How to help owners (nd yourself) del with the deth of beloved pet* 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 515 Remember the Five Stges of Grief Pge 515 Recll the Veterinrin s Oth Pge 516 Express Your Sympthy Pge 516 Seek Assistnce Pge 517 Avoid Burnout Pge 517 *Adpted with permission from Compendium Equine 2009;4:267-273. 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 your office nd simply sys, Doc, it s time. You gree, reschedule your other ppointment, nd wit for the owner to rrive, knowing the scene tht wits. Your client s beloved 12-yerold Lbrdor retriever, Buddy, hs recently been losing weight, nd you dignosed lymphosrcom s the cuse. Now Buddy 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 ct, Holly, jumped out of our yrd, rn into the rod, nd ws hit by cr. We re coming right over. You nd your stff know the grim scene tht wits s the mother nd dughter bring in their criticlly injured, beloved ct. Are you prepred to hndle these situtions? Would you know wht to sy to the owners? In the cse of Buddy, could better plnning hve helped void disruption in your chroniclly pcked schedule? This rticle on grief nd euthnsi ddresses some common questions smll niml veterinrins hve when counseling owners before nd fter they hve their pets 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 our ptients properly. It cn be dunting to simultneously hndle pet s medicl problem nd the owner s emotionl concerns. 1 When we del with tense situ- 514 Compendium: Continuing Eduction for Veterinrins November 2009 CompendiumVet.com
tion 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 The Gentle Doctor by Christin Peterson. (Reprinted with permission from Iow Stte University College of Veterinry Medicine) 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). This beutiful sculpture epitomizes the compssion we should ll hve towrd our ptients nd their owners. An especilly criticl time for the veterinrin client bond is when we recommend euthnsi for criticlly ill pet. 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 beloved pet. 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 de scribed the five stges of grief (Tble 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 depend on whether 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. tble 1 The Five Stges of Grief Stge The Owner s Rection Recommended Response by the Veterinrin 1. Denil The owner cnnot comprehend the pet s illness or impending deth. 1 The owner my seem dzed or confused nd unble to mke decisions. 1 Give the owner time to sk questions nd think bout your converstion so he or she cn djust to this new relity. 3 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 dog or ct. This stge is mrked by periods of crying nd extreme grief. 3 5. Acceptnce The owner finlly ccepts the loss nd my remember the pet with sdness but does not cry uncontrollbly. 1,3 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 nd be sympthetic. 3 Kübler-Ross E. On Deth nd Dying. New York: Scribner; 1969. CompendiumVet.com November 2009 Compendium: Continuing Eduction for Veterinrins 515
Our profession is held in high regrd in our society, nd by prcticing compssionte cre, we reffirm our unique position s trusted professionls. box 1 Additionl Resources Americn Veterinry Medicl Assocition How do I know it is time? (brochure) www.vm.org/niml_helth/ brochures/euthnsi/pet/pet_euth_ brochure.pdf Understnding your feelings of loss when your niml dies (brochure) www.vm.org/niml_helth/brochures/ pet_loss/pet_loss_brochure.pdf 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) 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 the loss is sudden nd trgic (s in the cse of Holly) or involves grdul deteriortion of the pet (s in the cse of Buddy). Mny owners re deeply ttched to their compnions nd view them s beloved members of their fmily. They my hve owned pet for 10 yers or more, nd its loss will leve lrge void in their lives. It is lso common for pet to represent specil time in person s life. For exmple, when single people who own pets mrry nd begin fmily together, the pets live in tht fmily for yers nd re often living reminders of the specil history shred by the fmily. The recent hit book (nd movie) Mrley nd Me is n excellent representtion of this scenrio. The sitution is even more complex if the dog or ct 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 pet euthnized, they my need some time to djust to the ide. If the dog or ct is not criticlly ill, it my be helpful for the clients to think bout the decision to euthnize nd to cll fmily nd friends before giving permission. When deling with geritric pets, such s Buddy, it is often importnt to discuss the pet s deteriortion with the owners. Older dogs or cts in poor body condition tht re not responding to tretment, feeding, or mngement chnges often hve incresing trouble wlking nd my slip nd fll. The owner my not recognize the pet 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 pet when ll cn be present, so the fmily cn sy good-bye together. This offers n opportunity to schedule your time ppropritely to prepre for the procedure nd void interruptions. Ech sitution is n opportunity to serve our ptients nd their owners. 