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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 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.