Companion Animal Bereavement: A One Health Workbook for Veterinary Professionals

By Angela Garner

This concise workbook is written as a guide for veterinary professionals to support owners through the many challenges they face before, during and after the death of their companion animal.

This unique text provides a wealth of practical advice to be used when supporting both adults and children through the grief process. It offers support when discussing subjects such as natural death versus euthanasia and guiding owners through after death services. Also, it covers the difficulties experienced by owners due to separation for other reasons, such as when a pet has to be rehomed. The book:

- Gives highly practical guidance on pet bereavement support for vet staff before, during and after animal loss, including communicating with highly distressed people;
- Includes exercises and activities which can be downloaded and shared with owners to help them cope with the destabilising effects of grief;
- Helps gain a deeper understanding of the owners' perceptions of the process, including their fears and feelings;
- Addresses the importance of self-care and peer support within the veterinary team or animal welfare organisation;
- Contains numerous case studies and practical examples in the book and via additional online resources.

• Language: English
• Publisher: CAB International
• Release date: Oct 6, 2021
• ISBN: 9781789245394

Angela Garner

Angela Garner, animal bereavement specialist and former nurse, founded a national support service in the UK to help people through the grieving process, developing a wide range of pet bereavement support resources. Awarded a fellowship by the Society of Bereavement Practitioners for her work, she lives in Devon, UK.

Book preview

1

Perspective from Opposite Sides of the Consulting Table

Covering:

•What it is like for owners facing the loss of their companion animal

•Examples of the challenges faced by veterinary professionals

Why is bereavement support an important area for veterinary professionals? Animal loss can cause deep and significant grief. Of course, no one can be responsible for how anyone reacts to the death of their pet, but it needs to be said that while euthanasia might be a common occurrence in veterinary practice, for the owner the loss of a beloved animal can be a life-changing event. As veterinary professionals, you play a key role before, during and after pet loss. This is important, because the way you communicate with the owner can influence how they cope throughout the whole process. People do not forget such a significant event – it can stay with them for years. It is worth remembering that owners talk to each other about their experiences – positive and negative – so word gets around.

Sometimes owners view their beloved pet as their child, as one vet reported:

In the two years I spent in mixed practice I had two clients who had bought their dog to replace a child who had grown up and moved away, making the dog much more than just a pet. I felt really unprepared to tutor them through the difficulties their pets encountered.

Many years ago, in my early days of offering pet bereavement support, I remember receiving a voicemail from a gentleman, who was clearly upset, asking me to phone him as soon as possible because ‘his son had died’. I returned his call with the intention of gently explaining that I was unable to offer child bereavement support, but he might want to approach another organization (I had a relevant contact number to pass on to him). However, it soon became clear that his ‘son’ was in fact his dog. He was an elderly man who lived alone with very little in the way of family support and his dog had been central to his life. Subsequent conversations revealed him to be a veteran from World War II who had fought for his country and had been involved in the Normandy landings.

I have no doubt that two days before the call, as this gentleman had stood in front of his vet discussing the impending death of ‘his son’, he would have done his utmost to remain stoic in the face of his impending loss, significant as it was. This story is shared as an example of a backstory to a consultation about euthanasia and a fairly common perspective from an owner about how they view the companion animal that shares their life.

As your next client enters the consulting room, having read any available medical notes, you may be assessing the animal’s behaviour, body language, body condition, mobility and looking for any obvious signs of injury or disease. Your priority is to secure the best welfare outcome for the animal, but, of course, it is not that simple, because there is a human on the end of the rope, lead or pet carrier, who, like the elderly gentleman mentioned above, presents another crucial part of the picture.

As the owner brings in their beloved charge, there could be a whole range of emotions, thoughts and worries going on about the possibility of their pet’s life coming to an end. They may come full of hope for their animal to have more time or even for a miraculous cure, or be summoning their inner strength and mustering the courage to ask you if their pet needs to be put to sleep. They may have tried the conversation in their head many times before even making the appointment. Or they may be steeling themselves to receive bad news.

