Dr. Amir Shanan was recently featured on WGN!
Ways to nurture our pets at the end of life
By Amy Souza
Kramer, a black poodle/terrier mix with warm brown eyes, has silky black ears and a slightly tousled tuft of hair above his triangular face that makes him resemble his Seinfeldnamesake. He has lived with Frank and Carol Miller for eight of his nine years,ever since the couple adopted him from a local shelter. To an outsider, Kramer appears healthy and vibrant, as a dog his age should. But the Millers see what a stranger cannot: slight stubble on his chin and thinning back hair caused by chemotherapy, and a slight thickening around the waist from taking prednisone.
Last September, during a routine dental cleaning, Kramer’s vet discovered a mass on the dog’s tongue. The news was dire. Though pathologists were unable to pinpoint exactly what type of tumor Kramer has, they know it’s an aggressive immune-cell cancer. Because of the tumor’s location, radiation was not an option, but vets estimated that with surgery and chemotherapy, Kramer could live for one more year. The Millers were told not to expect a cure.
Seven months and many treatments later, it’s unclear whether their beloved pet will make it to another September. Whatever happens, the Millers are determined to do everything they can to keep Kramer healthy, happy and by their sides for as long as possible. So, they are taking his care into their own hands.
In a small room bordering the sitting area of their Maryland home, near a small refrigerator holding Kramer’s medications, Carol maintains a calendar to keep track of Kramer’s treatments. She has filled in each day of the month: “C” for chemo; “P” for prednisone; and “1,” “2” or “3” for the particular homeopathic remedy he is to receive that day. The drugs keep Kramer’s tumor in check, minimizing his discomfort and allowing him to eat.
What is veterinary hospice?
Veterinary hospice has existed for more than a decade, but it is far from mainstream. That appears to be changing, however, asmore and more practitioners begin to focus on end-of-life care and discover a huge demand for their services. It’s not surprising: An increasing number of people with pets are willing to give subcutaneous fluids or learn how to inject pain medication, especially if it means a few more months, weeks or days with their pets. Dr. Liz Palmer of Charlottesville, Virginia, opened a mobile end-of-life care practice a year and a half ago. Though she has never marketed her services, Palmer has an extensive clientlist.
After a local newspaper published an article about her business, she received more phone calls than she could handle. Other hospice providers report similar experiences; when people read or hear about their services, they receive an influx of calls.”There’s a Catch-22 right now, and that is we don’t have very many people who see themselves as providers in this area, and there are a lot of potential users of animal hospice who have no idea that it exists,” says Dr. Amir Shanan, who has offered veterinary hospice for more than 10 years in his Chicago general practice. “Pet owners don’t ask about hospice services, and veterinarians don’t offer information because, they say, pet owners aren’t asking about it.” Part of the reason is that neither general-practice vets nor the general public know exactly how to define pet hospice.
The confusion stems, in part, from the term itself, because “hospice” also refers to a standard of care provided to dying humans. Pet hospice takes many forms, however: a couple like the Millers tending to their dying pet, veterinarians who travel to people’s homes, or even a physical location where animals live out their final days. In the broadest sense, hospice is a philosophy of caring for a dying animal in a loving, appropriate manner, while also supporting the pet’s family. Many people agree that the best place for a pet to die is at home, surrounded by familiar sights and smells and the people who love them.
Veterinarians focused on hospice or end-of-life care aim to make the time before death comfortable for animals by teaching people how to administer medications and fluids, and helping them decide when euthanasia is warranted. During more than 25 years as a general practitioner, Palmer says she never had time to dealwith end-of-life care properly. “I was so focused on treating disease, spay/neuter and primary care,” she says. “When I was trying to figure out what I was doing [with this new business], I was trying to find a word for it. It’s care in the end of life, but I also consider it ending life. I’m involved in the dying process.” During an initial visit, Palmer conducts a thorough exam, particularly to detect pain, but she believes it’s equally important to assess an animal’s environment. “I really pay attention to how much an animal has to struggle to get through daily life. I like to go to homes, to sit on the couch and observe. I like to see the obstacles a pet faces and give the owners the ‘What are you going to do if …’ scenarios,” Palmer says. “I look at the quality of life of the owner, too. I don’t want the relationship to be a frustrating burden.
That’s not good for the animal or the human.” Making tough choicesAs animal guardians, we must make choices for our pets, but on the whole, the veterinary profession -while excellent at offering medically oriented solutions -is not well equipped to help people make end-of-life decisions. These decisions are fraught with emotions and bring up all sorts of practical, ethical and existential questions. What value do we place on life? Does that extend to animals as well as humans? What constitutes suffering? How do we know when euthanasia is warranted?
The Argus Institute at Colorado State University’s veterinary teaching hospital has on-site counselors who are available around the clock to assist people facing difficult medical decisions about their pets. Dr. Jane Shaw directs the institute and teaches veterinary communication at the school. Students often ask her what to do if someone doesn?t want to euthanize a pet. “We ask questions of the client and can discover whatever barriers are there,” Shaw says. “There’s a subset of clients, mostly because of spiritual reasons, for whom euthanasia is not an option.
