Lessons from Hospice: Nurture the Soul

     Our work at New England Pet Hospice teaches us something new every day. I consider open-mindedness and open-heartedness the most critical character traits for all of our staff members, no matter what role they play in the organization.

     This work and what it teaches us is a gift; we must be open to receive it, open to learn from it, and open to share it.

Elderly and Special Needs - You Call that Hospice?

     At New England Pet Hospice, we care for elderly and special needs animals as well as those who have a terminal diagnosis.  This is one of the few areas we differ from the human hospice model.  In human hospice, the patient must be diagnosed with a terminal illness with less than 6 months to live (some hospices accept patients with a 12 month prognosis).

     Why the different standard?

     Because of euthanasia. It is widely accepted that the vast majority of pets in our country will be put to sleep (except for those who die of traumatic injury). This has a direct impact on our elderly and special needs animals in many ways, but especially in three ways:

    1.  Quality of Life.   The Quality of Life scales used to judge when a terminally ill animal is ready for euthanasia are equally applied to our animals who are elderly or have special needs. And all of our elderly and special needs animals will "fail" that test at some point (or points) in their life, almost always within a year and often within a few months.  While some families may have the knowledge and muster the strength to carry on without support, many - or perhaps even most - will not.

Death is Not a Dirty Word

     For as long as we have records, people have been afraid of dying – partly because we didn’t have good pain strategies and partly because many feared the unknown or their own beliefs about what comes after death. 

     But it has only been in the last 100 years that the dying process itself  has become so foreign and invisible to us that the unknown about the dying process causes us so much fear and anxiety.

     Less than 100 years ago 80% of all people died in their own homes, the average life expectancy was 50 years and the infant mortality rate was 24 times higher than today: more than 16% of children died before their first birthday.  People may not have liked it, but they were very familiar with death and the dying process.  Parents knew the anguish of losing a child; children witnessed the decline and death not only of grandparents, but also of siblings and parents; and the primary caretakers through illness and death were close family members in the home.

     Today, almost 70% of people die in institutions (hospitals and nursing homes) and the average life expectancy is close to 80 years.  We do not witness or participate in the dying process often in our lifetimes.

     Dying has become a mystery to us and the rituals we once had of washing the body, preparing for burial and the burial itself have been transferred into the hands of strangers.

     In addition, medicine has come so far that we expect it to prevent death, stop the aging process and keep us eternally happy, healthy, comfortable and young.  Aging and death are seen as failures of the medical community and our own will.

     Death has become a dirty word.

     We are awkward around the dying and bereaved.  We don’t know what to do or say.  We avoid witnessing dying and prefer that others do not discuss it.

     But we are making a big mistake.

     Death comes to all of us and everyone we know and love at some point.  Our ostrich approach to dying benefits no one, least of all ourselves and our children.

     Those who have witnessed the peaceful  death of a loved one – human or animal – are  universally transformed in any number of ways, almost always in a positive way.  Most feel a deeper and stronger connection to the one who has passed, a reduction in anxiety about dying ourselves, an appreciation of the beauty and gift that is our own lives and the lives of those we love, and a peace within.

     There are times when it is not possible to care for your loved ones at home, and some occasions where there is a need to be in a hospital, but there are many times when there is a choice whether to care for our own at home, allow others to care for them somewhere else, or hide from death altogether by ignoring the situation.  In the animal world, we are also often faced with the choice of euthanasia.

    Not every situation allows for hospice-assisted natural death at home, but if the opportunity were there, would you have the courage to try?  Would you be able to overcome your fear of death and isolation from the dying process to take that leap of faith?  Could you trust yourself, your knowledge, your skills, your instincts, and most of all your compassion enough to be that loving family caretaker?

     We think you can.  We believe in you.  And we know, no matter what comes,  you will never regret trying.

     Death is not a dirty word.  Take that leap of faith.

A Funny Thing Happened in Oregon...

