When You Die Podcast Dr. Emily Reiner, Doctor Veterinary Medicine
It’s so hard to let them go. And it’s especially hard when you have to make that decision for them. But everyone’s afraid that they’re going to make that decision too soon. I can tell you, that is not the case. Ninety-nine percent of the time, if you’re thinking about it, it’s not too soon. Because obviously, you don’t want to let your animal go. But if you look at them, and you think, “This is not my dog, or my cat, oh, this animal is not who they used to be,” chances are it is time to start thinking about that. And chances are that if you decide to let them go, it will not be too soon. The worst thing you can do is wait too long and watch them suffer. Everyone wants to find that perfect moment. And it’s so hard because you have to err on the side of sooner. – Dr. Emily Reiner
Johanna Lunn
This is the When You Die podcast. If it has to do with death and dying, we’re talking about it.
Your host today is Kelley Edwards
Kelley Edwards
On today’s podcast we’re speaking with Dr. Emily Reiner. Emily owns Forever Loved Veterinary Hospice and In-Home Euthanasia, which is a service that offers end-of-life care to pets and to their owners, as well. Welcome. Thank you so much, Dr. Emily, for being with us today.
Dr. Emily Reiner
Well, thank you for having me and being interested in the animal side of this.
KE
We know the human end of it well, what hospice and palliative care is, but how does that translate into the animal realm?
Dr. R
It’s a very similar idea. It’s that period at the end of life where we kind of know that an animal is on the way out in the fairly near future. And in human medicine I know hospice usually expects the patient to die within six months or so. I don’t think it’s as clearly defined in the animal world. But I would say it’s often less than that. Often, what we’re dealing with is the last days, two weeks of an animal’s life. And really, it’s just a matter of offering support, pain management and comfort to the animals in their last days.
KE
So, how do we know that they’re in the last days? I mean, nobody wants to admit that that’s the case. And I know I’ve certainly been there myself. How do you assess that?
Dr. R
Unfortunately, it’s a really individual kind of assessment. There’s no one size fits all answer to that. It’s a little complicated, but basically, owners know their pets the best, right? They’ll maybe notice some subtle changes; maybe they’re not as enthusiastic anymore about getting out for a walk. Maybe they’re starting to get a little bit picky with their food. Maybe it’s just sort of like a look in their eyes, that’s starting to change a little. Those are sort of the early signs that things are really changing. And they’re very, very subtle at first. Once they get a little bit closer to those final days, if it’s a big dog you might have some serious mobility challenges. They may not be able to get up easily or without assistance. They may be looking a little panicked about that, even. I see a lot of dogs that are what I say it is acutely down. So, they’ve gone down, they can’t really get up; they’re freaked out. And that is often a sign for, say, a large dog, that they’re really close to the end. And that can go along with all kinds of other health issues as well. Maybe they’re not eating, maybe they’re having vomiting, diarrhea, maybe they’re cognitively impaired, maybe they’re up pacing all night before this. So, with a big dog a lot of times in the end it’s the mobility that really is the final straw. With something like a cat or a smaller dog, often the biggest sign that we have is they go off their food; they don’t want to eat any more. To me, that’s always a red flag. Like that is a sign that they’re getting ready to go. Beyond that a lot of weight loss, weakness, those sorts of things. And then again, cognitive changes, they’re not themselves, they often seem a little bit distant or not quite present.
KE
And it’s very much about quality of life and enjoying things. Do you have a questionnaire where you would ask someone what quality of life signifiers there are?
