A veterinarian says pets have a lot to teach us about love and grief

DAVE DAVIES, HOST:

This is FRESH AIR. I am Dave Davies, in for Terry Gross. My guest, Karen Fine, loves animals, but she finds that when cats and dogs who've encountered her before detect her smell, many will leave the room. She's been told that some cats run and hide when they hear her voice on the phone answering machine. Fine is a veterinarian. She's practiced for more than 30 years, most of that time making house calls.

In a new memoir, Fine reflects on her experience treating pets and counseling their owners and using acupuncture and other nontraditional treatments to help her patients. She's written a veterinary textbook about narrative medicine, a field that seeks to improve care by viewing patients in the larger context of their life stories. Her book also deals with the emotional toll the profession takes on veterinarians, who suffer from suicide rates far higher than those of the general population. Karen Fine practices small animal medicine in central Massachusetts, where she lives with her husband and son and an assortment of rescues. Her new book is "The Other Family Doctor: A Veterinarian Explores What Animals Can Teach Us About Love, Life, And Mortality." Karen Fine, welcome to FRESH AIR.

KAREN FINE: Thank you for having me.

DAVIES: You know, you begin this book with a lovely story about a couple you know who had adopted a feral cat - not the easiest animals to approach. And they call you 'cause he appears to have an infected front paw. Tell us what happens when you get there.

FINE: So this was a very difficult cat. He wasn't aggressive or anything. He was just feral. And I had caught him before in a fishing net, which is something that another veterinarian who treated a lot of cats had shown me how to do. And when I - I got him wrapped up in the net, and I moved him out into the kitchen where the light was better, and I could tell what was wrong. He had a front toenail that had grown so long it had grown around into his paw pad and had punctured it, and it was infected. And I knew that I could give him antibiotics for the infection, but it wasn't going to stop until I trimmed that claw. And I knew if I got him out of the net, he would run away.

And I didn't know what I was going to do because I didn't have any anesthetics with me. And as I was wondering what to do, this cat stretched his leg out straight through the netting - somehow managed to do that - and spread his toes and stayed perfectly still as I trimmed his nail. And then, I was able to let him go and give the people some antibiotics to put in his food. And it was just an amazing encounter.

DAVIES: Yeah. So this animal who was panicked and in this net at some point realized, this woman is here to help me, and I know what the problem is. Here, take a look. What lessons did you draw from the cat's behavior?

FINE: I think there's so much we don't know and understand about animals. And I think there's a lot that we sort of assume that we know, but that they really have skills and senses that we don't or that we don't utilize to the best extent. But certainly, say, their sense of smell is much better than ours. And I think there's a lot we can learn from them. And I feel that I learn from my patients all the time.

DAVIES: Right. And a lot of that knowledge is in the book. You have to be careful with a cat or a dog that doesn't know you. What are some tricks that you've developed for making it so that you don't get bitten or scratched?

FINE: Well, I really listen to my sixth sense, and I found that when I don't listen, when I'm in a hurry, that's when I'm more likely to get injured. And sometimes it's a person, say, with a dog, and they say, oh, I really don't want my dog to be muzzled. And that's fine. I understand that. And sometimes I'm able to do that. But there are some times where, oh, if I can just put that muzzle on for a couple minutes, I can get everything done. And really, most dogs don't stress that much over something like that. And it saves me the worry and the anxiety about, am I going to get injured on my job? So it really depends. I really - especially being in the home, I think a lot of animals are much more relaxed. So I probably didn't have to do that as much. And I certainly always wanted the animal to be relaxed.

And in fact, if an animal was better with a muzzle on, I would encourage the person to get their own muzzle, get the animal used to it. And I once saw a dog that - they had come into the clinic, and the woman said this was a rescue dog that was very difficult. And she had worked with the dog a lot, and she pulled her own muzzle out of her pocketbook, and the dog's tail started wagging. And I was so impressed with that, that this dog had clearly realized that good things happen when the muzzle came out, and it was not something he was afraid of at all.

DAVIES: Now, cats are tricky. I mean, a lot of times when they're in carriers, they don't like that. They feel confined, whatever. And then, you plop them up on this examining table. What do you look at to see whether you can pick that cat up or what you should do?