There must be thousands of such scenarios going on each day, each unique to the ‘vet–animal–owner’ triangle. Across the globe at any time there will be vastly different ways this is played out, demonstrating a diverse range in human–animal relationships and subsequent reasons that an animal may need to be put to sleep. For example, in India: a vet talking to an owner about the welfare of his donkey that, despite a broken leg, continues to work carrying bricks up and down roughly hewn stone steps on a building site. In the UK: someone having to have a much-loved companion animal euthanized because they cannot afford necessary vet treatment or because their dog has bitten someone and is now deemed too much of a threat to keep alive.

What can be said with certainty is that it is not easy for either you, as the veterinary professional, or the owner. In some cases it can be highly traumatic for both. Below are real-life examples of the perceived challenges and difficulties experienced or felt by owners and veterinary professionals from either side of the consulting table.

What it is Like for Owners Facing the Loss of Their Companion Animal

Owners describe a number of fears and difficulties they face regarding the impending loss of their companion animal and the weight of responsibility they feel:

•Making the right decision.

•Finding the right time to say goodbye.

•Actually making the decision and seeing it through.

•Making the call, knowing what to say on the phone.

•It brings up how much I love him.

•Never seeing them again.

•Fear of loss – emptiness.

They describe their fears about the process of euthanasia, such as the following.

•I’m frightened of seeing my animal put to sleep.

•Fear of seeing something traumatic during the process.

•I want to be sure my horse passes peacefully without suffering.

•After previous experiences of having cats put to sleep, I’m worried about when it’s time for each of my other cats.

Afterwards, owners have said how they struggle with different aspects of bereavement, including loneliness and having to deal with people who do not understand the rawness and the depth of their grief, and other effects, such as:

•Not knowing where animals go after they die.

•Feeling guilty.

•Losing such a massive part of my daily life.

•Loss of my routine – it will leave such a big hole.

•Memories die with them, making me feel nostalgic and fearful of my own time of passing.

•Not being able to see them every day.

•Them no longer being there.

•Losing my best friend.

•How long it will take to feel better.

•Fear with how I will be with other people and their questions.

•Would I ever be able to go through this again? Will it put me off having another?

•Losing a friend, somebody who was always there.

•Being alone through the process.

•Being left with no-one to talk to.

•No one will be able to cope with me grieving.

Examples of the Challenges Faced by Vet Professionals

From the other side of the consulting table, a whole different set of challenges have been raised by vet professionals. Some of these are centred on the procedure itself and not knowing how both an animal and their owner will react.

Before euthanasia:

•Coping with owners who cannot bring themselves to make the decision, especially if welfare is a concern – how to persuade them euthanasia is the right thing for their animal and that they need to think of the pet rather than themselves.

•Dealing with denial of an owner regarding the need for their animal to be put to sleep.

•Warning clients what to expect, such as the eyes will stay open.

•Presenting the owner with the facts without terrifying them and not knowing how they will react.

•Giving them all the options to make an informed decision and to be sure of their decision.

•Choosing the method of euthanasia – advising owners of different methods and the best method for them and their equine.

•Timing of procedure – how long to wait after the decision is made (some people book several weeks in advance and cancel several times).

During euthanasia:

•Coping with traumatic or unprepared euthanasia – in respect of witnessing the animal’s suffering and/or the effect it has on the owner who is present.

•Dealing with sudden and unexpected deaths.

•Dealing with emergency situations where euthanasia is the only option, so the client is shocked and the situation is very upsetting for everyone.

•Practical issues of euthanasia, wanting it to go well.

•Managing the physical act (shooting versus injection) in equine euthanasia with possible loss of control.

•Unpredictability of an equine’s reaction – will they rear and fall back?

•Most owners prefer their pet to be put to sleep at home, as the animal is certainly more relaxed and this avoids them having to drive home with the body of the deceased pet in their vehicle. However, I know that some vets fear the injection not going smoothly without the usual support that is available within the surgery, although having a nurse to assist is considered to be best practice.

Issues about offering support to owners during the consultation:

•Physical contact – when to reach out and how to deal with owners touching me.

•Other people rather than owner being involved.

•Difficult environment causing safety issues for vet and owner.

•Coping with the stress of it being a public event and the decision-making and possible criticism.

•Dealing with personal emotions – what is an appropriate amount of emotion to show?

•Balance between being too emotionally involved and seeming heartless.