     Oregon is the only state in our nation that has legalized Physician Assisted Suicide.  On September 27, 1997, Oregon's legislature enacted the Death with Dignity Act which allows patients to self-administer a lethal dose of prescription medication, prescribed for that purpose by a physician.  The person must be at least 18 years old, suffering from a terminal illness and informed of the opportunity for palliative and hospice care as well as counseling.  Being elderly or having special needs does not qualify unless also combined with a terminal illness.  Two doctors must agree on the diagnosis and there is a 15 day waiting period between the written request and the prescription.

     I cannot count the number of times people have said, "If I had X,Y, Z Disease, I would want to die rather than suffer to the end" and "I am so grateful we are able to give the gift of euthanasia to our animals and can't believe we don't have the same right for people."

     But here is the interesting thing, according to the most recent statistics available (for the period from 1998-2010), after thirteen years only 525 people in total  had in fact used the Act to commit suicide.  In 2010, there were 65 deaths under the Act, representing 20.9 deaths under the Act per 10,000 deaths -- or 0.00209%.

     The most recent comprehensive report issued by the Oregon Department of Human Services (2005) indicates that in the first 8 years the Act had been in effect, a total of 246 people committed suicide under the Act as compared to 76,947  people who died in the same period of the same underlying diseases.  In other words, only 0.003% of people who could have elected assisted suicide chose to do so.

     This does not surprise me.  Those of us working in hospice see people dying every day who suffer in innumerable ways, lose the autonomy and dignity that are most often cited as the reasons for electing assisted suicide, and yet fight to stay alive as long as possible.  It's easy to say, and easy to believe, that we would want to die in that situation, but the reality is that when it happens most people do not.  The vast majority want to live.

     So what does this have to do with animal hospice?  

     I live in a state where physician assisted suicide is not legal for humans and euthanasia is expected for animals.  A perplexing situation for many.  If euthanasia is the most compassionate choice for our animals, shouldn't it also be true for our human family members?  If assisted suicide is morally wrong for humans, why is it the kindest gift for our animals who do not have the ability to express an opinion or make a choice?  Is there something fundamentally different about a dying animal and a dying human?  If so, what is it?  Is it a qualitative difference or a quantitative one?

     Although I am a big believer in our ability to sense  what our animals need and want, we do not have the ability to ask them what they want and have them respond in clear words for all to understand.  Research in the last 10 years has shown, however, that animals perceive and experience pain in very similar ways as humans do.  The leading thinkers in animal pain management today tell us to expect that anything which would cause us pain or discomfort will similarly cause pain and discomfort in our animals.

     Is it such a leap to suggest that if most people want to live as long as possible, most animals do also?  That if the vast majority of people given the opportunity to elect painless, simple, legal euthanasia when facing a terminal illness do not choose it, perhaps some (many? most?) animals would prefer to die in their own time, in their own home, with their pain controlled and their family at their side?

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.

Allowing Our Animals to Teach Us the Value of Vulnerabiliy

     Dr. Brene Brown, a researcher professor at the University of Houston Graduate School of Social Work, has spent her career researching what makes us joyful and fulfilled - and what doesn't.  After listening to her TEDx talk about the power of vulnerability, I was inspired and knew I couldn't miss her session at the Massachusetts Conference for Women last week -- and she didn't disappoint.

     One of my key take-away points from both her TEDx talk and meeting her last week was this: Vulnerability matters; it is the only way to experience true joy.  Our ability to be vulnerable and tolerate vulnerability opens our heart to true joy, gives creativity life, and grants us courage.

     Sharing our lives with animals is a huge lesson in vulnerability.  We know from the outset that we will almost certainly outlive them.  That they will become sick, old, challenged and it will be us who must care for them and advocate for their welfare making excruciatingly difficult choices along the way.

Changing the Language of Euthanasia

     Somewhere along the line, euthanasia came to be discussed as "a gift" - the final gift, the most generous gift, the most compassionate gift, the ultimate gift.  This term has so worked its way into our language that we now accept the idea that this is something we not only can, but must do for our animals as loving, compassionate caretakers.

     On the other hand, some who wish for a hospice-assisted natural death at home view euthanasia as a failure on the part of themselves, their veterinary team, their hospice team or society in general.  They agonize over having made a euthanasia decision and feel crushed if they are unable to provide the kind of natural home death they envisioned or had experienced with another animal.

