MORE HOURS IN A DAY

A week ago I interrupted Dr. Grant and her team during A Very Important Surgery because I was absolutely at the end of what I knew how to do.

I was spending about 1 ½ hours a day reviewing patient histories before each day started and 2-3 hours finishing records at the end of every day. I felt like I was sleeping and working. Wait - I mean I was sleeping and working.

“Dr. Grant, when you have time, will you help me please??” Dr. Grant stopped right then (thank you!!) and when I explained my struggles said “Stop writing everything down.”

“You will continue to struggle. You are handling every case at least twice. I’ve been where you are, and it is not sustainable. Stop writing everything down.”

We had both come from slower paced hospitals before Westgate Animal Clinic. I loved the pace before at other practices, but I love this pace too. More even. I love being busy and getting to help more families than ever each day. I did not want to crash and burn right as I walked into this incredible practice.

Before I could object, I heard Pastor Scott say clear as day, “Once you start saying ‘This is the way we have always done it,’ you are already in trouble.” (Thank you Pastor Scott! I WAS listening! Always.)

So I didn’t say that. I put my pen in my pocket and my paper away and nervous as heck, started to wing it.

It is scary hard! I have already introduced myself to three clients I had already met. I have almost called a girl dog a boy dog. But you know what? I am thriving.

I always said I couldn’t think on my feet well. I can! I know how to interact with people and pets in an exam room - better than I was ever giving myself credit for. I know how to think critically.

The technicians and assistants I work with are super badass and are helping me SO much to prepare thoroughly for each patient in real time and finish notes after. Which, honestly, is better medicine than I was practicing.

Thank you Dr. Grant! Thank you awesome team. I appreciate you all so much.

My brother Dave asked what I am doing with my four reclaimed hours a day. I am spending time with family and friends. I am watching silly TV. I am doing Sudoku and planning our garden. I am writing and doodling and sticking stickers on things. I have down time again, and everything is so much better.

Now to get just a few more helpers started around here. It is ridiculously busy and very fun - great medicine and such a supportive atmosphere. We need you. But now…now I feel like I can survive till you get here.

KINDNESS IN THE VETERINARY FIELD

Every issue we have in the veterinary profession, locally and globally, can be solved with kindness.

I do not think it is more nuanced than that. I do not think some of our issues are too complex to be solved with kindness. I do not think there are exceptions. I do not think it is possible to solve anything with a different approach or that some people need a heavier hand or a less kind environment to do their job well and thrive and succeed professionally.

We found the drawer with all the Secret Penguin stickers you all! And this one - I love it.

And though I am holding up kindness as THE solution to well…everything…I do think that manifests differently in all sorts of situations. And I do realize some things are not solvable or do not have an easy fix. And that issues truly are complex and nuanced. I do think kindness needs to be the base from which we start. I would love to get your take on this.

Is kindness THE answer or part of the answer to the issues we face in veterinary medicine? Issues including team satisfaction and retention, talented and passionate people leaving the field, our mental health struggles, our dismally high suicide rates and substance abuse issues, conflict resolution - all of it.

Not all of it fixable, not all of it straight-forward or directly caused by unkindness by any means. But I do think kindness needs to be the base from which we approach all of it. Not all of it unique to our field, but we do have specific challenges, don’t you think?

On a spectrum of can’t hurt-might help to kindness being the solution to everything, where do you fall? Worth a try though right?

Bill and Felix

And YOU - you are the best of the best. Keep doing exactly what you are doing. Your kindness - to those on teams with you and to clients and patients and colleagues - is what makes this career so amazing and why I keep coming back. I love this profession - and the people in it - so much.

Oscar oscaring.

Happy New Year. I hope you are overwhelmed by kindness - and dog kisses - at every turn.

Oscar and Felix wishing you a Happy New Year!

PERIWINKLE PUG LOSES AN EYE

Not 10 minutes into my new job at Westgate Animal Clinic (a couple of weeks in), Periwinkle Pug developed a red and squinty eye.

I requested permission and gathered all the eye stuff from work and did a work up at home with Blue. We had to look up how to use the newest tonometer - I had not yet used it! Periwinkle had glaucoma and uveitis of her left eye.

She already had keratoconjuntivitis sicca (dry eye) bilaterally, and had recently developed retinal degeneration that had left her nearly blind. She will almost certainly be completely non-visual eventually.

