(dog barking) - [Announcer] "The Cost of Caring" is made possible in part by.

(dog panting) (cat meowing) (dog barking) (cat meowing) (dog barking) (dog panting continues) (animal noises end) (water whooshing) (kettle lid clattering) (burner clicking) - I usually wake up around two o'clock in the morning and thinking about cases that I had and like, "Oh shoot, I should have done this instead."

Or I'll realize I forgot to send some medication home, or I forgot to call a client.

And so, that's typically what's going through my head.

And also like, what are my cats doing?

Huh, P?

This is breakfast in the morning.

So, two dogs, six cats, the parrot, 10 or 12 chickens, two ducks, a chinchilla, a hamster, and the occasional cow that stays.

So, yeah, it's a lot.

Hi, guys.

You want some pancakes?

Here, Doug, Doug?

Hold on, Lucy.

Oh, Doug's a little blind.

(laughing) Oh God, sorry.

I am never prepared for the day.

There's no preparing 'cause you never know what's gonna walk through the door.

And even though like, I don't work emergency, like technically, you never know.

Like, somebody wakes up in the morning and found out that their cat was vomiting all night long, or somebody gets home from work, and their dog just isn't quite right.

Or somebody has been ignoring a problem for months, but now they're going out of town so they need it addressed right now.

And so, we have our schedule.

There's stuff that's set on the schedule, but there's always stuff that comes in that you never know.

And then, nothing ever goes according to plan.

So I just, I just do my best.

Try to sleep well every night, pack lots of food because I'm better at working through things if I'm fed and hydrated.

But yeah, I'm never ready for the day.

(laughing) - [Staff Member] Dr. McArthur?

(ominous music) - [Nicole] That poor dog.

(dogs barking) (people chattering) (medical equipment dinging) - [Staff Member] Dr. McArthur, Dr. McArthur.

(cat meowing) (medical equipment dinging) (dog panting and whimpering) - I told both my kids this morning 'cause I'm like, Sadie's sick.

I'm taking her into work.

And so, they're used to like, if I take something, and they know that, usually it's bad.

My name is Nicole McArthur.

I'm a veterinarian, daughter of a veterinarian, wife of a veterinarian, and a mama to two girls.

Good morning.

I have Sadie here.

(phone ringing) - [Receptionist] Bayside Animal Hospital.

Is this an emergency, or can I put you on hold for a moment?

- [Staff Member] Yeah, sounds good.

We're gonna see if Carrie can hang out with Delanie.

- [Staff Member] Yeah, that would be great.

I mean, that would be ideal.

- [Nicole] Nomann's gonna have a spay with an umbilical hernia.

This one's a quality of life.

It's a puppy, and then two puppies, and then two annual exams.

These are drop-offs so they'll come in at some point.

This is my surgery so I want her to drop off at 11 'cause the surgeon's not gonna be here till 2:30.

My personal philosophy is, and my professional philosophy is, you know, an animal comes to me, I am to, like, their life is in my hands, and I take that very seriously.

And in small animal, these are people's fur babies.

There's an emotional attachment there that I feel, and I feel responsible for.

We feel this bond with animals.

And so, I think a lot of us go into veterinary medicine because we want to work with these animals.

We want to help them.

We want to fix them.

We want to help them have a peaceful death when it's that time.

- [Staff Member] Aw, look at your paw.

- Everybody thinks, everyone.

Oh, you work at a veterinary hospital?

(gasping) That's so exciting.

And it is.

It really, really is, but then they're like, you get to pet cute puppies and kittens all day.

I do, sometimes, but 99% of the rest of the time it is just runnin' around like a chicken and figurin' out what needs to happen next and putting out fires.

- You know, in one day they might have the cutest, most delicious little puppy and kitten, and then they walk the corner, and they have to deal with somebody on the worst day of their life.

So, it's a emotional rollercoaster.

- And you get whipsawed.

My God, I just saw a little french bulldog puppy.

Oh my God, you're cute.

(gentle piano music) And I go in the next room, and there's an elderly cat that's a skeleton that it's time for the final grace.

And now, I gotta do a callback, and I gotta interpret lab results.

And now I'm in a surgery, and now an emergency comes in.

And now I'm back with a kitten.

It is, talk about a whipsaw of emotions.

There's hardly time to process all of it.

(traffic noise whooshing) - [Nicole] So, they're just talking amongst themselves.

This is kind of one that I want them to be on the same page.

This is dad's dog.

Dad says it's time.

Mom's like, shouldn't we run some tests?

So, I'm gonna let them sort that out.

Who, what else do I have to do?

I have Tanner, right, the limping dog in room one.

- [Staff Member] Is that who Tyler's working with?

- [Nicole] Yes.

- [Staff Member] Yes, Tanner's in room one.

- [Nicole] Okay, so if you guys can keep an eye on room four.

- Okay.

- Mmm hmm.

- [Nicole] And peek in if they peek out.

(phone ringing) (people chattering) This is so sad.

Yeah, the biggest thing is, dad, this is dad's dog.

Dad's watched him go through two, it sounds like seizures, like horrible seizures.

Mom hasn't seen it.

Dad's health is not good.

