COMPASSION FATIGUE IN THE VETERINARY SECTOR

This is Julie South and this is the transcript for episode 007 of Paws Claws & Wet Noses – celebrating all creatures great and small and the fantabulous professionals who look after them all.

Over the next few weeks, you and I will catch up with veterinary professionals to hear what it’s like working on the front line in some of New Zealand’s veterinary clinics and hospitals, while our borders are closed to entry from overseas-qualified veterinarians.

This week we’re going to look at some of the mental stresses that your favourite veterinary professionals are under so you can get a better understanding of what it’s like to walk a few kms in their shoes.

This episode touches on some painful issues.  You don’t have to listen to those if you don’t want to.  I’ll let you know before we get to those so you can stop listening at that point.

Cost of pet ownership in New Zealand

Before we start walking those few km I mentioned just now, let’s first look at what’s involved in owning a pet in NZ.

Back in 2017, the NZ Herald ran an article entitled “Man’s best friend costs a doggone fortune”

The article referenced Southern Cross Pet Insurance research that reported 32% of respondents found it hard to pay for their vet bills.  Tragically, one in ten had to put their pet down due to cost.

It costs around $2,000 per annum to own a dog in NZ – that includes food, annual vaccinations and checkups.

It doesn’t include emergency visits to the doctor because your fur baby managed to find the Christmas cake you thought you’d hidden and ended up with an emergency trip to the after hours clinic for raisin toxicity.

The cost of owning a cat is around $1,000 per annum in NZ.  That doesn’t take into account an emergency trip to the ER because that beautiful poinsettia you were given for Christmas ended up making your cat very sick.

Let’s say your dog lives just ten years – that’s $20,000 over its lifetime you need to have available for its care.   A cat can live for 20 years – there’s $20,000 there too.

If you have a cat and a dog – there’s around $40,000 you’ll need to budget to care for them.

If you’re not budgeting around $40pw for your dog and around $25 pw for your cat, you may be one of those people who instructs your animal’s medical team to put them down because you can’t afford to keep them.

That’s tragic!

Sadly, humans who don’t factor this financial outlay into their budgets cause lots of stress for their fur babies’ doctors and nurses.

Imagine how it must be for them:  most I’ve spoken to have deliberately chosen veterinary medicine because they love animals.  Very few of them fall into being an animal doctor or nurse.

It’s their vocation.

“… if you cared you’d do it for free!”

So imagine how it must be for them when an animal owner walks through their clinic’s doors and can’t afford to pay for their animal’s medical care and tells the veterinary team they don’t care enough, because if they did, they’d do it for free …

or they don’t care enough because they’re only in it if for the money, otherwise they’d care for their pet for free …

or that an owner can’t afford to pay for the treatment of an otherwise healthy animal so they instruct the veterinarian to put it down.

Imagine how hard that must be for that animal’s doctor or nurse!

It’s hard enough when a vet and nurse have to put down an animal because that’s the humane thing to do … but to put down an animal because it’s owner didn’t have any idea how much pet ownership would be…. That’s an extremely hard pill for the medical team to swallow.

Animal healthcare vs human healthcare

So let’s look at the cost of healthcare treatment for animals.

Unlike human medicine – there is no government subsidy for animal healthcare.  There’s no Pharmac for veterinary medicine like there is for human medicine.

There are no government subsidies for veterinary clinics like there are for the medical centre you’re registered with.

If your pet is involved in a motor vehicle accident – say it’s been hit by a car – there’s no ACC to cover the medical costs of that accident, which a human would have received.

Moreover, human animal owners and caregivers expect human level care, procedures and equipment for their fur babies, but most don’t get that this needs to be paid for.

Somehow.

And because it’s not the government footing the bill, it means it has to be the fur babies’ owners.

Human context

Let’s give this some context.

You’ve probably heard of people having ACL injuries – that’s the anterior cruciate ligament located in your knee.

The ACL limits the forward movement of the tibia – the shin bone – underneath the femur – the thigh bone.

Your ACL is critical in controlling the rotation, or pivoting, of the tibia – the shin.

If you tear your ACL, your knee loses stability when twisting or “pivoting”.

You’ll feel the knee slide out or give way when you attempt to pivot – when your ACL is stretched beyond its ability to resist, it tears.

This could happen with a direct blow to the leg – eg a rugby tackle; a sudden twisting movement either during a fall or while trying to pivot on a planted foot – which is a classic netball injury, or by hyperextending – or over-straightening – the knee.

