The classroom is quiet. It’s a Friday afternoon in the first week of a new quarter. The threat of a midterm exam is far off, and all we really want to do is go home and enjoy the weekend.
Dr. Miller stands at the bottom of the classroom. (Names in this piece have been changed.) He’s waiting for the clock to strike the hour. I say bottom because third-year veterinary medicine students have lectures in a classroom designed like the nosebleed section of a stadium. Someone once told me it’s the steepest classroom in North America. I’m not sure if that’s true, but it always gets a laugh at vet conferences.
Miller is tall and balding, with ears that jut out from his head. He dresses in the classic uniform of Midwestern academia: khakis, dock shoes, plaid short-sleeved button-down, thick leather belt. We know the look well: My classmates and I have been through a grinder of a program, literally hundreds of hours spent studying or in class together. But despite our obvious comfort with one another, the room is dead quiet. Why?
It might have something to do with the title slide that Miller has just projected: Euthanasia and its many forms: on farm and at home.
We all know that this lecture will be grim—Miller is a pig vet, after all. That might mean nothing to you, but in the vet world, it says everything. Swine vets work on swine systems and whole populations. They treat groups of animals, not individuals the way general-practice vets do. Doing so requires an incredible amount of data, and the ability to interpret it dispassionately.
Because of this, they’re also stereotypically cold, calculating, and, in a word, ruthless. They’re not your typical warm, fuzzy family vet, and they’re not shy about “liquidating” entire farms if their data says it’ll help the overall system. For this reason, I know that Miller’s talk will cover mass euthanasia—how to put down entire farms of animals, and how to do it effectively.
“I know this is the last thing you all want to talk about,” Miller says. “But this is the one thing you all need to do, and do well. You see, our business is healing, yes. But you all know there’s only so much we can do. In the end, euthanasia is an option.
“I want to make this abundantly clear: If there’s one thing you must do flawlessly in your career, it’s killing. I don’t care if it’s an old dog, a sow, some pet chicken, a stallion, or a fucking 3-day-old kitten. You will do it humanely. That means quickly, painlessly, and compassionately.
“Some of you say pig vets have no heart,” he continues softly. “That might be true, but find us when we have to liquidate a farm. Those days I still carry with me.”
Miller starts to tell us how euthanasia works. His instruction is exhaustive and methodical. But there’s a crucial thing he leaves out: what all that killing does to humans.
“Andrew, it’s not good—100 percent broken. Poor thing can’t even walk,” my vet tech Hanna tells me.
It’s two years later, and I’m now a small-town vet working in Pennsylvania. I’ve treated everything from cats to chickens, but I’m still learning, so I’ve learned to trust my techs when they say something’s wrong.
She’s just finished going over the history for my next patient. It’s a busy Saturday in November. The air is cold and the sky is bleak. The day has been abysmal. To start, I have a puppy with parvovirus, who is, despite my best efforts, trying to die. At the same time, a cat I diagnosed with cancer died in its cage after we sedated it to place a catheter. The owner had elected for euthanasia, but we couldn’t place the catheter while the cat was awake on account of it being quite vicious. We had sedated it and left it to get sleepy, only to come back and find that the sedation had killed it. Did the cat suffer? No—the sedation also has a powerful opioid that relieves pain. The owner was a different story, screaming both at me and my staff that we had robbed them of the chance to say goodbye.
Welcome to my every day. As I’ve discovered in my two years as a vet, being verbally abused by owners is part of the job. A 2021 study conducted by the British Veterinary Association revealed that of 572 veterinarians interviewed, 57 percent had felt intimidated by clients’ language and behavior, a 10 percent increase from the year before. In small-animal practice, it’s even worse, with 66 percent of respondents reporting that they’ve felt intimidated and harassed.
Usually, management tells us to endure these diatribes. Some practices are gravely afraid of losing these clients at the expense of their staff’s emotional well-being.
“Let’s see what we’ve got here,” I say, going over the chart with Hanna. My patient is a 5-month-old female mix named Lacey whose leg was crushed in an accident three days ago. She hasn’t walked right since.
Entering the exam room, I immediately notice the little dog lying down on a blanket. While responsive, with eyes that track me as I move, she doesn’t rise to greet me. She’s small and fluffy, black-haired with white accents.
Her male owner is sitting with her on the floor, cradling her head. Her female owner is on the bench. Both look shaken, nervous, and distraught.
I find in trauma cases it’s best to get to the point. “Hi, guys. I’m Dr. Andrew. I understand Lacey has hurt her back leg. May I take a look?” I move toward Lacey and lower myself to the floor.
“Doc, it’s the leg that’s up,” the male owner tells me, eyes bloodshot from crying. He clutches Lacey’s upper back with the large, worn hands of a working man.
I gently place a hand on Lacey’s back and move it down her leg to the middle femur. The injured leg is three times the size of the other, and with just my light touch, Lacey screams.
It’s not a sound of surprise, like a yip or a squeal. The scream a dog makes when it’s hurt is soul-cutting. This animal is in pain. The female owner shudders and looks away. Lacey looks around and whimpers, pawing at her male owner for help. I immediately remove my hands.
