Stephenie Hoke :: Ambulatory Veterinarian

It's 7:30 a.m as I step out of the barn and into the soggy, melting snow. I shove my chilly hands into my pockets and survey my surroundings. There's the barn and the new large animal facility. A simple, two-room clinic and a house next door. And then there is my favorite part, the pasture and prairie surrounding it all. The large expanse dotted with trees seems to stretch out for miles, toward the snow-covered Rocky Mountains in the distance. I wander over to the animal pen where I'm greeted by a horse who seems eager for some petting and picture taking. I stand there feeling a bit foolish as I talk to the animal and a bit apprehensive as I wonder what lies ahead.

I'm here on the grounds of Dark Horse Veterinarian Services to spend the day with Dr. Stephenie Hoke, an ambulatory veterinarian who has built this business over the last seven years, after graduating from Colorado State University's veterinary medicine program in 2009.

At Dark Horse, Dr. Hoke treats all species, including horses, cattle, pigs, llamas, sheep, iguanas, cats, and dogs. She sees some clients during regular office appointments at her clinic and travels throughout Northern Colorado to treat other animals where her clients live and work.

Currently Dr. Hoke and her assistant, Courtney, are inside the clinic, meeting with their first patient of the day, a large, anxious, and not-so-friendly dog. I opted to stay outside so as not to add stress to the animal's vet visit. Which is how I find myself speaking to a curious horse while trying to calm my curious mind. When Dr. Hoke wraps up the appointment 30 minutes later, she meets me near the barn with a somber expression.

The injury is one of the worst of its kind

"I'm afraid our first appointment on the road this morning is not going to be a pleasant one," she explains. Dr. Hoke has just received a call regarding an injured horse alongside a road nearly 50 miles away. The animal is unable to walk and the owners are out of town.

"A lot of vets won't travel that far," she says. "But I haven't built my business by saying no to people." She pauses. "This is a matter of doing the right thing. So I'm going to go." Which means I am too.

I follow Courtney and Dr. Hoke in her maroon pickup, the king cab of which she gutted long ago. She's replaced the seats with medical supplies and emergency equipment, added electrical power, and built a make-shift x-ray table that fits inside, all of which allow her to perform procedures in the field. We drive for a good hour, over winding, snow-covered roads, deep into the Colorado foothills.

Eventually, we find the horse on the side of the road, up an embankment. Together, Dr. Hoke, Courtney, and I climb up to the animal. It appears to have wandered through some barbed wire and flayed a major leg muscle. After accessing the demeanor of the animal ("animals under duress don't always make smart decisions," Dr. Hoke says) and determining the situation safe, Dr. Hoke talks softly to the horse and ties a lead rope loosely around it's neck. She tries to move him away from the road below. He won't budge. After several attempts at getting him to take even a tiny step, he still hasn't moved. She acquiesces and brings out some hay for him.

"This is pretty bad," she confides. "One of the worst of its kind I've seen."

"Why doesn't he lie down?" I ask.

"Horses are prey animals and they know that," Dr. Hoke explains. "If he's injured and lies down, it makes him look weaker to predators. But if he stands here nonchalantly, looking alert and strong, he doesn't seem as vulnerable."

"So, he's faking it?" I ask. "About how serious it is?"

"Exactly."

She puts her hand gently on his head and whispers

After examining the wound and considering the options, calls are made to coordinate care decisions and, ultimately, with major surgery well out of the owners' budget, the animal has to be put down.

Dr. Hoke tells me that of the methods for euthanizing an animal, she has limited options given our location. "The medicine used for euthanasia is a controlled substance. I can't use that here," she says, motioning to the wilderness around us. "We're pretty remote and have no clue when the retrieval service can come get the horse's body... which means other animals or wildlife could come upon the horse and be exposed to the substance as well."

"I understand," I say, not really understanding.

"So I'm going to use a firearm," she says, to be clear.

"I understand," I say, finally getting it.

Dr. Hoke then proceeds to tell me exactly what she aims to do and how. She offers me the option of sitting in my vehicle or walking down the road or closing my eyes. But I am here to experience her world and as difficult as it is, I decline. Dr. Hoke offers me ear plugs then and points to a spot farther up the embankment where she wants me to stand.

As she and Courtney prepare the necessary equipment, namely a hand gun, a man walking his dog appears on the street below.

"Is that animal OK?" he shouts up.

Instead of answering him or waving him on, or even making eye contact, Dr. Hoke turns her back on him. I stand there, confused.

"Privacy issues. We cannot discuss the animal, its owners, or the decisions we're making," she says.

"Is the horse gonna make it?" the man shouts up again. We give no response. I look down, pretending to fiddle with my camera settings, and wait for the man to pass.

When he does, each of us takes a moment. Courtney feeds the horse and talks softly to him. I rub the horse's neck, holding back tears. When it is Dr. Hoke's turn, she puts her hand gently on his head and whispers what could be anything, but I take for a blessing. Then, we all take a step back and as the horse lowers his head to take a bite of food, Dr. Hoke raises the gun to his forehead and fires.

