'I am an angel of death'

Death: It's what she does as a veterinarian. (Shutterstock)It's more than just euthanasia, and it's not just putting a pet to sleep. It's more than a 15-minute slot in the middle of an overbooked day. It's more than another sympathy card hastily signed because 20 other medical records demand attention. It's more than a sad “That's too bad,” and a brief hug with a “Hope the rest of your day is better.” It's more than the end of the life of a biological organism.

It's death. And it's what I do as a veterinarian.

My tuition-free degree in death

The loss of my grandmother, grandfather, uncle, mother, three jobs, one dog, two cats, two rabbits and two personal relationships within a four-year period by the age of 30 gave me a tuition-free degree in death, grief, depression and loss. I can't recall how I survived weaving through these things amid back-to-back appointments at a veterinary hospital.

I remember gripping the sink, breathing deeply as the little boy asked me where his best friend went and why I took him.

But I do have a recollection-many, actually-of stepping into the bathroom for a moment to wipe away tears. I can remember gripping the sink in the exam room, breathing deeply after the little boy asked me where his best friend went and why I took him. I can also remember leaning over the toilet, sick with bile boiling inside me, because I had to work the day after my mother died as I'd used my three bereavement days watching her die and was denied more.

I had to get it together. I had to walk into another room and smile. When I think of the enormity of what anything dying means, the inherent respect demanded from this process arises as a familiar lump in my throat.

Simplistically stated, dealing with death is hard. But you know what's always harder? Inducing the death. People don't know how we do it so often, because we don't know how we do it so often-at least I didn't. I did not process death respectfully. I did not exemplify my best all the time. I did not heal emotionally and mentally. Our veterinary peers, and often our superiors, say we're weak when we need some time to process our emotions after a humane euthanasia. I thought I was weak too.

The art of death

It's different for me now that I'm a veterinarian dedicated to hospice and end-of-life care. I've practiced and trained and worked to improve my bedside manner. Today, from the moment I receive notification of a euthanasia appointment and start to think about the family and pet ... to the moment I decide on the best cocktail of drugs ... to the moment I prepare myself, my appearance, my car and my emotional state ... to the moment I pull into the driveway ... to the moment I begin my purposeful walk toward a grief-stricken human being, bypassing their outstretched hand and providing the strong embrace they really need ... it all culminates in this: I am here, I see you, I see your pain.

Clients know that no one and nothing holds more importance than they do, than their sick pet does, right in that moment. I don't need to have been there for the past 10 years of that pet's life. I am here now.

Here's a list of ways I pay attention to every small detail in my home visits (which is also visually presented below):

• As I enter a home, I notice whether the pet owner has shoes on (if not, mine come off too).

• When I see the pet, I always say out loud how beautiful the cat or dog is-and I honestly see that beauty.

• In facing the pet for my visit, I put down my bag, get down on my knees and look into the animal's eyes.

• When it's time to speak and explain, I talk through the procedure and the pet's condition, and I validate the family members' feelings. I want to reaffirm their decision and tell them what I can and will do for them in our time together.

• When it's time to start, often the reclusive, dying dog or the painful and rigid cat will rise and come to me. I feel sometimes, when they do this, that pets are silently conveying their readiness to move on.

• As I speak, I am constantly sensitive to those around me. I listen patiently. I ask questions to learn what I need to help write a memorial. I ask for a check when the time is appropriate. I judge whether the family needs a joke or a prayer at any given moment.

• When I'm finished and the pet has moved on, I know I'm not done. I don't leave until the family is ready. I know sometimes, when I gently hold an old woman's hand, that she has lost the most important thing in the world to her, and when I walk out the door, she'll feel alone.

• When it's time, I bundle the pet in a blanket, carry it carefully out with me, place it gently beside me in the front seat and buckle it in. I know that pet's body matters. I show that to clients in the careful way I handle it. That's not always easy, depending on the pet. I lift weights and take boxing classes, because I'll be damned if I'm going to ask the man choking back tears to help me carry his dead dog to my car when he can barely rise from his knees.

• At the very end, I look into family members' eyes as I gently shut my car door and promise that no one, absolutely no one, will touch their pet but me after from that moment until I get where I need to go.

• After the visit, I'm still doing my job when I write the card, craft the right words for the memorial or customize the personal email. I clip the fur in every color from the pet's coat. I carefully take the paw print in plaster. I call to check in with the pet owner the next day. I call to let the family's veterinarian know how everything went.

In an ideal world, we'll all have time and space for the right euthanasia

I hope for a day when general practitioners have the time, space and support to provide pet-owning families with an exceptionally humane euthanasia experience and with the time and space to grieve right in the veterinary hospital. But until then, I am here, ready and willing to be the rainbow bridge between veterinarian and client.

I am determined to preserve memories with a nontraumatic passing. I am determined to support all the homeless pets out there by supporting the proper death of those already in a home, because the better I do my job, the easier it will be for a person to go out there and save another life.

It is a trite simplification to say I am good at death. But I am. And I am so glad I have chosen to place my value as a veterinarian in the art, skill and compassion of death as part of the field of hospice and palliative veterinary care.

Melanie Santspree, DVM, practices in Albany, New York, with the mobile euthanasia and hospice service Lap of Love.