How to keep the bastards from grinding you down

Wish I knew.
I'm pretty good at being optimistic, but chronic financial issues, long distance relationships, school related stress, and sleep deprivation have this niggling ability to grind down the most optimistic of us, from the inside out (I tell you, my impetigo flares up way before I feel stressed). Sometimes I want to shut the door, ignore parents, try to ignore my friends and boyfriend, bills, hunger, tiredness, other responsibilities, and just STUDY to get school overwith faster. But it doesn't really work like that, and even thinking that makes me feel beaten down because it admits that I can't deal with it all. I remember the day before the first day of school talking to students ahead of me who said they dropped their boyfriends and other friends because (in a snooty voice) "who has time for that shit when you're in vet school?!". I vowed then and there that I would rather be miserable and human than bitchy, disdainful and callused.

Ground down, but trying to exist constructively as a mushy pile of positive goo,
Alyssum.

Death is part of every life

I came away from my PBL class (post below) feeling like there was an answer (maybe many) to be had, but that I just couldn't see it. I gave lots of thought to the matter, plumbing my feelings about what my responsibility as a vet will be. People look up to veterinarians not just for their clinical knowledge, but for their [supposed universal] compassion and insight. With this in mind, I asked myself what I would consider when presented with the task of helping my clients prioritize their decisions. Boiled down, I found lots of ethics and opinions of my own. Obviously, I should not allow these personal beliefs and conclusions cloud my consultation. So what insight can I offer? Again, after much consideration, I realized that this is what I can offer:

We in the west (as Mick has so poignantly pointed out in a comment below, and as Mom has reminded me this morning) are generally not okay with death. This leads to occasional circumstances (more common than one might realize) where inordinate amounts of energy, time, thought, emotion, and resources are poured into a situation than is necessary, or even significantly effective. That is, one can eat right and exercise as much as possible, and the person will still die. Similarly, we can ultrasound, blood transfuse, treat with antibiotics, and monitor an old cat with chronic renal disease, but the cat will still die (and probably sooner than an old cat without chronic renal disease). So, then, is it worth all the energy to try to keep it alive? Well, the worth is something that each person will have to decide for themselves. However, one point that we can always remind them (and ourselves) of, is that "death" in and of itself is a neutral essence. It doesn't matter if something is alive or dead. It really does not matter. That isn't to say that we won't miss a person or animal (or plant) if it dies, especially if it had a positive influence in our own lives (we will also miss them in a negative sense if they had a negative effect on our lives)--but note that we place that importance on the life; it is not inherent. Similarly, my life seems important to me while I'm alive, but if I'm not alive, then it doesn't matter at all. As long as I am able to contribute to the world, and enjoy the world myself, my life is worthwhile to me.
This brings us to the second point to remind our clients (and ourselves) of; suffering is something that is uneccessary, and it can be dealt with. Some suffering may be worth the sacrifice to get through to see the other side (vet school for instance). This sort of suffering may increase the contribution and enjoyment of self and others in the world. But other sorts of suffering are simply unneccessary. As doctors, we can attempt to alleviate suffering through treatment and care. This runs the gamut from prevention, to antibiotics or surgery, to euthanasia. As we consider what treatment or care to use, it is important not to keep euthanasia as a last resort, but as a method of alleviating suffering equal in viability as anything else. With this in mind, and truly accepted (DEATH IS NOT BAD), the options can be considered more clearly. Euthanasia is often not so much a question of "artificially ending" a life, but of determining when to cease artificially extending (via medicine) that life.
Worth can be measured in the ability of something (person, animal, etc) to contribute to the world around them, and (in the case of living beings) the ability to appeciate the world around them. As an owner, part of the measure of your own worth to the world around you is by how you distribute your resources. Resources may be allotted to your pet, or may be to your family, or your job, or charities, and so forth. Therefore, when presented with a situation in which euthanasia is a viable treatment alongside an expensive or time/labor-intensive treatment, it is not necessarily "selfish" to weigh the considerations of cost as a reason to opt for euthanasia. If your resources are better put to use in other realms and the ability of the animal to contribute to or enjoy life is compromised, then euthanasia may be appropriate. Not good, not bad, but appropriate.

