Melanie Bowden, DVM
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As I mentioned before, I am a veterinarian. And it's been my experience that most people don't personally know a veterinarian in their own life. They may have one that they go to for services, but they don't have one as a friend or a family member or something like that. And as such, I found that very few people can relate to what I do for a profession and really understand me as a person. So to get us all on the same page, I wanted to start by just going through some facts about the veterinary profession. It took me ten years to become a veterinarian. That includes four years of undergraduate work, two years of post-bacc studies while working as a veterinary assistant to gain clinical hours. I then enrolled in WSU College of Veterinary Medicine - "Go Cougs" - and there did three years of lecture and lab work and then a rotating year in clinics, where you get to practice with animals, under supervision. $286,000 is approximately the amount of student loan that I took just for WSU alone. I affectionately call this my "brain mortgage." It equates to $1,100 a month for the next 30 years of my life, and I will make my last payment when I am 62. 60% of veterinarians are now female. We broke the 50-50 mark when I was a sophomore, and so I'm really excited to be able to be a female representative of veterinarians today. We have a problem within our industry where more veterinarians are leaving the field than coming in every year. It's about 5% attrition rate right now. Some of that has to do with the fact that baby boomers are leaving, but it also has to do with a lot of compassion fatigue and burnout that's happening amongst my colleagues and the fact that they're choosing to leave because they just can't do it anymore. This next statistic is hard to transition to in any type of gentle way. Of the veterinarians who have died since 2010, 10% have committed suicide. Of the veterinarians who commit suicide, 75% are your small animal veterinarians that work with dogs and cats. Three is the number of my friends who are veterinarians who have taken their own lives since I graduated in 2016. All of them were in their first five years of practice. And then there's me. As a female small animal veterinarian with a high debt load, I represent one of the highest groups for suicide rate in our country. And my profession is ranked number two, just behind police officers, but I am three and a half times more likely to take my life than anyone else in this auditorium today. I'm sure that was really shocking for most of you to hear and not what you expect when you come to hear a veterinarian talk. (Laughs) The vast majority of people I introduce myself to picture me doing something like this. And they're not wrong. There are definitely great moments in veterinary medicine, and I love what I do. But usually I am snuggling a dog like this because I just dealt with a case like this. So I'd like to take you through a day, a typical day, at my veterinary practice, right now. It's going to come at you pretty quickly, and that's okay - that's how I experience it myself. On this particular morning, about two or three weeks ago, I arrived at the office around 7:45. I like to get there a little early so I have time to review my schedule, what's coming in that day. On this particular day, I was met in the parking lot by my technician: "Dr. Bowden, you've got to come in right away. There's a pet here; the owner's crying. I don't know what to do - it's dying." I was like, "Okay, I'm coming." Ran into the back, assessed the pet, turned to the client, and turned and gave her my poor prognosis that the pet really wasn't doing well. She turned to me, and she said, "But Dr. Bowden, you have to save her." And so I turned to my team, "Guys, we need to place a catheter and start fluid boluses. I need monitoring on this pet, blood work, X-rays, stat. Let's get going." They're rushing around, trying to do this stuff. Everybody's dropped what they're doing to focus on this pet. And while we're initiating treatment, the pet's heart stops. And so we start CPR, but she dies. And the client's bawling in the back with us, and so I turn to offer her a hug, and I'm consoling her. But I'm distracted because up over her shoulder is my other technician, Sarah, and she's popping her head around the corner, obviously trying to get my attention. And so as [gracefully] as I can, I transition from my hug and embrace of this client to go figure out what's going on with Sarah. So I walk over, and Sarah says, "Oh, Dr. Bowden. I don't know if you know, but it's 8:20. Your first appointment's at 8:00. She's waiting, livid; she's late to work. She said if you're disrespectful of her time, she's going to leave, put it all over Facebook." I said, "Okay, no worry. I'll go in right now. What is she here for?" "She has a new puppy; they need vaccines." Great. So I walk up to the door, and I take a deep breath to compose myself. (Breathes) I put on my best, award-winning smile, I open that door, and I say, "I am so sorry, Mrs. Smith, you have my complete attention. Oh my gosh, who's this cute little puppy? Where did he come from? Congratulations on your new family member!" And our day progresses from there. In the next room, I had a dog that has chronic allergies. The client was upset because she spends so much at our practice, so I printed all of her invoices to show to her, for the fifth time, that if she paid for the allergy medication, it'd be a lot less expensive than seeing me all the time. In the next room, we had a dog that had a bum leg. He blew out his knee; he needed orthopedic surgery. Put that on the schedule for next week. Then I had a couple of wellness appointments, thank goodness. Those