Vet Stress What I killed in 2008: The veterinarian’s edition

Can you guess how many animals I euthanized last year?

Sadly, this morbid mental exercise is kind of like guessing how many jellybeans are in a jar. But it’s undertaken less as a senseless descent into morbidity than by way of reaching into my profession’s heart of darkness…and attempting an exorcism of the demons that live there.

That’s what whatikilledtoday is all about. In case you’ve never heard of it, it’s an excellent blog on one wildlife worker’s euthanized cases. From crabs and fish to small mammals, this not-for-profit employee has it rough on the death front.

Mostly, these “beautiful deaths” are recorded matter-of-factly, allowing any of us to read into its grim words what we will. It’s nothing short of brilliant—if you like Nietzsche, that is.

Yes, it’s sobering stuff, all this euthanasia talk. But when you do what we do—whether you’re the direct supplier of death or the one paid to caress the dying and attend to their remains—it takes its toll. Sometimes it really can be every bit as gut-wrenching as you’d expect it to be.

That’s why counting all the dead who have passed through our hands is a worthy practice. After all, it deserves some contemplation, this serious detail we take on as veterinarians.

Over on VIN (the Veterinary Information Network), there’s a vet-only thread where veterinarians who have taken the time to research this past year’s kills are posting their stats: 128, 140, 201…

My stats for 2008: 96 dogs. 128 cats.

It might sound like a somber way to ponder what we do. And you’d be right. But, somehow, there’s much more going on behind the numbers, just as I intuit in whatikilledtoday’s cold, hard facts.

Whenever we discuss euthanasia among colleagues, there’s always a spectrum of emotions attached: relief, sorrow, fear, and the blackest kind of humor reserved for those who require collegial commiseration and personal expiation.

You might find it dark and lurid to count off the pets whose hearts we’ve stopped. But where would we be without the willingness to accept this opportunity for reflection?

January 6th, 2009

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I'd be more interested in the accidental deaths myself. Euthanasias are planned and can be (somewhat) anticipated. A beloved cat that unexpectedly dies under anesthesia must be much more traumatic than a FIV positive stray being euthanized.

zandperl January 6th, 2009 10:36:23 AM

zandperl: My computer's practice management program doesn't allow me to sort by accidental deaths, but perhaps we can look at total cremations and subtract the euthanasia codes for an estimate of non-euth deaths. I'll look into it for you...

Dr. Patty Khuly January 6th, 2009 11:01:36 AM

Our clinic doesn't need tracking software for accidental deaths- we had one unanticipated death, after a routine dental cleaning. I'll never forget that cat. It was traumatic for all involved- pet owner, veterinarian, and clinic staff.

Megan January 6th, 2009 11:10:40 AM

That sounded snarkier than intended- I mean that, while routine euthanasias are.. well.. routine and common, the accidental deaths are rare and traumatizing.

Megan January 6th, 2009 11:18:15 AM

Oops...somehow I misunderstood what zandperl was going for...sorry. Yes, we too can remember every single accidental death...at our hands, that is.

I thought you meant all the pets that died for a host of other accidental reaons, not just anesthesia or out of real or perceived veterinary negligence.

Dr. Patty Khuly January 6th, 2009 11:40:54 AM

Which is harder emotionally, the euthanization of a much beloved pet with grieving owners present? Or the euthanization of a pet you feel doesn't need to die? Or maybe they hurt equally, just in different ways.

Arlene January 6th, 2009 12:30:40 PM

Arlene: Door number two...for sure.

Dr. Patty Khuly January 6th, 2009 01:16:33 PM

For me, it's definitely number two. It hurts, and I usually feel angry and powerless too - part of that is because I know I can't save them all; the vets and staff have already saved the ones we could and nobody at the clinic (including willing family members) has any more room in their houses for another animal. On the bright side, I've noticed a slight trend toward seeing fewer euthanasias for unnecessary reasons.

brebis noire January 6th, 2009 01:44:35 PM

I know the toll it takes. Even if it is done for all the right reasons, at the right time, and everything is right.

A life that you are holding in your hands slips away. I hate euthanisia. DOn't get me wrong, I have had it done and will again and I totally support it, but I hate it none the less.

I have personally lost 15 cats to FIP in the last 18 months. I have held every one of them as they died except for one who died overnight while in the vet hospital. I have also lost 4 cats to simple old age in the last year. A few were euthanized to prevent their further suffering.

