Imagine being recommended a medication that you were told could lower your risk of dying. But to be fully informed before taking it, you were first required to spend 24 hours in a room wallpapered with all the potential risks and side effects of taking that medication printed in large, bold font.
The words all over that wallpaper are:
Dizziness, nausea, weight gain, diarrhoea, constipation, abdominal pain, vomiting, back pain, migraines, suicidality, paraesthesia, restless leg syndrome, blurred vision, ringing in the ears, eczema, itchiness, hives, agitation, irritability, nightmares, confusion, muscle pain, swelling of the face, lips, tongue, and/or throat that may cause difficulty in breathing or swallowing, impaired concentration, poor memory, hair loss, decreased thyroid function, hepatitis, liver failure, hallucinations, slurred speech, kidney failure, trouble walking, tremors, seizures, coma, death
After 24 hours you are let out of the room and presented with the medication. Would you take it?
I’ve had some experience assessing health related risk versus benefit. Professionally I’ve done it with every animal I have recommended a treatment or diagnostic test for, from the simple (routine vaccinations) to the complex (invasive surgery in a patient who is already unwell).
But perhaps my personal experience of taking psychiatric medications on and off for the last 15 years is more relevant. The above list is just a sample of the potential side effects of some of my medications. If I printed them all out, and then wall papered my house with them, I could easily torture myself into not taking any of them.
This is the wallpaper effect.
I don’t disregard any of the words on that list. I know someone who almost died as a direct result of taking one of the medications I take. I have recently been diagnosed with decreased thyroid function, very likely as a direct result of taking one of my medications, There have been other medications I have tried and had to discontinue because of side effects.
And to put the risks I am working with into perspective: Common side effects for many of these medications are considered able to affect up to 1 in 10 people, uncommon side effects may affect up to 1 in 100 people, and rare side effects – so the more serious ones in the above list – may affect up to 1 in 1000 people.
As risks go, they are not exactly tiny.
And yet I opt to religiously take these potentially life-threatening medications. Why? Because the risk of side effects (in me, at the moment) is less than the risk of my Bipolar 1 Disorder symptoms being poorly controlled.
I have a higher risk of both a poor quality of life and death from my Bipolar 1 Disorder if it is unmedicated than I do from my current medication regime. My risk of death if I do nothing to manage this illness sits between 15%-20% (including not only suicide but non intentional causes of death due to manic or psychotic symptoms, which can include increased risk taking, hypersexuality, poor judgement and delusional thinking).
Thanks to modern medicine, humans in first world countries are confronted with death less often. It is easy to delude ourselves into thinking that death can be avoided if we ‘do our research’ and make the right choices.
Speaking of ‘research’: True research is not a google search. Neither is it being spoon-fed unsubstantiated claims on social media by someone who couldn’t make their way through one research paper if they tried, let alone the hundreds it would take to qualify what they were doing as actual research. Research is something academics, including scientists and some medical doctors, are trained to do. It is rigorous, unbiased, and a skill that takes years to learn.
I believe the choices most of us make about our health have less to do with ‘research’ and more to do with the biases our environment soaks us in.
If you see mobile morgues or dead bodies outside your window, you are more likely to want the vaccination that reduces the chances of you dying from what killed the people outside your window, even if the vaccine carries a very small risk of death.
If you don’t know anyone who has died from that same illness, but you are marinated in the announcement of a potentially fatal side effect of the vaccine every time you look at a screen, you are likely to be more reluctant to be vaccinated than someone in the first group.
The scientific risk of death due to side effect is identical in both populations but the human response is different according to which narrative is shoved into our malleable brains. The capacity to weigh true risk against benefit flies away.
And that is why I choose not to live in a house wallpapered with my medication side effects.
I never considered my mental health as part of the decision to have a baby, because when I first fell pregnant within a month of trying, I had never experienced mental illness.
The pregnancy was uneventful.
Then I went into a thirty-three hour labour on two hours sleep. This severe sleep deprivation and the swirling hormone levels woke a slumbering monster, a genetic predisposition, which ensured that by the time my baby was one week old, psychosis had wrenched me away from reality. I found myself in the Special Care Unit of a private psychiatric hospital trying to explain my way out of my delusions, while my husband and mother cared for my daughter at home.
Long before Covid-19 arrived, vets and vet nurses were quiet, hard workers who didn’t complain about less than ideal working conditions. And, possibly unbeknownst to most of the pet owning public, for many veterinary staff, challenging working conditions were the norm.
