Saturday, March 9, 2019

The 80%

Yesterday was International Women's Day, so I thought I'd take a moment to point out a fact that you might not have noticed or considered: no other profession has experienced as great a shift in gender balance as veterinary medicine.

In 1970 barely 10% of veterinary school students were female, now over 80% are. And the trendline is continuing upwards. In some schools, it's 90%. In contrast, medical school is still 50% male, as is law school, and dental school is 62% male. The 50:50 crossover point for veterinary medicine occurred in the mid-1980s. My own school, the Western College of Veterinary Medicine in Saskatoon, was ahead of the curve as my first year class in 1986 was already about 70% women.

In 1970, a tiny number of practicing veterinarians in Canada were women, now 60% are. These women are on average 10 years younger than their male colleagues, so this number will steadily rise as the men retire and are replaced by the 80% of graduates who are female. In the span of a half century the profession has gone from being overwhelmingly male to being overwhelming female.

Why is this? Part of the answer lies in the changing nature of the work. Over the same time period as the gender shift, the profession experienced a parallel shift from rural and farm animal oriented to urban and companion animal oriented. The fact that women continue to bear the primary responsibility for childcare in many families makes the more regular and predictable hours of the latter much more accessible and attractive. Farm practice can be 24 hours a day, 7 days a week at times, with hours and hours on the road away from home. But that factor alone should have only lifted barriers and given more equal opportunity to women, not pushed them to a predominant position. Why have they shot past the 50:50 equilibrium one might otherwise predict?

It's complicated. One factor is that competition to get a spot in veterinary school is ferocious, more ferocious than for any other profession, and young women are increasingly in a better position to win that competition. Women now dominate in academics, often occupying the top rungs in the lists of the best students in any given class. The reason for this is beyond the scope of this post, but just Google the subject and you'll see that the falling academic performance of young men is the cause of much hand-wringing.

Another factor is that veterinary medicine pays less well and is perhaps less prestigious than many of the other professions. This is a terrible statement about the state of gender relations in our society, but women historically have accepted lower pay and men historically have been encouraged to seek prestige. These things are changing, but some ingrained cultural norms will take a long time to truly fade away.

And finally, veterinary medicine requires more empathy than any other profession. If you are reading this blog then you already know why this is true. Again, this is likely more a statement about our culture than anything else as I don't think I am any less empathetic than my female colleagues, but perhaps I am less concerned about those subtle cultural signals. This is not to absolutely deny the influence of biology. In a survey of very anxious dogs, 7 out of 10 preferred a female veterinarian. Something about men's deeper voices and harder features freaks them out. (I'm joking, of course. To the researcher's endless frustration the dogs were unable or unwilling to answer the questions. But the observation is generally true.)

None of this is black and white, all of this is just tendencies and trends. But look where those tendencies and trends have brought us. When I think back to when I graduated in 1990, it's astonishing how things have changed. Even though I looked like I was 12 years old, I was male and I was immediately assumed to be the doctor, whereas many of my female classmates struggled for years with reactions along the lines of, "When is the real doctor coming in?"

Veterinary medicine has changed and it is thriving like never before. I'll let you draw your own conclusions.

Thursday, February 21, 2019


The downside of the whole nine lives situation with cats is that when they have run through all nine and have come to the natural end of their lives and no longer find any pleasure in their daily routine they tend not to just pass away peacefully in their sleep. They tend to need to come into the clinic to be given that final gentle nudge into the great beyond. Cats are that tough. Consequently, we see a lot of really ancient, really skinny, really creaky cats come in for euthanasia. Often they are accompanied by entire families, sometimes including older teenagers who have never known life without that cat.

It's been a long time since I've had to say goodbye to my own cat, but after the last old cat euthanasia - an 18-year-old torti named Kitten - it's been on my mind. Kitten reminded me a lot of our oldest cat,  Lucy, also a torti. I recalled that Caturday would soon be upon us. Lucy was a stray so we have no idea when exactly she was born, so making an educated guess we assigned her birthday to the first of March. Gabi, the second oldest cat, has her birthday in September (we think...), but the newest beast, Lily was probably also born in early March. It was then that we decided to make the first Saturday in March "Caturday" to mark both Lucy and Lily's birthday. This Caturday Lucy will be thirteen and will officially be an old cat. Not ancient by any means, but old. Old enough that I look at her a little differently.

