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Saturday, November 23, 2019

Don't Forget To Put Your Heart Into EVERY Euthanasia.

Hello Erin,
As a veterinary practice owner I want to sincerely apologize for this. I cannot say that I know, or even remotely understand this?, but, I am sorry that you left feeling penalized and punished at one of the saddest moments of any pet parents life. If I can help I am here. Again, I am so sorry for your loss and frustration. Sincerely Krista.


Nashville
Starting a conversation with an apology is about as common for me as "hello." A few years ago there was an outpouring of articles all proclaiming how over used and detrimental apologies were especially passing from the lips of females. It was heavily marketed that apologies as a preamble masked submission, leading to shame, and that women in all places and positions, especially those in leadership positions, were being throttled to abandon.  I spent years pouring over these articles, catching myself constantly to pull those three little words back in each time they slipped out, while beating myself up for the deference apologizing for everything brought me.  And yet, I still apologize often. Way too often.

The opening paragraph above is a private message I left Erin, on Nextdoor.com just a few days ago. Sad as it is, it is true that I am so prolific in apologies I even send them to strangers. Stranger or not, with this apology I meant every word I was delivering.

Apologies fall like confetti daily in my veterinary life. I apologize for the small and insignificant just as much as I do the grand,, and everything in between. Failures of the staff, the facility, the limits of human abilities, the boundaries of my soul-sucking emotional requests, the anger every so often a person seems to need to explosively purge at the clinic, as they are, after all my responsibility and I take ownership of them even if they don't recognize them. For me, as a veterinarian, and especially the veterinary practice owner, there are a boat load of fully justifiable reasons to extend a word of apology as ubiquitously as raindrops.

"I'm sorry we were running late today. I appreciate your patience."

"I'm sorry that I don't have better news," always the case of providing some death sentence diagnosis to a parent unprepared for the bombshell I just provided.

"I'm sorry but we don't provide walk-in euthanasia services." (Cause ya know, everyone should be able to decide last minute that "it's time" without the assistance of a doctor to consult. Which always elicits hostile accusations of us "not caring that their pet is suffering!" Somehow that is our fault too. These are only pets we haven't seen in years, or, pets we have never seen. I always want to reply, "would you call your pediatrician and request; "Hey! my kids suffering, it's time for goodbye" and NOT expect to be questioned?). (where is that fire headed emoji?).

"I'm sorry but I cannot take the 4 kittens you just found in your backyard." (Personal note the clinic has 5 cats in need of homes presently, and, we used to take in kittens to help adopt to homes and in the last year 4 were "returned",,, what the &@*&!).

"I'm sorry but we don't have overnight staffing to keep your critically sick, eminently dying pet, you WILL have to go to the ER, or take them home." (people you cannot leave your pet here to die alone, right?).

"I'm sorry but your dog is so frightened by restraint we cannot safely hold them. We will need to reschedule another time when we can provide pre-examination sedation." Also usually met with incredulous judgmental angst, as if we were the party who failed to provide the conditioning needed to do a nail trim safely? Odd how so many clients know they cannot trim their own GSD's nails at home, and yet get angry that we can't either. Even more disturbing is how many people prefer the staff be injured as long as the nails can be trimmed, right now!.

As  you can see from the examples the apologies range from introductory opening statements to help shoulder the burden of the disappointment about to follow,, "I'm sorry, but, I can't..." To the "I'm sorry, but, I won't." To the most common; "I'm sorry for your loss." It is a Santa-sized sack of apologies to be plated and served daily.

They all work, even if their pallor and place varies so enormously. What other prelude would be appropriate?

But let's get back to my apology to the stranger, Erin.

Social media reaches into the tiniest corners of every community. It is undeniably powerful and in a matter of seconds a social media post can reach millions of people and cause lives to change irreversibly. If you own a business it can be the death of you. Literally.

I am a champion of social media. I have (albeit unforeseeable) found overnight notoriety through the power of an emotionally charged video that struck a nerve with not just me, but bitter burnt pet parents the world (although lets be honest, overwhelmingly just the USA). Instant fame has been found by many a social media post, some good, much otherwise.

