End-of-life care can easily be the worst part of veterinary medicine. It does not matter where you fall in the hierarchy of a practice, dealing with it can be very uncomfortable.
Up front for the reception staff, it is difficult to know what to say to “that owner” at check-in. For veterinary technicians and assistants coming into the room to start the appointment, they can feel grief hanging in the air. For the veterinarian, who was there for the pet’s first juvenile exam and had worked up the diseases and small issues through the years, it will not be easy to break the bad news.
You would not want to live through such scenario, but if you work in a general veterinary practice, you live it all too often.
Early on in my career. I needed to have the end-of-life talk with a client due to a terminal situation. I was a 27-year-old newly minted veterinarian trying to explain end-of-life care to a client, who was likely in her mid-70s, and I struggled for so many reasons. Later that evening, my boss walked in, sat by my desk, and said something that has resonated with me since: “Cade, you are a veterinarian, not a human doctor. If you live a full life, practice a full career, and retire in 30 years or so, you will outlive every patient you will ever work on. If you choose to live and die with each patient you treat, you are going to die with every one of them.”
This part of our life is one of the biggest drivers of burnout and compassion fatigue in veterinary medicine. It drives many of us to the end of our careers, if not worse. Unlike our human medical counterparts, we see the entire life span of our patients—from neonatal and pediatric care, all the way to the hospice and end-of-life care. It can be a lot to take in. Add in the emotions of some patient owners and the outflow of despair, grief, and disbelief that this is the end of their life with that special pet, and it can add a whole different layer of problems.
Simply put, people can be very mean. There are things said to veterinary professionals that are not okay, anywhere. In veterinary medicine, we file them under the heading of “they were emotional,” but those statements linger. Emotional “untrue” statements will lead to doubt. Was there something else we could have done?
Here are some helpful tips when you find yourself in a similar situation.
Laying out the timeline
The “Are you sure it’s time, doc?” question should be headed off easily. I recommend starting with detailing a complete diagnosis and medical backing of the condition. Learning how to break down an often complicated but common veterinary medical condition in a way anyone can understand is an art form I recommend everyone starts working on.
Begin by explaining the progression of disease processes and then tie in where a given pet is on the downward path. This is very helpful for clients unfamiliar with the condition. It helps them understand where their beloved pet is in the process, the different stages they will encounter, and the reality of the situation. Keep in mind, we are talking about a terminal illness in this scenario. These processes might be days, weeks, or months, but with most conditions these progressions can be made within reason.
Not every disease process will look the same from patient to patient, but most will follow a similar course. Helping our clients mentally work through this eases concerns and doubts to when it is the appropriate time to alleviate undue suffering.
Prioritizing patient comfort
Looking back through my career, I can remember some overwhelmingly sad events. Working after-hour emergencies and traumatic cases and attending to pets I had known for 15-plus years, and being there for them and their families at the end, can be overwhelming.
Performing euthanasia in the office, in vehicles, at people’s home, laying in backyards, at a city park, the list goes on and on, for me personally. It is likely the most emotional time you will have as a veterinary professional with our clients and our patients.
I truly believe we should do everything in our power to make that moment as comfortable as possible for our patients. Can all of us offer at-home or “off campus” euthanasia? Probably not, but it’s worth evaluating.
I preformed one a few nights ago, after work and in a client’s backyard for a patient I had known his entire 13 years. Gus looked just like one of my old pets from my youth. Those are the hardest ones.
One of the practices I have adopted is the use of sedation or anesthesia prior to euthanasia. The only regret I have is not starting that practice earlier. Doing so takes away anxiety from the patient and eliminates a lot of the fear our clients have that their pet is in any kind of pain. It also allows us to have the client more involved—safely—if they want to be right beside us through that process.
Some pet owners want to be there until the last moment, some do not. Having their pet anesthetized and relaxed, allows clients to have a last visual of the patient calm and comfortable. It allows us, as medical providers, the ability to work on our patient, calm and still. It allows for a calm atmosphere to help everyone through the process, including us.
“Are you ready?” I ask that of my coworkers every time, before walking in for a euthanasia and secretly, I am asking myself, too. I then say a silent prayer every time. A prayer for everything to go smooth, for calmness, for the dignity of my patient, and decreased anxiety for my client. However, how do you as veterinary professional prepare yourself? By the time we have gotten to this moment, I personally know it is the right decision and time for my patient. By making sure there are no doubts about the condition being terminal and the reasons behind our decisions, is part of the emotional preparation. Eliminating all doubts is very key to this.
One of the core values we all have in veterinary medicine is, above all, do no harm. I believe euthanasia can be core to this. If we have a patient that each day is worse off than the day before, decreasing undue suffering is a part of “do no harm.”
Take time to walk the client through the process, one last time. Explaining every step in detail will also help prepare you, too. Knowing in your core that this is the right decision is important for your own self-protection. If there are doubts, then questions should be asked. All doubts must be cleared before you move on.
Dealing with ‘convenience’ euthanasia
If you practice veterinary medicine long enough, you are going to encounter the client who is “moving and cannot take the pet” or is “tired of them scratching.” There will be a client who will say that “they won’t stop barking,” or “the pets aren’t getting along” and they need to euthanize them. I could add to this list and so could you. The emotional roller coaster these thoughts take down are difficult enough just thinking about them, but I have encountered all these in real life, too. How would you handle this? What about your practice? Is there a protocol? I have handled this a few different ways as a practice owner and a practitioner and here are a few.
First and foremost, I have clients surrender the pets over to me and my practice. I quickly type out a statement for clients to sign that I am the new owner. It doesn’t have to be “wordy,” just make sure they are transferring ownership and they sign the document. This is about saving the patient. Most of the time this client is already emotionally checked out and they just need a way out. You also do not know what else is going on with the client personally or emotionally, and I decided a long time ago it is not my job to judge them. It is my job to save the patient.
Through the years, I have formed partnerships with rescues and fosters to help me, should an event arise. Whether that is finding a foster home, taking in the patient, or just posting the patients availability for re-homing while it lives with us for a while. All these scenarios have come through my office in the past. Having plans worked out in advance can decrease stress for everyone involved when this situation walks into your lobby.
We, as a veterinary community, are known for our empathy and the strength of our love. We love our patients, our profession, our titles, our schools, you name it! We work tirelessly and give whole-heartedly to everything we do without thoughts on how it will affect us. It is time, however, for us to consider how the end-of-life care of our patients affect our well-being. I never want to change our love for our profession and our patients, but we need be more cognizant of our own self-preservation.
Cade M. Wilson, DVM, is a practicing veterinarian and a three-doctor mixed-animal practice owner in Ardmore, Okla. Dr. Wilson has been practicing small animal medicine for the last 18 years and been a practice owner for the last 15 years.