Charlotte: Welcome to VSPN's Grief Counseling chat! Your hosts this evening are Elizabeth and myself!
Elizabeth: Greetings VSPNers

TJ: hey...
Dawn: hello: now I can be counseled through my grief
Robin: Seasons greetings!

Elizabeth: How many work in a practice right now?

Margaret: n
Charlotte: I work in a practice now :)
TJ: I do.
Robin: teaching/shelter
Dawn: university clinic ... lots of death and grieving owners ... (as well as staff)

Elizabeth: it looks like we probably all deal with euthanasia and grief in some way, directly or indirectly.

TJ: The staff is alive though, right?
Dawn: staff alive. But the intensive care takes its toll on all of us
Charlotte: And the holiday season is an especially emotional time of year

Elizabeth: Let's talk first about how we can help clients who are making the decision. I think that, especially around holiday time, people may look to us for reassurance, guidance, etc. And may be more prone to pursuing treatment beyond what is reasonable, not wanting to deal with losing a pet at this time. Does that sound reasonable?
Charlotte: Very reasonable E.... they think more with their hearts at emotional times

Dawn: I have noticed the opposite to be true EW

Elizabeth: Dawn, I have noticed that money can be more of an issue at holiday time, clients can't afford treatment due to spending a lot on other things

Robin: They should be given all options regarding treatment; not just what we assume they want
Dawn: Also, family and friends are coming. Sometimes the older pet can be too much of a burden and/or embarrassment

Elizabeth: true. I'd like to review our role in helping with the decision. We can/should wear 4 hats:

Educator - Educating regarding the prognosis and costs with and without treatment, what to expect from the euthanasia procedure, etc
Supporter - Supporting their choice, whatever it is.
Facilitator - Making sure the euthanasia goes smoothly and as easily for the family as possible
Resource - Offering resources for dealing with grief

Elizabeth: What types of things specifically do these roles entail? For example, when someone asks, what would you do if this were your pet? I as an educator, what can/should you say?

TJ: I am always honest... is that not right?
Margaret: me too

Elizabeth: How so TJ and Margaret? Do you give your opinion?

TJ: I give what I know.... what I see... what I have experienced... For example: Saddle thrombus in cats... these don't go well at all.
Margaret: I would put myself in their shoes and tell them what I think, and then why I think it, while trying to stay neutral, of course.
Robin: can give statistics as to how you see diseases USUALLY progressing preface by saying you don't know the family circumstances.... but

Charlotte: I am honest about what I personally would do, but I try to stress all the options that the docs give
Elizabeth: I always start with, I can't tell you that because s/he is not my pet and you know him/her in a way that I never could, BUT then I chime in with whatever input I have because there are times that I would tend to say one thing or the other, and then as I hear the client's story I would change my mind. So I try to relay neutral experiences, but then I will try to figure out which way the client is leaning and explore that. I think the worse thing that could happen is that we, someone in the clinic, would tell the client to do this or that, and then if things don't go the way we think, the client resents us. For example, if the vet says prognosis is poor so suggest PTS and the client later decides she would have wanted a second opinion that is a bad situation.

TJ: I always try to look at things realistically. If there is a chance of recovery then I tell them. If the owner is hesitant because of cost. I do not express any emotion over those thoughts. I want them to make the decision that is right for them. The older you get the more you understand that things can go wrong in any given circumstance.
Robin: Decisions are very personal

Elizabeth: In talking with people who have gone through euthanasia with a pet and who had a negative experience, the one thing that comes up again and again is that the client didn't feel they had enough information when they made the decision. So I prefer if people can spend some time thinking about it before they decide, talk to family, do research, etc. Be confident in the decision, not pressured. It's so hard when they have to decide NOW--in the emergency clinic clients don't have time to even process what's happened, much less make a coherent decision sometimes.
Charlotte: I always stress to the client that it is their decision.... but working in the same town you grew up in- you know some of clients more personally than others

TJ: That is what we deal with most of the time. We tell them that they can take some time to think about it if they want.

Elizabeth: What about facilitating? What can we do to make the euthanasia easier emotionally? Anyone have any tips?

Dawn: I don't know. I am of the opinion that we are a society that does too much to avoid grief
Margaret: Is it possible?

