How to help owners (nd yourself) del with the deth of horse Feture Amy I. Bentz, VMD, DACVIM Veterinry Lerning Systems Yrdley, Pennsylvni Christin Bch, MSW, LSW Director of Clinicl Socil Work nd Pet Berevement Services University of Pennsylvni At Glnce Prctice Being The Gentle Doctor Pge 268 Remember the Five Stges of Grief Pge 268 Recll the Veterinrin s Oth Pge 269 Express Your Sympthy Pge 270 Seek Assistnce Pge 270 Avoid Burnout Pge 273 I hold it true, whte er befll; I feel it, when I sorrow most; Tis better to hve loved nd lost Thn never to hve loved t ll. In Memorim A. H. H. (from Cnto 27; 1849) by Alfred, Lord Tennyson Imgine the following: During n lredy hectic dy, one of your best clients clls you nd simply sys, Doc, it s time. You gree, reschedule your other ppointment, nd drive to the frm quickly, knowing the scene tht wits. Your client s 35-yer-old Thoroughbred gelding, Skip, hs been losing weight nd flling down recently. Until now, the owner hs been ble to help Skip stnd. But now Skip is recumbent nd listless, so the owner hs decided to hve him euthnized. or During n lredy hectic dy, one of your best clients clls you, crying, nd sys, My dughter s horse, Breeze, jumped out of the pddock, rn into the rod, nd ws hit by cr. Plese come quickly. You jump into your truck, knowing the grim scene tht wits s the mother nd dughter try to comfort their dying horse. Are you prepred to hndle these situtions? Would you know wht to sy to the owners? In the cse of Skip, could better plnning hve helped void disruption in your chroniclly pcked schedule? This rticle on grief nd euthnsi ddresses some common questions equine veterinrins hve when counseling owners before nd fter hving their horses euthnized. In veterinry school, we re trined in the science of veterinry medicine. We lern how to dignose, tret, nd prevent vrious mldies, but we cnnot lern the rt of veterinry medicine until we begin to prctice. After grdution, we quickly relize how vitl it is to effectively communicte with clients to chieve the gol of treting equine ptients properly. It cn be dunting to simultneously hndle CompendiumEquine.com July/August 2009 Compendium Equine: Continuing Eduction for Veterinrins 267
CriticlPo nt In veterinry school, we re trined in the science of veterinry medicine. We lern how to dignose, tret, nd prevent vrious mldies, but we cnnot lern the rt of veterinry medicine until we begin to prctice. the equine ptient s medicl problem nd the owner s emotionl concerns. 1 When we del with tense sitution such s euthnsi, the need to communicte effectively becomes even more criticl. While personl communiction styles differ, the informtion in this rticle cn help even the most sesoned veterinrin hndle euthnsi nd grief more esily. FIGURE 1 Prctice Being The Gentle Doctor Our profession is held in high regrd in our society, nd by prcticing compssionte cre, we reffirm our unique position s trusted professionls. The Gentle Doctor sculpture by Christin Peterson t the Iow Stte University College of Veterinry Medicine depicts cring veterinrin crdling sick puppy while the mother dog looks up with concern (FIGURE 1). Although this is not sculpture of n equine veterinrin, it epitomizes the compssion we The Gentle Doctor by Christin Peterson. (Reprinted with permission from Iow Stte University College of Veterinry Medicine) should ll hve towrd our ptients, lrge or smll, nd their owners. An especilly criticl time for the veterinrin client bond is when we recommend euthnsi for criticlly ill horse. We cnnot eliminte our clients pin, but we cn decrese their grief nd nxiety with ptience nd compssion. 1 By spending few minutes to explin nd listen, we offer owners chnce to process informtion before mking permnent decision to euthnize their horse. After euthnsi, this cn help owners feel better bout their decision. Remember the Five Stges of Grief In On Deth nd Dying, Dr. Elizbeth Kübler-Ross described the five stges of grief (TABLE 1). Although not everyone experiences this process in the sme wy nd my not exhibit ech stge, these stges re common rections to loss. The owner s emotions tble 1 The Five Stges of Grief Stge The Owner s Rection Recommended Response by the Veterinrin 1. Denil The owner cnnot comprehend the horse s illness or impending deth. 1 The owner my seem dzed or confused nd unble to mke decisions. 