For other people who desire a natural death for their pet, we walk them through what that death might look like. In many disease conditions, the death is not peaceful, and we have to have pretty frank conversations about that. Euthanasia is a controlled process and, done appropriately, is peaceful. Natural death is completely unknown, and that makes some vets uncomfortable. They’re worried about the animal’s welfare and the client’s welfare.” In non-emergency cases, quality-of-life scales can help people evaluate their animals.
One widely used scale,created by oncologist Dr. Alice Villalobos, asks people to rate their pet from 1 to 10 in six areas: hurt, hunger, hydration, happiness, mobility, and more good days than bad. “Every member of the family should do the scale separately, because there’s always one person who has blinders on,” Villalobos says. Dr. Nancy Ruffing, a mobile hospice veterinarian in Pittsburgh, Pennsylvania, supplements Villalobos’s scale with a handout containing her own words of wisdom about end-of-life decisions. “A lot of people don’t want to make it a numerical decision,” she says. Yet, assessing a pet’s quality of life is crucial, and she considers it a big part of her job. “Owners have to have some type of a mental plan for what to do at the end of life, but you have to look at your pet critically when they’re having a good day so you can recognize the subtle differences on a bad day,” Ruffing says. “You really have to be in tune with your pet, and that starts at the beginning.”
To end life or let life end?
Gail Pope, founder of BrightHaven, a residential hospice on 10 acres in Santa Rosa, California, believes strongly in letting an animal’s life play out to the very end. It’s a stance she arrived at slowly. For many years, Pope worked at a conventional veterinary officeand was schooled in conventional practices, including the idea that euthanasia constituted a normal end to an animal’s life. She and her husband started BrightHaven in 1996 with the simple goal of caring for elderly and infirm animals.
When one of theirresident cats, Mariah, began showing signs that she was about to die, Pope panicked. She was alone and couldn’t leave the other animals, so she called a vet to come euthanize the cat -a notion that now makes Pope shake her head. “It’s the old thought of ‘She’s dying, hurry up, let’s kill her.'” Her veterinarian promised to send someone out during the lunch hour, and in the meantime Pope phoned a friend and animal communicator who instructed her to carry Mariah outside to an oak tree and sit with her in her arms. “I was terrified. I didn’t know what was going to happen,” she says.
Pope remained agitated, but Mariah was calm. The cat died quietly in Pope’s lap. She says, “My friend told me, ‘Mother Nature designed this,’ and that has stuck with me to this day.” Over the next few years, as Pope moved toward administering alternative medicine, such as homeopathy, and feeding animals a natural diet, she saw amazing things happen. Animals came to BrightHaven to die, but more and more of them instead grew healthier and livelier. Now, she says, her cats routinely live into their 20s. Though Pope is not opposed to euthanasia in cases when she feels it is absolutely warranted, her philosophy and practice are to allow for natural death with few to no drugs other than natural remedies.
Euthanasia is often employed too quickly, she says, and in an effort to relieve suffering, people actually may be ending their animals’ lives prematurely. Pope’s position is atypical in the pet hospice community but it is shared bysome, including Kathryn Marocchino of Nikki Hospice Foundation for Pets in Vallejo, California. Marocchino thinks that in many instances, people would rather not euthanize an ill animal, but they’re not presented with any other option, such as hospice care. “There is intense debate in the community around what is hospice for animals,” says Marocchino, who helped organize a pet hospice symposium in 2008.
“Hospice to vets means, ‘I will do everything to help you, but I have a quality of life scale, and when the dog reaches a certain number, it’s time for euthanasia.'” At the symposium, Marocchino says only two veterinarians in attendance had ever witnessed the natural death of an animal. This fact suggests to her that euthanasia is used too frequently andtoo readily by veterinarians. “They’re not giving death a chance,” Marocchino says. “Euthanasia should be a last resort.” The majority of people working in pet hospice, however, do believe that euthanasia is a necessary -and humane -tool. Some of themworry that the larger veterinary community, and the general public, will misinterpret the term “pet hospice,” believing that death without euthanasia is a fundamental tenet.
“Hospice is not about replacement of euthanasia,” says Dr. Robin Downing, ownerof the Downing Center for Animal Pain Management in Windsor, Colorado. “In 23 years of practicing oncology, I have a fairly high conviction that the number of animals who die a natural death is few and far between. Most animals reach a point where they are actively in distress, and we have an obligation to let them leave while they still know who they are and who their family is. The only time a client has expressed regret to me is the regret that they waited too long.”
The subject of death prompts strong feelings in most humans, and there are no easy answers for doctors or people with pets when confronting an animal’s final days. As the veterinary hospice field grows, it is crucial that practitioners remain open to divergent opinions and values, says Shanan, who this year co-founded the International Association for Animal Hospice and Palliative Care. “We must humbly accept that the subjective experience of dying is a great mystery,” Shanan says. “Also, we are acting as proxy for the wishes of a patient who is not of our species. It is very easy to err no matter what guiding principle we choose to follow.”
