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Vet Talk

The Cremains of the Day
November 10, 2014 (published)



As an ER veterinarian practicing for 18 years, I’ve performed my share of euthanasias. Certainly in the hundreds, possibly thousands. And while I know what happens to the pet after the final goodbyes have been said and the family leaves, most pet owners probably don’t. Where do the remains of euthanized pets go, and what happens to them along the way?

Afterwards, the veterinarian’s first act is to confirm death, listening for a heartbeat with a stethoscope. There’s often a visit, the family or pet owner spending a last few minutes with their loved one. Many deaths are unattended, the order given over the phone, or they happen in the middle of the night in ICU; 4 a.m. seems to be that loneliest of hours when Death makes his rounds and adopts a new pet.

Discussions for the sequence of events that happens next often takes place before euthanasia or natural death. While many owners have an idea of what they’d like done with the body, some don’t know what to ask, or what the options, steps and final outcome are. There are typically three choices: taking the body home for burial, group cremation, and private cremation. Before you get to those options, the body has to be stored.

For home burial, we prepare the body and help the owner load it into the car. Part of the preparation is removing any equipment, such as IV catheters, oxygen lines, EKG leads, etc. Many clinics have cardboard coffins for transport. Some technicians will draw a flower or bouquet on the casket, or stylistically write the pet’s name with a flourish on the top.

I understand the desire to take a pet home, but like so many other things in life the reality rarely aligns with the expectation. Home burial has several drawbacks: I think it’s unpleasant to handle the remains of a pet, now literally dead weight. I’ve no idea of the physics behind it, but pets seem to double their weight after death, and always try and slip out of your arms onto the floor. This is unpleasant for anyone, but the cognitive discord of having your pet’s volition go from their own willful control to that of faceless and uncaring gravity would jar me as a pet owner. Burial can be a seasonal hardship if the ground is frozen. Wild animals have been known to dig up pets buried in a too-shallow grave. In some municipalities, home burial is illegal.

Cremation has always been handled with dignity and compassion, for me, anyway, as solemn as it ever is for people. I’ve dealt with half a dozen companies over the years and to a one they have all been exemplary. It’s not an industry that tolerates slacking, rude jokes, or poor customer service. True, you hear horror stories of lost remains (the industry term for the ashes is ‘cremains,’ a portmanteau that has always struck me as too macabrely cutesy and convenient for what they describe) or of receiving the wrong pet, but these are the miniscule exceptions, usually inflated and passed around by the media like a beach ball at a concert.

There are essentially no mortuaries, morgues or coroners for pets; pet embalming and funerals are performed at an infinitesimally small rate compared to people. So why the disparity between how my pet is handled and how I’ll be handled when I die? Finances play a big role. People love their pets, but a pet funeral is a rare and newsworthy event (often in the mildly off-putting and vaguely tongue-in-cheek ‘other news’ section) while a human funeral is as commonplace as a wedding. People will often spend thousands to keep pets alive but after they’re gone, it’s usually a quick and inexpensive resolution.

Where it falls apart for me is the step right before cremation. Between death and cremation, the body has to stay somewhere. In most cases, that’s the hospital where the pet died. It may be several days before the crematorium comes by to pick up the body, and some hospitals have to deal with lots of dead bodies. ERs can be the worst, the veterinary equivalent of an inner city hospital morgue on a hot summer night. To my horror, during my residency I once euthanized nine patients in an 18-hour shift. Space, finances, and convenience are the big factors, and the common solution is a freezer.

This presents some problems. Some practical problems.

I am not going to pull any punches from here on out, so please read with caution, particularly if you have recently lost a pet.

The step right before the freezer is the bag.

The plastic bag.

I wish I could say it was at least one of the fancy ones with a zipper, like you see on TV for people, but it’s usually not. In some cases, the crematorium will provide extra-tough plastic bags that resist tears and spillage, but usually it’s your standard hardware store plastic bag. Again, it's convenience, finances and space. It’s not pretty, but it’s not done out of a lack of respect or love. There has to be a way to contain, transport, and seal off a pet after death, and this has been the expedient solution for decades.

Once anything dies, be it man, beast or amoeba, everything sort of relaxes, and muscles that kept everything inside no longer keep performing that function. Things get a mite messy and runny at times. When I die, I expect the same thing will happen to me. Death is not a pretty business, but it’s more manageable if you can wrap it in plastic and freeze it.