Dr. R
Absolutely. It’s a really effective tool, actually, this quality of life scales out there that pet owners can use to kind of assess their pet’s quality of life. A lot of it looks at changes in their behaviors, like their social behaviors, their physical condition, as well as their behavior surrounding things like eating, drinking, peeing, pooping, those sorts of things. And cognitive changes, those sorts of things. Families can look through these scales, and they can really get a very good idea. Like, often you come up with a number, which is really nice, because it’s so objective, and you can see where your pet is on the scale of quality-of-life. Now, one part of that, that we also include in our quality-of-life scale, is the family’s quality of life, because a lot of people don’t really think much about that. They’re a lot more concerned about their pet, how’s my pet doing? Are they happy? And this sort of thing. Chances are, if you’re doing this quality-of-life scale, they’re probably not doing great already. And you really need to look at what kind of sacrifices the family is making; or the caretaker or whoever is working to keep that animal going. And whether those really payoff. Now, if you feel on the scale that the animal’s still doing okay, you think they’re still enjoying life, then maybe it’s worth it to keep going and to keep supporting them in that way. But if you look at them, and they’re miserable, they can’t control their bowels or their bladder, they can’t move around. They’re not eating, things like that, and you’re still working day and night to try to manage them and their condition more than the payoffs, which are not there anymore, then you’re sacrificing too much of yourself and the animal is not benefiting.
KE
And sometimes we tend to be a little selfish in that, I think, too. Because we want them to stay with us, of course,
Dr. R
One hundred percent. It’s so hard to let them go. And it’s especially hard when you have to make that decision for them. But everyone’s afraid that they’re going to make that decision too soon. I can tell you, that is not the case. Ninety-nine percent of the time, if you’re thinking about it, it’s not too soon. Because obviously, you don’t want to let your animal go. But if you look at them, and you think this is not my dog, or my cat, oh, this animal is not who they used to be, chances are, it is time to start thinking about that. And chances are that if you decide to let them go, it will not be too soon. The worst thing you can do is wait too long. And watch them suffer. Everyone wants to find that perfect moment. And it’s so hard because you have to err on the side of sooner. There are a lot of expressions that go something like, “Better a day early than a day late.” And that’s very much the truth in these situations. So, it’s a matter of taking that moment and being as selfless as you can, and really looking at things from the pet’s perspective.
KE
Now, I will admit, I do find this kind of conversation, extremely emotional, because I have been on that end of it. And it is. So, if I get a little teary, I will apologize. Years ago, I had this experience of in-home euthanasia. And I have to say it was amazing in that the quality of my final moments with my cat, there was the comfort of knowing that there’s no stress, because my cat was traumatized every time we had to get in a car. And so, I didn’t want the last moments to be that or in a strange place. And that’s what you’re offering, is to make these last moments as fear-free as possible. It’s comfortable to be surrounded by the environment that they’ve always been in. And that’s the really important factor.
Dr. R
I would agree. And I think most people would agree with that, too. I worked in clinic for 12 years. I worked as a small animal veterinarian and did all the things that there are to do. One of the things, of course, that I had to do, often was euthanasia. We always did our best to make it as peaceful as possible. And clinics always do. And I absolutely give them all the credit for that. They try to have calm spaces and quiet and respect and that sort of thing. But it’s a strange place. It is a place that’s full of the smells and pheromones of animals who are scared and who don’t want to be there. So, of course, other animals are affected by that. And especially cats. I mean, cats don’t like getting in the car at the best of times, because they know they only go to the vet. At least if you’re a dog and you like the car, maybe you could be going for a swim or something. But a cat pretty much knows if it’s going in the car, probably it’s going somewhere it doesn’t want to go. So, for me, I like home euthanasia very much for a cat. I think it really takes that stress out of those final moments. Instead of having to get loaded into a carrier and put in a car and drive to the vet and be around these scary smells and noises, they just get to be in their home. A lot of the times I’ll arrive, and I’ll sedate the cat in its bed in the corner or looking out the window. And then it just drifts off to sleep. And there’s rarely much of a moment of stress, maybe a tiny sting with a sedative. But that is what it is. They get to drift off in their own home. And it’s as close, I think, to stress-free as it can be. And the same can be said for a lot of dogs. I mean, a lot of dogs don’t like the vet either. There are a few who don’t mind. That is fairly rare. But there are those dogs that don’t mind because that’s where the treats are or whatever. And so, there are some dogs that if you feel comfortable taking them into the vet, they like it there, they’re not going to be stressed then absolutely. If that feels like the right option for you, go ahead. But I think the vast majority of animals, just like people, are more comfortable at home, and it’s a nice last memory to have with them letting them fall asleep in your home, relaxed without the stress. I think it helps people heal a little quicker just knowing that there wasn’t panic or trauma and those last moments.