If you tore your ACL playing rugby or netball, ACC would pay for your surgery and help towards the cost of rehab afterwards.  If your knee somehow became hyperextended in a motor vehicle accident, again, ACC would pick up the tab.

The surgery alone could be $10-$15,000.

A similar surgical procedure for your dog – TPLO surgery – or Tibial Plateau Levelling Osteotomy – is a procedure to correct a rupture of the cranial cruciate ligament in the knee of dogs. The cranial cruciate ligament is the principle stabilising ligament of a dog’s knee.

Remember – the true costs to repair your ACL rupture are in the region of $10-$15k – all of which the government will fund (for residents and citizens).

The similar canine procedure is about a third of that – somewhere in the region of $3800 – $4200.

One third!

Further, only a veterinary surgeon would contemplate doing such a procedure on your dog.  This same veterinary surgeon would earn nowhere near their human-doctor knocking on a million dollar-per-annum-salary equivalent.

To put that salary into perspective – the highest salary I’ve heard of being paid to a veterinary specialist surgeon is $200 kpa.  And this was to a very experienced, very qualified, highly skilled surgeon.   I don’t know of any veterinary surgeons who earn anywhere near a million dollars a year that their human counterparts earn.

Vet clinics need to be profitable to stay in business

But let’s get back to the topic of this podcast – walking a few kms in your animal doctors’ and nurses’ shoes.

Imagine how stressful and hurtful it must be to hear day-in & day-out that they don’t care enough because they won’t work for free.

Just like you and me, veterinary professionals have mortgages or rent to pay, mouths to feed and many have humungous student loans to pay off.

Imagine if they did work for free – where do you think the money is going to come to fund the high-tech equipment animal owners expect to help diagnose their pet’s illness is going to come from?

In last week’s podcast I mentioned that, unlike human doctors, animal doctors (and nurses) are required to be able to treat a number of different species (cats, dogs, cows, sheep, horses, turtles, birds, rabbits).

Another major difference between human and animal clinicians is that human patients can answer questions about what they’re feeling or how something happened.

Veterinarians need to be detectives as well as doctors

Animals can’t.  This means that veterinarians must have amazing critical thinking skills.

As well as being clinicians, they need to be detectives.  All they have are the facts as the patient presents:  what they can see and what test results show.  From there they have to work out what could be wrong.

So the next time your fur baby’s veterinarian wants to run tests, it’s because they need to know because your fur baby can’t tell them what’s wrong.

They need to go through the process of elimination.  It’s part of their duty of care.

They need to take x-rays to know for sure what an animal has eaten – because it can’t tell them what it did or what happened to make them sick or be in pain.

And this equipment costs money.

No animal equivalent of Pharmac

As for medication – as I said before, there’s no animal Pharmac equivalent.   Veterinary medicine isn’t subsidised.

And pharmaceuticals cost money.   A lot of money.  A current example of that are the Covid-19 vaccines.   Think about how much research has gone into getting the vaccines this far.  And even now, some people are wary because they don’t think enough testing has taken place.

Testing costs money

The meds your veterinarian prescribes have gone through rigorous and expensive testing already.  That’s why they cost so much!

But back to walking a few kms in your veterinary team’s shoes.

There’s this condition, this state, the majority of health care workers are currently experiencing called Compassion Fatigue.

It affects both human and animal health care workers.

Most people I know who work in the veterinary sector, do it because they love animals.

As far as career choices go, there are many others that offer better pay and hours, are easier on the body and don’t have as many potentially risky situations.

Any veterinary professional headed home at the end of a shift with dog drool in their hair and cat fur on their scrubs, will tell you that they’re not in the job for the glamour.

While they share an undying love for their animal patients, working in a veterinary hospital can be an emotionally demanding career.

Caring too much can hurt

Not every day is filled with successful treatments, fur-baby cuddles or happy endings.

Sometimes caring too much can hurt, and compassion fatigue in veterinary medicine is a very real problem they deal with on a day to day basis.

Veterinary medicine is a noble field to be in.

Helping animals of all shapes and sizes appeals to a certain personality type.  Veterinary professionals are usually driven, passionate, empathetic, and sometimes, caring to a fault.

Because of these personality traits, they’re they type of people you want on your team… to have as friends … to be around.

But these personality traits can also have their downfalls.

Their jobs, while often rewarding and fun, can sometimes have a dark side.

On a daily basis they must grapple with death, suffering, and even suspected abuse in their pet patients.

In the Open Letter I wrote inviting Prime Minister Ardern to join me in visiting veterinary clinics around the country, I mentioned that – especially in emergency & critical care hospitals – the veterinary team there never knew what was going to walk – or crawl – through their doors each night:  hit-by-car casualties, gunshot wounds, stabbings and poisonings – yes! Even in New Zealand – imagine how hard this must be emotionally!

