Even after 16 years as a veterinarian, 13 of them as a veterinary oncologist, there are cases that still haunt Jennifer Kim.
Like the woman with end-stage ovarian cancer and her dog, her support throughout her illness, stricken with cancer too.
"I ended up euthanizing the dog probably less than a week before she died. At the time of the euthanasia, she said, 'I was supposed to die first.'"
There were other clients — 9/11 family members, a young mother suddenly widowed — who implored her to save the pet that was all they had left of their lost loved one. there were the animals she’d cared for since they were puppies and kittens that were at the end of their lives.
“I’ve had patients that I’ve seen every month for years, and when they die, I hold it together in the room. But as soon as they leave or as soon as I get in my car, that’s when I cry,” said Kim, a veterinary oncologist with NorthStar VETS, a specialty and emergency practice in Maple Shade and Robbinsville, N.J. “I feel if you don’t cry about this job every once in a while, you’ve lost your heart.”
But for Kim and a growing number of her colleagues, losing heart isn't the most dire consequence of the work they love. Increasingly, the veterinary community is marshaling efforts to address suicide rates that, according to recent research, are about twice that of the general public. That comes at a time when the overall suicide rate in the United States climbed by more than 30% from 1999 to 2017.
A study by researchers with the U.S. Centers for Disease Control and Prevention and Auburn University published last month in the Journal of the American Veterinary Medical Association found that from 2003 to 2014, male veterinarians died of suicide at a rate 1.6 times higher than the U.S. average. For female vets, the situation is worse yet: 2.4 times higher. Another study published earlier this year found that suicide rates among veterinarians were even higher.
Overall, suicide rates among men are higher than those among women. Not so with veterinarians. Nearly 62% of veterinarians are women, and that share is expected to rise, given high female enrollments in veterinary schools.
The CDC-Auburn study suggested that one reason for the high suicide rates is that veterinarians have ready access to drugs that can be deadly in excess.
"Poisoning was the most common mechanism of death among veterinarians; the drug most commonly used was pentobarbital," the study states.
Pentobarbital, a barbiturate that can be used as a sedative and as an anti-seizure medication, is commonly used by veterinarians to euthanize animals.
But access to lethal drugs doesn't explain the despair. Many veterinarians say the recent studies have just proven what they and their colleagues have suspected in a profession fraught with high stress — emotional, moral and, increasingly, financial.
The average debt from vet school is more than $152,000, according to the American Veterinary Medical Association (AVMA), and that doesn't include undergraduate debt. That's close to the average debt for medical school, but the average starting salary for a vet of about $82,000 is substantially less than that of a new physician.
Medical advances have increased care options for pets, but they are too costly for many pet owners, most of whom do not have pet insurance. Some veterinarians talk about being accused of "just being in it for the money," and many say they are torn by the moral dilemma — as much as they want to do more for an animal and its anguished owner, they also have to pay the bills.
On top of that, many vets — just like their peers in human health care — work long hours and neglect self-care. They suffer burnout as well as compassion fatigue over the animals they were trained to treat and their owners, which they were not. And part of their job remains, at times, ending lives.
"I've gone in the bathroom and cried after euthanasias," said Evan Gandler, a veterinarian for 19 years and owner of Sterling Veterinary Associates in Stratford, N.J. "A couple times over my career, I've cried in the room with clients too."
"I think that as veterinarians, we've finally reached the place in our profession where we're allowing ourselves to talk about it," said Carrie Jurney, a veterinarian who practices in California's Bay Area and completed her neurology residency at the University of Pennsylvania's School of Veterinary Medicine. Of the 86 people in her University of Georgia vet school class of 2005, at least three people have died by suicide.
Jurney is also a founding member of Not One More Vet, an online support organization that started with 25 members about five years ago and has grown to over 20,000. One impetus was the 2014 suicide of Sophia Yin, a renowned animal behavior pioneer whose books are a staple in many veterinarians' libraries. The group's website has many resources, such as crisis phone numbers for vets in the United States and abroad, access to crisis intervention training, financial planning, and help for compassion fatigue. There are also aids to deal with cyberbullying, something an estimated one in five veterinarians will experience at some point in a career.
The AVMA has also beefed up its online resources. The association holds an annual wellness summit and offers free access to QPR — Question, Persuade, Refer — a suicide prevention program.
"Our goal is to have every veterinary professional trained in QPR," said Jen Brandt, AVMA's wellbeing director.
More vet schools and some larger practices, aware of the crisis, are also taking more steps to help their vets cope.
Penn's vet school has hired a financial counselor, a career counselor, and mental health counselors at both the Philadelphia and New Bolton campuses.
Dean Andrew Hoffman said recent research has shown that the stress experienced by pet owners can be akin to the stress of caring for human loved ones, and that stress affects veterinarians.
"Caregiver burden transfer is something we have to recognize as an important contribution to why veterinarians are experiencing this stress," Hoffman said. "It's measurable, it's quantifiable, and it happens a lot."
Page Buck, New Bolton's mental health counselor, was hired two years ago to work just a few hours a week. In that time, her hours have more than tripled as she serves interns, residents, and faculty, as well as students.
"The need hasn't increased because they're less well," Buck said. "They're more aware of what services there are, and there's less stigma."
Banfield Pet Hospital, the nation's largest general vet practice with more than 1,000 locations, including two in Philadelphia, has instituted student debt relief programs to aid its veterinarians. In addition, Banfield recently announced plans to embark on two new suicide prevention initiatives by Jan. 6, 2020 — a date chosen because of a 2015 study that stated one in six veterinarians have considered suicide.
One initiative is to close all Banfield facilities for two hours for mental health and well-being training. The other will be to make its suicide prevention program ASK (Assess, Support, Know) available as a free resource to all veterinary professionals.
"It's not a solution by any means," said Lisa Stewart-Brown, Banfield's health and wellness program manager, "but it's a piece of the puzzle."
A recent Wednesday was a relatively slow day for Jennifer Kim. Nine hours instead of the usual 12. Eleven cases, as opposed to 16 or more. There was Cody, a tail-wagging goof of an English chocolate lab in for a check-up. He was in remission from cancer and doing well.
More worrying was Dannyboy, a 3-year-old golden retriever. The dog had completed six months of chemotherapy, and in that time, Kim and Dannyboy's owner, Rosemarie Ruggiero Williams, a retired judge, became close. Treatment seemed to be going well; recently, though, Dannyboy showed signs of gastrointestinal distress.
"I thought he was going to grow old with me," said Williams, with a worried smile.
Dannyboy was taken in for an ultrasound. Kim gave Williams a hug as they awaited the results.
Over the years, Kim has learned ways to cope with the emotional toll of her work.
"My best friend is also an oncologist. We have a sort of rule," she said. "If we've had a really bad day, we'll call each other instead of taking it home to our significant others. We realize doing that can be destructive to our relationships because most people can't handle the sadness we have to on a daily basis. Nor should they have to. They didn't choose this life. We did."
Kim has also learned to ask for help. She's turned to therapy, and antidepressant medication helps with her stress-triggered migraines.
As a member of the New Jersey Veterinary Medical Association's education task force, she's with a program for the annual conference, where wellness will be a focus. Part of that is encouraging people to seek help if they need it.
"Strength is valued and weakness isn't. It's not about being weak. It's about making yourself stronger by making sure you have the support," Kim said. That could be going to therapy, she added, or even just turning to a trusted colleague.
“It just means you can share your story and not be alone.”