For those of you following my blog, you know that my 14-year-old Somali cat is currently in hospice care for suspected infiltrative GI lymphoma. We were given a rainbow of hope when we started Prednisolone, even though it upset me to move to the “last step” in her treatment. In other words, the Pred is the last thing we can do to help her. I knew this, so starting it seems like the end. But she rebounded so nicely, started putting weight back on and grooming herself more. Then we fell under the delusion that maybe she isn’t sick after all? My friend the hospice nurse said this was normal, families begin to feel like maybe the end isn’t coming, because the animal responds so well to the treatment. Yet she warns, it’s just that the palliative care we are giving her is working, for now. In practice, we often have families who cling to the last little bit of hope. Sometimes it borders on denial, and it’s difficult to make them understand that their pet is suffering. This is particularly true because most people don’t understand how a pet demonstrates suffering. This is even more true when the animal is being hospitalized for their condition. We’ve all seen it before; a hospitalized patient who musters up every little ounce left of happiness, and spends it all on their families when they come to visit. As we watch the dog finally wag its tail, or a cat responds with purring to its owner, we may think, wow, this is not how s/he is doing back there in the cage for the other 23 hours of the day! At the same time, the family is thinking, well, s/he’s not really that sick after all, look how good s/he looks! It becomes difficult to explain to the family that this reaction is great, but may not be indicative of the animal’s true condition. The side effect of this type of situation is the impact it has on the veterinary practice team. The team, particularly the medical support staff, must take care of this animal all day or night long, knowing the poor condition s/he is in, and wondering why the family is letting him or her suffer like this. This impacts the team even more than the attending veterinarian, who is rounding every day with this patient, but is spending a lot of time with new or other existing patients. Whereas the medical support staff is delivering nursing care to this animal around the clock. It makes us wonder, is the doctor explaining this suffering to the family? Is the family being cruel by not ending the suffering? We can even get angry, at both or either one, for the suffering we see. This anger or disappointment also rubs off on our relationship with the doctor or family. Where should we take these feelings, so we can discharge them and move forward? That is the big question. The big answer is closer than you think, talking to your peers who are experiencing the same thing. Ask questions of the doctor and get answers. Find out from the doctor what is the reason this family is holding on to hope? At the end of the day, hope is the only thing left to hang on to.