I never fail to revisit the need for those euthanized. Over and over in my mind for both days before and days after. Usually frustrated that I am left with no other choices. I imagine that the frustration is something that you also feel. That there is simply nothing more that can be done in some cases.

But I imagine those that bother you the most is the client that euthanizes because the cat keeps peeing on something, or the dog who bites some one. Euthaisia for a behavor must be extra frustrating because many times here is a case that might havea solution.

When I think about the people that do the shelter euthaisias (SP?) though, that must be the worst. Perfectly health cats and dogs (and other animals) dying simply because there isn't enough time, enough space, enough homes. The toll on those must be mind numbing. Or worse....

http://lorrim-fip.blogspot.com/

LorriM January 6th, 2009 01:48:30 PM

I read the blog of a young man who worked for an animal control agency in the southeast and he described what it was like for him each Friday morning (the day the unwanteds went into the gas chamber). It was one of the most horrifying pieces I've ever read and it clearly was taking its toll on the writer, who was an emotional mess and taking anti-depressant drugs to do what he had to do (he did say he really needed that job). At our local "humane" society they have a euthanasia tech who does most all of those poor animals who die because there isn't room for them, or they are too old, or too something or another. She appears to be quite able to do that and stay detached from the actual animals whose life she is taking. In fact, I find their whole philosophy a bit too cavalier. It should not be easy to take the life of any animal. I have had several of my own pets euthanized over the years and I only have one beautiful Samoyed whose death should not have happened. It's a long story, but she was killed before her time and I have lived with that guilt for every single day of my life. If there were "do overs" that would be one of my first. Even my beloved cat who had a saddle thrombis and clearly was not going to recover was a tough one to let go, although I did feel at peace with the decision to let her go. Thank you to all of you who care enough about the animals who come into your life to take a look at this hard subject and to open it up for discussion here, Dr K.

dottie January 6th, 2009 03:25:10 PM

:( you almost made me cry. then again, i'm still thinking about the THREE trusting & sweet starving dogs i met volunteering at the shelter the other day. and the many cats i "tortured" with blood draws and ear cleanings who forgave me anyway. i wish the veterinary dream was the same as the reality. thank you for being able to handle it. i wish i could. the lab isn't nearly as cute or challenging or fulfilling but i'm strongly encouraged to help keep the patients alive and i like that. (don't get me wrong, i am thankful for euthanasia in ending hopeless suffering. i just wish that was the only time vets have to perform it.)

sarah January 6th, 2009 05:11:07 PM

If I were a veterinarian, I too, would reflect upon euthanasias. I think it is not only normal, but commendable and healthy to do so. If you didn't, I would surely wonder how much of reverance for life there is.

Most definitely, the sadness of un-needed euth. in an otherwise healthy animal has to be incredible & some detachment has to occur, including dark humor for a coping mechanism. I think that is completely normal in professions riddled with "unpretty circumstances".

But please, Dr. Khuly, you do not STOP their hearts. Euthanasia creates deep coma/anesthesia, where the brain ceases to conduct nerve connection to the major organs, including the heart (yes, I know there are a few other components in addition to the pento-barbital).

If you simply stopped the heart ONLY, it would not be "euthanasia"---sorry to be a bugaboo....Barbara A. Albright

Pocket's Story from NH January 6th, 2009 06:07:38 PM

I just remembered an excellent book I read a few years back by a literary author (Coetzee) who truly cares about animals. Disgrace is the name, and it's the only piece of literature I've ever read that treats animal euthanasia as a solemn subject, right up there with any human-centered issue or idea. It helped me to realise the importance of my work in the scheme of things.

brebis noire January 6th, 2009 07:59:28 PM

This thread strikes me right to the heart. My beloved golden retriever, Cooper, is in the last stages of lymphoma, and I've been struggling with the right time to euthanize. It was almost time on New Year's Eve, but he rallied, and is doing better, though I know that it is a short term rally. I am lucky enough to work for a great vet who has seen me through this, and has told me to call him whenever I (and Cooper) need him. It is never easy to let go. My sons went back to college on Sunday, and said their last goodbyes to Cooper, their buddy, the dog they grew up with. We were all in tears. I'm glad that I have the option to end Cooper's suffering, and pray that I will know when it is the right time.

I've participated in many euthanasias in my work, and none are easy. I agree with Dr. Khuly - the ones that really don't need to die are the hardest to take. The ones where a well-loved pet has it' pain ended are tough, but feel - right? Does that make sense?