Charlotte: First we explain the procedure as fully as possible to the client so they know what to expect

TJ: I tell owners that they did the best that they could, depend on the situation. I don't make them feel guilty for not having brought the animal in three days earlier.

Elizabeth: For example, explain everything including what we do, what to expect, etc. Get the bill and paperwork out of the way first. Let them have a room to themselves for however long they need it.
Charlotte: I usually encourage the owner to be present - their arms and words are the last things that their pet is going to hear and feel. Yes- gets paperwork done first. This is a small thing- but I always make sure that the Kleenex box is handy and visible

TJ: YES!

Elizabeth: Sedate the pet first if that is indicated. Place an IV catheter if indicated. I hardly ever see euthanasias with the client not present anymore. I think we are better about encouraging them to be there. I've heard people say they are just torn to pieces because they don't really know what their pet's last moment was like if they were scared, struggling, etc. If the client doesn't want to be there, I will assure the client that I will be present in their place and will make sure they [the pets] feel love and comfort to the end

TJ: We still have a lot of them. People just can't stand it sometimes.

Charlotte: If we do the procedure in an exam room- I get the nicest blanket we have to set the pet on if they have not brought one in

Phyllis: Ask them if they would like a snipet of the pet's hair.

Charlotte: Phyllis- that one that I never thought of! Thanks :)

TJ: Sometimes only one of the spouse's will be there.

Charlotte: After the procedure, the vet and I leave the room and tell them to just let us know when they are ready to leave their pet

TJ: You know what makes me uncomfortable. When the family goes home and gets the kids and brings them in. I hate that. I start balling.
Margaret: me too, TJ

Charlotte: TJ- that is a tough one
Elizabeth: I think it really depends on the kids age and the family dynamics. The worst case I ever dealt with was a mother who made her 10-year-old son decide whether or not to euthanize their dog. It needed to be done, but still.

Charlotte: Wow- E.... that must have been rough!
TJ: GEE WHIZ! That would make me angry. When the family has the kids and talk about when the child was two and on and on about the pet and the kids... oh man... To be honest... I feel that I am inadequate in these situations most of the time.

Elizabeth: Me too, and I talked a lot to the boy, but I felt *very* inadequate. I'm not a child psychologist! I think most of us do

TJ. I know I do most of the time. I do my best and try to think what I would want if it was me.

Charlotte: TJ- sometimes I just come out and ask- what can I do for you to help?
Elizabeth: That's probably best Charlotte. People have very different needs during times of grief TJ: You see that's a problem. I want to be left alone. Totally alone in these kinds of things.
Charlotte: TJ- sometimes they want to be left alone- sometimes they want a hand to hold
Elizabeth: As for remembrances, Iëve seen things such as a digital picture before the euthanasia, a clay paw print, an ink paw print, a clip of fur. Anything else you all do or have seen done? I think this is a new trend in vet med, we are acknowledging the value of the pet in the family more.

Dawn: we do paw prints in cement ... the staff often decorates them and they are sent later. The response from the owners has been overwhelmingly positive and it's often good for the nurse too.
TJ: We send the ink paw prints later in the mail, unfolded.

Charlotte: Dawn- I think that is the most misunderstood part of our job- they don't realize how close we get to our patients. More times than not, I have had as many tears as the owner!

Dawn: Exactly. I don't think we acknowledge it enough either, sometimes I just get sick (no pun intended) of losing them.

Charlotte: Dawn- especially the ones that you have cared for since they were a pup or kitten
Elizabeth: Supporting--during the procedure and after, things we can do: acknowledge, normalize, give permission, ask questions, self-disclose, and structure the environment, touch. How do you feel about touching?

TJ: I am not good at it. You know... some people are just huggers.
Margaret: me either
Dawn: It can be hard; it's a very personal sort of touch. Not a routine one and you never know how much they want or how much you are willing to give especially since animals are so touch oriented.