He's worried he's not gonna be around for very long so he doesn't want his wife to see what he saw.

Yeah, so for him it's easy.

He's goin' to sleep.

For them it's not, so just make this as nice as possible.

Okay?

- [Staff Member] We will do that.

- [Staff Member] It's okay, it's okay, it's okay.

He needs to go back and get turned out still.

- Okay.

- Oh, not bad.

(staff chattering) (staff chattering continues) - [Nicole] So see how peaceful he is right now?

All right, Keeper.

Okay, I'm gonna put his head down.

So, he doesn't know what's going on.

He's completely asleep right now, okay?

- [Owner] Yeah, his heart is beating.

- [Nicole] It is.

That wasn't the euthanasia solution.

That was just the anesthetic.

So now I'm gonna give him, this is pentobarbital, and so this is what's gonna stop everything, okay?

And so what I'll do is once I give it, I'm gonna listen to his heart, and once it stops beating, I'll let you know.

And then, I can stay here with you.

I can step out if you want time with him.

Everybody's different in how they, how they react afterwards, okay?

I tend to step out to give you some space.

Some people don't want that.

Some people absolutely need it.

It just depends on how you're feelin', okay?

- Okay.

- Okay.

Okay, Keeper.

You're a good boy.

Yeah.

- [Owner] Oh my.

That is quick.

- [Nicole] It is, it is.

(sighing) It's quick, and he's sleeping.

And no more pain.

- [Staff Member] Are they gonna take a moment with him?

- [Nicole] (sighing) Yeah.

Okay, so if we can just keep an eye on them.

They're just sitting there.

Mom's kind of in a state of like.

(hands squishing) All right, let me have some puppy therapy real fast.

Just all the things.

- [Staff Member] I know.

You have to go back to normal work.

- [Nicole] What?

- [Staff Member] He says I'm okay as long as someone's engaged in engaging with me or holding me or touching me.

- I started a group called Not One More Vet in 2014.

I called it Not One More Vet because my pie in the sky dream is not one more vet is lost to suicide.

I don't know that's an entirely realistic goal, but we can all dream, right?

- My name is Dr. Noel Lucas.

I'm a veterinarian, and I started the Blue Oasis Pet Hospital in 2013.

(gentle piano music) Veterinarians are type A.

We're very driven.

We wanna just do everything perfectly, and we expect that from everyone around us, which makes it really hard on the team sometimes.

We feel like failures when we can't make that pet owner happy, or the outcome was not what we expected it to be.

And then we're just guilt-ridden about not being able to do it all perfectly.

And we can't be perfect, but we have that in the back of our heads.

We have to do it perfectly.

We gotta be the best mom, best wife, best veterinarian, best team member.

Like all of it just is the best, the most perfect way, and it is a mantra that happens in our industry.

And then, we crack.

- She can either come home and have a regular day, or she can come home with her hair on fire.

I mean, there's just two different versions of it.

If I can hear the stress in her voice when she comes home, I know right off the bat I am going to pour a glass of wine, and it's gonna be like there at the door.

It's just part of the business that she's in.

- Sometimes I think that there's days where I just take lot of the stress home with me, and you know, like even my, my girlfriend can see, you know, did you have a bad day?

She kinda automatically knows the whole process of it.

So, days where you feel like, oh dang, I should done this, or I could have made, I could have done this better, or something goes out of control, like I said, and it does go home with me.

And it keeps me up at night.

Sometimes I even like think at night like, dang, I should have done this differently instead of trying to go to sleep, you know?

- I remember days I would stress.

I would wake up, and I spit blood, and this was because of stress.

So, some people cope with stress.

Some people can't, and you know, the way we handle stress is very different.

- Being a vet student was probably the time in my life when my perfectionism was at its worst.

I think about it as the place my brain goes for safety when I'm really stressed out, and when I was in vet school, I couldn't get anything less than perfect grades.

I couldn't.

I had to learn everything.

I had to do everything, and I really wasn't able to let myself off the hook.

And I think a lot of vet students feel that way.

- And we bring them into vet school, and we teach them that perfection is the goal.

You get the A plus.

You practice the gold standard of medicine, which in vet school means working with the veterinary neurologist to work up a seizure case, right?

And so we train people, you get it right.

You get an A plus.

You do the gold standard, and then we release them into practice, where people come in with $75.

They're not goin' to the vet neurologist.

Everything's a trade off, right?

There's, you're always managing resources versus outcome versus the time that the pet owner has versus the fact that you can't control what they do at home.

Like, you're not gonna get the A plus outcome.

That's not realistic.

And so, we train them in perfection, and then release them into a world that's absent of perfection.

(traffic whooshing) - Same temperature so.

We see a lot of Frenchies and pugs and puggles here in the Bay Area, and a lot of them are named Potato.

And it's my favorite name for them 'cause they are little potatoes.

- Oh, fun.

- Oh, Potato.

- [Staff Member] Oh, Potato.

(Potato barking and growling) Poor guy.

- [Owner] Potato.

- [Staff Member] Oh poor guy.

- [Carrie] He knows.

He's like, well, he's awake, he's alert, he's conscious.

