Compassion Fatigue – excerpt

Chapter One

Fri. 4/15 1800

at home

Diff Dx: NA

Tom Summer turned off the car and recited his affirmations: he had made progress; he was helping; his best had been enough. He would leave his clinic work at the clinic, because now he was home. His knuckle itched where the skin had split, but was finished bleeding. Nicks and scrapes were part of his day, and nothing to hide.

He went to find Lynette in her studio, in a converted barn down the hill. Long before they bought it, the place had been a working farm. Now thin woods encroached on the back of the property, and the surrounding fields had been sold off to a corporate outfit that rotated soybeans and corn and timothy. Sometimes the man driving the tractor waved back when Tom was outside, sometimes not.

Lynette shuttled along her greenhouse wall misting spider plants for an installation. He stood in the open door for a moment, letting the sun-warmed air inside mingle with cooler mud-scented late spring day at his back. She stopped and peered at one plant and then another, arranging their shoots or pinching off one growing errant to her idea. She said she wasn’t sure exactly what she wanted from this project, was going to let it surprise her, an approach Tom had never been able to fully grasp. How do you put so much work into something, hold it that close, and then let it grow away from your intent? It was the kind of question he’d ask earnestly when they were dating, and one she would’ve tried to explain, then.

Now when she asked about his day, he told her about the terrier that ate rat poison, and the collie whose eye he might have saved a week ago, before it went septic.

She winced in sympathy. He hesitated, then told her about Mrs. Kinsinger, and he watched her expression turn to revulsion. “People,” she said, shaking her head, and though he exactly agreed, in her mouth it sounded meaner, an indictment of his clientele she hadn’t earned. “And they all just assume, everybody thinks like them.”

“I honestly don’t care what they believe,” he said. “Politics, any of it. I just wish they’d keep it to themselves. Before that, she was telling me, don’t worry, they weren’t going to be all docile and dependent, DD and D, whatever that means.”

“It’s a slogan,” Lynette said. “She wanted you to say it back, and agree.”

“Whatever it was,” he said, changing the subject, “I almost made a bad call, right after her. Sandy stopped me.”

“Oh?”

He sighed, and after he’d gone through the whole thing with Mikey, she said, “A bad call? That sounds more like a hard decision.” She paused. “You knew where it would go.” The first year or two, he’d brought home every temporary case, until too many became gut-wrenchingly more than temporary, and it seemed like he was feeding as many animals at home as he saw in a day at the clinic. Lynette had encouraged better boundaries then, casually and ‘for his sanity’ at first, then more vehemently. Though she was right, his work was the opposite of hers: it made no difference how he felt as he did it. The craft wasn’t important to suturing a torn ear, it was only the doing that mattered. They were all tasks he could not leave undone. “You do what you can do,” she told him now. “It’s not about ‘enough.’”

“And Sandy reminds me we’re understaffed,” he said, pitching this understatement for a laugh.

“She’s right,” Lynette said. “But you offer referrals.”

He nodded, pinching the bridge of his nose. “Sure, to practices an hour away,” he said. “But when someone doesn’t have the money in the first place?” He shook his head in irritation. “You forget, half the time my clientele thinks I’m making money off fucking heart worm pills, like I’m trying to upsell them.”

“I don’t forget that.”

“Then the other half come in expecting, I don’t know, Dr. Whatever from Animal Planet, the Miracle Vet. And I’m not that.”

“I know you’re not.”

“I know.”

She watched him, waiting, holding her mister in the air.

“It won’t keep on like this. I just have to keep going until something changes, right now.” It could happen, he thought: someone might answer his ad for a tech, or even open a new practice to fill the void over in Keane; God knew he’d welcome the competition.

She looked at him doubtfully, with a hint of pity that annoyed him. “You’ve been saying that for a while.”

“I know. I have been.”

“All right,” she said.

He shut his eyes, then gave a brisk nod. “I’m done. OK. What’s the news here?”

“So Azusa emailed,” she announced in a forced casual tone. “The galleries in Chicago are opening back up,” she said. “Their schedules are—well they need to book shows.”

“There must be so much new work,” he said. “Like, backed up. But Azusa thinks she can get you in?”

“More than that,” she said. “She’s asking me for the week after next.”

“A week to consider,” he said. “Sounds reasonable.”

“No,” she said. “This would be for an opening—in ten days.”

“Well that’s crazy,” he said automatically. “What about, I don’t know, PR? Every show you’ve ever done, had literally months of lead time. Right?”

“I know!” She bit the corner of her lower lip gently, baring the tip of one canine, failing to fully hold back a smile. “But it’s, well, it’s a fantastic opportunity. I just—don’t know if I’m prepared.”

