"Death is something we, as a society, have grown more comfortable not talking about. It is only after personal loss that death becomes a reality. Grief is a difficult journey indeed, one that could use some kind words and light shed upon it."

— RYANE ENGLAR, VETERINARY STUDENT AND CO-PRESIDENT, PET LOSS SUPPORT HOTLINE, CORNELL UNIVERSITY

Perhaps Barbaro's owner, Gretchen Jackson, said it most eloquently: "Certainly, grief is the price we all pay for love." The impact of Barbaro's Jan. 29 death on horse enthusiasts can't be underestimated, experts say.

It's a high-profile example of an issue that equine veterinarians confront routinely: trauma and humane euthanasia. Understanding the grieving process will help doctors offer resources and some guidance to clients on healthy ways to heal from their loss.

The veterinarian's response to loss

The birth of a foal is a welcome event, perhaps bringing hope for a Thoroughbred champion or new trail companion. But a critically ill patient, or one that suffers a life-threatening injury, may stir thoughts of an "unsuccessful" outcome — the loss of a client's horse and faithful companion in the balance.

The veterinarian strives for wellness and caring, so his or her compassion is at the essence of the profession. "Success takes place every day as each patient's quality and quantity of life is extended. It takes place when clients are genuinely supported through difficult times," says Carolyn Butler, counselor, Impact Communications LLC. "It is important to remember that, with veterinary medicine, success cannot solely be defined as cure, nor can failing be defined as recurrence of illness or death," Butler says.

Still, it is no surprise that veterinarians often struggle with grief-related issues after the death of a patient, particularly with their role in euthanasia. This is especially true when the relationship to a client's horse extends over many years.

"Although medical training teaches the importance of exhibiting detached concern — a component of practicing medicine that is key to veterinarians' survival — the reality is that a veterinarian may find himself or herself mourning the loss of a patient," Englar explains. That dichotomy, between what is taught and what is practiced, is sometimes difficult to weather.

On one hand, a veterinarian might feel he or she needs to be "strong for the client," and therefore not express emotions. To a degree, that is true. Throughout the doctor-patient relationship, but especially at the critical moments surrounding patient death, the veterinarian's role is to be there for the client. "One must always take caution never to make those final moments about yourself or your needs," Englar says. "It is always about the client. It would be inappropriate to be overly emotional or over-involved.

"But at the same time, we as professionals need to be open and honest to ourselves, and to our feelings, if not in the room with the client, then certainly at the end of the day. Try as we might to distance ourselves from our patients, we are only human," Englar says.

The veterinarian who has watched a foal grow to adulthood naturally will miss that presence and that patient. Veterinarians need to accept that about themselves, and to recognize when cases have affected them. It is important that they and their staff communicate those feelings to one another, and recognize whether they are in fact grieving.

"The manifestations of grief occur on physical, intellectual, emotional, social and spiritual levels," Butler explains. They may include crying, shortness of breath, sleep disturbance, anorexia, denial, confusion, inability to concentrate, a need to reminisce about the loss, a sense that time is passing too slowly, sadness, anger, depression, self-doubt, feelings of withdrawal, feelings of being overwhelmed, alienation, rejection and shaken religious beliefs.