     We at New England Pet Hospice feel that such value-laden terms are not helpful and can actually be harmful.  Euthanasia is neither inherently "good" nor inherently "bad". 

Loving Care

     In our work, many people ask us why and how we can do this work.  To those who haven't spent much time around death - and in particular good death - this can seem perplexing, especially when we say we truly love what we are doing.

Beyond the Battlefield: What Soldiers Can Teach Us About Animal Hospice

     The Huffington Post is currently running a series of articles entitled “Beyond the Battlefield” by veteran war correspondent David Wood.  The series is about soldiers who have been catastrophically injured on the battlefield by IEDs (improvised explosive devices), some with multiple amputations, some with severe facial deformities, some with genital mutilation and extreme internal injuries, most who were not expected to live but were saved by the heroic efforts of military medics and surgeons.  On Thursday, Terry Gross interviewed David on NPR’s Fresh Air.  It was an incredible interview.  I highly recommend listening and reading the series.
  

     One of the things I found very interesting is the military’s new implementation of a family support program.  In the past, families have been left out of the rehabilitation process, but now are flown in to see their injured love one and participate in the rehabilitation.  Transportation, housing and childcare are provided.
  

      What are they finding?  Patients recover faster, families come together, hospital resources are more efficient, and patients do better in the long run.
  

     Perhaps without knowing it, the military has embraced a hospice model of care.  And found that it works.
  

     And yet, when soldiers go home, they face enormous hurdles.  Gone is the 24/7 attentive care, the multi-disciplinary approach, the world’s best specialists in dealing with catastrophic injury and trauma.  Gone is the financial support that enables the soldiers and their families to get the care and support they need.
  

     Many injuries don’t heal in a linear fashion.  Some get worse with time, some change, some nag with pain or incapacity to a point of becoming overwhelming.  Too often the solution is highly effective, highly addictive, and highly inadequate pain killers.
  

     But dull the physical pain, ignore the psychological, social and spiritual pain, and you have a recipe for misery, violence and suicide.
  

     David said that when he started his report, he was asking himself and others the extraordinarily hard and honest question, “If these guys are so badly wounded, wouldn't it be better if they died?”
  

     Then he met with hundreds of catastrophically injured soldiers at Walter Reed National Military Medical Center and asked these soldiers themselves.  Without exception, every one of them said, “Yes – I am glad they saved me.”  Make no mistake about it, their lives are forever changed, they will never fully “recover” from their injuries.  Their mobility, physical appearance, and ability to do many of the things they once did are severely affected.  Many suffer from ongoing pain, day to day struggles most of us cannot imagine, depression and post-traumatic stress disorder.
  

     And yet, at that time, when receiving wonderful support and care, every single one said they were glad to be alive.
  

     When David asked one of the trauma nurses at Walter Reed, “But what kind of quality of life will they have?” she chided him and said, “It’s not up to us to define their quality of life.  It's a very personal thing for them to decide.”
  

     In many, many ways, I agree with that sentiment.  But with it goes a community responsibility to support the patient and their family – in a hospice fashion.
  

     Over and over again, the soldiers and their loved ones say they felt ALONE, abandoned.  Doctors might tend to their physical injuries as best they could, but there was no help for their other needs.  They didn’t know where to turn.  When they asked for help, they didn’t get it.  Their enormous problems and needs were ignored, minimized or deemed too difficult or too expensive to treat.
  

     Over and over again, when **I** meet with families in our work at New England Pet Hospice.  I hear the very same thing.
  

     And when we offer our families hospice care – care that extends to the entire family, care that supports not only physical needs, but also psychological, social and spiritual needs – there is relief, there is power, there is a belief that this can be done and this is worthwhile.
  

     While our animal patients can’t tell you what they think and feel about all of this, I can tell you that when their needs are supported and their family is peaceful, the animals are peaceful, relaxed and grateful.
  

