Why online bullying is a new problem for vet suicides…

Vet cyberbulling during grief

Unfortunately vets deal with life and death every day, patients will die. With this there are owners who are suffering from grief. It is an emotional time that can quickly escalate out of control by doing what now comes naturally and posting about it onto social media.

Often these stories are emotional, they are however only the owners version of the story. Why? It is really simple – vets are bound by rules on patient confidentiality – they cannot share anything about a patient or owner publically online or elsewhere. It is a offence with the RCVS for which they can be struck off and lose their license, their income, and their career.

Most vets are compassionate people, dealing with death so often means that many are trained in the process of grief. This is why often an angry owner will just be allowed to make threats, and given time and space to calm down after losing their loved pet. Anger is part of the grieving process which is split into 5 stages:

  • The first stage is that of denial that their pet is dead, this is often rapid and is a stage where a person refuses to accept what has happened.
  • This is followed by the second stage – that of Anger – the pain of loss is so great that we cannot cope so the pain of loss is reflected out as anger. This can be at anyone – however as vets that care for animals it is often directed towards the doctor that tried to save them. During this stage it is a vicious cycle as the owner then feels guilty about being angry and becomes even angrier.
  • Once through the anger the healing process begins – the next stage is bargaining – the what if stage. Its where you attempt to regain control – where you start questioning what you did looking at ways that things may have been different. What if you went to vets sooner? What if you got a second opinion? What if…?
  • Then is a stage of depression – where the loss breaks through and we prepare to deal with the loss. Often a quite personal stage where we prepare to say goodbye to our loved one.
  • Finally is acceptance – not everyone will ever get here. It is the stage of making peace – of calm withdrawal. It is not a happy stage, however it the stage that allows you to move on.

Vets are taught these stages; they are taught that anger is normal, and whilst not psychiatrists they are taught to support the owner through the process. They may suggest that you call or come back in a few days once this stage is past. In the past before social media came about this was not an issue as owners would share with friends and family.

However social media is a boulder on top of mountain, once you give it a push it is very difficult to stop rolling. A single post made in this anger stage can now be picked up by hundreds or thousands of people you do not know all out for justice. Whilst during the anger stage this group outrage at the perceived injustice may help you feel better it will outlive your anger.

Vets already have the highest rate of suicide for any job – every day is an emotional rollercoaster. A vet may start with an euthanasia of a unwanted puppy, then fail to save a loved cat hit by a car, then have to do consultations with the client that cannot afford the needed medications within a single hour… And then they have to keep going the rest of the day. Vets often are perfectionists – we like to be in control and we do not like to lose a single patient – it is often these patients that we think about at night instead of the 99 others that we succeeded in helping. Vets care a whole lot more than you will ever realise as we are taught that we need to support you as owners so often hide our own pain

Unfortunately vets are not taught public relations – there is simply not time with everything that vets have to learn in school. So when that anger snowballs into a massive thing online by social media with random people calling them monsters – or worse. When their own clients (who may have an emergency) with their pets cannot get through because of the abusive phone calls and emails. It leaves a vet feeling helpless, alone, and can even drive them to turn to suicide as the only option when they give up..

There is very little support for vets in this situation right now – it is something new from a very old grieving process. Before social media speaking to friends and family was self-limiting – it let people go home and talk through what happened slowly with the time to heal. Now social media allows someone that is blinded by anger reach a worldwide audience right from the front step of the vet office.

And those are words that cannot be taken back. Anything online will be there forever in some form, angry messages are emotional and spread faster than any plea to take them back when you leave the stage of anger.