Hoping for a miracle
A few weeks ago during a walk at a nearby lake, Kramer became short of breath and had to be carried home. The Millers made an appointment with the vet, who x-rayed the dog’s lungs to see if the cancer had spread there. (It hadn’t.) Two days later at the same lake, Kramer acted like his old self, chasing geese twice his size.
“Animals don’t know they’re dying,” Carol Miller says. “Toward the very end I think they might, but they don’t get anxious about it all the time like we do. Sometimes when I’m upset, he looks up at me like, ‘What’s wrong? What can I do for you to make you feel better?'”
Above all, the Millers don’t want Kramer to suffer. One form of chemo made him violently ill, and neither Frank nor Carol wants that to happen again. Their oncologists presented options for new treatments, and the Millers chose one that seems to be working.
“We are enjoying every precious day,” Carol says. “Kramer’s spirits are high.” But if the drugs lose effectiveness and his cancer spreads, they’ve decided to stopchemotherapy and continue herbal treatments and prednisone until Kramer’s body gives out or he indicates to them that it’s time to go. They still hope for a miracle, but the Millers are practical and know they must plan. They’ve contacted a mobile veterinarian, who, when the time comes, will perform euthanasia in their home.
Seattle Kennel Club – Dedicated to the sport and welfare of purebred dogs.
Vet Involvement Key to Success of Pet-Hospice Movement Ranny Green 2011 It’s a scenario we all dread and a sobering reminder that our pet’s stay with us is never long enough: Fido suddenly becomes very ill, or quits eating, or is in pain with each step he takes, or begins coughing and vomiting blood. You quickly call your veterinarian and rush him in for diagnosis and treatment. After a battery of tests and X-rays, the veterinarian either sends you home with a handful of medications until he/she receives the laboratory results the following day or refers you to a nearby emergency hospital in hopes of stabilizing the patient’s condition. And then the waiting begins. It seems like the longest 12 hours in your life until the phone rings the next day. Your optimism or glass-half-full outlook is suddenly crushed when the veterinarian says gently your dog is suffering from a terminal disease leaving it with only several weeks or possibly a few months to live. Tears begin streaming down your face, and moments later your once-smooth psychological landscape is converted into a rocky mix of shock and pain. It takes time – a few minutes, hours or even days, in some cases — to collect your thoughts, digest everything and then ask for your veterinarian’s suggestions on a course of action. Quality of life is the No. 1 priority for this valued family member, but how to maintain that is equally important.
Pet hospice has become a valuable option – 40 years after the modern human hospice became an alternative for terminally-ill patients dying in hospital intensive-care facilities. The No. 1 caveat, however: Only a small percentage of veterinarians embrace the concept. If the American Veterinary Medical Association national convention in Atlanta this summer is any indication, the door is slowly being nudged open. Several veterinarians, including Dr. Tina Ellenbogen, of Bothell, addressed large crowds there on cutting-edge hospice care and pain management and the need to incorporate these in their practices. For two decades Ellenbogen has championed hospice care in her profession and practice, and she left Atlanta feeling good about its future. ―Veterinary/animal hospice is here to stay. It’s a specialty on the rise, although it is not board-certified as yet. But with pain management becoming a specialty, hospice should follow,‖ she says. ―Conventional /traditional vets may not be embracing it yet, but they are seeing that clients know of it and want that option. Practitioners don’t have to incorporate it into their practice, but need to know those specialty practices and they can refer to those. They also need to recognize that they can incorporate the parts of hospice that interest them and refer the other parts.‖ Ellenbogen, who operates a mobile practice, is often called upon to offer euthanasia services for beloved family pets in owners’ homes, but chiefly focuses on assessing the patient’s health status in the home with the family so that all parties can discuss end-of-life options and comfort care. ―Clients’ feelings vary widely,‖ she says. ―The focus needs to be on orchestrating a peaceful, graceful goodbye without fear or regret. Some clients are well-prepared and some have a hard time letting go. This is no time for conflict or differences. I am in the home to provide comfort, relieve suffering and honor the pet.‖ Dr. Carrie LaJeunesse, a Southworth (Kitsap County) veterinarian and president of the Washington State Veterinary Medical Association, says the organization ―has always been progressive and open-minded. We recognize hospice as part and parcel of what veterinarians do. We obviously acknowledge that dying is a natural process and that we’re here to help the patients and their owners navigate that physically and emotionally. ―Because we are not trained to deal with psychological stress, we have our limits. Just like any other profession, some handle owner grief better than others. It’s incumbent on all of us to sit down with each grieving owner and ask what she or he needs beyond the medical care we offer. Then we must immediately find them the resources to deal with that.