All that to say, if this eye was already trouble, and now being mean, if it did not shape up, it would have to go.

I returned to work and stared at the not yet familiar options in the pharmacy. Everything she needed was there. Dr. Petersen helped gather meds. And offered surgery if needed.

We started her on eye drops and pain medications.

Her eye pressure normalized by the next day. Her eye remained terribly painful.

Normally Periwinkle is the goofiest thing you could ever meet. She has a unique bark she only uses when Russ is making popcorn too slowly. I swear she laughs when she thinks she’s done something cute.

She stomps her paws and headbutts doors if she thinks she is being left out of something fun on the other side. She grumbles if we try to help her onto the bed that Russ made very very low for Joy’s sake. We left it low for Periwinkle. She always needs a butt boost and always swears at us when she gets one.

The roughest part of this whole ordeal was seeing our clown of a dog reduced to a scared, shaking little thing, frozen in place. I was more heartbroken about that than the thought of her losing an eye.

Dr. Petersen rearranged the entire schedule and had her issue solved very quickly. (That is all the details you or I need about that!)

Half the team sat with her durning recovery petting her and giving her oxygen while the other half the team ran interference to protect me from a surgery I very much should be comfortable with and very much am not, especially when it involves my own little Pug.

When I did come see her, she looked like she had just won a bar fight - a little rough with a bit of a shiner, but smug and content. The pain was already resolved.

The bruising and swelling were resolved in a day, and any post-op pain was completely covered by one of the most amazing medications I have ever known. (Just because carprofen is old and common as dirt does not mean it is not amazing.)

Periwinkle is snoring constantly beside us now. I am forever grateful to Dr. Petersen and the entire team for returning our little goofball to us, once again whole, happy and pain free.

WESTGATE ANIMAL CLINIC

I texted Dr. Petersen, the owner of Westgate Animal Clinic.

I requested a chance to reapply for the position I had turned down two years ago (while crying I might add - I knew I was giving up a great opportunity to pursue an equally great opportunity, and that HURT.)

It had been such an amazing two years - it was absolutely the right decision at the time - but now here I was wondering if I could be so lucky as to have it all. I wanted to work with this team too.

This one time, at a family dinner, I was telling my brother Dave about what a great team Westgate Animal Clinic had and how much I had enjoyed meeting them two years prior. He said later that my eyes lit up when I told him.

Russ overheard and said maybe that was next. “Absolutely not,” I said. I continued to line up other options.

Russ let it go knowing I have scary good intuition.

Eventually he asked why I would not even consider looking into this opportunity. I told him Dr. Petersen and his team were the kindest group of people I had ever met, and if I worked there and learned that were not true I would be devastated.

Russ stared at me and waited. “Oh…” I whispered, and texted Dr. Petersen.

Fear is sometimes a good reason not to do a thing, but it is sometimes a barrier that keeps us from taking a risk we should take. I mean me…I.

Dr. Petersen invited me to visit. “Wow! Can I hug your client??” I asked when I got there. Without waiting for an answer, I hugged his client. It was Ryan Sorensen! “Oh, I know him,” I explained, much later in the interaction than I should have.

Dr. Grant and Bre let me shadow them in surgery. “Are you all as kind as you seem?” I asked. When Dr. Grant said they were I said, “you know a good guy AND a bad guy would both say yes to that.” I then let her complete surgery while I watched politely as I assume (but do not know for sure) that normal people would do.

When Dr. Petersen asked if I had questions, I asked if he was going to hire me. “Yeah probably,” he said. And then he just…did. I was (am) so happy.

(Art above from Pixabay by ractapopulous - used with permission, color corrected to dog and cat vision.)

In my very first solo appointment, I opened the exam room door and knocked the art off the wall. I introduced myself with my back to the client and her dog while I tried to rehang the picture. “Are you…a doctor?” she asked.

“Yup!” I said as I dropped the corner of the picture and started over trying to put it back up. She was very gracious and let me see her dog even though she had not yet seen me be able to handle anything I touched!

The appointment improved, and it was a very enjoyable day.

This is a great next chapter you all. I love it here so much.

SURGERY DAY

Surgery day finally arrived. I was so relieved knowing that this was the turning point. I would go from week after week of consistently ongoing draining energy to healing.

I had never had anesthesia before, but any anxiety about that or surgery was overshadowed by the excitement of better days to come.

