Peace of Mind for Pet Parents Episode 048: The Gift of Anticipatory Grief: How Hospice Care Transforms Pet Loss

Episode Transcript: 

Karen Wylie: Hello and welcome back to Peace of Mind for Pet Parents. I'm Karen Wylie here as always with my wonderful friend Gail Pope. Today we're going to take things in a different direction than we have previously. In looking at grief, we're going to begin looking at how we have experienced grief with our pets because grief, of course, doesn't start at the moment of death.

So how we care about our pets as we move toward that moment of death makes a difference, and has made a difference for Gail and me. So we know that our experience of our pet's deaths and the grief that we have felt afterward has often been very different from what we hear other people describe. 

We don't say that with any judgment at all. We just say that because for a long time we really haven't focused on why our experience of grief is different. We've come to realize over the years, it's not that we're grieving less but rather that we grieve differently. It's how we have cared for our pets at end-of-life that seems to have made a difference for us.

Gail has provided hospice care for several decades with the BrightHaven Sanctuary and all the animals that she took in there. Unbeknownst to Gail or me, I was on the East coast taking care of my own pets and coming to the conclusion that allowing them to go on their own time whenever possible was how I wanted to approach their loss and their death. 

I didn't realize I was providing hospice care. Gail has said at various times that she never considered she was providing hospice care because she was just helping everyone live as long as possible and as well as possible. But in reality we have been providing hospice care for almost all of our pets when possible and allowing a natural transition, again when possible.

That has allowed us to have more real time to be present both before and after the death of our pets. We feel that has changed our experience of grief. Today we want to explore a little bit about how grief can actually begin before the death of our pets. How caring for our pets in a hospice capacity can actually change how we feel later and in our ability to cope with grief, to grieve differently, and how we carry that loss forward for months or even years further.

So with that, Miz Pope, most pet loss support really focuses on supporting pet parents after the death. There's pretty much an epidemic or what I would call an epidemic of pet loss support therapies and groups out there to help people cope after their pet is gone. I have felt it very beneficial that most of the time I was doing some grieving before they left. I know you've spoken about that. If I can ask you to speak a little bit more about it now.

Gail Pope: I know I've told this story before but I think, for me, it was the foundation for me to start to really learn about grief: what it was and all the different stages of it. I think in actual fact, I had become so focused on my animals living well at all stages in life that the atmosphere at BrightHaven was happy. There was joy and there were animals at all stages of energetic life: there were those running around in wheelchairs, jumping on couches and then there were those reclining in bed, or getting closer to the end.

But the atmosphere was, for the most part, gentle and joyful. At the same time, I would be focusing on the decline towards the end of maybe one or more at a time in different stages as they lay,  or were still walking around even sometimes. I was so focused on caring for them and living in this joyful energy that I guess the subject of grief didn't even occur to me. This is really a story I've told before when one day a volunteer came and she said to me, "It's a little embarrassing. I don't want to offend you but I'd love to ask you a question."

I think one of the cats had died a couple of days before over the weekend, and she said, "Here you are vacuuming, cleaning litter boxes, picking up and cuddling and laughing with the animals. I almost didn't come because I thought I should perhaps honor your grief."

And I felt awful. It hit me like a wave coming out of the ocean and I thought, "Oh my God, am I senseless? Am I cold? What is wrong with me?"

So that really opened the floodgates for me to start looking back and that's when I realized that basically I'd grieved with the animals before they reached the point of death. I guess it was about acceptance in the atmosphere we had at the sanctuary.

It was all about acceptance of who you are and what stage of life you are at and what help you might need. So I guess following that direction had carried an undercurrent of worry mixed with grief. We always anticipate what “might” happen, so those thoughts are always in the back of the mind but I hadn't identified any part of that little tangle as grief. 

Now I hear it referred to as anticipatory grief— maybe we started that conversation, I don't know. But it's very true and I think we all do it. Some of us are very aware that we are creating a path and we are grieving with our animals but a lot of people don't realize that they are spending time grieving whilst loving and caring and getting on with life too.