KE
In a human hospice they talk about the rally, and how people will, in their last moments, come back, and you think oh my goodness, that there they are again. And so, I had that with the first cat that I had to have die at home. And as the doctor came to the door I said, “I don’t know if this is right. Is this right? Is this the thing to do? Because you know, now he’s moving and he’s doing his usual stuff.” And her words to me were, and this is what always gets me, but it helped me so much, was “This is the last kindness you can do for them.”
Dr. R
Oh, a hundred percent.
KE
And that really helped me get through that. And I tell myself that every time or if it’s someone else. And I’ve had to do it again a second time, because I had old cats. No, it really makes a difference. And there’s a compassion for families in that as well.
Dr. R
Oh, I think so. Most people that I go see do need a little bit of help, just coming to terms with it. They need to be reassured that they’re doing the right thing. Ninety-nine times out of a hundred, they’re doing the right thing. And in that one case, oftentimes, there was some doubt, anyway, and we talk about it, and then we make a plan. And that’s fine. But it really is, that is, it’s exactly right. It is the last kindness you can do for them. In the animal world we have that final rally. Also, I just wrote a blog post about that, actually, because it’s something that we see very commonly. We see it in cats, we see it in dogs. I think in dogs, it takes people by surprise a little bit more, because it can be quite drastic. Sometimes, I think with people that they can do that, too. They’re suddenly quite lucid and that sort of thing. Well, a dog might suddenly get up, eat breakfast and want to play for the first time in a year or month anyway. So that is very much a final rally, knowing what the dog has been going through or the cat, they’ve been deteriorating, they’re really unwell, you’re at the point where you’re ready to let them go. If you’re at that point, and suddenly they seem much better, there’s every chance that you’re just on the cusp of losing them anyway. So, they’re likely to die within a couple of days from that point. I think in the human world it can be hours, it can be days after that. But I would say the same goes in the animal world. So, I always tell people, if you’re seeing that they’re suddenly a whole lot better, or even just a little bit better, just enough that you’re questioning your decision, the chance is that you’re looking at this animal deteriorating significantly in the coming hours or days. Keeping that in mind, I always tell people it’s really better to let them go on a bit of a high note. Why not let them go on a good day? Because I can almost promise you, this is the last one. Yeah, the rally is so common, though, it throws people off. So sometimes people cancel their appointments. And then they reach out to us in a day or two and say, “Oh, we had to rush to the emergency because he crashed.” It’s too bad because they didn’t get the experience that they wanted. In my mind it’s so predictable, right? It is a thing. We all have this wish that they’ll just go peacefully at home. It’s not a peaceful process. Oh, it can be, I think, the same with people. Sometimes people die in their sleep, right? I hear all the time from clients that they’ve been waiting and wishing that their animals are just gonna pass away in their sleep. I will tell you that does happen. It is the exception, for sure. And you just don’t know if an animal is going to die peacefully or not. I would say the majority of them don’t. I would say the majority of them die with fear and often pain. Sometimes they start seizuring and things like that. And it’s just awful to watch. I would say most of the time you’re not likely to see a really nice, calm, peaceful death without assistance. I will never say it doesn’t happen. It does. And when it does, it’s lovely. But I would never counsel somebody to wait for that. Because if you wait for that, you are definitely risking seeing something traumatic. I mean, you and your pet experiencing something traumatic right at the end, and that will stick with you. And that will be really hard to recover from.
KE
There are the pets. And there’s us saying goodbye. Who should be present for that?