1 2. Anger The owner my lsh out t you or your stff nd my refuse to py the bill. 1 Guilt my ccompny this stge. 1 3. Brgining The owner my sk for second opinion or wish to pursue unusul tretments to ttempt to gin control over the sitution. 3 4. Depression This is the true stge of berevement, when the owner mourns the loss of the horse. This stge is mrked by periods of crying nd extreme grief. 3 5. Acceptnce The owner finlly ccepts the loss nd my remember the horse with sdness but does not cry uncontrollbly. 1,3 Give the owner time to sk questions nd think bout your converstion so he or she cn djust to this new relity. 3 Give the owner time to sk questions nd process the new informtion so he or she cn djust to this new relity. 3 Listen to the owner, cknowledge his or her feelings, be sympthetic, nd explin tretment options so the owner cn prticipte in the decision. 3 Listen to the owner, be sympthetic, nd tret the horse with compssion. 3 Kübler-Ross E. On Deth nd Dying. New York: Scribner; 1969. 268 Compendium Equine: Continuing Eduction for Veterinrins July/August 2009 CompendiumEquine.com
depend on whether the loss is sudden nd trgic (s in the cse of Breeze) or involves grdul deteriortion of the horse (s in the cse of Skip). Mny owners re deeply ttched to their horses nd my hve owned them for 20 yers or more. Owners my view their horses s compnions whose loss will leve lrge void in the owner s life. The sitution is even more complex if the horse is loved by child nd the prents look to you for comfort nd dvice. When speking with your clients, remember tht they my be experiencing vriety of emotions. If they re considering hving their horse euthnized, they my need some time to djust to the ide. If the horse is not criticlly ill, it my help them to think bout the decision to euthnize nd to cll fmily nd friends before giving permission. When deling with geritric horses, such s Skip, it is often importnt to discuss the horse s deteriortion with the owners. Older horses in poor body condition tht re not responding to tretment, feeding, or mngement chnges often hve trouble during the winter, such s slipping nd flling on snow or ice. The owner my not recognize the horse s grdul deteriortion or the potentil consequences. If the owner is given time to think bout euthnsi nd decides to hve it performed, other fmily members might wnt to be present. The owners my choose to euthnize their horse on sunny, wrm dy so the fmily cn sy goodbye in n optiml environment, llowing you to schedule your time ppropritely to prepre for the procedure nd void interruptions. Ech sitution offers n opportunity to serve our ptients nd their owners. I rrived on the frm nd quickly exmined her, she hd shttered her left third metcrpl bone, nd only soft tissue held the limb together. Although the scenrio ws very trgic, I ws grteful to be ble to end the mre s suffering nd offer comfort to the owners. box 1 Additionl Resources Americn Veterinry Medicl Assocition Equine euthnsi www.vm.org/crefornimls/ nimtedjourneys/goodbyefriend/ equineuth.sp The Argus Institute for Fmilies nd Veterinry Medicine College of Veterinry Medicine & Biomedicl Sciences Colordo Stte University www.rgusinstitute.colostte.edu (Grief informtion for veterinrins nd pet owners) Horsehir Jewelry www.ponylocks.com www.twistedtils.com A New Prdigm for Equine Euthnsi Crolyn Butler, MS www.ep.org/helth_rticles_view. php?print_friendly=true&id=175 The Veterinry Socil Work Progrm t the Mtthew J. Ryn Veterinry Hospitl of the University of Pennsylvni www.vet.upenn.edu/rynhospitl/ VeterinrySocilWork/tbid/255/Defult.spx CriticlPo nt Our profession is held in high regrd in our society, nd by prcticing compssionte cre, we reffirm our unique position s trusted professionls. Recll the Veterinrin s Oth Being dmitted to the profession of veterinry medicine, I solemnly swer to use my scientific knowledge nd skills for the benefit of society through the protection of niml helth, the relief of niml suffering 2 Although grief nd euthnsi re difficult, we cn end the horse s suffering nd bring some comfort to owners nd cretkers, especilly in ctstrophic situtions. When I (A. I. B.) ws in mbultory prctice, one of my worst cses requiring euthnsi involved beutiful, young Thoroughbred mre. She hd been turned out overnight nd inexplicbly broke her leg in level, open pddock. When box 2 AAEP Guidelines for Recommending Euthnsi The following criteri should be considered in evluting the immedite necessity for euthnsi of horse to void nd terminte incurble nd excessive suffering: 1. Is the medicl condition chronic nd incurble? 2. Does the immedite medicl condition hve hopeless prognosis for life? 3. Is the horse hzrd to itself or its hndlers? 4. Will the horse require continuous mediction for the relief of pin for the reminder of its life? 5. Will the medicl condition result in lifetime of continued individul confinement? 2007. CompendiumEquine.com July/August 2009 Compendium Equine: Continuing Eduction for Veterinrins 269