Unexpected Emotion/Ethical question

In PBL (problem based learning) today, we were discussing a hypothetical old, skinny cat who had an infection and renal disease and who couldn't stand up. Medically, we spent the past couple weeks figuring out all the things that were wrong with it and what we could do for the animal. Good medicine meant taking an ultrasound of the kidney, giving it fluids, keeping it in the hospital for 5 days, doing a blood transfusion and checking in on the animal every couple of weeks thereafter, and keeping it on antibiotics, high blood pressure meds, etc. All in all if it were a real animal it would have cost ~$2000-3000. The animal had gained weight and seemed bright and alert and was doing better a month later.

As we discussed the case, I just broke down inside, wild confusion in my head, "This medicine is exciting, how neat that we can actually help the poor cat. But it still has renal failure and is an old cat. Is it worth two or three thousand dollars to try to fix an animal that will never be a perfectly healthy animal again? Two or three thousand dollars plus all the resources that go into my education to be able to work up this case, plus all the physical resources to do the medicine (plastic, plastic, plastic, ultrasound technology, lab work, blood work, more plastic...)---it seems so wasteful; there are so many more pressing issues in the world that would benefit from those resources than an old cat with a chronic disease. Things like conservation/ecological education, starving people, political corruption, alternative energy sources, stopping genocide, promotion of peace...... Yet, to that single person that owns the cat, this may be just as important. Or maybe not. And as the veterinarian, the doctor, what I present to her will make the difference in how this is handled. So do I tell her to just euthanize the animal? Do I go ahead and do all this medicine (that most clients, especially in states like Kentucky where the health and wellbeing of the people is fairly degenerate, and animals are a far second in priority) or just maybe a couple of the treatments which would cost significantly less but not give the animal as great a quality of life?"

I brought some of these issues up to my classmates, frog in my throat, tears welling--and they took my concerns seriously. But they also were quick to rationalize it. Which made me confirm that they are made for cat/dog work, and I am not. I simply can't see working in a field that seems based on luxury. Owning pets and feeding them is a luxury that we in this country take almost for granted (I have had poor clients not pay their electricity bills in favor of their animals' antibiotics, so I see how important it can be for people to have companions, but this is an extreme case). Owning horses is an even greater luxury (though I wish we all owned horses rather than cars at this point). And therefore I can't see myself working as a small animal or horse vet. Cows, goats, sheep, llamas, etc---these are owned by people for sustainance and clothing which seems more basic a need. Of course, in this country, the way cattle are "grown" is deplorable and I'd have even more problem working in a field that supported that industry. Sigh....

Just 2 nights ago I was saying that I could maybe work as a feline vet since I love cats so much (petting 6 cats in a day=good day for Alyssum) and seem to have a "way" with them. I just didn't expect to get so upset about this, it came out of nowhere, I didn't see it coming.

Back in the Saddle

After a week of stress and not much productivity at all, I have finally hit a stride (that I hope will last) with schoolwork. Pacing myself is not really an option, but staying constantly productive helps to keep the moving target of exams and reading from moving further away. I have been steadily working on an hour of material at a time, doing the best I can to not let myself get overwhelmed with the pressure of it all. I wish I didn't get exam scores back and that they could just tell me if I passed or failed. Because passing is all I need, but low passing grades are SO stressful for me with the reality of what it's like to have to repeat a year behind me. Sigh. Just plug away, plug away!

Takes All Types

Just a follow up from yesterday's post, reminding myself that it takes all sorts of people to make this world of ours go 'round. We need single-minded people to be as dedicated to one thing like many of my classmates are--because otherwise I doubt there'd be as many veterinarians in the world. And there's already a shortage. I venture to say the same about most hell-long professional paths. Just because my "worthwhile" is not their "worthwhile" doesn't mean they are bad people. In fact, they are very good people. It's not worth putting effort into worrying about.