“Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone.” – Mister Rogers
Every day in our profession, veterinarians either confront or contemplate situations and questions that touch upon mortality, both in the animals we treat and with ourselves. That reality alone could explain why the field of veterinary medicine has a suicide rate that’s three times higher than the national average. Addressing these questions in terms of stress levels, toxic environments, lack of self-care, difficult people, and access to lethal means does not sufficiently explain the disparity. Many career fields have these types of stressors, but there is one that is unique to vet med.
Veterinarians are, simultaneously and by definition, healers and executioners. However much we try to convince ourselves that euthanasia is a gift, the same hand that births the foal also pushes the Pentobarb. Think of what that does to a person: to arrive at the decision that gentle death is the only humane option, and then bringing the death about by our own hand. There are hundreds of veterinarians who do this work exclusively, and often speak of providing euthanasia as “an honor.” How did they come to believe so? How did they escape the natural tendency to wonder about our own suffering, and whether it is worth enduring?
This Mental Health Awareness Month, we might think about making friends with the darkness permeating ultimate and irreversible decisions. I submit that the decision to euthanize and the decision to die by suicide are related and, emotionally speaking, indistinguishable. To address the mental health issues and suicide rates that plague our community, we must bring the darkness out into the light, not numb ourselves or shy away from it.
Think about the first time a client asked you, “Do you think it’s time?” In that moment the darkness knocks on the door and reminds us of our own mortality and our limitations. The doctor, the caregiver, the healer inside us subconsciously groans in reflexive pain at realizing that we may have come to the end of our ability as healers. Bravely, we construct ethical frameworks and clinical protocols and systems of care upon which to hang this duty of veterinary medicine, as we sense the end of our ability to change the outcome. We ask ourselves harder and harder questions, like:
- “Can we ever be sure when suffering makes intentional death the best option?”
- “What would you do if it were your pet?”
- “Would I want to be ‘put to sleep’ if I were in the animal’s situation?”
The ability to engage with these and countless other questions is a critical and protective skill to develop. And yet, the mental stress of the questioning, if not faced with the presence and help of trusted peers, takes its toll cumulatively and can come at the highest cost.
Among the complex reasons for suicide, which include hopelessness, feeling like a burden, and social isolation, the one closest to our experience as veterinary professionals is the fact of our proximity to death itself. Who among us has not wondered at some point whether the world would be better off without us? Let us therefore stop treating these thoughts as pathological, as unmentionable. Years of data now make clear that the more trusted social contacts we have, the less likely we are to take our own life.
Last year, a client of mine died by a fatal overdose two hours after a session. I was probably the last person they talked to, and my entire training is in “preventing” this catastrophe. My EAP counselor shared a name for what I was going through, that many others have gathered around and found solace in: “clinician survivor.” I learned that’s what I was. Allowing that to be true in front of others is what has saved me. Six months before that (just after Vet Tech Week), a coworker in the anesthesia department of our hospital died by suicide. Allowing the loss to be true in front of each other is what saved our close-knit professional group. As clinician survivors of euthanasia and suicide, we can connect through the experience of doing everything right and having the worst still happen; through accepting that we will inevitably reach the end of our healing capabilities.
This Mental Health Awareness Month (which exists because we don’t do it well enough yet), let us turn toward each other with the idea that the darkness inherent to our profession is mentionable. Imagine the change in how we relate to our colleagues, our leaders, and ourselves that becomes possible when we move toward the pain together. Imagine the strength that becomes available when we accept our inability to change the final outcome. Imagine the brightness of the flame of our care and our vocation, that moves hand in hand with the darkness, that grows as we connect heart to heart with our fellow travelers.
So what can we start doing today?
1. Treat our colleagues and ourselves with deep-rooted acceptance – we’re all doing the best we can.
2. Work on building a culture where our struggles with the darkness are mentionable.
3. Be willing to accept our inability to change the final outcome.
4. Tell someone whose response you trust how you’re feeling. Pain shared is pain diminished.
5. Companions are often more helpful than experts.
Resources for veterinary-specific peer support:
NOMV’s Lifeboat program, sponsored by IndeVets
Free QPR Gatekeeper training for suicide mitigation through the AVMA
For further exploration:
A self-directed exercise on the concept of “radical acceptance.”