So, potato is a 7-year-old puggle, who's here because he obsessively and aggressively chases his rear end, and he's biting at it.

So, it looks really abnormal.

It looks like he's really mad at his butt.

And so, we're gonna try to figure out why that is.

I mean, neurology, we get all of them.

My animal is doing something weird, and I just wanna know why they're doing that.

So, a lot of like, we call 'em the electric shocks, like they do like that.

And like sometimes it's that they have gas, and sometimes it's that they have a brain problem.

And so, you know, and we get the tail chasers and the obsessive compulsive diseases, and the mad at our butts.

So, you know, just a standard Monday.

- [Staff Member] Come here.

Adult rescue.

Potato Skin is off the hook angry.

She let me touch the paws, the legs, the butt.

You can see there's the hair loss on all four.

She's got a bald spot on the back of her neck.

- [Carrie] All right, let's start with the front.

- [Staff Member] We're on the Chlorhex, and the Apoquel, and the Cytopoint.

- [Carrie] Oh, the skin things.

- [Staff Member] Adult rescue, so her age is a little bit of a guesstimate.

- [Carrie] No, no, no, no, no.

(Potato barking) Okay, okay, all right.

I would be upset too.

- [Staff Member] That's fair.

- [Carrie] Fair, fair.

- [Staff Member] There's no safe word in neurology, honey.

- [Carrie] Oh, oh, ba, ba, ba, ba, ba, ba, ba, ma'am.

(Potato barking) Hey, hey, hey, hey.

- [Staff Member] Please, you're a puggle, please don't.

- [Carrie] Hey, hey, hey, hey, hey.

Okay, okay, okay, okay, okay, okay, okay.

(Potato barking) Easy for me to say, I know, I know, shh.

(Potato crying) It's just the rim really hurt that badly?

Huh, what's happenin' back there?

Miss?

Say, oh my goodness.

- [Staff Member] We did not like that.

- [Carrie] Nobody asked you.

What's is on your face?

Is that a raw spot?

Nobody, oh my goodness, ma'am.

I know you don't like us anymore, and I can't, who can blame you?

Who can blame you?

- [Staff Member] We were very rude.

- [Carrie] Hey, hey.

Sweetheart.

(Potato crying out) Oh my goodness gracious.

Does that hurt, or are you just a little sensitive 'cause somebody went in there without asking?

(Potato crying out) I think that hurts.

I think it hurts.

I think it hurts.

So I'm Dr. Jurney.

It's really nice to meet you.

I just met Potato.

So that behavior, thank you so much for the video.

It's really, really helpful.

It's pretty extreme.

Does it happen anytime you take the cone off?

Is that?

- [Owner] The last time I took the cone off, like six minutes later it just happened.

We haven't tried to take it off again because it's scary to watch, and we don't want her to do it in case it's damaging.

- It's dramatic, yeah.

When I am, moving her tail around and I did a rectal exam to push on some of the bones in there, she was really not pleased that I was doing that.

Fair, nobody asked her.

But you know, I do think that she has discomfort in that area that's in excess of just please don't touch me.

So, I'm worried she could have something like a slipped disc or something back there that would explain like if she's got a pinched nerve, like if her foot all of a sudden is like burning, stinging, painful, like that's a reason that she could be going at it like that.

- [Owner] We tried to give her Rimadyl, I think.

- [Carrie] Okay.

- [Owner] It didn't work.

It didn't do anything.

That was when we tried to take the cone off again.

- [Carrie] Yeah.

- [Owner] And then the vet tried to prescribe us a Gabapentin, I think.

But we also, we just didn't wanna experiment it again.

and wanted to get her examined first.

- [Carrie] I do think that one's worth a try, just so you know.

So, MRIs are something that are done in an outpatient facility in Redwood City.

They are done under general anesthesia, and they're a little bit more expensive.

So, they're about $3,000 to get an MRI.

Just so you know what you're gettin' into.

So, if you are interested in that, we can get you scheduled.

- [Owner] If we choose not to do the MRI, what's the alternative?

- [Carrie] Yeah, I mean, I think if you choose not to do the MRI, then we don't know what's happening.

so then it's hard to treat.

So, I think, Rimadyl is very reasonable just for that knee.

Right, like that knee is crunchy, and I think Rimadyl.

Like, anytime we're off weighting like that, like that means there's pain there.

Think about how bad you have to hurt to limp.

So like, we have some baseline pain in that leg that I think we should just treat, right?

So, you can definitely use things like Rimadyl for that.

If you're gonna use Rimadyl long term, you need to have blood work checkups with your regular vet fairly reasonably.

- [Owner] Right.

- And then Gabapentin is fairly, you know, safe medication in the realm of medications.

And we can try it.

I don't know if it's gonna be enough.

Surgery for something like that, your total bill is gonna be in the neighborhood of $10,000.

So, it is not a cheap experience, okay?

- [Owner] Got it.

- [Carrie] And it's hard when you don't know what the disease is.

Like, I can't tell you what's gonna happen.

So, I think if you guys don't wanna do the MRI.

If it's just not practical or possible, then we treat this conservatively and we see how it goes.

Yeah, I would give the medications a couple of days and then like take the cone off and see if it's better.

