Pushed to the brink by mounting debt, compassion fatigue and social media attacks from angry pet owners, veterinarians are committing suicide at rates higher than the general population, often killing themselves with drugs meant for their patients.

On a brisk fall evening in Elizabeth City, N.C., Robin Stamey sat in her bed and prepared to take her own life.

To her side lay a stack of goodbye letters Stamey had written to her loved ones, including her parents who lived hundreds of miles away. Gripping a catheter loaded with a deadly dose of Beuthanasia-D and Telazol, euthanizing agents the 46-year-old veterinarian had brought home from her nearby practice, she exhaled slowly and began to bid the world goodbye. But as she turned to look at Gracie, her apricot toy poodle, Stamey started to sob.

She couldn’t do it.

“The only person I couldn’t explain my suicide to was my dog, who was sitting there looking into my eyes,” Stamey recalled. “She’s the reason I’m still alive.”

The path to rock bottom was an unexpected one for Stamey. A chipper animal lover who went back to school at age 36 to pursue her lifelong dream of becoming a veterinarian, she had previously worked in a few small clinics before eventually opening her own.

Pulling this off wasn’t easy; Stamey graduated from veterinary school with more than $180,000 in student debt. Her first vet jobs paid about $40,000 a year, forcing her to work long hours to scrape together enough money to get by.

These financial troubles were compounded by the strains of the job, which is known for taking immense emotional, physical and mental tolls on its professionals. But like many people who work in medicine, Stamey had always thought of herself as a caretaker and was afraid to ask for help. Instead, she swallowed her frustrations and soldiered on, ignoring the creeping depression that began to cast a shadow over her life and her work.

In 2007, everything fell apart. Burnt out from a near-decade of grueling work, Stamey was struck by crippling fatigue and painful internal swelling that doctors couldn’t explain.

This mystery ailment — diagnosed years later as Bartonellosis, or cat-scratch fever — stripped Stamey of the vigor that had once defined her, leaving her barely enough energy to crawl across her floor to feed her pet dogs, let alone run her practice.

Rumors that she was addicted to drugs and alcohol, fed by small-town gossip and social media exchanges between angry clients, spread through the community. Eventually, even friends turned on her.

“I didn’t lose an arm or a leg, so my illness and my withering mental health wasn’t real to them,” Stamey said, citing a tense phone conversation with an old friend as the moment that she decided to commit suicide. “I was suffering, alone, and didn’t know where to turn to for help. I just wanted it all to end.”

Stamey said she felt isolated in her pain at the time, but she has since learned a startling truth: Veterinarians are in the midst of a suicide epidemic of massive proportions.

On Jan. 1, the Centers for Disease Control and Prevention released the first study to ever examine veterinarian mortality rates in America. The results were grim: Between 1979 and 2015, male and female veterinarians committed suicide between 2 to 3.5 times more often than the national average, respectively.

These findings not only reflect a higher suicide rate among all veterinarians but also suggest that women in the field are more likely to take their own lives, which starkly contrasts trends within the general population.

Considering the profession is becoming increasingly female-dominated (more than 60 percent of U.S. veterinarians and 80 percent of veterinary students are now female), the study’s authors suggested this trend could foreshadow even more veterinarian suicides in the years to come.

Additional research, including a 2015 CDC study that found 1 in 6 veterinarians have considered suicide, have shaken the veterinary world to its core, exposing a growing crisis that few knew of and others had sought to ignore.

Fatigue, burnout, debt

Stamey is among those who are standing up and sharing their stories, refusing to brush the problem aside.

“It was devastating to realize how many of us are hurting, but it’s more important to know the cards are finally on the table,” she said. “We can’t truly address this until we start being honest with ourselves and caring for one another.”

To grasp the extent of their desperation, you have to understand what it’s like to be a veterinarian today.

One of the most competitive medical fields — veterinary school acceptance rates are comparable with medical school acceptance rates, but prospective vets are often asked to complete more prerequisite undergraduate courses — it’s a profession that attracts intelligent, driven people who, above all else, want to help and treat animals.

As obvious as it is, that latter component is critical: People don’t become veterinarians for prestige, power or high pay. But diving into passion-driven professions leaves the door open for compassion fatigue and burnout, and the veterinary field is riddled with mental health hazards. Unsurprisingly, two of the largest factors at play are money and death.

Veterinarian school is costly. Recent studies conducted by the American Veterinary Medical Association (AVMA), the industry’s largest nonprofit advocacy entity, show that the average veterinary student now graduates with $143,000 or more in debt; about 1 in 5 leave school with more than $200,000 to pay off. Veterinary salaries — which start at about $67,000 a year — aren’t keeping pace with rising tuition rates.

“Tuitions are going up, salaries are staying stagnant and the debt just compounds by the second. I’ve got friends who have graduated with anywhere from $100,000 to over $500,000 of debt,” said Lynn Green-Ivey, a San Antonio veterinarian who graduated from the Texas A&M College of Veterinary Medicine & Biomedical Science. “Many of those people with those higher debt loads are facing an insurmountable monetary challenge. They will die with that debt and it’s really, really sad.”