CriticlPo nt An especilly criticl time for the veterinrin client bond is when we recommend euthnsi for criticlly ill horse. We cnnot eliminte our clients pin, but we cn decrese their grief nd nxiety with ptience nd compssion. Express Your Sympthy There re no perfect words to sy to owners experiencing loss. Often, the best pproch is to express your sympthy nd listen to the owner. Sending crd nd/or flowers is n excellent wy to express your condolences. 3, If you knew the horse well, write down memory or two, nd the crd will be tresured by the owner. Some prctices collect mne or til hir for mking into brcelets nd other jewelry through vrious outlets (BOX 1). Some prctices cll clients to check on them few dys fter their horse died or ws euthnized. This cn be very helpful for owners who my need ressurnce tht they mde the correct decision. Some prctices memorilize the ptient through dontion to n niml shelter or reserch fund nd send crd to notify the owner. Seek Assistnce The humn niml bond is incresingly recognized in our society s powerful nd unique reltionship. 1,4 This bond offers much-needed comfort nd compnionship in our hectic Drs. Tmer McNmr, Jennifer Proctor, Cthleen Lombrdi, Jen Feldmn, nd Vlerie Devney. Personl communiction, Veterinry Informtion Network, Jnury 30, 2009, through Februry 1, 2009. tble 2 Five Common Client Rections to Pet Loss lives, even improving our mood nd blood pressure vlues! However, when our beloved nimls re experiencing terminl suffering, the topic of euthnsi should be ddressed (BOX 2). Mny veterinry schools offer pet loss support hotline (BOX 3) nd support groups for smll niml owners experiencing the loss of pet. For exmple, the University of Pennsylvni School of Veterinry Medicine offers progrm for pet owners, including grief counseling nd berevement. I (C. B.) tech veterinry students to be wre of five common rections clients my exhibit fter their pet hs died or been euthnized (TABLE 2). I lso tell my students, People need to wnt help; they will seek you out if they require more ssistnce. If n owner is demonstrting persistent need to discuss his or her horse s disese nd deth, it my help to refer the owner to helth professionl. Children re often involved in equine ctivities nd develop strong ttchments to horses, so it cn be very trumtic for child to lose horse. Honesty is the best policy when explining the horse s deth to child, but use developmentlly pproprite lnguge. The child wnts to understnd wht hppened, so use simple terms; however, do not sy, The horse ws put to sleep, becuse the child my become frid to sleep. The child needs time Client Rection Exmple Recommended Response by the Veterinrin 1. Guilt The owner my sk, Did I wit too long to euthnize, or did I euthnize too quickly? The owner my feel guilty months fter the pet s deth nd my contct you for ressurnce. Listen to the owner nd ressure him or her tht the correct decision ws mde. 2. Shme The owner my feel shmed to tell nyone or my be frid someone will sy, It ws only n niml, you cn lwys get nother one. 3. Relief If the niml dies before the owner mkes decision to euthnize, the owner my feel relief tht he or she did not hve to mke the finl decision to end the pet s life. Ressure the owner tht the horse is unique or specil nd will not be replced by new ddition. 4. Loneliness Be sympthetic nd supportive. Provide list of pet loss support hotlines nd other resources. 5. Yerning Be sympthetic nd supportive. Provide list of pet loss support hotlines nd other resources. Developed by Christin Bch, MSW, LSW, Director of Clinicl Socil Work nd Pet Berevement Services, University of Pennsylvni. 270 Compendium Equine: Continuing Eduction for Veterinrins July/August 2009 CompendiumEquine.com
