On December 31, 2013 we lost Lexi our beloved 4 footed family member for 10 and 1/2 years. Lexi had a very fast acting cancer.
Lexi was a huge part of my boy’s life and even after my divorce spent special time with my x-husband, Mike. She was a dear, shy, wonderful friend to all of and will be dearly missed…
I think of Lexi as a puppy, so small she could curl up in a laundry basket, her little nose peeking out of her special blanket. Or the look on my son Josh’s (now 23) face when Mike surprised Josh at Kung Fu practice with little Lexi. Now at 79 pounds (Lexi had lost 10 pounds in 2 weeks because of the cancer) Lexi was family and we were heart sick when the results of her ultra sound showed her liver, spleen and major blood vessels were stricken. Lexi had only a few days before the internal bleeding would take over. We had to make some make some major decisions that would make things as easy and stress free for Lexi as possible…
I had recently read about an organization, “Home to Heaven” and felt their ability to have a veterinarian come to our home was the way to go. I also felt that the ability to say goodbye to Lexi in her home where she would be surrounded by those that loved her was a much better option than going into the animal hospital. Plus Lexi was not fond of going to the veterinarian and I didn’t want her final memories to be stressful. My boys were behind me and Mike agreed this would be the best for Lexi.
We proceeded to set up an appointment with Home to Heaven for Thursday, January 2. The staff at Home to Heaven were wonderful and reminded me that if for any reason Lexi was getting worse and we were worried about her being in pain they could come to our home sooner.
Everything happened so fast. The results of Lexi’s ultra sound came back on a Monday and by Tuesday morning Lexi was having trouble breathing and had a very swollen belly (which indicated internal bleeding). I called Home to Heaven and they scheduled Dr. Becky Flemer to come out at 2:00 that afternoon.
As all of us (Mike, Josh, Brandon and his girlfriend Macy) waited for Dr. Flemer we gave Lexi lots of attention and one of her favorite treats. We told stories of Lexi and all the special moments from the last 10 and 1/2 years. All of us were dreading having to face losing Lexi and I have to admit I was worried that it would be stressful or even painful for her.
When Dr. Flemer (Becky) arrived she put all of us at ease. She had a wonderful calm energy and Lexi (normally shy) went right up to her.
Becky went over everything that would happen. First she would give Lexi (just under the skin) a sedative that would put her into a deep sleep. While Lexi was in a deep sleep and when we were ready Becky would administer the drug that would stop Lexi’s heart. Becky also talked about some of the things we might see after the drug was administered such as an increase in heart rate and emptying of the bowels. Though, as Becky also said Lexi would not feel these things…
When we were ready we had Lexi lay on our living room floor surrounded by all of us. Lexi was calm. When we were ready Becky gave Lexi the sleeping medication. Lexi didn’t even feel it. Within 10 minutes Lexi was sound asleep…
When we were ready Becky administered the drug that would stop Lexi’s heart. As Becky was doing this I said the Shem’a, thanked Lexi for the years of love and joy she had given us, that we loved her and would missed her and asked that her soul pass peacefully…
Through tears of sorrow we watched as our beloved Lexi passed. There was not an increase in heart rate and an emptying of her bowels. Lexi passed peacefully, spiritually and without pain…
We knew that our love for Lexi had given her this gift. A peaceful passing in her own home surrounded by the people that cared and loved her…
As sad as all of this was this ritual around Lexi’s passing was something of beauty. Everyone involved knew we had done the right thing in a truly loving way…
A process that left me feeling really good about what we had done and how we had done it. I knew that Lexi’s spirit had gently passed on and “she was home”…
Although today (January 8, 2013) was the first time that I met an incredibly sweet and gentle soul named Finnigan, I was fortunate enough to feel as if I already knew him. I had the great pleasure of speaking with his mom for some time, and her glowing description of her precious Finn was so accurate. Finnigan had begun to decline in health, and doctors´ best estimate was that he would not live past September or October. However, Finn surprised them all, by not only surviving but continuing to thrive and be the happy-go-lucky boy he always was.
Finn´s mom worked so hard to keep him as comfortable as possible, even moving with him to a home without stairs, to make it easier for him to have a normal daily life. Although she herself is a strict vegetarian, his mom even made sure to stock up on all kinds of meat, to help Finnigan stay strong and healthy. Throughout everything, Finnigan absolutely never complained, and even as he became weaker and had more difficulty walking, his tail never stopped wagging.
