Working with Death Wednesday: Veterinarian

Today, I have Carrie La Jeunesse, DVM, CT, CCFE on the Death Writer Blog.  I'm very excited to have a veterinarian share her experience with us!

Carrie graduated from University of California, Davis, School of Veterinary Medicine in 1983. After completing an internship in small animal medicine and surgery, she entered private practice (primarily emergency and critical care for most of her career). She owned a house call practice wherein home euthanasias were frequent. Dr. La Jeunesse holds CT (Certified in Thanatology) and CCFE (Certified Compassion Fatigue Educator) certificates and is commissioned as a Spiritual Director. In addition to veterinary practice, Carrie maintains private bereavement support and spiritual direction practice.
She contributes to magazines on issues related to death and dying, spiritual care, and compassion fatigue. In addition, she presents continuing education and workshops/retreats and provides consulting in all of the aforementioned areas. Past President (2010) of the Washington StateVeterinary Medical Association (WSVMA), she is currently a trustee of the Washington State Animal Health Foundation and member of the ember of the WSVMA animal welfare committee.

Some links you and readers might find useful: (Association for Death Education and Counseling) (Washington State Veterinary Medical Association...links to resources for pet owners)

DW:  Why did you want to become a veterinarian?
CLJ:  I became a veterinarian out of a love for medicine, working with people (as clients) and other animals (as patients). I love to learn, and the field is challenging and requires life long learning.

DW:  At what point in your professional journey did you realize that you would have to deal with death?
CLJ:  I realized I would be dealing with death and euthanasia long before I became a veterinarian. We had family pets who were euthanized or died. As well, I worked with various veterinary practitioners and euthanasia was a regular point of care.

DW:  Can you explain the process of euthanasia?
CLJ:  Special medication (euthanasia solution) that is most often a barbiturate of very high concentration is given into a vein. The injection works quite rapidly and affects the centers in the brain that intitiate heart beat and respiration. Those areas are essentially anesthetized (what you DON'T want to have anesthetic overdose...if you're having surgery) so that heart beat and breathing stop and the animal dies. It is essentially an anesthetic overdose, so that animal would experience the same sensations as they would if they were being anesthetized for a surgical procedure.

In some instances, a sedative, pain medication, or medication for anxiety can be administered ahead of time depending on the individual circumstances. These choices are made cooperatively with clients and tailored to fit the individual condition and comfort of the animal, as well as the preferences of the owner.

I encourage the use of intravenous catheters if owners choose to be present during the euthanasia. This gives more flexibility with regard to how clients can be situated with their pets, and can allow the veterinarian and staff to get out of the way a little more. More importantly, IV catheters ensure that the euthanasia solution will all be administered into the vein, which could otherwise be a problem if the animal moves and only part of the solution is administered. If only part is administered, animals are unconscious but can experience an "excitement phase" of anesthesia that can result in vocalizing and thrashing about. It's very unsettling to witness this to say the least, so I use intravenous catheters to ensure this won't happen. It is understandably very traumatizing to owners when it does, and is a horrible last memory to have.

DW: Do you remember the first euthanasia you were involved with?
CLJ:  No, as I worked around animals from quite a young age and can't remember the specifics.
As a veterinary student, it was a much loved Schnauzer who was owned by a lovely older couple who brought in fresh kosher turkey every day to try to coax the dog to eat. The dog had cancer which caused an immune system problem so she was gobbling up her own red blood cells and despite treatment and transfusions, simply grew sicker and sicker.

DW:  How was that experience for you?
CLJ:  It was very sad. I grew close to the clients, as well as to the dog. They were a lovely little family. It reminded me that despite extreme dedication on the part of all involved, especially her owners, sometimes nothing really works that you would think ought to. It was very humbling...a reminder that doctors are human and medicine is imprecise and limited in what it can do.It was gratifying to share so deeply in the bond between pet and owner and to know that while the medical efforts were important, it was my compassion, my dedication, my presence that perhaps made the biggest difference. I learned then to be comfortable with the pain of others, to remain present and available.

DW:  What is worse, the pet owner who drops off their animal because they can’t bear the pain of being with their pet in their last moments or the pet owner who stayed in the room and broke down?
CLJ: Neither of these scenarios is particularly difficult for me. I have found that whatever choice clients make with regard to their presence (or not) at the actual time of euthanasia always seems to be the right choice. People who love their animal companions so deeply seem to always make the right choice. I think the honest expression of emotion (wailing, crying, whatever) is appropriate and hope to provide a safe, non-judgmental place for folks to express that emotion. We're all in this together and support for client needs around the time of euthanasia is critical. Also, some understanding that there is broad individual and inter/intra-cultural responses to death and dying is fundamental to being comfortable with how people react.

DW:  Did you ever feel as if you had to be a counselor to the pet owner because of their pain and grief?
CLJ:  Well, as it happens, I do provide bereavement support because I work as a thanatologist (death/dying/bereavement). I would not call what veterinarians do "counseling," as most are not formally trained to do so. But yes, it is common to offer listening and support to clients before, during and after the death of an animal companion. Most often, it involves listening, reminiscing, supporting decisions around euthanasia, and validating for clients that the loss is significant and may be the worst loss they have ever experienced. If that is the case, that this is the worst loss, some clients are stunned that their reaction is so great, and feel as if something is wrong with them for feeling worse about the death of their dog than, say, the death of their beloved mother. Veterinarians (and friends and family) can make a huge difference if we just acknowledge what the experience is like for the owner, and not judge, try to minimize, or encourage a rapid "recovery" from grief.

DW:  Amen to that!  Did it ever get easier?
CLJ:  It does not get easier. If anything, it has become more difficult. I take conscious steps to do my own grief work surrounding the death of patients.

DW:  Were there any instances where you felt that a pet owner was spending way too much money to prolong a pet’s life when it would have been better to let it die?
CLJ: Yes. Sometimes people are just not able to admit that all hope is lost. Or, some people feel very strongly that it is not their place to end a life. These are usually pretty deeply held personal, spiritual/existential or ethical beliefs. As a veterinarian the best I can do is truly listen to what people are needing or wanting. Then, factor in what is happening with the animal to help owners understand. Some people feel it is a betrayal to euthanize. Some people do not understand that their pets are suffering and that the suffering can no longer be managed effectively. Others believe that a certain degree of suffering is necessary at the end of life for beings to progress appropriately in the next existence. So you can see the situations can be quite complex and to require a reasonable amount of time in discussion with the clients

DW: In regards to euthanasia, do you think we’re more compassionate with our animals than with our humans when it comes to death?
CLJ:  I don't know that we are more compassionate, but I do believe that euthanasia for animals is an appropriate means by which to alleviate suffering when there is no longer hope or there are other circumstances which prevent owners from being able to provide needed care. Do I wish this option were available for people? No. I think, as Ira Byock would say, the argument should not be miserable/painful death vs. euthanasia, but rather miserable/painful death vs. comfortable death. Greater utilization of hospice and palliative care, and better death education for people would make a huge difference.

Readers, what has been your experience with pet death?  Have you ever found it equally or maybe more painful than a human death?

I have very little experience with human death, but I've lost five beloved animals in my life.  When I had to "put down" my twenty-year old cat Spooky, I vowed to never adopt another animal because their deaths were too painful.  I'd had that cat for half of my life.  But, I got over that and now I've welcomed Violet and Judy into my home.

On Monday, Jennifer Forbes talked about the death of her two children.  In our correspondence, she told me about an experience that occurred at her vet's office that she wasn't particularly proud of.  She had to put put down her 19 year old cat a few weeks after losing two of her children in an auto accident.  You can read about her experience here.