•Being seen to support the owner.

•Knowing how the client is going to react, as everyone is different – some prefer a direct approach but others don’t.

•Dealing with hysterical reactions and emotions of the owner.

Of course, there are times when vets are also owners and have to go through their own loss and deal with personal grief. Vet Vicky Grove kindly shared her personal story about her own dog needing to be put to sleep just after she had qualified:

When I was a final year vet student, our 12-year-old golden retriever, Crackers, was diagnosed with a nasal tumour; he was given three months to live. He lived three months exactly but as I had qualified by then, it had been previously agreed within the family that I would be the one to give the final injection when the time came. Cancer has the nasty habit of giving the patient good days and bad days. He could have two bad days in a row perhaps before having a good day. I couldn't put him to sleep when he’d just had a bad day as I feared he had a good day around the corner. Silly, I know. However, he did actually call it very clearly one morning as he went out and lay down in the flower bed. I injected him, through my many tears, and we buried him there where he had died.

(Vicky Grove, Veterinary Surgeon)

To conclude this first chapter, here is an account from vet Victoria Nicholls, who also had to say goodbye to her own beloved canine companion.

To me, Frisby was the best ever ‘vet dog’ as he was so patient between calls and seemed content to listen whilst I ranted about my typical equine veterinary day. He was also incredibly tolerant of the endless car phone conversations as we went from client to client. He was very much loved by both clients and colleagues. Outside of work, Frisby’s life was full and exciting and he enjoyed holidaying in France twice a year.

Unfortunately Frisby had become well versed with the veterinary profession following a diagnosis of unilateral elbow dysplasia eight years earlier. Thankfully I had found a wonderful orthopaedic specialist who was able to support us through each decision and treatment option; this included a relatively new technique of stem cell therapy which is usually reserved for equine patients. Frisby soldiered on through all this, gaining new celebrity status in our practice office – often benefitting from ginger snaps, which he quietly received with relish from colleagues when my back was turned.

As veterinary surgeons we have to deal with loss of animals on a regular basis, often taking a utilitarian approach to death. Some vets become emotionally detached whereas others wear their hearts on their sleeves, but I have no doubt that we are all affected on some level. Supporting owners through these difficult times can be daunting, especially as many of us will not have received bereavement counselling as undergraduate students, which thankfully has changed within today’s veterinary school curriculum. However, we can never really understand what it is like until we find ourselves on the other side of the consulting table when it becomes clear that animal loss, whether from euthanasia, illness or accident, is both inevitable and harrowing for those involved.

Frisby was staying with a good friend, who is also an equine vet, for a week to avoid the lengthy trip we were making to France, so that at the age of 12 years he could enjoy the comfort of just being driven to and from my friend’s various calls (which ended up being mostly in second gear to avoid moving him as he lay with his head on her lap!). I received a call on the Monday to say Frisby had been vomiting and, although this was not seen as a significant cause for concern, he had been admitted to my old practice as a precaution. My brilliant network of ‘phone a vet friend’ was duly consulted and we waited for dear old Frisby to be discharged – but he never came home.

As his owner and his ‘mum’, I just wanted to see my dog. I have often said to owners that they ‘will always know when it is time’, but because I was away I was unable see him with my own eyes. I became conscious of maintaining the fine balances between the myriad of unanswered questions in my head and turning into the nightmarish demanding owner who we all dread. And, as I phoned a vet friend at the practice, where all the staff had been brilliant, I was determined to avoid asking, ‘What would you do if this was your dog?’ but the words were out of my mouth even as I reprimanded myself. The quiet pause on the other end of the phone said it all and we flew back the very next morning making me grateful to have such an understanding husband and family who supported this decision. For the first time in my veterinary career, I was not the detached professional but had become the distraught owner.

When I said goodbye to my constant companion of 12 years, who had been my faithful running partner, my late-night call protector, keeper of my secrets, and conveyor of unconditional love, I finally understood what it means to be ‘heart-broken’. When I had to say goodbye for the first time, it was from the other side of the consulting table – as an owner rather than a vet, as a client rather than an employee, and as a distraught mum rather than detached professional.

