From The Blog

Ahhh…relaxation!

What is it about being near the ocean that is so peaceful and so healing? Just watching the seemingly infinite expanse of water wash ashore in wave...

What is it about being near the ocean that is so peaceful and so healing? Just watching the seemingly infinite expanse of water wash ashore in wave after wave drains the tension from my mind and body and fills me with positive energy. There is something magical in the cosmic alchemy of sun, wind, sand and salt water that has a great capacity for healing. Just being near it carries the weight of the world far from my mind as effortlessly as the clouds that slip by overhead in the breeze. Soaking it all in leaves me feeling content, blessed and rejuvenated!

My wife, Leigh, and I extracted ourselves from work for two days earlier this week. My wonderful mother-in-law agreed to put aside all of her obligations for a few days so that she could come up and care for our boys, and we went to sit by the seashore. And, sit we did! We basked in the sun. We absorbed the beauty of the salt marsh and savored the healing power of the ocean. We held hands as we walked along the beach like a couple of school kids without a care in the world. We talked about our lives – past, present and future. We sat next to one another as we read and we napped in the sun. It was a marvelous sabbatical from the strain of our busy daily schedules that tend to drain our energy and constantly pull us in different directions. It was a welcome opportunity to recharge and recuperate!

My wife is a youth minister, and I think all of us in the care giving professions experience a special kind of exhaustion in our lives and in our work. It creeps up on us while we are distracted with one crisis or another and engulfs us slowly like fog. We love what we do and we devote ourselves to our calling day after day, often sacrificing hobbies or personal time with family and friends in order to meet the needs of those entrusted to our care. We don’t even realize it is happening. We just start to feel dispassionate and tired. It’s not until we step out of our routine that the fog begins to lift and we realize how depleted we have become.

Veterinarians seem to be especially vulnerable to this form of sacrificial burn-out. A study published last March in the British Veterinary Record identified a disturbing trend among members of our profession. Their research indicates that the suicide rate for veterinarians in Britain is four times higher than the general population and twice as high as that of physicians. When I originally read the report of that study, it just made my heart hurt to think that so many members of our profession would feel so desperate and lost, presumably because of occupation-related stress, that they would consider taking their own life. It caused me to wonder what it is about our vocation that is different for us than for other care providers. There is no doubt that, like any other medical field, we face difficult, life-or-death, stressful situations almost every day. However, I do believe we contend with issues that are unique to the veterinary field that may explain why we would be at greater risk.

I think as a group, our natural skill set, our driven nature and the reality of our role within society put us at risk of attempting to live up to impossible expectations. Most veterinarians I know are genuinely caring, altruistic, thoughtful people who are exceptionally bright and insightful. In choosing our profession each of us consciously gave up considerable financial rewards in other fields in order to care for God’s creatures that can’t speak for themselves. Everyday we struggle to tease the secret sources of disease, pain and dysfunction from exquisitely complex and cryptic organisms that are incapable of providing us with a first hand account of how they feel or where they hurt. We employ all of our senses to observe their miraculous biological machinery in hopes of discovering the source of disease that robs them of their vitality and quality of life. But, even with all of the diagnostic tools available to us in general practice, biological organisms begrudgingly divulge their secrets and we see but a glimpse of the total picture. We peer into an immense biological factory through a peep-hole and do the best we can to draw accurate conclusions about what is functioning well and what is not.

Meanwhile, our concerned clients – the animal owners – are anxiously observing our efforts and trying to digest the volumes of information we heap upon them. We do our best to explain how the physical findings and laboratory results fit together. We walk them through our mental algorithm as we rule-in or rule-out potential diagnoses. We endure the glassy eyed stares and the furrowed brows – tell tale signs that worry has given way to confusion. We do our best to explain what our findings seem to indicate about the case without jumping to conclusions or overstating – always careful to mention the alternate possibilities that may be hard to prove. All the while we strain credulity in our efforts to come across as calm, confident and reassuring.