I order an X-ray. I think it’s broken, but I want to confirm. “The X-rays are $150—is that OK?” I ask. The owners both nod. I call for a litter to transport little Lacey back to the X-ray room.
Most people think the vet takes the X-rays, but many, including me, do not. We’re taught how to in vet school, but in a well-run clinic, the vet should never take them; the techs do. So, after I give the tech my instructions, I step into my office to make a call to another owner. After I have an in-depth discussion with them about why they shouldn’t be feeding grain-free food to their pet, Hanna comes running back.
“X-rays are up for Lacey; it’s not good,” she says. Doctors do read X-ray films, but you don’t need to be one to diagnose Lacey’s problem: Her left femur is severely fractured. In fact, the fracture is so bad that the fragments have made a cross—literally perpendicular, with one laid over the other.
In orthopedics, the less a fracture moves—meaning the less the fragments of bone move in relation to one another—the better. And fewer fragments are better. Lacey has two fragments—normally not so bad, but they’re so commuted that to splint or cast this fracture would be impossible. Lacey needs surgical fixation.
For the uninitiated, surgical fixation is a process by which a surgeon (usually an orthopedic specialist) puts the fragments back into alignment with bone plates, wires, and pins. The surgery to do this is expensive—around $5,000 to $6,000—and entails a lengthy, delicate recovery where the dog cannot be allowed to run or jump. The alternative would be amputation, a surgery I could do myself for about $800. The dog would be left without a leg, but most dogs adapt well to a three-legged lifestyle. I explain these options to the owners in the room after I take Lacey back in.
“Can’t you just cast it?” the male owner asks. His eyes dart between the X-ray image and my face. “I could try after we sedate her,” I reply, “but I am afraid we wouldn’t get good alignment of the fragments without surgery. The fracture is too commuted, and we’d have a limb that does not heal or heals at a very odd angle.” I explain that with surgery, plates and pins hold the bone fragments together and in the proper position. “With casting, an external device does this, and not as well—and it might cost more money in the end.”
The owners listen, but I can tell they’re very upset and have something else to tell me. The female owner shakes her head.
“Doc, we can’t afford any of the things you suggested, not even amputation,” the female owner says, fighting tears. “We can’t even have it casted, and we wouldn’t want to if it’s not going to work.”
This type of response is not uncommon in the veterinary world. Many people have animals, yet have no way of paying the costs that come with emergencies. There are, however, numerous options to make payment work for a client.
“Let me see what we can do,” I say. “I’m not sure what kind of options we have, but let me do some looking.” I leave the room and tell the staff what’s going on. Hanna has seen this situation loads of times. She reaches for a CareCredit brochure.
CareCredit fronts money for expensive surgeries and basic veterinary care. The clinic gets paid just like any other credit card charge, but CareCredit takes on the responsibility of payment. In Lacey’s case, it turns out that her owners don’t qualify for CareCredit. And our hospital doesn’t do payment plans—ever.
Simultaneously, another client says she urgently needs to talk to me. After assuring the client that the meds she picked up from us today are correct, Hanna comes back and says, “OK, so fracture dog: What if they surrendered the dog to me, and I paid the hospital for the amputation?”
It’s an attractive idea, but the owners won’t be able to see their dog again. They’d be surrendering their animal to another person—literally giving up ownership—no different from what happens at a humane shelter. I suppose Hanna could let the previous owner see Lacey again, but that would be entirely up to her. Still, this option would put Lacey first: It would mean we could do the surgery for the dog and avoid the ever-present threat of euthanasia.
Why couldn’t I just do the procedure for free? While this sounds altruistic, it’s not practical for every heartbreaking case we get. To keep people employed, we have to charge for services. Some hospitals have Good Samaritan funds; ours does not. It’s also Saturday, and I can’t contact management to approve a free surgery.
Besides, the way vet hospitals often fail financially is by giving services away. It leads to long hours with little to no pay, burnout, and a sense of worthlessness that perpetuates the veterinary profession’s already sky-high suicide rate. It’s not going to start with me.
I tell Hanna that her idea of surrendering the puppy is a good one. “See what they say, but make it anonymous,” I advise her.
This being a Saturday from hell, I’m pulled away to talk to a client who has been on the phone for 15 minutes with a tech, screaming about her dog’s spay incision. I talk the spay client down, reassuring her that we did in fact remove her dog’s uterus and ovaries in the surgery and that she had signed a form consenting to that. Then Hanna finds me.
“They don’t want to surrender even if it fixes their dog,” she tells me, on the verge of tears. “They don’t even want to cast it; they want to euthanize.” That’s odd, I think to myself—bizarre, really. Why would an owner want to kill a dog that could be saved? Now that euthanasia has entered their minds, I walk back into the exam room and have one last go.
“So, I did some digging, and I’m sure Hanna has mentioned it to you, but a tech here has volunteered to take Lacey if you surrender her,” I tell them. “You won’t own her any longer, but the tech will have the surgery done, and I really think Lacey’s chances of success are good.” I explain that I don’t think that euthanasia is warranted in this case—the dog is young, growing, and doing well, aside from this injury. I also don’t think that casting would be best for the dog because there’s more risk and likely more long-term expense for the owner.
