*While this is based on a true story, the names of patients and aspects of their cases have been altered for confidentiality purposes.
I would like to tell you about my day.
Right now, while the memory is fresh. I'd rather not wait, since I’ve found that the mind, given a bit of time and distance, has an incredible ability to soften the blow of reality, making the facts not seem quite so harsh, the truth not quite so jarring.
So let me tell you my story before I've had the chance to get a good night's sleep and wake up donning a pair of rose colored glasses. Before I've had the time to rethink everything in a different light and tell myself once again,
Oh, it wasn't that bad.
Because it was.
It must be, for two more veterinarians to take their own lives this past week. For the suicide rate in veterinary medicine to be three times higher than for the average population. For most of my colleagues, when asked, to say they wished they’d chosen a different profession.
It's bad enough now that those of us in the veterinary profession are finally taking a collective pause and wondering how on earth we got here, and what can we possibly do to fix this situation.
So if it's ok with you, I'll start from the beginning.
I arrive at work at 10 am. Well, if I’m being perfectly honest, its 10:15 am. I was here until midnight last night and I'm late now because I stopped for a much needed cup of coffee. As I rush through the triage area, feeling guilty about my tardiness, I can already tell by the frantic pace of the technicians, the cacophony of pumps beeping, the ECG machine belting out the not-so-rhythmic beating of a sick patient’s heart, that today is going to be a long day.
I throw off my jacket, place my still full cup of coffee on a table, and head to the triage board, where I look over all the patients still waiting to be evaluated by a doctor. Three are marked “critical,” meaning they really should be evaluated immediately. The fourth is a dog that is here for limping. I glance at the other doctor on duty, already drowning in his own cases. It’s just the two of us until noon. I grab all three critical cases and get to work. The limping dog will have to wait.
My first patient is Lucy, an ancient Chihuahua, here for collapsing and being unresponsive at home. My exam reveals an animal that has been sick for a very long time, and it’s a miracle she’s still breathing. She has no meat on her bones. Her eyes are glazed over. Her gums are ash white, her heart rate and temperature are low. Her old body is shutting down before my eyes, and she is doing what we will all do eventually, despite our best efforts.
Lucy is dying.
I’m an emergency veterinarian, and a good one. Saving lives is my job.
But I’m not God.
I call the owner, thinking that surely she will see the reality of the situation and elect to be with her pet during this time.
To my dismay the owner insists on a blood transfusion and continued care in our ICU. I tell her frankly that I don’t think I can save Lucy. I tell her that it’s very likely her dog will pass away in the next hour or so, and I gently suggest that perhaps she would want to be with Lucy, rather than have her die by herself in an unfamiliar setting?
The owner says keep trying. Don't stop. Do everything you can to save her, Doctor.
I glance at the frail little creature in the incubator, bundled up under blankets, wishing I had the time to just sit with her so that she did not have to be alone.
Instead I order initial treatments and tests for Lucy, then turn to my second patient. Harry is a six year old Schnauzer with a history of diabetes, presenting today for vomiting and refusing food. A quick blood test reveals an extremely high sugar level. I check his urine for ketones and discover that Harry is in a “diabetic crisis,” meaning his disease is not regulated and he is now dangerously sick. I order an IV catheter, preliminary bloodwork, and fluids, then I call the owner and explain the situation. Harry needs insulin, but I can’t give insulin until he is stabilized and hydrated, otherwise I’ll put him at risk of sudden electrolyte changes that could kill him. I tell the owner that I can save Harry, but he will require multiple days in the hospital with very careful monitoring and care. The owner is receptive and polite, and agrees to everything I recommend. Until he hears what it will cost.
“Wow, I should have been a veterinarian!” He exclaims, laughing haughtily. “How do you even sleep at night? Robbing people when they're most vulnerable. You should be ashamed of yourself.”
I feel myself grow numb inside, and realize its a new reaction.
I used to get angry, feel hurt, reactive defensively. Now I close my eyes, take a deep breath, and say “I understand this is a lot of money, and it is a lot of information to take in all at once. Unfortunately Harry is very sick. I’d like to do everything I can to save him.”