I came home after Kitten's euthanasia, made myself a mug of tea and sat in my usual spot on my usual couch. Lucy was sleeping on the other couch but stirred when I sat down. She looked over at me, stretched, leapt down and made her way over, purring loudly. Oh yes, she definitely still can leap. In fact, there's nothing about her that would hint at her age except for the fact that she has become thin. She was always the fat cat - the fat boss cat who would prowl about the house, keeping the other pets in line, handing out swats and issuing hisses as she deemed necessary and appropriate. But in the last couple of months, she has very gradually become thinner. She seems healthy enough in every other respect and she is still just as bossy with the other animals, but the other change is that she has become friendlier to me. She was never unfriendly, but she always favoured Isabel and Lorraine. However, the arrival of Lily (aka The Hellbeast, aka The FK - I'll let you figure that one out) resulted in a slow-motion shuffling of loyalties. From the start, Lily was Isabel's kitten. Lucy still wanted to be with Isabel, but she could not be in the same room with Lily, so after a few months of cats screaming at other cats, she stopped trying as hard. In the meantime, Gabi, the "middle cat", cemented her position as Lorraine's cat. Lucy and Gabi could have shared that role as they used to be best friends, but some subtle cat politics were at play wherein Lily's arrival cooled their relationship.

Enter me. I don't mind being third string.

I petted Lucy absentmindedly while checking my emails. When I was finished I looked more carefully at her. Yes, she was definitely not just thinner in the sense of happily no longer being fat, but thinner in the sense of possibly being too thin, making her look older than her almost thirteen years.

My thoughts then drifted to how she was snuggling. She never used to do that, at least not with me. It made me think of Kato, the cat Lorraine had when she was a student. Kato was a Siamese cross and was named for Inspector Clouseau's sidekick in the old Pink Panther movies. Like her film character counterpart, she would ambush you with frightening savagery at the most unexpected moments. I learned to enter Lorraine's place with extreme caution. When we moved in together it was to a pet free apartment and Kato went to live with Lorraine's parents. It was only much later, when we had a house and Lorraine's parents had passed on, that Kato came back to live with us. By this point she was a very old cat and she was a completely changed cat. No more ambushes. No more savagery. In her old age Kato had become mellow and affectionate. Letting her go when her time finally came tore our hearts out.

Lucy apparently had enough snuggling and stretched and sat up, looking about her. Lily had entered the far side of the room. Lucy tensed and jumped down. As she stalked towards Lily I took note for the first time how boney her hips were. Yes, I would have to take her to the clinic and run some tests. She had had a full check-up and blood tests within the last year, but a lot can change quickly in an old cat. Old cats need special attention and special love.

My grandfather lived to the age of 93. Shortly after he died I was talking to one of my uncles. I don't recall exactly what I said, but I must have implied that it is easier to let go when the deceased is very old. I may not remember what I said, but I do remember my uncle's reply very clearly:
"Philipp, just because someone is very old doesn't mean that you love them less. In fact, the older they are, the longer they have been part of your life and it is possible that you love them even more."

Happy Caturday Lucy, my old cat.

Thursday, February 7, 2019

Fido v The World

Urban wildlife encounters in three parts:

Part One - Sprayed

Before I even saw him, I could smell Brownie. The whole clinic could smell Brownie. Probably the neighbours could smell Brownie. Maybe even the people driving by on Portage Avenue could smell Brownie. But Brownie didn't care. He was still the same old happy tail wagging chocolate Lab we loved, or at least we used to love until he came in and made everyone go, "Oh my God! What is that smell? Is that skunk??"

Yes, it was. Brownie had been skunked. He may not have cared but his owner was in a state of some considerable distress. She kept apologizing for bringing him in, but she didn't want him in the house and he had met the skunk in the yard, so she didn't want him there either until she was sure that it was safe, and it was a hot summer day, so she couldn't leave him in the car. The only place left to go was the clinic, where she was desperately hoping we could help. We did have "Skunk-Off" in stock, so a brave vet tech put on a large smock and led Brownie, tail still wagging, to a distant room to apply it. Brownie was lucky because he hadn't gotten it in the eyes, where it can be quite irritating, and he was lucky because he was up to date on rabies vaccines and it didn't look like he had actually come in direct contact with the skunk. Skunks are the most common carriers of rabies in Manitoba.

