Editor's note: This is one in a series of stories looking at front-line fatigue among health care and other workers in Utah.
In a Layton emergency room, Dr. Kara Tassone does CPR on one person's beloved pet on one table while her colleagues give oxygen to another animal on the next table when the phone rings. One of the staff members rushes to answer in the back room only to be shouted at by an irate pet owner complaining about the extended wait time that has become typical among veterinary hospitals and clinics during the pandemic.
"You can't tell that we're likely saving a life. You can't see it from outside of the room. You can't see the chaos," she said. "And of course, there's someone in the corner cuddling a kitten amid all the mess and criticism, because there's that happy aspect, too."
This kind of emotional roller coaster isn't new for veterinarians, but the pandemic has placed even more pressure on an overwhelmed system. Experts largely agree that the veterinarian industry has been facing a mental health crisis for a long time before COVID-19 emerged, to the point of having the highest suicide rate of any other profession.
In 2018, the Centers for Disease Control and Prevention released a report analyzing 36 years of data that showed that during that entire time frame, the suicide rate for veterinarians was significantly higher than that of the general population.
A study released in January 2020 showed that veterinarians report higher levels of burnout than physicians despite working fewer hours and are 2.7 times more likely to attempt suicide than nonveterinarians.
The very first thing Tassone said was that she absolutely adores her profession. She and her husband are both veterinarians and get to do what they love every single day, which is a dream come true for them and not something most people can say. But that dream isn't exactly constant bliss.
She explained that it's not unusual to have to go from euthanizing a 13-year-old dog the vet has treated since puppyhood to greeting an affectionate new puppy in the next room. Then after work, she toasts a drink to each patient she loses that day and picks a favorite photo of them to keep in remembrance. The emotional highs and lows can lead to emotional exhaustion and compassion fatigue.
That fatigue in turn can lead to depression, anxiety, post-traumatic stress disorder, withdrawal from friends and family, substance and alcohol abuse, becoming more irritable or emotional in their personal lives and leaving the profession, Tassone recounted.
"People don't get the emotional toll we take home with us," she said. "The workforce we are surrounded by is dwindling and hurting."
Veterinarians have created groups like Not One More Vet, an organization dedicated to preventing veterinarian suicide by using social media support groups and even hiking or yoga groups to try to address these issues, which have helped on an individual level. But the suicide rate among vets has remained steady.
Never catching up
The morning before Dr. Isaac Bott was interviewed, he had a plan and a schedule. That schedule was then completely derailed by an emergency C-section on a 100-pound Great Pyrenees with 12 puppies.
He was in surgical gear with blood spraying all over his face and scrubs, giving his best effort to take care of the furry family member entrusted to his care. Meanwhile, the owners were getting increasingly upset about the 30-minute delay without knowing the intricacies of the unexpected procedure.
Operating on animals requires a lot of the same tools, skill and technique that operating on humans requires, except the patients are usually smaller, the staff is much smaller, there are usually fewer resources and most patients don't have insurance. And the pandemic has just made things worse.
During the initial outbreak in Utah, elective surgeries for animals were put on pause. Bott said his practice couldn't spay or neuter dogs for three months.
"We never recovered from that. We're still trying to catch up," he said.
He added that a lot of the stress of being a vet is the sheer volume because the ratio of pets to veterinarians in the country is around 1,500 to 1, and the divide continues to grow during the pandemic to the point that many clinics aren't taking new patients.
"The pet ownership and animal market has nearly doubled. There's already a nationwide shortage before the pandemic, and now the caseload has doubled and the resources have dwindled until the demand is quite high," said Dr. Shawn Zimmerman, an assistant professor for the Department of Animal, Dairy and Veterinary Sciences at Utah State University.
Animal ERs like the one in which Tassone works have been taking some of the overflow for the backlog of unperformed surgeries.
She also mentioned that the overwhelming workload has been even higher since the pandemic started because people were home with their pets and sought out higher-end care for problems they may not have noticed when they were not working out of the home.
Just like what has been happening with humans, once things began opening up and people started bringing their animals to public areas like dog parks again, there has been a spike in upper respiratory infections. The animals' immune systems were weakened by the isolation and pets are now developing and spreading these infections.
There are also the pandemic pets who didn't get the proper socialization during quarantine and bite and injure other animals or start presenting with more behavioral issues and anxiety when their owners spend more time away from home.
And of course the preventive measures against COVID-19 also added another layer or two of work, like spacing out appointments for social distancing, cleaning and disinfecting every time an owner passes through a clinic and running a new curbside service.
Tassone mentioned that the day practice where she worked for about a decade has seen turnover time double because of these pandemic-specific safety procedures.
