I seem to be working with a theme here after my last post, but I believe that end-of-life, palliative care, and hospice are such important concepts and techniques for veterinarians, veterinary health-care team members and pet-owners to embrace.
I had a deeply personal encounter with all of this in May of this year. In spite of nearly seven years of preparation for my mother’s death, knowing that she would ultimately succumb to the ravages of ovarian cancer, it still came as a shock when it was her time to enter into hospice care in the final days of her life.
My mother had never been a patient of a physician here in Northern Colorado during her journey with cancer. Her medical oncologist has his practice many miles away, and she “commuted” between Colorado and his practice during her illness. She was committed to remaining his patient as he had demonstrated his commitment to helping her achieve her goal of long-term survival in spite of disseminated ovarian carcinoma. When the time came for her to enter hospice, I worried that having her previous oncology care so far away might be a barrier to her receiving her end-of-life care close to my home. My mother’s greatest fear as she faced her final days was that she would experience unrelenting pain. As a pain-management expert who just happens to be a veterinarian, my greatest fear was that I would not be taken seriously by the physicians involved in her care as I advocated on her behalf.
I can never adequately express my relief and gratitude that my worries were unwarranted.
Once it was clear that my mother needed an interventional approach to hospice, I began a dialog with the medical director of the hospital-based hospice. It was important to me to establish open communication about my involvement in my mother’s care as she approached her death. It was her request that I be actively involved to help mitigate her pain, discomfort, and distress and to act as her medical advocate. The medical director could not have been more supportive of my assuming that role on my mother’s behalf.
My mother entered hospice on a Tuesday and she died peacefully, quietly, and free of pain 11 days later. During that time, I and my family had the privilege to witness the incredible team of hospice workers – nurses, CNA’s, social workers, chaplains – weave their comprehensive “quilt of caring” with which they surrounded my mother. At every step of her process, my mother reaped the benefit of their many years of collective experience. I was welcomed to participate in every aspect of my mother’s day-to-day care. For this I shall remain forever grateful. In addition, at each stage of my mother’s escalating pain and discomfort, I was “heard” in my requests for a matching increase in her pain management strategy. Working together, all of us empowered my mother to achieve the balance of adequate comfort with mental clarity – - a balance that was critically important to her.
What an inspiration this experience was for me as a provider of advanced pain management, palliative care and hospice to animal patients. It was heart-breaking to lose my mother. But it was a blessing to participate in her final journey here on earth. It gave me new perspective to imagine how it can be for our animal companions whose curative care is behind them but whose lives truly are not yet over. Intercepting and defeating escalating pain for my dying mother, particularly once she lost the ability to communicate by speaking, makes me fearless in my pursuit of advocacy on behalf of those beings we in veterinary medicine serve – advocacy on behalf of beings who cannot advocate for themselves.
This experience, unlike any other so far in my life, fuels my passion for outreach – to veterinarians, to veterinary technicians, to students, and to pet owners – - to educate about what is possible in the face of the inevitable. We have so much to learn, but examples are out there for us to follow.
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