FINE: Cats are difficult. And certainly, doing house calls, one of the things I ask people to do is to put the cat in the bathroom because the hard part was chasing a cat out from behind a sofa or under a bed. The poor things would be so stressed, and it was just stressful for everybody. And then, by the time I'm looking at them, their heart's racing. You know, they're kind of in fight-or-flight mode, and it just made it difficult. So some cats were totally fine. Some cats, people could go pick them up wherever they were and just bring them to me. And some cats, you know, as soon as there's a noise at the door, they're under the bed. So especially those cats, I said, please, can you put them in the bathroom? At least, then we know where they are.

DAVIES: You decided to - I guess you kept a part-time clinical practice and opened your own business of making house calls and did this for 25 years. Why did you do it?

FINE: I always had the idea in the back of my mind because of my grandfather. So my grandfather was a physician, and part of his practice involved doing house calls. And he also had an office, where patients would come to see him. But when he saw patients, he also knew them - even if they were in the office, he had been to their home, so he knew them very well, and that really informed his treatment plan. When he died, the family decided that I would inherit his doctor bag, which even came with some instruments - some forceps and hemostats. And I kept it as a treasured possession. And I always had this thought that it would be just a lovely way to practice and to kind of have his lifestyle.

So I thought, you know, I'll try it for a year, and I'll see how it goes. And I just really loved it. I loved going into people's houses and sitting at their kitchen tables and seeing sort of where their animals ate and things like that. I would say, you know, OK, what are you feeding them? And at the clinic, people don't remember the name of the food. You can't tell how much. And at home, someone might say, oh, he only gets a little bit. And I can look across the kitchen and see three overflowing food bowls. So I know that there may be a little bit of denial going on, or maybe there's multiple people feeding the animal or - you know, we can kind of suss out, OK, why are there three overflowing food bowls if you think that, you know, you're really tightly restricting how much food this animal gets?

DAVIES: So you really get useful information from just seeing where they live and how people in the home interact with them, right?

FINE: Yes, very much. Yeah.

DAVIES: You know, you write that when you were at a clinic, you hated when pet owners would drop a pet off and just leave - the drop-offs could be - why? You wanted to say - ask them questions - right? - that...

FINE: I wanted to ask them questions. And it's sort of getting a story especially because my patients can't talk. I need to get that history from their caretaker, from their human. And getting something over the phone - unless I know the person well. If I know the person well, that's a different story. But if I don't know them well, then over the phone, you're missing all of those nonverbal cues. And also I like to see them in the room with the animal and just seeing that connection. And for instance, vomiting with, say, a cat - there can be almost any cause. It could be something mild. It could be something major. And how much - how far do they want to go in terms of testing, and how long has it been going on for? And sometimes, just like with people, it's hard for people to think back - well, when did it start? It's hard to get a good history. So those nonverbal cues, I find, really help.

DAVIES: Right. Right. There's a lot to talk about once you get going. You write that sometimes when an owner drops a pet off, you'll get a note that says vomiting and ADR - capital A-D-R. What does the ADR mean?

FINE: Yes, I love ADR. So ADR stands for ain't doing right. And that is something that was said in the days of James Herriot, who wrote in Yorkshire, England. His real name was Alf Wight. So he was that veterinarian. And now they have the show "All Creatures Great And Small," which is based on his book.

DAVIES: Oh.

FINE: So ADR just means ain't doing right, can't put my finger on it. They're not themselves.

DAVIES: Right. It's easier to figure that out if they're there to walk you through...

FINE: Yes.

DAVIES: ...What their habits are like and where they poop and where they don't and all of that.

FINE: Yes, exactly.

DAVIES: You advise cat owners if - when you're about to come to corral the cat - and just get it into the bathroom 'cause at least it's confined. You also noted that sitting on the toilet seat can help, right?

