artists who are good at marketing is astonishing. So if the clients fold their arms over their chests and glare at me while proclaiming how I have to separate out all the components of the vaccine and give them according to the schedule "written on this here piece of paper" (usually scribbled, in pencil), well, I just think the breeder did a lovely snow job and the client is feeble-minded. 
("Internet breeder" [whom the client has never even met, nor seen their facility nor met the "parents' of their puppy, etc.] gets extra points).

-- The Negligent: They've known for weeks that their pet is sick and in pain, and they thought she was going to die, several times. But she didn't. So now they're in my clinic, and now they want me to fix her, too late. And -- AND -- they've allowed their pet (with whom my true sympathies lie) to suffer this whole time. 

-- The Former Vet-tech (or Nurse): "I used to be a tech, so I can just do this at home. Give me the supplies and I'll treat him at home." And then they continue to ramble on and reveal a number of errors (IV fluids versus SubQ fluids is a personal favorite) which reveals to me they have no fucking idea what they're talking about, and maybe they used to be a vet tech because they sucked at their job and got fired.

-- The Internet Junkie: You know I have a special place in my heart for these folks. They've researched their pet's condition on the Internet, they know what their pet has, they know the treatment, but they need me to give them the drugs. That's it. Just a shot of [insert wrong drug here]. --- Mostly, these clients are gravely mistaken. They aren't doctors. Many of them aren't even intelligent. (Sorry, but there are some non-intelligent people out there, and many of them have pets.) They're usually way off on the wrong track from the get-go, so the pet does not have a chocolate toxicity but Diabetic Ketoacidosis. Or both. -- Or, they haven't read any scientific articles but merely blogs written by other non-medical people who have exactly as much experience with the condition they've written about as the clients themselves. The blind leading the blind, indeed. 

-- And, truthfully, I have learned not to roll my eyes at these folks mainly because I must admit, I do the same thing. It's normal these day to google something that's new in your life to find out a bit more. I don't even really mind a little bit of, "I read on the internet [insert stupid thing here], Doc. What do you think about that?" Then we have a chat and I calmly explain why that's not correct. --  No, I reserve my hackles for those who pair Dr Google with:

-- The Righteously Indignant: I should stop right here and say that I'm fairly scrappy. So the best way to raise my ire is to come straight at me, distrusting me and accusing me without even having had a civil conversation first. One of my philosophies is a paraphrase of a Goethe quote: Never attribute to malice that which can be explained by negligence. 

Which is to say, people aren't intentionally trying to fuck up your day; they're just plowing ahead with their own lives, oblivious of the toes they're stepping on.  In any case,  I don't know why some people approach life as if everyone is out to screw them over, but they must feel it works for them. 

And then they meet me. I do not eat shit, especially from someone I'm trying to help. The dogs? Yes. They try to bite and scratch and kill -- I get it. We're an alien species, and the cats & dogs don't understand we're just trying to help. But the humans? They should know better. Or at least be civil.

So, the woman who strides into my clinic declaring to the receptionists that she already knows we're just out to take her money and overcharge her and "do a bunch of unnecessary tests,".... Well, why doesn't she understand the receptionist is going to tell me that, and, see, now I already dislike her? I am already compromising on what I think is best for her pet, before I've even met her or seen her pet? She isn't telling the doctor: "Alert: this woman will not be fucked with!"; she's putting me on the defensive, right off the bat. And isn't that just what you want in someone who's trying to care for your loved one: someone who is now more focused on you & your shit than they are on taking the best possible care of your family member? (My sister is a human nurse & says the same thing happens to her. I really wish people would get this through their heads: Don't piss off the waiter, or they'll spit in your food.)

                                

I know what a lot of you kinder, gentler people are thinking: These clients are just frightened. Maybe they don't have much money and so they cloak their insecurity behind a big blowhardy personality. Or maybe they know they aren't very book-smart, and having to talk to a doctor is overwhelming because they already know they aren't going to really understand what's going on with their pets. Or they love the shit out of their pets and they're just really scared, so they aren't thinking much about their words or actions?

I agree. In my estimation, this is about ten percent of the people who come into my clinic and act like this. The rest are just assholes. 

And here's the kicker. After all the theatrics and grandstanding and gnashing of teeth and tearing of hair, after the half-dozen different estimates for various step-down plans of care (each one cheaper than the rejected one before), after the dozen conversations where we explain to first the husband and then a half-hour later the wife what each line item means, and we have gritted our teeth to calmly indicate we aren't going to explain exactly how a pancreatitis test works (not kidding), ... After all this time and energy and effort, many of the families elect euthanasia. And then, then, I have to be compassionate.