What I don’t tell him is that I’m drowning in student debt ($286,000 at the moment, to be precise), with interest rates so outrageous I'll never pay them off unless I choose to live a life of destitution. I don’t tell him that it took 10 years of extensive training and sacrifice to get to the point where I am knowledgable enough to save his dog’s life. I don’t tell him that critical cases cost money, that if he were hospitalized for the same issue, his medical bills would be astronomical. And I don’t remind him that if he were hospitalized, his insurance would also help cover the cost, whereas Harry here doesn’t have medical insurance.
The man begrudgingly agrees to hospitalize Harry, but not before yelling at my assistant and calling her a “terrible person” as she takes his financial deposit. She has tears in her eyes as she puts the phone down, and I finally feel that swell of anger rise in my chest. I tell her that no client has the right to talk to her like that. Next time, I say, hang up on him and I’ll deal with it.
My third patient is Archie, a young cat that is sitting in the incubator adjacent to Lucy, crying out in pain and struggling to breath. Exam and preliminary tests reveal that he has a heart murmur, fluid in his lungs, and no blood flow to his back legs. I tell the owner that this sweet, healthy cat that he just adopted from the nearby shelter is now in heart failure and has thrown a clot to his aorta, and there is nothing I can do to save him. The owner is young. He tells me that Archie is his first pet. Since COVID, we have not been allowing owners in the building, but we do make an exception in circumstances like this. We bring Archie’s owner into the hospital to visit, and I sit with him as he says goodbye to his new friend.
From behind a mask and face shield, I tell him that I’m sorry, I wish there was more I could have done. We cry together. He thanks me for my kindness. He drives home alone, to an empty house.
A technician comes up to me as I walk out of the euthanasia room, saying that the owner of the limping dog is causing a fuss. She’s complaining about the wait time and demanding immediate attention. But limping is not technically an emergency and she’ll just have to continue to wait. We promise to get to her as soon as we can. I hear the woman yell through the phone as the technician relays my message.
It’s 11:30 AM. I head to my desk to retrieve my cold cup of coffee when a “stat” patient is rushed back. It’s a limp, unresponsive puppy. Low heart rate, low body temperature, possibly ingested something at the park. I authorize an IV catheter and shot of Narcan before ever talking to the owner. The puppy nearly jumps off the table, wags her tail, gives me kisses. I call the owner and he is ecstatic. He thanks me profusely, tells me its a miracle and he’s so grateful that I could be there to save his pet’s life.
I smile for the first time all morning.
At 11:45 another patient is rushed back and needs immediate assessment. This one is a Labrador with a distended, firm abdomen. I notice thready pulses and a high heart rate and decide he’s probably a “bloat” meaning his stomach has flipped over and he needs emergency surgery. I glance at the clock. I really can’t handle another case right now, but this dog will die if we don’t act fast. I sign him up for an IV catheter, fluids, and an abdominal x-ray to confirm my suspicion. Another doctor comes in at 12 pm, she can take over when she gets here.
At 12:30 pm my technician tells me that little Lucy's heart has stopped. She is listed as DNR so we do not start resuscitation efforts. I immediately call the owner. She’s upset because she wanted to be with Lucy when she passed. I bite my tongue, thinking of how many times I tried to tell her that her dog was going to die. She asks me if someone was with Lucy when she died, did she die peacefully, can she take Lucy home now and how long does it take for a body to start rotting?? I’m trying to answer these impossible questions but I’m glancing over at Harry, the Schnauzer with diabetes, and he doesn’t look good.
Then I look down at the puppy who ingested opioids, who has become very drowsy again.
I do my best to politely get off the phone, telling Lucy's owner how sorry I am, then order another Narcan dose for the puppy and recheck vitals and electrolytes on Harry.
I take a sip of my cold coffee and realize I’m shaking because I haven’t eaten. I also really have to pee. I plot my escape but on the way I’m asked to stop and look at a dog that just came in for rat bait ingestion. Isn't anyone else available? I really just need to pee and eat something before I pass out. My phone rings as I grab something from the vending machine. It’s a referring veterinarian, wanting to speak to someone about a case she’s sending our way.