FINE: Yes. Yes. And this one - I kind of wished I'd discovered this sooner, but this one cat I was chasing around and round this very nice, large bathroom. And the cat was very nice but just wouldn't allow me to get within a couple of feet of her. And I'm sort of going around and around. And after about 10, 15 minutes of this, I'm thinking, OK, this - I'm really not getting any closer to this cat. The owner can't pick her up, so what am I going to do? And then I went, and I sat down on the toilet seat, and she came right up to me and let me pat her. And I patted her for a couple of minutes, and then I picked her up, and I was able to examine her. And she was perfectly fine. So some cats, you just can't get that close to them. And I thought, oh, well, of course. She's used to her owner coming in and sitting on the toilet and patting her and talking to her. That happens every day. So of course, that's normal for her.

DAVIES: Right. Right. The humans are fine when they're on that chair. Things are...

FINE: Right.

DAVIES: ...Going to be OK.

FINE: That's right. No one's ever come after me from sitting on the toilet, so...

DAVIES: Let me reintroduce you. We are speaking with Karen Fine. She's a veterinarian in central Massachusetts. Her new book is "The Other Family Doctor: A Veterinarian Explores What Animals Can Teach Us About Love, Life, And Mortality." We'll continue our conversation in just a moment. This is FRESH AIR.

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DAVIES: This is FRESH AIR. And we're speaking with Karen Fine. She's a veterinarian in central Massachusetts. She has a memoir about her experiences treating animals and counseling their owners. It's called "The Other Family Doctor: A Veterinarian Explores What Animals Can Teach Us About Love, Life, And Mortality."

You write that you got interested in alternative treatments, such as acupuncture. What role does it play in treating cats and dogs and other animals?

FINE: Yeah, I use acupuncture quite a bit. And I find that it works well for a lot of chronic conditions where Western veterinary medicine maybe either can't really address well or can address with medications that have other side effects. And in some cases, acupuncture just works better, like often for arthritis. That's one of the main things that I use it for. And I really enjoy using it. I feel like it's another way to look at the patient. When I learned traditional Chinese veterinary medicine, I realized it's a whole other system of medicine. And it's just fascinating to me to be able to kind of think Western medicine terms and then to kind of flip over and think Chinese medicine terms and how they're similar and how a patient can fit into - you know, if it fits into both systems in a certain way, then I can feel like, OK, I really think that this treatment plan is going to be effective. So it's something that I've really enjoyed,

DAVIES: Right. I mean, it - part of it is acupuncture. It also involves the use of different nutrients, I guess, herbs that are added in some cases.

FINE: Herbs and supplements.

DAVIES: Yeah.

FINE: Yeah. I use some Chinese herbal formulas and supplements. And the theory is pretty much there's not a magic bullet that we're looking for. We're not saying, you know, this - take this supplement. It's going to fix everything. It's sort of a holistic approach, looking at everything in the animal's life. And let's look at lifestyle and let's look at diet and those types of things. So sometimes I'll use Chinese medicine and Western medicine together with the same goal. And sometimes I'll be able to use less Western medication or no Western medication because of the Chinese medicine, because of the acupuncture.

DAVIES: You tell a fascinating story about your own cat, named Daiquiri, who you'd had for a long time. And you say he was acting strangely, and you say he may have had a headache, which a lot of people don't realize animals do get. How did you know?

FINE: Well, when we realized - so the first thing he did was he attacked my dog, which was incredibly out of character. He was a very gentle cat. And he was 15 at the time. And when my husband and I talked about it afterwards, we realized we had seen him - what we call head pressing. So he had sort of put his head down and pressed his head into her body before he attacked her. And she may have just moved away or something like that. And animals, we assume, can get headaches. Headaches are so universal among people that we would think, you know, why wouldn't animals have headaches? And they're not going to kind of put their paw on their head or something like that. What they're going to do is they're going to isolate themselves. They're going to close their eyes. They're going to go to a quiet, dark place.

So when people say, my animal is hiding, sometimes we think, OK, well, they're not feeling well, but it may be a headache. But in his case, he ended up having a brain tumor. And that was something I had learned in school, but not really - it's not a very common symptom, this head pressing. But I think that's what he was doing and that's why he attacked my dog. So then, I took him for an MRI, and he was diagnosed with a brain tumor.

DAVIES: Right. You saw the brain tumor. And then, you got in touch with a Canadian vet, Steven Marsden - right? - who...

FINE: Steve Marsden, yeah.

