I have always been an animal person. If I am being honest, I am just a few pets away from being the stereotypical crazy cat lady of the neighborhood. In fact, there is a high likelihood that the 90 year old version of myself will live in a house with at least a dozen stray cats and five rescue dogs. Animals find me everywhere (ok, maybe I find them). During my high school years, I somehow adopted more than one neighborhood feral cat. I once left a beach party in the Dominican Republic to hang out with the local beach dog. A feral kitten climbed into the wheel well of my tire 8 years ago and she still lives with us. I went to the pet store for cat food one day and witnessed a pair of juvenile cats get separated as one was purchased; so, I adopted the other one. I now have three dogs - all rescues and all a bit quirky.
Why do I have so many pets? It's simple, really. They bring me and my family lots of joy. They teach us invaluable life lessons; things like love, patience, responsibility and care giving. But, they also teach us about something else - grief and loss.
When our senior dog, Sandy, made it clear to us that her time was coming to an end, we had a long conversation with our two boys, ages 5 and 8 at the time. The plan was that our veterinarian would come to our house and euthanize Sandy in front of the fireplace, her favorite spot. We asked our boys if they wanted to be there and arranged for child care in case they didn't. Surprisingly, they both wanted to stay and be a part of it; and so they were. After spending the afternoon loving Sandy, giving her all her favorite things and carrying her to her favorite places in our home, the four of us sat on the living room floor, in front of the fireplace, in a circle around Sandy while the vet and his vet tech helped us to say goodbye. She died in our arms and it was the most beautiful, amazing and heart breaking thing we have ever experienced as a family. Saying goodbye to Sandy after 12 years was nearly impossible; but watching our children say goodbye to a pet they had known their whole lives crushed us.
Death is death. Loss is loss. Grief is grief. For many people, losing a pet is exactly the same as losing a human and for children, the loss of a pet is often their first experience with death. It was for my boys. It was their first family member to die and I so badly wanted to shield them from the grief but I knew that I just couldn't. Death is as much a part of life as birth and one of my jobs as a parent is to help my children understand and process all the things that surround death. Having worked in the bereavement field for many years and having experienced pet loss twice as a parent, once as a sudden loss and once as a planned loss, I have developed some important insights into how best to handle pet loss with children.
1. Remember that every child is unique.
A family friend recently lost their dog and I asked my two children for some advice for their friends. One child said "Talk about him. A lot. It helped me to remember stories and look at pictures." The other said, "Think about happy things - vacations, movies, stuff like that. Don't think about the dog. I didn't like when I thought about her." Their approaches could not be more different and both approaches are ok. Remember that no two children are the same. Siblings will likely grieve very differently. It is normal. How one child handled one pet loss may be different than how they handle another pet loss later in life. Remember that there is no cookie-cutter approach to handling loss with children. Let their individuality guide you and resist the urge to compare.
2. Be honest
If you know a pet's health is failing, be honest with your children. Children are smarter than we often give them credit for and they probably have already noticed the same signs you are noticing as your pet's health fails. There is a tendency, especially with smaller pets like fish, birds and hamsters, to lie to children and quietly replace the dead pet with a new pet. I always advise against taking this approach. For starters, your children will, at some point, find out that you lied to them, and while we lie about things like the Tooth Fairy and Santa Clause, lying about death is a different type of lie and can cause confusion in children later in life. Death and grief are painful but your children will encounter them in their lives. Help them face death, grief and loss head on. Look at it as an opportunity for growth rather than an impossible challenge.
3. Invite them to be part of the process
If euthanasia is being considered, let children know, in developmentally appropriate terms, what is happening in the pet's body and what the plans are for saying goodbye. Let your children know they can ask you and the vet questions (check with your vet ahead of time). Invite them to be part of the process and explain what their involvement could look like. Let them know they can back out of the process at any time and have an escape plan ready for them. While having them be part of the process may be scary for us as parents, it can actually provide children with the concrete information they need to more effectively handle the loss. It also sends them a message that they are important and their input is valued.
4. Have grief books available for them.
There are countless books available for children of all developmental stages about pet loss. Purchase books, borrow some from a friend or take home a few from your local library. Leave the books in a designated spot in your home and let your children know you are always available to read the books with them or they can take one and read it on their own. This approach gives children control and power but also sends the message that you are there to support them. Take some time to read the books first to make sure they will be appropriate for your children. A list of books can be found here.