One of the burgeoning eruptive social media sources of the last few years is Nextdoor.com. Nextdoor groups people based on location. There are multiple daily posts by my local community members  looking for advice on all sort of things, like services. For instance "nanny needed," a newly diagnosed patient in need of a need of "orthopedic surgeon recommendations for hip surgery," or, notifications like "hound dog loose" replete with photos, times, and pet descriptions. It has also been the place for bad services experiences to be vented publicly, back yard crier style. If you own a small community based business Nextdoor is a potential hotbed of agony.

Here is the original post from Erin, to whom all of my apologizing to a stranger was about;
"New Vet Wanted"
We had to put our sweet boy down last month... pancreatic cancer.  We spent a few thousand at XXX XXXX Animal Hospital during his treatment.  The day we Euthanized him.... our original quote was $330 which was euthanasia and private cremation.  Once they realized that we wanted to stay with our dog during euthanasia... they upped the charge to $390,  They actually charge $60 more for you to be present while your dog is being put to sleep!!!!  I have NEVER been more disgusted in my life.  Our receipt actually says “Euthanasia—owner present”.  Their prices are exorbitant almost extortion like.... I stayed with the practice while  our Nashville was being treated there but I will never use that practice again now that he is gone.  Looking for a reasonably priced, non price gouging bc of “ the neighborhood” compassionate veterinary practice.

In the very exhaustive list of things that you just don't do in veterinary medicine screwing up a euthanasia is at the top of my list. Think you can't possibly screw this up? Let me give you my resume of them.
1. You put the wrong tag on the wrong body. Yep, not requesting the proper cremation (say the parents wanted the ashes back and you didn't tag it appropriately. Yep! really really bad).
2. The process doesn't go smoothly. Yep! happens. Death is not an easy ask most often. Our bodies are wired to keep breathing, and beating no matter how much drugs you provide. Or, they gasp for air as their bodies fight to give up. Not the last impression you want a family to have.
3. It is a busy, frantic day at the clinic and you (hard as you try) cannot get into the family waiting for you to be calm, patient and generous, as you secretly worry about the pet you are trying to save from death next door. I often think we need to have "euthanasia only" hours to avoid the chaos our general practice life throws us into.
4. People are people. Some know what to expect and know you, so there is not so much chit-chat to exchange. Others think they know what they need for their pet and then lose it last minute. (I once had a parent start CPR on their dog as I was injecting the euthanasia solution).

If you mess up a euthanasia the 10 previous years of anything you ever did for that pet gets flushed. Along with that scar you leave on your (previous) clients heart goes the devastating word of mouth they will share with every loved one they know.

So to every well intentioned Fortune 500 seeking femme fatale out there attempting to ascend that ice sheer under that omnipresent glass ceiling i apologize for my prolific apologies. I woefully fear (apology again), that I have set us back a few centuries..

For my place in vet med empathy is about apologizing for fate that few can outwit and outplay. I cannot undue the fact that all of my patients will die. Many of them too soon despite the best of care, the most adoring of parents and the miracles of modern medicine, but, I can apologize for the failures of not being able to spare them the grief of loss. I never surrender anything here, just remind them that kindness comes in many forms and a bow clad apology is one.

Where did this  practice go so wrong? They forgot that giving an estimate over the phone sets you up for big problems. Every case is case based, and an estimate is "estimating." Although less is always met without fued, more is a set up for angry torches at your front door. I try very hard to not provide estimates. For the cases of pay in advance euthanasia services they pay up front (if they want to) and I eat the overages if it happens.. (avoid the torches whenever possible).

You also never forget, no matter how crazy busy the rest of the clinic is at the time, that these last few moments of a life you cared for matter just as much, maybe even more, than all of the rest. Stop, embrace, say you are sorry for their loss, and be empathetic!