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 dog or ct s suffering nd bring some comfort to owners nd cretkers, especilly in ctstrophic situtions. When I (A. I. B.) ws in privte prctice, one of my worst cses requiring euthnsi involved hndsome, young chocolte Lbrdor retriever puppy. He developed cute renl filure nd did not respond to tretment, so the owners decided to euthnize him. Although the scenrio ws very trgic, I ws grteful to offer some smll mesure of comfort to the fmily t difficult time. 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 pet well, write down mem- Drs. Tmer McNmr, Jennifer Proctor, Cthleen Lombrdi, Jen Feldmn, nd Vlerie Devney. Personl communiction, Veterinry Informtion Network, Jnury 30, 2009, through Februry 1, 2009. 516 Compendium: Continuing Eduction for Veterinrins November 2009 CompendiumVet.com
ory or two, nd the crd will be tresured by the owner. Some prctices cll clients to check on them few dys fter their pet ws euthnized. This cn be very helpful for owners who my need ressurnce tht they mde the correct decision. Some prctices offer wys to memorilize the ptient for the fmily, such s pw print csting or lock of hir; dditionl options include mking dontion to n niml shelter or reserch fund nd sending 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 lives, even improving our mood nd blood pressure! However, when our beloved nimls re experiencing terminl suffering, the topic of euthnsi should be ddressed (Box 1). Mny veterinry schools offer pet loss support hotline (Box 2) 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 tble 2 Five Common Client Rections to Pet Loss been euthnized (Tble 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 pet s disese nd deth, it my help to refer the owner to helth professionl. Children re often very ttched to the fmily pet, so it cn be very trumtic for child to lose dog or ct. Honesty is the best policy when explining the pet s deth to child, but use developmentlly pproprite lnguge. 5 The child wnts to understnd wht hppened, so use simple terms; however, do not sy, The dog or ct ws put to sleep, becuse the child my become frid to sleep. The child needs time to grieve nd my wnt to memorilize the beloved niml by mking scrpbook, hving memoril service, or burying the pet 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 dog or ct for yers, becoming like member of its fmily, so you lso my experience grief t its deth. 6 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. An especilly criticl time for the veterinrin client bond is when we recommend euthnsi for criticlly ill pet. We cnnot eliminte our clients pin, but we cn decrese their grief nd nxiety with ptience nd compssion. 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 pet 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. CompendiumVet.com November 2009 Compendium: Continuing Eduction for Veterinrins 517
box 2 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 Honesty is the best policy when explining the pet s deth to child, but use developmentlly pproprite lnguge. 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 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 through 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. 518 Compendium: Continuing Eduction for Veterinrins November 2009 CompendiumVet.com
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 pet, 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. Conclusion Our compnion niml 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. 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 Additionl Reding Brton Ross C. Pet Loss nd Humn Emotion: Guiding Clients Through Grief. Phildelphi: Tylor & Frncis; 1998. 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. Tory T. The humn-niml bond nd loss. J Ment Helth Counseling 2004;26:244-259. nd client berevement in equine prctice, prt 1. Equine Prct 1996;18(1):19-22. 5. Brndt JC, Grbill CM. Communicting with specil popultions: children nd older dults. Vet Clin North Am Smll Anim Prct 2007;37(1):181-198. 6. Brckenridge SS, Shoemker RS. The humn/horse bond nd client berevement in equine prctice, prt 3. Equine Prct 1996;18(4):20-23. 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. CompendiumVet.com November 2009 Compendium: Continuing Eduction for Veterinrins 519