‖ In Atlanta, Dr. Tami Shearer, of Dillsboro, N.C., led two sessions, ―Quality of Life: Setting Up Hospice and Palliative Care Services in Small Animal Practice‖ and ―Quality of Life: Hospice and Palliative Care Protocols,‖ emphasizing that as pets are recognized as family members, owners seek medical care that more closely matches that offered to humans. Prompted by that demand, Shearer has developed a five-step protocol to guide veterinarians through a treatment mode: (1) Evaluation of the owners’ needs beliefs and goals for the pet. (2) Education about the disease process. (3) Development of a personalized plan for the pet and owner. (4) Application of hospice or palliative-care techniques. (5) Emotional support during the care process and after the death of the pet. After offering house-call services for years, Shearer founded the Pet Hospice and Education Center in Columbus, Ohio, in 2003. ―My long-term vision was, and still is, that no one should have to euthanize their pet because they can’t afford palliative care,‖ she emphasizes. One of the keys to the acceptance of pet-hospice in the mainstream veterinary community will be its emphasis in the curriculum of the nation’s 28 veterinary colleges. At this point only Colorado State University focuses on it to a limited degree. Gail Bishop, co-founder and co-faculty advisor of the CSU program, explains, ―Our curriculum does not include pet-hospice per se. We teach end-of-life issues and quality of life in many of our core classes, especially in the students’ junior and senior years. Those students who choose to volunteer with us receive pet-hospice education. But that is a small percentage.‖ Those volunteers visit homes of terminally ill patients in nearby Fort Collins and Loveland, Colo., on a schedule dictated by the referring practitioner. During the visit they provide pain control and physical comfort in addition to assisting with prescribed hydration and nutrition therapies. Following each visit, the volunteer case manager updates the referring veterinarian of the patient’s physiological status. Washington State University College of Veterinary Medicine offers ―comfort end-of-life‖ advice in some of its classes, particularly those relating to oncology
By Christine Fugate
Oprah.com | November 07, 2008
For many people, the death of their pet comes with many difficult decisions. Because each pet is different, as are his or her owners, options, feelings and coping mechanisms vary. Experts predict that over half the human population has a pet at home. The average life expectancy for pets is 15 to 16 years. Given these statistics, it’s safe to say that a great number of people will experience the death of a pet at least once in their lifetimes.
The relationship between humans and their pets is often described by psychologists as a simple one—free of the complications that people experience in dealing with each other and full of unconditional love. This can often make the grieving process more intense when a pet dies. A pet
is a constant companion, and facing its loss can be devastating. Angela, who is facing the impending death of her own cat, says: “Stones is my baby. I got her as a kitten and raised her right after I moved out of my parents’ house. She has lived my adult life with me, and this is, by
far the most ‘adult’ decision I’ve ever made. It’s terrible, and nowadays I can’t look at her without apologizing or crying.”
Dr. Amir Shanan, who runs the Compassionate Veterinary Care facility and is one of the country’s leading veterinarians on hospice practices, euthanasia and end-of-life conversations, urges grieving “pet parents,” as he calls them, to consider all the options. “We don’t have a lot of
control over the fact that we’re losing our pet,” Dr. Shanan explains. “We still have control over a lot of things, and having that control can make a really big difference in how we experience the grief.”
Dr. Shanan feels that working with a vet to explore options is the best course of action, such as providing pets with hospice care at home, acupuncture, and exploring holistic medicines to provide comfort to a pet with an illness. Dr. Shanan’s Lincoln Park practice offers humanfriendly
hospital rooms for ailing pets that require constant vet care. The individual rooms have sofas for pet parents to sleep on overnight to be near their pets. The grieving process during the end of a pet’s life is different for everyone, but it may include some of the complex emotions of the grief cycle, which are guilt, denial, anger and depression. Experts recommend speaking to others who understand pet loss and can provide support to pet parents.
In addition, many online sites have chat rooms and message boards for grieving pet owners to utilize. Dr. Shanan says that his practice receives many phone calls from grieving pet parents and his well-trained staff will stay on the phone as long as needed, even if there are clients in the
waiting room. “When you’re at a point as a pet parent and you have a decision that many people say is the most difficult in their life, being heard, being validated, the message they get from us is, of course, you’re sad,” Dr. Shanan says. “That alone gives the caller some strength that they didn’t have earlier.”
Memorializing a pet can be a healthy part of the grieving process. Dr. Shanan recommends reminiscing about the pet’s life with friends and family. Writing a letter to a pet may help clarify a pet parent’s grief. A framed photo or a photo album can help remind a pet parent of their pet.
Some people keep the ashes of their pets and bury them in a spot favored by their pet. Many pet owners wonder if they should get another pet, but can feel guilty about “replacing” their pet. Most animal lovers enjoy the pet relationship so much that they do adopt another pet
with they feel the time is right. Michelle says: “I knew I could adopt again because every pet has a distinct personality. My son and I waited about a year until we could handle young cats, and then we looked for months for the right cats for us.”
Losing a pet can be one of the most devastating things to happen to a pet owner. Sometimes the loss is sudden, but more often it is the result of an illness or condition that has worsened over time, facing the pet wonder with the difficult decision of whether to euthanize or let the animal
die naturally. The fact that it is difficult to gage how much a pet may be suffering makes the decision all the more difficult. Support and understanding are especially important to seek out.