It is not just one country – it happens worldwide – just yesterday I wrote about a shelter vet in Taiwan, and there was a vet who saved a cat in New York. Both of these were directly related to social media and cyberbullying. Many times it doesn’t even reach the news – not a week goes by where I don’t see at least one vet being targeted online. Just yesterday a owner lost a tortoise – and in anger posted onto social media about it… These are some of the replies by strangers with just one side of this story…
2 3 4 5 6If you are that vet that is a target of cyberbullying – then reach out! There is http://vetlife.org.uk which is a confidential telephone & email support service for vets. Even just talk to a colleague or friend…

Somehow we need a solution to this – whether it is better education of clients – or development of a grief app for the smartphone to add a delay to posts so that it can be reflected on before being made public after the anger stage if there is still a need…

The truth about animal shelters

Jian Zchicheng Animal Shelter Vet

I was deeply saddened yesterday to read about the shelter vet that was bullied to suicide. Sadly with social media there is a lot of power given to people – however it is how they choose to use it as whilst it can do great good, it can also do great harm.

Animal shelters are never an easy place to work, it is a highly emotional environment and you really want to save every single animal that comes in. I’ve seen some bad shelters, and I’ve seen some good shelters. However the attitude of people working there is always the same – and that is to do the absolute best they can. Many workers will at one point fail to say no and adopt an animal from the shelter themselves as it is so hard to say no to these beautiful animals.

Unfortunately it is something the majority of the public will never see, rows of dogs wanting your attention to play. The hundreds of cats waiting and watching you for cages along the walls. These animals need the best care that can be given. They need their own space, they need to be able to relax, need to have space to play. They need to be protected from infectious diseases which are all too easy to spread in a shelter environment. And the people looking after them need to have the funds to be able to do this.

Now Jian Zchicheng did this every day for up to 500 dogs and 100 cats (can you even imagine what this looks like?!?!) which is the shelter capacity. However under Taiwanese law an animal shelter cannot refuse to take in stray animals – and just because the shelter is full doesn’t mean that animals magically stop arriving.

The limit on the number of animals is not random – it is there to ensure that diseases cannot spread, that animals have space, that animals have staff time, and that it’s possible to maintain cleanliness. Going over this limit puts every single animal in the shelter at risk – reducing an animals space and social interaction can affect behaviour – and this reduces the animals chance of finding a home.

When an animal arrives there are checks done both medical and behavioural – if it is too aggressive then it will be euthanized for safety reasons. If it has a disease or injury that is not easily treatable it will be euthanized. Unfortunately when you have 500 animals in your care spending £1000+ on surgery for a single animal is not realistic – this will feed all 500 animals for 2 – 3 days – and you know that within hours the next animal that does not need £1000+ in surgery is going to arrive.

So Jian Zchicheng did this, saving countless animals every single day, rehoming countless animal every single day. Yet when she appeared in a TV documentary a year ago which she probably hoped would help more animals get adopted all some animal rights people cared about was the euthanasia’s. They called her names like ‘female butcher’ and ‘beautiful executioner’, they made threats against her, and they gave her a torrent of abuse about the animals she could not save.

Every single “animal rights“ person that called Dr Jian names needs to take a look at themselves in the mirror now, you have taken an angel away from the 600 animals that were under her care. You have made other staff at other shelters hesitant about appealing to the public because of fear of your torrent of abuse. And you have driven a vet to death. I hope that every single day you remember this, and that every day going forward you become part of the solution. Encourage people to adopt not shop, volunteer at a local animal shelter, raise funds for local animal shelters, walk dogs from local shelters.

Jian left in her note “A (human) life is no different from a dog’s; I will die from the same drugs that we use to put dogs peacefully to sleep.”

I really hope you are peaceful Jian, and that you know every single animal you saved remembers that.

400 days to graduation…

Chris in Slovak Paradise

What feels like forever ago when I first started my diary I was counting up each day another day on my journey to becoming a vet. Now however I am counting down – that is either scary that I will be released onto poor unsuspecting animals, or amazing that I will finally be able to put my hard won skills to good use to make a difference.

I’ve come a long way since I’ve started not just in my knowledge but as a person. I never understood what I was letting myself in for when I got on the plane to come here – back when I started it was only accessible by Budapest and then a road transfer. I realised in Budapest that there were languages other than English – and that not everyone spoke English when trying to find my transfer company. It then got better when I was shouted at in the supermarket when I tried to buy ham – seems that I don’t understand here is mistaken for I cannot hear…

However I love Slovakia – and whilst I have just 400 days left here I am reflecting on what a great country it is. I’ve met some of the nicest people I’ve ever known, and seen some of the most beautiful places I’ve ever seen. The culture is amazing – I’ve never been anywhere where I can just walk down main street to find something going on – whether that is drums and folk dancing – or the Christmas market with hot wine in the snow. I’ve been up mountains in the snow – and at times thought I was going die – and then in summer laid by the outdoor swimming pools.

