Thomas E. Catanzaro, DVM, MHA, FACHE, Diplomate American College of Healthcare Executives
|Courtesy of T. Sam Houston Hospital and Delta Society|| |
Seneca said it, animals do it - "Begin at once to live, and count each separate day as a separate life" - caring staff help clients understand it - celebrate the life which was.
As a veterinarian, the hardest question at the examination table doesn't deal with a patient, it deals with our patient's family. The clients, their children, and others who depend on the animal's non-judgmental love undergo severe stress when our patient becomes a critical healthcare case. The grief associated with a terminal illness or death causes that toughest of questions: "What do I tell the children?"
The Academic Answer
If we read the cursory literature, we are told to be truthful. The concept is solid and the need critical, but those cursory pamphlets don't tell us how to deliver this truth. A truth delivered without sensitivity is a way to lose clients. A caring concern that contains the truth is how we retain our clients.
What is the truth? Fluffy was "put to sleep" by the veterinarian is the worst form of truth. Many children will then fear sleep, or blame the veterinarian, or in some cases, expect the pet to return when they reawaken. Why do we continue to support this euphemism?
"The veterinarian thought it was best to put Fluffy out of her misery." Again, here is a truth that conjures up a fear of becoming hurt in children, a fear of telling Mom that the stomach pains are causing them misery. The shifting to why answers will generally cause referral of responsibility, an avoidance of personal participation in the decision process. The child needs to know the truth, but at their level of understanding.
The Caring Response
Don't "give" the child the truth, rather "answer" each question honestly. The child's ability to understand is dependent upon both personal experiences and knowledge development. The age groupings provided herein are only general concepts, since each child is on a continuum of development that is completely dependent upon their specific life experiences.
Usually do not comprehend the idea of absence of life. Often television analogies confuse the concepts we offer. The children make very literal interpretations of adult euphemisms and accept self-blame very easily which cannot be explained away. Preschool children need to be told in terms that relate to experiences they understand. But do not give them more information than what they request. Repetition of questions will be common as they struggle to understand this new concept of death. Parents, relatives, and siblings need to be consistent in answering questions in order to minimize misconceptions.
Early School Age
They understand death is final and can identify specific external causes, believe death is a gradual process, often happening only to others, personify death as a spirit role such as a ghost or bogeyman. They may believe they can cause death by wishes or ill feelings, show increased interest in permanence of death, role play in death rituals, and can also misunderstand euphemisms, although they realize the assumed meanings contradict the evidence. Early school-aged children will understand the pet is dead, but may need concrete evidence of the death. Encourage this five- to nine-year old to ask questions about anything they do not understand, but answer at their level of knowledge and experience. Parents should support exploration and play related to death, and keep teachers informed of the potential grief reactions so they can be consistent and caring.
Older School Aged Children (10-plus years)
This is the age where abstract thinking begins, using ideas, theories, and logical relationships to explain their experiences. They understand that death will happen to all living things, eventually, that it may be immediate rather than gradual, and that it can occur suddenly and without warning. The children begin to accept the natural cessation of life functions as the cause of death, and are capable of understanding religious or philosophical concepts, such as heaven or rituals. Older school-aged children have a good understanding of death, and should be encouraged not only to ask questions, but also express their thoughts and feelings. Children at ten years and older are capable of participating in the decisions or arrangement of the body and should be consulted before and after the euthanasia and/or final disposition.
There are many ways to support the family and children at the time of a loss of a loved one. Kids Grieve Too! by Lombardo, V. S. & Lombardo, E. F. (1986), published by Charles C. Thomas, Springfield, IL, is one of the most recent references, and Talking with Young Children About Death, Rogers, F. & Sharapan, H. B. (1979), by Family Communications of Pittsburg, one of the cornerstone references. Texts that can help parents are provided in a supplemental bibliography, and the one(s) that fits your practice style must fit the needs of your clients. As such, a large selection is provided. The fact that The Tenth Good Thing About Barney works well for me doesn't mean it will fit well for you or for the client who has only hunting dogs.
Start reading now, and use the grief library as you choose to use the chemotherapeutics on your pharmacy shelf. Pick the one that best intercedes in the process to help the recovery of the patient.
Books to Help Children Cope with the Death of a Pet
The following books depict children as they deal with the death of a pet. Adults may wish to review books before sharing them with children, in order to find those which are most suited to individual situations.
Abbott, S. (1972). The Old Dog. New York: Coward. After his dog dies, Ben realizes there is a difference between death and sleeping. Ben's grieving time is cut short when his father brings home a new puppy. Ages 4-8.
Armstrong, W. H. (1969). Sounder. New York: Harper. After the deaths of his father and the family dog, a boy's memories of both become valuable tools in dealing with future experiences. Ages 10-14.