Finnigan could not have had a more peaceful passing. This morning, he enjoyed having a delicious snack of chicken nuggets. He was able to go with his much-loved human friends to the forest preserve where he had enjoyed many happy times with his mom. It was a beautiful crisp day, and Finnigan took in every bit of it, chewing on sticks, giving friendly kisses, and happily enjoying some more treats in the park. He lay down on his comfortable bed in the fresh air, and relaxed and became sleepy, lying nose to nose with his beloved mom. Finn´s last sweet breath was the familiar smell of his mom, comforting him through his very last moments. ~ Dr. Juliana Lyles
If you want to read the entire blog, visit Brandi here http://lugofmylife.blogspot.com/2013/01/the-eulogy.html
Yes, my day started off with a heavy heart as I remembered this day nine years earlier when Mico died. I had foolishly thought the surgery would take her back to the “old normal” – the vivacious little puppy that was my entire world! But, it wasn´t to be – and April 21st will always come with a set of emotions for me that span from sadness because she is gone – to gratefulness in what she has done for me in my mission and in my work. I will eternally be grateful to her for the lessons she taught me and for being such a large “chapter” in my life!
So while the day was a bit heavy – it was also an exciting day,…. a day that Wes and Amy welcomed into their life a little “canardly” (when one “can hardly” tell what the breed(s) are!)! Oh the text was amazing! A photo and a message straight from Mommy-Amy that read “Welcome to Your New Grand-Furbaby – Berky!” I almost cried as I thought about what the adoption of this little pup really meant!
Here was a little puppy, 12 weeks old, who was now an integral part of Wes and Amy´s life journey. Their journey that started off with their marriage chapter now has another chapter, one with a wiggly, black little puppy. A puppy who would now be a large part of photos, of travel planning, of social planning, of stories, of Christmas traditions, of her own rituals, and would grow into this being with a personality that will forever change them. A doggie that now organically will be a part of their new young life together and of the many adventures that await them during this time!
So while this day was bittersweet for me – with the adoption of Berky, I couldn´t help but to also remember the day that Mico came home. A two-pound puppy, 5 weeks old, smelling like a shelter,… Ah, I remember it like it was yesterday! It was so exciting! I became this pet-mommy that did everything I could to make sure Mico was happy – was content – and was living a life that every puppy could dream about!
Who would´ve thought that day would change my life and my life´s mission forever?
Education about medical treatments is just as important as education about death care processes
Here´s the article that Dr. Marty Becker shared – in its entirety:
Sticks and Stones May Break Your Bones, But Words Can Cost Your License
By James F. Wilson, DVM, JD; Christina Moore, DVM candidate 2012; Erich Roush, DVM candidate 2013
November 15, 2011
A 10-year-old Yorkie died unexpectedly after receiving the third mitotane (Lysodren, drugs.com/pro/lysodren.html) tablet you dispensed to treat her Cushing´s disease. You know that either you or your room technician told the client about the possible risks and complications of this treatment because “someone always does.”
Now you are being investigated by the state veterinary medical board, your license is at stake, and Ms. Loveherpet is threatening a lawsuit for $100,000 in damages for emotional distress for the loss of her best friend “Gigi.”
Even worse, she´s threatening to trash your practice by starting a website to determine how many other pets you have “killed.” You couldn´t sleep last night because all you could think about were the 14 years of your life you´ve spent building a practice that is now at risk because of a simple breakdown in communication.
According to Laura Downes, executive director of the Maryland State Board of Veterinary Medicine, unprofessional conduct lawsuits often boil down to charges of negligence or issues with communication. She says, “It is not uncommon for investigations to indicate that the standards of medical care have been met but documentation of the communications by the veterinary team was inadequate. If the pet´s condition deteriorates or the pet dies while under veterinary care, clients often assume that substandard care was provided. Excellent communication at the beginning and throughout treatment can assuage misunderstandings later should the pet not respond favorably to treatment.” Complaints from clients can result in hefty fines, mandatory continuing education, and even license suspension.