Sassy January 6th, 2009 08:12:00 PM

I have essentially the same belief on this for humans and animals. I believe that death is transition and not final. A few of my pets have died peacefully at home and that is the way I hope to go too. Most of my pets have been euthanized when the time came; death does not usually come easily or without pain and that’s just the way it is. My only regret was the first euthanasia of a pet. The Vet did not tell me that I could have stayed with him during the process and I didn’t know to ask. All the others have been euthanized in my arms and I’ve seen the pains of age and illness leave them as they relaxed back into a more youthful appearance. It always makes me cry for my loss but not out of regret for the euthanizing.

I would think the euthanasia of animals for no reason other than behavior or lack of home would be particularly difficult but it still seems better than the alternatives which are almost inevitably filled with pain and suffering. Even so, I’m not sure I could do it every other day or in huge batches weekly.

PJBoosinger January 6th, 2009 11:37:49 PM

Euthanasia is never an easy choice for me. I have had to have many pets put down over the years and it doesn't get any easier. I always doubt that I have done enough. Or I wonder if I didn't make the decision because I was tired of the extra work caring for a sick animal can cause. However, deep in my heart I know that I have always put the animal first and if anything I may have waited too long a couple of times and let my pet suffer longer than I should have. Knowing the heartache it has caused me each and every time I just don't understand how people can do it just because an animal misbehaves or is no longer wanted. I have a very low opinion of these people. I would love to volunteer at the animal shelter but could never bear the thought of any of them being put down just because they weren't wanted. Humans seem to continually disappoint me. A lot of them lack the loyalty and forgiveness that cats and dogs show daily.

KrazyKatLady January 7th, 2009 01:26:06 AM

Sassy: I'm so sorry for your Cooper's lympho. In a few months I'll probably find myself in your shoes as my Sophie Sue's brain tumor makes its way back after 18 radiation treatments. Wondering when it'll happen, watching the 'time bomb' tick, is hard to do. But at least we know we've done our best. We've kept them happy and comfortable. And we'll pre-empt their suffering when it's needed. I can live with that.

As to euthanizing my patients (those that require it), I always derive a degree of profound satisfaction when I do so. It's an irony that may mean my human coping mechanisms are pretty well attuned to my profession, but it's worthwhile to note that euthanasia isn't all doom and gloom. It's a wonderful gift, being able to alleviate suffering.

Dr. Patty Khuly January 7th, 2009 09:09:35 AM

I volunteer at a hotline for people to call and discuss their feelings over losing a pet and I feel like I get as much out of it as the grieving pet owners who call in. I often wish there were something similar waiting for me when I become a veterinarian. Maybe it's just a matter of making time with colleagues to do some commiserating, but do you find time for reflection at work? Or do you make time outside of your regular schedule to help deal with some of these issues? Just wondering...

Ingrid January 7th, 2009 09:57:11 AM

Ethanasias suck, but in those cases where the animal is suffering, they are much easier to deal with (for me, helping the vet). I almost always cry, even if I don't know the animal well, because their trust and love of their owners is usually so evident. Those owners who can accept that they are giving a gift, even when it hurts so much, actually make it a better experience. We may end up crying together, but there's a small element of happiness, especially when they (and we) know that they'll be able to share their love and compassion with another pet in the future. "Knowing that they will die, knowing that in the end we will be alone and in pain, and choosing to love despite this." (Lisa Hughes)

The people who say they can't deal with it and are never going to get another pet, and don't stay with the pet, are the ones who are actually missing that whole experience. We can't have the good without the bad, so that we can come back around to the good again.

KateH January 7th, 2009 10:24:34 AM

Wandered in here by blog surfing.

I just want to thank you, and all vets who read this for being strong enough to make euthanasia possible. Thanks to you, we can give our beloved pets, one last bit of love. I adore my vet, who is brave enough to cry with me when he has had to help our pets out of their suffering.

He is also willing to stop suffering when needed. I always manage to end up being the one friends call when they've found a stray. Two times this year, I've ended up with malnourished, mangy, flea covered, puppies that also were in advanced stages of parvo. Dr. Portie could try to take my money and convince me that he could save said pups, but that's not who he is.

Again, thank you. What you do, matters. If not to the humans, but the animals.

CeeCee January 8th, 2009 10:11:51 AM

Thank you for highlighting the toll this takes on vets. In the UK I have read that vets have the highest rate of suicide out of any other profession. A tragic statistic, considering they do so much to alleviate cmpanion animal suffering.

Jane January 10th, 2009 07:20:08 AM

Jane, a tragic statistic indeed, but as previous blog comments go, how many are connected to drug & substance abuse??