I’ve had opportunities here that I would never have got anywhere else. From anaesthetising a tiger, to working with dolphins, to chasing bulls around hills with a blowpipe. It is not always smooth, and its often crazy organisation – however that is just medicine – it depends on a lot of things and plans often go out the window. I’ve learnt loads, done loads, and seen even more.

So yes I am excited that I only have 400 days left, however I am sad that I only have 400 days left in this beautiful country. Each and every day I will learn a little bit more, both I hope in veterinary and as a person…

The big gaping hole in the skin…

Vet student in surgery

Something that is said a lot by surgeons is that unless you do something then you will never understand just what it takes. I realised today that this feeling depends on what you are doing. For routine stuff such as castrations where the goal is to remove some organs through a small tidy incision with no impact on function I am confident. I know what I am doing, how to do it, and that everything is going fit back together afterwards.

Today however I was put into a new situation, I assisted on an amputation after a car accident, and was left with a big hole on the side of the chest to cover with skin. I was basically doing reconstructive plastic surgery for the first time – and I started to feel the pressure. I had to make sure that the skin came together without tension without any dead space and with good opposition. I started walking the top flap down across the open space suturing it to the underlying muscles as I went. Once I had reduced the space here I realised that the edges did not line up – it was my responsibility now to cut the skin so that it fit together. For the wound to be straight with no dead space as if I left space underneath the skin it would form a seroma and fill with fluid. This has always looked so easy when someone else is doing it, however now it was me and it was not so easy. This was the easy wound as there was not going be much movement here yet I was still not sure just how much I could or should take.

I did the only thing I could that made sense and did it in stages as I brought the skin back together and it worked. Nothing like the results in the textbooks – however tonight I am going sleep fine with confidence that it was a good job and will heal.

The next part of the surgery was to repair a wound on the back leg as well – the skin had been peeled back either side of the thigh from the front with dirt inside with really dirty edges. This time it was more difficult to judge – this wound was going have movement across it with every single step. Every step was going change the tension on this wound, and it was big from the top of the thigh all the way until just above the top of the knee. Normally the length is not a consideration (wounds heal side to side not front to back!) – however the closeness to the knee meant that different tension patterns were going apply to different parts of the wound.

I made my plan; I picked up the scalpel, placed it against the skin roughly 3mm from the torn edge and started my cut. My cut was long and went around the entire wound taking in a random hole at the lower end as well. It was slow, and I was petrified that I was going take too much, or worse go too deep and cut something I shouldn’t. As I cut there was bleeding – I’m lucky I know more about bleeding now than most – and seeing this blood I was concerned but not alarmed as it was only a little. I clamped it off whilst I finished my cut – clamping it applied pressure and gave it time to clot so that by the time I was going suture the wound it would have stopped bleeding.

I then set about cleaning the surface of the open wound that had been contaminated with a curette (like  sharp edged spoon) so that I had a clean wound bed that would stick to the skin I was going place over it. I took my now relatively cleaner wound and then flushed it with sterile saline to hopefully remove as many germs as possible that I may have missed and started suturing it back together. Firstly bringing the edges of the skin close to each other, and then suturing the edges of the skin together.

Finally it was time to head to recovery – which went extremely smoothly with the dog up on its 3 good legs within 30 minutes of the end of surgery. I just hope now the dog finds an amazing home.

The collapsing trachea…

Vet student in surgery

Most mammals, birds and reptiles rely on oxygen passing into their lungs to survive, with most of them doing so via a tube from the mouth to the lungs called a trachea. The size of this is normally relative to the species to allow for the exchange of air to take place into the lungs.

