A Square Peg in a Round Hole

We had a blustery storm the other night. The outside chairs blew all over hell and creation. I’m hoping it blew out the chaos that descended from the full moon and lunar eclipse that happened at the same time. From all appearances it was a humdinger and packed a wallop.

The private club

As a rule, breakfast in the barn is a serious affair. Everyone is focused on what’s in their bowls in front of them. They don’t get the sugary Fruit Loops kind they’d like, but low carb and nutritious is yummy all the same.  Once outside, though, it’s antics and play. I’ve always had this vague feeling the horses have like a private club. Sometimes I just hang out, peek in the windows and watch. Once in a while they invite me in and I feel privileged. We’re close, but it’s special to get an invite.

This morning, the bay mare walked up for her usual long hug and scratching and asked how it was all going. I told her; every now and then I think we all just need a long break. I told her it seems that now, at this stage of life, I need long breaks just to digest and figure some of it out. It takes me longer than it used to. There’s so much I don’t understand, I told her. I said my whole life I’ve worked with species other than my own. I’ve come to respect and understand them. It’s my own species that puzzles me.

A girl with depth

This mare is good. If she were your girlfriend, she’d be the wiser one, but with just enough hair toss silliness to keep you interested. And, hers is not a usual rags to riches story like many we’ve had show up. Rather the other way around. This girl had a charmed life. It happened to take a detour when her person passed away with no contingency plan for her or her sissy. I’ve wondered what the two of them thought when they found themselves abruptly thrown into an unknown, vacant situation. How much did not make sense to them?

After a couple years of living on the seedier side of town, as luck would have it, they found their way to me. The two of them could then regain their sense of royalty (as it should be). I wonder if they thought, finally! -whew, that was a close one!

Tell me all about it

Unlike some of her compadres (with the exception of donkey), she always makes me feel like she’s got nothing else to do and nowhere else to go but indulge me. That is, as long as I keep scratching and cooing. Go on, she’ll say, spill it out and tell me all about it. And I do.

I tell her, for so many years I heard pet families tell me they wished they could come to veterinary medicine for care for themselves. They said they felt more trust, more caring, like they mattered. They knew when they brought their pet in to be seen they were listened to – they were heard.

A complex way to listen

We say nonhuman patients can’t verbalize how they feel. And while this may be true, there is a deeper truth. In fact, in veterinary medicine we have to listen with the complex hearing system of a bat. Our ‘listening’ must be multifaceted. A dog is brought in for suspicion of being painful. We’re listening to families describe what they see. Then we read and listen to the patient.

The instincts we use are as old as time. Palpate, palpate, yip, nip. Ah, there’s the pain. Then, it’s on to the next part of the puzzle. And, it’ll take what it takes before the diagnosis is made and the square peg gets put in the square hole. Listening to the family, the patient, the numbers – our hands, our other senses. This is what we do to minister to nonhuman patients.

A good comparison

Forty years ago, I had a client who was a pediatric nurse. She had a lovely orange kitty with an acute anemia. During the course of his treatment and repeated visits, she said, “You know, your job isn’t much different than mine in ped’s.”  I agreed and we both recited our connection. We cared for beings that had to be listened to in a variety of ways. As a result, we all did well by her cat.

The other discipline

I tell the bay mare; human medicine now moves like a high-speed railway. I show my age by remembering MD’s making house calls, even in a big city like Chicago. I was born in a big hospital. But the same doctor that delivered me, delivered my brothers and many of my cousins too. I remember a trust so strong; my mother would have tried to hold off a birth (similar to a mare I had) just so she could have her doctor deliver her baby. Everything was slower then. She could have those expectations.

The missing piece

But, now, human healthcare is a timed event. Now, we only have time for sound bites. Listening is something that takes up too much time, too much space. Even during a complicated visit there is only enough time for quick snippets of information before it’s on to diagnostics or a referral to a specialist. Did they know it would be like this when they signed up?

The people side of healthcare is the picture of sophistication and talent. The flipside to that is listening has become a lost art. And, not taking the time to listen dismantles trust almost single handedly.  As a result, in some cases, suffering gets worse and potentially for extended periods of time.

“We think we listen, but very rarely do we listen with real understanding, true empathy. Yet listening, of this very special kind, is one of the most potent forces for change that I know.”  ~ Carl Rogers

An old dance

Before, in addition to diagnostics (yes, I know they’re lifesaving), there had to be deductive reasoning. And, in order to have excellent deductive reasoning, there had to be attentive, active listening. The back and forth of listening and asking appropriate questions was the dance between doctor and patient.

“Each patient’s story should be considered on its own terms before deciding how to proceed. That’s also just common sense.”   ~ Leana Wen, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests

Some things remain constant

Deciphering information from a nonhuman patient in the future is a skill that will likely remain unchanged on a basic level. I don’t see a future where our patients hop up on the table and recite their symptoms or give a report on their progress – verbally anyway. As to the trajectory of a human healthcare professional, adopting the skills of a veterinary professional would serve humans well.  There is no diagnostic that can take the place of deep listening.

“Our central premise is that doctors are not listening to their patients, leading to misdiagnoses—and often, no diagnosis at all.”  ~ Leana Wen, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests

The risk factor

Listening, with a focus that says your patient is the only thing that matters at that time, builds trust. Without that kind of attentiveness, without trust, there is the risk of trying to force a square peg into a round hole.

We looked at each other, the bay mare and I, and she agreed. And just like that, the roan boy came in (making a liar out of me again) and group session could begin.