And if it's not better, I mean, I know the tests are expensive but the reality is like if we don't know what we're treating, then we can't treat it.

So, yeah.

- Okay, that makes sense.

- Yeah.

- Okay.

Yeah, we'll have to think about it.

- [Carrie] Totally reasonable.

You guys let us know.

Those are reasonable medications.

You already have them.

We're gonna go get your girl.

Anne's gonna get you checked out, and then if you guys decide you wanna go forward, great.

If not, just let us know if the Gabapentin works or not.

Okay, 'cause we have other things we can try.

- Okay.

- All right.

- [Owner] Thank you so much.

- [Carrie] Nice to meet you.

- [Anne] Okay, I'll go get Potato, and then it'll be just the consult for today.

- [Carrie] Yeah, so I mean, they're still thinking about it.

I think the reality is that's a very expensive procedure that dog potentially needs.

And I don't think.

The impression I got is they weren't quite financially ready for that and really need to think about it.

And so, we're gonna treat pain a couple of different ways and see if that helps.

But, the long story short is without a diagnosis, we don't know what to do other than to treat symptomatically.

So, I think well-intentioned, lovely owners, here for information.

The next step is a big step.

So, it's a problem in neurology, definitely.

All of the tests are expensive so.

(gentle piano music) - One thing that we struggle with in the veterinary profession that they may not be dealing with in the human profession is it's a cash system.

So, clients have to pay.

When we have clients that are faced with a decision, well, do I pay for my mortgage?

Do I pay for my car payment, or do I pay for my pet?

It's a real struggle.

Veterinarians and veterinary students and technicians and all of us really go into the profession because we love animals.

We also have to understand the animals come with people.

The struggles that veterinarians have with euthanasia and welfare and not being able to do the best medicine for a particular animal really weighs heavily on us, and if the public had an understanding, I think it would be just a much more compassionate area.

- As a result, his ear's in pretty bad shape, but we're gonna clean it out.

Put some medicine in there.

I spent five years as a county veterinarian, and really I'm just a shelter vet.

It was, the county vet title is just a glorified title for, day in, day out, grinding as a shelter vet, but reversing the euthanasia rates and dealing with just endless sad cases, hurt animals.

And the lack of humanity when you saw a barrel full of puppies thrown in and pushed down the river.

When you see cases like that, you start to lose yourself.

Very quickly, I got a dose of what I never really knew existed.

That was compassion fatigue.

So yeah.

So doing this work very quickly, I realized, came at my own personal expense.

That was the cost of caring, and it was a heavy, heavy burden to me.

- So, compassion fatigue is where we as a society, and especially veterinarians, really care about these animals and truly, really care about the clients too.

And when we see the animals struggling, and when we see the clients struggling, and we feel like we can't do something about it, it really, really kind of wears on us.

And it just can become very, very stressful for a lot of veterinarians.

- A side effect of being so compassionate is that oftentimes we focus on the needs and the wellbeing of everybody else first and oftentimes wind up accidentally putting ourselves last in that process.

- Some clients think that you have to go see their animals first, and if you don't, they might get upset.

And even though you try to explain that, we usually work on an order of priority.

So, the most pressing cases first, and then you just work down the ranks.

It's not always something that's comprehended very well by the owners of the animals.

- It is also exhausting to spend your day caring for someone else, something else, and not receiving something in return.

And I don't mean I expect whoever comes through the door to hand me a bottle of wine or give me a thank you card.

But when you give so much of yourself every day, and people are on the phone yelling at you because you didn't call them back soon enough.

You didn't get their prescription refilled in time.

You're not like Doc who just retired.

You don't know what's going on.

And it's like, you're right.

I don't.

I don't.

I can't possibly know because I can't be everywhere and do everything.

I can't, but I can empathize with you, and I can tell you I'm sorry.

And I can tell you that I want to make it better.

And I want to tell you that it's not gonna happen again, but I can't promise that.

- [Caller] Yeah, my name's (censor beeping), and I called yesterday to give a complaint and you know, the vets are on vacation.

Well, why are the vets on vacation?

Because people like me pay for them to go on vacation.

So, it's not important enough for y'all to call me back.

And, I just don't understand.

I talked to my brothers, and both of them are not gonna use you no more.

And everybody that I know, I'm gonna tell 'em definitely don't go down there 'cause all the vets are on vacation.

That's more important than the people you're supposed to serve.

And I've lived in this town for 50 years, and I know a lot of people.

And I guarantee you, I'll bet you call me back now after.

I'm not threatening y'all, but I'm tellin' ya, how y'all are doing business is very not right.

And so I hope y'all are all happy with your jobs down there, and all your vets are on vacation and livin' life up to the fullest.

But I'm tellin' ya, I'm very (...) about how y'all are doin' business down there.

And, like I said, even my brother said, yeah, we don't get treated right down there no more.

Ever since Dr. (...) left, y'all just went to (...).

- [Caller] I'll leave her there and let y'all check her out when you get a chance.

- [Receptionist] ] Yes ma'am, we can do that for you first thing in the mornin'.

- Y'all can't take her now?

- [Receptionist] No ma'am, I'm so sorry.

