Peace of Mind for Pet Parents Episode 023: Living to the Last Breath: A Pet Parent’s Perspective on Dying Naturally

Episode Transcript: 

Karen Wylie:
Hello, and welcome back to Peace of Mind for Pet Parents. I'm Karen Wylie, joined, as always, by Gail Pope.

And today we decided that we're going to talk a little bit about how we approach the end of life for humans—and also how we approach the end of life for our pets. Because there are some similarities, and of course, many differences as well.

And so Gail, as usual, I'm going to give you the first word—not to mention the last word, generally speaking. The pressure's always on. How would you like to start us off in our approach here—in how we look at, how we approach end of life for humans, and how we approach end of life for pets?

Gail Pope:
It's such a big subject. Such a big subject. I mean, to me it begins with—and I know I bring this up over and over again—but it begins with the word death and the fear that, as humans in our culture, we've developed such a fear for it.

I think the human world has done a heck of a lot better than we have in the animal world in many ways, with the advent of hospice care for humans. And even that is still not terribly well received in some areas, because people have grown to see the word hospice as meaning death, and they want to make that go away.

So that is very difficult. And of course the other—well, the other elephant in the room, if you like—is the term euthanasia, and the ending of a life, and how that happens. And of course, that's obviously much more familiar to the animal world than the human world. What do you think?

Karen Wylie:
Well, I think that is one of the absolute core issues of what is so different in our approaches, because when hospice is allowed to happen for humans—and it's not always allowed, because maybe the patient themselves has no interest in it, because it means death and they don’t want to go down that road, they think they're fine. Maybe it's family members who feel that hospice is equated with death, and so perhaps they're denying what stage of illness or dying their loved one is in.

But there's also the issue of the medical team in human hospice—or I should just say in human medical care. A lot of medical professionals don’t make the referral to hospice because they don’t want to be the one to bring it up to the family. And so supposedly, about half of the humans who could qualify for human hospice are never referred to it. And then of those that are referred, they're referred late.

I think I've mentioned this before in some of our conversations, that it's called late to care. It’s a phenomenon that is documented. And so about one-third of those that actually do make it to hospice are only there for about two and a half weeks, because they're referred so late and get into it so late.

Gail Pope:
Yes. Yes. It's that fear of the word again, isn’t it? You know, you’ve just taken me back to where my journey into the world of hospice began. And in actual fact, I started—oh, my goodness—BrightHaven became incorporated in 1993. I think we’d been doing the work for about five years, but it was really around the mid-1990s that I became familiar with death since we specialized in senior, special needs, medically challenged animals, I hadn’t even thought about the fact that death would be involved. But it happened upon us, and over the years as we trod the path to learning about death and dying with hundreds of animals—and getting to really actually absorb the guiding principle of human hospice care, which is to neither hasten nor postpone death—I became used to a very holistic way of looking at end of life. A very natural path, but also in the acceptance of euthanasia.

And so one day, there I was, sitting in my office at BrightHaven, and the phone rang. And a voice said, “May I speak to Gail Pope?” And I said, “Yes, this is she speaking.”

And this was a veterinarian, a very good friend of mine for many years now—Ella Bittel. And she said, “Oh, I’m so happy to get you on the phone. I’d love to talk to you about a new organization that’s forming for animal hospice care.” She was really upbeat and excited.

And I said, “Oh, I’m very sorry. I don’t know where you get your information from, but I know nothing about hospice care.” And, you know, I was quite cold—or cool, at least. And she said, “Well, hold on. I’ve been told that BrightHaven—you are all about end-of-life care and the dying process. Your animals mostly die naturally. What—I don’t understand. How have I got all this wrong?”

And I said, “Well no, hospice means—hospice is all about dying. Now here at BrightHaven, we’re all about living. We’re all about living well to the very end of life.” 

And so that’s kind of where my journey began.

So I can see it so clearly in the world now, even. If we approach the subject very gently without using that word, then it’s much more acceptable. But at the bottom of that is that word death, which still becomes unacceptable.

People don’t want to talk about it. But it’s something—you know, we plan for birthing, we plan for living, and we should be planning for dying too—for our humans as well as our animals.

