Veterinary caregiver bears brunt of euthanasia
In Dr. Brian Forsgren's proverbial list of duties, euthanasia ranks as the "greatest single responsibility" granted a practicing veterinarian.
"The mental anguish and stress that accompanies such a responsibility is enormous," says Forsgren, former director of Cleveland's Animal Protective League (APL), a humane shelter.
He adds, "The impact affects all aspects of the veterinary clinic from front-desk personnel to the veterinarian, the veterinary technician and auxiliary staff. In humane societies and animal shelters the specter of euthanasia stress is virtually omnipresent."
And the emotional toll on shelters is only half the picture. Veterinarians, whether in shelters or private practice, bear the brunt of the pet owner's decision to euthanize, long after the grieving pet owner exits the clinic.
"The complexity of the decision process that takes place during the contemplation of such a step is not even imaginable to the non-veterinarian," says Forsgren, now in private practice in Bay Village, Ohio.
Consequently, many veterinarians express feelings of consternation, guilt, even compassion fatigue.
Yet they believe that if the euthanasia is relieving an animal's suffering, it, on some level, numbs the caregiver's pain.
At APL, Forsgren would oversee numerous euthanasia procedures annually, based strictly on the animal's welfare. Now in private practice, Forsgren says the dilemma rages on, where veterinarians must "play God," understanding the animal's behavioral biology, prognosis and course of disease and the ability for "quality of life" given an animal's physical state.
He's not alone in this role.
In all, 9.6 million animals are euthanized annually in the United States, according to the American Humane Association. While no data recognizes the number of animals euthanized in private practice, it is likely a fraction of those that are euthanized in shelters.
Yet the impact on private practitioners is strenuous.
To David Hammond, DVM, of Brunswick, Ohio, euthanasia is the best and worst procedure he performs, which amounts to five or six weekly most of which are rarely convenience.
"I've left the room and locked myself in the office, especially after (euthanizing) the ones you've nursed for years and years. It's emotionally draining. You see them on the appointment schedule and you dread it the whole time. Usually those are the ones that really need it," he says.
But there's a silver lining of sorts. "With most of the (cases) you do realize you're relieving suffering and that helps you through it," he adds.
Understanding the client
Performing 77 euthanasia procedures annually, Dr. Greg Bogard of Tomball Veterinary Clinic in Texas, has a newfound appreciation of the human-animal bond.
He explains, "People aren't necessarily always in the same kind of relationship with a pet as they are with people, and they think that pet who doesn't criticize them loves them so intensely that they go through a lot before they get it all sorted out in their minds. I'm not well-trained enough as a simple veterinarian to know what to do when you're dealing with people when their best friends are dying."
To Nancy Katz, DVM, of Upper Montclair, N.J., to begin to understand the client's concerns about euthanasia, you must involve them.
"One thing that can be done to decrease a client's stress about the procedure is letting them make as many decisions as possible and keeping them informed," she says.
Apparently, the strategy, all things considered, has worked. Katz, who follows euthanasia procedures with a phone call or sympathy card, is taken aback by the number of thank you cards she receives.
"I don't know if that's standard," she says. "But people are very appreciative of sensitivity when it comes to that issue."
Sometimes, however, sensitivity on the part of the client is misdirected toward the practitioner, recounts Dr. Sue Whitman, of Bloomington, Ind.
Any emotional struggles tied to euthanasia that Whitman faces often stem from her being the target of an owner's grief process.
"I have had owners scream profanity at me because at 11 p.m., it took me 30 minutes to get to my office to euthanize their cat, which was suffering," she says. "Many owners need to blame someone for that suffering, and the veterinarian seems to be the closest target."
Yet understanding how pet owners grieve has enabled Whitman to proceed with the daunting task. Instead of getting swallowed up in the attacks, Whitman says she's learned not to take cruel words from owners too personally and attempts to forgive their outbursts.
As Whitman declines to perform "convenience" euthanasia, she doesn't lose sleep at night if a client rants.
"Because my staff knows that I will never perform euthanasia if other options or treatments exist, we are at peace with the decision, and actually feel that we are relieving suffering," she says.
Always personally affected, Bogard of Texas, says he can't imagine not sharing the strain and painful emotions of his clientele.
"If you're crying along with the client, there's nothing wrong with that. What we can't do is make it any easier," says Bogard. "What we try to do is just make sure they know the animal is not suffering and no one is going to criticize them for hard decisions they had to make."
"It needs more training than it gets. It's so macabre that we all shy away from it."
Katz, too, has been known to shed tears with longstanding clients, sometimes even hug them. "I regularly cry with the patients," she says. "I used to hold up around the client, but I find that I get a little more stilted because I'm concentrating so much on not showing emotion that I think I sound a lot more removed. Clients tell me they appreciate it."
Others appreciate the client-friendly services of Dr. Maria Miller in Tampa, Fla.
Miller, in the mobile veterinary care business for three years, is at home with her type of euthanasia service, brought to the clients' doorstep.
She says the service, which typically costs more than in-clinic euthanasia, has grown over the years, a sign clients value the option.
"It's actually easier for the pet owners because they don't have to take the cat or dog into the veterinarian, which is nice for the animal," says Miller, who performs up to 10 procedures a month.
Interestingly, Miller, who only euthanizes sick or dying animals, surmises more pet owners would consider the service if they knew it existed.
"I think most veterinarians don't let them know that there's somebody that does this service, because they want to have the business for them," she says.
Miller usually follows up by sending a sympathy bouquet of flowers to longstanding clients, along with a card and a poem called "Rainbow Bridge."
Bottom line is that euthanasia procedures warrant proper handling. That's why when Katz moved into her new hospital, she made sure it was equipped with a euthanasia room and several boxes of tissues.
"First of all, it's a separate place with a separate entry and exit," Katz says. "When owners come in with another pet or new pet, they don't come back to the same room. It doesn't stir up feelings."
Veterinarians don't always have the luxury of a separate place to release their emotions. Some turn to family, some seek solitude, others seek professional counsel.
Seeking external solace
Licensed psychologist Matt Zimmerman, MD, Ph.D., says he has often consulted veterinarians who struggled with euthanasia. Many times he says they're dealing with the same guilt as the general pet-owning public.
"You as a pet owner or the vet are responsible for the pet's welfare throughout its life," he says. "So when the pet needs to be put down, you also feel responsible for that. That contributes to a lot of guilt."
From interactions with veterinarians, Zimmerman has found they cope with stress in many fashions.
"There is a level of distance that is required, much like surgeons have to employ. Sometimes people experience surgeons or vets as cold or callous, but there is a certain element that is just about survival so that they can continue functioning in their profession."