Now some of you, especially those of my generation and older, will be thinking about all those old classic television shows where skunked dogs were bathed in tomato juice. Don't do it. First of all, it is easily more expensive than an enzymatic cleaner, secondly, it is ridiculously messy, and thirdly it doesn't actually work. It only seems to work because of something called olfactory fatigue wherein your nose has become overwhelmed by the combined tomato-skunk stench and calls it quits. Anyone new encountering the dog will still smell the skunk until their nose packs it in too. And then the competing tomato smell wears off and you have a pink stinky dog. If you really need a home remedy, the recipe you'll see online for 3% peroxide, baking soda and dishwashing soap does work. (If you're reading this you presumably have internet access, so just Google "skunk spray peroxide recipe" for detailed instructions.)

But on the plus side you and your dog have been exposed to a marvel of nature. Skunks can spray three metres from their little anal sac nozzles, their spray odour can be detected up to 5 km away and it only takes 10 parts per billion to make a stink. So mix a little wonder into your horror.

Part Two - Poked

In porcupine country, every clinic has these. In the city perhaps only one or two, but in rural areas probably quite a few. I'm talking about "quill dogs". We call them quill dogs because there appears to be a circuit in the canine brain that is dedicated to solving The Mystery of the Spiky Beast. You would think that getting a faceful of quills would be a deterrent to approaching the Spiky Beast again, and that's certainly what said beast intends, but to a quill dog, this is just a mystery that absolutely needs to be solved. A puzzle that needs to be figured out. An enigmatic opponent who needs to be bested. And this mystery is almost never solved. The Spiky Beast almost always makes a getaway.

The practical consequence of all this is that these quill dogs will present again and again to the vet to have the quills removed. This is rarely medically serious, but it is often a significant nuisance. On the rare occasions where it is serious, it is because a quill has gotten in the eye, or deep in the throat. In even more rare occasions they can migrate deeper into the body. Usually though it's just a matter of giving the poor bewildered dog an anesthetic and painstakingly searching for the quills. Once you find them they're easy to remove. "Once you find them..." Please do not be upset at your vet if he or she missed a few quills! Ones that have broken off at the surface can be very difficult to find. And please do not consider this a DIY project - you will miss far more if your dog is not sedated or anesthetized, and it will be painful.

On the upside, porcupine quills are coated in an antibiotic substance. We will still often prescribe an antibiotic as a precaution, but getting quilled leads to far less infection than you might expect. You might wonder why the porcupine is being so kind to others? It's not. It's being kind to itself because the animal most commonly poked by a porcupine is the porcupine itself when it accidentally falls out of a tree! This is more common than you might think. They are not especially elegant creatures.

And before we move on to Part Three I want to dispell a porcupine myth. They cannot shoot or even toss their quills. What they can do is jump very quickly towards their opponent and then lash out with their tail before jumping away again. Not elegant, but lightning fast.

Part Three - Chomped

As the saying goes, there's a first time for everything. And I suspect that this may also be the last time I see something like this. Mrs Bernard brought Duffy, her beautiful golden retriever, in after he had fought with a beaver and lost. He had a set of perfectly chisel shaped puncture wounds on his paw. Yes, a beaver. Yes, fighting with it and losing. And yes, right here in the city of Winnipeg.

So let's unpack that.

Last thing first. Winnipeg is a city of rivers and streams and beavers are actually quite plentiful here. They keep to themselves though and I suspect that the majority of Winnipeggers have never seen one, but if they walk their dogs near these rivers and streams, their dogs almost certainly have smelled them and are almost certainly intrigued. Well, Duffy was intrigued. He was intrigued enough to dive into the creek and investigate the source of that smell.

This brings me to the next thing, beavers and fighting. There is a general prejudice about beavers that they are amiable but dull-witted. People have a cartoon image of a good-natured, hard-working, basically passive animal going about its business without paying attention to much else. Well, they are hard-working, but they are as mentally sharp as any rodent and they are only amiable, good-natured and passive if you leave them alone. Duffy did not leave the beaver alone. The beaver tried to swim away, but Duffy followed until they got close to the lodge when the beaver decided to make a stand. It whipped around and chomped the surprised dog on the paw. It was a one-sided fight. Duffy may have intended to bite the beaver, but quickly changed his mind and splashed back to his shocked owner.

