Hospice in Action
(article in Practice Life magazine, November 2015)
adequate preparation, time and support, in-home palliative medicine and care
makes the inconceivable acceptable to even the most loving pet owner
For the past three years,
Susan Gregersen's practice, Vets2Home - Peaceful
Pet Goodbyes has been pioneering end-of-life vet care for pets in the UK,
specialising in around the clock, in-home palliative medicine and euthanasia
services. Treating a terminal illness or life-limiting, incurable disease is
also known as (in-home) animal hospice care. Applying the philosophy of
animal hospice consists of creating a specialised care programme using
standardised medical knowledge, techniques and skill-sets to achieve
comfort-orientated patient care and help clients prepare and say goodbye.
I have personally assisted with
the final parting in more than 5,000 end-of-life cases. One of the most
difficult - but also one of my most classic and rewarding examples - was
helping devoted cat owner Emily Harold come to terms with what was, to her,
unthinkable: the impending loss of her cat, Flossie. Emily shared a very
special, strong bond with Flossie because she was the last shared connection to
Emily's recently deceased parents.
This case proved to
be a classic example of how using animal hospice can make a huge difference in
helping owners part with a very special companion by minimising the inevitable
repercussions and emotional trauma afterwards.
role started late one Sunday afternoon, just hours after the discharge of
12-year-old Flossie from her local referral and specialist GP practice. After
rigorous investigations - including specialist ultrasound examination, FNAs and
other diagnostics - she had been tentatively diagnosed with suspected
carcinomatosis or diffuse GI-lymphoma with large amounts of free abdominal
This news was
unexpected and a big blow to Emily, who had been pursuing a diagnosis and
effective treatment for Flossie's mounting complaints for six long, stressful
months. Her initial symptoms had been subtle, starting with increased
irritability, incontinence, soiling, intermittent vomiting, anorexia and -
later on - unexplained pyrexia and general lethargy. Emily had sought
veterinary advice at three different vets including a reputable homeopathic
vet, ending up at the second-opinion referral practice. All avenues had been
explored with multiple, less sinister causes being suggested along the way and
included trial treatment for a skin complaint, FAD, psychogenic over-grooming,
cystitis, IBD and so on. Nothing like this had been mentioned and now she was
suddenly dealing with the final blow of a suspected terminal diagnosis.
was in shock and denial, and despite her gentle nature she was very, very angry
when she called me that Sunday. She explained she felt she'd had to mobilise
all her strength to be able to insist on taking Flossie home, as the specialist
vet had given her only two impossible options: euthanasia or further invasive
investigations while staying in at the clinic. From a rational, medical
standpoint Flossie was still very ill, pyrexic and anorexic for the fourth
consecutive day, and the prognosis was grave.
After 25 minutes of
conversation, while I mostly listened and reassured Emily, I made a quality of
life/hospice appointment to see them all at home the next day.
I immediately found
Flossie to be a typical, delightfully feisty tortoiseshell feline who was also
very reserved and trusted only her 'mummy', so we had to approach her very
delicately. (This is the time when having been a mobile vet dealing with pets
in their home for 10 years or more comes in very handy!)
After listening to a
very upset Emily recount their journey together during those past months, I
prepared a personal hospice plan to support Flossie - who was still not eating.
This included a couple of injectables, because the
dispensed oral Metacam was impossible for Emily to
administer (as is the case for many clients with this type of determined
After these initial
injections of steroids, diuretics, vitamins and a smidgen of diazepam to
kick-start her non-existent appetite, Flossie miraculously - and almost
instantly - started eating again. According to a more than thrilled Emily,
Flossie was suddenly back to a version of her normal self that she had not
experienced for months and months - and all this was on the very day of my
the following four weeks we made sure Flossie was given mild diuretics and
potent oral pain relief three times daily (Gabapentin is a wonder drug in
animal hospice, despite it having to be compounded in the correct dose to suit
a small feline) concurrently with her regular steroid injection. Smart as only
a tortoiseshell can be, she had craftily learned to try to resist the now expected
injection but Emily's husband and my experienced nurse found creative ways
around this and she was given a much-needed boost upon first signs of decline.
Emily was very much in tune with her companion's needs and could always pick
Alongside this regime
of medication, we were always
available 24/7 for texting, emailing and calls to address every little niggling
worry or question Emily had along the way. It enabled Flossie and her loving
owner to enjoy an amazingly spritely four weeks together before the cat's
ascites meant her abdominal circumference was at such magnitude that her
comfort level was compromised. But this time Emily was ready, too.
until this point Flossie's appetite, interaction and overall quality of life -
according to our tailored client-scoring charts - had improved from day one
after entering active hospice care.
More importantly, the
return of the shared, daily joys of their strong bond without the overriding
worries of Flossie not eating or being in pain, signalled the concurrent
healing trajectory of Emily's (and her husband Peter's) emotional states.
It was the first time
I had ever closely watched the classic stages of grief (shock, denial,
anger/frustration, bargaining, depression, acceptance) being played out so overtly
and in an almost textbook-like way over the course of one single month.
By the time we had
reached the end of the long, four-week journey, Emily was so composed and
prepared that she was oozing nervous but poised dignity and strength. She was
able to support and hold Flossie against her chest, sitting in her bedroom, and
neither of them even realised when I, without any preparation necessary, slowly
administered the sedative dose which gently and gradually, over 10 minutes,
sent Flossy peacefully on her way to eternity.
seminal case beautifully sums up what animal hospice is all about: preparation,
protocols and ample time and support of both the patient and the family while
they are coming to terms with their impending loss. Quoting Emily on the first
anniversary of her loss, she says that this animal hospice-supported journey
'made the impossible possible'.
Bearing this in mind,
it is tempting to propose that the well-known acronym within our profession of
referring to euthanasia (e.g. 'a good death') as 'PTS' (Put To Sleep) should
instead stand for: Preparation, Time, Support.
pro-actively addressing these three factors concurrently are what, in my
experience, produce the best and most consistent outcomes for everyone
involved: the pet, the client, the vet and the whole practice team. The true,
but so far rather intangible, silent reward is a happy pet owner that returns
to your practice with their next adorable pet.