Providing Comfort Takes More than a Pretty Room

Mary Gardner, DVM, Lap of Love, Yorba Linda, California

Providing Comfort Takes More than a Pretty Room

I recently gave a presentation on euthanasia at an emergency veterinary practice. Afterward, the team enthusiastically shuttled me down a hallway to see their recently created comfort room, which was off to the side of the practice and furnished with a large pleather couch, a dusty fake tree, and the requisite box of tissues. Unfortunately, I was quite underwhelmed.

Although having a comfort room is a nice gesture, a room alone cannot provide comfort. Even an expensive spa-like room does not guarantee the veterinary team is affording clients any comfort other than a soft seat. Providing comfort means helping to alleviate a client’s (or pet’s) feelings of grief or distress.

A peaceful, comfortable room in which the family can say goodbye does help, but many practices do not have enough space for a room dedicated to euthanasia.

However, lack of space need not be a problem. Treating clients and patients with the utmost care in every aspect is what is most important. Here are a few tips to enhance a euthanasia from start to finish—and none require a specific room. 

Compassion

A common concern for team members is that no one is sure how to behave with the pet owner or knows what behavior is appropriate.

The Phone Call

Within seconds, it is usually obvious that the client is calling to make this dreaded appointment. Express compassion instantly.

  • Get the pet’s name and use it.
  • Do not put the client on hold. This is one time another caller can wait.
  • Tell the client you are sorry (eg, I know this is a difficult decision, and I am so sorry you have to say goodbye to Rusty soon—he has been a lucky boy to be part of your family).

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The Appointment

You may have 20 appointments that day, but this appointment is the most important for the family, and they should believe the team feels the same way. Slow down, take your time, and really be present in the moment. Try not to automatically discuss the process; instead, first listen to client’s concerns and grief points, repeat back some things they say, support their decision, and try to remove any guilt they may feel. Ask the family what makes the pet so special or what they will miss most. When you are truly a part of the appointment, the family will feel your compassion and support, which is invaluable during this time.

  • Showing emotion: Crying is okay if you feel the need, as long as you remain in control and do not outdo the client. I once heard an appropriate quote on the show Downton Abbey: “A lack of compassion can be as vulgar as an excess of tears.”
  • Hugging: I hug everyone, but I know that can make some people squirm. If I am not sure clients want a hug, I ask for one—May I have a hug?—which gives the client the feeling he or she is doing something for me.
  • Touching: Gently touching the client’s shoulder or elbow or giving a 2-handed handshake can express kindness and compassion without invading personal space.

Comfort

Here are some of my favorite expressions of care to comfort the client.

  • Suggest the family make the appointment special by doing the following:
    • Bringing the pet’s favorite food or treats, if he or she has an appetite—even if that means pizza. Why not feed the pet’s last meal at the practice?
    • Bringing the pet’s favorite toy or blanket so he or she can smell the things that bring comfort. Most crematories will cremate pets with a toy or blanket, and families are comforted knowing their best friend has a bit of home.
  • Roll out the red carpet! Most medium and large dogs have mobility issues at this stage, so lay out a special yoga mat—or several—so the pet can reach the room without slipping.
  • Make the room comfortable.
    • Dim the lights.
    • Ensure all team members know what is happening so they keep their voices low.
    • Turn on some battery-operated candles.
    • Place a large, fluffy, nonslip bathmat on the floor or table for the pet to lie on.
    • Make sure soft tissues are handy and wastebaskets are visible.
    • Offer clients bottles of water.
    • Spritz the room with pheromones or lavender, which help with calming.
    • Offer clients a memorial item. (See Figure 1.)
Many clients appreciate a memorial item such as a paw print impressed on air-dry clay. Photo courtesy of Mary Gardner, DVM
Many clients appreciate a memorial item such as a paw print impressed on air-dry clay. Photo courtesy of Mary Gardner, DVM

Figure 1 Many clients appreciate a memorial item such as a paw print impressed on air-dry clay. Photo courtesy of Mary Gardner, DVM

Figure 1 Many clients appreciate a memorial item such as a paw print impressed on air-dry clay. Photo courtesy of Mary Gardner, DVM

Peaceful Process

The actual euthanasia process is the make-or-break moment. Remember, the definition of comfort is to ease feelings of grief or distress,1 and both reach maximum levels at this point.

I cannot emphasize this enough: When beginning the process, do not remove the pet from his or her family if at all possible. According to a 2015 survey our practice performed, about 90% of the 400 practices that responded separate the pet and the family, which makes it worse for both. Even a short separation can feel like an eternity to the family and cause the pet undue stress. Simply removing a pet from the room to get the catheter in the vein is unnecessary and breaks the bond. Most pets at this stage are sick, aching, and distressed, and taking the pet to another treatment room and away from family is the furthest situation from comfort for the pet and the family.

Gently explain the euthanasia process to the family to set their expectations and answer any questions they may have. Learning about the peacefulness of the process and knowing sedation will make their pet calm and comfortable beforehand puts clients at ease. Many clients do not understand the euthanasia process and assume their pet is given a heart attack, so educating them that the second medication is simply an overdose of anesthesia will greatly decrease their stress level. 

In my experience, honesty—without going into every small detail about every possible reaction—is the best policy. Prepare owners for the following side effects.

  • The patient will relax his bladder afterward, and because his eyelids are also a muscle, they will be relaxed and not tightly closed.
  • Other reactions may occur during the process (eg, stretching, changes in breathing patterns, the dreaded agonal breath) and should be explained only if and when they occur (eg, That is simply the diaphragm contracting and pushing the remaining air out of his lungs). (See Resource.)

A Peaceful Euthanasia

Following are more suggestions to ensure a peaceful euthanasia.

Sedation

  • For the benefit of the pet, the family, and the veterinary team, properly sedating pets before the euthanasia is highly recommended. Giving the pet a cocktail SQ or IM in front of the client will calm and relax the pet before placing the catheter, whether butterfly or indwelling. Seeing the pet relaxing or snoozing before saying goodbye makes everyone feel better.

Administration

  • A peripheral vein is not always amenable, so become comfortable with all AVMA-approved administration routes. I use intrahepatic, intraperitoneal, or intrarenal routes if a leg vein cannot be used. (See Resource.)

Afterward

  • Give a memorial item to clients before they leave. I have found clients react with big smiles when they are given a paw print impressed on air-dry clay. (See Figure 1.) Do not do special things only for clients who choose a private cremation—just because a client does not want the pet’s ashes does not mean he or she would not appreciate a paw impression.

Follow up

  • Call the family the day after the appointment because this is when they most need to hear from the veterinarian. Offer a simple and compassionate message (eg, This is Dr. Gardner. I wanted to let you know that I am thinking about you today. Please do not hesitate to call if you need anything at all).

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Conclusion

The entire veterinary team should work to make the euthanasia appointment relaxed, peaceful, dignified, and—dare I say—good. The most gorgeous comfort room in the world will not ensure a comfortable experience if the basics (ie, the way team members communicate and move, the way they handle the pet, the way the client feels after the appointment) are ignored. Euthanasia means “a good death,” and the veterinary team’s duty is to do everything possible to deliver on that promise.

1 Educate the team that their attitude and behavior is what ensures a peaceful euthanasia experience for the client and the pet, not a room with fancy furniture.

2 Learn to read the client’s nonverbal cues (eg, whether he or she wants to be hugged or touched) and how to send nonverbal messages of understanding to the client.

3 Ensure veterinarians are familiar with all AVMA-approved administration routes for performing euthanasia.

References

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