It’s not a job that everyone can do!

Compassion fatigue in veterinary medicine is a result of veterinary clinicians – doctors and nurses – taking on the emotional burden of the sad and bad things that happen to their animal patients.

It’s a form of mental trauma, resulting in the dulling of the ability to feel and care for others in their lives.

Compassion fatigue can result in feelings of sadness and isolation, making those in the veterinary profession at an increased risk of suicide.   It’s a problem that this industry is just now coming to better acknowledge.

Suicide – it’s one of those oh-so-scary topics to talk about … almost a white elephant in the room … almost taboo.

But unless the light is shined on this darkness, it will be forever dark.

Remember at the beginning of this episode I said you could stop listening … this is that point.

If you are going to stop here I ask that you consider supporting the parliamentary petition I’ve started to help get vets classified as critical workers in New Zealand to help get more vets into NZ.  Please visit GetVets.NZ at FB to sign the petition.  All signatures are confidential.

I’m not going to dwell too heavily on the dark side of being a veterinary professional – I don’t know enough about it from a veterinary perspective – does anyone yet? – but because suicide has touched me personally, I feel like I’ve walked a few of those kms I started off talking about…

While still at school, I experienced first-hand being blackmailed by someone threatening suicide; as an adult my father attempted suicide and then more recently, the relative of a very special friend of mine was caught just in time… before it was too late …

I have also stepped back before I got too close to the edge myself…

Dr Will McCauley’s story

Back in September 2019, Time magazine shared Dr Will McCauley’s story:

Dr. Will McCauley had just finished his shift at a small Dallas animal clinic when he went home, fed his pet pot-bellied pig and then held a loaded handgun to his head.

The 33-year-old veterinarian was wracked with student debt and worn down by the daily demands at work, which included euthanising dogs and cats and being vilified by pet owners for not meeting their expectations.

“I was tired in this miserable state of mind,” he says. “It just drained me so much.”

For reasons he attributes to either fear or hope, McCauley didn’t kill himself that summer day in 2016, and he quit his job later that week and stopped practicing.

“I knew I had to make a change,” McCauley says. “I was dead on the inside.”

New Zealand’s sadness…

Closer to home, back in April 2019, RNZ reporter Katy Doyle wrote an article entitled “Stressed vets say their profession is desperate for more support”

New Zealand’s veterinarians she said, are struggling with burnout, stress and suicide.

According to that article, Doyle reported the profession was already dealing with staffing shortages, and if things continued, it was only going to get worse.

They are calling for more support to help fix the cracks that staff have fallen through, she said.

Official figures show that in the 10 years to 2017, at least four veterinarians took their own lives – while another four cases are still active and suspected suicides.

In 2020 I know of at least two suicides – one veterinarian and one veterinary nurse.

No words can describe such pain and anguish!

You don’t have to speak to many in the veterinary sector before you find someone who’s encountered suicide first-hand – either in their clinic or someone from their year at varsity or polytech.

One vet told me she’s experienced the suicide deaths of five colleagues and another has experienced two deaths.

It’s not about numbers it’s about lives and even one is too many!

A 2008 study into veterinary suicide in Australia found vets were almost four times more likely to commit suicide than the average adult population.

Four times!

“Veterinary profession needs more support” – Dr Helen Jones

Sadly, author Dr Helen Margaret Jones said that was a trend that appeared to be the norm worldwide.

“Other countries are finding the same sort of figures. So you’ve got UK, you’ve got the US and both those countries they’ve put in preventive measures.

“They run courses that address some of the mental health issues that they might be experiencing.”

While no study has been done in New Zealand, a 2010 newsletter from the Veterinary Council of New Zealand said the same risk factors existed in New Zealand.

The mental stress of killing animals could be a contributing factor in high suicide rates.  Remember – the veterinary profession are there because they love animals – imagine how hard killing perfectly healthy animals can be on someone’s mental health.

In addition – and I mentioned this earlier – emotional blackmail from pet owners – who sometimes try to avoid paying bills, or can’t afford to pay a bill – also takes its toll.

In 2018, the New Zealand Veterinary Association conducted a survey of its members, asking about the profession’s biggest challenges.

The top answers were burnout, staff recruitment and retention, mental well-being and income.

If you listened to episode 6 of Paws Claws & Wet Noses, you’ll understand I’m doing my absolute damndest to help with the staffing shortage by petitioning parliament to classify veterinarians as critical workers so we can let more through borders.

