I have a confession (yes, another one—but it’s a biggie): I often prefer to sit with my computer and write to you than actually see patients and clients. I’ve been feeling guilty about this for about a year now, but it’s finally wearing on me enough that I feel the need to come clean.

I acknowledge this to you now after suffering a couple of weeks of grinding, work-related stress that urges me to flee from all work-related responsibilities in favor of a few days of unscheduled vacation (which I can’t presently afford).

You’ve all been there, I’m sure. Regardless of profession, we all share the same experiences: i.e., office-related strife, inter-staff dynamics and client nightmares that make us wonder why the hell we ever ventured this way to begin with. In my case, I console myself with the notion that this happens less often in my career than in others—after all, the animals are seldom the issue. Stress always seems to revolve around people.

Like yesterday’s moron with his dog’s teeth rotting out of her mouth, a whopping, untreated heart murmur, two blinding cataracts and his blank stare as a reward for every clinical finding and every futile suggestion. He dismissed it all with his silence, which made me wonder why he bothers to bring in his dog once a year.

I even found myself begging him to take some antibiotics for her end-stage periodontal disease. “To protect her heart,” I offered timidly, after explaining that her failing Mitral valve was prime candidate for infection as a result of her advanced (and painful!) dental condition. I’ll never know if he gave them to her or not. The best I can hope for is his dog’s speedy exit from a world of blindness and pain.

People like this deserve prosecution. But his medical decisions on his pet’s behalf are not litigatable. So I have to be as kind to him as possible so he’ll consider even my basic recommendations. Think of the control one needs to exert to remain silent in the face of this cruelty and you get an idea of how this job can wear you down.

When I write, at least I’m encouraged by the feeling that someone is reading and considering—even when they disagree with me. When I write, the pall of futility never settles over me. as it did this morning when I found a geriatric patient deceased in her cage--because sometimes it is about the animals and not just their people.

In spite of my work life’s peculiar challenges and inevitable letdowns, I’ll probably never stop practicing medicine. But it’s true that I’ll be writing significantly more when weeks like these take their toll on the confidence I’ve always placed in my choice of careers.