Sunday, March 6, 2011

5 Things No One Ever Told You about Dying

     I have never met anyone who works closely with the dying who fears death and yet the general public has an intense fear. This fear is brought about by the unknowing - not knowing what it is like to die or see someone die and not knowing what happens after death. We generally do not know how we ourselves will die and many of us feel uncertain about what (and even if anything) happens after death. Our perceptions and beliefs about dying come largely from external sources whether that be the overly dramatic, sensationalized and inaccurate portrayals of death in the media or religious teaching. Very few of us witness natural death up close and even fewer still witness enough of death and dying to see patterns.

Photo courtesy of M. Kessler
     At New England Pet Hospice, we believe that knowledge is power.  Knowing what comes next helps us prepare and not be as fearful in the moment.  My goal in sharing these concepts with you is to let you know that what you may be seeing is a normal, natural part of dying. It is not a crisis. It is not a sign that your animal is suffering or that you are doing anything wrong. If we are lucky enough to have a long life and die naturally, it will all happen to us also.

    
     PLEASE NOTE: here we are talking only about natural, non-traumatic death.  We are not talking about animals who have suffered an accident, injury or curable illness.  Keep in mind that although these concepts are common, but not necessarily universal.  If you are disturbed by how your animal is acting or what he or she is doing, please talk to your veterinarian.  Individual animals may vary and may require additional or other care to keep them comfortable.

     For this post we are assuming that physical pain is well controlled by appropriate pain medications.  Pain should never be left uncontrolled.  As a hospice, we are committed to effective, consistent pain relief and control.

     1.  Natural death is often a slow, rarely dramatic process. Bodies shut down slowly, system by system. Bodies waste away. Minds appear to come and go. This process may take days, weeks or even months. It may seem interminable and it is quite normal to wish it would be over while at the same time wishing your time together would never end. Try not to feel guilty or disturbed by these conflicting feelings.

     2. As you go through the dying process, your world contracts. First perhaps to your immediate neighborhood, then to your home, then a room and finally a bed. We are all bedridden at some point in our final days. So are our animals. The fact that your elderly cat does not or cannot leave her bed is not a sign of a problem; it is a normal part of the dying process. In the final stages of death, our world contracts even more, to what is inside us. Our bodies themselves are more than we need. We recede to a quiet place inside to finish our business with this world. The fact that your dog no longer lifts his head and wags his tail when you enter the room is as normal as a 90 year old woman who in her final time spends much of it sleeping. It does not mean nothing important is happening; it means the work is internal.

     3.  We all lose control of our bladder and bowels at the end of life. We enter the world as infants without that control and we die that way as elders. The same is true for animals. They come into this world relieving themselves when the need occurs and exit it the same way. Just as we would not leave an infant or grandfather to sit in excrement, we must not do so with our animals. There are many outstanding products and methods for managing incontinence in our dying and elderly companions.

     4.  The dying do not need to eat.  A body at the end if life has no need for fuel. The digestive system is often one of the early systems to slow down. Appetite decreases, food loses appeal, and we fill up quickly. At the very end of life, we all stop eating and drinking also. Although hard for us to see, this is perfectly normal. As nurturers, we want to feed the ones we love; it is a natural instinct. Whether the patient is human or animal, we will often go to great lengths to get the dying to eat - preparing special foods, coaxing, begging, and even force feeding. Although loving, these attempts are often detrimental to our loved ones. When the digestive system slows or stops functioning, eating only causes gastrointestinal distress, which can be painful and disruptive. When your terminally ill loved one stops wanting to eat, let them stop. They will not starve to death, they will not have hunger, and they will not suffer.

Stella, by S. Kent
     5.  All bodies waste away at the end of life. Long before we stop eating, our GI tract stops absorbing food well.  The dying may perplex us by eating large amounts and yet still losing weight. This is because they are not absorbing the food. It simply goes right through them. If they want to eat and take pleasure in it, there is no harm, but do not be disturbed if they seem to waste away anyway. It can be quite disturbing to see a being at the end of life. They may look like no more than a skeleton covered in skin. With humans, if we ever see a person at this stage, they are usually covered with blankets or clothing and we are unlikely to appreciate the severity of their body condition. With an animal, the condition is right before your eyes every day. Others may even think you are mistreating, neglecting or abusing your animal. It is a good idea to get a letter from your veterinarian stating that the animal is in hospice/end of life care and is not being abused, but rather cared for lovingly and appropriately just in case anyone questions you. Know that even though your care is excellent, this process is common, normal and not distressing for the dying.