DAVIES: Yeah, who specialized in a lot of these nontraditional treatments. And this was just fascinating. Give us - tell us a bit about his exam - what he concluded, what - how he treated Daiquiri.

FINE: So Steve Marsden was teaching a class at Tufts, and it was one of these wonderful timing situations that just worked out. My cat had just had his MRI, just had the diagnosis. Steve Marsden was there teaching, and I said, would you do an exam on my cat, who just had this diagnosis? And Steve ended up coming to my house because he wanted to see my cat in his own environment. And he felt his pulse and looked at his tongue and did a Chinese medicine exam. And he said he's suffering from excessive dampness, which is something that's a Chinese medicine construct. It's not something that makes any sense in Western medicine, but it's a fairly common diagnosis in Chinese medicine.

And he recommended some Chinese herbs and a diet change. And at this point, I felt I had nothing to lose. My next option was euthanasia. My cat had been very stressed going into the hospital, and I wasn't going to have him have radiation treatments for that reason. So I changed his diet, gave him the herbs. And three weeks later, he was normal kitty, and he lived for another year until he was 16. And I would have liked to have repeated the MRI, but it was very expensive, not to mention putting my cat through that. But it just amazed me the effect that the Chinese medicine had.

DAVIES: Right. You write that dampness meant that the cat was not adequately processing his food, so the byproducts were accumulating in the body and becoming toxic. And this was treated with these dietary changes. Wow.

FINE: Yes. Yeah, yeah. And it worked so well for him. And it's sort of a - it's a metaphorical - Chinese medicine is a metaphorical thing. So it's not like you can, say, test for these toxins. It's just from looking at him and his symptoms and his signs, his pulse, his tongue, all these other things that we can tell that this is what's going on with him. It's a pattern.

DAVIES: You know, one of the things you mentioned is that, you know, some diagnostic tools and treatments are expensive, like MRIs. And I'm wondering, you know, what do you do when the diagnostic tool or treatment is expensive and the owner says they can't afford it or just aren't prepared to spend thousands of dollars on an animal?

FINE: That is one of the main curses of veterinary practice and pet ownership, really. It's very difficult. And I myself have been in situations, as have most of my clients, where you're trying to consider, you know, do I have this money? Is it worth spending? And there are so many factors. One is, you know, whether you have it or not. But also, how old is the animal? Is it likely to give them, you know, a short amount of quality time, a long amount of quality time? If you have an animal with a broken leg, say that cat that had an amputation, now that cat's likely to live a normal life span. And cats do fine with three legs, so that's a very fixable problem.

If someone doesn't have the money for that, then a lot of times, you're looking at euthanasia. And that is one of the reasons, I think, why veterinary practice is so stressful, is that, you know, even though we may want to, you know, if it's our clinic, maybe do things for less cost or whatever, our bills are very expensive, and our debts are expensive. The student loan is incredible. And, you know, we have to pay bills. And there's almost an expectation, I think, among some clients that we should be doing things for free. And these services, even, say, the bloodwork, the costs have gone up a lot. They cost - it costs us money. So there's very little that's really free. And it's a very difficult thing.

DAVIES: Yeah. Is pet insurance an answer for this?

FINE: I think pet insurance could be an answer for this, and I think it's becoming more popular, and I think that's a very good thing. I - it's also a bit of a concern among the industry that it will become like human medicine, where we have to kind of input codes. And then, all the prices will go up because we'll have to hire people to deal with insurance companies, and it'll become - you know, we don't want it to become like human medicine. Right now, yeah, I think it would really help. And sometimes you see something like, say, a young dog that eats - gets into something and eats something and now needs expensive foreign-body surgery at a referral hospital. And that's going to cost thousands of dollars. And that's just a difficult situation. Whereas if you have the insurance, you can feel like, OK, if something like that crops up, I can deal with it.

DAVIES: Let me reintroduce you again. We're going to take a break here. We are speaking with Karen Fine. She's a veterinarian in central Massachusetts. Her new book is "The Other Family Doctor: A Veterinarian Explores What Animals Can Teach Us About Love, Life, And Mortality." She'll be back to talk more after a short break. I'm Dave Davies, and this is FRESH AIR.

