When Pets Are Dying (and Have Died), Owners Need Support, Too
I have written a bit about the process of pets dying before, along with the ways in which vets can be (or not) helpful. In that post, I shared a book by Barbara Karnes on understanding the pet-dying process, which I had found very helpful and which would have provided me with a fair amount of relief and guidance had I known about while Murjan was still alive. It explained much about his dying process and death that was comforting in retrospect. You can read that post HERE.
In this post, I want to share the emotional aspects not only of the dying itself but also of the role of the support community (which should be supportive but in our case was not so, at least not to the extent that we needed and that could have been). As a result, my experience with Murjan's dying days were traumatic--more traumatic than they should have been because of lack of support from the veterinary hospital that should have been my source of support.
As I explained in the earlier post, Murjan had been followed by an oncologist at the hospital for more than three years, most of which time he had been on chemotherapy. Once he reached the point that he was obviously dying, it became clear that she did not know what to do and was not motivated to help me or him further. When I would try to make an appointment to bring him in. I would either not be able to get through to the front desk or be put on hold until the telephone itself gave up, creating the need to call back. Then, when I asked for an appointment, none were available except for months in the future. (They were indeed working on a short-staff basis, but I had the suspicion that they were told to put me off as much as possible.)
The oncologist was never available to talk to me, not once. I would ask to leave messages in her voice mail box, She did not return my calls unless I called several times. I began to feel like I was harassing her, yet all I wanted was some support in the form of information and education in the dying process (such as what I finally got from a couple of emergency room vets at two other locations -- who did not know Murjan but tried to help but him and me.)
The couple of times that I did get a call back, the oncologist had no suggestions. When I complained that I could not get through to her, she said the clinic was understaffed but that she had left a note that Murjan was a priority call. Really? Reality seemed to indicate something else. She also offered, which probably was a better indicator of reality that she had 30 new cats to take care of. (And so, the one she had had for almost four years no longer mattered because he was so ill?) When I told her that Murjan seemed to be going the way of Carl, who had just died of cancer the month before, she agreed. Full stop.
There is something in us that wants from our doctors and from our vets -- on an emotional level -- something I did not get:
- information about the living and dying processes, including how to handle palliative care
- when to know to let go and how to do that (euthanize? let nature take its course?)
- explanation about specific behaviors (seeking dark, isolated places in the case of animals -- Murjan looked for these while out walking on a leash on his next to last day of life, and on his last day, he was too feeble to go outside but took refuge in a little "house" at the bottom of the cat tree)
- decision-making points about when and why to bring the pet to the emergency room for assistance? (When I called about Murjan, I was rudely told by the nurse that they could not make room for a dying pet and that it would be expensive, i.e. forget about it; on the other hand, when Intrepid was dying, a different nurse from the same hospital said to bring him in immediately, and he was given oxygen, which made his death a bit gentler; why the difference? Should there not be a common practice, and should there not be some concern for the emotional state of the pet owner?)
- discussion of self-care: expecting and managing anticipatory grief, where to find bereavement counseling, how to keep self in mental and physical shape to take good care of a dying pet, stress management
- guidance in actions to take for the cat (e.g., how to make the cat comfortable -- soft bed or little house? push food and water or not? hold? pet? Both Intrepid spent most of their last hour, by choice, with their head on my hand -- both were in carriers:
- In the case of Intrepid, Carl was driving us to the emergency room where, in spite of intervention, Intrepid died within an hour of our departure; Intrepid, true to his name, was wanly trying to peek out from the carrier to see the outdoors whizzing past; I put in my hand, he laid his head on it, and he never raised his head until we got to the hospital.
- In the case of Murjan, who died after Carl died, we drove together the 45-minute journey to the hospital emergency room (though we were told not to come because they did not have any interest in a dying animal), and son CB talked to him quietly through the carrier grate; when we arrived, there was an ambulance blocking the entrance, and we had to wait 20 minutes; Murjan stretched his paw out through the grate, so I opened it; he took my hand with both his paws and laid his head on it -- and rested there the 20 minutes we were waiting for the ambulance to clear; those were his last minutes; when we finally got in, the staff said he was on his last breaths.
The ER vet who was with Murjan was the same one who was with Intrepid; she was an empathetic soul. She could tell we were distraught -- more about the way the staff had treated us than about Murjan's death. We had said goodbye to Murjan while waiting with him in the car. Something apparently touched her about Murjan's situation (or maybe it was very sociable Murjan himself -- he had been in the ER a few times in earlier years, and he was the darling of the earlier ER staff, including this ER vet), and I was quite touched in turn when I subsequently received a note from the Birchbark Foundation that ER vet had made a generous contribution in Murjan's name.
I was also able to receive grief counseling from them. I still experience some grief. It is not just the loss; it is the trauma of his last days and what was not available to him -- and to me -- during that awful time.
Murjan was in no apparent pain. He was plucky, and he loved life, up until the very end. He was not, in my opinion then or now, a candidate for euthanasia. Most vets are capable of supporting pet owners as they go through the difficult emotions associated with euthanasia -- and they can talk about such things as euthanasia being best for the pet (and often it is, definitely so if a pet is suffering with no hope of getting better and a prognosis of getting worse). What they are not good at is supporting pet owners when a pet is deserving of a fighting chance or when it is clear that letting nature take its course will allow the pet a natural and not uncomfortable death (and a knowing -- to the extent that pets might be able to "know" -- chance to say goodbye in their own way, such has resting their head on a trusted hand).
Read about a vet organization that is good at pet owner support, including death & dying, anticipatory grief & bereavement: Metropolitan Veterinary Associates.
Read more Caturday posts.
Read more posts about grief and bereavement.