The Accidental Veterinarian

by Philipp Schott

  At around that time we were starting to find more and more uses for ultrasound, but no small animal veterinarians in Manitoba were doing it routinely, so we had to get a human ultrasonographer who moonlighted going from vet clinic to vet clinic with her portable machine. She was great, but the limitations of that set-up were obvious. Moreover, I found the technology fascinating, so whenever I had time, I would peer over her shoulder and annoy her by saying, “That’s the liver, right?” and “What’s that grey bit there? Beside the other grey bit?”

  I was not a partner yet, so I approached my boss at the time with a proposal to buy an ultrasound machine for the clinic. It was a very big-ticket item, and even with creative math, I could not make a solid financial case for it, but Bob was a remarkably wise man and could both sense the implications to the practice of my restlessness and see beyond what the immediate numbers showed.

  So in 2001 we bought an ultrasound machine, and I went to Calgary for a course. It was a revelation. Here was a world I could deep dive into that combined a fun technological toy with live anatomy, physiology and pathology, the subjects I had loved in school. Blood tests and urine tests and X-rays are cool in their own way, but they are static and removed and abstracted from the animal. Ultrasound was more like an extension of the physical exam. It was a live, real-time exploration of the interior of my patients. Another thing that excited me about ultrasound was how it was turning one of our weaker senses as a species, sound, into one of our stronger senses, vision. With ultrasound I was becoming like a dolphin or a bat and was seeing with sound. The hand–eye–brain coordination was going to take time to get consistently right, but the first few times that that grey mess on the screen automatically crystallized into a 3D organ in my mind were exhilarating. Furthermore, because it is done in a dark room, and because I drone on in a monotone, the animals were usually calm and the whole experience felt soothing and peaceful to me. I was hooked.

  Over time I took more courses, in California and New York, but it became clear early on that the key to becoming proficient was caseload. You just had to practise a lot. It was more like learning to play a musical instrument or a new sport than anything else I had encountered in practice. So I began to set aside time to scan healthy patients who were in for spays and neuters. This also helped me build up a strong sense of what normal looked like, as well as how much variation there was within it.

  And then the first referral came in. Another practice across town had heard I was doing this and wanted to send a patient over. I was terrified. I agreed on the condition that the pet owner understood that I was still learning. But it went well, and I failed to humiliate myself as expected. And then there were a few more referrals from that practice, and then some from a second practice, and then from a third and . . .

  In the last 15 years I have done over 12,000 ultrasound studies for close to 40 clinics from southern Saskatchewan to northwestern Ontario. Now there are many veterinarians as well as an excellent human ultrasonographer doing it, but I am still busy enough with ultrasound that it takes up about half my time. And I still love it, and it is still helping keep the burnout at bay.

  Black Coat

  Some days I feel like I should be wearing a black coat instead of a white one. Some days I feel like I am ending more lives than I am saving. Some days I really understand the people who tell me that they wanted to be a veterinarian until they learned that you have to euthanize pets.

  Twenty-eight years in practice, and euthanasia is still the hardest thing I routinely do. I’ve gotten used to all manner of grim fluids and funky smells and chaotic days and wacky clients and freaked-out pets and hopeless cases, but I have not fully gotten used to euthanasia. Watching the light go out of an animal’s eyes as their human companions dissolve into grief is not something that anyone should ever get used to, so it being hard will be a necessary and integral aspect of my job until I retire.

  And it is a frequent part of my job as well. I think most of us average maybe two or three euthanasias a week. They tend to cluster, so sometimes I can end up performing three or four on a single day. Those are the black coat days. Most pets, probably 80–90%, die of euthanasia rather than of “natural causes” at home. If you think about it, it makes sense. How many people get to die in their beds at home? The majority of us will die in hospital or by slow degrees in palliative or chronic care facilities. There is no such place for a dog or cat to go once their quality of life is poor at home, and there is no longer any hope of it improving. There is no ward for demented pets to live out their last days, wearing a diaper, unable to walk, unable to feed themselves. There is only a reasonably good life at home, or death.

  Seen this way euthanasia is of course, perhaps ironically, one of the best things we do as veterinarians. It allows us to fully focus on quality of life. No animal needs to suffer pointlessly the way some people do. It gives us a powerful tool many on the human side wish they had, if only they could find a clear path through the ethical minefield. We are still far more comfortable wielding the power of life and death over animals, but with that power comes responsibility, and with responsibility inevitably comes stress. It’s just the way it is, and the way it must be.

  It is interesting to note that I get far more thank you cards after euthanasias than after any other procedure. Far, far more. Some of this is thanks for service over the life of the pet, but some of it is also gratitude for the way the end of the pet’s life was handled. It’s funny, but veterinarians themselves are always most impressed by their colleagues’ diagnostic and surgical skills, by the cool cases they’ve figured out and by the new treatments they’ve mastered. Clients never are. They just assume we know how to do all that stuff. What they are most impressed by is our compassion and caring, especially in those terrible emotionally fraught moments at the end of a pet’s life.

  But all that said, my heart still sinks every time I see a euthanasia booked for me and I have to don that black coat again.