Facing the Facts
Many veterinarians will face situations like this at some point in their careers. Downes estimates that 75% to 80% of client complaints to state boards are the result of breakdowns in communication. Poor listening skills are cited in a large percentage of medical negligence cases as one of the main reasons why individuals take legal action against health care professionals.1
One of the main issues in these cases stems from obtaining educated owner consents. Without discussing diseases in lay person´s terms and documenting communications in patients´ records, clients can easily come back and say, “I didn´t realize this procedure required so many follow-up visits and care or had so many possible adverse effects, or I never would have agreed to it.” For this reason, the use of clear communications as well as written, signed consent forms that educate clients about the course of treatment and risks associated with various procedures helps minimize communication errors and omissions.
See the Informed Consent Form
What´s worse is that these facts may not change any time soon. Only 6 of the 26 veterinary schools researched for this article list a specific communications course in their curriculum, either as a required class or an elective.2 Some schools, like Washington State, Wisconsin, and Minnesota, require multiple courses that are specifically focused on communications throughout the 4-year program.2 Many others have some coverage of this important skill scattered throughout the curriculum.2 Still, the community of veterinary schools as a whole is not doing enough to provide veterinary students with sufficient client communications training.3,4
Common Mistakes
Typical communication mistakes veterinarians make include the following:
1. Assuming that other team members provide accurate and relevant information to clients without providing them with detailed scripts, question lists, educational consent forms, and/or operational instructions to use for key client interactions.
2. Assuming that clients understand what is being explained just because they are nodding along or saying “yes” or “uh-huh.”
3. Using closed and/or leading questions that suggest certain answers without allowing clients to expand on them.1 While closed questions make it easier to control the discussion, they can make clients feel intimidated or threatened; open-ended questions allow clients to describe their experiences, feelings, and understanding of the subject under discussion.1
4. Assuming that clients do not have the resources or are not willing to pay for what´s best for the patient and failing to explain why that course is the best option.5
5. Failing to use legal consent forms and discuss the issues they contain.6
Communication Strategy
There are many things you can do to ensure that you or your associates never face state board complaints, investigations, and/or disciplinary actions as a result of simple communication errors.
Use the term “medical care plan” instead of “estimate” to focus on courses of action for patient care. This semantically different term emphasizes the diagnostic and treatment part of the plan and diminishes the focus on money.
When possible, stand side-by-side with clients as you educate them, using “show and tell” models, images, or handouts. Encourage them to stop you for clarification and ask questions as you are explaining procedures or as they read the consent forms they are signing. When clients hesitate to sign consents, say, “Please be sure to tell me about any concerns you may have.” The side-by-side posture decreases the image that you are using confrontational communication techniques and, instead, illustrates rapport-building communication.
As much as is practicable, document all forms of communication in the medical record, including in-person educational discussions, phone conversations, and emails. Recording modestly detailed notes during and after these conversations allows you to refer back to them later, when time has faded your accurate recall of events. Detailed records ensure that you and your staff look and are “smart”; incomplete records make all of you appear careless. Remember that documenting courses of action that were recommended and deferred or refused is just as important as documenting the risks and adverse effects of procedures that may have been accepted.
Learn to use personality assessments such as Myers-Briggs (myersbriggs.org) or DISC (discprofile.com) to help staff understand their communication styles. Practice communicating with clients and staff who have different personality types to better understand how to be more effective.
Do your best to assure that someone on your team can speak Spanish or at least communicate in this language using medical terminology. According to the 2009 U.S. Census Bureau, 12% of the population is Spanish-speaking-and that number is only expected to increase.7 Keep an English/Spanish medical dictionary in your clinic and hang posters in or around the exam rooms with translations for common phrases and terms used in veterinary exams. Don´t let language be a barrier between you and your clients!
Invest in books that teach communication skills. Handbook of Veterinary Communication Skills by Carol Gray and Jenny Moffett, Getting Past No by William Ury, and Legal Consents for Veterinary Practices, ed 4, by James F. Wilson are good resources.
Communication regarding medical subject matter is a skill that is developed over a lifetime of effort and experience. You can educate yourself and your team regarding the most common mistakes and how to avoid them. Fundamentally, if we communicate well, then our clients will be happier, our patients will get well quicker, and we will all enjoy our jobs more.1 | EVT
References
1. Handbook of Veterinary Communication Skills. Gray C, Moffet J.-Ames, IA: Blackwell Publishing, 2010; pp 15-26.
2. Research performed by Christina Moore referencing web-based course content for all U.S. veterinary school curricula, 2011.