Part of the pre-op work up was a pregnancy test. I asked if I could just promise I wasn’t - nope! I turned to Russ as we waited for results and said, “This could be a completely different next several months than we had planned!” But then - all good and set for surgery!

Dr. Carlson asked me to explain what my procedure was in my own words. “I’m getting spayed!” I said excitedly.

He set his papers down and scratched his head and sighed. “Details?” So I explained the procedure apparently well enough to win, because soon a kind nurse was wheeling me to the anesthetic induction room.

“Hold this mask a sec,” she said. “I don’t remember that painting on the wall,” I said. “You are post-op,” she laughed. “All went well.”

Russ stayed past curfew with the night nurses’ blessing. We watched Ghostbusters and walked the halls slow as a slow turtle (some are fast), me with my walker and the nurses cheering me on. It was more encouraging than the crowds at cross country races in high school!

The next morning Dr. Carlson came to check on me. He was messing with the things on my table as we talked - I nest everywhere I go!

I had some cool toys and rocks with me. And a beautiful drawing Abby had done of Joy and a sweet note from both the kids.

Dr. Carlson picked up the cup my friend Dr. Neubert had given me and said, “What do you have in here, rocks?!”

“Ice water!” I said.

“Yeah you can pick that back up in six weeks,” he said. “You did great.”

As he was leaving I said, “Dr. Carlson, thank you. Really.” He smiled and was gone.

A more articulate thank you message is planned - for all involved in saving me. As any coworker or client can tell you, I am not always great with words in real time.

But I hope Dr. Carlson knows how grateful I am. I hope his team and the anesthesia team and my internal medicine team and even the allergy team all know too. I am forever thankful.

This was the biggest step to several long, slow weeks of healing leading to the best health of my life.

The best health of my life SO FAR.

A NEEDED REPREIVE

Every other year, the Nelson side of our family gathers for a week together, usually at a lake somewhere between Omaha and Chagrin Falls, where the Ohio Nelsons live.

This year we planned to travel to a beautiful cabin in Table Rock Missouri. I did not know until the week before if I would be able to fit the trip between medical appointments and surgery or if I would be strong enough for the car trip. I did, and I was.

This was the best week of the entire summer and some of the best family time of my life.

After so much health worry and uncertainty, staring out towards the lake from the deck was the absolute opposite of the summer thus far.

I was too weak to do more than sit, but truth be told, my entire vacation goal no matter my energy level is always to sit and take in the family time and surroundings. I absolutely kicked butt at reaching my goal this vacation! I did better at relaxing than any other vacation before!

After all the medical and other turmoil and stress we ALL had been through lately, I was an absolute sponge absorbing the time with my brothers, their kids and ours, Mom, Dad and Russ. And the geese.

Cara was not able to come which made us all sad, but we did agree to bump the trips from every other year to every year so hopefully we can all be together in 2024.

Russ planned the menu. Our kids helped carry out the meal plan. Arthur and I honed our eye shadow application techniques. The kids shopped. Bill revealed he had learned to play ukulele over the past year! He is super good at it.

We celebrated Father’s Day and Dad’s birthday. Abby had all the kids paint rocks for Dad.

We rode in the boat every day and sat by the campfire every night. Perfect.

One afternoon, I was sitting on the deck with Olive, Robert and Arthur. Olive asked me to open her bottle of tea. I tried and could not. I passed it to Robert who opened it with ease. Arthur said in a gentle reprimanding voice, “Aunt Shawn, you are older than us. You really should have been able to open that.”

I said, “I know, but I am pretty sick. I will be ok, but right now I need help with a lot of things.”

I asked Olive how her tea was. She said, “Not as good as if you had opened it.” It is one of my best memories from the week! I love those kids - all those kids - so much!

The week was so healing and such a great time with our family.

I came home the week of surgery ready to start putting all these health struggles behind me.

SCHEDULING SURGERY

I returned to the physician assistant on my internal medicine team who had been walking me through all of this.

“Could the source of my illness and all of my clinical signs be fibroids?” I asked, feeling defeated.

“Absolutely,” she said. “Next is a hysterectomy. All of the surgeons in the system are excellent.”

With renewed hope, I requested surgery with any gynocologist. Russ literally called the teams of every medical group in the city, within and beyond our insurance network.

I told the physician assistant that at this point I would accept help from any skilled veterinarian. Apparently that is more alarming than funny?