The horse falls like a rock. I stare, stuck with disbelief, my ears still ringing from the gun shot. As Dr. Hoke and Courtney attend to the horse in its last moments, I am suddenly aware of how obviously out of place I am. I don't have words or know how to act. I'm stuck between awkwardness and sadness for I am neither the doctor in this scenario who is a professional and keeping it together, nor the pet owner who can and should be sobbing and grieving. I am cemented between the two roles, an invited outsider. And in that between space, all I seem able to do is wish. I wish the owners could know that in their beloved animal's last moments, I tried to offer him comfort. I tried to comprehend. That I cried but also tried not to.

Eventually, the three of us pack up our things and walk back down to the road in silence. As we slowly caravan back to town, I consider closer the job of a veterinarian. The highs and lows. The requirement for equal parts compassion and science. The ability—and necessity—to find a balance amid it all.

You'd be surprised what a Dremel can do

The balance seems to tip slightly in our favor when, an hour later, we pull up to a house for a much happier stop on the south side of Fort Collins. We park in the dirt driveway and a man in the house, standing behind a screen door, waves and motions us toward the backyard.

"These folks have three horses," Dr. Hoke tells me while she and Courtney unload buckets, lead ropes, and syringes from the truck. "They'll all get vaccinations today and one is due for a dental check up. Routine stuff."

The three of us trudge through the mud to a wooden horse shelter behind the house. Dr. Hoke and Courtney work in tandem setting up equipment in one of the shelter bays then escort each horse in, one at a time, for its brief exam and shots. I circle around the space with my camera taking pictures from various angles and Dr. Hoke has to remind me, the newbie, where NOT to stand near a horse. "A good tip is to make noise when you're working around them, just so they always know you're there," she offers. I take the rest of my images from a safe distance and clear my throat periodically in case the clicking of the shutter isn't quite enough for my equine friends to hear.

When it's the dental patient's turn, Dr. Hoke administers the animal a light sedative and then, while waiting for the medicine to take effect, tosses a rope up and over one of the trusses in the shelter's roof. After rigging a harness to the dangling rope, Courtney and Dr. Hoke lead the horse into position and rest it's head in the harness to prevent her from jerking around too much during treatment. I watch Dr. Hoke go through her routine exam and wonder how in the world she's going to clean this horse's teeth. My question is soon answered when Dr. Hoke pulls out a large Dremel from her tool box in the corner. The expression on my face must reveal my shock because when Dr. Hoke looks at me, she smiles. "You'd be surprised what a Dremel can do," she says. "With all the long attachments, it works great to reach far back into the mouth."

With that, Courtney cranks open the contraption around the horse's muzzle so that it can't bite down and Dr. Hoke goes to work cleaning and smoothing down the sharp edges of the horse's teeth, which form as a result of the animal's normal chewing action. The procedure is called floating and the horse doesn't seem to mind; she's relaxed from the sedative. I, on the other hand, quiver at the sound of the grinding power tool. When Dr. Hoke is finished with one side of the horse's mouth, she offers me a look inside to see the difference.

I have never looked a horse in the mouth. Until now. Stooped down, a mere foot away, I peer inside. My first reaction? A horse's mouth goes on... FOREVER. All I can see are miles of teeth and a tongue so long it looks like a red carpet being unfurled. As I ooh and aah and otherwise stand speechless, Dr. Hoke points out the sharp, pointed bits on the teeth she hasn't yet worked.

I can see the difference right away, which does make me feel better about all the noise. That and the fact that the horse seems just fine. As Dr. Hoke finishes her work and begins to haul her supplies back to the truck, I mosey around the shelter to pet the two horses who'd had simpler visits. Near me, I notice Courtney leaning against a gate. She's standing in her boots in the muddy snow, still wearing her rubber gloves, and talking to a client on Dark Horse's mobile phone. Working, I think. These two ladies are always working.

"Have you ever heard a piglet squeal?"

After the appointment, we stop for a brief lunch, a luxury that doesn't happen every day. During our break, my two escorts continue to work, checking emails and returning phone calls in between bites of food. Though it's just after noon, I realize how tired I already am as soon as I sit down. Then Dr. Hoke puts her phone away and we make small talk and chat about our weekend plans.

"I'm hoping to head out for some mountain biking," she says, "if the weather cooperates."

"How long have you been riding?" I ask.

Just a few years, she tells me. She also recently started Enduro racing. Familiar with the term, but not the details, I ask her more about it.

As Dr. Hoke talks, her face lights up. It's easy to see she loves the sport. And although she doesn't say as much, I think of her riding as her escape, a way for her to connect with that other part of life, the part about fun and adventure and freedom, that her work life seems to take so much of.

Finally, Dr. Hoke stands up, ready to go.

"We're going to see piglets, next," she announces. "Have you ever heard a piglet squeal?"

I shake my head no.

"Well, this'll be exciting for you then," she says.

.....

We hit the Interstate next and travel more than 30 miles north to meet a couple and their sow's latest litter of 6-day-old piglets. The open plain is barren here and the late winter wind is blowing so hard when we exit our vehicles that all of our hair flaps sideways like a collection of flags. I scan the yard and see a bull, a cow, two dogs, and a pen where a turkey and several chickens are pecking the ground, all seemingly unfazed by the harsh weather.