We cannot handle any more cases today.

We are overwhelmed.

- [Caller] My husband's very, okay?

I'll come up with somewhere else now.

I mean, I have never, I have never.

Ever since I've known (...), I have never had nobody down there turn me down with my animals.

Now I tell you it's gettin' bad, but okay, that's fine.

God will take care of it.

- [Receptionist] Would you like for me to put, okay.

(somber music) (Hailey sniffling) - I'm the first person that they talk to.

They're home.

They decide that it's time.

Their pet is sick and dying or hurt, and they call me.

I answer the phone, and I am the one that has to talk them through the process, talk them through the decision making.

When it's time, when it's time to talk to the doctor.

I have also been the one who sits in the room and holds somebody's dog because they can't be here.

I have been off work and shown up here and held some of my favorite pets while they passed because the people just can't.

- Most of the time I can maintain my professionalism there, but every once in a while I just, it's all I can do to get out the door and just go find like a quiet little place and just cry.

You know, let it out.

- Veterinarians face death at a higher rate than human physicians do because of the lifespan of pets.

- Letting pets go and those euthanasia experiences that I go through have become harder and harder.

- Especially what gets me more now is when you've seen a puppy come in at six week old that you could put in the palm of your hand that now 15 years later is succumbing to whatever chronic disease or whatever.

And having to, in the exact same room you saw it as a six week old puppy euthanize that patient 15 years later.

It's, you've put your heart and soul into that patient, and it's very, very tough.

It weighs on you.

- You know, I find myself in this situation in this profession where I have to destroy my patients some days and then expect that at the end of the day I'm gonna walk home like nothing happened.

And then get up the next morning and keep doing this.

And you're not.

And people wonder why, you know, maybe we break down a little more than others or why we suffer from intense compassion fatigue, and why our suicide rate is higher than anybody else's.

And to me, that's why.

- And maybe I can understand that more than others 'cause I felt that pain.

I felt as America's veterinarian that helping pets hurts me.

The burden sometimes just feels like it's too much.

- I know that I get really upset if I can't save an animal.

I get really, really frustrated with myself, and I beat myself up for a long time.

And I actually had a doctor tell me at one point in my life that doctors and veterinarians, they carry little graveyards on their backs.

- There was a day before Thanksgiving this past year that I did seven in a day, seven euthanasias in one day.

I mean, that's the majority of your day takin' an animal's life.

- And tied to that is the moral stress of when maybe euthanasia has to be used because either finances are not there, or a lack of reverence for the animal's life, where it is a, they call it a convenience euthanasia.

They have to navigate that conversation, which can be very morally complex and uncomfortable for them.

- The hardest one is when you don't have a relationship with the clients.

In my opinion, it's somebody walks in you don't know.

They have a 12-year-old dog, and now it's having these problems, and they're ready.

Now, I'm sure they're right.

I'm sure they're right in what the decision that they're making, but in the back of your mind it's like, why?

I mean, I know maybe the dogs drinkin' a lot more water and peein' in the house, but is this somethin' simple or is this something?

So, you have to know that what they're doing is right for them, and they're tryin' to help out their baby.

They brought it to you.

They brought it to you because they wanted it humanely euthanized.

- And then we gotta actually do the procedure of letting them go.

And it's hard.

(sniffling) (traffic whooshing) (staff chattering) - [Emily] So, Riley's here for a quality of life exam.

The owners feel like, he has some good days, some bad days, but his biggest thing that he is doing that is hard for them to see is that he's urinating and defecating in the house.

He otherwise seems fine.

The dog's in there barking and wagging his tail, and he has really good energy, a good appetite.

His mobility's a little decreased, but basically I'm trying to talk the owner into giving me like a week with medications to try something.

But I also respect the owner, and he knows his dog best, and he feels like the quality of life is affected.

So, if he does choose the euthanasia route, it'll be hard for me because I'm only seeing one side of the story.

But I respect that guy's opinion, and I understand that it's hard to make this decision.

He seems really upset with the decision that he's faced with, but I wanted to at least give him a try with something because I think I could get this dog a little bit more comfortable.

I also offered doing blood work just to see if maybe the dog has kidney disease or is diabetic, or there is a reason, and that might actually help us make the decision.

So, that's why it's a tough situation.

He came in thinking it was a straightforward euthanasia, no questions asked, but have to ask questions when the dog's looking at me, wagging its tail, and barking, and seems really happy.

So, he's talking to his wife right now, and they're kind of going back and forth.

So, tough position.

- [Interviewer] How old is the dog?

- [Emily] He's 12 and a half, yeah.

All right, I'll send my nurse in just a second.

(door clicking) Euthanasia, yeah.

So they decided to go forward with the euthanasia, and I support them.

It sounds like the last couple weeks have been really hard for him.

He said that today is a good day, but the good days are pretty rare.

And he liked to let him go out on a high note, so I support him.

- [Staff Member] Okay.

- [Emily] It sucks, but they know him and love him the most.

So, I can tell that that's the right decision.

Hi, baby.

Hey, sweet boy.

He's so sweet.

He has many bad days and some good days.

Today he's having a good day.

So it made it really hard for the owner to make this decision and hard for me to understand why, but I trust him.

