Easing the pain
Whether it is an unexpected accident or a planned euthanasia, veterinarians need to be trained on how to deal with the intensely emotional experience of death, experts say.
For pet owners, grief can trigger many feelings from a deep sense of sadness to outrage, panic and anger. When done compassionately and with attention to detail, experts agree that euthanasia can be one of the events that bond your clients to your practice for life.
For veterinarians, death remains one of the most difficult subjects to broach with clients, yet helping clients with their emotional pain can also be one of the greatest services DVMs provide.
Laurel Lagoni, managing director of the Argus Institute for Families and Veterinary Medicine at Colorado State University (CSU), explains, "When you have been in practice for a while, you come up with a method that works for you, and seems to work for most of your clients in terms of handling end-of-life issues. It doesn't always mean it is the most effective or most supportive way of going about things."
CSU thought there was a better way too, and ponyed up for the creation of the Argus Institute to prepare veterinary teams to successfully meet the emotional needs of pet-owning families. The institute is composed of an interdisciplinary team of veterinarians and mental health professionals to train and study these issues. One such project has focused exclusively on pet loss.
"What we are trying to do is to really make the emotional care that is offered at veterinary practices somewhat standardized and somewhat predictable," Lagoni explains.
Helping with the burden
Lagoni says that people react very differently when they are informed that death is imminent for their pet.
The reaction could depend on the circumstances, too. For example, an accident is much different than a terminal prognosis that has resulted in extended treatment.
Each situation has different sets of circumstances, and each has different ways of effectively helping clients work through their anguish.
"Some people accept it fairly easily and want to do everything they can for their pet; for other people it is marked by a lot of anxiety."
Whether a client is in anticipatory grief or coping with an unexpected death, veterinarians need to help clients make decisions.
"They need to know how to help people turn that corner from trying to do everything they can medically to help a pet owner say goodbye," Lagoni says.
"I think it is a privilege when an animal is sick or injured to be able to perform euthanasia and to let people be there and say goodbye in a way that is meaningful to them," she says.
"If you are going to let the family be there, I think veterinarians are going to have to have a really solid technique on how that euthanasia is conducted."
Prepare for the end
One aspect of euthanasia that the institute espouses is the concept of a comfort room.
Typically, it is an examination room that can be quickly converted into a comfort room when needed. The idea is to create a serene atmosphere for the client and owner when euthanasia is the most humane option.
Lagoni also recommends conducting euthanasias at ground level on large rubber mats. It's a nice place for the family to sit with their pet to say goodbye. The euthanasia could also be conducted right on the floor with the pet's entire family present.
If it is feasible, let the clients decide whether or not they want the euthanasia performed in the hospital or possibly outside.
If a euthanasia is going to take place in the hospital, the goal is to create an atmosphere in the examination room that makes this experience peaceful and serene for both the client and patient. It could include equipping the room with dimmer switches to dim the lights. Privacy signs on the doors, plants and greenery, a cassette or CD player for music, plenty of handouts and plenty of tissues.
Lagoni says that it is important to give your clients time to experience grief with their pet.
And it should be conducted as a ceremonial ritual. Clippings of fur is a nice way to remember the pet. Another option might be use of clay paw prints as way to remember a client's pet.
Talk to me
Before and after the euthanasia, Lagoni says that listening is a very important skill when preparing an owner for euthanasia.
Some clients may sob uncontrollably, while others can act almost indifferent. Despite the outward appearance, all these clients are experiencing grief in their own way.
From a communications standpoint, Lagoni cautions against clichés or attempts to cheer the client up. "With grief, that is probably the worst thing to do. We want to help facilitate those feelings and really make the person who is grieving feel safe and comfortable in a place where they can express what they are feeling," she says.
Common clichés that are said might include: "Well, she had a really good life, or she is in a better place now." Another might be, "Just try to keep your mind off of it."
Instead, a better response is "I know she had a good life, but it is very tough to lose her." Lagoni says the goal is to give a client the chance to talk and to express his or her feelings about the pet.
Paraphrasing is an effective communications technique. Acknowledge the client's feelings.
For example, if a client expresses guilt about the pet's illness or death, don't try to talk them out of it. Instead, you might say, "I can hear how awful this is for you." Or, "I can imagine how badly you are feeling."
Lagoni says that research shows that people in grief are looking for two things, a feeling of support and emotional catharsis, which is an opportunity to cry and wail and just get it out.
Staying in the room and effectively helping a client through this cathartic experience takes practice and training.
When veterinary students are trained, a typical reaction is to get out of the room as soon as the death occurs. It is a very natural and defensive reaction, Lagoni explains.
Training, however, is focused on raising the veterinarian's comfort level with intense emotion. In the coursework for veterinary students, pet owners come in to explain how painful this experience is for them.
"It is not fun, and it can trigger some of your own thoughts and feelings, but each time you do it and you learn ways to cope with it, you gain more confidence and still focus on what needs to be done," says Lagoni.
Disposition of the body is another very important detail to address with your clients, whether it is cremation or preparing the body for burial.
Remember, you could do everything right in performing the euthanasia, but the stark reality of seeing a deceased animal in a garbage bag after death may negate everything you have tried to do. Be proactive and address body care options upfront and before the euthanasia, so there are no surprises.
Lagoni says it is very important to define the details, including disposition of the body, whether it is communal, cremation or rendering.
Protocol for delivering a terminal diagnosis and supporting clients during difficult situations.
* Assess family situations to determine any special needs of clients before the discussion.
* Attempt to deliver diagnosis in person, not over the phone.
* Make sure all staff members are aware of the diagnosis in person, not over the phone.
* Use private room (comfort room if possible).
* Allow at least 20 minutes for discussion.
* Make sure tissues are nearby.
* Sit at the same level with client on floor.
* Use slow, soft voice.
* Tell the client that there is bad news. Validate that giving them this news may be difficult for them to hear and difficult to deliver.
* Anticipate that clients will respond with varying types and degrees of emotion (shock, sadness, crying, anger, denial).
* Give clients permission to express themselves (e.g. It's okay to cry. I would cry too if I just found out my dog had cancer," or "it's okay to be angry")
* After the initial response to the diagnosis, explain it and discuss all of the options.
* Because the client may be in shock and unable to retain information well, write down or tape record what is discussed and send it home for them to review later.
* Offer referral list of veterinary specialists and human service professionals that may be able to provide more information and/or additional support.
* If appropriate, follow-up phonecall within 48 hours to see how client is doing, and to answer any further questions.
Source: Argus Institute for Families and Veterinary Medicine, Colorado State University