I cannot, as I frequently wish to do, give them fifty verbal lashes about how they shouldn't have waited until the seventeenth seizure before seeking help just because the internet said the dog would "snap out of it." Or how I know the reason they're truly making this decision is so they don't have to be inconvenienced by worrying about their pet while they're lying on a beach in Maui somewhere later this week. No, I have to suck it up and sympathize, because regardless of what has happened up until this moment, I do understand that for most of these families, it is a heartbreaking thing to say goodbye to their pet. 

As I said earlier, my ultimate empathy is for the pet. These pets are suffering already, and are going to  continue to suffer in these homes where their needs are so far down the list of the family's priorities that they might not even be being fed each day. In fact, sometimes my heart breaks more for those I "treat and street," providing outpatient care then discharging to their owners, than for those I humanely euthanize. It is for these discharged pets that I especially grovel to the client, in hopes that my beneficent attitude somehow will encourage that family to gather some more funds and come back for follow-up or continued care.

So, when I go home at the end of a long work week as this one has been, and I pour myself a Big-Gulp sized glass of red red wine, I try to focus on the woman I saw today who brought her dog in for a swelling under the neck. She was a new client. We were not "her regular vet." She was leaving for Hawaii in two days but her parents would be taking care of the dog while she was gone. I poked the lump, and it was an abscess: messy, requiring some home-care and oral medications to be given -- and she raised her arms and smiled, "Yay! It's an abscess!!," not put off by the inconvenience or expense, merely relieved & happy it was nothing serious for her pet's health. -- These are the clients that refill the well, and I'm grateful for each and every one of them.

The Weight of 100 Stone: Depression I

When I was sixteen years old, I wanted to die.  More accurately, I didn't want to live anymore. There's a difference: it's subtle, but if you're being precise, no one actually wants to go through the process of dying, right? Nevertheless, it seemed that the best way to "not live anymore" was to die. And the only way that seemed likely was for me to take matters into my own hands.  

You could ask what precipitated such an extreme and irreversible plan of action in a young woman whose entire future stretched out ahead of her, all the opportunity in the world waiting there for her to pluck like so much low-hanging fruit. But I couldn't tell you. Not because of any sense of privacy.  I just didn't know. 

It seemed I'd always been a solitary child, slightly out of step with the rest of the kids, whether in a neighborhood game of Kick the Can, or in school. Yeah, I alway felt like a weirdo in school. 

Finally, by the time I hit sixteen, I'd had enough. -- I don't really remember what happened next. I can tell you there were no dramatic Hollywood moments of ambulance lights flashing or paramedics working furiously to resuscitate me. -- Somehow I must've told my dad, who was a social worker, before I actually "tried anything." And the next thing I knew, my butt was parked in a chair across from my very first therapist, a miracle worker named Ellen. I cried the entire first hour I sat in that chair. I doubt I was able to utter even two coherent words during our first session together. 

Fast forward -- like, a lot -- and here I am, thirty-five years later, and still struggling. I've traveled many paths -- medications, exercise, diet, meditation, therapy -- and they all lead back here. It's something I live with and probably always will. Some days it's still nearly paralyzing in its severity.

So when I heard of a social art project called 100Stone taking place right here in my own town of Anchorage, it drew my attention. The lead artist, Sarah Davies, herself has struggled with depression -- not just the effects of the disease on her body but also the social .... I'll use the term "pariah-hood"... that accompanies it. She describes feelings of loneliness and shame for this illness -- a genuine illness -- that affected her for many years. To her, it felt at times like the weight of a bull on her shoulders. (Thus the title of the project -- Not one hundred stones, but a British weight unit of one stone, which is about fourteen pounds. One hundred stone is about fourteen hundred pounds, or the weight of a bull.)

I most certainly cannot express the sentiments of the artists better than they do themselves, so I'll merely "cut and paste" their own words from their website:

"Part of this project is the elucidation and demystification of our conditions, and normalization of our experiences. In order to do this we must join in solidarity to shed our shame so we might be a catalyst of change in the cultural attitudes that keep those of us who experience emotionally burdensome conditions isolated and fearful. It is your truth that will empower someone in need to reach beyond their closets into the light. Whether you tell it in word or symbol, revealing it is the key."

The project itself (which you can read more about here: http://www.100stoneproject.com) consists of casting forms of individuals from communities all over Alaska, people who answered Sarah's call. For you Alaskans reading this, 100Stone contains work drawn from the communities of Talkeetna, Fairbanks, Delta Junction, Tok, Glenallen, McCarthy, Valdez, Wasilla, Palmer, Seward, Homer, Bethel, Sitka, Juneau and Girdwood, as well as Anchorage.

Another excerpt from the project website:

"Each figure is sculpted from and by people who have been directly affected by persistent emotional pressures, working in burlap, plaster, cement, and straw. They are the physical encapsulation of hundreds of unique experiences of vulnerability resulting from circumstances such as traumas, grief, chronic illness, mental illness, and substance abuse and our powerful stories of resilience in the face of the marathon that is self-care and management."