Getting the pet into the bag can present some challenges as well; the whole process sometimes reminds me of exam questions from physics. It’s not an issue for cats and small dogs, but for any pet over about 45 pounds, the vectors and angles and force equals mass times acceleration involved can make it hard for one person to do it. If the body is on the floor, you have to wrap the bag over the hind quarters and wriggle and shimmy and bring it up over the front, much like a snake swallowing its prey. The whole effect is like someone trying to get into a too-small wetsuit. If you have two people, lifting the pet into the bag usually goes smoother, but there’s still that moment when gravity takes hold and the pet takes that sickening luge-like lurch into the depths of the bag; I often thought something akin to “I sure hope this bag holds.”

Freezers have a finite storage capacity. If you just finished the shift I mentioned above and have nine bodies to fit into the freezer, you just might take up all the room...and then a Great Dane comes in. Sometimes you have to get a bit creative with stacking and arranging, as the frozen and stiff ones may need to be rearranged to accommodate more; this leads to a sort of grim Tetris game to make everything fit. Most freezers I have seen used are the standard floor-model kind with a hinged lid along the back. There are no racks, and the bodies lie atop one another.

Identification, the veterinary equivalent of a toe tag, is needed for several reasons. Sometimes owners change their minds; for example, they initially wanted a private cremation, but then decided to take the remains home for burial. Without identification, there would be a whole lot of bags to go through to find the pet in question. The bodies are either tagged with a color-coded tag (say, yellow for private cremation or green for group) or the bags are different colors.

In some cases, owners need time to talk it over with family who may be at work or at college when a pet dies. These undecided ones are a particularly vexing challenge because there’s an unspoken rule in veterinary medicine that you can never rush someone deciding to euthanize a pet, or rush them on what to do with the body. But human beings being what we are, the 24 hours we often ask them to decide in sometimes becomes 48 hours. And before you know it those 48 hours become two weeks. After that, the hospital has a lumpy, plastic-wrapped bundle on its hands, taking up precious real estate in that small freezer. A simple phone call doesn’t always solve the problem, either; wrong or illegible numbers on hastily filled out hospital forms, outdated contact information – all can lead to a literal dead end when deciding what to do with the body that’s been there since the last presidential election.

It seems so easy at the time of death to say “Take your time – there’s no need to decide on what to do right now” in order to not rush the grieving family into making a hasty and irrevocable decision. But after dealing over the years with dozens of forgotten pets left lingering in freezers, my tack has switched to “I know this is hard for you, but please let us know what you’d like to do with the remains in the next 24 hours."

Once properly identified and in the freezer, they await the crematorium pickup, which is usually twice a week. This task also requires finesse; it would be a tad disturbing to show up with your bouncy 14-week-old poodle puppy for a 10:15 vaccine appointment and see two burly men in coveralls hauling plastic-wrapped bundles into a waiting van. The pickup usually occurs before the day starts at the hospital, or in an area shielded from the eyes of people not used to such a sight.

After the pick up, the cycle repeats. The bottom of the freezer usually contains an unpleasant mélange of dried blood, exudates and several other unidentifiable former liquids, leaving a frozen pool of swirly rust-colored slop shot through with patches of burnt umber that looks like the Slurpees served by the 7-11s in hell.

The bodies are taken to the crematorium and logged in. The private cremations are done individually, and the ashes carefully preserved. Private cremations are labor-intensive and require accurate record-keeping to avoid one of a veterinarian’s worst nightmares: misplaced ashes, or even worse, the group cremation of a pet whose owners had requested a private cremation. This is a thankfully vanishingly rare event, but I’ve heard of it happening a time or two. The paper trail and customized nature of a private cremation makes it a somewhat spendy option; most run anywhere from $150 to $300, depending on the size of the pet.

Group cremations are done en masse. After they are completed the ashes are ‘disposed of.’ In most cases I never really learned what that meant (but I guess they are just thrown out), with one exception. One crematorium I’ve worked with planted a garden every year and placed the ashes of all the group cremations in a separate plot for that year, complete with benches, paths, and spots for quiet reflection. It was a lovely, lush place, and the gardens were carefully tended and full of life. Many pet owners would visit the gardens, knowing that the remains of their pet were in there somewhere.