I believe that making veterinarians critical workers is the biggest and most meaningful & immediate change that can be made today – it will allow veterinarians in who earn less than the threshold of $106,080 currently imposed.

But, back to this podcast – walking the kms in your veterinary professionals’ shoes …

As trite and cliched as it sounds, I’m asking you to be kind to your animals’ health care workers.

Because they’re hurting – more than they’ll ever let on.

But just in case you don’t believe me – I’d like to quote Dr Mike from Carlyle Veterinary Clinic in Napier.

Back in early October, he shared what it was like putting a much-loved family pet to sleep was like on his clinic’s FB page – he entitled it “how we see ethuansasia”:

Facebook Post – Carlyle Vet Clinic – 06/10/2020

How we see euthanasia…..

So, you bring me this puppy – she kisses my face, devours the cookies I offer, and our friendship starts.

Several visits later, he starts to learn where all the cookie jars are in the clinic, and that man, well he’s okay….

Fast forward many visits later, now I am in love with your dog and your whole family because, well, you are just really really good people and I have not only watched that pup turn into a really sweet family member, but I got to watch the kids grow every year and be a very small part of your journey.

Remember that time she ate your teenage daughter’s thong underwear?  😝😝😝 yeah we all had a good laugh over that once surgery was done and she was recovered. Your daughter probably never forgave me for bagging that up and showing the whole fam-jam when they came to pick her up from the clinic.

So many adventures, so little time…..

And here we are, fifteen or so odd years later, having to say goodbye.

He’s got heart disease and I can’t fix it anymore.

She’s got cancer and there is no cure.

He has arthritis and the meds just aren’t working.

I want her to live forever for you.

I want that so badly it hurts.

I feel like I have failed him and you when I have run out of options to keep them, and you, comfortable and happy.

So now it’s time, and I am supposed to be professional.

Objective.

I am the doctor. Calm. Cool. Collected. Always under control.

Yeah right!

I have known you and her for a third of my life, and most of my professional career.

But I keep it together.

My superhuman amazing technicians have put the catheter in.

My support staff from reception to nurses have done all the paperwork.

Trust me they may not show it, but their hearts are breaking for you.

They have been there.

They know.

And they know you and care about you too.

And I have the drugs there with me for the last time.

In the same room that was always full of treats for him.

I take a deep yoga breath and come into the room.

Gotta stay strong now…….

She’s giving me that sweet look she always does, the one that is followed by puppy kisses and a glance at the cookie jar.

But she is too weak now.

She is ready. You are not. I am not.

But this has to happen because we love her too much to let her suffer.

She would keep going as long as we asked her to.

But we can’t ask her to anymore.

It’s not fair to her.

I wish our human hearts could be so giving all the time.

I wish I could be the person my dog thinks I am.

I wish I wish i wish I could find a way for them to live forever.

But I don’t have those magical powers.

I am just a vet.

So we kiss him back, not much left of his body that still works, but that old tail wags, just enough that I lose my shit on the inside but I try not to cry.

Gotta stay strong.

Her body relaxes, she is in your arms and you’re sobbing.

Another family has lost one of its most cherished members.

I put my stethoscope to her heart to make sure it’s stopped but she is held so tight to your chest that maybe that is your heart I hear pounding or maybe it’s mine and all the blood rushing through my ears as I try so so so hard not to turn into a blubbering mess.

Confirmed, he has passed.

You lay him gently on the table and we hug tightly as you go to leave.

The door closes behind you and I don’t know if you hear this, but I sob and whisper my final goodbye into your pet’s ear.

She is gone, he will be missed, and you have to face what I know will be one of the hardest parts of today.

Entering that house and they are not there to greet you.

Please know that I know how you feel.

As you leave the clinic, I just wish with every fibre of my being that you never had to face that.

I wish they could live forever.

And please know, I am so grateful that I was a small part of your journey.

Love always,   Dr Mike

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Emergency help numbers

Lifeline: 0800 543 354 or text HELP to 4357

Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO (24/7). This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.

Depression Helpline: 0800 111 757 (24/7) or text 4202

Samaritans: 0800 726 666 (24/7)

Youthline: 0800 376 633 (24/7) or free text 234 (8am-12am), or email talk@youthline.co.nz

What’s Up: online chat (3pm-10pm) or 0800 WHATSUP / 0800 9428 787 helpline (12pm-10pm weekdays, 3pm-11pm weekends)

Rural Support Trust Helpline: 0800 787 254

Healthline: 0800 611 116

Rainbow Youth: (09) 376 4155