Now there are several differences between species in how this works with different areas that problems can occur. However today it was a dog, and its trachea instead of being round was pretty much a flat rectangle. Breathing was such a problem that this dog was a candidate for surgical intervention to make breathing easier. There are several options for this type of surgery – best outcome is usually using a wire stent deployed inside the trachea however this is relatively expensive especially for Slovakia. The other option is to try and use an external support around the outside of the trachea – this is what we did.

Once in surgery we opened the neck of the dog. This is one of the most complicated parts of the body considering the size and the number of structures within this area. There are glands, nerves, and blood vessels that pass in this area which if damaged can cause major problems. This is an area that I have not seen much surgery in so I was excited to be assisting today.

Separating the muscles that lay above the trachea we get our first look at it. Instead of the circular tube that would normally be seen the trachea was similar to fat ribbon passing along the neck. This was over more of the length of the trachea than I expected as generally collapse occurs over the thoracic inlet. Our plan was to use a syringe case to provide a circular structure around the trachea and so restore its normal shape and size of the internal opening to allow easier air flow.

We prepared the syringe to fit around the tracheal rings so we could attach it to by cutting it into short sections and then splitting and shaping the ends to avoid causing trauma. We separated down the length of the trachea so that we could fit these sections around. Something that really surprised me was the size of the laryngeal recurrens nerve – the one responsible for voice.

We applied the prepared supporting rings around the trachea, and sutured the trachea into these at key points to provide a frame for the shape of the trachea. For a syringe that costs maybe 25p the fact that it can be used in such a way is very surprising. Reading around the surgery however there are some big potential complications which makes the internal stent a more attractive option if the funds are available.

The end of the semester…

Today is the end of the semester, it is scary how fast it has come, and more scary that in a little over a month I will start my state exams.

As off today my education from university in exotic pets, poultry, wildlife, and zoo animals is complete. I know everything I need to know to treat these animals, and on the 13th June I will be tested by a panel to confirm that I can do this. This is scary. I feel I have barely scratched the surface, when it comes to exotics I am lucky to have a lot of extra education through my work with education rabbit owners on proper care.

For zoo animals, I have been extremely fortunate to learn from some of the best zoo vets in the world, gained valuable knowledge and experience that I will treasure. I’ve worked with dolphins, tigers, orangutans, camels, sea lions, seals, penguins, coyotes and birds. Being allowed into a world that few ever see I am more confident on this part of the state exam than any other.

Then there is poultry, I dread this part of the exam. Personally I believe that whilst we need meat, just by spending a few extra pennies we can improve the conditions that these chickens are raised in. Unfortunately poultry medicine is focused on the population. With each bird worth just over a euro there is no money for treating individuals. These animals are here for the single purpose of feeding humans. My education here allows me to optimise the conditions for this to happen, for me to determine the best way to get the highest production. Is this an education I really want? No, however it has to be done. I just dread the day when this becomes an even more intensive process.

It is no longer random subjects which faintly tie into medicine, now it is a case of actual medicine – where what I know, or don’t know will affect patients. These state exams are the ones that count, and I really hope that I don’t mess up.

Tonight finished with a BBQ up on the hills looking over the city that I am proud to call home for at least one more year…

Why did the doctors go on strike?

I came across this and had to share – it is written by Dr Ravi Jayaram

I have kept quiet on here until now about the junior doctor’s strike but the time has come to stand up and say what needs to be said. Apologies in advance for the long essay, I will try to keep it simple. This is aimed at those of you who are not medical; those who are will know exactly what I am talking about.

If you simply believe what is said in the media, you might think that this is all about Saturday pay or even that junior doctors don’t want to work at nights or weekends. It is depressing to overhear people express these views but hardly surprising given the public coverage of the issue.

So what exactly is going on? A junior doctor is any doctor who is not a GP or consultant who is in training to be one of those two. Most doctors spend 8-9 years as a junior but many stay as juniors for longer, especially female doctors who may take time out for families, academics who take time out to do research and doctors in specialities where training in two specialties is needed such as paediatric intensive care. I myself spent 14 years as a junior doctor so was still one aged 37. Junior doctors are the doctors you will see first when you go to A&E or get admitted to a ward and will be responsible for delivering your day to day care when you are in hospital. Junior doctors are covering the hospital 24/7, 365 days a year and always have done. And contrary to what you might believe from the papers, they don’t have any choice in the matter, their contracts say they have no choice in working evenings, nights and weekends.

