AAEP News October 2018 III Associ Ation
From the President: The art behind the science of veterinary medicine
By Margo L. Macpherson, DVM, MS, DACT
My family recently lost a
longtime feline friend. Vinnie
was a 19-year-old cat that we
loved for the duration of his
long and somewhat
tumultuous life. Vinnie came
to us by way of a
Thoroughbred training
facility; his spunky, risk-tak-
ing behavior is what
enamored my husband, and
ultimately led to Vinnie
coming to our home.
Vinnie outlived his nine lives by at least five or six more,
surviving several life-threatening conditions that required
surgeries and prolonged ICU visits. In my heart, I knew
that Vinnie’s most recent surgery in the fall of 2017
would be his last. Still,
I

was completely unprepared for
the early morning phone call from a pet sitter who found
Vinnie in an obtunded state stuck between the washer
and dryer. The timing could not have been worse: I was
in England, my daughter was trekking in Alaska and my
husband and son were working their way down a river in
Pennsylvania.
Two scenarios unfolded in the ensuing hours. First, Vinnie
was admitted to an emergency and critical care center.
The emergency doctor did a great job of managing the cat
and communicating to me via a pet sitter. We agreed that
stabilizing the cat was a priority, and to assess his status
the following day through the critical care team. Vinnie
responded to palliative treatment
and was his usual
grumpy self when I heard from a young ECC trainee the
next day.
At some juncture after that call, Vinnie’s status declined.
The next phone call I received from the same trainee was
to ask/confirm that I wished to withhold life-saving
treatments in the event the cat arrested. There was little
preamble to the request, and the quantum leap between
the grouchy, improving cat to one that was in a life-
threatening state caught me completely by surprise. My
initial speechlessness was followed by a series of pointed,
demanding questions as I tried to reconcile the dramatic
change that had ensued with my cat over the course of
some hours. The more demanding my questions became,
the
more defensive my cat’s caregiver got. The conversa-
tion did not end well.
Ultimately, a senior clinician called and explained the
series of events that had occurred between the two con-
versations, and that same doctor offered opinions about
the likelihood Vinnie would recover. While the news left me horribly sad,
I understood what was happening with
my cat. Ultimately, we decided that it was not fair to
prolong Vinnie’s life long enough to return home and see
him through to the end. Instead of me, the senior clinician
in charge promised he would hold Vinnie as he took his
last breaths.
The moral of this story is that veterinary medicine is built
on science but practiced by art. Experience not only
teaches

us to be better veterinarians, but also gives us the
confidence to communicate difficult findings. I am embar-
rassed by my inability to remain patient with a young
veterinarian as we stumbled through a difficult conversa-
tion. I have been educating veterinary students and new
veterinarians for most of my professional lifetime. I have
learned that a clear message is not always well articulated
by these inexperienced individuals because they are
reluctant to deliver bad news. In an educational setting, I
have tried to capture similar conversations and replay
them so that there is a learning experience involved. Yet,
under the conditions of my own grief, stress and poor
understanding, I became the confused client. My
questions to the trainee caring for
my cat were probably
like those our clients have asked when faced with similar
situations. I should have known better.
This dilemma reiterated to me that the nuances of the art
of veterinary medicine are learned through many different
avenues. First, hands-on experience is a critical education-
al tool, both for veterinary procedures and communica-
tion. However, proficiency can also be gained by
watching someone skilled as she or he navigates a
difficult situation. Language that I have adopted when
handling sensitive matters with clients initially came from
observing skillfully managed conversations by my
mentors. As an observer, I was able to watch the nuances
of what a senior veterinarian said followed by the
response of the client. From these interactions, one learns

how

to be clear with a message while also providing
compassion and support. I don’t claim to have this com-
munication piece sewn up. At times I am sharp around
the edges and don’t articulate my point clearly, but I do
listen intently to skilled communicators around me. My
goal is to be a little better every day.
As mentors, it is our role to facilitate opportunities for
our mentees to learn and grow through guided support in
challenging situations. Mistakes will be made, but each
mistake provides a chance to learn. As mentees, it is OK
to recognize one’s limitations and ask for help when
things become overwhelming. Wisdom is a powerful tool.
Together, we will grow the art in more
veterinarians and
provide quality care to both our patients and the owners
who care for them.
Dr. Margo Macpherson