Karen Wylie:
Right, right—and yet we avoid even thinking about it, or acknowledging that it could be happening.

Gail Pope:
Yes.

Karen Wylie:
I think I mentioned this to you a few years ago, right after we had met. I never thought about what I was doing with my animals at end of life as hospice care, either. It never crossed my mind. I just tried and did everything I could to allow them to die on their own terms—and when they wanted to die, when they were ready to die, when their body didn’t have anything left to allow them to stay.

And if that meant I had to euthanize because of pain issues or a sudden detour happened, I would do that. Because I’m grateful that euthanasia is there as an option—just like I’m grateful that there’s morphine for humans for pain at the end of life as well.

So it’s not that everything is either/or, but I just was approaching it much like you—in trying to honor the wishes of the animal’s life. And when they were ready to go, I’d let them decide.

I just never thought of it as hospice care. And I’ve never, in all these years, had a veterinarian ask me if I knew anything about hospice care. Or when they would be telling me the predicament my pet was in, with whatever test results had come in and what might be happening in the future—I’ve never had anyone mention animal hospice.

Gail Pope:
Still a very slowly growing philosophy in the animal world. And it’s still struggling a lot with humans—with the “late to care.” My husband was one of those statistics. Richard. Neither his practitioners nor he were ready to accept the fact that here was this beautiful service that could really be helpful when it was becoming almost impossible to juggle medications and general daily life.

It was very, very clear that that was the time for hospice—but he became a late-to-care case, because he wasn’t about to acknowledge that. After all the years living in an animal hospice, basically, when faced with it himself—death and dying—he just backed away from it.

Karen Wylie:
Right. Right.

Well, animal hospice at this point seems to be more of an advertising slogan sometimes for veterinarians or their clinics. Animal hospice seems to be mentioned as a service that is offered by veterinarians and clinics. And yet…

Gail Pope:
Yes.

Karen Wylie:
I’ve heard over and over from our students at Animal Hospice Group going through the curriculum as practitioners themselves—they’re very highly sensitized to what animal hospice could be. And they go out searching for local clinics that would offer those kinds of services, and that they could really work with.

And over and over, they’ll be talking about how they call seven clinics that say they offer animal hospice services—and in reality, the only service at all related to hospice is offering to come out and do a quality of life evaluation. But that’s in preparation for identifying: is the animal ready for euthanasia?

Gail Pope:
“When is it time?” “When is it time?”

Karen Wylie:
“When is it time?” “When is it time?”

And really, yes—I remember one student saying they contacted seven clinics before the eighth one would come out and just do home care and talk with them, but not plan a euthanasia on-site at the same time as the quality of life evaluation. And another one talked about contacting six clinics, and only the seventh one responded.

So, you know, it goes beyond my own experience when I’m hearing our students describe this—because I know that they’re looking for the same kinds of things that we are, that we want to offer to our own animals. And so it seems that animal hospice is not always the right term. Because you and I offer home hospice for our own pets.

Gail Pope:
Yes, we do.

Karen Wylie:
And it seems there’s more “medical hospice” or “veterinary hospice.” I don’t know that everything we’re all doing can be subsumed under “animal hospice.”

Gail Pope:
Okay, yes. If only more caregivers could learn more about the hospice philosophy—and how lovely it is. It’s all about loving care, comfort, dignity, and just being with the patient, for want of a better word, through this last chapter of life.

It can be so beautiful, and so meaningful—and difficult. There is a lot to learn. But when you look at the joys and the comfort and the teamwork that surrounds hospice—and it can be done with a very small team—I think supporting the caregiver is probably, in essence, the main training.

Because they really are the center. Although the patient sits at the center, obviously, the caregiver has to sit side by side with them. Because they are doing exactly that—giving the care. That’s why they’re called the caregiver. And the burden of caregiving, whether this be for a patient on two legs or four legs—or however many legs— is difficult emotionally.

There’s a lot to learn. There’s a lot of support that can be offered. And yet, if people don’t know about that… so yes, the word “hospice” has a long way to go. I wish we could change it. Again, you know, we say “home hospice,” and it is at home, and it does create the atmosphere—the loving, homely atmosphere that we would like. I don’t know whether that will ever happen, though.