go quicker: they just need vaccines. Then, I was pulled aside by another technician, who said, "Dr. Bowden, we have a couple of drop-offs here." For those of you who don't know, when a veterinarian's schedule is completely booked - there's no more availability, but your pet is sick - we offer a drop-off appointment, which basically means the small shreds of time I have in between appointments, I'm going to see your pet and make sure that they get the care they need. So I pop into the back to assess these animals that weren't on the schedule. One had gotten into the trash. It was vomiting, diarrhea all over the house - big mess. Weren't sure if it had a foreign body or maybe it just had dietary indiscretion. And we had a pet with diabetes that we were worried was really ill and might be in a life-threatening condition called diabetic ketoacidosis. And a cat had been attacked by a dog, and it had wounds that needed repair. I triage these pets, give my technician the treatment plans, tell her, "Call the clients, get it approved. I'll talk with you later." So, head into my next appointment. So one of my favorite clients - she's a little old lady, lives at the retirement facility at the end of the road - she comes in mostly because she wants someone to talk to. She doesn't have family in the area - her husband passed away recently. And her decrepit, old, ancient, cute cat is her last remaining connection to her husband. And so she really wants Fluffy to just live forever. And so after that appointment, I walked into what we call "same-day access," meaning an emergent appointment that had to be booked that morning. And there is a pet that can't stand. Went to the bathroom, didn't come back in; owners went out, pet can't stand up. So I'm talking to them about it, and the female client's like, "Yes, Dr. Bowden. Everything you say, we're going to do. We'll go to WCU, see the neurology specialist. We'll do back surgery, whatever it costs. Money's no option." And her husband's like, "I don't know what she's smoking, but we're putting the dog down." (Laughs) So I have to bring them on the same page and advocate for what's best for that pet. I leave this, and I go into a phone call slot. Phone call slots are for what it sounds like: phone calls. I have lab work to call people back on, medical records I need to do. I need to call those clients with those drop-off pets and figure out a plan for them. I'm sitting down to do all this work, when my receptionist pops in. She goes, "Oh, Dr. Bowden, so glad I caught you - you're not doing anything. (Laughs) Mr. Johanson's up front. He came in for that diet for his cat, about the crystals. He doesn't know how it works. I don't know if you know I'm really busy. I have a whole line of people up front that I need to address, so I was really hoping you could come up and talk to him." And I said, "Of course, that's what I'm here for." So I walk up front and talk to Mr. Johanson and in doing so, know that now I'm not going to have a lunch hour, because I was going to sedate that cat and do that. I'm going to have to stay late and make all these phone calls. And guess what time it is? We're only at 11 a.m. It's not even lunch yet. (Laughs) And that's a very typical day at a veterinary clinic. It's not a bad one; it's not a stressful one. That's just my day. The vast majority of veterinarians are scheduled for 50 hours of work a week. They often end up working far more than that. They have to make, you know, phone calls; they need to connect with their clients. And so a lot of times, they end up having to stay late to do this after hours. The vast majority of, you know, my friends and colleagues also end up needing second jobs, which I never thought I would need. And so I pick up extra relief shifts, and on weeks that I do that, I end up working close to 80 hours. Being a veterinarian takes a lot more than just my medical training, which is something no one told me in school. I'm expected to be a counselor, an educator, a financial adviser, a team leader. I am the face and reputation of our business. When we can't fit this impossible standard, when we can't possibly fit in one more pet without compromising the care of others or compromising the health and well-being of my team by making them stay late, we're often attacked by our clients for being incompetent, for not caring, and in worst-case scenario, they sue us. There is this particular case that I will always remember. It was a cat named Ollie. And Ollie came in because he'd been straining to urinate for two to three days and the owners thought it was really painful. We were really hoping - it was at close, we didn't have time - but we were really hoping that it'd be something easy, right? Like maybe Ollie just had a urinary tract infection - we could give him some antibiotics, and everyone could go home. But, of course, it wasn't easy. Ollie had a urinary tract obstruction, which is when they develop stones, they can't pee because it gets stuck when they're trying to pass it, and they die. And so I told this to the client. I explained what was going on, and I let her know, "You'll need to go to the emergency clinic. This is beyond what we're able to treat today." And she turns to me, she goes, "But I can't afford to." I told her, "Well, you know, this condition is life-threatening. He's obviously in pain, and there's no guarantee he's going to survive treatment. There's no guarantee it won't happen again - actually, in 50% of the cases, it does. You know, one of our options before us today as well is euthanasia." And she turns to me, and she says - and I will always remember this in vivid detail - "Dr. Bowden, you're going to make me murder my pet because I am poor." And she follows up with, "Why are you even a