He wants him to go out on a high note.

- [Staff Member] You want me to put him in there?

- [Emily] Oh my gosh, that's so cute.

Yeah, I'll meet him in there.

- [Staff Member] What room?

- [Emily] Room three.

Meet you in there, buddy.

- [Staff Member] Nomann, what am I drawing up?

- [Emily] All right, I got the biggest, comfiest blanket we have.

I'm just gonna have you lift him up, and we can put 'em on this so.

(staff chattering) (machine beeping) - [Interviewer] Tell us how it went.

- [Emily] It went very smoothly.

You know, the guy, he's really just a compassionate guy, and he, the whole time was just like, I'm just happy you had a good day.

And just talking to him through the whole thing, like, I love you buddy, things like that.

Those heart-wrenching things that they say.

- [Interviewer] And how do you feel?

- How do I feel?

I'm sad, but okay.

It was, I think it was the right decision ultimately.

And like I said, sometimes you just have to trust those owners who know their dog the best, and I did, and he was a really nice guy.

So I do trust him.

So, I feel at peace with the decision.

I would not have done it if I didn't feel at peace with it.

Yeah.

(traffic whooshing) (car horn honking) - I'm Dr. Tracy Witte.

I'm a professor in the Department of Psychological Sciences at Auburn University.

My main area of research interest is suicidal behavior, and it really wasn't until I got here to Auburn that I started to get interest in veterinary mental health and suicide.

When I started to do a little digging into the research literature, I noticed that there was an elevated suicide rate in veterinarians.

When I had started here, I was mainly doing a lot of theoretical research based on a theory that was devised by my graduate school advisor, Dr. Thomas Joiner.

His theory is known as the interpersonal theory of suicide.

And in a nutshell, the idea is that in order to die by suicide, a person needs to have three things.

One is feeling really disconnected from other people, so thwarted belongingness.

Another is feeling like a burden on other people, so perceived burdensomeness.

And the third thing is known as the acquired capability for suicide.

That's the most novel part of the theory.

The idea is that suicide is something that's really scary and really painful.

And even when people are intensely suicidal, and they're feeling really disconnected, feeling like a burden, most people aren't able to actually kill themselves, thankfully, because it's scary.

So, I honed in on acquired capability and thought, there's not really any other profession I can think of where people are engaging in euthanasia, which is a key component of practice.

And it's a really important function to end the suffering of animals who have reached the end of their lives.

But I started to wonder, I wonder if that experience makes the concept of death less scary and makes it seem less aversive.

So, when combined with thoughts of suicide, so combined with feeling disconnected from other people, feeling like a burden, someone who has that experience of performing many euthanasias might be able to kind of get past that hurdle and end their life.

So back in 2010, the first project that I ever did was with students at our vet school here.

I looked at experience with euthanasia, the degree to which that was correlated with fear of the concept of your own death.

What I found in that study was that students who had more experience performing and observing euthanasias had lower fear of their own death.

That brings us to our 2019 paper.

In this study, which I think was one of the first to look at thoughts of suicide, we found elevated rates of suicide ideation, so thoughts about suicide, in veterinarians compared to the general population.

The other thing that hadn't been done before was being able to look in detail at the suicide methods that were being used.

Many people had wondered about the role that Pentobarbital and euthanasia drugs might have in veterinary suicide.

In our sample, the number one method that was used in general for both men and women was overdosing.

Then within the overdose category, Pentobarbital was the most common substance use.

You don't see that in other populations.

(buttons beeping) (safe beeping) - [Staff Member] Can you help us with any?

- [Kayla] Okay, so the solution that we use for euthanasia is called Pentobarbital, and it's a controlled substance.

So, it's only allowed to be drawn up by a doctor, an RVT, or I have my controlled substance license.

So, we're able to draw it up.

Each time you pull up anything from the bottle, you have to log how much was in the bottle before you used it, log how much you're drawing up, and how much you are, what the weight of the bottle is after you have drawn it all up.

And then, the doctors like to use what's called Propofol, which is an anesthetic.

We use it to induce anesthesia, but for them they like it 'cause it kind of acts like a sedative for the patients.

It makes them nice and sleepy before the entire situation.

So, the owner has a little bit of time to kind of see them nice and relaxed before we actually proceed with the procedure.

(staff chattering) (dog barking) - These studies have shown us that euthanasia solution is the number one method that veterinarians choose when they choose to die by suicide.

- They're right there at our fingertips.

And right there.

We do it every day, and we become used to euthanasia in a way that most people are not.

We don't like doing it, but we know that it happens, and we relieve suffering.

- A good friend and colleague, Dr. Andy Roark, he started a campaign called Four Eyes Saves Lives, where we talk about how euthanasia solution is always gonna be in vet clinics, but two people need to be there when we're dealing with euthanasia solutions so we can keep each other safe.

- We have a way of ending a life that we do a sales pitch for all day, every day.

And we talk about being compassionate, and we talk about being kind, and we, that's what we do.

That's the language that we use.

I think practices should look into making it so that individuals cannot get access to lethal drugs on their own.

I just, I think that that should be a focal point.