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22 comments:

  1. Thank you! Those two words sum up how I feel quite accurately. It is 6 years since my beloved Beta passed away. Even with the wonderful animals I have in my life now, nothing can replace him. While I knew I was doing all the right things for him at the end of his life, I still have guilt. Most of all, guilt that I selfishly may have let him live too long. Your article showed me that I did all of the right things and loved him unconditionally til the end. He was three months shy of turning 20, pretty good for a cat! The morning I woke up and I saw the look in his eyes, it was him telling me, "it's time." I still take him with me wherever I go, right here in my heart.

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  2. I have watched pets prepare for death, as well as humans.. it's a very sad yet helpful time for us as caregivers, companions and family. I am comforted by knowing what to expect with both humans and animals. Thank you for your insight into a companion's end of life. I have always thought that it's better to know what to expect than to be "surprised" at the end. We have had many pets and will continue to have. Death is a natural happening, even though we don't like to face it.

    Thank you again,
    Eileen
    Port St Lucie FL

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  3. I just found this blog thanks to a Facebook friend. I write a cat advice column and I get letters from many readers who are grieving the loss of animal companions or who don't know how to best cope with end-of-life issues with their cats. What a wonderful resource this is!

    I am very interested in doing pet hospice work, too, and this post has some great information for people dealing with the dying process.

    The most recent pet death in my family was Aki, our beautiful Akita-Samoyed cross dog, who lived for 15 wonderful years. I just happened to come back home on the day she was at the very end of her dying process; she was lying on the ground, not moving except for the occasional seizure-like twitch (which I've seen in other dying animals). My brother and sister-in-law had put blankets under her and over her with the intention of making her comfortable as she lived through her final hours.

    When I arrived, I sat next to her, giving her Reiki and telling her how much I loved her, how much her life had meant to me, and expressing my gratitude for her lifelong love and devotion. I was also able to sit with my nieces as they said goodbye to Aki and share some silent love and hugs with my brother, whose grief was silent but very intense.

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  4. Thank you for this article and all the comments. I experienced the above with my pug at 17.5 years whom I was determined to see through to the end and have felt selfish about it since. I also questioned the 'seizures' that came so far apart and read above, that that is normal. Thank you. I did keep trying to feed her and it seemed to be the catalyst that actually ended her life. But I know it was going to end anyway. I will not push it next time...She actually willingly ate some yogurt from a spoon and then collapsed for the last time.
    I do want to add that after her very last breath, in my arms, in our hammock, her face became more beautiful than it had ever been and I knew she was at peace and I am forever thankful that I was there to witness it.

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  5. Linda, Eileen, Jane and Mufasa,

    Thank you for sharing. Your words and stories truly touch us and we are grateful to know that we are able to provide some small amount of comfort or support to you.

    Each of you have has the wonderful gift of seeing a being through to the end, the closure and fulfillment that brings. It is hard, it is heart-wrenching, but it is deeply meaningful. We encourage you to share your stories and experiences; they may bring hope, insight and strength to others who need it desperately.

    - Heather

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  6. Linda,

    Your experience sounds beautiful. I have absolutely no doubt you lovingly cared for Beta and that you were able to see him through to the end was an incredible gift from you to him and him to you. Most people will never experience what you did. Beta left when he was ready to go. YOU gave him that opportunity and it is beautiful.

    Sometime when you can, I would suggest that you find a quiet time and place where you feel in touch with Beta in your heart, spirit, soul, or however else you think of him. Sit quietly. Breath in his love and breath out your guilt. Let it go. Free your heart. You are meant for better things than guilt and doubt.

    It is a terrible burden we put on families when we expect them to choose the "right" time of death for our animal companions. No one knows this. No one knows what work the animal is doing to prepare for death, whether the animal wants to die, what suffering may happen tomorrow, what spark of life may yet appear. In our view, our responsibility is to control pain; keep our animals safe, comfortable, clean; and, most of all, love them. Death will come in its own course and at the animal's "right" time.