In 2013 a beaver attacked a 60-year-old fisherman in Belarus. The bite severed an artery and the man died. Kind of gives you new respect for our supposedly comical national animal...

Wednesday, February 6, 2019

The Launch

Anything hinting at self-promotion makes me feel squeamish, but people have been asking, so here's the information:

The official launch with readings from 'The Accidental Veterinarian" will be Thursday, Apr 25, 7:00 pm, Grant Park McNally Robinson (Winnipeg) in the Atrium:

Also, Tantor Media in Connecticut has secured the audio rights and will be releasing an audio-book version around the same time!

And - now this is bizarre - my publisher has negotiated the sale of Polish language rights to Wydawnictwo Otwarte in Krakow. Yes, Polish specifically. 

Wednesday, January 23, 2019

The Curious Tale of the Restaurant Next Door

The Marigold restaurant recently closed its doors after fifty years of being our neighbour. It was bittersweet news as it's hard to see iconic businesses and institutions close, but on the other hand, to be honest, I was never really very fond of their style of North American Chinese food, with its dayglow pink sauces and its anatomically improbable chicken balls. Moreover, their Friday lunch buffet often caused problems as large van-loads of Marigold enthusiasts from the country, in town for a day of shopping, would clog our parking lot, either in defiance or in ignorance of our signs.

But maybe our signs needed to be larger because whenever I think of the Marigold restaurant I think of one incident in particular. This might have been fifteen years ago or so and it was a Friday in the summer. It was a reasonably busy day at the clinic when a nervous-looking looking middle-aged couple came in through the back door. The clinic is relatively long and narrow, with the parking lot out back and the front facing a busy street, so it was not unusual for people to try to come in that way. We generally keep the back door locked though because it can be crowded and chaotic in that part of the clinic and it's not really meant for through-traffic, but sometimes we forget. That day we forgot.

The couple walked slowly past the grooming area, and past the kennel areas full of dogs and cats, and through the treatment room with staff in scrubs scuttling about and pets on stainless steel tables and various machines going "ping". They walked past all of this and made their way to the reception counter at the front of the clinic. There they stopped and the man smiled shyly at the receptionist, cleared his throat and quietly asked a question. He asked, "Is this the Marigold restaurant?"

I'll let that sink in for a moment.

"Is this the Marigold restaurant?"

The most astonishing part isn't that they would walk into Birchwood thinking it was the Marigold. The back of the clinic and the back of the restaurant look pretty similar I suppose. And sometimes your brain just blanks out signs. I get that. It's probably happened a few times before and people just giggled at their error and made a quick about-face.

And the most astonishing part isn't even that after seeing everything they just saw, and hearing everything they just heard, and smelling everything they just smelled, that they would think that this could possibly somehow still be a restaurant. That's really astonishing, but it is not, in fact, the most astonishing part. These looked like trusting, innocent and, dare I say it, unsophisticated folk.

No, the most astonishing part is that after everything they saw, heard and smelled they were still hungry and apparently still interested enough to ask that question!

The Marigold is being replaced by a funeral home, so the parking will only get worse. And I sincerely hope that it doesn't generate any funny stories.

Wednesday, January 9, 2019

Everything You Wanted To Know About Euthanasia But Were Afraid To Ask

I imagine that many people didn't make it past the title, and that's ok. This post is not intended for everyone, but the last post reminded me that I wanted to have something on the record regarding this. It's a heartbreaking subject, but it's an important one. I understand that it could be too disturbing or emotional for some readers, and that others would just rather not know. Have no fear - if you're in either category you can happily skip this post and look forward to the next one instead (which I promise will be on a light topic).

There is a general rule that for every person who asks a question, there are ten others who have the same question but did not want to ask. I have no idea where this little bit of folk wisdom came from, but it strikes me as roughly true for many situations other than euthanasia. When it comes to euthanasia however, because of the intense emotions involved, I think the ratio is closer to a hundred to one.

Here then are the questions I have been asked:

Does it always work?
Yes, it does. It's poignant to consider that while veterinarians spend their careers trying to save lives, the one service they provide that is absolutely guaranteed to be effective is ending life.

