Editor’s note: While research remains incomplete on the question of suicide risk among American veterinarians, anecdote suggests some practitioners’ mental health is in peril in the United States, where the economic downturn, educational indebtedness, convenience euthanasia, dumped and neglected animals as well as general work and life pressures weigh heavily on many DVMs.
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Case in point: When the VIN News Service put out a call for stories of suicidal thoughts and attempts among members of the Veterinary Information Network — an online community for the profession — reporters were inundated by responses. Following are accounts by three practitioners who have had personal experience with suicidal tendencies, either their own or a colleague’s. Their names have been changed to protect their privacy.
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Dr. Alice Smith first had signs of depression at age 14. Five years ago, when she was in her 20s, she attempted suicide twice in one year. She was working in a small practice during the first attempt. She was at a 24/7 emergency hospital during the second attempt, and back to work two months after that. Today, she works in industry for a number of reasons, and takes a few ER shifts to keep her practice skills sharp. Her employer knows about her mental health background and is understanding of it, although the employer did request that she use a pseudonym for this article.
Being a veterinarian did not drive Smith’s desire to die, but it did influence thoughts about how to kill herself.
“I originally wanted to use euthanasia solution but didn’t know if I could hit my own vein and I couldn’t bring myself to steal from my employer,” she said, “so I went to the drugstore and bought two vials of insulin.” Some types of insulin do not require a prescription, and syringes can be purchased in some pharmacies simply with a signature.
In the first attempt, Smith’s roommate saw the vials in the trash and called 911. Smith then moved home to be with her parents. The second time, her mother found her unresponsive. Smith stopped breathing in the ambulance. Her blood sugar was so low it was unreadable.
In the emergency room, she was put on a ventilator.
“The first couple of days, my folks were told I wasn’t going to survive,” Smith recounted. “Then they were told that whatever woke up was not going to be me anymore.”
Fortunately, the prognosis was wrong. Smith isn’t unscathed — she has mild, permanent hypoxic brain damage resulting in hand tremors and hearing dysfunction — but after the second incident, she was successful in finding appropriate medication for her lifelong depression. Today, she works full time and has a 3-year-old son.
“Work has always been a grounding thing for me,” Smith said. “It’s never been a primary component (of) or contributed to my depression; it’s always been a brain pathology. I derived a great deal from work and if I didn’t love my work so much I would have tried sooner the first time.”
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Barely a decade into her career as a veterinarian, something went very wrong with Dr. Mabel Brown’s health. She couldn’t eat or sleep. She had all the clinical signs of chronic fatigue syndrome and fibromyalgia, but tests didn’t bear out those diagnoses. She kept searching for medical answers.
“During the last two years of practice, something changed in me. I know vet med is a stressful job, but I wasn't so sure stress was the cause of all my physical and mental issues,” Brown said. “I had a black brain fog and multiple physical ailments. By the time I left practice, I knew what the terminal stage of burnout looked and felt like.”
Brown felt she could no longer go on. She made plans end her life. Then fate intervened.
“When I was about to exit the planet and going to implement my plan in a few days, another suicide upset our hospital,” Brown recounted, “and it made me decide that I couldn’t do that to my family. I had to take care of myself and figure out what was wrong.”
It took years, resources and many doctors but at last Brown found the answer: Bartonellosis.
Best known for causing the malady known as cat scratch fever or cat scratch disease, Bartonella bacteria increasingly are recognized as stealthy pathogens that can cause a range of illnesses, from mild, self-limiting conditions to serious chronic disability. The germ in its myriad strains is transmitted to mammals by arthropods including fleas, lice and possibly ticks.
For veterinarians, Bartonellosis is an occupational hazard. And, Brown learned, suicide is a risk in people infected with Bartonella.
Her diagnosis came through a brain SPECT (single photon emission computed tomography) scan. “The neuropsychiatrist said ‘Your limbic system is on fire. It’s on fire all the time.’ It was then I understood why everything seemed so crazy,” Brown said. “Bartonella can make the coolest cucumber into an anxiety-ridden depressed person with a black fog in their head.”
The finding led Brown to doctors who finally were able to help her — practitioners who had been treating Bartonellosis for years and understood the neuropsychiatric effects. Bartonella is associated with fatigue, agitation, anxiety, panic attacks, irritability, impulsivity, aggression, poor sleep and depression.
“When people tell you vet med’s a stressful job and you have to relax, that only goes so far if you're physically ill,” Brown said.
She retired from her veterinary career at age 38, by which point she knew of 13 veterinarians who had committed suicide. Brown works today in an unrelated field.
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When a clinic owner is suicidal, every person in the clinic inevitably is affected. Dr. Carmine Jones’s experience exemplifies how.
Formerly a clinic owner himself, Jones took an associate position after immigrating to another country. The first 10 months at his new job were fine. Then the owner’s behavior changed. “He walked around with a funnel cloud over his head, and he got angry when asked questions,” Jones recalled.
One day, a technician reported to Jones a significant gap in the opiate log. Jones checked the order history and discovered the problem was far worse than the technician realized: The owner had requested some deliveries to arrive on Saturdays, none of which were logged.
Jones suspects the owner also abused steroids and that some of his behavior could be attributed to “steroid rage.” “For a while, he looked like Arnold (Schwarzenegger) in his ‘Conan the Barbarian’ days,” Jones said.