For Angela, whose cat, Stones, has been a steadfast friend for nine years, life without her seems empty. “I can’t imagine waking through this door and not having her here.”
PAWS Chicago, www.pawschicago.org
Christina Fugate is a writer who hails from Chicago. This article was originally published in the
Fall/Winter 2008 issue of Angel Tales.
By Marilyn Soltis.
Arthritis and old age had taken their toll.At age 14, Ruff, an Airedale-shepherd mix, was in pain and could move only by dragging himself around on his front legs.The dog who loved to romp in the snow and play in the rain could no longer stand.Hearing Ruff whimpering late one night, Cathy Cortese left the warmth of her bed and spent the night ona sleeping mat next to the family pet. Her presence seemed to comfort him, she said; the dog became quiet and more relaxed.Ruff’s respite was short-lived, however.
The next morning, Cortese couldn’t get Ruff up at all and resorted to crafting a makeshiftsling out of a towel.Cortese and her teenage daughter, Cate, faced a tough decision: Was it time to end the life of the dog who had been such a loyal companion for the last decade?Cortese didn’t know what to do. Her veterinarian was in the hospital undergoing cardiac surgery. She called another veterinary office near her Jefferson Park home.”They told me there was a vet who would come to your house and he was just wonderful. When you think of life and death, you think of home,” says Cortese, who works for a group of doctors who perform home births.
“Ruff would have been very stressed out an(less than)ywhere else.”Acting on the advice she had been given, Cortese called Dr. Amir Shanan of Chicago Home Veterinary Care to perform a home euthanasia for Ruff.Shanan came over the next day and examined Ruff. Unfortunately there was little that could be done.
Cortese and Cate talked privately and made the decision to end Ruff’s suffering.As mother and daughter cried together, Shanan put a tourniquet around Ruff’s paw in preparation for an injection of sedatives that would help end Ruff’s life and his suffering.That moment was too much for Cate, who remembers bringing Ruff home from a shelter when she was 8 years old, remembers Ruff’s fondness for snow and rain,for sprawling on the furniture and insinuating himself onto her lap.
“No, I changed my mind,” said Cate, not quite ready to say goodbye to “the best dog I’ve ever had or will ever have.”Shanan undid the tourniquet; Cate and her mother talked again. Cate composed herself and agreed to go ahead. As Cate cradled Ruff’s head, Shanan began the injection.”I love you, Ruff,” Cate crooned as the gentle old dog closed his eyes for the last time. Mother, daughter and even the doctor shed tears as Ruff took his last breaths.
Cortese and Cate spent some final moments with Ruff before Shanan took him away for cremation.
Cortese and her daughter are among many pet owners who are seeking veterinarians to do home euthanasia for their pets, a service provided by a handfulof doctors in the Chicago area. Home is a less stressful environment for the animal, and many pet owners feel that it is an easier way for them to deal with their own grief.Mary Jane Wang reached that same decision over the objections of family members. When her miniature schnauzer, Heidi, could no longer stand, Wang knew it was time.
She didn’t want to leave Heidi alone at a veterinary clinic, so she also called Shanan to perform a home euthanasia.”He was very gentle. He sat with Heidi on the floor and told her how much everyone loved her. She hobbled over to him. He was so calm and gentle.
She didn’t whimper or flinch. I told her what a good girl she was, how much I loved her and how she would always be with me,” Wang says. Having the euthanasia done athome helped her with the ensuing grief.Shanan, who also runs Allen Animal Hospital in Broadview, says that more and more pet owners are expressing interest in having their pet euthanized at home.”The human-animal bond or pet-family bond, which I see, isa variant of the family relationship,” he says. “This has been grossly underrated by human health professionals when you compare the amount of resources that go to other sources.
Two-thirds of all households own pets. There aren’t that many marital households,” Shanan says.He disagrees with the popular belief that pets are substitute children.”Pets don’t replace other relationships. It is often pointed out that a pet’s love is unconditional. It is much simpler and less complex than relationships between humans. Because of this difference, grief over the loss of a pet may be felt more intensely.”But grieving over animals usually takes less time than with human relationships because the relationship is simpler.
You know what you’ve lost, and it hurts,” Shanan says.The grieving process can be even more difficult for people whose pets provided a link to another person, he says. For example, the pet may have belonged to a close friend or family member who has died. In the case of divorce, it can be a connection to someone who is no longer part of the household.A home euthanasia can take on various forms. Veterinarian Charron Bryant of the Escanaba Animal Hospital in Chicago says he sometimes participates in ceremonies, which have included candles and special garments.
A year ago he was asked to euthanize a samoyed that had suffered a long bout with cancer.”There were about 20 people at the house –kids, grandkids, friends and neighbors. The people were highly religious. The wife read a special poem while I gave the dog a sedative,” Bryant says.Still, “some pets give the impression they know,” he says.The procedure requires excellent technical skills. Bryant may spend up to an hour at the house. If the pet has good circulation, death takes about 60 seconds.