Charlotte: I am very free with hugs :) Or just a hand on the shoulder :) But this is something that took me a while to get comfortable with.
Elizabeth: Something that may be very hard to do, but I think so very important for some people who really need to reach out. I think a hand on the shoulder is a good start, because if they don't want it they can step away if they do, they can reciprocate
Charlotte: For the clients that I do not know as well, a hand on the arm and letting them know that we are here if they need to talk usually does it

Dawn: and that is a big part of what their pet did for them even if they are normally stand offish to people: very hard to judge ... have to read the body language. But this is something veterinary staff do all the time we are experts at deciphering unspoken needs

Charlotte: I have a kind of funny one to tell you all.... It came time to take one of my own in....and my boss was nursing her baby at the time.... So after the procedure was over with, she was crying, I was crying and she came over to hug me- and due to the emotions- she was ""leaking"" from her nursing!
Elizabeth: Oh boy! Good thing it was you and you understood. You can't force yourself to be intimate--so don't do it if you aren't comfortable, find some other way to be supportive.

TJ: Oh my... Couldn't hide it.

Charlotte: E- sure was! It helped get us through :) And then I knew her emotion was very genuine LOL. I think that the key is the basic touch- to the arm, shoulder- let them know that we are here if they need us.
Elizabeth: Be cautious about self-disclosing, too: it can demonstrate your empathy, but might be taken as selfish

TJ: Selfish?

Elizabeth: TJ, like you are only thinking of your own problems during this client's crisis. I've had so many people say to me I'm sorry, I don't know why I'm crying--I shouldn't be acting this way. How do you respond to that?

TJ: It is understandable. Don't worry about it. Go ahead and cry.... Someone is at home telling them that the vet bill is too high.

Elizabeth: When people believe they shouldn't grieve over a pet, I usually say something like, 'many people are surprised by the grief they feel, but most of us feel it'
Charlotte: I usually tell them that they should cry- it is part of the grieving process- and don't let anyone tell you that it was just a dog, cat or whatever...the grief is genuine and should be acknowledged
Elizabeth: OK, Charlotte is going to tell you about the rainbow bridge now.
Charlotte: There is a poem called the Rainbow Bridge...it was written for pet owners :) We have it printed out on rainbow paper and send it to clients with the sympathy card

Phyllis: Who wrote the Rainbow Bridge? VIN doesn't have that listed.

Charlotte: Phyllis- it was anonymous or rather- Author Unknown it says on my copy. If you would like a copy of it, let me know- you can email me at Samyed3@aol.com

Phyllis: I just typed it up to pass out to clients and I wanted to make sure I wasn't missing the author.

Charlotte: There are also websites where the pet owner can post a memory of their pet and even some places you can post pictures. And here in VIN- at the Pet Care Forum, they have a grief support chat called Rainbow Bridge chat. The concept behind it is that all animals are restored to health and vigor and await you at the Rainbow Bridge then you can cross the Bridge together :)
Elizabeth: I think it's a great idea and a way people can get in touch with other people who are grieving pets, and learn more about the grief process. Another thing I hear a lot is íI thought I was the only one who felt this way
Charlotte: The chats at the Pet Care Forum were wonderful! I had more email from people on that chat when I hosted there about us truly helping them. E- Or that my co-workers, hubby- whatever- says it was just a pet
Elizabeth: exactly. No one understood why I was crying, didn't want to go to work, etc.
Charlotte: I also have a list of books that help with grief- some are geared toward children. The Iams company had a grief support hotline- not sure if it is still up and running now
Elizabeth: It seems that traditionally, euthanasia is the ëendí of what we do for a client, though I believe our role extends to grief support. To see the poem and lots of other info about pet loss and grief, go to www.petloss.com . I think there are also hotline numbers and other resources listed at that site.
Charlotte: I think that when the pet dies or is euthanized, that is when many of our clients need us the most. Whether it is just in those words or the touches that we talked about- or in help finding a new pet, they need to know that we will be there for them

TJ: I have copied that web site and I will link it to our euthanasia code in the computer. Thanks!

Elizabeth: What a great idea. Any other comments, questions, ideas, etc?
Charlotte: I think it is also important to recognize when the client is having a very difficult time with their grief and bring that to the doctor's attention. When after 6 months they are still in deep grief- they may need to get help through a grief support group. We have done that- and the clients have been very appreciative
Elizabeth: A follow up phone call in a week or two, just to see how they are doing, might be a good idea.

Participants: Phyllis, Robin, Margaret, TJ, Dawn, and Dora