Despite all of the precautionary measures, Bott, another veterinarian and two full-time technicians from his practice got COVID-19 in July. They had to shut down the business entirely for two weeks while everyone recovered.
Bott became very ill, though not ill enough to be hospitalized. Afterward, it took him six months to get his energy back and the clinic is still feeling the financial impacts of closing.
"Instinctively we think as soon as the pandemic is over, it's going to end. But we have to be real, this is not going to stop. This is just going to be our reality from now on," Bott said.
He has tried to combat the panic about the mass burnout because of the high caseload by trying to have fun events for his workers, like going to concerts, barbecues and parties to try to divert their thoughts from the difficulty.
All of the veterinarians interviewed for the article mentioned that vets also frequently take on more work than they can handle because they care so much for the animals and can't bear to turn them away.
"Just seeing one more pet ... that takes your 6 p.m. end of the work day to 7 p.m. Then there goes your babysitter. Then your dinner, and now life's in chaos," Tassone said.
A parallel outbreak
Since March 2020, there has been an outbreak of a virus that is almost entirely preventable if the population is vaccinated appropriately. Unfortunately, because of the decisions of a small portion of the population to not use the proven vaccine, a resistant strain has emerged, causing a severe disease that attacks the whole body, sometimes to the point of fatality.
No, this isn't the coronavirus. This is parvo, the canine parvovirus, which is seeing a spike among puppies who were not properly vaccinated during the early months of their life, who are picking the disease up from public spaces like dog parks.
The illness includes vomiting, diarrhea, dehydration, a suppressed immune system and sometimes even sepsis. Most puppies spend four to 10 days in the hospital, but when they go home their survival rate decreases from around 90% to around 60%, even with all the money and resources in the world.
Tassone recently lost a patient that was in the hospital for 10 days with parvo because the owners listened to a breeder who didn't believe in vaccines.
"It destroys the staff," she said. "Those take a toll. It's hard to look at a pet and say, 'One vaccine could have saved your life.'"
Bott volunteers with animal vaccination clinics at an animal shelter that offers vaccines for a low cost and without an office fee. He's seen 2,000 of those vaccinations in 2021 and wants to remind people that there are options and one of the worst things they can do as a pet owner is wait to get their pets vaccinated.
Supply chain hurdles
Dr. Shawn Zimmerman accepted her professor position at Utah State University and moved right when the pandemic began, which meant setting up teaching and personal laboratories and maintaining diagnostic labs during an ongoing shortage of supplies.
There was a shortage of petri dishes, glass slides for microscopes, pipettes, tubes and so many other small pieces of equipment.
She likened it to buying a nice house with a really nice kitchen and then realizing that you don't have the pots and pans or utensils to even cook basic macaroni.
"The hurdles for getting and keeping supplies and equipment border on comical," she said.
She had to be creative and scrounge what she could from the university surplus and repurpose equipment or use out-of-date, reusable equipment. Despite having ordered them at the beginning of the pandemic, she just recently received an order of disposable pipettes for her labs.
Veterinary clinics in Utah also had an incredibly difficult time getting examination gloves and masks after they donated most of their supplies to the state at the beginning of the pandemic to help with the human side of medicine.
Some medications remain difficult to get and require a lot of planning ahead. Bott owns his clinic and does all the ordering for its inventory, so he has struggled to make sure his staff can make it through the month without worrying about pharmacy shortages.
Vets across the country also received warnings from federal sources that people are consuming pet medications like ivermectin. Although Bott only uses injectable ivermectin occasionally in dogs, he said that more rural practices that deal with large animals are more affected by this.
"People are taking pour-on medicine for a cow when they're a completely different species, and overdosage of that is so dangerous," he said, noting that in dogs — collies in particular — an overdose of ivermectin can result in neurological manifestation like seizures or severe tremors.
Zimmerman sees the pandemic as the first time in a long time people have recognized and been concerned at a global level about what happens when animal and human pathogens intersect.
She explained that One Health — a collaborative, multisectoral and transdisciplinary approach working on all geographic levels to focus on health in people, animals, plants and the environment — had long been trying to bring together fractured and self-interested branches of science to no avail.
"Vets' importance to One Health and infectious disease science has been overlooked, but now we are uniquely positioned to help and be a part of this movement, because, regardless of which political side of the spectrum you're on, at some point we can all agree that (the novel coronavirus) came out of an animal," she said.
The tasks of surveillance and identification within animal populations have largely fallen to veterinarians, to ensure that scientists don't miss the reservoir in which the disease is hiding.
The development of the COVID-19 vaccines has largely depended on animal science, as they are tested on animals before they are tested on people. Veterinarians and animal researchers and pathologists are an integral part of understanding the science behind the disease and preventing it from spreading further.
But if veterinary programs and professors don't have the resources, support or mental health capacity to train the next generation, the field will be even more limited in spite of its importance.