As the three of us don coveralls, the couple comes out of their home to show us toward the work at hand. We head to a tiny shelter 20 yards away and the five of us duck inside. Lined with hay and lit with warming lights, the space is at once cozy and cramped. Still, it is a welcome reprieve from the brutal wind outside. After the warmth, I immediately notice the piglets—nine in all—scurrying every which way at our feet.

Again, Dr. Hoke and Courtney quickly set up shop and arrange their equipment so its both accessible and out of the way. Just moments later, they're holding the first piglet on its back and the noise Dr. Hoke warned me about comes out of the tiny animal's mouth at an excruciating decibel. It sounds like fear, high-pitched yelping, and fury mixing together over a loud speaker. It's difficult to hear one another over the commotion, but Dr. Hoke and Courtney work quickly, trimming the female piglet's sharp eye teeth. Snip. Snip. Next up is a male, who Courtney lunges to catch mid scamper. The treatment is the same, only this time the piglet is castrated as well.

The sow on the other side of the shelter, meanwhile, is head butting the wall between her and her babies. I wonder if I should be concerned but neither the owners nor the vets appear stressed. So I crouch down and keep shooting. When Courtney and Dr. Hoke are finished with each piglet, they quickly scribble a black circle onto its rear end with a magic marker before the piglet can squirm away. It's a low-tech albeit clever way to keep track of which little piggies have been treated and which ones have not amid the bunch racing around underfoot.

Between the squealing piglets, the irate sow, and the five of us crammed into the tiny space, it's easy to appreciate the distracting conditions in which ambulatory veterinarians sometimes do their work.

A patient educator

Our last ambulatory visit of the day is again with horses. It's a standard visit, for annual vaccinations, but one that allows me to see Dr. Hoke in yet another light. This time the clients we meet are relatively new to horse ownership. They have a beautiful stable and barn. They also have more questions than any of the other people we've seen throughout the day.

So while Dr. Hoke administers vaccines, she also answers questions. There are the animals' dietary needs to discuss, as well as medication and health care schedules to iron out. Dr. Hoke is no longer in emergency mode nor routine mode, but in teaching mode. She spends time with these people without rushing or stressing them. She is a patient educator and at the end of our 30-minute visit, she and her clients stand together in the couple's long country driveway and talk a while longer, each seemingly grateful for the other.

At 4:00 p.m. we finally head back to the clinic where the day ends with two office appointments for dogs.

The first one is for Frisco, a 12-week-old puppy who is due for vaccinations. A father and son bring him to the small clinic and listen closely as Dr. Hoke talks them through the vaccine schedule before administering shots. Curious, the boy looks on throughout the procedure, chatting about the dog he used to have and this new one, a terrier mix, who he helped name.

"I walk him. That's my job. And to feed him too," the boy tells us.

"That's a great job," Dr. Hoke says.

"My dad says I can help train him," the boy chimes in as he and his father start to leave. 

"That's an even bigger job," I say.

Outside, little Frisco has found a stick and is trotting through the grass while trying to balance it in his mouth. "See?" the boy says, proudly. "He already knows how to fetch!"

As they pull away, an older woman in a Lexus drives up. With her is her 13-year-old Maltese, Lily. Easily, the simplest appointment of the day, Lily just needs a quick nail trim.

"I just hate doing it myself," the woman confesses. And Dr. Hoke works her magic, talking and soothing the nervous pet while it sits in her lap and makes pleading eyes at its owner across the room. The appointment is over in less than ten minutes.

"What's your favorite part of your job?"

At the end of our day together, I ask Dr. Hoke to pose with her own dog, Quill, for a quick portrait.

"It was a good day," I say, sincerely thankful for the experience and Dr. Hoke's willingness to educate me along the way.

"It was good," she agrees. "I'm glad it ended the way it did, after our rough start."

I think of the horse she put down that morning, an exhaustive nine hours earlier, and then of the energetic puppy and young boy we met just a bit ago.

"What's your favorite part of your job?" I ask.

Dr. Hoke ponders the question, seeming to have a hard time settling on an answer. "Well, although I view it as an end to suffering, I certainly couldn't do euthanasia all day," she eventually says. "And I couldn't see puppies all day either."

After spending the day with her, I see what she means.

"I treat all species," she continues. "I like the variety—in the people and the care and the animals."

I look back at the time I've spent with Dr. Hoke and think about that variety. I consider all the ups and downs I've witnessed. The good and the bad. The calm and the storm. The way Dr. Hoke cared, intensely at times, but was also capable of making logical decisions based on her knowledge and experience. I am certain there are classes for veterinarian students about this, theories and proven methods for learning how to deal with the chaotic pull of emotions amid facts based in science. I am sure professionals in the field of animal care acquire the skills to bounce back and forth between these two extremes, sometimes in the course of hours, day in and day out. I am in no way there, not even close. But I've come to deeply admire those who are—and who helped me experience it, even if just for one day.

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