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DAVIES: This is FRESH AIR. I'm Dave Davies, in for Terry Gross. Our guest is veterinarian Karen Fine. She spent more than 30 years treating animals, often making house calls. In a new book, she shares some of what she's learned about animals, their owners and new developments in her profession, including the use of acupuncture and other nontraditional treatments and the field of narrative medicine, which views patients in the larger context of their life stories. Her new book is "The Other Family Doctor: A Veterinarian Explores What Animals Can Teach Us About Love, Life, And Mortality."

Death is a subject that that occupies a good bit in your practice and your experience. Animals don't live as long as we do. Your cat Daiquiri had gotten great treatment from a physician practicing holistic medicine. But eventually, you know, he was older and I guess at age 16 was in liver failure. And you felt that - it was interesting because at this point, you know, the holistic treatments weren't giving the results, and the time was coming. You said you felt you - that you could tell he knew he was dying and accepting it. Share - how did you know that? Share that with us.

FINE: Well, he retreated to - we had a little half bathroom upstairs, which had no windows, and he retreated there. But unlike when he was sick before and I felt that he was having headaches, he seemed comfortable. He was lying there. He was purring. He had stopped eating, which for him was - this was a cat who would eat the house. So the fact that he stopped eating, that's when I really knew that something was wrong. And he just was so calm and serene. And I really felt that he was ready. And I've felt that from many animals. When I see animals that are near death - that I feel like I see this recognition in them, that there's this process going on.

And it made me really think, you know, that they're having this mind-body connection and that their body is breaking down, and their mind is accepting that. And that's what they're experiencing. Sort of like if you think of an animal giving birth, no one's explained to them, you're pregnant, and you're going to have puppies. And this is what's going to happen. They listen to their body, and they kind of intuit what to do. And I think death is a similar situation for animals. And that is my opinion after watching so many animals die and be near death.

DAVIES: When the time came, you decided he should be euthanized, right? And you chose not to do this yourself, I guess. I mean, you'd done hundreds of them by this point, I assume.

FINE: Yes, I had. But - and some veterinarians want to be the one to euthanize their own animals. And I did not. I wanted to be focusing on my relationship with him and not whether the needle was going into the vein and not the logistics. I wanted to be really fully present with him. And I thought he might go on his own, and he would've. He was probably a day or two away from dying on his own. But by that point, I felt, OK, I think he's not comfortable. And knowing where this is going, I don't want him to be further uncomfortable. So that's where I made a decision.

DAVIES: When you euthanize a pet, tell us just a bit about how you do it to - you know, how you manage it so that the animal is treated humanely and the client, the owner, is supported. What are some of the techniques you use?

FINE: That's very important to me. And one of the things I do is I often ask the person, have you seen this done before? I'm trying to gauge their comfort level with it. And some people say, oh, yeah, and they kind of know what to expect. Some people say no, and then I kind of walk them through it a little bit that I'll often give a tranquilizer injection first. And then the other injection goes right into the vein, that it's usually - it's a painless injection, but sometimes, they don't like the needle or their leg being held or whatever. And it really depends on the person.

It's a whole different thing when their person isn't there. Then it's just me giving an injection and the person holding - usually, there's a staff member holding them. And we are very much aware that this is not like any other injection. We're very much aware this is a euthanasia, and there's sort of a respectful silence. It's a strange situation to be euthanizing your patients, I have to say. Even after all these years, it's a strange thing. And I feel like I have a lot of respect for that. And I try - I want people to feel supported. And I know that even though this injection may bring this animal so much peace if they're suffering, it may bring the person in the room with me or the people much pain and anguish. So it's really sort of a delicate dance in terms of supporting the person. I certainly want to make sure that the animal is comfortable. But we really try hard, myself and staff that I work with - we really try hard for it to be a good experience, certainly for the animal but also for any people that are watching.

DAVIES: You know, Karen Fine, before I even read your book, I knew one question I wanted to ask you was people get into veterinary practice, I think, because they love animals. And we all do. And I think for those of us not in the business, we think it must just be so heartbreaking to watch animals suffer. They are just these innocent creatures. And being a vet means that you see a lot of that suffering. And you're with pet owners when they're saying goodbye, when euthanasia occurs. And I'm sure you feel that pain.