Karen Wylie: And I imagine part of it does depend on what happens when you receive the terminal diagnosis. Whether you're told that there is any time at all or whether you are encouraged to make an immediate decision about euthanasia rather than maybe that day or in a few days. 

So I think that is part of it when I have received difficult diagnoses on my pets. I don't usually take them in as terminal. I don't focus on the fact that they're dying. It's more "okay". I found myself doing this in the car after I left a vet clinic where I'm reflecting on the conversation I had with my vet and it was more about, "Okay, we probably found what Greta's going to die from ultimately."

So that's how I begin processing it. I accept that whether it's a particular stage of kidney disease or identifying heart disease and wondering where that's going to go and how quickly it's going to go. I don't find myself jumping to the end. I focus on what we can do along the way. I think that when I am thinking about it in that way I'm saying, "Okay, I think we just found out what Greta's going to die from."

That is really beginning or allowing yourself to begin grieving. Just acknowledging that to yourself, "Okay, this is probably what we'll lose Greta from." That's how I start putting it and then, there can be many months or even several years with a pet with kidney or some cardio issue, heart issue. 

But I do think hospice allows our grief to start earlier while our pet is still with us. 

So we may be grieving a little bit every day but it does allow the grief to fill your heart and your life gradually. I think that really helps us in the end. It's like with human losses, human death, I think we would all say that there is a difference between a life partner, a spouse, a family member having a sudden heart attack and dying. Or a car accident and they've died in the car accident and they're gone. This morning they were fine and then they're gone. There's a very different experience in that kind of death. 

Then there is - if we know that there's a diagnosis in play, because of course with humans if you look at the statistics in the United States, anywhere from 92 to 99% of human deaths are considered natural death. Whereas, if we turn the tables to look at how we handle the deaths of our animals, those cared for in veterinary clinics during an end-of-life phase, 90% of them are euthanized.

So we typically have a totally different experience with our pets than with humans. But with how you and I have lived our lives with pets, we learned to cope with their deaths differently. 

I do think allowing natural transition is part of what allowed us to cope differently, because with euthanasia there's this thing that's called "Responsibility Grief". It happens anytime you are in a position where you have the authority or you're asked to assume the authority to make decisions about things. Especially with pets in terms of literally making the appointment of the day and the time that they will die. That's a really difficult type of grief for pet owners to deal with.

I think that's a lot of what we see but not what you and I have experienced because our goals were always to aim for a natural transition whenever possible, and only consider euthanasia if pain could not be controlled or if the situation made it very clear we couldn't continue down that natural road.

How does that strike you in terms of having that goal in mind to work toward a natural transition? How do you feel that has affected your processing of grief?

Gail Pope: Oh God, hugely. You probably saw I was writing something down so I wouldn't forget it. This was, I don't know, a few minutes back in your conversation and here I am left with these words right now, which have been my journey the same as yours with a slight kink in it, because my focus was and is healing for the highest good of the being— whether for continued life or for transition. 

And so when we would run diagnostics or see a specialist and get what was obviously going to be a terminal diagnosis. Then our focus holistically or wholistically (with that W in front!) was let's make today, tomorrow, and however long we've got as happy and joyful and healthy as possible, which is where the phrase "Healing for the Highest Good" came from. So we weren't focused on the dis-ease, we were focused on the being. We focused on “living” with them right where they were on that day. So again, the phrase “living in the moment” was born.

I think fear plays a large part. If you have a terminal diagnosis, the word death sits behind it. That brings the fear level up and yes, grief is obviously intertwined all the way because once you know that time isn't just time immemorial, there is going to be an "It's coming". So that must be when we start to learn about grief. 