    - Heather
    Founder and Team Leader
    New England Pet Hospice

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  7. Eileen,

    I could not agree with you more. Thank you for your support and sharing.

    - Heather
    Founder and Team Leader
    New England Pet Hospice

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  8. Jane,

    I could feel your love for Aki in your words and, even more so, in how you companioned with her through her death. I can only imagine how it must have touched you, your family and your outlook on life. We can all only hope for such a good death.

    We are very interested in the benefits of Reiki at the end of life and will be hosting an animal Reiki training class here in the spring. I will post more details in the next few weeks.

    Please feel free to share your URL so we and our readers can follow your column.

    - Heather
    Founder and Team Leader
    New England Pet Hospice

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  9. Mufasa,

    I hope your story inspires others on this journey. It is very hard, but so important. I can tell how much you loved your pug and all the ways you made her end of life experience a good one. May the love and peace you saw in her stay with you always.

    - Heather
    Founder and Team Leader
    New England Pet Hospice

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  10. Hi Heather,
    Thank you for posting this excellent article and the following comments. And thank you for reminding people to talk to their vets.
    My friend Murphy cat, who is close to 17, recently exhibited some of these behaviours. Due to his age and recent health issues we were preparing ourselves for his departure. We took him to the vet who discovered pancreatitis and put him on medication. After a week he is eating well, gaining weight and acting feisty with the girls.
    An important outcome of our experience is that we were able to talk about what is best for Murphy when the inevitable happens. Our vet knows we do not want to prolong his suffering for our own selfish reasons, nor do we want to put him through tests for no other reason than to have an explaination of what is going on. (Our vet tells us when tests would only verify her suspisions and not lead to any possible treatment.) We also know that our vet would expect to send him home with us to live out his days and will come to our house if we need assistance.
    Just as with our parents or spouses, the stress we are under during the end of a loved ones' life can make decisions difficult. We need to have these conversations so we are prepared (as much as we can be) when the time comes.

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  11. Excellent point, Kelly. The blog is never long enough to raise all of the caveats and of course it is very important to keep in close contact with your vet throughout the process to ensure that there is no untreated underlying problem, that pain is well controlled, and that you are doing everything medically possible to ease suffering.

    I also agree that it is important to talk to your vet about end of life issues before they arise. It is much better to know how your vet approaches these matters before they come up and you are filled with doubt, emotion and anxiety.

    The only thing I disagree with is the idea that anyone would keep an animal alive for "selfish" reasons. Provided pain is well controlled and you are able to care for your animal's needs (keeping clean, managing symptoms, providing attention and support, and the like), I don't believe it is selfish to allow death to occur naturally, in its own time. In fact, I believe it is a self-less act. Caring for any being at the end of life is a big burden, done selflessly out of love and respect. As animal lovers, we make the best decision we can at the time with our animal's interests and the realities of our lives at heart. Sometimes that means supported natural death, sometimes that means a period of palliative care, sometimes that means euthanasia.

    I, for one, would like to see the "selfish" concept eliminated from our discussion of end of life decisions for animals. It causes us to question ourselves, not trust our own inner wisdom and connection with our animals and instills guilt - none of which are productive or beneficial to our animals or ourselves. I choose to trust that you as an animal lover will make the right decision for your animal and your family given the information and resources available.

    - Heather
    Founder and Team Leader
    New England Pet Hospice

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  12. Heather,
    Perhaps the word selfish is too harsh. I am refering to the inability to let our friends go when the time comes, continuing to treat them with heroic efforts to prolong their lives which is not natural. I have seen this happen with animals and it is very common with people. That's why Hospice is so important.

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  13. My favorite line from this post: "Our bodies themselves are more than we need [as we reach the final stages of EOL]." It's clear you have much experience in hospice work. Thank you for writing this important post.

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  14. "Natural death is often a slow, rarely dramatic process." - With regard to this, some people get hospice services to take care and/or improve the remaining days of a patient.

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  15. Heather, I want to thank you for this outstanding post, and for sharing all the comments afterward. The information you are offering here to the public is so important for all of us to know. Our precious animals are so much better than we humans are at living in the moment, at aging gracefully and at dying with dignity and grace. We have so much to learn from them! Major kudos to you!

