What Being a Veterinarian Is Actually Like

When you tell people you're a vet, what do they assume?

Puppies. Every single time. They picture me rolling around on the floor with golden retriever puppies all day. Or they say something like "oh, I wanted to be a vet when I was a kid." Which, same. I literally wanted to be a vet since I was 8. Drew pictures of myself with a stethoscope and a dog. My mom still has them. But the gap between what I pictured at 8 and what I actually do at 31 is enormous.

Yesterday I expressed 11 sets of anal glands. That's both glands on 11 different dogs. You put on gloves, you insert your finger, you squeeze, and this dark brown, fishy-smelling secretion comes out. Some dogs scream. Most just look at you with deep betrayal. The smell stays on your hands even after you wash them. Aiden says he can smell it on me from across the apartment. I've been doing this for five years and I still gag sometimes if the glands are impacted and the secretion is thick. Nobody draws a picture of that when they're 8.

So what does a normal day actually look like?

I see 22 to 26 patients a day, depending on the schedule. Appointments are booked in 20-minute slots, but that's a fiction because nothing in vet med takes 20 minutes. A wellness exam on a healthy cat takes maybe 12 minutes. A dog with vomiting and diarrhea that's been going on for three days takes 40 minutes by the time I examine the dog, run bloodwork on the Idexx analyzer, take radiographs, talk to the owner, and write up the treatment plan. So I'm always behind. By 11 AM, I'm usually running 30 minutes late. By 3 PM, it's 45 minutes. My tech Bridgette manages the flow. She's the best tech I've ever worked with. She reads animals better than most vets I know. She can tell me a dog is painful before I even touch it, just from watching how it moves in the exam room.

A typical morning: I did a dental cleaning on a 9-year-old beagle, which means I anesthetized the dog, scaled all the teeth, probed for pockets, extracted two teeth that were loose, and recovered the dog from anesthesia. That took about 90 minutes. Then I saw three wellness exams, a cat with a urinary blockage that we had to sedate and catheterize, and a dog with an ear infection for the fourth time this year. Between patients, I'm entering notes into Cornerstone, which is our practice management software, and it is not fast. Every visit needs a full SOAP note. Subjective, objective, assessment, plan. I spend more time typing than I'd like to admit.

You mentioned a Tuesday that changed things for you. What happened?

So this was about two months ago. A 4-year-old golden retriever named Biscuit came in for routine vaccines. DAPP booster and rabies. The owner, a woman named Sarah, brought her two kids, maybe 6 and 8 years old. They were excited. Biscuit was excited. Tail going, licking the kids' faces, textbook healthy golden. I started the exam. Heart sounded good. Lungs clear. Ears clean. Then I palpated the abdomen, which I do on every exam, and I felt a mass. Mid-abdomen, maybe the size of a tennis ball. Firm. Shouldn't be there.

And just like that, the appointment changed. Two minutes earlier I was doing vaccines on a healthy dog. Now I'm feeling something in this dog's belly that could be a splenic tumor, an intestinal mass, a mesenteric lymph node, a dozen things. But none of them are good. Biscuit was acting completely normal. Eating, playing, no weight loss. The owner had no idea anything was wrong. She brought the dog in for a 15-minute vaccine appointment and I'm about to tell her that her healthy-looking dog might have cancer.

I finished the exam, gave the vaccines because there was no reason not to, and then I sat down on the bench in the exam room and said, "I found something on the exam that I want to talk to you about." Sarah's face changed immediately. The kids were on the floor petting Biscuit. I recommended an abdominal ultrasound and bloodwork. She agreed. We ran the blood right there on the Idexx, and the results were mostly normal except for a mildly low platelet count, which can be associated with splenic masses. The ultrasound, which Dr. Rowan did because he's better at abdominal ultrasound than I am, confirmed a 6-centimeter mass on the spleen.

How did you handle the conversation with the owner?

Dr. Rowan is 58 and has been at this practice for 22 years. He's done this conversation hundreds of times. I've done it maybe 30. The difference shows. He sat down with Sarah after the ultrasound and explained that Biscuit had a splenic mass, that the most common types are either hemangiosarcoma, which is aggressive cancer, or a benign hematoma, and that the only way to know is to remove the spleen and send it to pathology. Surgery would be $3,500 to $4,500. If it's hemangiosarcoma, the median survival time even with chemotherapy is about 6 months. If it's benign, Biscuit lives a normal life without a spleen.