And, from the other side of the consulting table I felt proud to be a vet as Frisby left this world lying in the sunshine with his head on my knee, surrounded by those who loved him.

(Victoria Nicholls, Equine Veterinary Surgeon)

2

Communicating with Distressed Owners

Covering:

•The destabilizing effects of grief

•Communication pathways

This chapter will cover how the potential or actual loss of a beloved companion animal that is a significant part of the owner’s life creates a distressing and destabilizing situation in which communication becomes a key feature.

Anticipatory grief starts as soon as the owner becomes aware that their pet is coming towards the end of its life. This is a time filled with anxiety and uncertainties and can be extremely difficult for the caring owner. When facing highly distressed owners, what is needed is ways and means to cope – not just with the person in front of you, but perhaps on occasions to manage your own responses. For example:

•How to understand the situation that is unfolding in front of you.

•Avoid being fazed by the overwhelming and sometimes alarming emotional reaction you are witnessing.

•Find your own centre of gravity and ‘quiet space’ that allows you to respond in a way that helps the owner regain their centre of gravity.

•Not feel that you have got to fix things for the owner or feel under pressure to say exactly the right thing at that point.

This chapter offers a fresh, new way of looking at grief through an analogy that I have used when teaching veterinary and animal welfare staff to demonstrate why an owner can feel that their world is ‘falling apart’ during the loss of their beloved pet.

The Destabilizing Effects of Grief

Everyone has their own routine and ways of dealing with everything that life throws at them, which in time creates what could be seen as holding patterns; it is what each individual is used to, which forms the basis of their day-to-day routine. Obviously these patterns change over time, but at any given moment they allow a level of stability and ease and therefore, to some degree, a harmony because it is what they are familiar with.

These holding patterns include all areas of life, such as:

•Home

•Family

•Partner

•Friends

•Work

•Money

•Health

•Companion animals

•Everyday activities with family pets

•Travelling

•Hobbies

•Fun

•Studies.

In this analogy, the daily routine is made up of these many facets fitting neatly together, like a jigsaw puzzle, forming the overall picture that describes a person’s life. Each piece of the puzzle represents a segment of their usual ‘going on’ and is an integral part of the whole, all interwoven with each part affecting other parts.

While the pieces stay in place, there is stability and the picture stays intact. If a less significant piece of the puzzle starts to become loose, as long as the rest of the puzzle stays in place, the person can cope with the disruption. For example, if a work situation gets more stressful than normal, provided other aspects, such as home, partner and family, remain stable, it is possible to manage. However, when significant parts of someone’s life are affected there is major disruption to the normal holding patterns, resulting in disturbance and increasing uneasiness.

A significant shock, such as a death, or the devastating news that a beloved pet is terminally ill, injured or facing euthanasia for any reason, affects the whole picture and all pieces come apart – as though the jigsaw puzzle, previously intact, has suddenly crashed to the ground, scattering the pieces into separate components. Then the overall picture, which up to now has been familiar and secure with the normal interconnectedness of everyday goings-on, disappears. So, in effect suddenly the owner may feel that their life is ‘in pieces’ – a description I have heard on several occasions when supporting people through pet bereavement.

As a result, owners can find themselves struggling with all manner of difficulties, such as the following.

Overwhelming emotions

•Shock, disbelief or denial

•Sorrow

•Pain

•Anguish

•Anger

•Despair

•Fear.

Mental distress

•Confusion

•Inability to focus or concentrate

•Anxiety

•Feeling of vulnerability – lost, lonely, scared

•Feelings of guilt

•Feeling unable to cope.

Physical effects

•Sleep disturbance

•Possible worsening of health conditions

•Stress reactions – palpitations, shaking, upset stomach and nausea.

Any sense of stability or harmony has gone and they may say, ‘My dog was such a massive part of my daily life – what will I do now?’ Or ‘My life has fallen apart!’

This is what may be going on with the owner in the consulting room, on the end of the phone, or as they sob their heart out distraughtly over the dead body of their beloved animal.

Communication Pathways

In light of these destabilizing effects of grief, how you communicate with the distressed owner becomes a key issue to facilitate as much stability and harmony as possible. This could involve settling their mind on various issues, clarifying anything they do not understand, giving reassurance where needed and thereby