PITTSBURGH – While walking the corridors of the clinic, a visibly upset veterinarian takes Lori Harbert aside and confides that she must tell a longtime client that the client's dog has cancer and cannot be saved.
Harbert, a social worker at the Pittsburgh Veterinary Specialty and Emergency Clinic, listens carefully and advises the vet how to handle the situation. The vet nods her head and walks through the heavy, wooden door into the room where she'll deliver the grim news.
"I am going to meet with her (later) and see how she is doing," Harbert said. "Telling this patient the news is going to be very hard on her."
This scene at the clinic in Ohio Township underscores the emotional stress that surrounds the death of a pet and the reactions that follow for the people on both sides of the examining table — emotions that, until now, haven't had an accessible outlet or a reliable resource to which to turn.
Harbert, 50, is part of an emerging profession called veterinary social work. She was hired at PVSEC last year, modeling a program at Ohio State University Veterinary Medical Center, which, like the Ohio Township center, sees a high percentage of complex and life-threatening medical issues.
The client side
Senji, a basenji, was Rebecca Barkley's everything.
The medium-sized dog was her constant companion, a best friend, for 17 years.
Thirteen years in, though, Senji started having health problems. Barkley found herself traveling frequently from her Greensburg home to PVSEC for the next four years. Seizures, kidney failure, cataracts, a liver tumor: Senji was struggling with an array of issues.
"Senji was my soul dog, but I did not want her to have to suffer anymore," Barkley said with traces of tears in her voice.
After a year of heart-wrenching indecision, she decided a few months ago to have Senji euthanized.
Two-weeks after Senji died, Barkley was still in the grip of enormous grief.
"I felt like I was dying and said to myself 'How can this be?' I am very strong, but this feeling was so unfamiliar to me," she said.
She turned to Harbert, attending individual counseling sessions as well as the Pet Loss and Grief Support Group that the PVSEC holds at 10:30 a.m. on the second Saturday of each month.
"Senji came in my life and filled my needs. The counselors helped me see why she was so important to me," Barkley said. "Now, as time goes on, I learn to go on with such memories."
Harbert meets with many clients at the PVSEC who have either lost a pet or are emotionally preparing for that day to come.
"Most of the families we have assisted have been about the quality of the animal's life and euthanasia," she said.
The client perspective in the veterinarian social work program focuses on the clients' role as life-or-death decision-makers, balancing their best intentions for their beloved pet and their personal financial situation. Most families do not have pet insurance and often are required to weigh the cost of medical intervention. This often results in guilt — what they could have done or should have done, Harbert said.
"They ask me, 'Am I crazy? Why am I grieving like this?'" Harbert recalled.
She tries to help the client understand his connection with the animal and identify the source of his grief.
"I help them understand their feelings," she said.
A resident of Washington, Pennsylvania, Harbert earned a master's degree in social work in 2003 from California University of Pennsylvania. She then worked in the human social work field, focusing on drugs and alcohol as well as trauma victims.
"It was just by happenstance that I came across the veterinary social work position at PVSEC," said Harbert, an avid animal lover.
The veterinarian side
Every day, five to 12 euthanasias are performed at PVSEC, the region's largest specialty and emergency veterinary center, seeing several hundred cases a day. The number of euthanasias is high because many pet owners cannot afford the complex medical intervention needed to save a pet's life.
"It's hard when they know the animal can be fixed but the process can't be paid for by the family," Harbert said.
The American Veterinary Medical Association, based in Illinois, reports that 1 in 6 vets struggle with thoughts of suicide. The Centers for Disease Control and Prevention found that veterinarians have a four times higher suicide rate than the general public and are two times more likely to commit suicide than dentists and medical doctors.
"We see the sickest cases, so it's hard for us as doctors and nurses every day to see deaths. We are sad every time," said Christine Guenther, a PVSEC veterinarian.
As a result, some PVSEC veterinarians suffer from compassion fatigue, burnout and ethical exhaustion when trying to come up with an alternative way to save a pet, given an owner's financial constraints.
"You empathize so much with patients that you take on the burden and it takes a toll on you," said Michael San Filippo, spokesman for the American Veterinary Medical Association.
Harbert works with the veterinarian staff to emotionally process the cause of a pet's death and help staff members cope with their own grief. She assesses how individuals are acting and then helps them reach a stable emotional state.
Training for this counseling is not typically taught in vet school.
Harbert fills the gap, training vets in how to deal with the losses as well as recognizing the signs of depression in staff members and themselves.
"The high suicide rate in the field is a major concern," Dr. Guenther said. "So, if having a vet social worker can help save one life, then it's worth having one."
Harbert also provides outreach to other veterinary clinics, such as one in Delmont.
"I have seen my entire staff cry when an animal was put to sleep — they want to fix everything, but they can't," said Jan Langlois, office manager at Delmont Veterinary Hospital. "When Lori came, she gave us insight that this reaction is normal."
PVSEC recently partnered with the University of Pittsburgh School of Social Work to create a program called "Social Work at the PVSEC." Students in Pitt's master of social work program are taught about grief and loss by working with the PVSEC staff and clients.
"The program has been a big success so far," Harbert said.
At the University of Tennessee's College of Veterinary Medicine, the profession is gaining ground at both the undergraduate and graduate levels of study. Elizabeth Strand, founding director of veterinary social work at UT, coined the term "veterinary social work" in 2002.
The program – which is working to expand its program to other colleges and clinics – certifies students as veterinary social workers by training them in four areas: the link between human and animal violence, grief and bereavement, animal-assisted interventions and compassion, and conflict management.
A similar program was started at Ohio State University in 1997 called "Honoring the Bond." Jennifer Brandt founded the program, which provides pet owners with free supportive services for Ohio State's medical center's clients. This inspired PVSEC to model its program after OSU.
Having a veterinary social worker on staff can be costly; most veterinarians are small-business owners. Those with multiple practices or corporate chains are more likely to afford one, the vet foundation's San Filippo said. But, hiring social work interns might be an affordable way to provide such counseling services, he said.
"I think in the future we are going to see some creativity in the area," Dr. Brandt said. "We can imagine clinics coming together and pooling resources that they have to afford mental health services."
She also believes it would be helpful to have counselors well-versed in what it is like to be a veterinarian during challenging economic times to fully understand "ethical exhaustion" — the feeling that results from being unable to perform life-saving medical procedures due to a family's financial situation.
So far, the PVSEC's veterinarian social work program has been a "big success," Dr. Guenther said. Six months ago, Harbert was joined by social worker Sally Mox, and they have served more than 400 client contacts so far.
"I think we are on the cusp of vet social work becoming a specialty service," Dr. Guenther said.