I didn't see anything that was going on in my life as me grieving. However, I have learned a lot about grief and it's only really, in fact, very recently that I've really become interested in how we work through our lives. That's for another conversation. But I think grief walks with us along with love, along with many other emotions, it walks with us all the way. Sometimes we are just not aware of it and other times we are very clearly aware of it. Obviously with grief we know that it can almost destroy some people sometimes. It's very sad.

Karen Wylie: Where they disappear from view for not just months but years and need that time to recover. As I was thinking about us having this conversation today, I was thinking about the fact that so many of our caregiving rituals every day give us an opportunity little by little to be grieving. When I have someone that I'm monitoring, somebody who's on medication, somebody who's on some level of subQ fluids or whatever it might be, my day begins with getting my hands on that pet. Checking hydration, looking for the pink in the gums, looking at their eyes and while I'm petting them in 30 seconds, I can get the information that I need as their caregiver then it's like "They're good. They’re going to have a good day."

It's just every time I'm pilling them or anytime I'm doing something, there is the awareness that you're providing these things because they're on a different path. 

We don't know how long that path's going to be but we are aware that they've got some challenge in their physical life that could take them from us. So in reflecting on it, I just find the opportunity to provide care as a caregiver every single day over weeks, months, or however long we have them offers a wonderful healing opportunity. It's healing in advance. 

Yes, we're grieving a little bit because we're thinking about what it's going to be like when they're gone. That does cross our minds because we love them so much and don't want them to go. 

I think when we do get to the time of death, to be able to look back and feel like you had time with them, you were able to show them the love you always felt for them and you were able to do that over time.

I just think and I expect I've said this before, I think providing hospice care is an incredible gift that we can give ourselves, not just to the pet that we're caring for but really in terms of how it will support us later on.

Gail Pope: You have just done it again! It's so funny. A little while ago, it just sprung into my mind that it's very much about comfort. Comfort is the word that sums up the end-of-life process or let's say the hospice process, because sometimes we tend to think end-of-life is the last few days but end-of-life can be, I don't know, a six month or even a year's process of gradually winding down.

But when you think about it, if you read any kind of overview on “what is hospice and palliative care”, the word “comfort” will probably be in the first sentence. I think you’re brought comfort and joy alongside caring with somebody, a being who is terminally ill. It's as though comfort has grief hand by hand and wrapping it up. I can picture these little people -  one with an arm around the other, saying "Come along. It's okay. You come along with me and we'll be comfortable together."

So yes, I think the word comfort sums it up. And yes, I think grief is there in baby steps. In this kind of scenario, it's there. We walk with it the same as with love.

Karen Wylie: It's very gradual and I would say that the comfort care is not just for our pet. We end up providing it for ourselves without that being our goal. 

Because I'm sure everyone's like us. It's like we're focused on them, but by having this gift of time to be with them and care for them, we’re caring for ourselves and able to care for ourselves. 

If you contrast that with sudden crisis decisions that either have to be made at the vet clinic or we're told maybe you can have the weekend but you need to come back. The grief you feel from those kinds of situations is dramatically different from the kind of experience you and I have been able to have. You don't have the same kind of emotional whiplash and shock that this is happening or shock at the moment of death.

You're using the language of “letting go” and certainly hospice care does allow us to let go a little bit at a time, which is very different. Then our body is not constantly in this stress mode, with the nervous system overwhelmed.

Gail Pope: You just summed it up for me, kindness and comfort. It's a two way street. It's a journey together. It's a two way street.

Karen Wylie: It is— for them and for us. We'll close this conversation and move forward because we've covered how hospice care can change our grief before the death of our pets. How anticipatory grief can unfold gradually. Why and how allowing a natural transition when possible can reduce guilt and some of this responsibility grief. 

I guess the thing I wanted to say was that hospice doesn't just change how pets die, but it changes how we humans live with the loss afterwards.

For our next conversation, we're going to take a look at how grief continues when our pets physically die and how we proceed after that point. So thank you for being with us for this conversation. We hope you'll return for part two of this continuing conversation about grief. Thanks. Bye-bye.

Gail Pope: Thank you.