The final injection is preceded by a sedative to keep the pet calm.Sometimes an owner will decide at a critical juncture to let the animal die naturally, especially if the pet is not in pain. This was the decision reached by Roger Nash of the Hollywood Park area. The family dog, Shannon, a beagle mix, was experiencing kidney failure and was disoriented but wasn’t in pain.
After a home consultation and weighing the pros and cons of euthanasia, the family decided to let nature run its course. Shannon died anatural death at home shortly thereafter.
For many cats and their owners, home euthanasia is the least stressful option, according to Dr. Colleen Currigan of Cat Hospital of Chicago. “There is minimal or no restraint. It’s very humane, like dying in theirsleep. It is basically an overdose of anesthesia,” she says.She recalls a bittersweet experience with one cat that had not eaten for a week and was dying of cancer.
Overweight and with a history of enjoying his food, he received the injection, walked the15 feet to his food bowl, ate his last meal and died.”It made us laugh, and the owner felt better that the cat could eat before he died,” Currigan says.She agrees that home euthanasia can help the grieving process.”From that point on, the owner can grieve. If they bring the cat into the office, it can be very difficult to carry an empty carrier out into a waiting room full of healthy cats,” she says.Since Ruff’s euthanasia, Cortese and Cate have been dealing with their grief.”I’m still very glad I hadit done at home,” Cortese says. “Whenever I took any of my dogs to the vet, they turned to jelly. I think it was better for us and for him. The privacy of being at home is better than sitting in the waiting room. We were able to express our emotions in a more comfortable situation. I don’t think it would be that way in the doctor’s office. We still cry and remember Ruff, but I think it was the best thing.
“He had such a sweet personality. He was more like a puppy in his old age. He loved to leap in the snow during the winters,” she says. “I kept wondering if he could have made it through one more winter.”
DEBATING KIDS’ AND PETS’ PRESENCE
Dr. Mary Baukert of Companion Animal Acupuncture in Skokie and founder and coordinator of the Chicago Veterinary Medical Association Pet Loss Support Helpline says that the issue of children being present at a pet euthanasia should be carefully considered. What may be right for one 7-year-old may be inappropriate for another.”You cannot tell untruths, but you can be very selective in what you do choose to communicate. It may be more than the child can handle,” she says.
For example, you should avoid the term “put to sleep.” Baukert says it can lead to a fear of falling asleep for the child afterward as well as being difficult if the child ever has to face a surgery and undergo anesthesia where they are told they “will be put to sleep for a while.””Some people use the phrase `help to die.’ ” Baukert said. “With my own children, ages 5 and 7, when our pet was ill, they were not part of the decision.
We relayed to them that their pet was very sick and getting ready to die soon. They saw the pet before and after. They didn’t see the procedure,” she says.It is important to share feelings afterward and to be open about your feelings and talk about it.”They might be having nightmares and not sleeping and exhibiting difficult behavior,” she says.
The bottom line is to be cautious and talk it over with your vet.As far as other animals in the household are concerned, there are no scientific studies on the subject.”It boils down to the owner’s values and what they believe their pets feel. The argument goes both ways,” according to Dr. Amir Shanan of Chicago Home Veterinary Care. “There is concern that if they are present, the awareness of what is happening will traumatize them. On the other hand, if they do not participate, they could be left to wonder about the obscure disappearance of a creature that has been a close companion,” he says.
When asked what to do by pet owners, Shanan says his philosophy of letting people make their own decisions as often as possible also applies to pets.”My experience is that if you let companion pets follow their instincts, their behavior varies. Some stay completely away. Some snoop around anxiously and then leave. Some act out their usual attention mongering, ignoring the circumstances. Owners usually remove this type quickly.”
There are no laws requiring a veterinarian to take an animal after euthanasia. If the pet is taken, it is for cremation. A private cremation may cost about $120; ashes can be returned to the owner. A group cremation runs from $30 to $60. Charges for the euthanasia vary from doctor to doctor and can range from about $150 to $300.
FOR THE GRIEVING
Individuals coping with the loss of a beloved companion animal can call the Pet Loss Support Helpline at 630-603-3994. It is a free service sponsored by the Human-Animal Bond Committee of the Chicago Veterinary Medical Association. There is a recorded message, and most calls are returned between 7 and 9 p.m. Ninety percent of the calls are returned by veterinarians who are volunteers and experienced in how pet loss affects individuals. Other volunteers are people in the veterinary field.
By Dennis Rodkin
He couldn’t take care of himself anymore. For the year and a half since the doctors had diagnosed his hard-core diabetes, family members had been giving him insulin shots every day. The living room had come to look like a hospital ward, with his IV bag hanging over his head and his bed covered with disposable linens in case he lost control of his urine while sleeping. Two days before, he’d had his third and worst comalike episode, slipping away but never quite making it over the edge before coming back to a life that wasn’t really life anymore. He didn’t recognize anybody around him, couldn’t get out of bed or feed himself. To say nothing of chasing birds.
Time was clearly up for Tweety, a 13-year-old black-and-white cat who had lived most of his life with Rick Corso. One night last summer Corso realized that Tweety shouldn’t be forced to wait out another day.