Erin's response;
Wow... thank you so so so very much for such a kind and beautiful message.  I knew that I was paying exorbitant prices at XXXX during his treatment but I was committed to just staying with them till the end.  If I had known that would have happened, I would have switched earlier.  It’s shameful that it happened and they seemed to have lost touch with human and animal compassion and are just about money.  One person commented that it’s about staffing and that is why they charge extra but in my opinion when it’s an end of life situation, money should not play a part , only compassion.  What practice do you own?  Thank you again for taking the time in your busy schedule to reach out to me.  It is most appreciated and speaks volumes. 


Here is Erin's description of why the price was different because she was present;
My daughter called them after the fact and was told it was for the catheter that was placed.  Owner present.... catheter placed.  No owner present... no catheter placed.  I was a tech for 10 years.  The vet that I worked for never placed a catheter because it’s unnecessary.  You can give the dog an IM shot of Acepromazine.  That will take about 10 minutes to make them sleepy and gives the family private time to say goodbye and then the vet comes in and gives the final euthanasia injection.  I asked for sedation from the tech first who questioned my request then when the vet came in, I had to ask her again.  They were actually going to give a wide awake dog the euthanasia injection through the IV!  I had to ask the vet (a second time) for sedation.  She obliged but then gave him the sedation IV.  He went from wide awake to dropping like a sack of potatoes in front of my distraught family.  The vet then said “I’ll give you some time now”.  I looked at her and said “Well you might as well give him the final injection now”.  I feel like that peaceful 10 minutes to say goodbye to him was stolen from us.  I have called several hospitals (like 5 or 6) to discuss their euthanasia policies and all have said that charging for owner present is disgusting.  Some said placing a catheter is unnecessary, some said that they place a catheter but do an IM sedation injection first.  The whole situation was horrible and completely in poor taste.
If the reason they place a catheter is because they want to make sure they get the vein then why don’t they do it if you are not present for Euthanasia.  That says to me that they are more concerned about getting the vein while in front of the family and not for the sake of the dog.  If you are not present , no catheter is placed.  That says to me that it is not about the comfort of the dog but for the comfort of the vet trying to find a vein in front of the owners.  Plus , they still take your dog “in the back” to place the catheter... it should be done with the family present.  Going “in the back” is scary for the dog... they still have to shave him and stick him with a needle to place the catheter.  What if you could not afford that additional $60 but WANT to be present?  Is that an “oh well, sucks for you” situation??!!  And what happens to the dog?  Does a sick, scared dog go in a kennel until they have time to euthanize?  Do they just jam a needle with euthanasia solution into your wide awake dog?  I’m thoroughly disgusted.

As a practice owner I understand that time is money. BUT, as a human being driven by the love of a pet I would never think of performing a euthanasia in a different manner because the owner is present. Why would there be a difference in how you handle the euthanasia? I know the answer I know why most vets place a catheter before. I know why vets act one way in front of clients, and hence practice differently in front of clients, but, for me, there is no difference. You could be a fly on the wall of any part of my clinic and the treatment is the same. I will tell you that " I am sorry," and that you "were loved." In some cases it is an animal that was never granted "pet" or "owned" status, but that doesn't mean they weren't loved, if only by me, for that moment in time we were together. How do you work for? Me, its the pets, my patients, 24/7/365.

Here is the story that Erin wanted me to share.
This was sent to me today.  I teared up.   😢 Pls excuse the cuss words...