Karen Wylie:
No, I don’t know either.

It is interesting, though, when you compare the end of life for humans. A natural transition is what is expected. We watch our human loved ones begin the dying process in a gradual way, where they start not wanting the same foods—or as much food—and then not wanting any food, not necessarily wanting much hydration either.

They start sleeping more, and family members and friends gather in preparation. And they hold vigil. They’re there. They’re getting to say what needs to be said.

And we consider that all a very positive process and outcome—for humans to die naturally. And morphine is typically available. If pain is perceived to be part of that decline, then it is addressed. But they’re not just given morphine to prevent anything from ever happening.

They use morphine or other pain meds to address something that’s happening.

And then, when we look at our pets approaching end of life, we seem to kind of get to the same point that humans get to—where no one’s mentioning hospice, but there are no treatments left to suggest, no procedures that would really be helpful.

And then there’s this chasm—this huge gap. And for our animals, it seems the only thing that’s suggested at that point is to schedule their death. To schedule a euthanasia.

Gail Pope:
Yes.

Karen Wylie:
And yet, the animal could still be enjoying their life. The fact that there’s no cure does not necessarily mean that their life should be terminated at that time. And that’s where I think our pet parents have such a difficult time—because they don’t know what’s possible.

And if their veterinarian—who they’ve been depending on to guide them through the treatments and the procedures, and what’s the best way to handle this and make sure the pet is not in pain—if suddenly there’s the end of the road and the only thing that’s offered is euthanasia…

That is so different from how it is for humans, where euthanasia is a hard thing to get for ourselves as humans.

And as you were saying, right before we started, you were talking about the fact that, generally speaking, a human has to administer the dosages of euthanasia medications themselves. And it’s one of the reasons so many of them choose to die earlier than they should really have to—because they’re worried about reaching a point where they would not be physically able to take the medications themselves.

Gail Pope:
Right. Right.

Karen Wylie:
So we definitely seem to have lots of messy, messy stuff—for both humans and how we handle our pets.

Gail Pope:
It’s sad. It really is. And I guess a lot of it comes back to religious and spiritual beliefs.

And the other doctor that I often mention—Mother Nature. You know, living and dying should be natural. It shouldn’t be weird to have death happening naturally. It shouldn’t be—but it has grown to become that.

We are a culture that is scared of what we don’t know. And I don’t think that’s ever going to change unless you’ve experienced your life after death, as some people possibly have.

We don’t know. It’s like… we’re hitting a brick wall, and then we’re gone. And so there is fear, and that’s always going to be there. But I think, for me anyway, just being present at the dying processes of so many animals—and some humans too—it doesn’t appear to me that it’s that difficult.

It’s a process of stepping out of the physical body that you are living in, when the time is right.

Oh, I don’t know. We have a long way to go, and I don’t know that we’re going to solve it all today. But I think just if we alone can educate more caregivers in the journey itself—what’s involved in the journey…

Pain, obviously. Pain, suffering—they’re the questions that come up at end of life that everybody is worried about. And we could start talking about them now, but we could probably talk for another three hours on this subject, couldn’t we?

Karen Wylie:
Well, I think one thing we haven’t yet spoken about, which I think is essential to this kind of conversation, is that in human end of life, generally speaking, the human who is dying is conscious enough and verbal enough to be communicating what they want—what their final wishes are.

And hopefully the family members know as well. Now, we know that doesn’t always happen—and what someone may have thought they wanted may be different when it’s them laying in that bed.

Gail Pope:
Oh yes.

Karen Wylie:
But with our pets, we’re always in the situation where we’re trying to do what’s best for them. And we’re trying to understand what they might want.

And that is based on us knowing our pets as well as we do, after however many years we’re fortunate enough to have them in our lives.

But for me, I always think that’s one of the great benefits of providing hospice care at home for my pets—

Gail Pope:
Yes.

Karen Wylie:
Is that there comes a point in their natural dying process where they begin to understand that they’re not getting better.

Whereas sometimes, when euthanasia is recommended, it’s prior to any point that the animal is even feeling badly yet.

Because a lot of times, euthanasia is to prevent suffering—it’s not necessarily to address suffering that is already happening. The veterinary oath talks about preventing suffering.

