The Emotional Costs of Euthanasia: Sarah Hoggan DVM (Transcript)

Here is the full transcript of Sarah Hoggan DVM’s talk titled “The Emotional Costs of Euthanasia” at TEDxTemecula conference.

In this TEDx talk, Sarah Hoggan, DVM, offers a profound insight into the emotional complexities faced by veterinarians during the process of euthanasia. She highlights the paradox of euthanasia as both an act of kindness and a source of significant emotional pain, shedding light on the internal conflicts experienced by pet owners and veterinarians alike.

Hoggan discusses the various “emotional fees” associated with euthanasia decisions, such as hindsight regret and the feeling of betrayal towards the animal’s trust. Through personal anecdotes, including the heart-wrenching story of her own dog, Cooper, Hoggan illustrates the deep emotional impact these decisions have on those who make them. She emphasizes the importance of acknowledging and processing these emotions to avoid the buildup of unresolved grief.

Hoggan’s talk also touches on the broader implications of these emotional costs, including their contribution to the high rate of suicide within the veterinary profession. By sharing strategies for coping with the emotional toll of euthanasia, she offers a message of hope and resilience for veterinary professionals navigating these challenging situations.

Listen to the audio version here:

TRANSCRIPT:

The Magic of Healing

The best part of being a veterinarian is when you get to send a patient home. And I don’t mean the ones that come in for a spay or a neuter or a vaccine. I mean the ones that are carried in, the ones that don’t respond when they are taken from the safe and loving arms of their family by a stranger. I mean the ones that when you see them, you are not confident that you’re going to be able to fix that patient and send them home.

So when they do go home, it’s like watching magic happen.

The dogs go up front to see their families, and they are so excited. They bark, and they cry, and they wag not just their tail but their whole back end. And cats – the cool kids of the animal world – lose their minds. They’re purring and they’re rubbing against the carrier because they’re so happy and they get to go home. It’s literally watching magic happen.

And every single time you see that, and every time you think of it, it makes you happy. Because it doesn’t always happen. I don’t get to do spays and neuters and vaccines. I am an emergency veterinarian. I don’t work at a clinic; I work at a hospital. That means good news doesn’t come to see me. I perform euthanasia daily, and sometimes multiple times a day.

The Kindness of Euthanasia

Euthanasia is a kindness we are afforded in veterinary medicine. I love my job because whether I am saving a life or I am ending suffering, I am making a difference. “Euthanasia” – the word literally means “good death.” Euthanasia is a kindness. “Euthanasia is a kindness” has been broadcast far and wide.

If it is a kindness, why doesn’t it always feel like one? It doesn’t feel like one, because it is a kindness that comes with an emotional cost. There are emotional fees to making that decision. One of the most common fees that I see is the hindsight fee, where, after the fact, people look back and say, “Did I do the right thing?” The answer is, “Yes, you did the right thing because you put your pet’s needs for peace above your own needs to hold on.”

A similar fee that I see is the crystal ball fee, where people look back at a hospitalization or a surgery that they had authorized that didn’t have the hoped-for outcome. And then they beat themselves up, and they lament that decision, and they say, “I shouldn’t have put him through that.” What a treatment failure means – what it really means – is that you know in your heart, you know to your core, that you did every single thing you could for someone you loved.

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The Emotional Cost of Euthanasia

And sometimes, injuries are too severe to overcome and little bodies wear out. And if you had had a crystal ball and could have foreseen the outcome, would you have made a different decision? Yeah, of course you would have. But nobody has a crystal ball. You made the best decision you could at the time with the information you had, and nobody can do more than that for someone they love.

The hardest fee that I see is the betrayal fee, where people feel like the decision to euthanasia is a betrayal to all the love and kindness their animal has showed them throughout their lifetime. And I hear them saying goodbye, and they say, “I am so sorry, baby.” When your pet is in pain, when they are struggling to move, struggling to breathe, when there is nothing more that can be done, giving them a soft goodbye and sending them peacefully to heaven is a kindness, not a betrayal.

I learned firsthand that these emotional fees cannot be separated from euthanasia when I had to send my own dog to heaven last year. Cooper was my 15-year-old beagle. He would leave a trail of carnage as he trampled the chihuahuas to be the first one in the kitchen for bacon. And he had always been like that. Until one day he wasn’t, and I knew something was wrong.

A Personal Journey Through Loss

So I took him to the hospital, and we did the ultrasound. And there on the screen, in black and white, I could see everything I didn’t want to find. There was cancer everywhere. Surgery wasn’t an option, and he was so far gone, chemo wouldn’t have been fair. So my choice was pretty clear. So I told him goodbye.

And my amazing technicians made him a sundae: McDonald’s cheeseburger, vanilla ice cream, chocolate syrup, bacon bits, and a Snickers bar. So they brought it to him, and his eyes lit up. And even as sick as he was, he savored every bite. And he was eating the Snickers bar, looking at me like “Did you know this was a thing?” And so I took the opportunity to tell him everything I needed to tell him.