The impact of these financial handicaps hits veterinarians far beyond their wallets. Pressed to pay off their debt while attempting to save money to buy homes, start families, or run their own practices, many vets find themselves routinely working well over 50 hours a week. They’re even forced to pick up second jobs in some cases, taking on overnight shifts at emergency clinics or helping out at rescue shelters.

“More often than not, you’ve got to work and work and work without a bathroom break and scarf your lunch down in three minutes or less just to keep up with the daily responsibilities,” Green-Ivey said. “The pressure to do more and to do better for your clients is constant and never-ending.”

Work-life imbalances

With little reprieve from a high-stress work environment that seldom provides an opportunity to take a break, eat lunch or go to the bathroom, many people’s work-life balances begin to suffer, Green-Ivey said. “We’re determined, passionate people who are used to putting our clients and our animals before ourselves. But these traits, which make us good doctors, are the same things that make us more susceptible to depression, anxiety and letting negative emotions chip away at us.”

Another key driver of this suicide crisis: Veterinarians are consistently asked to act as animal undertakers. Euthanizing animals can cause what a recent study referred to as ethical conflict and moral distress, which arises when vets are forced to put aside their expert opinions and accept pet owners’ decisions about if and when to put their animals down. More so, this proximity to death makes dying seem like a reasonable way to ease suffering.

These factors create a troubling set of circumstances, especially since vets routinely have access to controlled euthanasia drugs. If you’re armed with the knowledge of how to administer a quick, painless death and regularly experience trauma and stress, it’s clear how suicide can become an accessible option.

As this problem has become more publicly acknowledged, veterinarians have formed online support groups to discuss sensitive topics. It’s all about providing a sense of community to people who feel isolated, said Carrie Rountree, a vet tech who lives in Rock Hill, S.C.

Rountree created the Facebook group #TheFightingBluesForAmanda to honor her friend, Amanda Ryan, after Ryan killed herself in September. In less than two months, the group’s membership grew to nearly 5,000 people and includes veterinary professionals from around the world.

“Without online communities like this, I believe there would be increased risk and, consequently, even more tragic losses like Amanda’s,” Rountree said. “Now that we have tools like this to connect with people from all across the globe, this issue can no longer be ignored. Only through awareness can we create true change.”

Smaller groups, including a Facebook group Robin Stamey called “Veterinary Medicine: Staying Alive,” are now sprinkled throughout social media platforms.

The organization at the crest of the industry’s new wellness wave, though, is Not One More Vet (NOMV). An online support network that’s emerging as a leading nonprofit group in the field, NOMV has spearheaded a nationwide mental health education initiative and created a grant program to provide financial assistance to veterinarians who can’t access affordable mental health care. They also provide temporary relief workers to ensure emotionally depleted vets can take a few days off to rest and recharge.

“We’re focused on so many things right now, but at the end of the day, our first priority is training people about what to do when someone expresses the desire to die,” said Carrie Jurney, a veterinary neurologist and NOMV board member. “I want that skill to no longer be necessary, but until we can dig our profession out of this crisis, the first step is that emergency, mental health CPR-level care.”

These grass-roots efforts have caught the attention of the AVMA, the industry’s largest player. In addition to amplifying the findings of the CDC’s groundbreaking research, the AVMA has created a suite of mental ­well-being resources for its members, including free trainings on how to identify at-risk colleagues and direct them to professional support.

The organization has also begun leading discussions about work-life balance and wellness and provides guides to finding local mental health services, moves that reflect its mission to remove the profession’s long-standing stigma around the topic.

“For really the first time ever, this subject is being talked about from the time people walk into veterinary school, through one’s early career, all the way up to the top of the industry,” said John de Jong, president of the AVMA. “That’s the only way we can tackle this and make real progress: through a holistic, all-hands-on-deck approach.”

Unfortunately, there’s one X factor these organizations can’t account for: relentless pressure from emotional (and, at times, misguided) pet owners. Compared with dentists or doctors working in human medicine, veterinarians are more likely to have their professional opinions ­second-guessed or rejected by pet owners.

The experience is not only grating. It can also lead to angry Internet attacks by impassioned clients — including instances where viral social media attacks eventually lead to targeted veterinarians committing suicide.

Shirley Koshi, a Bronx veterinarian who took her own life after facing a barrage of harassment and accusations of veterinary abuse in a dispute over a stray cat, is an especially haunting example of what many professionals worry could one day happen to them. The specter of Internet attacks has become so severe that the AVMA introduced a Cyberbullying Response Assistance Hotline in 2016.

Struggle and hope

Despite recent efforts to address veterinarian suicide, most people in the field — the AVMA and NOMV included — acknowledge this is only the beginning of the healing process. It’s going to take time to understand the spectrum of factors fueling this phenomenon and gauge the success of still-developing prevention strategies.

But Stamey said, above all else, she’s feeling hopeful because the problem is no longer lurking in the shadows. With a heightened awareness of the prevalence of this issue, maybe fewer veterinarians will be pushed to the brink like she was.

“This isn’t some abstract. These are real people’s lives; husbands, wives, sons, daughters, your friends, your family, your veterinarian,” she said. “Healing and perspective will take time, but for now we just need to listen and learn. You’d be shocked by who’s struggling around you.”