I think there's a lot of things that we can do as an industry for suicide in that way.

- The ability to just walk to a cabinet and get a dose of euthanasia solution and know exactly what the dose is is something that just makes the decision to die by suicide just a little bit easier.

- We made it really difficult for our veterinary technicians to get into the locked box of controlled drugs.

So, we decided to change our technician protocol to two thumbprints.

So, they have to ask someone.

And then for the doctors, we decided not to do two.

It's one because we need to access drugs really quickly sometimes, and this was already a little bit of a burden.

We used to have a lockup key with two keys, but this is even safer because it's actually your fingerprint.

It is something that you take very easily, and you need to make it harder for veterinarians to have access.

And then, voila.

(drawer clicking) There are my drugs.

(drawer clicking) - I think that shows how important putting some procedures in place around that medication, how important that really is.

(wind whooshing) (birds chirping) (traffic whooshing) (water gurgling) - [R.W.]

They'll fall all over each other.

Yeah, the yellow one's up there now.

- I think it's funny you have a dog named Peach.

James' nickname he clowned when he was in a young boy with the church.

- [Interviewer] Yeah.

- And he was Peaches the Clown.

- [Interviewer] Oh my God.

- So that's what Worth called him a lot of times, Peaches.

James loved making people laugh.

He was a very kind, caring person.

Loved animals.

He loved his family.

He loved his friends.

He just enjoyed life.

(dog barking) - [R.W.]

Go get him.

- Okay, we're gonna get this.

- [Julie] So we were always laughing.

I mean, when we were around James, you always laughed and felt good.

He was one of the good guys.

Very kind, very caring, just out there, fun.

He kind of always colored outside of the lines though, so he could be a challenge at times, but that's okay.

- James was a good kid.

He was very caring, very loving, good youngin'.

He really was.

- He brought a lot of joy and just laughter.

When I think about James, that's what I think about.

He was always gonna have fun, and he was gonna make the people around him have fun.

- But he wanted to be a vet, and he became one.

- I met James when he came to the hospital that I was working at for his rotating medicine and surgery internship.

So, the things that were really remarkable about James, things that just made him like nobody else was, first of all, his love for cats.

Just crazy, crazy love for cats.

And I remember this cat that we had as a shared patient who had cancer, and her family had elected to euthanize.

And this is gonna be the last day of her life, and her family was gonna come after work to be able to spend some time and euthanize her, unfortunately.

And James made it his mission.

He was like, you know what, this is this cat's last day.

This family loves her.

This could be my cat.

And I remember him going into our treatment room and spending the whole afternoon and late into the evening to spend time and make that her best last day that he could.

So, he was really remarkable.

(gentle music) - He saw the sad side of being a vet and that he was so tenderhearted and so compassionate.

That was hard for him.

You know, he wanted to save 'em all, but he knew he couldn't.

- People who go into veterinary school are top-notch.

They're the highest academically achieving usually in their programs that they came from.

- I think in the end, James was focusing on all the negative things instead of all the positive things in his life.

And I think that was just the straw right at the end that he just couldn't push through.

I remember the Saturday before, sorry, the Saturday before he took his life on that early Monday morning.

I looked at him and said, where's my James?

Part of me understood if he was in so much pain that living hurts more than not living.

That's the hard part.

That's the hard part.

- He was a brilliant young man that had a series of unfortunate events, and he was a bad environment.

- Yeah.

- And we've, he's gone.

And I'm mad, and I don't know what to do 'cause my son and all of his wonderful knowledge and love and care, he's gone.

One of the images in my mind is seeing him with that beard and that bow tie.

- I was working an emergency shift with a veterinary technician who I had trained and was a wonderful human being, and she chose to take her life on my shift by injecting herself with euthanasia solution.

And I was the one that found her in her car.

That will always touch my heart.

And she was in a lot of pain, and I wasn't aware of that.

And I don't know how many times I've thought back, and wondered why didn't I know?

What could I have done differently?

We need to raise the awareness within our profession.

We need to think about how we can better care for one another.

We should be asking questions when we see any signs of concern or just checking in with one another.

How are you doing?

Have you thought about taking your life?

It turns out that the research shows that asking that question does not increase the risk of suicide.

It actually may lead to some information that helps us intervene.

- But I think people don't realize where they are in the pain of life, the experiences and expectations when they're there.

Early in my career, I felt that pressure and stress was just great.

Kept me from fallin' asleep on the job, you know?

And I like exciting things and a busy schedule, and it took a long time for me to realize the deleterious effects of that day-to-day stress.

But I think only when people drop to the depths, can they see where they are.

I didn't see the signs early enough, and I'd have to say that I did feel suicidal, and I recognized in myself a suicidal ideation and preparation.

By the time I was in deep trouble, I was in deep trouble.

And then when things started falling apart and fell apart, and so I had to realize, oh my gosh, what am I doing here?

But fortunately there were resources like Dr. Strand pointed me toward, and most crucially this resource.

(gentle music continues) (people cheering) (upbeat rock music) - [Man] Good job, good job.

- [Runner] Thank you, thank you, thank you.

- [Woman] How was it?

- It was long.

- Boy, we owe it to everybody to come clean and speak honestly and speak from where we've been 'cause we gotta take care of each other.