B. Albright

Pocket's Story from NH January 10th, 2009 01:40:47 PM

To B Albright (comment above) Interesting take on the statistic there - have you considered the stresses that might lead someone to drug and substance abuse? Depression, a lack of suitable support, a culture where professionals such as vets are expected to be able to cope in all situations without any personal affect, dealing day to day with the results of hideous neglect/cruelty/ignorance - I could go on, but the upshot of it is that working in an environment where life and death are the foundations of the job can have a deleterious effect on a human. Some people commit suicide because they can no longer tolerate their life - that life may be unsullied by substance abuse, it may just be too much to bear. Whatever the reason, our compassion is needed as much for the lost life and those they left behind as it is as protection for ourselves, lest we become immune to the frailties and tragedies that beset all humans. It's an indictment of our own lack of care towards each other as human beings that individuals can get to a state (often unnoticed by others) where they believe that life is no longer worth living. Whether these individuals are using drink or drugs is not relevant.

Jane January 11th, 2009 07:04:15 AM

Thanks, Dr. Khuly, for your sympathy. Cooper was euthanized yesterday, and his suffering is over. I know that it was difficult for my vet/boss to push that plunger, and it was hard for me to hold Cooper for it. But I knew it was time. His suffering is over; mine is just beginning.

Sassy January 11th, 2009 05:46:42 PM

Sassy, I am very sorry about Cooper. It is never easy, even when it is time.

Jane re "have you considered the stresses that might lead someone to drug and substance abuse?"

I don't think Barbara meant that statement as a moral judgment.

I am sure what you enumerate is true re: all of the factors that would lead someone to abuse drugs, and OTJ stressors like having to deal with euths etc. certainly would contribute to depression which in turn would make someone more likely to use drugs which in turn would make suicide more likely.

But I think there is another big obvious factor -- ACCESS.

I don't think drugs are irrelevant to suicide at all. Access to a modality to take your life certainly makes suicide in moments of despair more probable. To state that is not a moral judgment. I'd be willing to bet that access to a gun also has a strong positive association with suicide via gunshot, too. With drugs, there's always the difficulty discerning an accidental overdose from suicide, as well.

KrazyKatLady, re: "I just don't understand how people can do it just because an animal misbehaves or is no longer wanted. I have a very low opinion of these people" . . .

Ditto, well said.

Stefani January 12th, 2009 11:29:43 AM

Jane: This is one of those times when receiving threads would be helpful. I believe it has been published that the highest rate of suicide for human medical professionals are in the "dentistry" field. If so, I can not see how the work-related stress of teeth would coincide with your thinking.

But I believe that access to drugs and abuse may play a factor. And people that are substance abusers (regardless of work) are more likely to be depressed, disoriented, not seek professional help, and in turn, more probable to commit suicide or commit unlawful acts of harm. So I do believe that substance abuse is VERY relevant.

Barbara A. Albright/NH

Pocket's Story from NH January 12th, 2009 06:55:51 PM

Stefani, I am not sure what is being argued here - I wasn't referring to access to drugs as a tool for suicide, more as an issue where abuse of them is to ameliorate the stresses felt during depression. Often a person turns to drugs/alchohol when they have become depressed, and yes, plenty do become depressed once they have started abusing drugs/alchohol. There are many reasons and methods for and of suicide. My concern is what placed a person onto the downward slope, not the method that propelled them along it. In the context of your article and this thread my concern is what caused the depression in the first place. The statistics for professional suicide that I referred to were published by the GMC and the RCVS in the UK, possibly 4 - 5 years ago. They were also referred to in New Scientist. The paper did not refer to other countries or their statistics, just the UK. Dentists did not figure in the paper. Vets did. So Barbera, I am also unable to see how the stresses of dealing with teeth figure either. Dentists don't have to routinely euthanase their clients. Vets do. Doctors experience many situations where they are probably under as much stress as vets are when it comes to life and death. It would be interesting to see just how many cases of suicide by vets were attributable to substance abuse. Alchohol abuse is seen along with gross professional misconduct as a reason for vets being struck off the register of the RCVS - their disciplinary cases, findings and actions are published online. In the UK there is a stiff upper lip culture amongst this profession and also the human medical profession where it is considered a weakness to show that aspects of the work are wearing a person down badly. There is still such a stigma to mental health issues in this country that it's inevitable that some individuals will avoid seeking help where there is even the slimmest chance others in the profession will know help has been sought. There are some signs of change and humaneness appearing in the form of help lines and confidential access to counselling, but it's early days yet. Oh for more enlightened times! PS: Barbera, I don't know what "receiving threads would be helpful" means.