     Maybe what these incredible soldiers, these survivors are telling us can give us insight into our animals’ struggles.    Are you currently suffering in immeasurable ways?  Yes.  Is your suffering something we cannot fully control, no matter how much we want to do so and despite all of our efforts?  Yes.
  

     Would you rather be dead?  No.
  

     But we must not attend to the immediate crisis, deal only with the physical injury, then fail to be present and available for all the days that come.  We must not leave our families out on a limb with only pills and vague advice about how to manage physical injury and pain.  In the veterinary field, as well as the medical one, we must not diagnose a terminal prognosis or an unresolvable condition and then leave the families to struggle through the many ways this impacts the patient and all those around them.

     Veterinarians are heroes just like medics and surgeons.  Their skills and compassion are not in question.  But our animals and our families need and deserve more support than any one discipline can provide.

     Our animals and our families need and deserve hospice care.
  

     This is a journey.  It is powerful, it is fulfilling, it is incredibly important, and it may be the hardest thing you ever do.  Don't be afraid to ask for help and know that you, your animal and your family deserve it.

Death is Not a Dirty Word

 Sure, for as long as we have records, people have been afraid of dying – partly because we didn’t have good pain strategies but also because many feared the unknown or their own beliefs about what comes after death.  

It has only been in the last 100 years that the dying process itself has become so foreign and invisible to us that the unknown about the dying process causes us so much fear and anxiety.

Don't Delay - Seek Concurrent Care

     One of the main problems plaguing both human and animal hospice is that people wait too long to find us.  There is so much hospice can do to ease all types of suffering - from physical to psychological, to social and even spiritual.  Studies have shown that even just 4 days of hospice care can make a impact, but those of us working in hospice know that if we can have a few months with the family, we can make a huge difference in the level of care, comfort and peace for the patient and the entire family.

     Why do people wait?  Sometimes people don't know we exist (especially true for animal hospice), sometimes people think all we do is care for those in the active dying process, but often people are afraid.

Ditch the Plan

Is a nap in your plan?

     I recently spoke with a young man in the process of getting his MBA.  One of the things he had to do as part of his course work was not only to make a 5 year plan, but also a plan for his entire life.  Seriously.

     There are so many things caring for a being at the end of life and hospice work teach us, but one of them is this: ditch the plan and here's why.

Living, Suffering, Surviving and the Mystery of Dying

     I used to believe that dying was a linear, predictable process.  I used to believe that things get bad, then worse, then end.  Like many, I also used to dread death and think it was extraordinarily cruel that we are able to euthanize our animals, but have no ability to terminate the suffering of our human loved ones.

      And then I spent time - a lot of time - with death and dying, up close and personal, day in and day out.  I saw illness, disease and health ebb and flow; progress, plateau, improve and fade again.  I watched loved ones struggle, fight and beg for mercy and an end that did not come easily or readily.  My heart shattered and my mind disintegrated with helplessness and confusion.  My innate drive to help, to fix things, to make it all better, to nurture was infuriatingly stymied. 

      It was only after being with many who were dying that I have come to appreciate that the mystery of dying also brings beauty. 

Standing on the Side of Compassion

     Thank you to those of you who have shared your thoughts about and experiences with Angel's Gate, both here and privately.  It is a terribly sad situation whichever way it goes.  If the allegations are true, we will be saddened and outraged that animals are suffering.  If they are false, we will be disappointed to see animals being used as a tool to promote an agenda and a person's reputation trashed.  Many of you have asked if we know Susan personally or have visited Angel's Gate personally.  The answer is no to both.  We know of Angel's Gate and we know people who have visited personally and professionally. Like you, we despise seeing animals in pain and suffering and hope that objective investigation will find no abuse or mistreatment of any animal.

     At New England Pet Hospice, we stand firmly on the side of compassionate care for all animals, at all stages of life and health.  Our sole mission is to support families so that they may provide the most compassionate, loving care for their animals at times when that is difficult to do.  Caring for an elderly, special needs or terminally ill animal is hard work.  We exist solely for the purpose of enabling families to do what they feel is right for their animal at any given time.