But as much as Corso hated to watch Tweety suffer, he also dreaded taking the cat to a veterinarian’s office to be euthanized. “I had put an animal to sleep once before, and it was not an easy experience,” he says. “To be in a vet’s office where you’re not comfortable when you have all these very private feelings going on is bad enough, but you also get a feeling from the staff like, ‘Hey, who’s next on the assembly line? We’ll put your animal to sleep, then give the next one a booster shot, then clean a cat’s teeth.'”
Two days before, when Tweety had seemed to be going down for the last time, Corso’s regular vet had been unavailable, so he had taken the cat to see Dr. Amir Shanan at the Allen Animal Hospital in Broadview. During the exam Shanan explained that if Corso ever decided to help Tweety die, he would come to the house to do it, any time, day or night. Since January Shanan had made a couple of dozen house calls to euthanize dogs and cats in their homes, a setting he considers best for the animal and the owner.
Which is how Shanan, who runs both Allen and Chicago Home Veterinary Care, ended up driving from his house on the north side to Naperville at 10:30 one night. At almost midnight Shanan used a two-injection procedure that first sedated the cat–and allowed Corso and his wife, Michele, a few minutes to deal with the prospect of finally giving up Tweety–and then stopped his heart painlessly. Tweety died surrounded by the people, smells, and toys he had known best, and the Corsos got to cry and moan and generally handle the death the way any big loss ought to be handled: sloppily and unself-consciously.
“It was the best way for a cat to go, I’m sure, and for me it was more comfortable,” Corso says. “It gave me the opportunity to express my emotions without the stifling feeling of being in public. I’m not an extroverted, overly emotional person who would show my emotions in public, but I felt really sad and tearful. I was able to spend that time with myself and with my wife.”
Like Michigan’s notorious Dr. Jack Kevorkian, Shanan is a euthanasia entrepreneur who makes death easier for those whose lives have become unendurably painful. The difference is that Kevorkian is dealing with human life, something his critics evidently believe holds all its value even when it’s nearly drained away, while Shanan ends the lives of domestic animals–which are not nearly as sanctified. From his beat-up van to his black-comic paintings, Kevorkian seems to be saying we make way too big a deal about human death. Shanan goes the other way; he thinks we make too little a deal about pet deaths.
“We are talking about the death of a family member who is of a different species,” Shanan says. “One out of two households in this country has at least one dog or cat. Pet ownership is a more prevalent relationship than marriage, and it might be a relationship that breaks less often. The pet is an almost universal part of the family structure in our society, so obviously that relationship with a pet has more significance to us than just entertainment value.”
The end of the relationship, he figures, ought to resemble the relationship itself–a tender, mutually comforting good-bye instead of a clinical act. Since January, when he took out a Yellow Pages ad trumpeting “Euthanasia at Home,” Shanan has euthanized an average of one pet per week–usually for strangers who find him in the phone book. He’s not against veterinarians–he’s one of them, after all–but Shanan thinks veterinary medicine as it’s practiced today makes sensitivity to a client’s grief a too-costly distraction. Shanan recalls only one lecture on grief from his entire veterinary education at Michigan State University in the early 80s. “I’m sure those veterinarians who went to school in the 1950s, 60s, and 70s got even less than that,” he says. “It’s the atmosphere that was established early in the century, when animals were primarily fulfilling utilitarian functions–draft horses and livestock. It just wasn’t part of the formal material to worry about people’s feelings.”
Shanan believes that many veterinarians make time for compassion even though it’s a little like throwing bits of their income out the window. Even so his clients and others say the office setting is still stressful for the animal and the person. Susan Westbrook, who had a dog put to sleep at her regular vet’s office in Berwyn several years ago, says she can’t drive past the office without shuddering at her memories of the cold, sterile experience. This spring Westbrook called Shanan to euthanize another dog, an eight-year-old Doberman named Lady who hadn’t been able to walk for over six months. “I didn’t want my last memory of Lady to be of putting her up on a stainless-steel table to die,” Westbrook says. “If you’re a true animal lover, you treated your animal kindly its whole life; your last good-bye should be the same way. Lady loved us as her family, she gave us a lot of happiness, and I think we owed her that.” At the Anti-Cruelty Society the staff performs about 250 “owner-consent euthanasias” a month. Usually the owner is on hand to provide a familiar voice and touch–which many vets allow at in-
office euthanasia as well–but executive director Jane Stern says the clinical setting for an animal’s death ought to be the exception and not the rule. “No dog or cat wants to go into the vet’s office, even in good health.
