Veterinary caregiver bears brunt of euthanasia

In Dr. Brian Forsgren's proverbial list of duties, euthanasia ranks as the "greatest single responsibility" granted a practicing veterinarian.

"The mental anguish and stress that accompanies such a responsibilityis enormous," says Forsgren, former director of Cleveland's AnimalProtective League (APL), a humane shelter.

He adds, "The impact affects all aspects of the veterinary clinicfrom front-desk personnel to the veterinarian, the veterinary technicianand auxiliary staff. In humane societies and animal shelters the specterof euthanasia stress is virtually omnipresent."

And the emotional toll on shelters is only half the picture. Veterinarians,whether in shelters or private practice, bear the brunt of the pet owner'sdecision to euthanize, long after the grieving pet owner exits the clinic.

"The complexity of the decision process that takes place duringthe contemplation of such a step is not even imaginable to the non-veterinarian,"says Forsgren, now in private practice in Bay Village, Ohio.

Consequently, many veterinarians express feelings of consternation, guilt,even compassion fatigue.

Yet they believe that if the euthanasia is relieving an animal's suffering,it, on some level, numbs the caregiver's pain.

At APL, Forsgren would oversee numerous euthanasia procedures annually,based strictly on the animal's welfare. Now in private practice, Forsgrensays the dilemma rages on, where veterinarians must "play God,"understanding the animal's behavioral biology, prognosis and course of diseaseand the ability for "quality of life" given an animal's physicalstate.

He's not alone in this role.

Necessary evil

In all, 9.6 million animals are euthanized annually in the United States,according to the American Humane Association. While no data recognizes thenumber of animals euthanized in private practice, it is likely a fractionof those that are euthanized in shelters.

Yet the impact on private practitioners is strenuous.

To David Hammond, DVM, of Brunswick, Ohio, euthanasia is the best andworst procedure he performs, which amounts to five or six weekly most ofwhich are rarely convenience.

"I've left the room and locked myself in the office, especiallyafter (euthanizing) the ones you've nursed for years and years. It's emotionallydraining. You see them on the appointment schedule and you dread it thewhole time. Usually those are the ones that really need it," he says.

But there's a silver lining of sorts. "With most of the (cases)you do realize you're relieving suffering and that helps you through it,"he adds.

Understanding the client

Performing 77 euthanasia procedures annually, Dr. Greg Bogard of TomballVeterinary Clinic in Texas, has a newfound appreciation of the human-animalbond.

He explains, "People aren't necessarily always in the same kindof relationship with a pet as they are with people, and they think thatpet who doesn't criticize them loves them so intensely that they go througha lot before they get it all sorted out in their minds. I'm not well-trainedenough as a simple veterinarian to know what to do when you're dealing withpeople when their best friends are dying."

To Nancy Katz, DVM, of Upper Montclair, N.J., to begin to understandthe client's concerns about euthanasia, you must involve them.

"One thing that can be done to decrease a client's stress aboutthe procedure is letting them make as many decisions as possible and keepingthem informed," she says.

Apparently, the strategy, all things considered, has worked. Katz, whofollows euthanasia procedures with a phone call or sympathy card, is takenaback by the number of thank you cards she receives.

"I don't know if that's standard," she says. "But peopleare very appreciative of sensitivity when it comes to that issue."

Sometimes, however, sensitivity on the part of the client is misdirectedtoward the practitioner, recounts Dr. Sue Whitman, of Bloomington, Ind.

Combating criticism

Any emotional struggles tied to euthanasia that Whitman faces often stemfrom her being the target of an owner's grief process.

"I have had owners scream profanity at me because at 11 p.m., ittook me 30 minutes to get to my office to euthanize their cat, which wassuffering," she says. "Many owners need to blame someone for thatsuffering, and the veterinarian seems to be the closest target."

Yet understanding how pet owners grieve has enabled Whitman to proceedwith the daunting task. Instead of getting swallowed up in the attacks,Whitman says she's learned not to take cruel words from owners too personallyand attempts to forgive their outbursts.

As Whitman declines to perform "convenience" euthanasia, shedoesn't lose sleep at night if a client rants.

"Because my staff knows that I will never perform euthanasia ifother options or treatments exist, we are at peace with the decision, andactually feel that we are relieving suffering," she says.

Emotional release

Always personally affected, Bogard of Texas, says he can't imagine notsharing the strain and painful emotions of his clientele.

"If you're crying along with the client, there's nothing wrong withthat. What we can't do is make it any easier," says Bogard. "Whatwe try to do is just make sure they know the animal is not suffering andno one is going to criticize them for hard decisions they had to make."

"It needs more training than it gets. It's so macabre that we allshy away from it."

Katz, too, has been known to shed tears with longstanding clients, sometimeseven hug them. "I regularly cry with the patients," she says."I used to hold up around the client, but I find that I get a littlemore stilted because I'm concentrating so much on not showing emotion thatI think I sound a lot more removed. Clients tell me they appreciate it."

Others appreciate the client-friendly services of Dr. Maria Miller inTampa, Fla.

Special services

Miller, in the mobile veterinary care business for three years, is athome with her type of euthanasia service, brought to the clients' doorstep.

She says the service, which typically costs more than in-clinic euthanasia,has grown over the years, a sign clients value the option.

"It's actually easier for the pet owners because they don't haveto take the cat or dog into the veterinarian, which is nice for the animal,"says Miller, who performs up to 10 procedures a month.

Interestingly, Miller, who only euthanizes sick or dying animals, surmisesmore pet owners would consider the service if they knew it existed.

"I think most veterinarians don't let them know that there's somebodythat does this service, because they want to have the business for them,"she says.

Miller usually follows up by sending a sympathy bouquet of flowers tolongstanding clients, along with a card and a poem called "RainbowBridge."

Bottom line is that euthanasia procedures warrant proper handling. That'swhy when Katz moved into her new hospital, she made sure it was equippedwith a euthanasia room and several boxes of tissues.

"First of all, it's a separate place with a separate entry and exit,"Katz says. "When owners come in with another pet or new pet, they don'tcome back to the same room. It doesn't stir up feelings."

Veterinarians don't always have the luxury of a separate place to releasetheir emotions. Some turn to family, some seek solitude, others seek professionalcounsel.

Seeking external solace

Licensed psychologist Matt Zimmerman, MD, Ph.D., says he has often consultedveterinarians who struggled with euthanasia. Many times he says they'redealing with the same guilt as the general pet-owning public.

"You as a pet owner or the vet are responsible for the pet's welfarethroughout its life," he says. "So when the pet needs to be putdown, you also feel responsible for that. That contributes to a lot of guilt."

From interactions with veterinarians, Zimmerman has found they cope withstress in many fashions.

"There is a level of distance that is required, much like surgeonshave to employ. Sometimes people experience surgeons or vets as cold orcallous, but there is a certain element that is just about survival so thatthey can continue functioning in their profession."