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This Is My Brain On Grief

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I’d written an article for this issue on the femininity of the profession and its highlights and pitfalls, but was thwarted by the impossibility of averting a slew of hate mail and what I like to call the Hillary syndrome as it applies to women in the profession. Instead, I’m taking the coward’s way out and treating you to a similarly timely discourse on the dangers of compassion fatigue.

This week I’ve been exposed to six euthanasias, two of them this morning (an otherwise gorgeous Sunday in Miami) and another two in patients under 3 years old. One of the latter patients, a downer Dachshund whose prognosis fared better than middling, was particularly tragic and troubling.

I no longer cry when I attend euthanasias—rarely, anyway. I know just what to say and manage not to make it sound canned or trite. I’m now expert at my catheters or butterflies and never foul up the deed, even when flying solo. As one of my colleagues likes to say, “I give good death—every time.” I’m sure most of you in practice for more than 10 years can boast the same fine stats.

Nonetheless, surrendering yourself to the emotional toll of a string of “beautiful deaths,” as the word euthanasia denotes, is an inevitable risk. Even those of us well practiced in the art of death will confess to the feelings of gloom and angst such a close succession of fatalities affords—if we’re honest with ourselves.

There’s only so much steeling we can manage without compromising our humanity and ultimately failing our clients in the support they need when undertaking the procedure.

General practitioners, criticalists and internists have it worst, I think. Most other specialists often have the luxury of remanding their patients to their GPs when the going gets tough. Sometimes it’s a personal decision, often it’s based on referral ethics, but some specialists I know will always refuse to euthanize another doc’s patient.

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As one cardiologist recently said, “I’ve got 30 good years left in this profession. If I had to start euthanizing my patients now I don’t think I’d make it without burning out.”

She’s not alone. Another specialist–this one a criticalist–confessed that he’s “not dying with his boots on. There’s no way I can keep up this level of care if I have to give up so much of myself to be good at it.” He’s actively sourcing second career options for the next decade of his life.

I worry about it, too. I know vets who will readily admit to “turning themselves off” or “becoming automatons” when they attend euthanasias. We all probably do it to some extent. I must if I don’t shed the tears I used to, right?

Remember your first euthanasia? I do. In vet school an intern handed me the syringe and insisted I do it myself once the owners had decided not to be present. Red faced and teary-eyed, I wheeled my deceased patient out of the wards on the stretcher when our hospital’s social worker, who had a nose for finding the distressed among us, approached me. She urged me never to lose that level of sensitivity.

Right. If I didn’t, as I’ve had plenty occasion to consider since, I’d be a basket case. Though I’ll never forget her kind words, I’ve subsequently decided I value my career more than I do her then-compelling advice.

Is that rationalization? Perhaps. But can I help it if I know myself well enough to understand my personal limitations when it comes to coping with death?

Some of us eschew the procedure altogether. Notably, one critical care resident in vet school refused to raise the issue as an option until the owner did. More than a few have reportedly left the profession over it. Others require professional counseling (at the risk of too much information, I’ll confess it helps me).

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And why not seek mental health therapy? After all, the suicide rate in our profession is alarming. I’ve known three casualties personally. Great Britain reports that among professionals, veterinarians are at highest risk for suicide. Anything we can do to reduce our rate of attrition through awareness of our psychological risk is a positive, progressive step for the profession at large.

Last week’s 2-year-old Dachshund found me biking 15 miles after work to ease the angst of knowing I should have offered his owners the chance to sign him over (with all the legal and emotional pitfalls that entails, I’m increasingly loathe to offer this alternative). After the ride, I knew I’d done the right thing—for my sanity, at least.

It’s true. No other profession experiences death as directly or as often as we do. Why else would the Supreme Court look to us (albeit obliquely) to help guide their lethal injection decisions? But we do ourselves no favors by playing ostrich on this one. It’s a big deal.

This is your brain. This is your brain on grief. It’s easier than contemplating the results of the next election and the Hillary syndrome, right? Just promise me you’ll think about it.

Patty Khuly, DVM, blogs regularly at www.dolittler.com.

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