Death and Grief are occupational hazards for vets but for some it becomes so hard to handle that they leave the profession….

 by

Sonia Vasquez

Many years ago veterinarian Sally Walshaw euthanased the family cat because he had mesothelioma of the chest wall.    It’s an experience she will never forget.   

 “A few days later our young son said to me in an accusing tone, ‘Kitty died.    You are a vet and Kitty died’,” Dr Walshaw says.

Still grieving herself, Dr Walshaw was surprised at his words.    “I reminded him that we are veterinarians not God,” she says.

Intellectually, at least, most veterinarians would agree with that sentiment.    Emotionally, it’s a different story.     Veterinarians may take on the responsibility for loss, regardless of wether that loss was avoidable.

For many Veterinarians, the truth is that grief over the death of an animal can be compounded by doubt in one’s ability and feelings of helplessness in the face of death.

Frank Gaschk, a veterinarian and cartoonist, describes how he felt when he put his own cat to sleep.

“The god-like state of being a lethobarb-wielding veterinarian – dissolved in tears (I was) unable to hold back.    I felt like I should change professions because the sadness of euthanasia can be so depressing and having to give up so much energy to remain positive and strong, soothing the ones left behind,” he says.

Veterinary practice has been described as an emotional coalface where veterinarians and nursing staff often work under pressure for clients who can be highly emotional.    For example, Euthanasia is an event that is highly emotionally charged, yet a veterinarian may be called to perform euthanasia several times a day, in between tending to other patients, performing surgery and coping with emergencies.

When the importance of the human-animal bond became increasingly acknowledged by the veterinary profession in the 1980’s, Dr Walshaw became increasingly interested in the emotions of those who work with animals.    She was particularly interested in human emotions about animal death in the laboratory, but expanded her interests when she realised a need for more information about grief in general veterinary practice.

“After giving a program about animal death and human emotion to shelter personnel, one of the employees said to me, ‘At least you lab animals die for a purpose.    We have to kill very nice dogs and cats just because of human carelessness in our throw-away society’,” Dr. Walshaw says.

She has produced several publications on the subject of grief, and is invited to speak at conferences.

“Animal shelter employees and veterinarians must deal with especially heart-wrenching situations” she says.

Because they deal with patients that have a life span much shorter than their own, grief will always be an occupational hazard for veterinarians.    But it doesn’t stop at the loss of their own pets, or even the loss of patients.

Dr. Walshaw argues that veterinarians need to acknowledge the strong emotions they feel when faced with a distraught client.

“When I graduated from vet school in 1975 we were told that it would be unprofessional to show emotions in front of the owner of an animal.    I found that it was impossible to be emotionless when standing with an elderly man weeping over his dying dog,” she says.

Yet many veterinarians repress their feelings because of the belief that it would be unprofessional to show emotion, or to be perceived by the client or other staff as showing emotion.

Constant exposure in situations that may lead to grief, coupled with a high work load, have been implicated in the fact that veterinarians have a higher proportional mortality rate due to suicide than many other professions.

“Medical doctors and nurses who work in oncology and other terminal illnesses face the same situation.    It is important for veterinarians to understand the grief process, so they can help themselves and their employees as they deal with grief,” Dr Walshaw says.

Part of that understanding is realising that grief is not something you mechanically ‘get over’.    The loss of patients, the loss of our own pets and the feelings of staff and clients may all necessitate some kind of grieving process, although the nature of this varies.

“If you have experienced a significant loss, you are changed forever.     Hopefully, you will learn from grief and you will be strengthened in empathy, openness, wisdom, joy, commitment and energy,” Dr. Walshaw says.

Of course, it doesn’t usually happen this way.    More often than not, the experience of loss can leave veterinarians feeling like they’ve been suddenly shot out of a cannon.    Dr. Walshaw agrees wholeheartedly.

The key is to give yourself room to feel like that.    It might sound self indulgent but if you don’t grieve, things can get a whole lot worse.

Delayed feelings of grief do not automatically dissipate, and the desire to ‘get on with it’ can lead to complicated grief, which may manifest itself in a variety of ways including burn out and depression.

Veterinarians who feel they are at fault when an animal dies may respond by working harder and longer.    This can rapidly lead to physical and emotional exhaustion and burnout.