So what is all the fuss about? Well it is about being able to be safe. When I was a JD, I used to work ridiculous hours. In one job in my 1st year, every 3rd weekend I would go to work at 9am on a Saturday and leave at 5pm on a Tuesday. That was 80 hours in a row with sleep grabbed when the chances arose. It was dangerous and dehumanising and the even crazier thing was that I was actually paid at a lower rate for the unsocial hours than basic pay (1/3 of basic in fact).

Fortunately my generation of juniors was amongst the last to have to do that and things slowly changed. Now junior doctors get paid at a higher rate than basic for unsocial hours, that rate determined by the intensity of work in that specialty e.g. emergency room work would be a higher rate than dermatology. Standard hours are defined as 7am-7pm Monday to Friday (which are not exactly standard working hours for most people) and there are rules on the maximum number of hours per week and consecutive hours that can be worked. There are also safeguards in place so that if employers are consistently making juniors work beyond these rules, they can be fined; hence there is a disincentive for employers to overwork junior doctors, therefore they are not tired and dangerous 1990-style.

But work done outside standard hours is NOT overtime. These hours are contracted hours and have to be worked and, quite rightly, are paid at a higher rate than basic pay. In specialties where there is not a lot of emergency work, the majority of work is in routine hours, but areas like A&E, paediatrics, intensive care have a lot of work done in unsocial hours and attract a higher rate of pay for those hours. I stress again that this is not overtime; overtime is work done in addition to contracted hours. All doctors and nurses do overtime – staying late to complete work and ensure patient safety and very rarely if ever does anyone claim for these overtime hours.

But Jeremy Hunt wants to change the contract for junior doctors, his logic being that doing this will help to deliver the “7-day NHS”. Nobody is really sure what exactly this means. It may mean that he wants routine services such as outpatient clinics and planned surgery or scans for non-urgent problems to take place on Saturdays and Sundays, not just Monday to Friday. If this is the case then changing the juniors’ contract is not going to make this happen as without doing the same for (deep breath) consultants, nurses, porters, receptionists, pharmacists, operating department assistants, radiographers, physiotherapists and many other staff these things won’t be able to happen at weekends.

The 7-day NHS may refer to emergency work. If this is the case then it already exists. Junior doctors are already there at night and at weekends. The proposed contract changes are not going to change the numbers who are there as there is no plan to increase the total number of junior doctors. What is proposed is that the definition of normal time changes from 7am-7pm to 7am-10pm Monday to Friday and from 7am to somewhere between 5pm and 10pm on Saturday. This means that employers could make junior doctors work more unsocial hours as they have redefined as standard hours. It is true that the basic rate of pay for standard hours will be increased by 13%, which sounds great doesn’t it? Except that for the emergency specialties as above that routinely have a lot of evening, night and weekend work, what is currently paid at an enhanced rate will be paid at standard rate; even at 13% higher for standard rate, total pay for junior doctors in these specialties will drop considerably, maybe by as much 30% for some. Doesn’t sound so good now really.

And, of course, there will be the same number of doctors but spread over 7 days rather than 5 so there will be weekdays where there will be fewer juniors than there are now. A great analogy I heard was to imagine that you have a 10-inch pizza cut into 5 slices. You decide that 5 slices isn’t going to fill you up so your mum cuts the same pizza into 7 slices and tells you that you’ll be full with that. But she won’t get you a bigger pizza.

So same number of junior doctors spread more thinly is going to reduce cover on weekdays as compared to now. And weekdays are when not only emergency work but also routine planned work that also needs input from junior doctors takes place so this will have a detrimental effect on waiting lists for clinics and operations as well.

