Visiting Veterinarian

Hard knocks

By Michele Gerhard Jasny V.M.D. - April 27, 2006

It was an overcast damp day in mid-October1982 when I was called out to see a lame horse at Herring Creek Farm in Katama. I had just moved to the Vineyard that spring. Back then, the Vineyard Veterinary Clinic was the only veterinary practice on the Island. Dr. Kemp commuted over from Falmouth most days and focused on cats and dogs. Dr. Fair lived on-Island and did both small and large animals. That was it. Just the two of them. For the whole Island. They had hired me to help with the seasonal increase June through October. (If you want to think about how the Vineyard has grown this past quarter century, consider that there are now six practices here, employing eight or more veterinarians year-round.)

When I got to the farm, my patient was grazing with a few other horses in a far pasture. The manager chivalrously carried my big black bag as we strolled together across the field. Reaching the mare in question, I could readily see she was favoring her left front leg. One of the other horses curiously nosed my bag where it sat on the ground, while I ran my hand lightly over his buddy's leg. Detecting no obvious heat or swelling, I leaned over, bent at the waist, holding the hoof with my knees in order to examine her foot closely. She stood calmly while I proceeded, neither of us paying much attention to Mr. Curious who continued to hover nearby. Apparently incensed by my unintentional mooning, Mr. Curious suddenly wheeled and, without warning, kicked me, hard, in the lower back.

Veterinarians often experience occupation-related injuries and diseases, ranging from the annoying to the life-threatening. The most common injuries include dog and cat bites and scratches, and being hit or crushed by large animals. Most of us who have been practicing for any length of time know someone who has been permanently disabled, or even killed, on the job. Back injuries are common, and not just in farm work. Lifting large dogs from the floor to an examining table day after day can be as taxing as working with horses and cows. Vets are also at high risk for contracting zoonotic diseases, everything from ringworm to rabies, and becoming ill from exposure to pesticides, insecticides, disinfectants, radiation, anesthetic gases, and other biological hazards. No one knows the exact number of injuries. There is no central reporting agency collecting this data, and veterinarians, (God bless us) tend to diagnose and treat themselves...but the surveys that have been done are pretty sobering.

Hooves are a hazard
We all have our stories. About 20 years ago, Dr. Connie Breese of Sea Breeze Veterinary Services was preparing to do a reproductive exam on Dolly, a Clydesdale belonging to Bill Honey. In case you're not up on your large animal repro, one way we check cows and horses for pregnancy is by rectal exam. We're not talking a finger here. We're talking a plastic sleeve that covers the arm up to the shoulder. By gently passing a hand far up inside, a veterinarian can then push down and palpate the uterus that lies ventral to the rectum. Not every horse or cow appreciates this procedure. One study confirmed the fact that equine veterinarians sustain more serious kick injuries in the spring and summer, when they are doing pregnancy checks, than in the fall or winter. Before Dr. Breese could even begin, Dolly kicked, sending Connie flying across the stall. "Yup," Bill said, "She kicks like a mule sometimes."

Ah, mules. One study pointed out that although cattle were more likely to injury old Doc than horses, mules and donkeys were especially notable for their propensity for kicking vets in the genitalia. Other common injuries reported include scalpel injuries to the hands, trauma to arms, heads, and chest, lacerations, fractures, dislocations, internal organ damage, and dental trauma. One study actually had a category called "other interesting causes" comprised of gouging, goring, pushing, butting, ramming, running over or flattening the veterinarian. Dr. Breese reports that she was lucky...nothing was broken, but she had a very large bruise in the shape of a Clydesdale hoof over her abdomen and hip and was in bed for a couple of days. "Bill Honey drove me home after the kick," she says. "He wanted to know how he could find out if Dolly was pregnant. I told him to wait 10 months." Nowadays, Dr. Breese has a portable ultrasound that can aid in pregnancy diagnosis, but rectal exams are still a routine, and risky, part of farm animal practice.

Bites and punctures
Small animal doctors get hurt too, with a high incidence of animal bites, needle punctures, lacerations, scalpel blade cuts, back injuries, zoonotic infections, repetitive motion injury, and illness due to chemical and anesthesia exposure. Dr. Steven Atwood of Animal Health Care Associates was performing a postmortem on a cat when he accidentally got nicked by the scalpel. It turned out the cat had died of tularemia and Steve contracted the disease himself as a result of his cut. Ken Harkewicz, a veterinarian I know in California with a special interest in reptiles and amphibians, is missing the end of a finger from the bite of a 14-pound iguana. The best part of the story, Ken says, is that several days later the lizard vomited up the fingertip and the owners called to see if he wanted it back. We all have our stories, our scars, and our fears. I know several older veterinarians who refuse to work on specific breeds such as rottweilers or chows. They have simply had too many bad experiences and don't want the risk or the stress entailed.

Risk and stress: two daily companions of the veterinarian. Along with physical injury, veterinarians have a high incidence of burnout and suicide. A 2005 report from BBC news indicated that in the United Kingdom, vets have nearly four times the national average of suicide and twice that of doctors and dentists. In other studies high rates of burnout were noted. Why are vets so susceptible to these emotional struggles? Too high a workload, irregular hours, high expectations and demands from clients, perfectionism, needing to cover many fields of expertise alone, and low levels of professional respect may all play a role. Legal possession of potentially lethal drugs, combined with familiarity with euthanasia, may make it more likely for veterinarians to turn to suicide during times of stress. Our education includes minimal training (if any) in how to manage a business or to cope with the financial and emotional aspects of veterinary practice. We deal daily with life and death decisions, often without much support.

When I hit the ground at Herring Creek Farm, for a second I couldn't feel my legs. "This is it," I thought. "Paralyzed." Then my legs started to tingle and I wiggled my toes. Still in the macho phase of my career, I stupidly pulled myself to my feet and hobbled to the car, insisting I was okay. I couldn't lift my left leg to push in the clutch so I drove the few miles back to the clinic in first gear. Radiographs later confirmed that Mr. Curious's kick had cracked the wing of one of my vertebrae. Not a truly serious injury, but an inch or two more to the center, and my fears of paralysis could have been a reality. Seven long years later, I quit doing horse work altogether. Twenty-four years later, my back still hurts. Now, about those rottweilers....