box 3 Pet Loss Support Hotlines 352-392-4700, then dil 1 nd 4080; stffed by Florid community volunteers; weekdys, 7:00 pm to 9:00 pm Estern time; or 352-392-4700, ext 4744, t the University of Florid 517-432-2696; stffed by Michign Stte University veterinry students; Tuesdy through Thursdy, 6:30 pm to 9:30 pm Estern time; cvm.msu.edu/ petloss/index.htm 630-325-1600; stffed by Chicgo Veterinry Medicl Assocition veterinrins nd stffs; leve voice mil messge; clls will be returned 7:00 pm to 9:00 pm Centrl time; long-distnce clls will be returned by collect cll 540-231-8038; stffed by Virgini- Mrylnd Regionl College of Veterinry Medicine; Tuesdy, Thursdy, 6:00 pm to 9:00 pm Estern time 614-292-1823; stffed by The Ohio Stte University veterinry students; Mondy, Wednesdy, Fridy, 6:30 pm to 9:30 pm Estern time; voice mil messges will be returned by collect cll during operting hours CriticlPo nt Honesty is the best policy when explining the horse s deth to child, but use developmentlly pproprite lnguge. 508-839-7966; stffed by Tufts University veterinry students; Mondy through Fridy, 6:00 pm to 9:00 pm Estern time; voice mil messges will be returned dily (by collect cll outside of Msschusetts); www.tufts.edu/vet/petloss 888-ISU-PLSH (888-478-7574); hosted by the Iow Stte University College of Veterinry Medicine; opertionl 7 dys/week, 6:00 pm to 9:00 pm Centrl time from September through April nd Mondy, Wednesdy, Fridy, 6:00 pm to 9:00 pm Centrl time from My through August 607-253-3932; stffed by Cornell University veterinry students; Tuesdy through Thursdy, 6:00 pm to 9:00 pm Estern time; messges will be returned; www.vet.cornell.edu/org/petloss 217-244-2273 or 877-394-2273 (CARE); stffed by University of Illinois veterinry students; Sundy, Tuesdy, Thursdy, 7:00 pm to 9:00 pm Centrl time; www.cvm.uiuc.edu/care 970-491-4143; Argus Institute grief resources, Colordo Stte University 509-335-5704; Wshington Stte University College of Veterinry Medicine; stffed during the semester on Mondy, Tuesdy, Wednesdy, Thursdy, 6:30 pm to 9:00 pm, nd Sturdy, 1:00 pm to 3:00 pm Pcific time; www.vetmed.wsu.edu/plhl Accessed Februry 2009 t www.vm.org/crefornimls/nimtedjourneys/goodbyefriend/plhotlines.sp. CompendiumEquine.com July/August 2009 Compendium Equine: Continuing Eduction for Veterinrins 271
to grieve nd my wnt to memorilize the horse by mking scrpbook, hving memoril service, or burying the horse s shes. It is importnt for prents to inform school officils tht their child hs lost pet. If behviorl chnges or depression re noted, the child my need to tlk with professionl counselor. Avoid Burnout It is vitl for you to mintin your mentl helth. You my hve treted horse for yers, becoming member of its fmily, so you lso my experience grief t the loss of the horse. 5 It is importnt to recognize these feelings nd express them in your own wy. Owners will be very touched to see your grief nd compssion t the loss of their horse, forging stronger bond between them nd you. However, it is eqully importnt to tke time to refresh yourself nd mintin perspective. See Box 1 for dditionl resources to help yourself nd your clients. CriticlPo nt It is importnt for prents to inform school officils tht their child hs lost pet. If behviorl chnges or depression re noted, the child my need to tlk with professionl counselor. Conclusion Our equine ptients re often tresured members of the fmily nd re mourned when they die or re euthnized. We hope the informtion in this rticle will help you prctice the rt of veterinry medicine when hndling grief nd euthnsi. Additionl Reding Bertone J. Grief support techniques in bondcentered equine prctice. In: Equine Geritric Medicine nd Surgery. New York: Elsevier Helth Sciences; 2006. Kübler-Ross E, Kessler D. On Grief nd Grieving: Finding the Mening of Grief Through the Five Stges of Loss. New York: Scribner; 2005. Lgoni L, Butler C, Hetts S. The Humn-Animl Bond nd Grief. New York: Hrcourt Brce; 1994. References 1. Lwrence EA. Euthnsi nd the humn equine bond. Equine Prct 1993;15(10):34-44. 2. Veterinrin s oth. Adopted by the House of Delegtes, July 1969; mended by the Executive Bord, November 1999. Accessed Februry 2009 t www.vm.org/bout_vm/whowere/oth.sp. 3. Brckenridge SS, Shoemker RS. The humn/horse bond nd client berevement in equine prctice, prt 2. Equine Prct 1996; 18(2):23-25. 4. Brckenridge SS, Shoemker RS. The humn/horse bond nd client berevement in equine prctice, prt 1. Equine Prct 1996; 18(1):19-22. 5. Brckenridge SS, Shoemker RS. The humn/horse bond nd client berevement in equine prctice, prt 3. Equine Prct 1996; 18(4):20-23. July/August 2009 Compendium Equine 273