Junior doctors with children will be hit particularly hard, especially those who have junior doctors spouses, as more unsocial hours will be worked. Childcare is generally difficult to get hold of outside of 8-5 on weekdays; the department of health have actually said (with no hint of irony) that in this situation, family members who are non-medical and don’t work evenings or weekends should be asked to provide child care to get over this problem! It is very likely that couples could go several days without actually seeing each other or their families if rotas do not coincide.

But what about the increased deaths at weekends we have been hearing about? Actually, the statistics have been completely misrepresented and even the authors of the research paper that gets quoted regularly have pointed this out. The statistic was that if you are admitted to hospital on a weekend, your risk of dying within 30 days of that admission was higher than if admitted midweek. Your risk of dying is very low anyway and that very low risk is marginally higher (but still very low) if admitted on weekends. This is probably because admissions to hospital in the week consist of not only sick people but also well people coming in for routine things, whereas at weekends you would tend to avoid hospital unless you were desperately unwell and most likely would leave things as long as possible and so be sicker when you got there. Interestingly they also showed that if you were already in hospital on a weekend, having been admitted in the week, your risk of death within 30 days was lower than it would have been. Either way, there is no evidence of cause and effect in terms of numbers of junior doctors around at weekends. The so-called weekend effect has also been seen in the USA and Australia too so it isn’t peculiar to state-funded health as opposed to private insurance-based systems.

Interestingly the misrepresentation of this study has led to ill people actually avoiding hospitals on weekends and delaying presenting till Monday with potentially devastating consequences. Have a look online for the ‪#‎hunteffect‬. Scary.

Another worrying thing about the proposed new contract is that it takes away the safeguards against juniors being made to work ridiculously long hours. Whereas currently there is a mechanism that makes it in the interests of an employer to ensure the hours are not exceeded, the new contract removes these safeguards. It does suggest that each hospital trust has a “guardian” to whom junior doctors can flag up concerns about their hours but this “guardian” will also be a senior member of the trust who has no obligation to actually do anything about these concerns. I think back to my days as an exhausted junior doctor and it scares me to think that such unsafe and dangerous hours could make a return.

The pay scales are also changing. There has been automatic pay progression as you gain experience and seniority until now. The new system means that there are fewer points where pay is raised. This is not necessarily a bad thing as it can be argued that you shouldn’t get a pay rise unless you deserve it. But remember that over 10 years can be spent as a junior doctor in which time you are likely to acquire husbands, wives, children and mortgages; many existing junior doctors have made their financial plans for the next few years based on the expectation that there will be pay progression. One part-time junior doctor who has worked with me told me that if the new contract came in she would no longer be able to pay her mortgage and would have to sell her home. Bear in mind that these are young people who have spent at least 5 years at university accruing debts from both student loans for living expenses and now also £45000 in tuition fees before even starting work. The new pay scales do not reflect the levels of responsibility taken by junior doctors at different stages of their training at all which makes no sense whatsoever. For female doctors who are likely to take time out to have children and then return to work part-time, the consequences on their income will be huge. The department of health actually acknowledged that women would be hit unfairly but suggested that this had to be accepted as an unfortunate consequence.

The BMA junior doctors committee walked out of talks with the department of health because the DH’s definition of negotiation was that they would reserve the right to do what they wanted if they didn’t agree with what the committee was suggested. In other words, they did not want to negotiate so there was not point in the BMA trying. This is why industrial action was proposed because there was no other way to try to get Jeremy Hunt to talk. Sadly, even when negotiations restarted, he could not see that without a bigger pizza nothing was going to improve patient care and in fact things would be worse and so talks stopped. He has now said he is imposing the contract and that is that, he won’t talk anymore. When a strike ballot (of, let’s face it, intelligent reasonable and educated people) has a 75% turnout and 98% vote in favour, it is clear that there is a serious problem with the DH’s thought processes and they need to listen. It is highly improbable that a small bunch of radical lefties have brainwashed 50000 intelligent doctors who have been trained to analyse information and draw conclusions, much as the press like that idea.

If you have read this far, please take it on board and share with your friends. I’ve tried to keep it simple (even though it may not seem that way!) The public is not getting the full story from the TV and newspapers and if this contract is imposed then we will all be on the receiving end of the consequences eventually.