More Lessons from Human Hospice

Courtesy of Ben Lakey

     Regular readers know that New England Pet Hospice came to life as a result of my (Heather's) work in the human hospice field and that human hospice guides all of our work at NEPH.  I continue to spend much time learning and studying the human hospice model and working within it.  Tonight, during my regular weekly shift at the (human) hospice residence, I notice a booklet called "When Death is Near: A Caregiver's Guide" -- a wonderful 22 page booklet used by many hospices around the country as a resource guide for caretakers.  It is written for human hospice, but what it states is directly applicable to our work in animal hospice - and contrary to the "common wisdom" about when and why to euthanize animals.

     1.  Withdrawal.  It is completely normal for beings to withdraw from the people and world around them as part of the dying process.  They may stay in bed and sleep more than be awake.  However, the dying can almost always hear you, take comfort in your words, presence and touch.



    2.  Appetite.  It is similarly normal for a being approaching the end of life to lose his or her appetite.  As the body slows down, the body can no longer process food and does not need it.  Weight loss is expected and does not mean the being is in discomfort.  Do not force feed or fluid.  Let the individual be your guide as to what he or she does or does not want.

     3.  Elimination.  Incontinence is common at the end of life and should not be a cause of shame or embarrassment.  Diapers, pads, creams and lotions can keep the individual clean, dry, and comfortable.

Courtesy of Jenny Downing

     4.  Breathing.  Breathing patterns often change, especially the closer you get to death.  Breathing may be shallow, rapid, and irregular.  Secretions in the throat can cause a "rattle" or gurgling noise.  Sometimes this indicates pain, agitation or distress and should always be evaluated by a medical professional.  Pain can almost always be well controlled, anxiety reduced and breathing eased with certain prescribed medications.

     5.  Changes in body temperature.  As the body declines, it loses the ability to regulate temperature and circulation decreases.  The animal may get hot or cold, seek warmth or cold, even at times when the temperature seems right to you.  Extremities may seem particularly cold or warm.   Follow their lead rather than assuming a temperature that is comfortable to you is comfortable for them.  Use warm blankets or cool cloths, but be particularly cautious about electric blankets, heating pads and ice as the dying are often more sensitive to temperature extremes and skin may be more easily damaged.

     6.  Confusion and Disorientation.  While it is true that some medications and some conditions may cause confusion and disorientation, it is also normal to have such symptoms as death approaches.  Discuss the symptoms and medications with your veterinarian.  Take appropriate actions to keep your animal safe and work with your animal to gently orientate him or her to the surroundings and situation.

     7.  Restlessness and Agitation.  Sometimes the decrease in circulation causes a decrease in oxygen to the brain which can result in restlessness or agitation.  Frequent licking or pawing, pacing, inability to get comfortable or to find a spot to rest are all common signs.  Restlessness and agitation can be signs of pain an discomfort ad should always be evaluated by your veterinarian.  If pain is not the issue, there are special medications are available to address agitation.  We find that soft music, soothing words, light touch, and some forms of complimentary medicine are useful during these periods.  Adjusting the number of visitors and sticking to a routine may provide security.

     8.  Surge of Energy.  Both humans and animals can appear to "rally" or have a surge of energy towards the end of life.  The animal may become alert and interactive after a long period of unresponsiveness, may have an increased appetite after not eating for days, or may become more playful, affectionate or vocal.  This can be both heartwarming and heartbreaking - often people think this is the sign of a miraculous cure or improvement, but most often the being has mustered all of his or her remaining energy for one last experience before death.  Make the most of this time.  It is a gift and usually brief.

     9.  Saying Goodbye.  Animals, just like people, need to know that they have had meaning in your life and that you give them permission to go.  Saying goodbye can be very hard, but also very meaningful to you both.  Saying goodbye, spending that time, granting permission, talking about what they have meant to you, does not hasten death but rather brings peace.  Don't be afraid to do it, even if it seems awkward, you are unsure what to say or you don't know when the perfect time is.

     We as animal caretakers have so much to learn from the human hospice world.  How many of these items have been on "the list" of signs to watch for in order to determine when is the time to euthanize?  (All of them.)  When we learn to understand and respect the normal dying process, we can appreciate the time we have with our animals, make meaning, share, be vulnerable, love, and mourn in the natural cycle of life. 

     We and our animals are more than our bodies, more than what we are able to do, more than the sum of what we can produce, and more than how we perform.  When we commit to caring for an animal through their natural death, we give ourselves the opportunity to connect with them on that level and in that place where the physical does not define the being.