  When Darkness Overwhelms

  For Terry and Craig and Sophia

  This essay is going to be a departure from my usual lame attempt at a lighthearted tone (the last one aside). This essay is going to be about suicide in the veterinary profession. Statistics are not available for Canada, but in Britain two separate studies found the suicide rate among veterinarians to be four to six times that of the general population and double that of dentists and physicians. The American Centers for Disease Control did a survey of 10,000 veterinarians and found that a shocking one in six had considered suicide. I personally knew two colleagues here in Manitoba who took their own lives, and in 2014, a prominent and very well-liked behaviour specialist killed herself, drawing some media attention to this little-known aspect of the profession.

  To the casual outside observer this will be unexpected and possibly even slightly bizarre news. Aren’t veterinarians generally well respected? Isn’t it a secure, interesting and rewarding career? Isn’t it a dream job for so many people? Isn’t it wonderful to heal innocent animals and get paid to play with fluffy kittens? All of that is true. Except the part about the fluffy kittens. Why, then, does darkness overwhelm so many of my colleagues? There are three significant reasons.

  The first reason is that veterinary medicine attracts a disproportionate number of idealistic, introspective and sensitive people. Sensitive to the point of neurosis. This is true of all of the health professions, but it is even more so in veterinary medicine. Some of these introspective people are more comfortable around animals than around other people. They do not fully understand that it is actually a people job that happens to involve animals rather than the other way around. Grappling with this reality can be very problematic for some. Add to this the fact that competition to get into veterinary college is extremely high, and success favours perfectionists who can produce high marks. Perfectionism and idealism are fated to be brutally ground down by the chaos of reality in practice. And then their innate sensitivity
lays them wide open to the second reason: the inherent and often surprising multi-factorial stress of the job.

  Of immediate relevance to sensitive people is the fact that a veterinarian is at times marinated in death and grief. There are weeks — many weeks in fact — where I perform one or more euthanasias each day. Sobbing, crying, wailing, grief-stricken people, some of whom we’ve known for many years, are a routine part of our day. And for those of you who think this is simply a question of overwrought crazy cat ladies or frou-frou poodle people who too much resemble their dogs, I have two things to say to you. The first is that if you have not experienced a deep bond with an animal, then you are missing out on a key human experience, one shared by people from all walks of life, all backgrounds, all levels of intellect. It is one of the richest threads we weave. The second is that you have no more right to judge the grief of someone closely bonded to their pet than a blind man has to judge a photography exhibit. Simply trust me that these are normal people with legitimate and intensely felt grief. Additionally, a veterinarian is expected to be competent across a range of species and a range of disciplines, from dentistry to radiology to dermatology to . . . you name it, wedging the door wide open to so many opportunities to fail. And remember: “sensitive.” Mix sensitivity and failure and see what happens. And I haven’t even mentioned the financial stress of trying to be affordable to clients yet still able to service sometimes enormous debt burdens and meet payroll, etc. Or the stress of being a manager when you went to school to be a vet, not a manager. Or the angry clients. Or the angry spouse, upset because you’re stuck late again.

  The third reason is that we know how easy it is. How easy it is to die. Those daily euthanasias are consistently peaceful, painless, quick and reliable. One hundred percent reliable. We know the dose. We know the delivery methods. We have the drug right there. Can you see now why it happens too much?

  And to make things worse, this is clearly an iceberg situation, where the suicides are only the visible tip of a massive mental health problem in the profession. According to an exhaustive American Veterinary Medical Association survey, just under a third of all veterinarians have experienced depression at least once since graduation. A smaller Canadian study found that one in ten veterinarians were currently classified as having depression, and another 15% were borderline. Also, a third of veterinarians in that study were suffering from anxiety, and a shocking 47% scored high on measures of emotional exhaustion. Clearly the problems run deep and run wide.

  Fortunately, our professional associations are beginning to take notice, and mental health support is increasingly being incorporated into the services they provide. And what can you, the reader, do? You can’t do much about the first and third reasons listed above, but you can definitely do something about the second. If your friend or family member is a veterinarian, do not trivialize their stress. Understand that the real job is far more complex and serious than you imagine. Offer to listen with an open heart. And if you are a client and your veterinarian has done something to make you angry, please recognize their human fallibility and frailty, and try to find a calm and respectful way to address your concerns.

  And what about me? Well, fortunately I had a “happy optimist” chip deeply implanted at birth. The zombie apocalypse could roll into town and I would say, “Cool, this will make for some excellent photos!” And, “Maybe brains are better with a bit of smoked paprika?” I have painted a bleak picture when in fact most veterinarians are fine — even better than fine — but burnout is very real, and depression is very real, and, for a small, tragic minority, suicide is very real too. Not only in veterinary medicine, but in society at large, we must work to demolish the stigma that still surrounds mental health. If your leg is broken, everyone wants to talk about it, but if your brain is broken, hardly anyone does. This is wrong, and it is doing so much harm.

