Dealing with the death of a patient

We spend our professional life trying to save animals so when the unexpected loss of a patient occurs it can be devastating. I still remember the first animal I lost. A geriatric miniature poodle with rotten teeth. On the day of the dental the anaesthetic was administered and the little fellow promptly went into cardiac arrest.  I don’t remember what anaesthetic protocol was used but I still remember how it felt having to phone the owner and tell her her little pet wouldn’t be coming home. She was very gracious and understanding and ministered more to me than I did to her.

The loss of a patient is a traumatic experience. The worst part is we often feel completely alone. Although staff are supportive there is a palpable sense of relief that they weren’t the one to push the syringe plunger.

Notifying a client that their pet has just died has to be the worst moment for any vet. We are told good client communication prevents complaints. The difficulty in these situations is we are not in a good head space to communicate effectively with anyone. It is not unusual to feel:

  1. Traumatised: No one loses a patient and walks away unscathed.
  2. Conflicted. Telling a client their pet is dead is never easy. We know we have to speak with them but it is the last thing we want to do.
  3. Fear and apprehension. We worry that the client will be less than understanding.
  4. Loss of confidence. It is natural to question ones professional ability when things go wrong. It is equally important not to let failures define us.

There are three situations where sudden patient death can occur. Anaesthesia, surgery and adverse drug reaction. Anaesthetic deaths are rare but happen more frequently in animals than humans. Death during surgery is very rare and is usually associated with a serious vascular incident such as uncontrolled haemorrhage. Death from adverse drug reaction is extremely rare.

How to cope with sudden patient death:

It is important to recognise our own fallibility. This should never sanction incompetence but we need to cut ourselves some slack in the face of a disaster. There are plenty of people out there willing to act as our judge, jury and executioner. We don’t need to be one of them.

Allow yourself to have empathy for the pet owner. It is all too easy to get caught up in guilt and become defensive. This can make communication awkward, especially when the owners seek answers as to why their pet died.

We don’t always know everything that is going on with the patient. I have lost what I thought were perfectly normal animals under anaesthetic only to discover some serious anomaly later.  Running pre-anaesthetic bloods is a valuable patient resource.

Be honest with the owner(s). Bull dust just doesn’t work and will find you out. It is advisable to have systems in place to explain risk to owners when pets are booked for procedures requiring sedation, anaesthesia, surgery or other invasive procedures. Risk should never be underplayed. It is better to inform the client of all the pitfalls than try to explain what went wrong when risk has been underplayed. Be aware that insurance companies have a ‘no guilt’ clause in most of their policies. We can be sorry for the loss of a pet but we cannot openly admit guilt for the loss. This may go against how you feel at the time but it is what it is.

Talk with someone you trust. A problem shared is a problem halved. This may be a workmate, your boss, a friend, a family member or a professional councillor. Most Veterinary Associations have some form of support for members who are experiencing emotional difficulty.

Offering a post mortem is contentious. Clients are already upset and the thought of cutting their pet open can seem callous under the circumstances. If we offer a post mortem it can make us seem uncaring but if we don’t it can look like we are trying to hide something. I think there is value for all parties in the performance of a post mortem but it needs to be broached with sensitivity.

The only way to avoid patient loss is to avoid anaesthesia, surgery or the administration of drugs. This is not practical for the majority of vets. We have to accept that death is part of our job. We can do everything in our power to avoid patient loss but they will happen. For some the anxiety of practice is enough to eventually make them leave the profession. Sadly, suicide rates amongst veterinarians are some of the highest amongst professionals. Every new graduate needs to take steps to prepare for times of adversity. It is better to build support networks before they are needed. It is very difficult to look for help when we are caught up in the grip of struggles.

 

 

 

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