Sarah was trying to hold it together because her kids were right there. I watched her eyes fill up while she asked questions in a very calm voice. "How soon does she need surgery?" "Is she in pain right now?" "What happens if we don't do the surgery?" The kids didn't understand what was happening. They were still on the floor, and Biscuit was still wagging her tail. That's the thing about dogs. They don't know they're sick. They just keep being themselves until they can't anymore. Sarah scheduled the surgery for the following week. I don't know the pathology results yet. I think about it more than I should.

You have $178,000 in student debt. How does that shape your decisions?

It shapes everything. I'm on an income-driven repayment plan. My monthly payment is $1,180. I make about $105,000 a year, which sounds like a lot until you subtract the loan payment, rent in Portland, and the fact that I spent eight years in school to get here. Four years undergrad, four years vet school. My friends who went into tech or nursing are further ahead financially by a wide margin. My college roommate is a nurse practitioner. She did a two-year program after undergrad, makes $120,000, and has $40,000 in debt. I did four more years of school and have four times her debt for less money. The math doesn't work if you think about it purely as an investment. You have to want it for other reasons.

I wanted it since I was 8, so I don't regret it. But I'm 31, I don't own a home, and I won't be debt-free until I'm 41 at the earliest. Aiden and I talk about buying a house and the conversation always stalls at the same place, which is that my debt-to-income ratio makes lenders nervous. He's patient about it. But I can tell it's on his mind.

What's the thing about this job that you didn't expect?

How much of it is sales. I don't mean that cynically. I mean that I spend a large portion of my day recommending diagnostics and treatments and then watching owners decide whether they can afford it. I recommend bloodwork, the owner looks at the estimate and says "can we skip that?" I recommend dental X-rays, the owner says "let's just do the cleaning without the X-rays." Every recommendation I make gets filtered through someone else's bank account. In human medicine, insurance covers most of it and the doctor just orders what they think is right. In vet med, I'm presenting options like a menu. Here's the gold standard. Here's the middle option. Here's the minimum. Pick one. It changes the way you practice. You learn to read people's faces when you hand them the estimate. You learn who's going to say yes to everything and who's going to negotiate. That's not what I thought I'd be doing when I was drawing those pictures at 8.

What's yours?

Economic euthanasia. That's the term for when a pet has a treatable condition but the owner can't afford treatment, and they choose euthanasia. I put down 2 to 3 animals a month that could have been saved if the family had $3,000. A dog with a broken leg that's fixable with surgery. A cat with a urinary obstruction that needs three days in the hospital. The medicine exists. The animal could recover. But the owner doesn't have the money, and there's no pet insurance, and CareCredit denied them, and I'm standing in the exam room with a syringe of pentobarbital about to kill an animal that doesn't need to die.

The worst part isn't the injection. I've done hundreds of euthanasias and the procedure itself is peaceful. The worst part is the five minutes before, when the owner is crying and apologizing to their dog, saying "I'm so sorry, I'm so sorry," and the dog is licking their face because the dog doesn't know what's happening. The dog is just happy to be close to their person. I had a case last month. A 3-year-old pit bull named Blue. Fractured tibia from jumping off a deck. Surgery would have been $4,200. The owner was a single mom with two kids. She didn't have it. CareCredit said no. She asked me if there was anything else we could do and I ran through every option I had. Payment plan through the clinic, which Dr. Rowan doesn't love but will sometimes approve. She couldn't do even that. So I euthanized Blue while her kids waited in the car. I went home that night and Aiden asked me how my day was and I just said "fine" because I didn't have the energy to explain it. That was a Tuesday. I expressed 14 sets of anal glands that same day. The job is both of those things in the same 10 hours.

Equine vet sounds glamorous. Is it?

Glamorous is one word. I drove 28,000 miles last year. Farm calls, mostly. That's about 110 miles a day on average. My truck is my office. I've got a portable digital radiography unit in the back, an ultrasound, boxes of supplies, and about 40 pounds of drugs in a locked cabinet. I start most mornings by 6:30 because horses are morning animals and the people who own them are morning people. Hank Cahill, the ranch manager at Stonebridge Farm, calls me at 5:30 AM at least twice a month. He doesn't text. He calls. He's old school like that. "Doc, I got a horse that's off on the right front." And I'm in the truck by 6:15, coffee in the cupholder, driving out to a 400-acre thoroughbred farm in the dark.

