“Thank you so much for coming!” Beaming relief, Sandi ushers us out the door, “I feel so privileged!”
I glance back – Pebbles the cat is under the dining room chair, relaxed but watching us leave.
“That was the best veterinary visit ever! I just cannot get her in the box, and the trip to the vet is always so awful! She just poos on herself every time, and last time she peed herself on the vet’s table. It was so horrible! I could hear her screaming in the back. I felt so sad. I never want to go through that again. Thank you so much!”
The privilege is all mine. A home is a special place, and to be invited in, to handle the home’s innocent and intensely loved inhabitant, is an immense expression of trust.
My patients are wary, often downright terrified, and most of them are geriatric. They have a plethora of aches and pains, poor vision, diminishing hearing, and can feel quite insecure out of routine. It is a challenge to avoid causing them pain whilst we take blood pressures and lab samples. They have picked up on their owner’s anxiety, and the sense of relief when the visit is over, with all the unknowns having been dealt with, and knowing that there is no shaking, yowling, vomiting car ride back home, has an euphoric effect. I share that euphoric joy time and time again, because I can easily appreciate the vast difference between a clinic visit and a home visit for my patients.
Vancouver Feline Hospital, being so peaceful without the dogs and the tensions of a normal veterinary clinic, was already a reasonably cat friendly place. However, after 13 years, the décor and workflow design was starting to show wear and tear. A revamp was overdue, but I had not the heart for it. Working ten and twelve hour days was taking a toll on us, and often I would be working several weeks without a break. A tired doctor is not a good doctor. In the last couple of years, our veterinary assistants had worked some magic, easing some of my workload. No associate veterinarian that applied for the job could afford to move to Vancouver. I was frustrated and exhausted with trying to find feline friendly staff. Feline only practices don’t sell easily, and I didn’t really want to sell so much as ease off.
I bought myself a wetsuit on a Christmas sale, and started cold water ocean swimming. English Bay of Vancouver has choppiness, strong currents and great mountain views. The climate is mild enough that if you buy the technical gear, you can comfortably do watersports or sailing year round. So it was that on a sunny day, early April 2015, whilst swimming, I thought of a way to make a change.
It was a great opportunity, to sell the commercial real estate in a hot Vancouver market, clear all debts, and take a more relaxed approach to being a veterinarian. We made the transition to housecall practice in summer 2015.
We were instantly busy. The first month was quite experimental, just figuring out logistics. So many asked us if we were going to have a special van. Cats are simple creatures, and my bulkiest item was the ultrasound, which fits into a suitcase. The rest of the stuff we need is in 2 rolling toolbags, 1 smaller toolbag and a backpack. We only take into the home what we need, and my assistant will return to the vehicle if necessary. Thomas did regularly drop the babyscale, and I am looking for a more rugged model! We work in a city, and relished having a tiny car that is easy to park. Maybe Vancouver is exceptional, but we found parking to be easier than expected, and much cheaper. In a year, we picked up only one parking fine. The rain didn’t bother us either!
Traffic could be tedious, and we learnt to deliberately schedule appointments to avoid the heavy traffic times. We also found it was best to limit the number of appointments in the day – we might visit four homes, but I would see 8 or more cats.
We revelled in the unexpected pleasures of housecall practice. I am absolutely hooked on housecall practice as being the most feline friendly way to be a veterinarian. It is sheer pleasure seeing my patients, whom I know so well in clinic, being (almost) themselves at home. Any cat owner, including myself, can tell you how terrified the cat is in clinic and how differently their cat will behave on the home couch.
Pebbles is a new patient. I have not met her before today. She is gentle beautiful calico, a little tubby as an indoor middle aged cat can be, and explores our bags without much nervousness. It doesn’t take her long to find the catnip treat at the bottom of the bag, and she drags this out to play with it whilst Sandi fills out some forms for us.
Cats share space with us, without the same degree of brain function (mass) loss as other domesticated creatures. They experience significant stress and anxiety when out of their safe zones, and adverse events such as veterinary visit can easily contribute to post traumatic stress disorders. They recognise individual human faces. Pain and fear is easily triggered by a movement, a smell, or even the sight of a stethescope. The converse is true too – they do remember the gentle touch, and can come to trust another veterinarian over time. Cats whom we have visited often treat us as family friends. They know what to expect, and know that we wont hurt them.
“So let’s go look at the litter box.” Pebbles has just turned 14. She has been pooping on the rug the last few weeks, with increasing frequency. Yesterday, she peed on the rug. I have watched her wander around her home, sit and lie down, how she gets herself comfortable. I can see her food and water dishes in the kitchen. She has a number of cat beds around the home. The small apartment is arranged around her needs. It is clearly her home. We sat on the living room floor, and I did my exam, talking about every little bit, nose to tail tip. We have checked her blood pressure, and taken a blood sample. Pebbles is resting on one of her cat beds. Her part in the consultation is over. She relaxes and watches us stare at her litter box.
“We want to make this easy for her” I say, pulling out my phone to show pictures. Together, we wander around the home, looking at my example photos, and discussing practical ways to accommodate Pebble’s ageing and medical needs within the constraints of the apartment space. This is the magic of doing this consult at home – we don’t misunderstand each other and can discuss our patient’s needs within the context of the home environment and the individual cat and owner abilities. This is so different from the lecture given to a stressed out cat owner over a wide-eyed trembling cat on the exam table.
Whilst I having been talking, my assistant has gathered Pebbles lab samples, packed up the bags, and prepared the invoice. That is my signal to conclude our discussion, which will continue a day or two later when the lab results come back.
“Pebbles bit the other vet” Sandi confides as she completes the transaction, “The other vet told us to never come back!” Sure, Pebbles was pushed to her limit, then, and I am relieved her emotional scars from that encounter did not trigger fear during my visit. There are some cats that will not allow easy handling even at home.
For me, I never have to close those cage doors on a sick cat and watch the feeling of abandonment (mixed with guilt, fear and worry) in the cats and owners. Actually, I had stopped doing that many years ago. There was a reason why cats were so desperate to get out of those cages, pressing themselves against the bars and diving out as the doors open. No matter how big (we had 4’ and 8’ kennels for our patients, much more than any other veterinary clinic), how comfortable and homey we made that space with hidey boxes, endless washloads of towels and baby blankets, toys and accoutrements from home and the cat only cat friendly environment, most of the hospitalised patients were still fearful or worried. Cats heal better at home, if you can do the nursing. Several years ago, I realised I had not hospitalised a patient for more than a year! With good nursing backup, my patients were doing well with homecare. In the housecall situation, I can do so much more in guiding acute and chronic homecare. The difference is palpable, just because I can evaluate my patient and their dedicated nursing staff at home.
I don’t miss the clinic environment, and have no emotional regrets whenever I walk past the Vancouver Feline Hospital location. All its precious memories – those photographs and mementoes of my patients that kept us inspired, covering the walls of my office and reception, are now in the home office. The wall has been replaced with scrapbooks, and I still love to get those photos.
It has been a fantastic year being a housecall veterinarian. Unfortunately, my lung disease has got worse, and after several very bad adverse reactions to perfumes and cigarette smoke, I had to make the decision to limit my exposure to uncontrolled triggers. It may take several more ocean swims, but I guess, thinking of Pebbles and cats like her, that I will find a new way to take care of my patients.