Of course, with my own personal history, this touched me. Trauma? Check. Grief, illness? Check, check. Resilience? Well, I don't know. That's a daily struggle. I try.

I somehow missed the timing for the opportunity to have my own figure cast, to have told my own story by that medium, though I just found out that one of the figures I was handling today was that of an old coworker of mine. Not unlike many of us who struggle with depression, even I would never have guessed she was my sister in this battle. She's a cheery ray of sunshine any time she enters a room, always, it seems, seeing the best in everyone and in the world. Which just proves the point, I suppose: hidden, unmentionable. Public face vs private self.

This weekend, the finished 100Stone sculptures were moved to their exhibition area, a part of Anchorage called Point Woronzof, which slopes down to a type of "beach" referred to as "mud flats." From the time one arrives in Anchorage, urban legends abound of people being trapped in the quicksand-like mud flats and either being rescued or dying as the tide rushed in over them. A fitting place, then, for one hundred figures struggling under the weight of their burdens.

Fittingly, it was a dreary day, Anchorage's first real snowstorm of the season had passed through the night before, and supposedly the sunrise happened around 9am (though there was no sun to be seen among the swirling flakes and low-hanging clouds). Nevertheless, a group of maybe two dozen volunteers gathered in a pre-project huddle, decked out in puffy coats, Carhartts and bunny boots (nonAlaskans might need to look that one up) before starting the process of moving the figures from the backs of flatbed trucks (they'd been transported from the studio the night before) down to the mudflats. 

Another group of volunteers had already suffered the elements, two weeks prior, to dig out and install the mounting stakes which were already buried several feet into the ground. 

Today, the figures were mounted on those stakes by a combination of physics, tripods, winches, and sheer human effort.

Needless to say, it was an impressively coordinated and executed operation. Nearly all the figures were moved and mounted within the first two hours.

But of course I was there helping out for another reason than just unadulterated volunteerism. I had an ulterior motive, if you will. These figures? They're my brethren. The people who casted the statues had suffered, as I had suffered. I was not merely moving objects, or even pieces of valuable art (which, with all the time, effort and creativity involved, they certainly are that, as well). Each time I moved a figure, it felt alive to me. I felt like I was touching a vulnerable part of someone's life that they had bravely chosen to share with hundreds or thousands of strangers. The figures very quickly became "him"s and "her"s: "Watch out for her arm!" "There's too much pressure on his head, roll him to the left a bit." Not just me -- I heard it from the other volunteers, as well. 

There was some "standing around time" as we waited for trailers to shuttle between parking lots, so I got a bit chatty with some of the other volunteers. I was surprised to discover that most people were there "just because." None of them (I asked) had struggled with depression themselves. They just thought it sounded like a cool thing to be involved with, which (in my opinion) it certainly is that, too. 

Nevertheless, there was one young guy who was joking with his friends. "They look like zombies!" he laughed. I probably should have minded my own business, but in what I hope was the spirit of sharing, I gently offered, "It feels like that sometimes." I was staring off at the statues, intentionally not looking at him, but I could tell by not only his silence but the quieting of his friends that perhaps I had overstepped, had rained on the parade of a bunch of young toughs who were just trying to do a little volunteer work. But, overwhelmed by the mood of the day and what I interpret as part of the meaning of the piece -- even if it only means that to me -- it's important to understand how the world is for those of us who struggle. 

So I kept going, just a bit, gently, gently: "Sometimes it feels like you're a zombie, walking under this burden that no one else can see, that everyone around you is normal and happy, and why can't you just be like them, all happy & jolly?" A pause. "But then the next day is better. And so you just keep going." -- I walked off, then, to give them the chance to remark on my social inappropriateness, if they desired. But maybe -- just maybe -- one of those young toughs already knows what I was talking about. Maybe he feels like a zombie sometimes, too. 

And so I walked on. And as I walked among the figures, I again felt the stories of their models crying out to me. So many different faces. So many different stories. 

Some of the figures seemed hopeful, looking skyward.

Or striving to move forward:

Others seemed not to be faring as well, struggling... struggling...

A couple of the figures were paired, with a child, perhaps -- comforting? Being comforted? Struggling together?

This one crushes me:

He's barely keeping his head above water. And maybe when the tide comes in high, he won't. And maybe worth discussing, as well. 

We don't all make it. One hundred stone is a lot of weight to carry day in and day out. More than a fragile human heart can manage some days. 

But in the sharing, in the acceptance and awareness, in the support and love of friends and family and community, we can help each other leave that bull by the side of the road. 

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(If you would like to learn more about 100Stone, "Like" them on Facebook. The official opening date is Saturday, December 5, 2015, at 4pm.

Many thanks to the artists for sharing their vision with us all.)