5. Don't be quick to put everything away
We had to put Sandy's dog bed away immediately. It was too painful for all of us to look at. But, we kept her collar out. In fact, it's still out. Her ashes and collar sit on our mantle, a reminder that she was real, our love for her was big and that she was an important part of our family. We found a way to keep memories of her around without breaking our heart into a million pieces. It might be helpful for your children to leave at least a few things out to remind them of your pet. Talk with your children and get their input.
6. Consider some sort of memorial service
This tip may sound a bit hokey and cheesy. This service is not for your pet, but for your children. Formal services help us to acknowledge and share our grief. Children often need this time to openly and formally express and share their own grief and also observe the grief of others. Children can draw pictures, write out cards, put together a memory board or picture book and say a few words. Invite them to participate but let them know it is not necessary. Let them sort of drive the bus. One child may want to participate while another may not want to be involved. Both approaches are acceptable.
7. Have some quiet family time
There is a tendency to distract and keep everyone busy following a pet loss. While this is a good approach to a point, it may send the message that grieving about your pet is not normal and not allowed. It might send the message that grieving is abnormal and shameful. Some quiet time as a family should be scheduled to allow for some natural grief reactions to occur - things like movies at home, board games, quiet time for reading, etc may be quite healing for everyone. Sometimes, especially when we have active children, our lives move 100 miles an hour and time for things like grieving just slips away. Create some space and time for your children to feel and express their emotions. Bedtime also seems to be a good time for families to share some quiet moments together.
8. Remember that "mad" and "sad" do not equal "bad"
Anger and sadness are two of the most common emotions felt by children following a loss. For many children, these feelings are complex, confusing and overwhelming. As children are concrete thinkers and death is such an abstract concept, expressing their feelings with words can often be a challenge. Thus, it is common for some children to express their grief through actions and sometimes these actions can be labeled as "bad" behaviors. You may see increased acting out behaviors like siblings fighting and bickering more, teasing, negative attitudes and grumpiness. You may also see regressive behaviors such as bed wetting, thumb sucking, asking for help with things like tying shoes - things they were able to do for themselves previously. These reactions are often normal and are temporary. As children have opportunities to express and process their feelings, their behaviors will often return to normal.
9. Communicate with other adults
Depending on your child's age, they may have other important adults in their lives. Send a quick email to those important people (i.e. their teachers and their coaches) to let them know that your child just experienced a pet loss - not as an excuse for behaviors but as a heads up for the child seeming off and also as an extra set of eyes. Let your children know that you are doing so. When Sandy died, my boys were in 2nd grade and preschool. Both boys' teachers were great and pulled the boys aside privately to express their condolences and gave them an opportunity to talk about it with classmates. One did. The other didn't. The younger one did draw about it later on - sometimes during school, sometimes at home. The teacher appreciated knowing about the loss as it helped guide her discussions with him about his drawings and writings.
10. Be real
The trickiest part of all of this is that you, as a parent, are also grieving. Contrary to what many people think, it's ok to let your children see you cry. You do not need to "be strong." Rather, be real and let go of some of the pressure you put on yourself. When Sandy's remains were ready to be picked up, we were not prepared for how intense our emotional reactions would be. When we got everything home and took the urn out of the bag, I broke. Sobbed. Then, we all did. You know what? We were ok. We supported each other and my children were not scarred by seeing me cry. Rather, they had the opportunity to see me safely express my raw feelings and saw me put myself back together. Give your children a good model for grief.
For most people, many of the suggestions provided feel strange and uncomfortable. I get it. It is quite likely that my suggestions are completely opposite of what your gut may be telling you to do. So many of us have been conditioned to not openly grieve, to not talk about our feelings. Think about how we, as a society, view death and grief. We avoid them, at all costs. We provide 3 days off for bereavement and then send the message to those that have lost someone that they should hurry up and move on, get over it, find closure. I firmly believe these messages are wrong.
There is no such thing as closure. We never heal after a loss. There is still a hole in our heart and sometimes something triggers us, sending us right back into the dark depths of grief. That is normal grief. As parents, we can choose to send our children a different message about grief than the message that many of us were given. We can teach them that feeling pain and grief after a loss is normal, acceptable and healthy. We can provide opportunities for our children to express their feelings and can reassure them that grief, although at times messy, uncomfortable and frightening, is normal.