Why do you sedate first?
Not everyone sedates their euthanasia patients first, but I almost always do. To begin with, I want to make sure that the pet is not picking up on everyone's emotions at the end. They are often very attuned to this and can become frightened, especially in a vet office. Secondly, especially in ill patients, finding a good vein for the euthanasia injection is not always that quick. Sedation can go under the skin, but euthanasia needs to be in a solid and reliable vein. I don't want the patient to become anxious if we're taking a few moments to secure a good vein, nor do I want them to move while we're injecting the euthanasia solution.

How fast is sedation?
It varies quite a bit, but usually ten minutes or so. We wait until they are woozy and unaware. Some individuals will become fully unconscious with the sedation alone.

How does the euthanasia drug work?
We use an overdose of an injectable anesthetic. It's in the barbituate class, therefore similar to some sleeping pills or the anesthetic you might have had to get your wisdom teeth out a few decades back (safer drugs are used now, you'll be pleased to hear). We use such a high dose that all parts of the brain fall asleep - first the parts that keep a patient conscious and thinking, and then the parts that control breathing and the heart beat. Because it is an anesthetic the sensation is like that of falling rapidly asleep.

And how fast is this?
Very fast. Once we get a vein it can go very quickly. Depending on the size of the patient it may take a few seconds to inject the entire dose, but they are always completely unconscious before the injection is even done, and often have stopped breathing as well.

Why do you put alcohol on the vein?
I hadn't considered how this looked until a client asked, "Why are you sterilizing that when he's going to be dead in a minute anyway?" Good question, but I'm not sterilizing it. Alcohol helps make the vein stand out better.

Are there ever any bad reactions?
The great majority of the time everything goes smoothly. The sedation we use can sometimes briefly sting a little as it goes in, but very soon after they start to feel good. And on the odd occasion while the sedation is kicking in the pet can seem disoriented, but this passes quickly. Bad reactions to the euthanasia itself are extremely rare and usually take the form of vocalizing. This is very distressing to the owner, but the pet already has enough drug in their system that they're not really aware of what is happening, or in control of the sounds they're making. And again - it's extremely rare. They do sometimes take a couple of deep breaths at the end though, when they're already fully unconscious.

Why don't they close their eyes?
When you die all your muscles relax, including those in your eyelids. Eyelid muscles have to contract to close. Incidentally, bowel and bladder muscles can relax too, so sometimes they will release these as they die. They are of course completely unaware of this.

What happens to the body now?
The crematorium doesn't pick up every day, so in most cases the body will be kept in a dedicated freezer until they come. You are probably going in a special fridge for a short while after you die, so it's really very similar.

How do I know that the ashes I get back are from my pet?
We trust the crematorium, we know the operators well and we have all had our own pets cremated there. You are also welcome to visit the facility and even take your pet's remains there yourself.

You're not going to do experiments on him now are you?
No. The fact that I have actually been asked this more than once underlines how little some people understand about science, let alone professional ethics. Not only is the very idea repugnant, but there are honestly no useful "experiments" that can be done in this scenario.

Can I donate his body to science?
In rare instances, maybe. Every now and then there's an odd case where we might learn something from the results of an autopsy. While this is not really "donating his body to science", it's kind of the same idea. We would never do so without asking permission first though. As we often feel too awkward to ask, autopsies usually only get done when a client suggests it themselves.

Do you ever get used to having to euthanize people's pets?
No. Never. My heart breaks a little every time.

(If you have any questions of your own, please feel free to ask them in the comments section below.)

Saturday, December 29, 2018

When Darkness Overwhelms

(Updated from the original August 2016 post.)
This essay is going to be a departure from my usual lame attempt at a lighthearted tone. This essay is going to be about suicide in the veterinary profession. Statistics are not available for Canada, but in Britain two separate studies found the suicide rate among veterinarians to be four to six times that of the general population and double that of dentists and physicians. The American Centers for Disease Control did a survey of 10,000 veterinarians and found that a shocking one in six had considered suicide. I personally knew two colleagues here in Manitoba who took their own lives, and in 2014, a prominent and very well-liked behaviour specialist killed herself, drawing some media attention to this little-known aspect of the profession.