Jones called his local veterinary board for help. They had no experience with such situations and no suggestions. Jones eventually managed to persuade the licensing body to become involved. The authorities worked out an agreement with the owner by which he could continue working, but only under supervision by his employees.
At that point, Jones confronted the owner with evidence of drug abuse. Only the threat of losing his license forced the owner to cooperate, and consequently he underwent regular drug testing — although in retrospect, Jones believes all the owner learned was how to fool the drug-testing system. Meanwhile, the work atmosphere didn’t improve, either.
Jones and the other associates asked staff to keep an eye on the owner, which meant that all employees essentially were spying on the man who signed their paychecks. “The work environment was poisonous,” Jones said.
The technician who brought the opiate log to Jones’s attention was fired. Most of the other staff looked for other employment.
That wasn’t all. The owner, who was married to a veterinarian in a different clinic, began an affair with his hospital manager, an alcoholic who also was married. Jones suspects the owner was providing drugs to his mistress.
Jones knew he had to watch out for the welfare of patients. Under his careful eye, no major accidents involving patients occurred. But there were uneasy moments.
“I once walked into the clinic and could hear a dog whimpering so I went into the exam room,” Jones remembered. “He was there alone with a puppy on the table. The puppy was not happy, the ears and tail were down. He was standing there prodding the puppy with a pen and giggling uncontrollably.
“I grabbed him by the lab coat, slammed him into the wall and told him to lay off. I took the puppy away and made sure he never touched it again.”
The owner openly talked about suicide. He asked Jones how he would feel coming to work to find that someone had hanged himself. The owner didn’t try that, but he did run his car into a rock face on a clear day with no traffic – twice. Both times he walked away with a few scratches.
Jones tried to respond with compassion. “At first I tried to help him because everyone makes mistakes,” he said, but “all he did was try to make my life as hard as possible. In one case, my patient had died, and the (pet) owner was upset.” The clinic owner offered to talk to the client, ostensibly to smooth things out.
“What he actually did was talk the client into filing a complaint about me with the medical board,” Jones said. “The board found I was not at fault but the procedures were quite stressful.” To this day, he wonders if the owner meddled with the patient’s treatment to get back at Jones for interfering.
Jones worked at the clinic for 3-1/2 years. He stayed because he felt he should wait until the owner was back on track. When he finally left to open his own clinic, he had nightmares about the experience for a year.
At least one good thing came of the hellish episode, though, Jones said: Now there is a substance abuse program for veterinarians in his area, and a veterinarian’s license can be suspended to safeguard public interest.
As for the role of veterinary work in the difficult affair, Jones believes the occupation is not to blame. “Our line of work is fairly stressful but I don’t think you can blame the job per se,” he said.
Strategies for prevention
Rather than veterinary work being the cause of suicide, Dr. Michelle Gaspar, a Chicago veterinarian training to become a counselor, believes that work is a reasonable way to keep a person grounded in the present and stave off negative attitudes.
To fend off compassion fatigue, Gaspar suggests cultivating an ability to tap into some type of transcendency or spirituality. It need not necessarily be religion; just something larger than oneself.
“Nature, music, animals, exercise or a hobby — you don’t need a faith-based response, you just need something that takes you outside of yourself,” Gaspar said. “With suicide, the world gets smaller and smaller and smaller and you’re isolated and overwhelmed. You don’t reach out.”
Brown, who was driven to the point of suicide by Bartonella, urges all practicing veterinarians — particularly women planning to become pregnant — to have a thorough annual examination, much like what they recommend for their own patients but tailored to their occupational exposure.
“If I were still a practicing vet,” Brown said, “I’d have a full physical every year and be tested for zoonoses, get a CBC, blood chemistry, thyroid, Bartonella, Babesia, leptospirosis, toxoplasmosis, Lyme and comprehensive fecal parasite check. Deworm routinely. We work so hard for our patients and we forget about ourselves. We think if we exercise and spend time with friends that we have balance, but we don’t think it’s necessary to have a physical ourselves.”
What do you do if someone you know is feeling suicidal? What is said to those who are contemplating suicide is critical. One common response — as evidenced by comments on a message board of the Veterinary Information Network — is to tell the suicidal person to think of his or her family or say that suicide is selfish. However, experts say that is not advisable.
The American Foundation for Suicide Prevention on its website recommends instead letting the person “know you care, that he/she is not alone, that suicidal feelings are temporary and that depression can be treated.”
Smith, the veterinarian who twice attempted suicide by overdosing on insulin, noted that comments about selfishness can backfire:
“If someone said that to me while I was suicidal, the effect would have been, ‘Oh my God you’re right, that’s how awful a person I am, I need to hurry and commit suicide so I don’t have a worse impact on the people around me than I already do.’
“I can only speak for myself,” Smith continued. “Suicide had nothing to do with anybody else. Other people may have helped keep me alive longer, but when you become suicidal, when life hurts that much and the future is that horrifying to contemplate, you cannot bring yourself to live another 20 or 50 years just so other people won’t be sad. You can try for a while — I did — and you can rack your brain for all the ways to make it as easy on other people as you can, but you can’t just decide you’re not going to be suicidal for everyone’s else sake. If you could, you’d decide not to be suicidal for your own sake.”
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VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email firstname.lastname@example.org.