     We are not a rescue, sanctuary or residential hospice.  We are not veterinarians, morticians or police.  We do not promote political agendas or specific religious beliefs.  We do not think there is only one correct way to care for an animal at the end of life.

     What we are is support, backup, assistance, facilitation.  We are a loving, available, knowledgeable companion on your animal's journey and yours, whatever that may be.

     We are vigilant in evaluating and controlling physical pain and other forms of suffering in the animals we help to care for.  We are relentless in investigating and evaluating all forms of pain control and the alleviation of suffering.  And we are determined to make the end of your animal's journey here on earth comfortable, peaceful and fulfilling - for both your animal and your family.

     We love our animals - and yours - as adored and respected members of our family.  

     Join us in pledging to do all we can to provide peaceful, pain-free lives for the animals who share our homes and our hearts and especially for those who are elderly, special needs or terminally ill.  

PETA's Attack on Susan Marino and Angel's Gate

     I am deeply saddened that I have to write this post at all, but failing to say anything would be condoning what is happening and also ignoring the elephant in the room.  Yesterday, PETA "broke" the story that Angel's Gate, rather than being one of the most respected animal hospices and sanctuaries in the country, is actually a front for horrific and inhumane treatment of animals by a woman who disregards their needs and suffering.  They have made horrible allegations, posted pictures and videos and complained to the authorities.

     Perhaps you have seen all or some of this.  Perhaps you are disturbed.  Perhaps you feel betrayed and disillusioned.  I ask you to please consider the following:

There Must be a Machine that Does This!

     Last night as I sat with my 7 year old daughter and our good friend putting New England Pet Hospice logo stickers on (some of the) 500 lollipops we will be giving away at the Whisker Walk on June 5th, I couldn't help thinking, "Surely there MUST be a machine that does this!"  Each of the three of us developed a different method for getting those little stickers lined up just right so the edges match up and create the perfect little "flag" on the end of the stick.  Let me tell you, it wasn't easy and there were plenty of "redos" for each of us.

     I thought my daughter would lose interest after the first few.  She didn't.  I thought my friend would laugh and abandon the project in 10 minutes (she came over for another reason, completely unsuspecting that we would put her to work).  But she didn't.

Preparing for Your Animal's Future: Social Aspects

     Yesterday we talked about how to prepare financially for your animal's future.  As we said then, even though it may not seem necessary now, unless you face a tragic unexpected accident, all animals will grow old and face illness.  You can take action now that will substantially improve your ability to function at that time - whenever it may come.  We hope it will not be until they have lived out a wonderful life with you and your family, but unfortunately young animals get sick and have accidents also.


     What do we mean by "social preparedness" and why does it matter? 

The Arizona Tragedy and Words of Wisdom from President Obama

     Our hearts go out to all those affected, whether directly or indirectly, by the shootings in Arizona.  We are grateful to President Obama for his inspiring words and ability to bring people together in times of crisis.  Our friend, Nadine M. Rosin, picked the following quote out of his speech last night and we thought it was perfect, not only for the tragedy in Arizona, but also the work we do here at New England Pet Hospice:

 ‎"We recognize our own mortality, 

and are reminded that in the fleeting time 

we have on this earth, 

what matters is not wealth, or status, or power, or fame — 

but rather, how well we have loved, 

and what small part we have played 

in bettering the lives of others." 

Our Mission - From the Words of Cicely Saunders

     Thank you to Dr. Ella Bittel for sharing this wonderful quote from Dame Cicely Saunders, the founder of the modern human hospice movement.  It perfectly sums up our beliefs and the reason we do this work:

You count because you are.  
And you will be of significance
until the last moment of your life.  

And we will do everything we can 
so that not only can you die in peace, 
but also live all the way until the end.

     We are eternally grateful for the work of Dame Saunders and Dr. Bittel, which inspires us and forms the foundation of all that we do.

It's supposed to be hard

     When your pet is ill and dying, it is very difficult.  Your heart breaks to see your friend in pain or suffering in any way.  You feel helpless.  You struggle with the unknowing of what is to come and what you can do.  You want it to be over, yet would do anything to have your pet healthy and young again.

     It is hard.  It is supposed to be hard.