"How Can You Do This?"
“It must be so hard.”
“You have the worst job ever.”
All of these are comments said to me over the years, in respect and appreciation, but also in a kind of bewilderment.
Well, it can be hard. But I do find a lot of meaning in helping people through these most difficult times with their beloved pets. The end of life is precious to families, but also filled with emotion—sadness, loss, anguish, indecision, guilt, anger, frustration, joy, tenderness, and love, and many more. My goal is to help people have more time, and have more positive memories and positive emotions associated with the care-taking and decision-making at end of life.
I loved animal from a very young age, from before I can remember. As most veterinarians, I was drawn to the field for two reasons: helping animals and people; and the intellectual challenges associated with practicing medicine, an ever-changing and evolving field, with the promise of always more to learn. Basically, the veterinary field is filled with some of the biggest brains and biggest hearts out there.
When I first started practicing, I sought out the hardest cases, through emergency practice. These were the ones that really relied on my ability to diagnose and treat accurately and timely. It was really challenging, and effectively crushed my perfectionist soul. And I learned that people do not appreciate emergency care as much as I'd hoped, and can be angry and vengeful when treatment is costly, or the disease has a poor prognosis. There are a lot of reasons for these reactions. Feeling powerless, not being a part of the decision making process, and not having any “good” options, and feeling guilty (and feeling alone and in grief) all
contribute mightily to a family’s bad feelings in the ER. It is, unfortunately, the nature of the game. Emergency practitioners can not spend the kind of time discussing and talking through all the options and finer points of side effects and outcomes. It is an emergency, after all. Thank goodness they are there and do what they do, however thankless their job may be!
*Thanks to https://www.facebook.com/emergencyvettechmemes/ for their fantastic collection of memes summarizing the many frustrations and small joys of ER care.
After my brief two year stint in emergency, I started practicing as a GP in an urban practice with a wide variety of families and pets. It is what we would consider a “bond-centered” practice: the focus is not on high volume, low cost, but on defining what each family needs and wants for their pet, and trying to make that happen. It is a very individual and service oriented practice. There are protocols and standards of care, especially for prevention, but when it comes to managing chronic diseases, behavior problems, and other long term care needs, we worked very hard to develop a plan that reflected the needs and wants of the family and best honored the human-animal bond.
The process of navigating these waters with families was not something you could look up in a book. It was something that you practiced over and over, listening, thinking, being present, offering empathy and support. Sometimes, this meant that the diabetic cat didn’t get the perfect monitoring the textbook said he should, or the geriatric dog with cancer didn’t get chemotherapy or surgery, but the families were involved thoroughly in the decision making process for their pet’s care, and well educated on what to expect, and they were more thankful and happy for that, and so were their pets. As Maya Angelou said, “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
End of life care combines the most challenging medical cases, with co-morbidities and limitations on what kinds of treatments can be tolerated or performed, with the most challenging (and, in my opinion, rewarding) emotional needs of a family. Dying can be unpredictable and scary, but with the right support, it can also feel beautiful, peaceful, and planned for. People are often bonded to their older pets more strongly than any other living creature, human or otherwise. Helping people to cherish that bond and preserve it through the end of life, and even death, eases some of their emotional burden and grief. It challenges my analytical mind, but also my creativity, my emotional intelligence, and my empathy and compassion. Each family is different, each pet is different, and each disease unfolds differently in the individual, creating unique challenges and rewards. People who want this type of care are so grateful and thankful to have this kind of compassionate guidance when they need it most.
From left to right: Logan, Elias, Jasper, Leela, and Scout. of course, these guys above were and are my inspiration for it all. Love you always.