Dr. R
That’s a very individual decision. If there’s a family, parents, kids, even if they’re grown kids, unless the kids are super tiny, I think it should be up to each individual, whether they want to be present or not. So, it’s a conversation. If there are children, you have to be honest and let them know that it’s really not going well. He’s in pain; we have to help him to pass away and to die. What that means is he’s going to be gone. But we’re doing it because we love him. And we don’t want him to hurt. That sort of thing. You try to explain it in terms that they can sort of understand and then ask them if they want to be there in that moment, when he goes away. Some kids will, some kids won’t. And if they’re older kids, obviously you let them know you’re going to be euthanizing the dog. And it’s up to you. If you want to be present, it should be a peaceful process, but some people just don’t want to be there. So, I let each individual decide. Some people want to stay for just the sedation, and then go away for the second injection, which is the anesthetic agent that ultimately makes them pass away. Some people don’t want to be there for that part. There’s nothing traumatic there. The animal just falls asleep essentially and it’s quite peaceful. But you know, the transition can be really hard on some people. So, I like to let individuals make their own decisions whether or not they want to be there. The one requirement I have is that at least one person who was very close to that animal be present until the animal’s fully sedated. And that, to me, is just because I don’t want an animal being scared and alone in those last moments. I want them to have a familiar presence. And I want them to be calm and relaxed. And I feel like that only really happens when there’s somebody there that they know and love. And it doesn’t have to be everybody, just at least one person. Once they’re fully sedated, as long as they’re not aware, if you don’t want to be there for that final injection, you don’t have to be. The animal’s never going to know. So that’s my only thing. Most people that I deal with want to be there for the whole thing right up until the animal passes away. Because then they see how peaceful it is and how it’s painless and how it’s non-traumatic. And that is so helpful for healing, rather than imagining what those last moments were like. So, I always encourage people if they want to stay, stay. And then of course, in terms of other pets, again, it’s a little bit up to each family. I like to give other pets the option. So, allow them into the room unless they’re going to be extremely disruptive. Once in a while you have those bouncy little puppies or something like that. I sometimes have cats that have to get their nose in everywhere. And if they’re being extremely disruptive, maybe keep them out of the room until the animal is gone. But I usually like to allow them to come and go as they please, they know there’s something going on, usually. So, I want them to be wherever they feel comfortable. And wherever they feel they need to be in that moment. And then once the animal is gone, if we’ve kept the other pets out of the room, let them in. A lot of people think they’re going to want to sniff the body. They might, they might not. But just being in the same room seems to help them to understand what’s happened. So, I do like to do that. I like to have other pets come in, be present with the animal after it passed away. And then I think it helps with them understanding that their friend is gone.
KE
I don’t know if this is true, but I tend to feel that animals are more intuitive, especially to the life and death cycle. It’s a more natural thing. Where we tend to try and avoid it and push it away, animals, they know the deal kind of thing.
Dr. R
Yes!
KE
I’ve felt that, and in my case with my cat, I felt that that was important, because all of a sudden, they’re gone. And I feel that that’s something if you take your pet somewhere else, rather than having it in your own home.
Dr. R
This is anecdotal. In my own experience, I think it is a lot more common for other pets to struggle a bit more with losses when the animal has just been taken from the home and been euthanized at a clinic. Because as far as the one that’s left behind knows that animal just went out for, I don’t know, some kind of a walk or some kind of excursion and then just never came back. And that’s tough. I like the other animals to at least be able to sense a little bit more about what’s happened. I believe there’s a pretty quick change in the pheromones or whatever scents are coming off of these animals. And I think that helps with the understanding of the other pets. So, I like to have them close by. And I like to let them see when we take the animal away, if possible. Again, it’s all very individual. Some people don’t want their other animals present at all. And that’s okay, too. But the other pets may very well grieve the one that’s lost. And we can help them a little bit by giving them the opportunity to potentially understand a bit better what’s happened.
KE
Do you often hear the comment, “I don’t know how you do this. I don’t know how you face this every day.” Do you get that a lot?
Dr. R
Almost every visit. We get that so, so much. I actually wrote a blog about that one too. It’s sad. Like seeing so many people crying all day long, of course. But I’m lucky, because I get to see a family who loves their pet enough to make this decision for them, to give them the final kindness, to let them go in a peaceful way at home. And I get to see the grief that comes with that, which to me is just the flip side of love. This is an animal who has been loved its whole life, and who has had the opportunity to pass peacefully at home with his family there. I don’t feel badly for that animal. I feel badly for the family that they’re going to miss that pet. But I feel like what I do in that moment makes a difference. And I’m helping the people and helping the animal. I’m grateful for what I do. I feel good about what I do. Yes, it’s really hard seeing people sad all the time. But if you think about it, they’re sad for all the right reasons and that makes it not hard. It makes it easier to be there, be present, be a support, but also to not take on their grief. Because they’ve got that part taken care of. If they’re going to grieve that animal, I don’t have to. I get to look at it and say, “We’ve done a great thing for this pet today. We’ve allowed them to go; they’re not going to have to suffer; all their pain is gone.” That’s a good thing. And that’s what I take away.
