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Sunday, February 6, 2011

Grief Counseling

One of the hardest things a vet has to do is handle grieving clients.  Most of us get no training in how to handle this, as it's not emphasized in vet school.  However, we're faced with this on a regular basis as we deal with critically ill patients and euthanasias.  Some people are easier than others and every situation is unique.  Human grief is especially hard to deal with for those vets who are very introverted and don't handle people situations very well, yet we can't really get away from it.

Yesterday morning my very first case of the day was a male cat who had been straining to urinate for a day or so.  As soon as I looked at him I was able to tell that his bladder was very full, tense, and painful.  He was completely blocked and could not urinate.  This is a critical situation as the urine has nowhere to go and continues to accumulate in the bladder, eventually backing up into the kidneys.  The kidneys quickly become damaged, heart arrhythmias can happen, and a cat can die within 24-48 hours of this happening.  You need immediate hospitalization and care, as well as several days of leaving a urinary catheter in while hospitalized.  These cases can easily run $500-1000 or even higher, so it's not a simple fix.

I began to talk to the owner about this situation, and it was quickly evident that they didn't have the money for this care and wouldn't qualify for Care Credit.  (As an aside to those who feel that a vet should treat a case regardless of the owner's ability to pay.....how can a veterinary practice afford to give away $1000 in services and still stay in business?)  Really the most humane option in this situation was euthanizing the cat.

That's when the drama began.  The owner was crying and upset.  She had a little boy, around 9 or 10, who also started crying.  And her daughter (around 11 or 12) began screaming.  I mean fully screaming in anguish and not simply crying.  I left the room and gave them time to talk over things.  We could hear the girl screaming out all over the clinic, and I'm sure the clients in the lobby were wondering what was going on.  We could hear the girl arguing with her mother, and at one point she ran out of the room and her mother had to go chasing after her.  I've seen a lot of grief, but I have to say this was the most severe reaction I've ever seen.  In the end the mother finally calmed her daughter down enough to be rational, and we euthanized the cat.

We certainly don't get enough training in these situations, and I'm not sure that there is enough training to cover every eventuality.  So for any prospective veterinarians, I'd encourage you to seek out information on grief counseling whether it be from a good mentor or from a course or book.  Both you and your clients will benefit.

6 comments:

  1. I'm not going to lie - owners like that irritate the sh*t out of me. I love my pets dearly, and when any of them die, I will cry - a lot. There is a normal amount of grief though, and there is overdramatic hand-wringing.

    My 2 year old cousin drowned in a tragic accident when I was in vet school, and my family, including myself, behaved more rationally and maturely than some of the clients I deal with...

    Sometimes, I think it's a guilt trip, sometimes I have to step out of the room because it's getting to the point that I'm getting angry, and sometimes I just have to laugh. Gallows humor and all.

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  2. It sounds like that poor girl had lots of anger and frustration. Realizing how powerless we all really are for the first time is a sucker punch. Esp when your are young and figure life goes on forever.

    I was in an emergency room with my dog when a couple and their child came in with a sick dog.
    They did not have enough money and I remember the father looking through his wallet for credit cards, cash etc. ( I am sure he knew he did not have it) but his kid was watching him, expecting him to save the day.
    I even remember the kid saying: Dad I have grandmas christmas money. You can have it.
    Long story short they did not have enough money to save their pet.

    It was pretty rough on the kid. I sure wich I did not see it. Still haunts me to this day.

    Looks like this girl got to see Mamma is not the all powerful protector she thought she was.

    That is not necessarily the best lesson for growing up at 11 years old in my opinion.

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  3. We're lucky to have a great social worker at our hospital that works with clinicians and clients during difficult situations. She also teaches us in several courses throughout our curriculum, which I'm sure will prove to be very valuable.

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  4. This is definitely a tough case, I don't look forward to those moments in practice, but I know it will inevitably happen, especially working with horses, they can get very expensive very quickly and are so fragile.

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  5. I don't work in a vet clinic, but did work for a number of years in the CSU Veterinary Teaching Hospital. They are lucky to have a full-on grief program for their students (and clients). The Argus Institute is the first of its kind program in a vet school and offers grief support education, and communications education for the vet students. It's so needed! I have talked with so many grieving pet parents in my time, and having gone through the classes offered by Argus helped immensely.

    As an aside as well, the company that I work for offers materials as support for veterinarians and clinics. Our referral website has many articles and resources that can often be of help to grieving clients. www.veterinarywisdomforpetparents.com. (I hope this is OK here, if not, please delete my comment! I honestly believe in what we do as a great resource!) :)

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