The glamorous part is the horses. They're beautiful athletes. A thoroughbred at full gallop is one of the most impressive things a biological organism can do. The not-glamorous part is that my job is finding what's wrong with them. Horses are prey animals. They're designed by evolution to hide pain. A horse that looks sound at a walk can be three-tenths of a second lame at a trot, and my job is to see that. I watch them move, I palpate every joint and tendon, I flex the joints and jog them again to see if the lameness gets worse. Then I start blocking. Nerve blocks. I inject local anesthetic at specific locations to numb one area at a time. If the horse improves after I block the foot, the pain is in the foot. If not, I move up. It's a process of elimination and it can take two hours on a single horse.

Tell us about the $340,000 pre-purchase exam.

So this was about six weeks ago. A buyer based in Dubai was looking at a 3-year-old thoroughbred colt at a farm outside Lexington. The sale price was $340,000. In thoroughbred sales, the buyer hires a vet to do a pre-purchase exam before the deal closes. It's like a home inspection, except the home weighs 1,100 pounds and can kill you.

I spent about four hours on this horse. Full physical exam, heart, lungs, eyes, teeth, palpation of all four limbs. Upper airway endoscopy to check the throat for abnormalities. Then the imaging. I took 52 digital radiographs. Both front feet, both hocks, both stifles, the cervical spine. I ultrasounded both front tendons and suspensory ligaments. The buyer's agent was there the whole time, watching, asking questions. The farm manager was there. The trainer was there. Everyone was being very polite but the tension was real because $340,000 was on the table.

I found the fracture on the third metacarpal of the left front. The cannon bone. It was a hairline, a stress fracture, barely visible on the radiograph. But it was there. A thin dark line about 2 centimeters long on the lateral cortex. I showed it to the buyer's agent on my laptop screen and I could see his face change. He pulled out his phone, walked to the other side of the barn, and called Dubai. The farm manager, a guy I've known for years, walked over to me and said, "You sure about that?" I said yeah. He didn't argue, but I could tell he wanted to.

Did the deal fall through?

They renegotiated. The buyer came back at $180,000 contingent on a 90-day recheck showing the fracture had healed. Whether it healed cleanly would determine the final price. That's a $160,000 hairline fracture. Two centimeters long. If I'd missed it, the buyer would have paid $340,000 for a horse with a stress fracture that could become a complete fracture under race training. If I'd been wrong about it, I'd have killed a $340,000 deal on a misread radiograph. The margin for error in equine sports medicine is measured in millimeters and hundreds of thousands of dollars.

You had shoulder surgery at 39. What happened?

A horse pinned me against a stall wall. I was doing a rectal exam on a mare, which is exactly what it sounds like. You put a long glove on, you go in through the rectum, and you palpate the reproductive tract to check for pregnancy or ovarian abnormalities. It's routine. I've done thousands of them. But this mare swung her hindquarters, caught me against the wall, and my left shoulder took the full force. Torn labrum, partial rotator cuff tear. Surgery at 39, six months of rehab, and my shoulder still aches in December when it's cold.

That's the part about equine practice that people don't consider. These are 1,000-to-1,200-pound animals. I've been kicked, bitten, stepped on. Dr. Pamela Briggs, my practice partner, broke two ribs from a kick three years ago. She was back at work in two weeks because equine vets don't take time off during breeding season. The physicality accumulates. I'm 44 and I feel 54 some mornings. My wife Luanne is an OR nurse, so we both come home with body complaints. We compare stories at dinner. She thinks her job is harder. I think mine is. We're both wrong and both right.

What does the practice look like financially?

Our practice grosses about $1.8 million a year between me and Dr. Briggs. That sounds like a lot, but equine practice has enormous overhead. The truck, the portable DR unit, the ultrasound, the drug inventory, malpractice insurance, employee costs. By the time you subtract expenses, my personal income is around $195,000. Good money. But I'm 16 years in, I'm a practice owner, and I'm paying for that income with my body. A human orthopedic surgeon with 16 years of experience is making three or four times what I make. I don't begrudge them. I just notice it.

Your practice software is Easi-Vet. Does technology change equine practice?

It has changed imaging completely. When I started 16 years ago, we were developing radiographs on film in a darkroom at the clinic. Now I shoot digital radiographs in the barn and the images appear on my laptop in seconds. I can zoom in, adjust contrast, send them to a radiologist for a second opinion by email while I'm still standing next to the horse. The DR unit cost $65,000, but it paid for itself in two years because I can do more exams in a day and the image quality is dramatically better. The Easi-Vet software handles scheduling, invoicing, and medical records. Pamela and I can both see the schedule from our trucks. It's not glamorous technology, but it keeps two vets driving 200 combined miles a day from losing track of who's going where.

What's yours?