KE
And that’s why you’re there. And that’s why you’ve chosen to specifically deal with euthanasia.
Dr. R
It’s not for everybody. It’s not. And I’m lucky, because my team is phenomenal. And they all feel like I do. Sometimes we get a little bit down because it is sad. But we all feel really privileged to be able to help animals at the end of life and to help families through these moments. And we have the right team, and we have the right kind of people. I know there’re a lot of vets out there who would struggle to do this all day long. I think we’re each called to a different part of our career. For me, this is kind of my home in veterinary medicine. I think I make a difference. And I feel very fulfilled with what I do.
KE
And I feel like this is a more common thing now: a vet offering this service, to be able to come and keep your animal at home at the end of his life.
Dr. R
Absolutely. And it’s very, very common in the States. In other parts of Canada, it’s also more and more common. It’s quite common out west and in Ontario. Really the Maritimes has always been a little behind the eight ball on this. Our service is the first in the Maritimes, to my knowledge, that focuses on end-of-life care. I think there are going to be more coming, because I think people really do understand that this is a real gift. And we have a few pet lovers around here. I think so. I think you’ll see more and more of these sorts of services offered. Which is wonderful.
KE
What can people take away from this when they’re not sure about what happens? And the whole process? And how do you reassure them that this is the way to go?
Dr. R
I would say most of the families that I deal with are very concerned about suffering. They really, really don’t want their pet to suffer. And it really is hard to recognize suffering when you’re there with your pet every day. And they, of course, hide pain, and they hide illness, and they hide their suffering. So, whenever I come to your home for potential euthanasia, I will assess the animal myself. So, in the end, it’s really not just you making the decision on your own. I will assess that animal, and I will say yes, it is time, this is a good moment or, well, okay, we could do this today. But we also have some other options. If you want to talk about those, I will guide you in that process, I will give you my opinion, I will not euthanize unless I feel it’s the right thing. So, for one thing, I will help you to feel secure in this decision. Because it’s my license on the line. It’s my own ethical judgment on the line, so I’m not going to euthanize an animal that shouldn’t be euthanized. And sometimes that’s a helpful thing to know. And then I try to explain to people what the animal’s likely to experience in terms of the whole euthanasia process from the initial injection through the moments while they become sedate. And right into the final injection as they pass away. I try to explain to them the sensations that they might experience, the physical changes that you might see as they pass away. All of these are generally very, very mild and minor. And when you explain to them, how for the animal itself the vast majority of this process is painless and comfortable, and you’re taking away stress and pain throughout the whole process, then I think most people are on board and quite comfortable with it. But I think it’s really important to look at that pet’s perspective, and let people know from the pet’s perspective, what they’re likely to experience.
KE
Well, it certainly is something I think that many of us have experienced or will experience, and so, for some of us it’s the first experience with death, period. Particularly with kids. So, I personally think it’s a wonderful service to be able to have that option to give your friend his last moments. I want to thank you Dr. Emily Reiner. Thank you so much for talking to us today. Emily is in Halifax Nova Scotia and runs Forever Loved Veterinary Hospice and In-Home Euthanasia. It’s a mouthful.
Dr. R
Yep, it really is.
KE
It’s a wonderful service. And thanks for talking to us today.
Dr. R
Oh, look, you’re more than welcome. Thank you for your interest and for getting the word out there that this is an option for pets. It’s a good option, like you said, indeed.
Johanna Lunn
This conversation is brought to you by the When You Die Project, from existential afterlife questions to palliative care, and the nuts and bolts of green burial, if it has to do with death, we’re talking about it. Whenyoudie.org.
