June 22, 2009
Death and dying are uncomfortable subjects. For some, it stirs up painful memories of past losses. For others, it is a reminder of our mortality or the mortality of those we love.
As we tend to the animals in our care, we will lose patients to death despite our best efforts. Often at these times, we are exposed to the emotions of the families who have loved them. For some, there are dramatic outbursts; for others, emotions will be put on hold for private moments.
As different as people are, so are their reactions. No right or wrong. We must respect and accept the fact that we all grieve and express grief in our own way and in our own time, and we must be there to support our clients through this time.
Often, we’re uncomfortable with client reactions. No one likes seeing someone sad and crying, and we fumble, sometimes, in an attempt to make them feel better. Recognize, first of all, that it’s not possible to make them feel better at that time. With that in mind, there are some things you can do and some things that shouldn't be done during those times of client grief.
ØFind a place for quiet
Whatever the situation—a client rushing in with an injured pet or a pet dead on arrival, or an expected euthanasia—find a quiet place for the family. If a comfort room is not available, an exam room is the next best choice. If they need to fill out paperwork, take it with you as you escort them. Inform the receptionist that you are doing so, and usually she can retrieve the papers later for processing.
Standing in the waiting area during that time of high emotion is traumatic for the people involved and traumatic for other waiting clients. If this pet is in-house and the client is in the treatment area, respectful quiet is essential! Turn the radio off, and inform staff members what is occurring. If a dog is barking or crying in a cage, sometimes just standing next to the cage will quiet him. Make sure a box of tissue is handy.
The client will experience this particular loss once, and the sights and sounds of this moment will be embedded in memory.
ØAcknowledge the loss
The words “I’m sorry” may seem too simple and benign, but the meaning is sincere and speaks for itself. The phrases “This must be a great loss for you and your family” or “It’s obvious how much CoCo was loved” acknowledge that you recognize the loss as significant and can invite the owners to share their feelings. Sometimes they will tell stories of the dog as a puppy or how the cat helped them through a stressful time. These are the beginning moments to this person dealing with her loss.
ØListen, wait, listen
Active listening extends beyond the borders of passive silence. It requires skill, understanding and patience. It requires you to hear the client’s words and ascertain the feelings behind the words without argument, judgment or interruption. Remember that they will experience this particular loss only once.
ØRead body language
This art at the time of crisis requires skill and time. Some clients are very receptive to a pat on the arm or a hug, just as veterinary staff are comfortable with this form of bonding and expression of sympathy. But there are clients who because of anger, gender or personality do not welcome this type of comfort. Take into consideration your own comfort level. If you are not comfortable with this form of expression, do not use it because the client will sense your discomfort.
Instead, use less direct forms of body language. Eye contact, stroking the pet and talking in a soothing voice may be more appropriate for your comfort zone and will be more comfortable for the client as well.
ØIf you feel like crying, go ahead!
Years ago, it was thought that in times of pet loss the veterinary team needed to retain its professionalism by guarding the amount of emotion displayed. Tears were considered a loss of control. We now recognize that’s not necessarily accurate.
Certainly, it’s a different matter if you cannot control yourself, but on the whole, revealing your empathy and sadness through tears can be a healing start for all involved.
ØDon’t forget that words can hurt
Most of us have heard of people saying, “It was only a dog” or “Thank goodness it wasn’t one of your kids.” These are, of course, hurtful things to say and do nothing but invalidate feelings of loss and make people feel they are somehow abnormal.
But other phrases, even though well meaning, also can be inappropriate. It is improper to say, “I know how you feel,” because you really don’t. But what you may know and express is, “I have felt this pain.” Do you see how different these two statements are?
Another example of a well meaning but inappropriate statement is, “Be glad you had her this long.” The client may, farther down the grief process, realize it. But at that moment, no length of time is ever enough. Our pet’s lives, in comparison to a human life span, are relatively short. Can we ever have them long enough?
ØDon’t talk religion
It goes unsaid that religious beliefs are as diverse as the people who believe in them. Be careful of making references to your particular beliefs, which the client may not share.
ØDon’t disrespect the client
During busy times, when dealing with a client in high emotion because of loss or an impending or potential loss, it is important to focus on that person. Remain calm yet compassionate and maintain eye contact and composure.
Telling people how busy you are or appearing rushed will seem abrupt and is not appropriate. They don’t particularly care how behind on treatments you are or that another client has been waiting 45 minutes for a TPR. They only know they’re about to lose a family member.
Remember, you are the professional in control. They are often in shock or disbelief and are often out of control.
ØDon’t disrespect the pet
Treatment of the pet should be gentle and soothing before and after death. It’s not unusual to hear a client say after euthanasia, “Cover him up so he won’t be cold.” Irrational? Yes, but that’s the brain saying, “It’s too tough to handle right now so I’ll just give you a cushion to take a break.”
Handle the pet as you did in life, with care and gentle hands, soothing voice and tenderness.
Grief is the normal response to separation, loss or both. The responses of grieving pet owners can be correlated with the emotional stages experienced by dying human patients and their families.
Dr. Elizabeth Kubler-Ross in the 1970s pioneered the study of human grief and loss and divided the process into five stages, which have, over the years, been adapted to include pet loss and human bereavement. These five stages–denial, anger, bargaining, depression/grief and acceptance/resolution–don’t necessarily follow in order or have set time frames. For as different as people are, so are the stages of grief they experience.
You will interact with clients in each of these emotional stages. As far as we have come in this day of advanced technology and self-awareness, there is still no culturally acceptable way to grieve the loss of a pet.
In many cases, permission to grieve may come exclusively from the veterinary staff. Dealing with grieving clients is not easy.
It requires you, the veterinary staff, to come to terms with your feelings about death and dying so you can develop the sensitivity and empathy needed by grieving clients. They need our support, our respect and our acceptance.
Here are a few books that deal with pet loss and owner bereavement. Search the Internet and your library for more on the subject.
Valarie Hajek-Adams is director of the Healing Heart Pet Hospice of northwest Wisconsin. Katherine Dobbs owns interFace Veterinary HR Systems LLC of Oshkosh, Wis., and is the founder and president of the Veterinary Emergency and Specialty Practice Assn.
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