“We were taught to live, not to die. So the death of a patient is a failure to me.” “If they die, then I ask myself, ‘What else could I have done to help them?'” “I don’t like to tell relatives that the patient died, so I let someone else do it.”
These statements from doctors, collected in a study on the impact of death and bereavement on health care teams, are also ours. As a veterinary surgeon in a clinic, we have to talk to the animals’ carers about the evolution of incurable diseases and the dying process.
This article will not deal with how to emotionally manage the process of death and bereavement. We covered that extensively in the article “How to cope with the death of your patients and reduce Compassion Fatigue“. We will instead focus on how best to manage these emotionally sensitive circumstances, both in terms of communication with the client and the environment it takes place in.
Good death and grief management by the veterinary team will be the last memory the owner will have of their pet’s life.
It’s up to you to take the wheel in these situations to make the experience as painless, less traumatic and more empathetic as possible.
By doing so, you will generate a feeling of loyalty, a sense of dignity for the patient, professional and personal renown as a sensitive doctor or vet tech, and a job well done for the whole team.
How to make a difference in grief management
When communicating bad news, different persons may receive it differently, depending on how they perceive the problem, the degree and depth of information they need, and how they interpret the information we’re presenting to them. The type of responses they give you may also vary greatly.
Because these factors themselves are highly variable, as a practitioner you should try to control the ones that are within your control: the environment, non-verbal language, the presence of third parties, the verbal message and the emotions implicit in the communication.
Choose the right environment for delivering bad news
- Find a private, comfortable place with maximum silence.
- Make sure there won’t be any interruptions and that you’ll have enough time to talk.
- Privacy and the prioritisation of the moment will always be welcome.
The importance of non-verbal language
- Address the caregiver by looking them in the eye.
- Sit close to them (and to the patient).
- Adopt a receptive and friendly body language Do not cross your legs or arms, and avoid fidgeting with your pen or stethoscope.
- Also avoid physical barriers such as tables or counters.
- Some gestures of affection may be culturally acceptable and necessary, but you must first learn to read the situation and the type of client you’re communicating with.
How to deliver the message in the most empathetic way
Before communicating bad news about a patient, consider the following points, bearing in mind that warmth, respect, ethics and empathy are the keys to conveying the message.
- Find out what background information about the animal’s condition your listener has.
- Create a statement to prepare them for the fact that you’re not necessarily conveying good news.
- Choose your words proactively, directly, carefully, without using euphemisms or complicated medical jargon.
- Adapt your pace to the other person’s speed of understanding.
- It’s important not to spiral into negativity. Adding something positive in your speech or simply a positive objective fact, such as good pain management or some of the patient’s symptomatology despite the poor prognosis, will help the owner know that their animal is being cared for and suffering as little as possible.
- Interpret the person’s emotional reaction and allow full and free expression of their feelings, giving them space and privacy if necessary. Adapt your speech based on the person’s reaction.
- Give the owner space to ask questions and clarify doubts, with enough time to express themselves freely.
- Finally, summarise the information conveyed and what has been agreed upon verbally and in writing.
The special case of euthanasia
Managing euthanasia in the least painful way administratively
Once the decision has been taken, in addition to the obligatory signing of an authorisation for euthanasia, it is advisable to agree in advance on the methods of cremation and the treatment of the remains.
If deemed appropriate, prepayment will allow the client to leave directly and guarantee their right to privacy after saying goodbye to their companion. If prepayment might create an uncomfortable situation for the guardian, the reception team should proceed with the arrangements in a sensitive, private and expeditious manner to streamline the check-out process.
The euthanasia setting
The comfort of the patient and their human family should be your priority. Ideally, there should be a dedicated space for these procedures and all the formalities.
- If this isn’t possible, the euthanasia room should have a clean, comfortable bed for the patient, seating for family members, water and Kleenex available.
- Remove needles, vials, syringes and any “threatening” material from sight that may be associated with the clinical act and if this isn’t possible, keep them covered with a surgical cloth, for example.
- Cover intravenous lines after they are placed so that they are not visible. Immediately dispose of any leftover material discreetly in their containers.
Managing the euthanasia procedure with families
Encourage the caregivers to accompany their animal. (Needless to say how important this is for your patient!). Before starting the procedure, explain what is going to happen in a clear, calm and empathetic way, without going into technical details. Explain what you are going to administer, and for what purpose, and what can be expected from the animal’s physiological reaction.
Do not rush the moment of injection. Let the caregiver choose the right moment, always striving for maximum comfort, relaxation and well-being for the patient.
During and after the procedure, make sure to generate as much privacy and emotional comfort as possible in the room, with as few staff members as possible, to promote an atmosphere the family can express their feelings in. If the family wishes, allow them some time alone to say goodbye to their pet.
Cover the body afterwards with a clean blanket and do not prepare it for cremation until the family has physically left the centre.
A few days after the procedure, call the family, send flowers or a postcard with a note signed by the people on the team members the pet has had the most contact with. These are gestures that show great empathy, help to close the cycle of grief and generate loyalty to the centre.
Good management at the moment of death and bereavement generates gratitude and connection with the centre in all clients.
Learning to master emotional intelligence techniques to deal with these situations is a delicate balance of sensitivity, ethics and discipline. Not only will it allow you to create the necessary distance to avoid suffering from the mental patterns associated with Compassion Fatigue, but it will also build client loyalty and prevent bad reviews due to negative experiences at such a delicate time.
References
- Death, Mourning and their effect on health teams. Carmona Barrios, Z.E; Bracho de López, C.E. Revista de Salud Pública, 2 (2): 14-23, dic: 2008
- AVA . Grief and loss. In https://www.ava.com.au/member-services/vethealth/grief-and-loss/
- AVMA. Guidelines for the euthanasia of animals. In https://www.avma.org/resources-tools/avma-policies/avma-guidelines-euthanasia-animals
- Cleary, Michelle, Sancia West, Deependra K. Thapa, Mark Westman, Kristina Vesk, and Rachel Kornhaber. “Grieving the Loss of a Pet: A Qualitative Systematic Review.” Death Studies 0, no. 0 (April 21, 2021): 1–12.