FINE: Yes.

DAVIES: So when you comfort someone in that moment of terrible pain and you absorb some of that emotional pain, what do you do for yourself?

FINE: Yeah, that's hard. And that's - sometimes I think about it more now. Sometimes I write. Sometimes I talk to people. I had talked to a therapist at one point, which really helped. And I thought, you know, this is something big 'cause I think for a long time, I just thought, you know, no, it doesn't affect me. I'm fine. It's hard, but I do hard things, and I can do it. And it's not something - you know, I sort of was very stoic about it. And now I think I'm realizing how important it is that I think we need to talk about it. I think both as a profession - and I think people also need to address it.

And really, the reason I wrote the book is I see so much human suffering. And I've said - I've seen so many times where people are so upset. And I've had people say to me, I'm so glad you helped me through this, or I don't even know what I would have done if you hadn't helped me. And it just makes me think, well, what resources are there? This should - it's a difficult, painful situation, but it's so common. And I think people need to recognize how common it is and feel more supported so that it's not something that, I think, a lot of people feel terrible guilt afterwards. And I think that may also be related to the fact that we don't really talk about the importance of this bond in some of these relationships that we have and how we feel when our animals die.

DAVIES: One of the things you write is that when an animal dies and there are other pets at home, do you ever see the pets grieving the loss of a fellow pet?

FINE: Very much so. Yeah. They're very deeply affected, I think, sometimes more than people because we often leave and go to work or go take a walk or socialize or whatever. And our animals are, you know, often more confined to the house. And they have less. They're not watching TV. They're not listening to podcasts. So they are more, maybe, in tune with their environment. And some - just like some people, some animals are, you know, kind of - adjust more easily. And some really, you know, really have a difficult time with it. And then sometimes for the person to kind of set up a new routine with them, try to get them, maybe, some enrichment to kind of take their mind off of their grief so that they're not - you know, they can get back to eating and kind of enjoying their life. But we often see animals grieving.

DAVIES: Yeah. And what do you tell owners to do to help them?

FINE: To try to focus - keep them onto a schedule. And sometimes it's a new schedule. Sometimes it's keeping up a little bit with an old schedule, maybe try to, if it's a dog, say, get them out of the house. If they don't have their playmate anymore, try to go to somewhere where they can see another dog so that they can kind of keep doing a little bit of what they're doing, and just allowing them that time and space to grieve because it is a normal process.

DAVIES: Let me reintroduce you. We are speaking with Karen Fine. She's a small animal veterinarian in central Massachusetts. Her new memoir is called "The Other Family Doctor: A Veterinarian Explores What Animals Can Teach Us About Love, Life, And Mortality." We'll talk more in a moment. This is FRESH AIR.

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DAVIES: This is FRESH AIR. And we're speaking with Karen Fine. She is a veterinarian who spent more than 30 years treating animals, much of that time making house calls. Her new memoir is called "The Other Family Doctor: A Veterinarian Explores What Animals Can Teach Us About Love, Life, And Mortality."

You have become interested in the field of narrative medicine and are integrating it into your practice. You want to explain what this is?

FINE: Sure. And I found out about narrative medicine - I was doing some online research writing the memoir. I was looking into - what is self-disclosure? - which means you sort of as a practitioner saying, well, this is what I do with my animal. And I stumbled across this article from 2001 in a medical journal about narrative medicine for people. And I thought, oh, that's so fascinating. It's looking at the person's story. And it's sort of like a light went on for me. And I thought, well, that's why I don't like animals being dropped off, because I want to know the story. I don't just want a history with lists of things checked off and things written in lines. I want to know the story. And when I understand the story, then I can understand not just what's going on, but how to help. And that might be different with different stories.

Like, say there's an animal vomiting from the same cause. But different people may have - you know, there may be different things going on in the household that you can do to address it depending upon the story. And it also kind of goes back to my grandfather's style of practice where you really know who the people are. They're not just, like, a a disease process in an exam room. It's not just the diabetes case in Room 2. It's, who is this person, and for my patients, who are their family, because they have a caretaker? And the decisions are made by the caretaker. And what are their - what is their narrative? And what do they understand about, say, medication or cause of disease? And that's the type of thing they're looking at with human narrative medicine, which I think is just really fascinating and has a lot of potential to help veterinary medicine as well.