“We want her to be put to sleep, Doc,” the man says, crying, his large hands shaking and clutching Lacey’s thick fur.
“Sir, it does not have to come to that; there are options. Lacey can live a good life,” I say, looking from him to the woman, who’s now staring at the wall. How can this be happening? They have two good medical options, and yet they’ve chosen a third, life-ending one. I’m dumbfounded.
“I don’t want to surrender her, and we can’t afford any surgery. I want to put her down,” the man says, getting the words out slowly. His eyes dart from me to the female owner. He can’t hold my gaze but looks more or less in my general direction.
“Let me see what we can do about that,” I say leaving the room. In the hallway, the staff stares at me, expecting some sort of plan to spring forth from my mouth that will save Lacey. I grip the treatment table, looking down and taking a few deep breaths. You cannot seize an animal, nor can you compel an owner to surrender or do what you think is best. I had just tried to sway them away from euthanasia, but to no avail.
OK, options, I think to myself. The owner is refusing both recommended treatment plans. I could euthanize. I could refuse to euthanize and send them home, pain meds on board, but the dog would still suffer, and the owner might take matters into his own hands. And yes, owners do shoot their own dogs. This may sound unthinkable, but in a rural community, it’s common. Despite what people might tell you, it’s not a humane solution.
So, I’m left with euthanasia or no euthanasia. No euthanasia will lead to more suffering and more trauma for Lacey before she inevitably dies, likely a slow and agonizing death at that—or one done by her owner with a gunshot.
There in the clinic, Miller’s words come crashing back: “Do it flawlessly.” Lacey deserves that, at the very least. Despite her owners’ decision, she at least deserves to die in peace. “You will do it painlessly,” I tell myself.
Gosh, this job breaks you.
I release my grip on the table and turn toward my techs. You’re the quarterback today, Bullis. Make a call.
“Have them sign a euthanasia consent form and an AMA. Put a catheter in her, and I’ll get the meds,” I say to no one in particular. I slowly walk back to the drug cabinet, hands shaking, and draw my injections.
Hanna places the catheter in the exam room in front of the owners so as to not move poor Lacey. I walk into the room and start giving my normal euthanasia speech, basically preparing the client for the process and what’s about to happen. The man interrupts me, now sobbing uncontrollably. “Just get it done.”
“OK. Let me just sedate her first,” I say. I reach down and start the injection.
The euthanasia goes smoothly. The only pain Lacey experiences is from the small pinch of the catheter. She doesn’t react to the drugs and doesn’t have any negative side effects. She dies in her owners’ arms, and they leave sobbing, without a word.
The staff—me included—is emotionally exhausted afterward. The whole day was bad. Not one easy client or patient. Two of my staff members are crying. I tell one she can go home, but she says it wouldn’t be fair to the rest of us. Some of these people make less per hour than a gas station attendant.
Despite my weariness, frustration, and even anger, I remind myself once more that I’m the doctor. I have to say something to my staff. I have to at least try and be a leader.
“I know you all are itching to leave, and trust me, so am I,” I tell them. “But I just want to say I’m really proud of all of you. Today we were handed a whole lotta shit.”
I tell them they’re the best techs I’ve ever worked with, and I mean it. “We don’t get to choose the challenges we’re faced with,” I say. “What happened today with the cat and the pup and all the angry clients was beyond our control. Sometimes animals just die. You can push as hard as you want, and sometimes they still die.”
The techs, some of them as old as my parents, nod and listen, but it’s Hanna who speaks up. “We get it, Andrew, but do you? It’s really important that you do.”
I nod, willing myself not to cry.
I drive home in a daze, take a shower, and sit on my couch, unmoving, feeling like absolute shit. I live alone. I have no girlfriend and no family in the area.
Until I started working, I never understood why veterinary medicine has such a high suicide rate. Female veterinarians in clinical practice are 3.4 times more likely to die by suicide than the general population; male vets are 2.1 times more likely. Three-quarters of these deaths come from vets in small animal practices like mine.
There are a number of reasons for this. Poor compensation is a major factor. Another is the crushing expectations of clients. Then there are the long hours, lack of work-life balance, and isolation from colleagues.
And the euthanasia gets to us. Really gets to us. Cases like Lacey’s haunt you. I didn’t see her owners again, but I know they have more pets. They just won’t bring them here.
It isn’t until you have a day like this that you realize the stress animal owners put on you or the gravity of the decisions you have to make. The pressure is so high—you’re the only one who can make the final call. In veterinary medicine, doctors operate alone. Yes, there are specialists and techs to assist you, but the system is much less organized than human medicine. It’s just you on an island, and you’re supposed to be the be-all and end-all doctor for anything and everything your community needs.
It’s hard, but Dr. Miller was right—at the end of the day, sometimes killing is the best thing we can do. Animals deserve a painless, humane death. I went to sleep that night knowing I at least did that and I did it flawlessly.