Jane January 13th, 2009 12:58:18 PM

Jane, Receiving threads or updates by email. The only time I know if another comment is added is to recheck all the blogs.

I understand your concern and perhaps the "frowned upon" thinking of getting needed help for substance abuse. Believe me, it hasn't changed too much in the states, either. No matter what walk of life, it most often remains hidden. Job promotions withheld, social status ruined, etc., abuse taking many outlets, but all are harmful.

The point being, that medical professionals have "access" to "prescription drugs" to abuse over & above alcohol, but are not necessarily more "susceptable" than a "blue collar". And abuse "magnifies" 10-fold under-lying depression or 'mental illnesses'.

That was my point of the "dentist" profession being 'reported' as a higher rate of suicide. I seem to remember a weird connection to working with particular lighting implicated.

I have visited the UK's disciplinary site and wonder how the public views the job the board does?

Barbara A./NH

Pocket's Story from NH January 14th, 2009 07:10:09 PM

Barbera, thanks for explaining "receiving threads" - all is clear now. I think we are moving into a different discussion area now - in my experience those I know who have had reason to start a formal complaint to the RCVS have not found it easy. The two people I have known follow the complaint through to the end have been happy with the outcome - the vet was struck off in one case and the other was put on probation and made to work under supervision whilst undergoing intensive retraining in specific procedures. I don't think that many people with pets in this country even know the RCVS exists, yet alone know about the board's action. Some people know they aren't happy with their vet and just move to another practice. The RCVS have made efforts to make it easier and clearer about just what needs to be done when pursuing formal complaints, but the stumbling block is often the client's vet. Despite new practice standards being rolled out across the UK this year that clearly state exactly how vets must respond in cases of complaint, some vets still insist that being defensive and dismissive of client concerns is a suitable response. Because vets here have a similar professional image as human doctors, there is understandable reticence to question them. Unfortunately "doctor knows best" is a mindset that prevails. In the past when I have had serious concerns about a vet and her apathy when it comes to diagnostics, one mention of the RCVS brought about some appropriate action, but not everyone is as pushy as me. I think a massive education programme for animal owners would help everyone get the best from veterinary services. Too many owners don't take full responsibility for compliance with instructions or educate themselves about their animal's condition - so they don't know what questions to ask - conversely some vets do need to view owners as something other than idiots. Getting back to the topic - it's not reasonable to tar all vets with the same brush. Many are excellent and do recognise when things are getting too much for them and seek advice/referral to colleagues. It's the ones who struggle and can't reach out that my concern is for, both as human beings and also as paid guardians of animal well being. I don't think it takes much to tip a person over the edge into irresponsibility - the key being that everyone needs to be aware - all professionals are only human.

Jane January 15th, 2009 08:29:35 AM

re the substance abuse issues and suicide: Veterinarians have been determined to be more at risk than the general population for both. Correlation is there. The causes are questionable in both cases.

1-Access is a huge issue. When you have the key to the drug box meds are so much easier to abuse. And suicide is only one venipuncture away.

2-Depression: Do more depressives enter veterinary medicine? Does euthanasia/compassion fatigue take its toll?

3-Isolation: Many vets (like dentists) still practice in isolation--only one or two vets in a practice. Studies show that those who are isolated are more likely to abuse drugs and commit suicide.

4-Sensitization: It has been postulated that veterinarians and anesthesiologists may have a higher risk for becoming sensitized to the anesthetics in the environment. In other words, the physiological exposure to these drugs, aerosolized in minute quantities over time, can provoke a drive to seek out more of the same. This, coupled with access, makes these professions more dangerous to those already predisposed to drug abuse or mental illness.

Ultimately, we have to remember that drug addiction and depression are diseases. They have genetic roots and physiological explanations. Those who abuse drugs regularly are usually suffering a form of mental illness that's particularly insidious and difficult to treat. Trying to tease out what's work-related depression and what's substance abuse is an incredibly difficult task in these cases. It stumps psychiatrists every day.

Dr. Patty Khuly January 15th, 2009 09:01:17 AM

Excellent blog, Dr. Khuly.

I just stumbled across this and have now bookmarked it. You address so many issues pertinent not only to veterinarians, but to clients & pet owners. It's great to be able to glean insight into what it's like from a vet's point of view. You help me appreciate my own veterinarian even more.

Keep up the good work, in the clinic AND online!

Deb