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  16. This is a little off track but I recently read a life-changing book about death. It's called "The Soul's Journey" by Michael Newton. Dr. Newton had been hypnotizing patients for years for issues like smoking, fear of heights, etc. But as he got into deep hypnosis he continued to hear the same stories about the death process, and then what happens to to soul after that. It's about humans, but it was so incredibly comforting and eye opening for me that I just have to share it with everyone I know. It will totally ease your fear of death and make you look at each person totally differently. Bless all pets living on earth and living in our hearts.

    Keep up the amazing work bring this community together, Heather.

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  17. We had last night some rather terrible hours as our beloved dog Gregory died at almost thirteen. The seizures and the dreadful breathing at times we had not anticipated, imagining him just quietly slipping away. At the very end he did, and we talked and stroked him as the breaths came more and more seldom.Now some of what I read above has helped, but I still feel we may have made a bad decision not to opt for euthanasia. Still, he was keen to be always with us, still wagging his tale, very aware of his world, up to four hours of his death.

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  18. Maragrete,

    I'm so sorry for your loss. You followed your heart and did the very best you could for Gregory, which is all anyone can ask. Please try to find peace in the fact that all you did, you did in love. I have no doubt that Gregory knew and appreciated that.

    One of the things we do when supporting a family through the final stages of their animal's life is coordinate with their veterinarian to make sure the family has "what-if" medications. Anti-convulsants, sedatives, strong pain medications are all good o have on hand to ease the symptoms if and when necessary. These medications are given not to hasten or postpone death, but rather to provide palliation and comfort. It is often hard to know what might be necessary, when to give it, and what to do, which is where hospice support can be so beneficial. It is our job to use our training and experience to think ahead and be sure the family has the tools available to manage whatever might arise and then to be available to them throughout the journey.

    Our heartfelt hope is that hospice care for animals will become the norm in the future and that more veterinarians and care providers will be able to support the families as they face these decisions and situations. It is almost always the case that we can provide a peaceful, pain-free passing if the right support and tools are available and accessible to the family.

    Our hearts and thoughts are with you as you process Gregory's death and mourn his loss. Be gentle and compassionate with yourself and each other.

    - Heather
    Founder and Director
    New England Pet Hospice, Inc.

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  19. As an animal chiropractor, I care for many elderly animals, and some even in their last few days. It is so hard to explain to their owners the process of dying and what they can expect to see and how it is best to care for them. What I do is very hands-on, and even gentle mobilizations and massage can do so much to relieve pain, comfort and sooth an animal in hospice care. But I find it very difficult to explain the other parts of palliative care to owners and how they can help their animal prepare. I would love to share these thoughts with them, as you explain it so well. I hope you do not mind.

    Dr. Angela Martin-King, Certified Human & Animal Chiropractor

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  20. Thank you, Angela, for your kind words. At New England Pet Hospice, we love chiropractic and find it very helpful in relieving pain and increasing mobility for our patients.

    Please feel free to share the blog post.

    You may also use the following link to direct people to the website where they may download the article in an easily printable form:

    www.bit.ly/NEPHLoss

    - Heather
    Founder and Director
    New England Pet Hospice, Inc.

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  21. My beloved cat Tigger died two days ago. He was about eight. He disappeared for two days. When he came back his face was terribly swollen. I immediately took him to the vet. He had a puncture on his ear through which some very nasty bacteria entered. It formed an abscess and caused cellulitis of his face. The vet gave him a powerful antibiotic. The next day he took a turn for the worse, just lying there and not moving at all. His breathing became labored. I called the vet and she said it sounded like he was dying. She wasn't in for a couple hours but said in the meantime I could take him to an emergency vet clinic. she said, though, that the bacteria was overwhelming the body and the end was probably near and they would likely suggest euthanasia. He went downhill so fast. Suddenly his breaths were as much as ten seconds apart and he was jerking his legs. Then he died. I kept looking at him and thinking I could see his rib cage moving. This isn't supposed to happen! I could have taken him to the emergency place. I think I hear his meow at the front door, then I realize it's the sound of kids at recess at the nearby elementary school. Seeing my little buddy die broke my heart. I hope his suffering was minimal.

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