  Chomp, Chomp

  Many people assume that veterinarians get bitten a lot. In fact, quite a few people seem to assume that this is the worst part of the job (not having considered the truly bad parts of the job I mentioned in the previous essay). I often get comments, accompanied by a wry chuckle, along the lines of, “It’s a good thing you’re seeing Killer today, Precious would take your arm off!” (Incidentally, this also illustrates a general principle that there is often an inverse correlation between the name of the patient and its behaviour.) I’ll sometimes catch people mentally counting my ten intact fingers. The truth is that I’ve only been badly bitten twice. I’ve been in practice 28 years and see somewhere in the neighbourhood of a couple thousand patients a year. These are much better odds than you probably guessed.

  That being said, the exceptions form an indelible mental rogues’ gallery. Every veterinarian has one of these. At the top of mine is Oscar Westenheimer. Oscar was a little chihuahua cross (of course he was) who resembled a baked potato with four toothpicks stuck in for legs and an angry walnut for a head. Oscar was in for a nail trim. We knew that he had anger issues, so we were careful to muzzle him. The nail trim was done up on a table, and afterwards Oscar was set back on the floor, and then the muzzle was taken off. Have you guys been to Sea World? Or at least seen a video clip of when the trainer stands on a high platform and holds a fish out for Shamu, who then leaps cleanly out of the water to get the fish? Well, Oscar was Shamu, I was the inadvertent trainer, and my right index finger was the fish. How that little baked potato could catch so much air astonishes me to this day, but as soon as the muzzle was off, up he came. Sailing through the air, fangs sharpened, and then chomp, right through the fingernail. Off it came. This hurt. Fortunately the client wasn’t there, so I was able to verbally express myself in a vigorous, honest and uncensored fashion.

  The second time was more surprising. Despite the name (see first paragraph) I generally trusted Peaches, so I thought nothing of examining her mouth. I carefully opened her mouth, holding the upper jaw steady with my left hand while gently levering the lower jaw down with that poor right index finger. Chomp. I still don’t know why she did this. Perhaps she had always wondered what it would be like to bite me? Perhaps she was hungry, and I didn’t wash the sandwich residue off my hands thoroughly after lunch? Or maybe just early onset doggie dementia?

  The reason we get bitten so (relatively) rarely is that the great majority of dogs will warn us using body language. I was probably too intent on chatting with the owner and on Peaches’ tartar to tune in to her warnings.

  Occasionally, though, you will encounter a sociopathic dog. A dog who does not conform to the norms of dog communication. A dog who is going to bite you just for the heck of it. So although it was not a “bad bite” (i.e., no wound dressings or antibiotics required), Daffodil deserves honourable mention in my rogues’ gallery. She was a Brazilian German shepherd. Very expensive, very fancy. She sat perfectly beside her owner in the waiting room just as a very expensive, very fancy dog is expected to. The owner and I were talking, and I was leaning on the reception counter, perhaps as far away from them as the distance across the average living room. Daffodil looked very relaxed and at ease. And then, before I could flinch or even blink, she was across the room with her jaw clamped on my thigh. Half a second later she was back beside the owner, sitting primly again, as if nothing had happened. The owner seemed unfazed. I, however, was thoroughly fazed and excused myself to go take my pants off in the washroom. Daffodil hadn’t broken the skin, but she had given me a temporary red dental chart tattoo.

  What about cats? I’ve been lucky. Cats also generally give plenty of warning. A cat that is going to bite you radiates tension like a force field. I’ve also become very adept at carrying them gingerly like unexploded ordnance and handing them over to my staff, who are almost magical in their ability to manage the exploding cat. Usually. I do get scratched with tiresome regularity, though. Once the nails went right through my lab coat and my shirt, raking me across the chest and giving me a faintly piratical scar that I bear to this day.


  But Oscar, oh Oscar: when I am one hundred years old and drooling and cannot remember that shoes go on my feet and not on my hands — I will remember you.

  Part 3

  The Science of Veterinary Medicine

  The Known Unknown Unknowns

  I solemnly pledge that this will not only be the first time, but also the last time, that I will make reference to Donald Rumsfeld. In 2002 the then US Secretary of Defense famously said, “There are known knowns. There are things we know that we know. There are known unknowns. That is to say, there are things that we now know we don’t know. But there are also unknown unknowns. There are things we do not know we don’t know.”

  Veterinary practice is defined by the known knowns and known unknowns. But the unknown unknowns, such as the unknown pets with unknown diseases, are important too. Because we know that they must exist, they are actually the known unknown unknowns, if you follow me. You can, however, safely read on if you don’t. There are no reliable statistics as to how many of these pets are out there, but in 2009 the Canadian Veterinary Medical Association published a survey showing that almost a quarter of dogs and half of cats owned by the respondents had not been to a veterinarian in the preceding 12 months. Keep in mind that people who participate in surveys tend to give answers that they think are more socially acceptable, so the real numbers are probably higher. Unfortunately, the survey did not dig deeper to determine how long it had been since those dogs and cats had seen a vet. Two years? Five years? Ever?

  Why does this happen? Why do people fail to take their pet to the vet? Studies have looked at this too, and while the percentages vary, the main factors are as follows: