Is Being a Veterinarian Stressful?

The debt. I owe $214,000 in student loans. I make $128,000 a year. My monthly payment is $1,980. I did the math on the back of a receipt at a bar with my friend Megan, who is a dental hygienist. She makes $82,000 a year with zero student debt and a two-year degree. She bought a house last spring. I am 28 years old with a doctorate and I cannot get approved for a mortgage because my debt-to-income ratio is disqualifying. Megan and I sat there with a pen and a crumpled receipt and she looked at me and said, "Wait, you owe more than my house cost?" Yes. I owe more than her house cost.

The clinical work is fine. I like the medicine. I like running bloodwork on the IDEXX Catalyst analyzer and piecing together what's wrong with a sick cat. I like the puzzle of it. Dr. Patel, who supervises me, she's been practicing for 22 years and she told me during my first week, "The medicine is the easy part. The money is what breaks people." I thought she was being dramatic. She was not being dramatic.

My mom Christine calls me every Sunday. She's proud of me. She tells her friends her daughter is a doctor. And she is not wrong. I am a doctor. But she doesn't know that I cried in my car last month because I got a letter saying my loan servicer is switching to a new platform and my autopay didn't transfer and I missed a payment. One missed payment. It felt like the floor opened up. I called Megan from the parking lot and she talked me down. The stress of this job is not the 14-hour days or the dog that bit me last Tuesday or the client who screamed at me because I wouldn't prescribe antibiotics for a viral infection. The stress is that I did everything right, got the degree, passed my boards, landed a good job, and the math still doesn't work.

The isolation and the physical danger. I cover a 90-mile radius. Cattle, horses, dogs, cats, the occasional goat that somebody's kid is raising for 4-H. Most of my farm calls I do alone. My partner Dr. Enid Shaw is semi-retired and works three days a week, so the other four days it's just me and the truck and whatever's waiting in the pasture when I get there. Last March, I was doing a rectal exam on a 1,400-pound Angus bull at the Hensler ranch. The ranch hand, Dwight, was working the squeeze chute. Bull shifted, the chute didn't hold, and he kicked me in the ribs. Cracked two of them. The sound was like stepping on a branch. I could feel the fractures move when I breathed.

I drove myself to the hospital because there was nobody else to drive me. Dwight offered but he had 40 head still waiting to be worked and it was getting dark. So I got in my truck with two cracked ribs and drove 35 minutes to the ER in Kearney. The ER nurse asked me what happened and I said, "Bull kicked me." She didn't even blink. She'd seen it before. That's the kind of thing that happens out here. It's not unusual. It's Tuesday.

My wife Bonnie teaches 4th grade. She worries. She knows every time I leave at 5 AM for a calving call that I'm going to be alone in a barn with a 1,200-pound animal that's in pain and scared. She doesn't say it anymore but I can see it. She packs my lunch and sets it by the door and there's something in the way she does it that feels like she's memorizing the routine. The portable ultrasound rides shotgun in my truck. Sometimes when I'm driving back from a call at 10 PM on a dirt road with no cell signal, I think about what would happen if I rolled the truck. Nobody would know for hours. That's the stress. Not the medicine. The being alone.

Triage. Specifically, the moral injury of triage when you don't have enough hands. Last Thursday we had six emergencies in the lobby and two vets on shift. Two dogs came in with bloat within ten minutes of each other. Bloat kills dogs in hours if you don't operate, so both of those go straight back. That left four other emergencies waiting, including a cat with a urinary blockage who'd been straining in the carrier since the owner noticed it that morning. Urinary blockage in a male cat can be fatal within 24 to 48 hours if it's not relieved. The cat waited 90 minutes because I was in surgery on the first bloat and my colleague was stabilizing the second.

The cat's owner came to the front desk after about an hour. She was crying. She told Trent, our front desk manager, that we were killing her cat. Trent absorbed it. That's what Trent does. He stands there and takes the grief and the anger and the fear from people who are watching their animals suffer in a waiting room while they hear surgery happening behind the doors. He told her we were working as fast as we could. She screamed at him. I heard it from the OR. My tech Vanessa looked at me over the surgical drape and didn't say anything. She didn't have to.

The cat survived. I unblocked him at 11:40 PM. I'd been on shift for 14 hours by then. I pulled the I-STAT blood gas and his potassium was elevated but not fatal. He was going to be okay. I called the owner and she sobbed on the phone and thanked me and I said, "I'm glad he's doing well." I didn't say, "I'm sorry it took 90 minutes." I wanted to. My roommate Philip is a software engineer. He asked me how my night was when I got home at 1 AM. I said, "Long." What I meant was, I spent the night deciding which animals were allowed to suffer longer so that other animals could live, and a woman screamed at my friend Trent because I made the right call and it still felt wrong.

The euthanasia volume. I euthanize between 8 and 12 animals a week. Not because they're sick. Not because they're aggressive. Because the shelter is full. We have capacity for 120 animals and we've been at 130 since last August. When the kennels are full and the intake keeps coming, something has to give. Every Wednesday I get a list from our shelter director, Carolyn. It's the animals who've been here the longest without an adoption inquiry. The ones nobody picked. I call it "the Wednesday list." My therapist, Dr. Huang, told me the clinical term is "moral distress." I told her I know what it's called. I just don't know how to make it stop.

I went into vet med to save animals. That's what I wrote on my application essay. That's what I believed. And four days a week I do save them. I spay and neuter, I treat upper respiratory infections, I set broken legs on dogs that came in from the street. But on Wednesdays I draw up sodium pentobarbital into syringes and I walk down the row of kennels and the dogs wag their tails at me because they think I'm there to take them for a walk. The smell of the euthanasia room is something I can't describe except to say it's antiseptic and warm and it stays in my nose for the rest of the day. Joaquin, our kennel tech, he cleans the room after. He doesn't talk to me on Wednesdays. Not because he's angry. Because he doesn't know what to say.

Dr. Huang and I have been working on separating my identity from my job function. She says I'm not the one who failed these animals. The system failed them. The people who didn't spay their dogs failed them. The landlords who don't allow pets failed them. I understand that intellectually. But I'm the one holding the syringe. I'm the last person these animals see. That's the weight I carry out of the building every Wednesday at 4 PM.

The owners who can't stop. I had a couple, Wayne and Denise, who brought in their golden retriever with osteosarcoma. I staged the cancer, ran the diagnostics, sat them down and gave them the numbers. With aggressive treatment, doxorubicin-based chemotherapy and amputation, the dog had maybe a 6% chance of making it two years. Six percent. I told them what that meant. I told them what the treatment would look like. They said they wanted to try everything. I understand that impulse. I do. But "everything" cost $47,000 over eight months and the dog spent the last three of those months nauseous, losing weight, and limping on three legs through a protocol that was almost certainly not going to change the outcome.

After month four I sat down with Wayne and Denise again. I pulled up the VOIS treatment records and showed them the trend. Quality of life was declining. The dog was not responding the way we'd hoped. I told them, as gently and as directly as I could, that it might be time to talk about comfort care. Wayne looked at the floor. Denise said, "We can't give up on him." My colleague Dr. Okonkwo, who handles radiation oncology, she'd had the same conversation with them independently. They couldn't hear it from either of us.

The dog died at home four months later. Thin, nauseous, tired. Wayne and Denise emailed me the next day asking if there was something more they should have done. I stared at that email for 20 minutes. I didn't know how to answer it. The truth is they should have done less, not more. But you can't say that to people who just lost their dog. You can't say, "You spent $47,000 extending suffering because you loved him too much to let go." My wife Priscilla used to be a vet tech. She left clinical work for pharma three years ago. She told me she left because she couldn't watch it anymore. Not the animals dying. The owners breaking. I'm starting to understand what she meant.

The knowledge isolation. I treat birds, reptiles, small mammals, the occasional primate. On any given day I might see a cockatiel with a respiratory infection, an iguana that's stopped eating, a ferret with adrenal disease, and a tortoise with shell rot. When a client brings in a sick green iguana, there is no "call the specialist." I am the specialist. There are maybe three other exotic vets within 100 miles of me. My mentor, Dr. Petra Nowak, retired two years ago from her practice in Los Angeles. When she left, her clients started driving to San Diego to see me. That's a two-hour drive for someone whose parrot is sick. That tells you how few of us there are.

The research base for exotic animal medicine is a fraction of what exists for dogs and cats. When I'm dosing a medication for a bird, I'm often working from case reports, extrapolated doses from related species, and my own clinical experience. I weigh everything on a gram scale because the margin between therapeutic and toxic in a 400-gram parrot is measured in milligrams. I run avian blood gases on the iStat and I'm interpreting values against reference ranges that were established from maybe 50 birds in a study from 2011. The evidence base is thin. I'm making clinical decisions on animals from over 200 species with less published research than a single breed of dog has generated in the last decade.

My tech Reese has been with me for six years. She's learned more exotic medicine on the job than most vet techs learn in school, because exotic medicine barely exists in the curriculum. My partner Diana is an accountant. She asks me how my day was and I say, "I tube-fed a toucan." She laughs every time. But the truth under the joke is that I tube-fed a toucan based on a nutritional protocol I adapted from a study on toucans in Brazilian zoos because there is no standard-of-care feeding protocol for toucans in a clinical setting. I made it up. Educated guess, yes. But still. The stress is being the last line of knowledge for an animal that nobody else in the building, the city, maybe the state, knows how to treat. If I'm wrong, there's no second opinion to catch it.