Gail Pope:
Yes.

Karen Wylie:
And so there can be a jumping in early—to prevent pain that might happen but hasn’t yet.

And so, in a home hospice situation, where we are watching day to day—ready to address what we see happening, not what might be happening, but what we’re seeing happening in front of us—

I usually see my pets start to turn a corner where they do start to understand that they’re not going to get better.

And for me, that’s very helpful—for me to let go—when I see them changing their approach to their own death. Then, yes—then it’s not me making the decision for them. But I’m supporting the decision I see them making.

Gail Pope:
And that’s something that we see in humans, too. It’s very much a parallel, because—I’m just remembering when my mum was reaching the end of her life. She followed the trajectory that you’re talking about exactly.

And there came a time when she was… she was a little different. And she was a little more comfortable—and I wasn’t, particularly. She didn’t want to eat anymore. She didn’t want to drink. And I was absolutely focused on trying to find something she would want.

It’s very difficult to give up those things. But from then forward, she settled into a place of comfort. And she wasn’t actually taking any morphine, she wasn’t on any drugs at that point. But she entered a state of… almost happiness.

She was kind of joyful inside of herself, you know? And they talk about hospice patients in bed reaching up—she would do that. She would tell me about people who visited and talked to her. She was dying, but she was also in a very comfortable place to be dying. It wasn’t something to be fearful of or panicked about.

And yet—I’m human, and my mom’s dying. And so there was an element of, “Oh my goodness, I wonder what…” Nothing ever happened. There wasn’t a “what if”  that happened.

And that’s what we see with animals. And as their loving caretakers, we are going to have our minds thinking forward as to: “Well, this is okay, but what if…”

There are always going to be those questions. So if we’re prepared that something might need treating—as would be in the human world—

Karen Wylie:
There you go!

Gail Pope:
—we can do the same for our animals. We can be present. A loving presence for them.

Karen Wylie:
As they’re going through this process—because we’re not in a state of fear and panic.

Gail Pope:
Right, right.

Karen Wylie:
And I have found, as I know you have as well, that providing that care at home over a period of time allows us to go through our grieving with our pet while our pet is still here.

We’re still going to grieve when they die and they leave us. But having that opportunity to care for them over days, weeks, months—

Gail Pope:
It’s a gift.

Karen Wylie:
—is something that softens the blow after they leave us.

And that’s something, generally, I find with those who have decided on a euthanasia before they were really ready—that they have a much harder road to resolving their grief.

They’re always second-guessing that. “Should I have done this?” “Should I have kept them longer?” and so forth.

I don’t have those same levels of regret when I provide hospice care.

Gail Pope:
Yes, I think that’s generally true for those of us who do it more frequently.

Karen Wylie:
It’s something I wish everyone had the opportunity to do.

Gail Pope:
Exactly. I think hospice care—well, it bridges a gap, doesn’t it? And it gives you the time to grieve. It gives you the time to step into acceptance of what’s coming. And it gives us time to actually learn what it is to be human, perhaps.

Karen Wylie:
Perhaps. And find out that our four-footers are not that different from us after all?

Gail Pope:
No, they’re not.

Karen Wylie:
They have so much to teach us. So much to teach us.

Gail Pope:
Teachers.

Karen Wylie:
The all-important pet perspective.

All right. Well—what do you think? Have we done ourselves in on this conversation?

Gail Pope:
Oh—but there are so many nooks and crannies!

Karen Wylie:
Right, right.

Gail Pope:
Like this—we could dive into so many of these little nooks and crannies. But no, I think we’ve done enough for today. We can revisit various parts of this, I’m sure.

Karen Wylie:
We can. And I’m sure we will, too. Yes.

All right, well—with that, we’ll bring a close to this conversation today, and thank you for being with us.

And remind you that Thursdays at 10 a.m. Pacific is our time for Cuppa and Conversation with us, and any pet parent is welcome to join us.

Please visit our BrightPathForPets.com website. And right there on that homepage, you’ll find information about how to join us on Zoom at 10 a.m. Pacific on Thursdays—every Thursday.

And with that, we’ll say goodbye and thank you.

Gail Pope:
Goodbye. Thank you so much for joining us.