To the casual outside observer this will be unexpected and possibly even slightly bizarre news. Aren’t veterinarians generally well respected? Isn’t it a secure, interesting and rewarding career? Isn’t it a dream job for so many people? Isn’t it wonderful to heal innocent animals and get paid to play with fluffy kittens? All of that is true. Except the part about the fluffy kittens. Why, then, does darkness overwhelm so many of my colleagues? There are three significant reasons.

The first reason is that veterinary medicine attracts a disproportionate number of idealistic, introspective and sensitive people. Sensitive to the point of neurosis. This is true of all of the health professions, but it is even more so in veterinary medicine. Some of these introspective people are more comfortable around animals than around other people. They do not fully understand that it is actually a people job that happens to involve animals rather than the other way around. Grappling with this reality can be very problematic for some. Add to this the fact that competition to get into veterinary college is extremely high, and success favours perfectionists who can produce high marks. Perfectionism and idealism are fated to be brutally ground down by the chaos of reality in practice. And then their innate sensitivity lays them wide open to the second reason: the inherent and often surprising multi-factorial stress of the job.

Of immediate relevance to sensitive people is the fact that a veterinarian is at times marinated in death and grief. There are weeks — many weeks in fact — where I perform one or more euthanasias each day. Sobbing, crying, wailing, grief-stricken people, some of whom we’ve known for many years, are a routine part of our day. And for those of you who think this is simply a question of overwrought crazy cat ladies or frou-frou poodle people who too much resemble their dogs, I have two things to say to you. The first is that if you have not experienced a deep bond with an animal, then you are missing out on a key human experience, one shared by people from all walks of life, all backgrounds, all levels of intellect. It is one of the richest threads we weave. The second is that you have no more right to judge the grief of someone closely bonded to their pet than a blind man has to judge a photography exhibit. Simply trust me that these are normal people with legitimate and intensely felt grief. Additionally, a veterinarian is expected to be competent across a range of species and a range of disciplines, from dentistry to radiology to dermatology to . . . you name it, wedging the door wide open to so many opportunities to fail. And remember: “sensitive.” Mix sensitivity and failure and see what happens. And I haven’t even mentioned the financial stress of trying to be affordable to clients yet still able to service sometimes enormous debt burdens and meet payroll, etc. Or the stress of being a manager when you went to school to be a vet, not a manager. Or the angry clients. Or the angry spouse, upset because you’re stuck late again.

The third reason is that we know how easy it is. How easy it is to die. Those daily euthanasias are consistently peaceful, painless, quick and reliable. One hundred percent reliable. We know the dose. We know the delivery methods. We have the drug right there. Can you see now why it happens too much?

And to make things worse, this is clearly an iceberg situation, where the suicides are only the visible tip of a massive mental health problem in the profession. According to an exhaustive American Veterinary Medical Association survey, just under a third of all veterinarians have experienced depression at least once since graduation. A smaller Canadian study found that 1 in 10 veterinarians were currently classified as having depression, and another 15% were borderline. Also, a third of veterinarians in that study were suffering from anxiety, and a shocking 47% scored high on measures of emotional exhaustion. Clearly the problems run deep and run wide.

Fortunately, our professional associations are beginning to take notice, and mental health support is increasingly being incorporated into the services they provide. And what can you, the reader, do? You can’t do much about the first and third reasons listed above, but you can definitely do something about the second. If your friend or family member is a veterinarian, do not trivialize their stress. Understand that the real job is far more complex and serious than you imagine. Offer to listen with an open heart. And if you are a client and your veterinarian has done something to make you angry, please recognize their human fallibility and frailty, and try to find a calm and respectful way to address your concerns.

And what about me? Well, fortunately I had a “happy optimist” chip deeply implanted at birth. The zombie apocalypse could roll into town and I would say, “Cool, this will make for some excellent photos!” And, “Maybe brains are better with a bit of smoked paprika?” I have painted a bleak picture when in fact most veterinarians are fine — even better than fine — but burnout is very real, and depression is very real, and, for a small, tragic minority, suicide is very real too. Not only in veterinary medicine, but in society at large, we must work to demolish the stigma that still surrounds mental health. If your leg is broken, everyone wants to talk about it, but if your brain is broken, hardly anyone does. This is wrong, and it is doing so much harm.

This is for Terry and Craig and Sophia.