Relationship Centered Care

• Letter From the Editor (148.5 KB)

When I mention that I teach veterinary students client communications and professional skills, people look at me like my dog Sadie zeros in on voles—tilted heads, puzzled eyes, and all. Many people can’t imagine why such considerate professionals as veterinarians would need to be taught to converse. It’s not until I explain that I also train students to conduct humane euthanasia* that a person will solemnly nod, often sharing a story of saying goodbye to a beloved pet.

Our focus in this issue is on relationship-centered care. I can think of no area of veterinary medicine that can better use this mode of care than end-of-life discussions. It seems almost everyone who has had to euthanize an animal companion can recall the experience with razor-sharp clarity.

I have my own story; it’s one of the reasons I felt compelled to specialize in veterinary communication.

Sophie and her family

Sophie’s Story

Sophie, a gentle yellow Labrador, joined our family when my daughters were quite young. My little blonde girls and my yellow dog romped away many days in our backyard, and Sophie wore her share of hats and dresses. Sophie was most in her element at our family cabin. We would sit on the deck overlooking the lake, watching Sophie dive into the water again and again after sticks thrown by the kids.

Sophie gave us more than we could ever give to her. She was a friend, a playmate, and a constant comfort. Of course, since our canine friends have much shorter life spans than we do, she eventually became a little old lady. As the girls were finishing high school, we could all tell that Sophie was going downhill.

The decision to euthanize Sophie came before my work with the veterinary profession; I wondered how we would know when it was “time.” A friend said Sophie would tell us in the same way she communicated for the 13 years we shared. Sure enough, one morning she didn’t raise her head to greet me, and the heavy Lab tail that had felled many a coffee cup and wine glass didn’t move. She didn’t show any interest in the food and water bowls I placed close by. Since she wouldn’t stand, my husband and I carried her outdoors to relieve herself. As we watched her sitting motionless on the snowy ground, we both knew. Sophie was saying goodbye.

I called the veterinarian who had cared for Sophie for many years. A kind, if somewhat abrupt man, he told me to bring her in that afternoon. “But how does it work?” I asked. “I’ve never done this before and I have no idea what to expect.”

“Well, you just bring her in and leave her with us,” he said. “We’ll call you when it’s over. Don’t worry, we’ll take good care of her.” As I hung up the phone, I remember thinking, “Really? That’s it? I just drop her off at the office and never see her again?”

To this day, I tear up thinking of Sophie’s ending. Since the vet didn’t offer me an alternative to the euthanasia he described, I did what he said. I helped the techs carry Sophie to the back, and said goodbye. I wasn’t there to hold or pet her at the end. I wasn’t there to make sure her last breath was an easy one, or that her head was in the lap of someone who loved her.

I wish I’d known better. I wish my veterinarian had offered me choices. I wish I had the chance to do it over again so Sophie could have died as she lived, with our family close at hand.

Sophie’s Legacy

I don’t share this story to condemn my veterinarian or the profession. I think he did the best he could with the resources that he had. Family-present or home euthanasia wasn’t yet common. As sad as Sophie’s ending was, it provided the motivation to learn more about helping others. It spurred me to start a pet loss hotline and provided the incentive to teach veterinary students how to work collaboratively with clients when helping them with end-of life-care.

In our profession, there is no greater time of connection than during euthanasia. I know this personally and now I understand this professionally. Not every client will want to remain with her pet, and not every client will want to partner with you at the end. But, when you practice relationship-centered care, you’ll always make sure you educate your clients about choices and help them make the best decision for that family and that pet.

Sharing this concept is my legacy to Sophie. Sleep well, girl.

* Read Dr. Ruby’s article, "Euthanasia: The Compassionate Goodbye" in the January issue of EVT.
 

Kathleen Ruby is the head of WSU’s College of Veterinary Medicine Counseling and Wellness Department and is a licensed professional clinical counselor.