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In 2019, after about 11 years of holding these conversations I felt the need to vent. I wrote a snarky article for DVM360 entitled, He seems fine, but I’m in pain. This was a comical look at what we see everyday because as we all know, if we don’t laugh sometimes, we’ll cry all the time.
In the article I tell the tale of Poopsie, a senior poodle styling a cheetah print sweater who was in desperate need of veterinary care. This sweet girl's owner had to unfold her legs so she could stand on the table for her exam. This nice family was like thousands that I’ve seen who say “She seems fine”.
So how do I handle this painful situation? Gently, but firmly.
One of the things I have learned as a hospice veterinarian is that families definitely do not want their pets to be in pain but don’t know how to tell if they are. Not only this, but sometimes, they are reluctant to accept that they are. Why? I do not have the exact answer to this, but I think that fear plays a large role.
Acknowledging pain means they have to accept that their sweet love is aging or has a disease which requires pain intervention. Perhaps they didn’t make the connection that being “stiff” means there is pain and now they are embarrassed. Possibly they know they cannot afford pain medication and feel guilty.
Whatever the reason, I used to tread lightly in these conversations with mixed results. If I was too gentle, they wouldn’t hear me, too firm, they got angry. I had to get it just right. Turns out, just right was very simple. Now my answer when I am asked, “Do you think she is in pain?”
“Yes.”
Wait a few seconds, then gently give them a concrete example they can see:
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“Do you see how she is subtly keeping all of her weight on one leg while standing?”
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“Have you noticed if he is reluctant to go up the stairs?”
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“Does she tend to chew her food only on one side of her mouth?"
Often, the connection is made and then the door is open to further discussion. I usually start praising the family for bringing their pet in, for asking good questions, for what they are doing right. This helps soften the blow of what they are now seeing for the first time.
Being an end-of -life care veterinarian has opened my eyes to how clients see their pets and how we can alter our conversations just a little to help both the family and the pet. Some clients are more visual learners, so using pain scale charts are helpful. Some respond to other pet’s stories and some like filling out a questionnaire.
If you are interested in providing any of these resources for your clients, please email joshua@caringpathways.com
Hampton Roads Veterinary Hospice is honored to help support referring veterinarians and their clients with end-of-life decision making through many in-home service offerings such as:
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