Since this crisis hit, these essential workers are not getting much opportunity or airtime to communicate the difficulties they currently face at work.
The advent of the Covid-19 pandemic has put the challenges of veterinary work on steroids.
I know a bit about what it takes to work in this industry.
I fell in love with veterinary work at fifteen, when I started volunteering at a local vet clinic. I wiped down tables, cleaned cages, and held animals. Then I started work as a casual junior vet nurse on Saturday mornings.
I committed the second half of my teenage years to the tunnel visioned hard work it took to get into veterinary science at university.
I worked as a small animal vet for twenty years, in many different practices in Australia and the UK. Working conditions ranged from excellent to atrocious.
Thanks to my experiences, I know this:
Vets don’t talk about their work stresses outside their own tightly knit vet circles. Some of us don’t even confide our struggles to our colleagues. We talk about our cases in detail for hours, but many of us still cringe at opening up about the state of our mental health.
Our clients get our kindness, our compassion our sympathy our skills our knowledge, our communication skills. But they never see our vulnerability. They don’t understand how high our risk of burn out (borne of caring too much and being overworked and undervalued) is.
They don’t see that when we walk through the door of the clinic our rostered working hours become irrelevant because we give ourselves over completely to everyone else who walks through that door after us.
Our clients don’t feel our pain when we lose yet another amazing member of our profession to its sky-high suicide rates.
I am currently taking a break from veterinary work while I concentrate on writing and mental health advocacy work. But I have many vet friends who are out there working and hurting.
I have spent the last couple of weeks collecting descriptions of work life from some of my (currently working) veterinary friends and contacts, because I believe that for the veterinary profession to survive this pandemic with its collective mental health relatively intact, the pet owning public needs to know about the difficulties its workers face at this time.
Here are some of the (summarised, paraphrased, and quoted) insights these vets generously shared with me:
On Covid-19 Regulations:
Some aspects of veterinary work make social distancing between staff impossible. For example, it is not feasible for a nurse giving a wriggly, excited puppy a cuddle and a vet looking in its ears with an otoscope, to be 1.5 metres apart.
Some of the protocols necessary to minimise the risk of Covid-19 transmission, such as contactless consultations (where the owner waits outside the clinic in their car, the pet is transported inside by a nurse in PPE, the vet examines the pet and then phones the owner to discuss further diagnostics or treatment), severely hamper efficiency and slow everything down.
Vets are used to working as efficiently as possible:
‘Normally I would type the history while the owner is in the consult and do an exam in between taking notes. Now I can only do one of these things at a time.’
Contactless consultations also limit a vet’s ability to read their client’s body language during the consultation, which can interfere with effective communication between vet and client.
Pets can be more anxious when separated from their owners. This may mean it takes longer to perform a physical exam, or it may be impossible to do as thoroughly as the vet would like.
Covid-19 level cleaning recommended between consults is more labour intensive and takes longer than usual.
Downsizing or closure of a practice due to further restrictions or a Covid-19 infection will have negative effects on the practice’s financial stability very quickly.
‘The nature of small to medium sized veterinary practices even in normal times is to run with incredible efficiency, but still on very low margins. They cannot sustain even mild to moderate downturns. They will not survive and jobs will be lost long before the drop of 30% revenue occurs required to be eligible for the Job Keeper Payment.’
Locum vets are particularly vulnerable to job loss now. As practices work to minimise the risk of a Covid-19 infection in their permanent staff, many locum vets are having their shifts cancelled, and are facing the financial difficulties and mental health challenges that come with job loss.
Vets are also more aware than ever of the financial constraints facing many of their clients.
‘It is super sad when you see a client who wants to do everything for their pet, but they have lost their job and can’t afford it. It breaks my heart. I am doing a surgery at a 25% discount tomorrow. The client didn’t ask for it, but I feel so sad for them.’
‘I feel even more conscious of the usual dilemma we have in vet practice of having to mix financial discussions with emotive ones as most people are understandably a lot more stretched financially right now. But veterinary practices are also under a lot more financial stress and if our invoices are not paid, there won’t be a vet for clients to take their animal to.’
And now more than ever vets are at risk of being on the receiving end of their clients’ financial frustrations.
‘I’ve already been abused in the car park once this week and I am preparing myself for a lot more of that to come as the stress is almost palpable in the air.’
On Mental Health
Vets often hold themselves to a very high standard. Under sub optimal working conditions that pressure will increase stress levels further.