3. The KPMG study: The current and future market for veterinarians and veterinary medical services in the United States. Brown J, Silverman J. JAVMA 2:161-183. 1999.
4. NAVMEC Report, final draft. aavmc.org/veterinary-educators/navmec.aspx.
5. Law and Ethics of the Veterinary Profession. Wilson JF, et al-Yardley, PA: Priority Press, 1989, p 112.
6. Legal Consents for Veterinary Practices, 4th ed. Wilson JF-Yardley, PA: Priority Press, 2006, pp 4-7.
7. Language spoken at home: 2005-2009 American community survey. U.S. Census Bureau; factfinder.census.gov.
It was a tragedy heard round the world, the loss of numerous Navy SEALs in combat. A loss that breaks anyone´s heart; tugging at my heart even more with a son-in-law SEAL.
But, what began to tug even more so at hearts was a photo taken at U.S. Navy SEAL Jon Tumilson´s funeral in Rockford, Iowa. A photo showing unconditional love at its finest – Jon´s buddy, Hawkeye, his loyal friend, not leaving his master´s side, even when his master lie in a casket.
Huge kudos to the Hauser Funeral Home staff for supporting this act of love. An act that, as described to me by Mr. Allan Whiteside, funeral director and manager of the Hauser Funeral Home, made all of the sense in the world. For, as Mr. Whiteside said “Hawkeye was a huge part of Jon´s life. Therefore, it only made sense that he was a part of this too. It´s what Jon would´ve wanted. It´s what all of his friends wanted, and needed.”
While the Navy SEAL´s team was mostly in charge of the arrangements for Jon´s service, the Hauser team was there to support their every need. Therefore, when it was mentioned that Hawkeye should be there, Mr. Whiteside said “we were all for this, too. Having Hawkeye there was an incredibly appropriate thing to do.”
So, again, kudos to the Hauser team for supporting this act of love!
And, now I turn to you – as pet care professionals, we are serving pet parents every day in our business. Are you proactively asking if there´s a pet at home that should also be involved in the final arrangements; a part of the visitation, a part of the service, given a chance to say their “good-byes?”
For, although, these may not be deaths that were broadcast nationally, these people are heroes in someone´s eyes. And, that someone possibly might have four legs.
Did you see CNN last week? My good friend, Jim Rudolph, made me aware of their latest finding! Grand-puppies! The latest demographic to emerge in this crazy pet world,… there are now officially “grandpuppy-parents!” And, let me tell you – they are a proud group!
The beginning of the article shows a pet mommy Skyping her fur-kid, Gracie´s, grandpuppy-parents. And, they all look like they are having a ball! Including Gracie, who appears to be incredibly intent on talking to her grandpuppy-parents.
From the article,… “When we look at the evolution of the dog from protector, hunter, to companion, it may not be so unlikely for the dog to appear in the ´family tree,´ ” said Dr. Rebecca Johnson, director of the Research Center for Human-Animal Interaction at University of Missouri College of Veterinary Medicine.
So, there you have it. There are grandpuppy-parents – grandkitty-parents everywhere! They might be waiting on human grandkids but there´s been a delay in this, for some reason. They might have a child that doesn´t want children and will only have their fur-kids. Or, maybe it´s a baby boomer who´s empty-nested, adopted the new kid, a pet, and bring these new grandkids to their parents. And, a variety of other scenarios!
Therefore, when one of these precious grandpuppies or grandkitties dies, a grandparent will want to remember their relationship with the special pet too. There are numerous things that one can do to honor this love:
Create a special rock to honor this pet in their flower area.
Make a clay paw print to showcase next to a special photo.
Remind pet parents with point-of-purchase signs to remember the grandparents with numerous other memorialization pieces.
Purchase a piece of cremation jewelry to hold a bit of the pet´s fur.
Include the grandparent´s names in the on-line memorial posting of the deceased pet.
Have a portrait done of the pet.
Have a special blanket done with a picture of the pet.
And, many more things that can be done.
Just a hint, as hard as it can be, make sure to have these pre-planning conversations with the Grandparents ahead of time. Understand how they will want to remember their special pet,…
Bottom line, this demographic is proud to be a grandparent of a dog or cat. Therefore, GrandPuppy-Parents and GrandKitty-Parents will want to do all they can to honor the relationship they had with their precious “grand-kid.” As a pet loss professional, it´s our responsibility to help them with this process. They deserve it.
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