Written by Shannon Fujimoto Nakaya, DVM
When I first started offering veterinary hospice care in my own practice, I wanted clients and patients to sign up early, when they were still feeling good even, so that they could begin to appreciate every good day as a gift sooner rather than later, and that we could preserve their feel good state for days and weeks and months and maybe even years. After all, what happens in human hospice care is all good. The patient is assigned to a hospice team which typically includes a medical doctor, social worker, spiritual consultant, registered nurse, and a team of volunteers. Their goal is to provide physical care and emotional and spiritual support for the patient and the patient's family, all in the comfort and familiarity of their home environment. Volunteers do anything and everything from helping the family get through housekeeping chores to running errands to just sitting with a patient or a family member. Doesn't that sound pretty good? As I was going through human hospice training, I kept thinking that this is the way ALL patients should be treated, not just the ones who are dying.
The "catch" in human hospice is that hospice patients must be (a) terminally ill, (b) not undergoing medical treatment for their condition, and (c) not expected live more than six months. Patients that live longer than six months can come off of hospice without penalty or hospice can be extended without penalty. Still, the average "stay" in human hospice is only six days.
Veterinary hospice is not limited by the rules of human hospice. Veterinary hospice does not have to mean abandoning attempts to treat a condition or prolong life. Veterinary hospice does not have to be just about preparing for death. Initially, I tried to coin veterinary hospice to mean, "physical, emotional, and spiritual care in the home environment for animal patients and their families." Nobody got it. It proved too deeply implanted in people's minds that hospice is about dying and no one wanted to go near that prematurely.
But I would hope that people can still see the benefit to getting the most joy out of each day as if there might only be a few more of those left. And if there are more than a few of those good days, then better yet. Comfort, good food, good water, good air, quality time with those we care about and who care about us are fundamentally what gives our lives meaning. Often times, it takes a knock on the head to simply appreciate when life is good. Our beloved pets being diagnosed with some disease that threatens their ability to joyfullly carry on is that knock on the head for many people.
This is why I have coined the term, PRE-hospice, and made its goal appreciating every good day as gift, and its assignments all about preserving and making the most of all the good things that we still have to work with in that patient. I don't know that my term PRE-hospice will ever really stick, but I hope the ideas will.
PRE-hospice is about LIVING with a diagnosis.
PRE-hospice is that time between being diagnosed with cancer or kidney failure or congestive heart disease or something with a poor prognosis, and actually feeling like it. Animals naturally live in the moment; HUMANS obsess about a diagnosis and worry about how things are going to decline. We are what we are, and they are what they are, and there is a reason that we were paired. Trying to anticipate and plan for the future is not bad; trying to preserve wellbeing as long as possible is what I do. But equally important is the lesson taught me by my animal patients: appreciate and nurture the now.
Here's a sample lesson from my dog, at age 13, when I discovered a tumor on his lower jaw and obsessed about what it might mean. I fretted, worried, researched, considered. And when I looked over at him, life was no different for him compared to the week before I discovered the tumor. He was emotionally unchanged, anticipating an afternoon ride in the car, a walk on the beach, and a swim, followed by dinner -- yum. It suddenly became very clear that my dog was equipped with a natural tendency to enjoy life and that my job was to preserve his ability to do that. And in the meantime, live like a dog; appreciate and nurture the now.
PRE-hospice is about supporting ALL the parts, particularly the good ones.
We tend to obsess about what's NOT working. And certainly, that should be addressed. But we should not forget about nourishing all the parts of the system that are doing well because it ultimately helps the patient feel better and compensate for the illness. Maintaining a positive energy balance (good food), hydration (good water), breathing (good air), and habitat (good energy) make for a happier, healthier, stronger, and more resilient patient.
PRE-hospice is about preserving quality of life.
Feeling comfortable and safe allows our animal comopanions to spend less time worrying and more time enjoying life. Comfortable beds and blankets, appropriate assistive devices, special meals, reassuring sounds, massage, herbs, acupuncture, drugs, and just being together all contribute to patient comfort and wellbeing.
PRE-hospice is about pacing the caregiver for a marathon.
You never know. It might be a longer journey than you initially imagined.
PRE-hospice is about appreciating each day as a gift.
As sad as it is realizing that our animal companions will someday cease to breathe, perhaps it is the one-of-a-kind and finite nature of each life that makes it so precious. Too often, in our quest for more, we neglect to fully appreciate what we do have. Every being and every life is unique, and if it happens that our path overlaps with that of a particularly special being, that is gift.
PRE-hospice is about sharing a journey.