Meeting the need for better end-of-life care
Suzen Gregersen with her senior vet Joaquin P. Feliu
In the early 2000s, while I was working in various practices around the UK, and especially in the emerging field of emergency and critical care (ECC), I realised that end-of-life care within the vet profession needed a massive makeover.
I had qualified as a vet in Copenhagen, Denmark, in 1999. Only weeks before graduating I’d had my baby daughter. I started my career volunteering in urban, small animal practices because part-time vet jobs weren’t available. I decided to relocate to the UK to fast track my clinical experience and, 17 years later, I’m still here.
Both as a practice-based vet doing home visits in Norfolk and later as a mobile vet in Sussex, I realised just how much job satisfaction there was in preventing animals from suffering at the end of their life by skilfully and compassionately helping their owners to let their pets go. I found the best way of doing this was away from a busy, clinical environment, so in 2005 I co-founded my Vets2Home mobile practice in Sussex –rebranding it in 2012 as ‘Peaceful Pet Goodbyes’ – the first UK in-home hospice, end-of-life and euthanasia service.
What my job entails
I help clients prepare for the end of their pet’s life. My two-step home euthanasia (always with a specially designed, pre-euthanasia sedation) is the primary service I provide: medical palliative care for the animal and family support makes up the remainder.
The treatment a companion animal receives at the end is often a life-changing experience for the family, and one that leaves a lasting memory. The best outcome is achieved by gently helping the owner decide when the time is right for a planned, peaceful euthanasia.
My mission and driving force is to reduce the overall suffering of animals and owners at the end of a much-loved pet’s life.
I believe this job is my calling. Around 25 per cent of my work is focused on providing medical comfort for the pet, and 75 per cent on guiding and supporting the family who are navigating the complex emotional challenges that accompany what can be a very difficult process. The earlier I am invited to get involved, the better the outcome usually is, with less suffering and less risk of a crisis and the urgent need for a traumatic, emergency euthanasia.
No two days are alike
Most days I spend between seven and 10 hours driving around Sussex to help pets and their owners at home.
Typically, I see between three and five clients a day, although sometimes as many as six or seven.
I also return incoming calls, triage and take bookings, mostly for same-day end-of-life services, and advise on how we can help with the hardest part: making the decision at the right time. Once I return home, there’s the admin, journal keeping and general running of a vet practice to do. It’s much more than a full-time job but it’s worth it, in every respect.
Every day is different – rewarding and also emotionally challenging. In animal hospice work, we have an unwritten, half-joking rule to never be more openly upset than the owner. That said, shedding a tear or two is part of the job because we are involved in lots of sad and intimate moments. On the other hand, I give a much-loved family pet a beautiful and gentle send-off at home with no hurry. Having the time to see an animal that had been suffering, peacefully surrounded by loved ones makes my day, every day. It sure beats the typical euthanasias in the vet clinic, where I often felt rushed. Even the so-called extended consultations of 20 to 30 minutes were not enough sometimes, and I was always anxious that I wasn’t able to do my best because of a lack of time.
As a vet, the ultimate job satisfaction is to end a good and happy life with a good death. This is the true meaning of the word ‘euthanasia’ and it should be a right that is granted to every living creature. Many of my clients say they would like to sign up for my service for themselves (or their spouse!), which is when we sometimes share a laugh – a normal and understandable response after an emotional experience.
'It’s much more than a full-time job, but it’s worth it, in every respect'
The most important skills I have acquired while doing this unusual job are people skills – managing expectations and managing difficult and behaviourally challenging animals – and clients – in their home environment without the back-up of auxiliary staff, such as nurses. It also means having predictably unpredictable facilities available!
Having my own one-woman vet practice and being on-call 24/7 for 15 years makes for a unique lifestyle.
These days, I usually work for an extended period almost non-stop and then take a long break in which to travel.
Learning to prioritise time off when on-call 24/7 is hard, and having found and trained a lovely, trusted vet associate to take over the reins in my absence has been instrumental in making this balance work. Luckily, my work is also one of my favourite hobbies. My two beloved, now senior, dogs come with me every day in the car – my mobile office – where I listen to audio books and relaxing music. I also relax with yoga and meditation and enjoy going to live music gigs all over the world. Feeling alive and connected to the world is so important when dealing with death on a daily basis.
A job for the more mature
This is emotionally challenging work, which – like all veterinary practice work – carries the risk of compassion fatigue.
Maturity, clinical skills and broad life experience are prerequisites if you’re to thrive in this field. It’s not the job for a young graduate and I never dreamed it would be my life’s calling, but I’d recommend it to anyone who feels the confinements and increasing and changing demands of traditional clinical practice are not a perfect fit for them.
I firmly believe that euthanasia belongs in a non-clinical setting, just like end-of-life hospice care does for both people and pets.
'As a vet, the ultimate job satisfaction is to end a good and happy life with a good death'
Almost all of us would wish to die at home in our own bed or in the arms of a loved one, so naturally this is what we want for our four-legged family members too. The demand for a better end is growing, so being the best you can be at delivering this most memorable procedure is something we should all focus on far more. The amount of hugs, cards, chocolates, wine and five-star reviews I have received along the way is very nice testament to that.
Training in end-of-life care
In-practice training can help colleagues improve their confidence and approach to end-of-life consultations. More information is available at peacefulpetgoodbyes.uk/vet-training
I’m also proud to have helped start the Companion Animal Euthanasia Training Academy (CAETA), alongside euthanasia specialist Kathleen Cooney in the USA. CAETA offers hands-on and online training for vets, vet technicians/vet nurses, vet students, shelter personnel and grief support staff in all aspects of companion animal euthanasia.
Coursework topics include (but are not limited to):
The physiology of death
Managing the caregiver/family dynamics
Special sedation and anaesthesia protocols before euthanasia
Euthanasia techniques (intra-organ injections)
Challenging situations and dysthanasia (bad death) protocols.
Alongside the online modules, some training programmes are held at locations around the UK (and in the USA and Canada). In 2020, these will include training at collaborating vet schools, such as the Royal (Dick) School of Veterinary Studies in Edinburgh.
Students receive a certificate of completion, a seal of excellence for their CV and ongoing access to the CAETA library and resources.
The full course and certification costs around £310. For more information, log on to www.caetainternational.com
1999: Graduated DVM in Copenhagen
2002: Product specialist for Abbott Laboratories in Denmark
2002: MRCVS – small animal practice in Norfolk; senior emergency vet, Essex; locum out-of-hours and general practioner (GP) vet, Sussex
2005: Co-founded Vets2Home GP mobile practice in Sussex
2012: Re-branded Vets2Home as Peaceful Pet Goodbyes, the UK’s first in-home hospice, end-of-life and euthanasia service
2013: MBA in general management (with distinction), University of Brighton
2016-present: Executive adviser for Compassion Understood
2016: International relations and strategic adviser for the Companion Animal Euthanasia Training Academy
2017: First European board member of the International Association for Animal Hospice and Palliative Care (IAAHPC)
2018: Certification in animal hospice and palliative care (CHPV)