How your vet sees euthanasia.....
So, you bring me this puppy - she kisses my face, devours the cookies I offer, and our friendship starts. 
Several visits later, he starts to learn where all the cookie jars are in the clinic, and that lady in the white coat, well she’s okay....
Fast forward many visits later, now I am in love with your dog and your whole family because, well, you are just really really good people and I have not only watched that pup turn into a really sweet family member, but I got to watch the kids grow every year and be a very small part of your journey. 
Remember that time she ate your teenage daughter’s thong underwear?  😝😝😝 yeah we all had a good laugh over that once surgery was done and she was recovered. Your daughter probably never forgave me for bagging that up and showing the whole fam-jam when they came to pick her up from the clinic. 
So many adventures, so little time.....
And here we are, fifteen or so odd years later, having to say goodbye. 
He’s got heart disease and I can’t fix it anymore. She’s got cancer and there is no cure.  He has arthritis and the meds just aren’t working.  I want her to live forever for you. I want that so badly it hurts.  I feel like I have failed him and you when I have run out of options to keep them, and you, comfortable and happy.  
So now it’s time, and I am supposed to be professional.  Objective. I am the doctor. Calm. Cool. Collected. Always under control. 
*&$# that. 
I have known you and her for a third of my life, and most of my professional career. 
But I keep it together.  My superhuman amazing technicians have put the catheter in. My support staff from reception to assistants have done all the paperwork. Trust me they may not show it but their hearts are breaking for you. They have been there.  They know. And they know you and care about you too. 
And I have the needle in the pocket of my white coat. The same pocket that was always full of treats for him.  I take a deep yoga breath and come into the room. Gotta stay strong now.......
She’s giving me that sweet look she always does, the one that is followed by puppy kisses and a glance at the cookie jar.  But she is too weak now. She is ready. You are not. I am not. But this shit has to happen because we love her too much to let her suffer.
She would keep going as long as we asked her too.  But we can’t ask her to anymore. It’s not fair to her.  I wish our human hearts could be so giving all the time. I wish I could be the person my dog thinks I am. I wish I wish i wish I could find a way for them to live forever.  But I don’t have those magical powers. I am just a vet. 
So we kiss him back, not much left of his body that still works, but that old tail wags, just enough that I lose my shit on the inside but I try not to cry.  Gotta stay strong. 
Her body relaxes, she is in your arms and your are sobbing.  Another family has lost one of its most cherished members. I put my stethoscope to her heart to make sure it has stopped but she is held so tight to your chest that maybe that is your heart I hear pounding or maybe it’s mine and all the blood rushing through my ears as I try so so so hard not to turn into a blubbering mess. 
Confirmed, he has passed. You lay him gently on the table and we hug tightly as you go to leave. 
The door closes behind you and I don’t know if you hear this, but I sob hysterically into your pets ear.  She is gone, he will be missed, and you have to face what I know will be one of the hardest parts of today. 
Entering that house and they are not there to greet you. 
Please know that I know how you feel. As you leave the clinic I just wish with every fibre of my being that you never had to face that.  I wish they could live forever. 
And please know, I am so grateful that I was a small part of your journey.
Love always,   Your vet.

We all want to be this veterinarian. It costs us something to be her. Vulnerable, fragile, and emotional. It is not a big ask, but, remember in the same breathe, at the same moment for one person that we are expected to be this person, in the next room over there is a person with a cat they say they only feed, "it's not theirs" who has a very treatable condition and wants you to treat for free because if you don't "you're a cold hearted bitch." Do you know which one you are supposed to be for which room? There are many reasons the suicide rate in medicine is what it is.

This blog is dedicated to Nashville,,, and Erin.


Erin's story and Nashville's photos are posted with her permission.


Why Women Apologize and Should Stop, NY Times.

It's Time for Women To Stop Apologizing So Much

Suicides Among Veterinarians Becoming A Growing Problem. Washington Post

Taking A Stand And Facing Consequences. What Would You Do If You Were Asked To Euthanize A Pet You Didn't Believe Was Ready to Die? How often do you think it happens? I know most vets euthanize anytime asked. Why? Because if you dont you get labeled as "uncaring."

Compassion Fatigue. Lessons on avoiding the lure of veterinary suicide.

More on Jarrettsville Veterinary Center here.. JVC is a place where compassion comes first. Compassion towards our patients is paramount. We are kind, generous, and never allow financial constraints to dictate access to care.

If you would like to know more about the topics I discuss here please find me on Pawbly.com. It is free to use and open to everyone who loves pets. Pawbly.com is designed to help educate, inform and inspire pet people everywhere. We have just added our "storylines" section to help people share their own pets experiences and to help others learn from them. Please also consider joining if you have experiences to share and pet support to lend.

If you would like to learn more about me at the clinic please visit our Facebook page at Jarrettsville Vet.
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