*Trigger Warning – This article deals with pet loss*
I knock on the door and am welcomed into a cozy comfortable home. I introduce myself while looking into the glistening eyes of the woman who invites me deeper into her home. She leads me to the living room where the rest of the family is seated by a glowing fire and an old white poodle curled up in his bed. He lifts his head to look at me but then places it gently back down on his front legs. He is weak and showing signs of pain. He looks as if he’s had enough.
I sit down on the floor beside my patient and converse with his family. I ask them what’s been going on.
“He has cancer.” They say. “He was diagnosed 3 months ago, and has been on a medication for pain control”. They are fuzzy on the details.
“Which kind of cancer?” I ask. “In his belly” is all that they know. “The vet told us to come back to them when he stopped eating” they state, “but we wanted him to pass at home, so we called you.”
These statements sadden me. There is so much more that could have been done for this patient between the diagnosis and this point. At first, I am angry at the veterinarian but then I take a step back. Do I think that this is what the veterinarian really said: “He has cancer, call me when he stops eating”? No, I have much more faith in my colleagues than that. Veterinarians care so much about their patients and what they do. Do I think that is what the family understood and was able to take in at that moment? Yes, I do. I believe that stressful news numbs our senses and makes it impossible to hear or remember all of the details.
As a hospice and palliative care veterinarian I have heard this statement or similar ones to this, more times than I can count. Through my experience and education, I have learned that families need much more support during this time than most veterinarians are able to extend in their busy schedules. It is not as if they do not care or do not want to help, it is just not always an option or something they can accommodate in their regular practice. This is where I come in.
The Diagnosis:
Let’s look at another patient. We’ll call him Buddy.
Buddy was a black lab who lived with his family which included a husband, wife and 2 children. Buddy grew up with the kids and was loved very much. He had always been very happy until one day he stopped eating. He went to his veterinarian and was diagnosed with an aggressive form of cancer on his spleen. The veterinarian had a long discussion with Mary, the wife, about Buddy’s condition and what to expect. He gave her different options ranging from a referral to a veterinary oncologist to euthanasia. There was a lot of information and Mary went home with a headache and without making a decision.
At home, Mary still felt overwhelmed. She tried to tell her husband, Scott, what the veterinarian had said but she could barely remember anything and emotionally, she wasn’t prepared. She kept thinking about life without Buddy. He had been with her through so much. She worried for herself and for the kids. They didn’t know a life without Buddy. How would they manage. Buddy was such an integral part of their lives.
Once the kids were put to bed, Mary pulled out the information her vet had given her and found my card. She briefly remembered her vet telling her about me. She wasn’t sure if she had the strength to call but she gave the card to Scott. He made the call and we set up an appointment to meet at their house.
The Palliative Appointment
It was one of those cold, windy days when the air seems to bite at your cheeks but it was warm and cozy inside Buddy’s home. Mary and Scott invited me into the living room where the kids were playing on the floor. I made myself comfortable on a chair and Buddy made himself comfortable on my feet. He was a very lovable guy. We all talked for quite some time about what the family understood was wrong with Buddy. We talked about their fears and their expectations. We also discussed what would help them feel better, more in control and what they were able to accomplish. I reviewed Buddy’s medical record and performed an examination on him. We tweaked some of his current medications and the family decided to pursue a referral to a specialist.
Further Care
We worked with the specialist to provide the best plan for Buddy. He received specialized care from the oncologist and his primary care veterinarian and I worked to ensure that Buddy’s quality of life was not suffering and that the family was able to continue along with the initial plan. We did adjust the plan a few times along the way and Buddy had a great quality of life for some time. However, the family knew that he would not continue on this way forever so they set up an appointment to discuss the final stages of Buddy’s life.
Memorialization
The family wasn’t exactly sure what they wanted but they knew that they wanted something special for Buddy. He had been an amazing dog and they wanted to acknowledge and memorialize him to the best of their ability. It wasn’t time to say goodbye yet, but they wanted to be prepared. We had discussed different ideas for memorialization. They were surprised at many of the ideas we shared with them:
- Professional Photographs
- Portraits
- Pawprint impressions, in ceramics, tattoos, garden rocks
- Donations to charities
- Printed Items, such as blankets, mugs, t-shirts
- Renditions in felt, copper, etc
- Leash and Collar crafts
- Special urns for remains
- Memorial Jewelry
- Memorial services
- and many more
Mary and Scott let the kids decide which type of memorialization felt right for them.
Planning for the End
Mary and Scott had each had pets as children but had never had to make the decisions that surround the end-of-life of a pet. They were understandably anxious about making these decisions for Buddy so we worked with them to determine what they felt was best for their family. Ideally, they wished that Buddy would pass away quietly in his sleep but unfortunately, this is not often the case; we hoped for this, but planned for other scenarios. We spent time with all of the family members learning about their expectations and their fears and addressed them all as best as we could. We discussed all of the options available to them and the consequences of each. The family created an optimal plan for them as well as plans B and C in case things didn’t go as expected. These plans were communicated with each of the team members including the primary veterinarian, the oncologist, and the family’s support system.
The End
In the end Buddy was euthanized at home. He passed very peacefully on his favourite bed with Mary, Scott and their oldest child surrounding him. He was sent off with nothing but love. Candles were lit and gentle music was playing in the background. The family was sad but at peace with the decisions they had made and the route that Buddy’s journey had taken.
Not Really the End
Of course this is not really the end. Some of the toughest times come after this final goodbye. There are constant reminders of the loss and anniversaries can heighten all of the grief, bringing emotions bubbling back up to the top. Our team kept in touch with each of the families mentioned above. We offered support through phone calls and e-mails but for each family there came a time when that wasn’t enough. We were able to refer them to appropriate grief counsellors who helped them work through their emotions and move forward. We know that grief never goes away but we help people manage it and move forward.
Knowing that a new pet can never replace an old one, Mary and Scott did eventually adopt the cutest new puppy when the whole family was ready.
We are so grateful to have been invited to support each family during such difficult times and are committed to continuing to improve the journey from diagnosis to passing.
“We can not change the outcome, but we can affect the journey.“
— Ann Richardson
Author: Dr. Janet Henderson
Palliative Tails 