The Association for Pet Loss and Bereavement
The Pet Loss Support Page
If you have ever known someone with a terminal illness, you probably are at least somewhat familiar with the "H" word. You know the word. It's the one that makes many people cringe when they hear it. It's the word that can stop a cocktail party conversation in its tracks. It's the word that most people facing an illness with a loved one hope no one ever utters around them. It's the word that for many people is synonymous with giving up, giving in and asking to die. For many, it's a word that is probably uttered less than a curse word.
Even the act of reading the word stirs up deep dark painful feelings. I can hear many of you now. "Once THEY got involved, mom died right away." "THEY only want to kill their patients." "THEY make you give up all hope." "We don't need THEM." Many of you have already gone ahead and closed down this article. Often, people want to avoid talking about the H word at all costs - even if it means losing out on an opportunity to improve someone's quality of life when quality perhaps matters the most.
But, like any good Social Worker, I'm here to gently encourage you to look at the hard stuff; explore your feelings a bit more in detail, offer some education and perhaps even aid you in adopting a new perspective. What if we could change our collective view of Hospice? What if we could truly find a way to help people at the end of their life?
Don't get me wrong. I completely understand the feelings and the sentiments about Hospice. But, the vast majority of the information I hear from the general public about Hospice is wrong. In my professional and personal opinion and experience, Hospice and Early Intervention (or Part C Services under IDEA Law) Services are two of the most misunderstood and under utilized resources available to Americans.
For many people, it seems Hospice is only considered in the last few days of life but that's a bit like only being open to enjoying summer during Labor Day weekend and forgetting about May, June, July, August and the start of September. When selected with open-mindedness and proper timing, Hospice can be a gift and an opportunity.
Hospice Improves Quality of Life and Provides Extra Support
Think about what many people facing terminal illness experience as they approach the end of their life: pain, hospitalizations, financial burdens, loss of power and independence, isolation, fear. Hospice can help with all of that! Nurses and doctors who specialize in effective pain management are available for consultation with one of their primary objectives being patient comfort. Conditions, treatments and problems that usually require hospitalization can often be successfully and comfortably managed in a patient's home. No more ambulance rides, waiting in emergency rooms or having to share hospital rooms with strangers. If the patient would like, they can have multiple hospice visits per week from people such as nurses, home health aides, homemaking professionals, social workers, chaplains, volunteers and alternative therapists specializing in treatments like music, massage and reiki. Family members can take a break and be more than caregivers. They can be family again - just there to visit. Hospice can even arrange for 5 days of complete respite care for patients and families. Patients can have someone to talk to without feeling like they are burdening their family. With Hospice, patients' experiences at the end of their life can be quite different. Imagine what it could look like: comfortable, at home, less financial stress, ability to make decisions, companionship, space to safely process feelings.
Hospice Just Might Make You Live Longer
What? You are eligible for hospice when two or more doctors believe that it is likely that with typical progression of your disease, you could die within 6 months. Yet, research has shown that sometimes signing on to hospice not only improves your quality of life but also lengthens how long you live. (Click here for additional information on this research.)
No, Hospice doesn't have a secret, magical cure. Rather, I suspect that the improvement in quality of life and the additional supports allow patients to relax and release some of their stress. This change in quality and focus then translates into more time. Not just more time though - better time!
Hospice May Allow Greater Control
Some of my most amazing professional memories have come from my work in Hospice. With Hospice, patients are given space to dream and imagine ways to take control of their final months of life and truly make some life changing decisions. I have witnessed a young father purchase beautiful earrings with the support of Hospice to be given to his teenage daughters on their future wedding days, long after he would be gone from this Earth. I have witnessed a grandfather say that his dying wish was to make it to his granddaughter's wedding. With support from his Hospice aide and generous donations secured from the community by Hospice workers, he was able to attend the entirety of his granddaughter's wedding despite being bed-bound, on a morphine pain pump and on continuous oxygen. And I have witnessed a very young mother pen a number of letters and cards for her then 5 year old daughter to have for future birthdays and special events. Hospice gave these patients the permission, encouragement and tools to leave some pretty amazing legacies. They were able to die without any unfinished business left behind.
Hospice Offers Choices
There are some pretty amazing Hospice agencies out there today. There are small boutique agencies with only very small caseloads. There are mammoth agencies that serve thousands of patients. There are agencies that only provide hospice services at home and agencies that only provide service in nursing homes. Patients have choices! Patients and families can choose the hospice agency that best meets their needs.