Home is usually not a stressful place for an animal,” she says. “He sees all his familiar things around him and smells all his familiar smells, and it’s just like going to sleep.” For people who think death is icky, having a pet put to death at home may seem sort ofgruesome, but for several of Shanan’s clients it’s turned out to be the only way to go. They say they got to deal with their grief privately, they didn’t have to haul an already weak and miserable animal across town to a vet’s office or emergency clinic, and they felt real closure to the relationship afterward. So far Shanan has even had one repeat customer, Christine Staszkiewicz of River West. On June 1 Staszkiewicz had Shanan in to euthanize her six-year-old cat, Barney, and five days later she called him back to do the same for her 19-year-old poodle, Nikki. The cat had an ear problem that may have been cancer; it had recently spread into his jaw, which a surgeon wanted to remove for tests. The cat’s hearing and balance were ruined. “That wasn’t my catanymore,” she says. “He had always been vibrant and under your feet, and now he was just lying there unable to eat. I had to give him water through a syringe. It was too much for him.”
When her regular vet wasn’t in, she started thumbing through the phone book and found Shanan’s ad. A short time later Shanan injected Barney with a sedative and then a lethal, concentrated overdose of an anesthetic. “Dr. Shanan said, ‘He’s gone,’ and I said, ‘How do you know?’ He said there was no heartbeat, so I stood up and the cat was limp. That was it. Dr. Shanan stayed with me until the pet cemetery came to get the body. He had tears in his eyes, but he had never met me or my cat before that day.” Meanwhile Staszkiewicz’s dog had an attack, probably the stroke a vet had warned she was on the verge of.
A few days after Barney’s death Nikki began falling face forward onto the floor every so often. The dog had been on medications for 15 years, was blind from cataracts, and had to be carried outside at night to pee, but Staszkiewicz hadn’t been able to face what she had to do. Until Shanan euthanized Barney. Then she knew she could let go of Nikki the same way. “They lived here–let them die here,” she decided. After Shanan euthanized Nikki, Staszkiewicz borrowed his stethoscope to listen for a heartbeat. Hearing none, she cradled the corpse until the pet cemetery’s person showed up. Her fiance tried to console her by pointing out that the dog had led a good life. It wasn’t helping. Finally Shanan took the fiance aside and asked him to change tacks.
“If you emphasize that the animal led a good life, you’re really telling her, ‘You have nothing to be sad about,” Shanan said. “Your fiancee is in pain and she’s going to be for a while. Please don’t tell her she shouldn’t be sad.What you can do is let her understand that she has lost something important, that she has a valid reason for grieving, and then just be there for her.” A few minutes later the fiance, a Chicago police officer, took Shanan into another room and told the doctor, “You know, I wasn’t aware that I was saying something that was taking away from her right to be in pain.”
That, says Shanan, is the key: people have a right to be in pain when their pets die–either naturally or by euthanasia. “That animal has loved you unconditionally,” he says. “It’s a big loss, and very few people are ever prepared for it. We’re not even very well prepared for the death of a human loved one, because in our culture we don’t like to talk about it until it happens. Some people probably grieve more for an animal than for a spouse or relative, because the relationship was so simple–all love, no other problems tocomplicate it.” Shanan’s main interest is the human-animal bond. He follows the research of a California psychologist who studies the role of pets in child development. She has found that pets provide kids with the same unconditional love that grandparents can offer and are as entertaining and fun to be with as siblings. “At the same time they don’t have the negative sides with their pets,” he says. “No sibling rivalry, and grandparents can be very set in their ways, limiting the relationship.
So having a pet is almost like combining the best of a sibling and a grandparent.” Strangely enough, this comes from a man who grew up without pets. Growing up in Israel, Shanan didn’t even start hanging around with animals until he started working on a kibbutz, where he tended cattle and other livestock for four years. He loved nature and was interested in agriculture, so he majored in biology in college. He came to this country to attend the vet school at Michigan State, then moved to Chicago in 1985. Over the next decade as a practicing vet, he became increasingly interested in “the human-animal team that walks in the door of the vet’s office” and eventually figured out that many people with pets can’t stand the thought of putting them to sleep in a vet’s office. “Some people have thought a lot about it, but they look around and find there aren’t other options, so instead they put off the decision,” he says. Since first advertising his euthanasia program, Shanan has only rejected one potential client.
The caller’s wife had just had a baby, and he was worried that their five-or six-year-old cat would hurt the baby or otherwise get in the way. Euthanasia sounded like a solution to him, but not to Shanan. “I said, ‘I think there are other options for a cat that age–acat over ten might have trouble moving to a new home, but yours wouldn’t.’ He never called me back.” The clientele so far has been mostly childless couples, many of them gay. “What they all have in common is that their pets have been important members oftheir families,” Shanan says. To his surprise, nobody has asked for a memorial service, something he is eager to develop because he’d like to see if it helps people handle their grief. Most pay him to take the corpse to be cremated or buried, although some make their own arrangements. Backyard burial is illegal almost everywhere, so he hasn’t seen any of that.
There’ve been no priests, no incense, no pallbearers for dogs, no overdone floral arrangements–relatively little nuttiness. Just people dealing with loss the best they can. Better, maybe, than people who would rather not watch their parents or other relatives linger beyond hope but see no choice. “A lot of us who see pets being euthanized when their lives are over see the benefit of euthanasia,” says the Anti-Cruelty Society’s Stern. “Many of us here feel that we are lucky that we can do this for these animals, and we wish people had the same opportunity to decide.”