The politics. Specifically, the pressure to clear a horse as sound when you know it isn't. I've been in situations where a trainer has a horse entered in a $200,000 stakes race on Saturday and I examine the horse on Wednesday and the horse is lame. Not catastrophically lame. Subtly lame. A 1.5 out of 5 on the AAEP lameness scale. The kind of lameness that a casual observer wouldn't notice but that I can see from across the barn.

The trainer wants me to say the horse is fine. The owner wants me to say the horse is fine. The jockey agent is calling to ask about the horse. And I'm the one who has to say, "This horse has pain in the left front fetlock and I'm not comfortable recommending it race this weekend." That conversation has cost me clients. A trainer at a farm I won't name switched to another vet after I scratched his horse from a race. He didn't fire me to my face. He just stopped calling. The new vet he hired is competent, I'm not questioning his medicine, but the message was clear. I was the vet who said no.

Luanne asked me once if I ever thought about just saying the horse was fine. And I told her that every time a horse breaks down on a racetrack, someone's vet said it was fine. I don't want to be that vet. But the financial pressure is real, because when a trainer leaves, that's $40,000 to $60,000 a year in revenue that just walked out of my practice. That's the tension. Doing right by the horse can cost you the client, and the client is how you pay your mortgage.

What does an average shift look like in a veterinary ER?

There's no average. That's the honest answer. I see 18 to 25 emergencies per shift, and the distribution is random. Some nights it's mostly stable cases. A dog that ate chocolate, a cat with a blocked urinary tract, a laceration that needs suturing. Those are stressful but manageable. Other nights, three critical cases come in within an hour and I'm running between treatment areas trying to keep all of them alive simultaneously. The median ER bill at our hospital is $1,800, but the range goes from $400 for a simple toxin ingestion to $10,000 or more for a major surgery.

My shift is 3 PM to 11 PM, four days a week. Dr. Elise Tran covers the overnight, 11 PM to 7 AM. She's been doing overnights for three years and she's built different. I couldn't do that schedule. Overnight in a vet ER is a specific kind of lonely. The hospital is quiet between 2 and 5 AM, and then suddenly a hit-by-car shows up and you're the only doctor in the building and you have to go from asleep in the break room to making surgical decisions in about 90 seconds. Elise handles that better than anyone I know. I bought her a pillow for the break room couch last Christmas. She uses it every shift.

Tell us about the Friday night GDV.

Friday, about 8 PM. A 90-pound Rottweiler named Duke came in carried by his owner, a kid, maybe 22. College-age. Duke was bloated, retching without producing anything, and his abdomen was tight as a drum. I knew it was GDV before I touched him. GDV is gastric dilatation-volvulus. The stomach fills with gas, then rotates on its axis, cutting off blood flow. If you don't get it into surgery within about an hour, the stomach wall starts dying. Two hours, and you're looking at splenic torsion, cardiac arrhythmias, shock, death. This is the case that every ER vet trains for, and it still makes your heart rate spike because the clock is ticking from the second the dog comes through the door.

Marcus, my lead tech, he's been in ER for 11 years. He had an IV catheter placed and a lactated Ringer's bolus running within four minutes of Duke hitting the treatment table. I pulled up the I-STAT blood gas analyzer and ran a venous blood gas while we were getting the IV fluids going. Duke's lactate was 7.2, which is high. That tells me tissue perfusion is already compromised. I passed a stomach tube to try to decompress the gas, but the tube wouldn't pass, which confirmed the volvulus. The stomach was twisted and nothing was getting through. This dog needed surgery now.

And then you had to talk to the owner.

That's the cascade. The medical part of my brain was in full triage mode. Start fluids, run blood gas, attempt decompression, prep for surgery. But the other part of my brain, the part that has to deal with the human in the lobby, knew that I was about to tell a 22-year-old that his dog needed $7,500 to $10,000 emergency surgery right now or Duke would die tonight.

I walked out to the lobby. This kid was sitting in a plastic chair, alone, and he'd been crying. I sat down next to him, not across from him, and I explained what was happening. Duke's stomach had twisted. Without surgery, he would not survive the night. The surgery estimate was $7,500 to $10,000, depending on whether we had to remove part of the stomach or the spleen. I watched this kid's face go through about six stages of processing in ten seconds. He said, "I don't have that kind of money." He was a student at UT Austin. He'd had Duke since he was 14. Eight years.