Then, as if that is not enough to deal with, inevitably around this point in a complicated case the issue of money has to be addressed. I sincerely believe this contributes more to our mental anguish than any other single case-related factor. The reality of our practice model is that we have to function as a business in order to provide care. As compassionate and caring as we may be, I, unfortunately, have to remind my staff repeatedly that if we are going to be of any use to anybody we’ve got to keep the doors open. We have no government assistance to lean on. We have a limited third party payment system that few clients take advantage of. Most of the medication, supplies and technology that we use in our practice costs the same, if not more, than it does on the human side. Yet, our average invoice is considerably less.

Entering into this discussion about money is difficult. Clients feel guilty for putting a price tag on the well being of their beloved pet as they try to decide which diagnostic and therapeutic plan makes the most sense for them in light of their personal finances and their pet’s condition. It requires great creativity and flexibility on the part of the veterinarian to develop a alternative plan for a client to consider when we recognize that the most desirable approach to a case may be priced out of reach. I often tell my clients they are paying for degrees of certainty and the likely-hood of a positive outcome. The outcome with a less expensive approach may eventually be the same, but the degree of certainty about the diagnosis is never as high and the positive outcome is less likely. As the advisors in the case and the gate keepers for the medicines and technology within our reach, we often feel some degree of guilt for having to withhold a useful test or treatment because of our clients inability to pay.

The other single most taxing factor we contend with in patient care is the fact that so often the veterinarian on a case bears the full weight of an uncertain outcome on his or her shoulders alone. For our counterparts in human medicine, they often have the benefit of sharing that burden. When a tough case is admitted to the hospital and there is uncertainty as to whether a patient will survive, legions of specialists swarm to the bedside and begin to divide up the master problem list. Kidney disease becomes the responsibility of the nephrologists, bone disease the orthopedist, brain disease the neurologist and all the mysteries of the case that are left over fall into the hands of the internists.

In our practice, when I am faced with a similar situation, I am elated when an owner has thousands of dollars of discretionary funds with which to pursue specialty care. I encourage them to accept a referral that means they will have access to the most advanced diagnostics and treatments for their pet. However, that doesn’t happen very often, which leaves me in a difficult situation. I offer to do what I can, with what resources I have, within the bounds of what the owner can afford, and I hope. And, I worry. And, I carry that burden home with me at night.

If our patients begin to show signs improvement it’s like choirs of angels singing overhead! Our spirits soar! Our clients praise our acumen and hug us like long lost children! However, when our patients don’t improve…when days go by and they refuse to eat, or the lab values continue to deteriorate, or the diarrhea just won’t stop, we feel the burden of their demise press in on us from all sides. It’s crushing, and although we recover to fight another day, it takes it’s toll.

In essence, we are a held to a high standard of care and expected to achieve desirable outcomes under very difficult circumstances within a society whose adoration for their pets continues to increase as their experiences with death and loss continue to decrease. We as a profession need to be mindful of this.

If you are reading this and you are not a veterinarian you may be wondering why I’m devoting so much time and energy to this topic. I guess it just happens to be on my mind as I sit here by the seashore with my wife, whom I adore, contemplating my life’s work and how I might better serve my clients and patients. To put it in writing helps me to organize my thoughts and thoroughly explore the issue. I’m also inclined to share this with you because I see understanding and trust as symbiotic forces within the veterinarian/client/patient relationship. The better we understand one another, the more we are able to trust and trust is what truly potentiates quality care.

If you are a veterinarian reading this, I hope it serves as a reminder that before we can care for anyone else we must care for ourselves. We want our clients to see us as somehow super-human, but we cannot live up to those expectations for long. In the words of one of my favorite authors, Rob Bell, if we are to truly thrive as human beings and as professionals we must kill “super-vet” before “super-vet” kills us. Take time for yourself. Enlist the resources of the veterinary community around you for support. Attend good continuing education seminars. Unplug from the practice machine from time to time and be in community with the people you love. Sit by the sea or on a mountain side or by trout stream or wherever you are inspired by the raw, unspoiled beauty of creation and let the cosmic power of nature seep back into your soul. Rediscover an appreciation for the complexity, intricacy and finite nature of life. And, emerge ready to rededicate yourself to your mission of caring for the speechless members of God’s animal kingdom.


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