(inspirational piano music) - [Kelly] This is the only ride I've ever done across the United States.

Meeting over 50 hospitals on the way across the United States was incredible 'cause most of 'em didn't know about NOMV or the problems.

So, it was nice to spread awareness that way.

And if the ride helps one person not take their lives and or life, then it's, every mile is worth it.

- I love what I do.

I go to work every day enjoying what I do.

- Veterinarians are recognizing that it's okay not to be okay.

It's okay to ask for help.

It's okay to take care of myself.

- I think from the practice standpoint of just enforcing breaks and lunch breaks, coffee breaks, whatever, going home on time, those are things that happen at the systemic level to say you're gonna get off time.

No one should get to the end of the day, and say, I didn't have time to go pee.

And I hear that all the time.

And like, those are small things, but those are important things.

- And so, one of the things that I think has changed the most in veterinary colleges across the country is that now this problem's been recognized.

They have mental health counselors that are dedicated just to the students.

Many of them have counselors that are dedicated to the clients, and so that they're not havin' to wear multiple hats.

And people are recognizing how valuable this is.

So many of the counselors that are at these universities, their schedules are, they're packed.

They are making a difference every single day.

- My name is Ally Olsen-Gerlach, and I am a senior Animal Science major at WT, and I'll be attending vet school in the fall.

- My name is Kelsey Shields.

I am a senior Animal Science major here at WT, and I will be attending vet school in the fall.

- This is one of those things that we've worked for for like nearly our entire childhoods, and to finally get that email that says congratulations is mind-blowing.

- I mean, I'm thrilled to be a veterinarian.

- Being a veterinarian is part of who the veterinarians are to begin with.

So no, I don't see myself doing anything else.

- You know, I love my profession.

I love being a vet.

- And I don't wanna make it all seem, veterinary medicine to seem so glum because it's not.

We get to smell puppy breath.

We get to see pets that are so happy to see us that their tail wags so vigorously from side to side it lifts alternate back legs off the ground.

And to have a pet that, even though it's in pain, that gives you the equivalent of a canine tonsil swab, there are amazing joys in veterinary medicine.

So the next time you see a veterinary healthcare professional, thank them.

(inspirational music continues) - My hope is that from a documentary like this that people will understand a little bit more about what's going on for that veterinarian.

One of the sincerest hopes is that that would result in a greater sense of empathy and compassion.

When we have a pet, I think it's really helpful for us to think in advance about their medical care and about the costs that could be associated with that.

- Get health insurance for your pets.

Save money for that so that you can pay for your pets.

You can go to your veterinarian, and you can ask them, do they have a Good Samaritan fund?

And you can give to their Good Samaritan fund so that when they're faced with a morally complex case, they can take care and save an animal just from their heart.

- We try not to make money an issue if we can avoid it.

So, I mean, you didn't go to vet school because you wanted to get rich.

You went to vet school 'cause you wanted to help out animals.

So at the end of the day, it's pretty easy to fall back on.

- We have the challenges that we have because the work that we do matters and because it's rewarding.

- At this point, would I ever consider another career?

Absolutely not.

There's so many things you can do as a veterinarian, and it would be impossible to go through the world and life and have been a veterinarian and not be constantly drawn back to that.

- [Jim] While this is a profession with a lot of challenges, I have to say that I genuinely believe it is still a great profession.

In fact, I might even argue that it's the world's finest profession.

That that might be a little over the top.

But the reality is that helping animals, helping people can be tremendously rewarding.

It's not a gloom and doom situation that we're in.

In fact, veterinary medicine can be really satisfying.

- Let me show you my animals.

This is Nora and Fanta.

I've grown up around them.

They're super cute.

I love them.

And then I have six cats.

Some are in the kitchen.

Some are in the living room.

Some are in the bedroom.

They're scattered everywhere.

These are my baby chickens.

They're not fully grown yet, so we can't put them outside with the other big chickens yet.

This is a mama and her two baby kittens.

She's only gave birth to one kitten, and she adopted another kitten.

I really wanna be a veterinarian growing up 'cause I feel like I have a lot of experience, and I know a lot about animals.

So, I really wanna be a veterinarian.

- I'm so grateful that long ago I decided to become a veterinarian.

I've been through ups and downs in the field.

I've suffered from burnout.

I've suffered from compassion fatigue.

I've lost dear colleagues to suicide or simply leaving the profession.

And yet, along the way, it's been so satisfying and rewarding to help animals, to meet wonderful people who care for those animals, to work with an amazing team around me, to enjoy work that is challenging.

Compassion fatigue, it's a real thing, but I don't think we talk enough about compassion satisfaction.

So, compassion fatigue is the cost of caring.

It is very real, and compassion satisfaction is the flip side of that.

And that would be the joy, the satisfaction, the rewards that we can experience by knowing that our work is really making a difference.

And so for all those reasons, I feel lucky to be a part of this profession.

(lighthearted piano music) (lighthearted soft rock music) - [Announcer] "The Cost of Caring" is made possible in part by.

(cat purring) - [Person] Woo woo.

(cat meowing) (gentle music) (upbeat music)