DAVIES: But I have to ask you a bit about the business of veterinary medicine. You've been doing this a long time. And I think you think people have a misimpression that vets make a lot of money. Give us the real story.

FINE: Oh, the real story is veterinarians do not make a lot of money. Most of us drive cars with over 100,000 miles on them. And the debt is just incredible. And I think that's one - that's a theory with, you know, one reason why there are so few men going into the profession. If you're going to have that amount of debt, you want to have a profession where you're going to be able to have a kind of a hope of paying it back without living a very difficult lifestyle.

DAVIES: You're talking about debt for training.

FINE: For training, yes; school debt, yes, school loans. And the other thing is, you know, people think, wow, it costs so much money to have my animal have surgery. Well, if they were a person, it would cost, you know, many times more than that. Yet we're using basically the same anesthesia, the same surgical instruments that need to get sterilized. You know, much of the care is very similar. And you're getting it at a fraction of the cost. So veterinarians and certainly veterinary staff is paid very little. So that's why it's a difficult profession. And people get upset. People sometimes take out their frustrations on the veterinary clinic staff, and that can be a very difficult situation as well.

DAVIES: You mentioned one small thing people can do is buy their medication from the vets as opposed to, you know, looking for a deal online.

FINE: I do think that helps. And I think there's become a perception that, well, you should just get a prescription from your vet, and it's cheaper online. And a lot of veterinary clinics have online suppliers, and at least they can get that little bit. And that really does support the veterinary clinic. Even, I think, if it's corporately owned, it's going to be that, OK, this clinic is making more money. They can have another receptionist. They can have more equipment - that kind of a thing. So I think buying your flea and tick and heartworm preventative from your local vet clinic, I think, is one way to really support your local veterinarian and staff.

DAVIES: We were talking about the emotional difficulty of seeing animals die and giving, you know, owners very bad news about their pets and the stress and emotional toll it takes on veterinarians. You write in the book that veterinarians have high rates of suicide. This is confirmed just over time.

FINE: Oh, it is. It is. Yeah. Multiple studies have shown it to be true. And it's really an issue within the profession. And since it's really come out, there's been a big focus on wellness, that we should - veterinarians should try to take good care of ourselves and get enough sleep and eat right and exercise. And I kind of feel like that's - it's a very good start. But we also need to try to focus on why this work is so difficult and how bonded people are to their animals and how intense some of these interactions are.

And there's also a concern that the focus on wellness kind of puts it back onto the practitioner that, well, if you're struggling, then you're not taking good enough care of yourself. So we don't want - you don't want that to kind of be the thought, either. So I think the profession is trying very hard but still has some more work to do, I think. And I think people, too, need to maybe understand how difficult this work can be.

DAVIES: Well, I'm wondering how you change the profession so that it is less stressful and emotionally difficult.

FINE: Yes, that's an excellent question. And I think one thing is just to realize that it's difficult because even for veterinarians and - say, in school, veterinarians - many of us are perfectionists. And, you know, if your animal - just like a human physician, you think, well, if your patient dies, is that a failure? So kind of really talking about some of these things and reflecting on them - and I really feel that reflection and looking at some of our work is important. And in human medicine, there's more of a history of that. Like, certainly not every physician, you know, is necessarily reflective. But you have the medical humanities, which really looks at, what does it mean to be a doctor? What does it mean to be sick? And we don't have that with veterinary medicine. We're just starting to have a couple people talking about veterinary humanities and that sort of thing and about how we can reflect upon our work.

DAVIES: Well, I wish you luck, Karen Fine. Thank you so much for speaking with us.

FINE: Thank you so much for having me. It's been a pleasure.

DAVIES: Karen Fine is a veterinarian in central Massachusetts. Her new book is "The Other Family Doctor: A Veterinarian Explores What Animals Can Teach Us About Love, Life, And Mortality." Coming up, Ken Tucker reviews the new solo album from Caroline Polachek of the indie band Chairlift. This is FRESH AIR.

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