Brown, M. W. (1958). The Dead Bird. Reading, MA: Addison-Wesley. This classic book addresses death with simplicity. A group of children find a dead bird and carry out an elaborate funeral. Ages 4-8.
Carrick, C. (1976). The Accident. New York: Seabury. A boy deals with anger and sorrow after his dog is killed by a truck. Ages 5-8.
Cate, D. (1976). Never Is A Long, Long Time. New York: Thomas Nelson. Billy's father eventually agrees to get him a new puppy after the death of his old dog. Ages 9-11.
Fairless, C. (1980). Hambone. Plattsburg, NY: Tundra. Jeremy copes with the death of his pet pig by planting a memorial tomato seedling in Hambone's honor. Ages 8-11.
Gackenbach, D. (1975). Do You Love Me? New York: Seabury. The accidental death of a hummingbird helps Walter see that not all animals want to be pets. Ages 5-9.
Graeber, C. T. (1982). Mustard. New York: Macmillan. Alex's parents are supportive and honest as they help him cope with the illness and death of his cat, Mustard. Ages 4-10.
Hall, L. (1976). Flowers Of Anger. New York: Follett. A girl's anger and sorrow after her horse is killed distance her from her best friend. Ages 10-12.
Hegwood, M. (1975). My Friend Fish. New York: Holt, Rinehart & Winston. A young boy encounters death for the first time when his pet fish dies. Ages 6-9.
Hurd, E. T. (1980). The Black Dog Who Went Into The Woods. New York: Harper & Row. A young boy, along with the rest of his family, copes with feelings of loss after Black Dog dies. Ages 5-7.
Little, M. E. (1979). Old Cat And The Kitten. New York: Athenaeum. Joel's strong sense of responsibility and loyalty are shown as he must choose between euthanasia and abandonment for his cat. Ages 8-12.
Rawlings, M. K. (1938). The Yearling. New York: Scribner. Jody must kill his beloved pet fawn when it begins to destroy the family's crops. Ages 12+.
Rogers, Fred (1988). When A Pet Dies. New York: G.P. Putnam's Sons. First experiences picture book from Mister Rogers' Neighborhood series, exploring the feelings of frustration, sadness, and loneliness that a youngster may feel when a pet dies. Ages 4-9. (Available from AAHA, PO Box 150889, Denver, CO 80215-0899.)
Simon, S. (1976). Life And Death In Nature. New York: McGraw-Hill. Simple experiments that help children explore decomposition, ecology, and the balance of life are described. Ages 6-10.
Stull, E. (1964). My Turtle Died Today. New York: Holt. The cycle of life is emphasized, as the death of a pet turtle is followed by the birth of kittens. Ages 3-6.
Thiele, C. M. (1978). Storm Boy. New York: Harper & Row. In Australia, a boy raises an orphaned pelican. His fond memories of the bird are great comfort after it is shot by a hunter. Ages 8-11.
Tobias, T. (1978). Petey. New York: Putnam. Emily's parents help her cope with the illness and death of her pet gerbil. Ages 6-9.
Viorst, J. (1971). The Tenth Good Thing About Barney. New York: Athenaeum. A boy is encouraged to remember good things about his cat after it dies. Ages 5-9. (Available from AAHA, PO Box 150899, Denver, CO 80215-0899.)
Wagner. J. (1969). J.T. New York: Van Nostrand Reinhold. A young boy feels a sense of being needed as he cares for an injured alley cat. His parents attempt to comfort him after the cat is hit by a car. Ages 8-10.
Wallace, B. (1980). A Dog Called Kitty. New York: Holiday House. Kitty has helped Ricky overcome his fear of dogs. After Kitty is killed, Ricky eventually accepts a new puppy. Ages 9-11.
Warburg, S. S. (1969). Growing Time. Boston: Houghton Mifflin. Jamie needs time to adjust to his old dog's death, and at first rejects the new puppy. Ages 5-9.
Wilhelm, Hans (1985). I'll Always Love You. Belgium: Crown Publishing. The family's story of Elfie, from puppy through life and into death, and the family's feelings. Ages 4-12. (Available from AAHA, PO Box 150899, Denver, CO 80215-0899.)
Winthrop, E. (1975). A Little Demonstration of Affection. New York: Harper & Row. A brother and sister are drawn closer together after their dog is shot. Ages 12-16.
White, E. B. (1952). Charlotte's Web. New York: Harper. Wilbur the pig is saved from death by the cleverness of his spider friend, Charlotte. Later Charlotte dies, and Wilbur is comforted by friendship with her children. Ages 7+.
Young, J. (1974). When The Whale Came To My Town. New York: Knopf. The death of a beached whale is depicted as part of the natural order of things. Ages 6-10.