Just before cremation, the body is loaded into a container called a retort, in which the remains are reduced to a small pile of ashes. Actually, that’s not completely correct – some of the larger bones make it through the process intact and have to be manually ground or smashed down to the right consistency. Once the cremation process is over, ashes are sealed into the container the owners chose and labeled for return to the hospital, where the owners pick them up. In a few cases, cremains are mailed to owners rather than being picked up. This completes the process, which can take a week or more for a private cremation.

None of this is pretty or even pleasant. We have an innate distaste for death in any form as it represents something we can’t inherently get our heads around: not being here. Not being. But even though everything I’ve described may seem somehow mechanical, detached, disrespectful, or callous, veterinarians and veterinary technicians are some of the most caring professionals around. We do it to help people and to help pets, but it takes its toll on us. Compassion fatigue, suicide, and professional burnout haunt us, and the intimate knowledge of death seems to me to be a big part of it.

Most people move through life without being aware of death. Our distaste for it, and the fact that modern medicine has taken death from something that happens in the parlor of a home to something that happens in a fluorescent-lit hospital behind a curtain, means that most people are blissfully unaware of what it looks like, of what happens. But we know – we make it happen, and we’re there when it happens. We know the heft of a dead body, the way the once-shiny cornea loses its luster. We can’t un-know it, and we often strive to protect pet owners from knowing what we know about death. We hide the details, only offering them up if asked, which rarely happens.

Not every euthanasia affects us deeply (it couldn’t, or we would cease to be able to function) but we are moved by many of them; we are moved by the family who brought us that mewling poodle puppy as a 14-week old for the 10:15 vaccine slot ages before, who come again when the years have had their way with him and he sees the world through gray, glaucomatous eyes and with legs that will no longer carry him.

For me, the worst and hardest euthanasias to bear are always the aged people, most of whom have already lost a spouse to death and lost children to the rushed, selfish pace of modern life and geography. Too often, all they have is a little geriatric Yorkie or ancient and creaky cat curled up beside them on the knitted throw, and I have to be the one to take that last bit of comfort and warmth away from them, that last supporting piling that keeps the whole pier afloat.

We meet them and help them. We know the secrets of the arc from euthanasia to return of the ashes, the bags and the freezer and the retort.

But we don’t tell them. Not then.
 

5 Comments

Deni
November 17, 2015

More than thoughtful and generous--an honest, even searing look at what must happen to all animal life, and a look that stresses gentleness at the end. A vet's tasks, like a human doctor's, need some automatic revivifying process attached: Cancun every six weeks, or musical immersion in whatever (I would choose Thomas Tallis or Chanticleer, myself). A friend of mine reminded me today that writing is easy: you just go to the computer and open a vein. That is what has happened here, and I am the better for it. Thank you, Tony.


Deyonne Knight
November 17, 2015

Beautifully written, Dr. Johnson.  Your words tell us loving pet owners about the behind the scenes reality.  Thank you.  Thank you.  Thank you.  I write my comments with such love, compassion and empathy for the caring medical professionals and the other pet owners.  Please, as a medical professional, take care of yourself too.  We need more of your type around.  We don't want you to burn out in your profession.  We want to feel your love for our patients, our pets.  We want you to care.  We want the very best for all of us--our pets (number one), our veterinarians and their staffs, and us--fellow pet owners.  Thanks for a beautifully written essay.  Don't ever lose your ability to relate--with animals and humans!  You have made me cry and appreciate your profession even more!


Joni Coberly
November 17, 2015

As someone who suddenly lost a pet two days ago (my first loss as an adult), and being a "need to know" type person, your article was just what I needed. We have (now had, I suppose) five rescue dachshunds - Sadie was 13. We opted for private cremation. I felt the need to know about what happened in the interim. Thank you for a beautifully written explanation.


Mari Ellen Brown, DVM 
February 8, 2015

Beautifully written essay, as a fellow ER vet, this put my thoughts to words. Thank you.


Marianne Williams, DVM 
November 11, 2014

You hit the coffin nail on the head, Tony, but darn it- as an ER Vet - a little too close to home! You made me cry at the end!  Well said.


 


 
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