Hospice Does Not Require Giving Up Hope
Many people believe that you cannot sign onto Hospice until you are unable to work, unable to leave your home, unable to drive and have agreed to sign a DNR or MOLST form. Guess what, it's simply not true. Contrary to what some people believe, there is no need to sign a Do Not Resuscitate or Medical Order for Life Sustaining Treatment. Patients can change their minds and discharge themselves from hospice services. They can change their minds again the next day and reinstate Hospice. Patients can still be working full time. Patients can drive and travel long distances. I once helped a patient travel from Boston to Hawaii to see her family and arranged for Hospice care from a Hawaii-based Hospice agency while she was away! Some Hospice agencies even have open door policies that will continue to pay for treatments like chemotherapy and radiation while a patient receives Hospice services.Patients can still fully live their lives while also accessing services and supports through Hospice. Patients can still have hope!
Hospice Provides Bereavement Support for Families AFTER Loss
Perhaps one of the biggest secrets in Hospice is the existence of bereavement support. All Hospice agencies are required to provide bereavement support to the families of their patients for at least 13 months following the patient's death. Many hospices facilitate grief groups, provide individual grief therapy, host annual memorial services and provide monthly support newsletters. The bigger secret? You can access most of these bereavement supports even if your loved one did not access hospice.
I know that not every Hospice agency is perfect. I know that not every Hospice worker is in the field for the right reasons. I know that some people have had truly awful experiences with Hospice. None of those, however, are the norm. Hospice does not have to be the "H" word. Doctors and well -meaning friends don't have to tiptoe around Hospice discussions with patients. Hospice can be a light in the storm, a ray of hope, a lifeline. It can be good.
If you are interested in learning more about Hospice agencies in your area, either for a patient or as a potential volunteer, please visit the National Hospice and Palliative Care Organization website at http://www.nhpco.org/find-hospice
"You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die."
- Dame Cicely Saunders, nurse, physician and writer, and founder of the hospice movement
Sometimes when I walk into a patient's room I can feel their emotion before they say a word. This morning was one of those times. The grief hung thick in the air and was visible on my patient's face as soon as I entered her room. As if she had a shameful secret that she had been saving for my ears only, she quickly shared with me recurring feelings of guilt and sadness about her daughter, husband and brother - all deceased. Her usual cheerful, bright mood had been replaced this week with irritability, restlessness and a great deal of self-doubt. Casting her eyes down at her hands and sighing loudly she said, "Something's wrong with me. I looked down at my hand at Bingo last week, saw my ring and started crying about my husband. That's not normal. I'm not normal."
I'm willing to bet that, at some point or another, all of us have thought this very same thought: "I'm not normal." You know the feeling, suddenly, out of nowhere, we are reminded of a loss in our lives. A rogue wave of grief, sadness, despair washes over us without warning and suddenly we are drowning in our sorrow. Again. It's as if the loss has happened again. Days, months, years may have passed since the loss but it feels brand new again.
Right behind this wave of grief comes another wave - a wave of embarrassment and shame. What do we often say when this happens in front of someone else? "I'm sorry." We place intense pressure on ourselves to keep our feelings inside and to manage the grieving process in a neat, tidy, orderly and proper manner. It's easy to see where this pressure comes from; just look at what happens when we suffer a loss. Most employers provide their employees with a mere 3 days of bereavement leave after the loss of an immediate relative. 3 days. 3 days? 3 days!! After those 3 days the message begins to creep in from a number of areas that it's time to pull yourself together, stop crying and move on. Guess what? That message is wrong.
Grief doesn't go away. The wave doesn't crest, crash on the shore and disappear. It stays with us. Forever. The hole in our heart never goes away. It never heals. There is no closure. Grief is forever. When we lose someone, that loss stays with us. It changes us. It's always there, just beneath the surface. It doesn't mean it breaks us or ruins us or takes away all hope. It just becomes a part of us and it is certainly not a part of us that should bring us shame. So, sometimes, when we look down at our hand and catch sight of our deceased husband's wedding ring on our finger, we grieve all over again. Nothing is wrong with us. We are normal.
Imagine what would happen if we stopped feeling embarrassed about our grief, stopped apologizing, stopped trying to control and contain it and just acknowledged it honestly and supported each other unconditionally. What if instead of saying, "something's wrong with me" or "I'm not normal" we said "This is grief and it's ok to show it. I'm just like everyone else."
Wouldn't that feel better?
Grief is everywhere for all of us - yet our society does a poor job allowing people to grieve. It is ok to grieve and it is normal to struggle with how to continue living your life while dealing with grief.