I head to the bathroom where I remain on the toilet for just a moment, savoring a chance to sit down, and glance up at a flyer posted on the inside door of the stall. It’s a recommendation for meditation practices and how to live a “stress free” life.
The day continues, and the cases keep flooding in. A puppy with a broken leg, a cat that can’t urinate, a dog that fell off a moving golf cart and has head trauma, a kitten with a cold. Some go home, some get hospitalized, some reach the end of their road.
In the evening a beautiful young Golden Retriever named Sadie walks in. She has a happy tail and kind eyes. But her pulses are bounding, she’s running a fever, and she winces when I push on her belly. The triage technician informs me that Sadie had surgery a few days ago for ingesting a sock, and the owners say that she hasn’t been doing well since. When I glance in her belly with an ultrasound I find free fluid, and my heart drops. There must have been a complication after surgery, and now this beautiful young dog has a "septic abdomen," a life-threatening condition. She’ll require another immediate surgery if we’re going to save her.
I know from experience that, due to prognosis and cost of care, over half of owners elect euthanasia in these cases. It’s been a long day already, and I don’t know how much more my heart can handle. I turn to my colleague, hoping that she might be able to take this one. But then I remember that she had to euthanize her own Golden Retriever just last week. Our eyes meet and I see her shake her head slightly, and I know that I must handle this.
The owners elect euthanasia, and do not want to be present for the procedure. So Sadie and I are alone in an exam room. I lay a blanket down for her, offer her some peanut butter. I tell her that she is loved, and that I’m so sorry. She licks my face and wags her tail as I inject pentobarbital into her vein, and in that moment a part of me dies with her.
I have to wipe my tears away and keep moving. There are more patients to be seen, more clients to speak with, more difficult decisions to be made.
At 10 pm my shift is finally over. I’m exhausted, hungry, and can feel a tension headache creeping up the back of my neck and behind my eyes. But the day isn't done. In veterinary school we are taught that in this land of litigation, 1 in every 14 veterinarians gets sued every year. It’s up to me to write everything down in my records, so that if I happen to end up in a lawsuit I can “cover my ass.” What that means is that at the end of a long day, I must relive it all. Archie’s pain and his owner’s sorrow. Lucy's solitary death in the incubator. Harry’s mean, difficult owner. Sadie’s wagging tail and gentle kisses as I ended her life. I experience it all again.
Its 1 AM by the time I’m finally done.
I drive home in silence, the chaos of the day unfolding again and again across my tired mind. I think over each case, wondering if there was something I could have done differently. I wonder if I made any mistakes. I wonder if I could have been a better doctor, a better advocate for my voiceless patients. I think of the pets who didn’t go home today, and of their grieving families. When I get home I'm greeted by my own dogs, so happy to see me again. I hug them hard and they lick tears from my cheeks as I wonder what I'll do if and when either of them ever needs to be rushed to the ER.
I’m exhausted, and a voice inside whispers gently "Get some rest. It will all be better in the morning."
But the sadness has a cumulative effect. It adds up, beginning to weigh on the mind and chip away at the soul, and I know that, even after a good rest and a few days off, there is a part of me that has begun to crack and will soon be irreversibly broken if something drastic doesn’t change.
I hear the term “compassion fatigue” thrown about often, a common phenomenon in the medical field. But it’s a syndrome that is often misinterpreted. Compassion fatigue isn't an absence of empathy. It's a weariness so profound that an empathetic reaction just can't be summoned, a despair so deep that the body's only remaining defense mechanism is to merely shut down.
This is not a cry for help, but a call for action. Because my day is not any different than most veterinarian's. We are a group of profoundly empathetic people who struggle with stressful caseloads, insurmountable student debt, angry and irrational clients, and heart-breaking experiences on a daily basis. We face the world with a smile while secretly breaking down inside.
We say "Not one more vet," and our hearts break for the all colleagues we've already lost.
And we know that something must change, before any more of us shatter under all this weight.
*For more information on suicide prevention in the veterinary field and ways to help, please visit https://www.nomv.org
Teresa (Tess) B. Schumacher is a veterinarian with a gypsy soul and a passion for storytelling through writing, videography and photography. Check out more of Tess's stories at Candid Voyage.