I told him about CareCredit. He applied on his phone right there in the lobby and got approved for $5,000. That left a gap of $2,500 to $5,000. He called his parents. I could hear his dad on the phone asking questions. I gave him space. After about ten minutes, he came back and said his parents would cover the rest. I went back to the treatment area and told Marcus we were going to surgery. From the time Duke came through the door to the time I made the first incision was 47 minutes. Duke survived. His stomach was viable, no resection needed. I removed the spleen because it was congested and tacked the stomach to the body wall to prevent recurrence. He went home three days later. The final bill was $8,200.

How do you make decisions that fast under that kind of pressure?

Residency training and repetition. My residency at Texas A&M was three years of the sickest animals in central Texas. I did over 200 GDV cases during residency and in the years since. At this point, the medical decision tree for a GDV is automatic. I don't think about what to do. I think about the variables that make this particular case different from the standard protocol. Is the lactate above 9? Then I'm worried about gastric necrosis. Is the dog geriatric? Then anesthesia risk goes up. Is the owner able to pay? Because that determines whether I'm doing surgery or having the euthanasia conversation.

The pressure isn't the medicine. The medicine, I'm confident in. The pressure is the 47 minutes. It's the fact that every minute I spend talking to the owner in the lobby is a minute that Duke's stomach is dying. And I can't rush the owner, because this person is making a $10,000 decision about the life of their best friend and they deserve time to process it. But the dog doesn't have time. I'm holding those two realities at the same time, every shift, multiple times a night. That's what ER vet med is. Not one emergency at a time. Multiple emergencies with competing timelines and competing emotional needs.

You use the SurgiVet monitoring equipment during surgery. What are you watching?

Heart rate, blood pressure, oxygen saturation, end-tidal CO2, ECG, temperature. A GDV dog is at high risk for cardiac arrhythmias, especially ventricular premature complexes, which can happen during or after surgery. So I'm watching the ECG tracing the entire time. If I see VPCs firing in runs of three or more, I'm reaching for the lidocaine. Marcus monitors anesthesia on most of my surgeries. He's the one watching the numbers while I'm focused on the surgical field. We've been working together for four years and we barely have to talk during a procedure. He adjusts the isoflurane before I have to ask. He calls out blood pressure changes before they become a problem. That kind of trust between a vet and a tech takes years to build and it's worth more than any piece of equipment in the hospital.

The whiteboard in the break room. Why does the streak matter?

Because losing patients is the default. We are a level-one veterinary ER. We get the cases that are already dying. Hit-by-cars with shattered pelvises. Septic abdomens. Dogs in fulminant DIC. Cats in acute kidney failure. A good percentage of the animals that come through our door are not going to make it regardless of what I do. So when we have a streak of 14 shifts where everyone goes home alive, that means something. It means the triage was right, the medicine was right, the timing was right, and the owners said yes to treatment enough times in a row. That streak is partly skill and partly luck and the team knows the difference. But it still matters. Marcus updates the board every morning. When it resets, we all know it's going to reset. Nobody is surprised. But seeing the number climb again after a reset, going from 1 to 5 to 10, that's the thing that keeps you showing up for the next shift.

What's yours?

Compassion fatigue. The clinical term for what happens when you watch too many families say goodbye to their dog and your brain stops letting you feel it normally. I went to therapy after year two because I realized I hadn't cried at a euthanasia in six months. And that scared me. I used to cry with every family. Not sobbing, but tearing up, feeling it. Six months into ER practice, I was doing euthanasias with a flat affect. Walking in, injecting the pentobarbital, confirming the heart had stopped, saying "I'm sorry for your loss," and walking to the next room. Like a procedure. Like it was the same as placing an IV catheter.

My sister Catalina is a pediatric nurse. We text about our respective worst days. She's seen some terrible things in pediatric oncology. But she told me something once that stuck with me. She said that in human medicine, death is the exception. Most of her patients get better. In my ER, death is a regular occurrence. Not most of the time, but enough that if you don't build a wall, the grief accumulates. The problem is that the wall that protects you from the grief also blocks the connection. And connection to the animals and their people is the reason I got into this field. So you're stuck managing this impossible balance. Feel enough to stay human. Don't feel so much that you can't function.

My therapist, a woman named Dr. Huang, she sees a lot of veterinary professionals. She told me that vets have a higher suicide rate than physicians, dentists, or the general population. I knew that before she told me, but hearing it in a therapist's office after admitting that I'd stopped feeling things was different than reading it in a journal article. I'm better now. I feel things again. I cried at a euthanasia last month, a 16-year-old lab whose owner was a retired firefighter, and the man thanked me for being kind. I went to the bathroom after and cried for real, not performatively, and I told Marcus about it and he said "good." That's all he said. Good. Because he knows what the alternative looks like.