‘Veterinary practice is already an emotionally draining vocation with highs and lows every day. Our staff feel responsible for their patients and care for our clients. And it goes against the grain to just drop our standards of care because of what’s going on. So, we are not going to start cutting corners.’
Many clinics have split their staff into two or more teams to reduce the chance of the whole clinic having to close if one staff member contracts Covid-19. This means vets and nurses may be working under short staffed conditions and even longer hours than usual:
‘The phones are ringing constantly. We hang up and pick up the next one. I am answering dozens of phone calls daily as a vet, as well as being my own anaesthetist, recovery nurse, and doing the usual vet things. And right now none of us have regular access to our stress relieving hobbies.’
Splitting staff into teams at work usually also means no contact between teams outside of work.
‘There were genuinely tears after the last ‘normal’ shift as people realised they may not see some of their friends for weeks, months even.’
Before Covid-19 brought added work stressors with it, vets were already at a high risk for mental ill health. This knowledge weighs heavily on many of us:
‘I’m concerned that abuse of controlled substances will increase and don’t even want to think about the suicide issue the veterinary industry already faces.’
Vets appreciate the many clients who are doing the things that make their work less stressful, such as practicing social distancing, being patient when things take longer than normal, and assessing what might constitute an essential phone call.
For example, now is not the time to phone your vet clinic for a lengthy discussion about which breed of cat you should get.
‘If the public can show extra understanding towards vets and vet nurses that will only be a good thing. We are not the only profession under strain but the pressures we are under are very real. Everything is taking longer so people need to be patient.’
‘We place a lot of blind faith in the honesty of strangers at the moment…I feel angry when I hear of my colleagues having got to the end of a consult only to have a client mention that they just came back from a cruise a week ago.’
‘Thankfully 99% of our clients are understanding and adhering to protocols without complaint, but I don’t think they quite understand how hard everything is for us right now.’
‘The shortage of equipment is tricky – no hand sanitiser, limited paper towels and gloves. It makes it hard to follow the guidelines to use hand sanitiser between every patient. Some human medications we use are in short supply, which will be hard to explain to clients when their pet’s medication needs to be stopped suddenly.’
‘We have also been asked to supply a list of things we can donate if needed – such as ventilators, propofol, midazolam, and surgical gowns and gloves.’
What is getting us through?
Now more than ever, humour, teamwork and appreciative clients balance out the challenges of veterinary work.
‘On the positive side of things, I work with a group of amazing humans and the way we all have each other’s backs has definitely shone even more so in recent times.’
‘On the upside we have always been good at the ‘make do and mend’ mentality. Also, we were born for this – we just need to pretend every person is a parvo puppy!’
(Parvovirus is a highly infectious, potentially fatal viral infection, most common in puppies, and requires full isolation nursing.)
‘Our team are amazing and have chosen to pull together with a plan to fight and minimise risks to client and staff safety, mitigate risk to the business and work toward sustainability.’
‘We have had wonderful support from our clients and community who have commended us for our initiatives during this pandemic to ensure both human and animal welfare,’
To conclude I will reach for words one of my close vet friends passed on to me. Even though upper management of veterinary practices, can be notoriously out of touch with the needs of its veterinary workers, this directive from the upper management of my friend’s practice encapsulates perfectly what I would want all vets working through this pandemic to hold close to each day, and what I would want all veterinary clients to be aware of and respect:
‘Throughout our career, veterinarians have always put our patients first, then our clients, then ourselves. In this pandemic, we must put our safety and the safety of our nurses and support staff first.’
Everyone knows depression is bad. But does this mean mania is good because it supposedly sits at the opposite end of the bipolar spectrum?
Mania is often painted as the cartoonish counterpoint to depression. Perpetually bright, happy, and fun. But it is not fun. It is the character in a horror movie who starts out friendly but then morphs into someone with sinister, glowing eyes.
I just read an article that described one of singer Guy Sebastian’s friends as having:
‘lost his life to his battle with mental health’
Tragic. Another young man has become a statistic that should be at least partially preventable. Sadly, we can’t bring him back.
But there is something we can do to inch our way towards better describing why this happens. We can use accurate language when we write and talk about these tragedies. Language that doesn’t mislead. On the surface it may not look like there’s much wrong with the above quote.
I recently removed the key to the dangerous drugs safe in the veterinary practice I’ve just resigned from, from my key ring to return it. And as I did so, I thought:
‘I wonder if my suicidal ideations will change now?’
I’ll come back to that.
I also recalled how often I’d heard the following over the last twenty years in practice:
‘My son/daughter/nephew wants to be a vet when they grow up.’