He nodded soberly. “You’ve got all the new work. It’s good.”

“It’s not coherent,” she said. “Or organized. I don’t want to be premature.”

“This is a good thing,” he said. “Congratulations.”

“Premature,” she admonished. “And a whole lot I have to whip together, fast. Can you take Annie in to the thing tomorrow morning, in town? If I work here?”

“I can,” he said. “What thing?”

“It’s, I guess, a graduating senior recognition day. And, some kind of street fair.”

“Oh,” he said. “A multipurpose community event. Will there be a tractor parade? Marching bands?”

She smirked wearily but played along. “Boy-girl-cub scouts, and horses. High school girls in convertibles.”

“Horses go last,” he said. “For poop reasons. And you say there’s no culture.”

He knew this was close to a nerve, but she just said, her gaze unfocused, “Full-on Americana. Norman Rockwell-grade shit, right there.”

“I’ll take Annie. And Jonah?”

Lynette gave him a what do you think? look. “He’d be online thirty hours a day if he could.”

“He’s a good kid though. We have good kids.”

“Sure,” Lynette agreed.

Annie and Jonah were healthy, and excelled at most things they tried. But there lay the implicit flip-side: with both of them speeding into their teens, he had the ominous feeling of waiting for the jolt. What did it take, what kind of random event was enough to knock a kid off track? It made him fearful to intervene, in case of screwing up what was good. Thinking of ‘his family’ at that moment felt like standing before one of Lynette’s ethereal sculptures of needles and dried grass, his hands splayed to the shape of a delicate weightless thing it was impossible to touch.

Fri. 4/15 1700

Pt. K9♂︎ Mikey

Hist. NA Dx NA

 PTS

The Kinsinger incident and his near-fail of Mikey had both come at the very end of the day, and they bothered him for different reasons, somehow compounded by their proximity.

He had just pronounced their twelve-week-old shepherd-X happy and healthy when Mrs. Kinsinger said what she said. The puppy wiggled in constant motion in the Kinsinger girl’s arms, tail and ears twitching, pink nose scenting the air, as the mother watched Tom expectantly.

“I’m here to help,” he said noncommittally.

The puppy yawned, curling its tongue and showing all its tiny white teeth.

His vet tech knocking preemptively and then barreling in was a welcome interruption. “Tom we have a problem,” Sandy said, fists on her hips. Her gaze flickered over the Kinsingers, assessing and dismissing the wholesome scene they made, the proud mother, the little girl holding her puppy.

“We’ll be back for his shots in two weeks,” Mrs. Kinsinger said, and reassured her daughter, “It’s OK, we trust those kind.” Turning back to Tom, she beamed and said, “Don’t worry, I researched you.”

Sandy cleared her throat. “Doctor Summer,” she said, her voice lower. “Exam room two?”

He told the Kinsingers Shira would take care of Bart’s follow-up and followed Sandy into Two. “Did you hear that woman?” he lamented as the door shut behind them. “What is even wrong with people?”

“What’s wrong with you, Tom?” Sandy demanded, folding her arms to stand behind Mikey, a pit mix with one ragged ear and visible scars along his brindle muzzle. “He’s perfectly healthy.”

“I’m aware of that.”

“And where’s his owner?”

“He didn’t want to stay.”

“I thought you told him, absolutely not.”

“I told him,” he explained, “what the euthanasia cost. Because he asked.” Tom didn’t know what the deal was, a breakup or an eviction or moving out of town, but he didn’t have to ask the thin-faced man who’d kept his hands in the pockets of his dirty jeans and avoided Tom’s eyes. It was clear he couldn’t keep Mikey. “It’s OK,” the man had said, his shoulders hunching in, his head bowed. “I’ll take him home.” And that was when Tom had offered to do it for free.

He hated PTS, for Put to Sleep, the most of all the acronyms in his lexicon, for what it meant as much as what it coyly avoided saying. He would skip the euphemism, if he had a better alternative.

“What the hell?” Sandy asked him. “You already wrote ‘diagnosis NA.’ Why not the shelter?”

“You know why,” he said. “At the shelter, I’d be putting him down next Sunday. Why put him through that week on the kill list first?” Even on his best behavior, Mikey was a grown dog with a pit face, the opposite of a likely-adopt. Anxious and scared, he would act out, and be listed as soon as his ten days expired. “Sorry guy,” Tom said. He asked Sandy to prep the Euthasol.

“Tom?” she said, not moving. “Who are you?” In the fifteen years since he bought the practice, which came then with Sandy included, she’d always been the one to fight for their scrappiest cases, the most uncute and outwardly unlovable. Mikey was not even a stretch here, a charismatic and healthy guy who’d just drawn a bad hand. “This is not a healthy attitude, you’ve been coming apart all winter. Everyone has. Now it’s time you got your shit together.”

