Most of the time here, when I write it’s about how to take care of our beloved pets through the course of chronic or terminal illness, and how to take care of ourselves as we face that process.  But it’s important to remember that our relationships with the animals that share our lives don’t end when those animals pass away, and that hospice and end-of-life care also encompasses honoring that bond and supporting the caregivers after a loss.

Our culture has many commonly accepted ways to honor and remember the loss of people in our lives, but often I’m faced with clients who want to find some special way to remember a beloved pet but don’t have an idea of how.  So I thought I’d put together a list of some ways to celebrate the memory of a pet that has passed.

  1. Create a photo pillow – You can take a favorite picture of your pet and make a pillow.  If your pet had a favorite blanket, you can use that fabric for the pillow as well.
  2. Make a keepsake box – this can be a way to save treasured items in a special place.
  3. Sponsor a service dog in their memory – So many animals out there serve as much more than pets for the people who depend upon them.  Helping someone get the service dog they need can be an incredible way to honor the bond you had with your pet.
  4. Take part in a charity walk or other event to help support pets in need: Here in Massachusetts the MSPCA runs an annual charity walk; similar events take place around the world.
  5. Write: Tell the story of your pet and your life together.  This may take the form of a blog post, poetry, a story, a childen’s book, or whatever form seems most appropriate to you.  Whether you share it with friends, the world, or keep the words for yourself, creating the story can be an incredible act of celebration and memory.
  6. Hold a memorial service: invite your friends and family who also loved your pet to come together and celebrate their life.  Ask everyone to share a favorite picture and memory of the pet, and celebrate your time together.
  7. Memorial jewelry: This can be anything from a pawprint necklace to a bracelet charm made from their collar or tags.  There are also necklaces that can be made to hold a small amount of ash, if you have your pet privately cremated.
  8. Make a memorial garden: Plant a tree, a flower bush, or if you don’t have an outdoor space, a house plant in honor and memory of your pet.
  9. Commission a painting: have a portrait made from your favorite picture of your pet, to hang in a place of honor in your home.
  10. Make a memorial stone: Even if you are not able to bury your beloved pet, an engraved stone can still help remember and honor them.  You can make one yourself and decorate it with family members, or order one custom-made for your pet.

These are just a small handful of ideas – there are so many other beautiful ways to honor and celebrate those who have passed from our lives – but I hope they can act as inspiration for those of you facing the challenge of how to create a fitting memorial for a pet that you have lost.

National Pet Memorial Day

Today is National Pet Memorial Day – a day for celebrating and remembering all of the special animals who have made our lives better with their presence. AC&C is hosting an online memorial today; we invite everyone to comment here andpercy share memories, pictures, and stories here in honor of our beloved pets.

I have been lucky enough to share my life with so many amazing and beloved pets, but most of all today I want to celebrate Percival. My best friend, constant companion, study buddy all through vet school, and the cat who taught my current kittens how to be cats. He crossed half the country with me, slept on my pillow every night for over a decade, and his presence is still felt in my life every day.

Thank you, Percy, for so many years of love. I still love you, I miss you, and you made my life better with your presence.

Remembering Those We Have Lost

This Sunday, 9/11 is National Pet Memorial Day.   On that day,  in honor of all of the beautiful, beloved, and special pets that have passed from our lives, AC&C will be hosting an online memorial, here and on our facebook page.

On Sunday, I invite you to share a picture, a story, or a memory of a pet that touched your life. Together, here, we can honor their time with us and celebrate their lives.   This will be a space of remembrance, and of shared experiences – by reaching out to tell the stories of our pets with others who have known both the joy of loving a special animal and the pain and grief of their loss, we can hopefully help ease that pain, and remember the happiness they brought to all of us.