Russ and I joked that if you have a flour sack with a hole, at some point you need to repair the defect or get a new sack of flour. He said “I don’t want a new sack of flour, I want you.” My heart! :)

Dad, ever my hero, talked to a leader at Methodist who was related to a friend of his to try to help expedite the surgery. Thank you Friend. Thank you Leader. Thank you Dad. You saved my life.

Original Gynecologist called and offered to schedule surgery at the end of July. It was the beginning of June.

“Yes please,” I whispered, tearing up.

“It won’t help, and you will have a long, difficult recovery from abdominal surgery in addition to the unrelated underlying condition,” she said firmly.

“Ok,” I answered, “thank you.”

I sat on Mom and Dad’s deck and stared into the (changing) corn field with Dad.

Eventually he said “You have a surgery date. That’s good, right?”

I said “I won’t make it that long Dad….I will bleed out by then.”

Dad shot out of his deck chair, seemingly in a panic. He is the least alarmist person I know. When I came into the kitchen to check on Dad, he asked me to read the email he had drafted. We replaced “death sentence” with more benign language and hit send.

Within days, the team of a different gynecologist had called and scheduled a consult and hysterectomy at his first availability. A back up plan was also put in place in which the doctor who had set all this in motion and his associate would perform surgery before that if it became an emergency.

Thank you Dad. Your actions saved my life. You and Mom, Russ and the kids and my brothers and friends and other family got my through this alive. The people on the medical teams who worked to make things happen are the reason I am still here.

I am forever grateful.

AFTER JOY

Next in my medical journey this past summer was a uterine ultrasound in which masses suspected to be fibroids were found.

My next stop was a visit to a gynecologist for biopsies to confirm the diagnosis as directed by the physician assistant who had been leading my care, Karen. Karen is the hero of this story, by the way.

Not every real life story needs a hero and a villain of course.

And villain is hyperbole. I am grateful to this gynecologist and her team for getting me to the next step. Without biopsies, a hysterectomy (spoiler - that came next) would not have been authorized.

But I am including this chapter of the story because it informs the rest. And honestly, it - in hindsight and since I did not in fact die - is one of the more interesting parts. So I will just tell it like it happened. And with sincere gratitude to this doctor who got me to the next step.

Russ and I arrived at the doctor office for my biopsies. I needed my walker all the time at this point and also was leaning heavily on Russ. I was having trouble staying awake, even for the duration of an appointment. I had fallen asleep during the short stay in the waiting room. When I was awake, my brain was foggy. It took me YEARS (several minutes) to get down the long hallway to the exam room. I met the team and doctor.

I asked what the pain management plan for my biopsies was. She said I should have taken ibuprofen as directed. I said I had and wanted to know the plan from there. She said she understood I was scared and it would only take a few minutes. I said I was not scared, but if I were about to remove parts of a dog’s body, I sure as anything would have a pain management plan.

She said she did not have anything available. I said we are at The Women’s Hospital and you absolutely do. I added that I also would not surgically remove parts of a dog without appropriate analgesics in the building.

We were off to a roaring start! I think we felt the same way about each other!

I asked if my illness and fatigue could all be secondary to fibroids. “No, absolutely not” she said.

“What do you think it could be then?” She said she only knew about the uterus. I am almost positive there is not a person on earth who only knows One Subject. And technically, this WAS a uterus question. So I pressed. I asked again if the root of my issues could be fibroids. “No,” she said.

“What then?”

Clearly exasperated that my appointment was taking longer than a biopsy should, she rolled her eyes and said, “I don’t know! Cancer?!”

And we moved on.

The biopsy went great and did not hurt. She was very skilled.

After the visit, as we were getting into the car, I became absolutely livid, which is not a super familiar emotion to me.

It actually felt good, I felt charged after feeling flat for so many weeks. But still! What if I were scared? What if it were one of my first experiences with gynecology? What if I did have a painful condition or the biopsy had hurt? What about all the women before and since who needed a comforting voice and did not have someone like Russ right there holding their hand?

I received the good news soon afterwards that fibroids were confirmed. The doctor said she would not do surgery because it would not help and reminded me this was something much worse - fibroids alone would not make me feel this terrible. I had not forgotten. Cancer was not a word you forget.

To be clear, if cancer or any unfavorable differential is a possibility, it should absolutely be discussed. Just…NOT in exasperation and absolutely not with an eye roll.

It took intervention on the part of several people to get surgery scheduled in a timely manner.

Next week - back to heroes - back to hope.