“Cooper, honey, I love you. And remember the poem I read you about the Rainbow Bridge? The one that connects dog heaven and people heaven? I’m going to be on Rainbow Bridge for you. I’ll find you there. I’m going to be on the green stripe – on the green stripe, okay? Yes, I get it. You’re a dog; you’re colorblind. I – the – the – the – the grass-looking stripe, the – the – the cold stuff you roll on, that’s – that’s where I’ll be.”

So I told him goodbye, and I sent him softly to heaven with breath that smelled like chocolate and bacon. And I thought that was the end. But for three days, this little voice in my head kept saying, “Are you sure you made the right decision? Are you sure you did the right thing?” And it drove me crazy because it went against every single thing I knew. I didn’t need a crystal ball. I had done the ultrasound. I had seen everything right there in black and white, and my mind accepted it.

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Embracing Grief and Love

And that was when I realized it wasn’t my mind asking the question – it was my heart. Because it wasn’t ready to let go and it wasn’t ready to say goodbye. And it did the only thing it could, and that was question. And that was when I had to recognize that this time, I wasn’t just the doctor – I was the family. And I had to sit down, and I had to tell myself, “Yes, it was the hardest decision, but it was also the kindest decision. And I’m going to miss him too.” And with that, I was able to give myself peace.

Grief is the natural price we pay for loving. It is always worth loving. When you are watching your cat trying to bathe and they’re doing their bathing yoga and they’re trying to lick the spot between their shoulder blades and they fall off the couch and then pop up really quickly like nobody saw that? That’s hilarious.

When you’re eating salad and a piece falls on the floor and your dog grabs it and chews it and then – bleah – spits it back out and glares at you like, “That is not food!” Those moments make your life rich. It is always worth loving.

But the grief is hard. The hindsight fee, the crystal ball fee, the betrayal fee can’t be separated from euthanasia. And what they mean is that you are normal and you are grieving, not that you made a mistake. Those are the fees that the family pays. But euthanasia takes a toll on the doctor and the staff as well. Unfortunately, the suicide rate of veterinarians is about twice the national average. Those are the doctor’s fees of euthanasia.

Strategies for Coping

To deal with those, I’ve developed three techniques to keep myself out of those statistics. The first one is I will not do convenience or revenge euthanasia. If somebody’s living arrangements have changed, if somebody finds it no longer convenient to have a dog or a cat and they bring that healthy animal to me and want me to put it to sleep, I refuse.

If somebody brings me a dog that has chewed up the Jimmy Choo heels and looked at the owner with the high heel hanging from his mouth – “These are delicious” – and they want it euthanized, I refuse. The cat that vomited on the Oriental carpet maybe thought it was ugly. They want it put to sleep? I refuse. Euthanasia is too big of a responsibility to be handled lightly for human convenience or human anger. I advise those families to take their pet to the shelter and give him a second chance.

Another technique I use is I give myself permission to feel everything I need to feel in that moment. When a professional Santa Claus came in to me carrying a dying kitten – Santa Claus: red suit, white trim, beard, famous – and I had to tell him I couldn’t fix his kitten, it was sad. You want to challenge your karma? Tell a weeping Santa Claus you cannot save his kitten.

When I watched a police officer in his dress blues lay on the floor and cradle the body of his canine partner that I had just euthanized because he lost his battle not to a criminal but to cancer, it was sad and it was hard. Yes, I do cry. And sometimes I cry a lot. But it is better to cry, to shed some tears and spend that grief currency, than holding onto it and stuffing it down inside me like a deposit and pretend it wasn’t really hard. My grief vault is intentionally kept empty.

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The final technique I use came to me as an epiphany early in my career. One night, a woman brought in a gigantic dog to me for euthanasia. He had very advanced cancer, and there was just nothing more to do. He was in pain. And she told me that the night she adopted him from the shelter, he had saved her life. She went into that shelter that day, not with a plan, just looking, just seeing who she fell in love with. And she saw this giant goofy face and knew he was the one.

So she took home a hundred pounds of fluffy love. And that night, she was awakened by the sounds of a dog snarling and a man screaming. You see, she was a law enforcement officer. And someone that she had put away discovered her address, and he broke in that night with every intention of doing something unspeakable to her. And that was when he met her new addition.

She got out of bed to find a terrified man pinned on the floor. And the giant fluffy face that she had fallen in love with was curled into a snarl that said, “Oh, no. Not my new mom, and not my new house.” So he saved her life. And we gave him a soft goodbye.

The very next night, a woman came in with a little terrier with very severe congestive heart failure. He was old; it was advanced; they had done everything. His little heart had just worn out. Even in oxygen, he was struggling to breathe. There was nothing more I could do. She tearfully told me that he had saved her life and her family’s life years before. One Christmas Eve, they left the lights on – the Christmas lights on – and the tree caught fire. And he barked and barked and barked until everyone woke up, and they safely evacuated the house. She said the paper the next day, the headline, read, “Pepper saves family for Christmas!”

So here I was again, being tasked with sending a bona fide canine hero to heaven. And that was when it came to me that if I was going to send lives lived with this much purity and this much sincerity and love, I had better live my life up to their standards. So that’s when I decided I’m going to live my life like a dog. I don’t just tell people that I love them, I show them that I love them. And when I go to the beach, I chase the waves. And whether it is offered to me as a gesture of affection or as a reward for a job well done, I never ever refuse a cookie.