Zimmerman became a researcher after she realized that, although she loved the science, she didn't have the mental and emotional wherewithal to remain in practice.
"I found a way to give back without me having to sacrifice that last bit of myself, and I'm secretly hoping some (of my students) do decide to become researchers and pathologists," she said.
Bringing out the worst
Although vets largely haven't dealt with the backlash against most health professionals who diagnose and treat COVID-19 patients, many veterinary staff, especially those at the front desk, say they are seeing unprecedented levels of disrespect, belligerency and bullying from pet owners.
"How they treat our staff is absolutely deplorable," Tassone said. "It seems like fuses have gotten even shorter during the pandemic. All day every day we have people say, 'Why can't I come in? I'm vaccinated!' or 'This virus is fake. It's a conspiracy.'"
Although many stores and buildings are open, most veterinary clinics and hospitals in Utah are still requiring pet owners to wait curbside for their appointments. Consistent mask requirements have also been a point of conflict.
Tassone said that one man came in with a mesh mask to meet the requirement of a face covering without actually maintaining the safety protocols. When they asked him to wear a different mask, he argued and fought with staff.
"Mental health in this field is already strained. They're pushing a system that's already teetering and now has more work and slower work," Tassone said. "I get it. It's tough. You put your soul into a patient and it passes away and the owner blames you."
Her hospital lost three front desk staff members in two weeks after particularly brutal phone calls with insensitive pet owners.
Bott is especially selective about his patients and has a zero tolerance for people mistreating his workers, but his clinic still gets calls from random people who take out their frustration on his staff. There have also been a few times his workers told prospective clients that they are not allowed back because of their mistreatment of staff.
"For me, it's not worth it. People grieve in different ways, and that's different (from the mistreatment). I don't know what more we can do," he said.
One aspect of these volatile reactions toward vet practices that has become more and more common during the pandemic is cyberbullying through online reviews, attacks on social media and the facilities' websites.
"Social media is just as dangerous as it is wonderful and helpful. Some of my colleagues have been particularly affected by the negative commentary or criticism and attacks on social media," Zimmerman said.
She compared these attacks to having a private, minor dispute that could be easily resolved, acted out on a public stage or televised without any context, which is then fueled by online trolls.
"The pandemic has brought out extremes: the best in people and the worst in people. Those like vets who wear their hearts on their sleeves are not weathering it well," Zimmerman concluded.
The ones left behind
Almost every veterinarian knows colleagues or classmates who have died by suicide, and the Utah vets interviewed for this story were no different. Some also know colleagues who died from COVID-19.
For Bott, every loss makes his world feel even smaller.
"It's as if every single one of us is holding onto the edge of a large rock and trying to hold it up in the air. When someone leaves through suicide or anything else, it puts more pressure on us, the ones left behind," he said.
He wishes he could personally speak to every vet and remind them how important they are and how much they're needed, because "we can't lose anymore, and it's heartbreaking that they're in a spot that difficult and feel that alone."
What Zimmerman has always loved about her profession is that veterinarians are so brave and so noble, but she acknowledges that sometimes it comes at a great cost. She described the people in her profession as perfectionists who want to help anything defenseless, often at the expense of themselves.
And the profession still comes with a large amount of stigma, something that many veterinarians are trying to tackle and break down.
"We tend to be a lot like our animals and mask, sometimes even from the people closest to us in our lives. There's an inherent fear of failure and letting someone down. Failing ourselves never factors into that equation," Zimmerman said.
The COVID-19 pandemic has caused a mental health crisis both globally and nationally, which has been particularly hard on those already combating mental illness on a regular basis, like those in the veterinary field, creating a monstrous problem.
Tassone said that a significant part of the reason she loves her job is the joy that comes with interacting with pet owners, hearing their stories and seeing them interact with their animals. But with the pandemic, a large part of that fun part of the job is restricted to phone calls.
How to help
People can help struggling vets by simply being aware of the inevitable stress and mental blows that come with the profession, Bott explained.
"More than ever, we need civility and kindness in our society. We need people to realize that vets are overwhelmed right now and the best way to help is to be kind, patient and understanding," he said. "As simple as that sounds, it's something that our society is really lacking right now."
The meanest thing vets can hear is that they are in it for the money, he continued. Most vets don't make as much as physicians do and are not particularly financially well off. The reward comes from saving a life and making the world a better place, even if it's for one family.
Although Zimmerman believes that everyone is being affected by the pandemic mentally, she strongly recommends living by the golden rule and not taking out that stress and emotion on other people, especially veterinarians who are already struggling and at risk for suicide.
"We need to be giving everyone grace. The last thing I would ever want to do is be the straw that broke the other camel's back," she said.