veterinarian? You clearly don't care about animals." And I should have said something rational, like "No, I'm offering euthanasia because your pet is in pain and suffering and will die." But instead, I fled the room because it had struck a chord. It was the end of a long day, and I was going to cry, and I didn't want her to see the impact that she'd had on me. I went to the back, and I turned to my team and said, "Look, these people really don't deserve our compassion, but Ollie needs our care. And so I need two people to volunteer to stay late and help me treat this pet." There is nothing more soul-crushing in life than having the skills and ability to help something helpless, and you can't do it, because someone can't afford treatment. And in Ollie's case, we were able to save his life. But I didn't do it for them. I did it a little bit for Ollie, but mostly I did it for me because at the end of that day, my mental health could not take taking that guilt home. So I took the consequences. I got berated by my practice manager the next day for adjusting the bill to what they could afford. My paycheck was docked for the difference. But I'd saved a life. And I understand and empathize with my colleagues how on the end of a really bad day, a bad shift, they get to a really dark place. And they sit at home, and they think about how, cuffed by their student debt, there's no escape except to repeat this pattern of burnout and compassion fatigue over and over and over again for 30 years. And in my profession, if a soul is suffering and there is no treatment option - there's no other way out - it's not only acceptable but compassionate to euthanize. And we end up with headlines like one I read a couple of years ago. I believe that veterinary medicine can be different. Our profession is working really hard to take responsibility for the part that is our own in this problem. But profession-wide change is really hard, and it's slow, and it's unlikely to help someone like me, suffering today. And that is why I took this stage. Because I believe the people that have the most impact on my friends are all of you. There are two groups available to us - one's called Not One More Vet, the other one's called the Veterinary Confessionals Project - where veterinarians can reach out and vent or talk about their issues with compassion fatigue, burnout, and suicidal thoughts. And the postings that I read over and over and over and over again are those about how every perceived failure, every time we have to euthanize a pet because we're unable to help, every time we have a negative client interaction or there's a bad review about us online, it slowly chips away at our humanity and our love for this profession. But the posts that really scare me are the ones where it alludes to the fact that a really negative client interaction, maybe like the one I had with Ollie's parents, tip the scale, and it made that day their last day. You'll see hundreds of veterinarians post below that, "Call me - here's my cell phone number." "Reach out - you're not alone." But they never respond, and you just don't know. And I bet you that that client has zero idea the impact that their words made that night. I believe that change is going to take open conversations like this one, where we truly understand how we impact each other. I think it's going to take being more compassionate and empathetic as humans, in general, and really listening to each other and meeting each other where we are. But it's also going to take the general public understanding what it looks like to be a responsible pet owner. Because I guarantee you - no veterinarian ever wants to be in the situation I was in with Ollie. And if we could stop that from happening, I'd be elated. So every single client I see that comes in with a new puppy or kitten, I recommend they get pet insurance or they start a savings account for their animal. Because that little puppy or kitten - the one thing I can guarantee is that it will grow up, it will get older, it will get sick, and it will die. And difficult decisions and discussions will have to be had around not only what is medically possible for that animal, but what you can financially afford and what your lifestyle actually allows you to do in terms of management of chronic disease in your pet. I also believe that people should not give pets as gifts, even to your own children, because pets not only are a financial commitment but one of time. Pets need love, they need socialization, they need training, they need exercise and mental stimulation on a daily basis. And I see far too many people coming in and asking for sedation or tranquilizers or anti-anxiety medications because their young Lab is bouncing off the walls and they just can't handle it at home, when really he needs a training class and he needs more exercise. But the biggest thing that you can do - and I can't underscore this one enough - is you can partner with your veterinarian to be a proactive member in the health of your pet. Whether or not your pet is healthy or sick, needs vaccines or not, you should be seeing your veterinarian every single year for an exam. Through the detection of disease early on, I can be my most effective for you. Disease is not only way more treatable but sometimes even reversible, and it's less expensive, and there are far more options available to us. By partnering with your veterinarian, we can get what we both are seeking. You are in my office because you love that creature. It means the world to you. In many cases, it's your child. I am there because I equally love that animal. And both of us want Fluffy to live the longest, happiest, and healthiest life possible. And that is why I became a veterinarian in the first place. Thank you. (Applause)