“I’m being realistic,” he snapped back. “Or maybe you haven’t noticed, the way things are now.” He had kept the clinic operational through the long months of lockdown. And now things were supposedly back to normal, except they were deluged with the backlog, too many of which now were animals he couldn’t help, or whose owners couldn’t afford the necessary treatment or referral. Sending Mikey home would have gotten him either dumped on a country road, or put down in the back yard with a twenty-two.

“All right,” Sandy declared. “Then I’ll take him home with me.”

Tom sighed, and looked up at the air. “Surrender papers,” he said. “We didn’t do those.”

“Shira can call the owner back in,” she said. “Tell him, you changed your mind, service refused.”

“We could try that,” he said.

She gave him the look she’d given him a lot lately, a suspicious stare in which he read an always-latent disappointment.

“Well I don’t know what to do,” he protested. “I don’t even mean, just Mikey. It’s not the Kinsingers just now, it’s everyone. What’s wrong with people?”

Sandy’s expression complicated as she turned her face away from him. “Even the hardest ones to love,” she said. “There’s somebody that does.”

He had no answer to that, before she closed the door behind her. He scratched Mikey lightly behind his good ear then, and the dog looked back, guileless and rapt, just as if Tom hadn’t been all set to kill him.

Fri. 4/15 1730

The heavy bag

After Shira packed up her workstation and Sandy led Mikey out to her faded Toyota, Tom went over his checklist. The kennel area was clean and unoccupied, the webcam monitor blinking green in the corner over two empty cages; both his primary and secondary exam rooms were sterilized, their floors swept, and the cabinet containing controlled substances was secure. Out the front window, he saw Shira turning left onto the county road, then Sandy going right.

Satisfied he was alone, he shrugged off his white lab coat, laid it aside for the hamper, and cracked his shoulders. The stainless steel surface of his surgery table in Exam Room One lifted neatly into a vertical position to fit through doorways, and after he released the spring-loaded brake catches on each wheel, the whole heavy table pivoted and rolled soundlessly to his gentle directing pull. The thing was a fantastic piece of machinery, and would elevate the heaviest of his patients to waist-height at the touch of an electric foot pedal. It had been one of his first improvements on the clinic, over Doc Ray’s medieval-looking ceiling winch.

He did have to maneuver the table wheel by wheel over the two-inch raised sill in the back hallway, an architectural anomaly he’d learned to step over without looking when his arms were full, though it tripped new assistants on a regular basis, and even Sandy still caught a toe on it occasionally and swore. In the storage room, past shelves of feed and cleaning supplies, he set the table’s brake. His homemade heavy-bag, a burlap sack full of towels crammed around a core of four sand-filled milk jugs, slumped ungracefully when he pulled it onto the table, but still it was no less clumsy than loading a sedated St. Bernard, the thump of dull mass and joints echoing onto the steel no matter how gently he laid the animal down. It always struck him, how truly insensate a body could be rendered, this thing full of feeling we so intuitively protect.

Back in the exam room, he raised the table to its limit, righting the punching bag to clip onto Ray’s old winch. He stowed the table and took a minute to center his breathing and shake out his shoulders. Then he began beating the ever-loving shit out of the bag.

His hands went quickly numb after the first few punches, and he focused on his breathing and the mechanical repetition, left-right one-two, leading with his middle knuckle and concentrating and driving a straight forward line, blowing out hard as he threw each punch. The greatest force he could muster barely swayed the bag, and he moved around it, adjusting his stance to its gravity and proximity.

His left knuckle split and began to bleed, and Tom appreciated each new kiss of scarlet as it blossomed on the bag’s colorless skin. His hands ringing, he stepped back and measured his range. He knew he had no technique, he couldn’t even kick properly to waist height, but the bag hung low enough and his scrub pants fit loose, and he’d seen it done in videos online. He tried a crescent kick at the slowly turning bag, connecting at the end of his tibia, just above the ankle, and the impact felt fantastic. He stepped back and gave it a shot with his left foot too, and alternating this way made an ungainly dance, but not without rhythm.

His hips tired quickly, and he launched a last rapid-fire round of punches, leaning forward until his cheek met the bag and he inhaled the ancient smell of the thing, all the sweat and anger he’d ever put in it. He hung against the bag until his breathing slowed. Then he let go.

The paper towels and disinfectant spray were right there, perfectly efficient for wiping down the bag, erasing the blood-spots. Then he wrapped a clean cotton towel around his left hand, and did the rest of the work to dismount the bag and lay it out on his wheeled table.

Out of habit, he took a breath to compose himself before leaving the room. When he had animals in the building, they would sense it if he came out still angry.