Anticipatory Grief Complexes Cancer Management

Dealing with grief caused by having a pet sick with cancer can be difficult if not all aspects of the grief are understood.

She had a Kleenex in her trembling hand and was on the verge of tears when I entered the room. She burst into tears as we discussed the biopsy and the overall poor prognosis.

She could not hold herself back from intense feelings of loss and injustice and regret. She told me that she just loved her dog and that she did not want her to suffer from the awful cancer that had invaded the base of her tongue. She declined surgery, radiation therapy and chemotherapy (which would have only been palliative anyway). She said that even though Dori had lost 17 pounds and had trouble eating, she was still behaving close to normal and was cheerful in every other way. So she wanted me to do what ever I could do to help Dori live a quality life.

I introduced the concept of end of life care. I like to call this phase of cancer care, “Pawspice” in honor of Hospice, the home care system set up for people with terminal illness. We talked about recognizing and learning to correct the 3 H’s (Hunger, Hydration and Hurt).

Then she burst out into extreme grief with the tears flowing again. Even though my other two exam rooms were full and there were people in the waiting room, it was important to focus on my client’s distress for a few precious consultation moments.

I began by letting her know that we will help her and her pet through the next several months and that she is not alone in her grief. I let her know that pet loss has the power to bring all our personal losses to the surface and that grief makes one feel raw all over or feel like there is an open sore over one’s heart. I suggest that pet loss tears are shed not only for this pet, but also for all our past losses and that these tears that come so freely may be called “tears of the ages.”

She then burst out with deep emotion telling me that she rescued Dori from the pound just after her brother committed suicide. She went on to tearfully tell me that her father had recently died and that she was holding his hand when he died and that she just could not take another loss. Now we both recognize that the deep grief truly is for all her losses and that Dori is helping her deal with repressed grief in a very special way. I go on to say that, “Dori has a mission in her life and that she won’t leave her until it is accomplished.”

This brings the grieving person to a reality checkpoint. When it seems appropriate, I tell her that I am now going to put the hat on as Dori’s doctor and that I will help in the care and medical treatment to the best of my ability within their means and their philosophy. We continue the examination and make a treatment protocol for pain control, immunonutrition and client monitoring of the pet’s weight and hydration with scheduled rechecks in order to monitor the well being of both pet and pet owner!

Two days later, a follow up phone call found that she feels much better and so does Dori!

Another client who has a dog that has been in a prolonged remission with cutaneous lymphoma tells me in a phone conversation that she wants to die if her sweet Buddy dies.

This statement is very dangerous to ignore.

The first thing to do right there on the spot whether on the phone or in the exam room (when ever and where ever that statement is made) is to validate the importance of the pet in the pet owner’s life and then say something like this.

“Pets were not designed to live as long as we do. They come to us with an internal time clock, like an hourglass, that runs out way before ours does. If you love a dog or a cat and if you have one to three pets at a time, you will have up to 27 heartbreaks in your lifetime! Some of these heartbreaks especially if it is your first one will be harder to take than others. So you must take Buddy’s loss and each future loss in the perspective of your life as a person who will probably live to be 90! In my opinion pets like Buddy come to you with a special mission on earth. Only you know what that mission is because it is very personal. Buddy’s illness and passing will teach you something about life and death that you did not want to know but you will be a much deeper and richer person when he leaves you. Your love and the joy that he gives you is the reason for your deep sadness. The cycle of life it is round and the highs are always balanced by the lows. Your sadness is a rich emotion just as beautiful and rich as the love bond that you share with your pet. If you let the grief stay inside, it makes a hard knot in your throat. If you release it and let it out, you will be free to just be sad and then go on with your life and your future. You are experiencing life’s richest emotions of love and loss and you will live through this and you will be Okay. Buddy won’t leave you until his job is done and you will know when his mission is completed and you will be the one that tells him it is Okay to go. You will be a much wiser person for the experience that he gives you so that you will be prepared when a family member or close friend gets cancer passes on. You can learn the tools to help others who feel that they are in the same hopeless situation that you learned about so well with Buddy." 

It is also a good idea to kindly and sweetly suggest that you (as their veterinarian) sincerely “see” this person in the company of paw prints in the near future and that their special pet needs an heir. I like to send home the book, Angel Whiskers by Laurel Hunt and ask the client to read my favorite story. Eugene O’Neill wrote this insightful story for his wife who was inconsolable when their Dalmatian passed away, The Last Will and Testament of Silverdene Emblem O’Neill.

Pet loss is a special kind of grief. Much of it is called anticipatory grief. It is important that veterinarians are able to identify this profound sorrow. It often pops up at the time one receives the diagnosis of cancer. Anticipatory grief is often not recognized. Most of these special pet owners will verbalize or act out their grief. We need to validate their feelings of loss. We also need to lead them to the idea of pet loss counseling with either group therapy sessions or with an individual who is qualified and interested in this area of counseling. Because we are a referral practice, we also inform the referring veterinarian and ask them to alert their staff to provide as much comfort and support to the pet owner as possible during the “Pawspice” and to directly encourage the pet owner to seek counseling.

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