“You have top be kind to yourself.    That includes taking time to reflect, rest, relax, walk and cry if want to.    If you feel sad, it means you have a good, kind heart and that is the most important attribute for your family, friends, clients and the animals,” Dr Walshaw says.    She warns against treating time out as a luxury, arguing that if veterinarians don’t address personal stress, they can easily fall into compassion fatigue.

Compassion fatigue

Losing a pet is a distressing experience at the best of times, but for the veterinarian it can be a situation that is played out on a daily basis.

According to Tracy Zaparanick, a clinical social worker at the University of Tennessee in the US, veterinarians, veterinary nurses and shelter staff can suffer from a syndrome known as compassion fatigue.

Ms Zaparanick is currently compiling a series of studies to determine the incidence of compassion fatigue in US veterinarians.

“Compassion fatigue results from the combined effects of primary traumatic stress, secondary traumatic stress and burnout,” she says.

Primary traumatic stress arises from an actual or perceived actual threat to oneself, while secondary traumatic stress arises from witnessing such a threat, or experiencing it second hand (for example by hearing about it).

“A common theme among animal car providers is that they will imagine what caused the injuries of the animal that sits in front of them.    If the alarming vision is accompanied by fear, hopelessness or horror, they have experienced secondary traumatic stress,” Ms Zaparanick says.

Burnout occurs when demands or perceived demands on an individual outweigh perceived resources – “when people arrive at work needing to be refuelled only to find work demanding more energy”.

Common symptoms of compassion fatigue include disturbances in sleep, decline in work performance, experiencing sudden, uninvited thoughts, diminished desire for intimacy, loss of confidence and self motivation or substance abuse.

The ultimate consequence is that a person suffering from compassion fatigue may opt out of veterinary practice altogether.

Ms Zaparanick says it is common for veterinarians to drop out of private practice and choose a career that requires as little interaction with the public as possible.   These, she says, are wounded caregivers.

“I was talking to a veterinarian who described to me her last few weeks at work.    Several of her long-term patients had died and as she tried to console the owners and her staff, she was really struggling with maintaining herself,” she says.

Unfortunately, the profession lost a very competent, very caring veterinarian.

“Many consider these symptoms pathological, indicating something inherently wrong with the person.    I have found that they are usually an alert system,” she says.

The solution, she argues, is self care.    She counsels veterinarians not to feel guilty or underestimate the importance of taking time out.

“A great analogy is a parallel drawn from the necessity to care for oneself and the emergency instructions on aeroplanes.    Whose faces are we directed to place the first air mask on?    Our own.   Why?   So we are better able to assist others,” she says.

It sounds simple but many veterinarians place great expectations on themselves and often allow work and home life to become inseparable.

Ms Zaparanick argues that it is crucial to prioritise relationships with others, because it is through others that “we find hope, meaning and relief from our work”.

A healthy social life is extremely important, as is regular talking to trusted colleagues or friends about traumatic workplace experiences.

While some veterinarians argue that they need a level of emotional involvement in order to do their job properly, it is important to recognise that being fully present to others requires a professional to be in an energised state.

In order to maintain that energised state, we need to enjoy time with our loved ones, and time to ourselves.

The benefits of physical activity cannot be under-stated.    Many practitioners who work full-time do not eat or exercise properly, often skipping meals during rushed breaks or relying on junk food to get them through the day.    These factors can exacerbate burnout and depression.

Some kind of aerobic activity is essential,” Ms Zaparanick says.

Veterinarians need to recognise that colleagues are also vulnerable to the effects of compassion fatigue, and may have difficulty coping.

“Managing traumatic experiences, real or perceived, is not that simple.     Those threatening uninvited thoughts and feelings hijack the mind and play havoc on the body’s functioning.     Understanding how trauma affects our co-workers can provide us with some choices about how we might support our wounded colleagues.” She says.

 More Information

• A confidential, 24 hour telephone service is available to veterinarians and veterinary students through Doctors Health and Advisory Service, phone (02) 9437 6552.    Detailed information is available at www.doctorshealth.org.au

• Walshaw SO. Consoling bereaved clients.  Compendium on Continuing Education for the Animal Health Technician 1981; 2(6): 310-316

• Walshaw SO. Animal death and human emotion in the laboratory.  Lab Animal 1994; 23(6): 24-29

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This article is reproduced with the kind permission of the Veterinarian Magazine as is taken from their October 2003 issue.    Copyright remains with them and cannot be reproduced without written consent.    We also offer our thanks to the author.

Further information can be found at www.theveterinarian.com.au