Always uttered under the impression that veterinary work is a dream job. But the dream can morph into a nightmare. There is currently a shortage of vets (in part) because our burn out and suicide rates are sky-high.
So why, after dedicating years to entering this prized profession, do many vets want out?
The day I found out my first baby was a girl, I cried. Until that moment I hadn’t thought much about gender. So, the heaviness that settled on my shoulders when the ultrasound revealed it, was unexpected. The weight of believing I had to be the perfect female role model for a daughter momentarily choked the joy of having one out of me.
A young man in the inner circle of one of my work colleagues died earlier this year. I didn’t know him, have few details, but the devastation written on my work mate’s face said it all. And the details I do know are telling:
He suffered from depression.
But he was going really well.
And then he died…unexpectedly…by suicide.
Tragically, the unexpected element in this scenario is such a common postscript to male suicide it could almost be described as a hallmark. A third of all deaths in young men are due to suicide. As the mother of a son this statistic makes me want to stick my fingers in my ears and hide behind these words:
‘That would never happen to us.’
But I know enough to know that sticking one’s head in the sand just adds to the risk. Unfortunately, there will always be a percentage of unpreventable suicides, but even reducing the statistics would be some comfort. So how do we do that?
Maybe a starting point is to recognise the emotional differences between girls and boys, and how we react to those differences. I haven’t researched this scientifically, and every family is different – but here’s what I’ve noticed in mine:
My daughter and I talk a lot. Ad nauseum. I know her emotional barometer almost as well as my own. My son is easy-going, unless he’s tired and/or hangry. He demonstrates his affection physically with a hug or wanting a tickle. Whereas his sister demonstrates it by saying: ‘I love you’.
A lot of my son’s verbal output revolves around Pokemon Go and food. Because of this it can be easy to dismiss what is going on in his head as uncomplicated. I do it sometimes. Life gets busy and he seems ok. But it’s a mistake, because when I give him the right time and space he shows me he has plenty of other thoughts, and that his worries and fears are often no different to his sister’s, but the way he processes them is.
Without wanting to stereotype, or discount individual personality differences, my perception is that while our daughters often wear their emotions on the outside, our sons’ emotional barometers are internal organs. Sometimes we have no idea where they are at until the pressure is at exploding point. In little boys that might be a meltdown, or a quiet sadness. It might be something that can be soothed with a cuddle and a casual chat about what’s bothering them.
But what about bigger boys? As tweens, teens, and young men they don’t sit on their mum’s lap and cry when their thoughts don’t make sense. They tend to stay quiet. Sometimes too quiet.
There are no simple solutions. But we can start by teaching our little boys how to communicate emotional pain long before they grow into young men. And if they do give us hints that all is not right in their world we should take serious notice. Just because they might not express their emotions as noisily as their sisters doesn’t mean our response to their distress should be any less urgent.
While we work towards getting better public mental health services, there are things we can do for our boys and young men. We have to educate them about the link between substance abuse and mental illness, particularly if there is a history of mental illness in the family. And if our young man has a mental illness with depressive or delusional symptoms we must learn to sit with the following discomfort:
Talking about suicide, is much safer than silence.
We need to eradicate stigma! Suicidality is so often a symptom of a mental illness. Stigma blocks the dissemination of information about how such illness can be successfully managed. Parents must understand that it doesn’t matter how much you love and support your child, if that child is sick – whether it’s cancer or a mental illness – you do not have the professional knowledge, skills, or resources to save that child on your own.
Private Health insurance often gives you better choices, but if that’s not an option there are places to go for help. For 12-25 year olds Headspace https://headspace.org.au/ is a good starting point. Your GP can provide psychology and psychiatry referrals. But perhaps one of the most important things you can do for your son (or any other young man in your life) is to be vigilant in the face of his silence.
The image accompanying this post is a favourite of my son. He’s less than a week old. Three generations of hands cradle him – my mother’s, mine, and my daughter’s.
Things have changed since it was taken. These days my son can hold up his own head, but he still needs his family to show him how to open up, not shut down when he’s feeling vulnerable. We need to show him every, single day that we support his emotional health, and that even when he is much taller, hairier, and physically stronger than us, we will continue to have his back.
I don’t dwell on what might have happened had I been sent home on day five after my daughter was born. But whenever the news throws up sensational stories reporting murder, infanticide, or suicide, and there is even a slim possibility the perpetrator might have been psychotic – then I think about it. Because that could have been me.