“Shared pain is lessened; shared joy, increased – thus do we refute entropy.”  -Spider Robinson

Changing Roles

Some people look upon the relationship between a person and an animal as pet and owner.  Some people describe themselves as pet parents, and the animal as their furry child.  Others look upon the relationship as one between teammates, or partners, or friends.  But whatever we call ourselves, the truth is that we all fill many different roles in our pets’ lives.
We are their source of food and shelter.  We give them love and companionship, just as they do for us.  We keep them happy and healthy.  And, as they age or develop chronic or life-limiting illness, our roles in their lives change – we become their primary caregiver as well as, or sometimes instead of, their source of play and companionship –  and this can be challenging, both for them and for us.


While we always provide care for our pets, there’s a significant difference between feeding, walking, cleaning the litterbox, and otherwise maintaining a healthy pet and managing  multiple medications, appointments, nursing care, and household adaptations for an ailing or declining pet, and while we all know that bringing an animal companion into our life means agreeing to the former, very few people are prepared for the level of both emotional and physical labor involved in the latter.


Being the primary caregiver for any chronically ill being, human or otherwise, is challenging.  It takes time and money; it means dealing with bodily substances and putting in physical labor, whether that be carrying a pet that is no longer fully mobile or cleaning soiled floors or bedding.  It means paying attention to details of multiple medications, managing schedules to be home and available when they need you, and it often means changes to your environment as well, as you build ramps or move furniture or adjust the temperature of your home to provide for their comfort.   At the same time, it also changes your interactions with your pet – instead of being just a source of treats and cuddles, you’re now responsible for giving medications they may not want to take or providing grooming care that they may not enjoy.  And they may no longer be able to participate in shared activities that strengthened your bond, like going for walks or sleeping in the same bed.


All of these changes and challenges can create a serious burden for you as a caregiver, and can lead to feeling frustrated, hurt, overwhelmed, or like this is more than you and your pet can handle.  So if you are facing this situation, there are steps that you can take to help make such a transition easier and less stressful.


-Talk to your vet.

In this phase of life more than any other, it is critical to make sure that any care plan for your pet is designed around both your and your pets’ needs and abilities.  If you know, for instance, that your pet is hard to give pills to, ask for other treatment options.  If you have a strong objection to, or concerns about, a particular treatment, let them know.  Your vet can help work with you to make a plan for your pet’s care that is manageable and not overwhelming.


-Write things down.

If your pet is on multiple medications, make a chart or get a weekly pill minder to help keep track of what gets given when.  Make a calendar  to track appointments or non-medication treatments.  Use a chart or calendar to track any changes or observations you make about your pet.  Being organized can help avoid mistakes, and can also help you feel like you have control over your pet’s care.


-Find ways to maintain the parts of your relationship with your pet that you love.

When you’re spending much of your time with your pet giving pills or changing diapers or treating problems, it can be easy to feel like there’s nothing more to your bond with them.  Even if your pet is no longer able to engage in some of the activities they used to love, you can work with your family and your pet’s care team to find ways to bring those favorite activities into their life in new ways.  A dog who used to love chasing balls may enjoy lying outside and rolling a ball back and forth; a cat who is too fragile to go outside alone anymore may still enjoy time on a screened porch or in a playpen in the sun; for most of the things in our lives that bring happiness we can find a way to adapt them to our pets’ new lifestyle.


-Ask for help.

This is critical.  Nothing makes us feel more helpless than a lack of support.  Being a primary caregiver is an immense role, and we all need support ourselves.  Reach out to family members, friends, and neighbors – sometimes just having someone to give your pet their evening medications for a night so you can go to a movie can be an immense relief.  Likewise, finding someone to sit with your pet during the day once in a while can relieve worry about their condition and lighten the burden of their care.  Many older or chronically ill pets that need frequent care can even benefit from a pet-sitter or dog walker stopping in on occasion to check on them, keep them company, clean up after them, or aid in their particular care.  Don’t be afraid to make use of these resources, to help both your pet’s quality of life and your own.


The transition from ‘mommy’ or ‘best friend’ to ‘chronic caregiver’ is a challenging one, but it can also be incredibly powerful.  Let your friends, family, and veterinary team help you find your way through this new and challenging phase of your relationship with your pet.

Moving Forward

When I first learned about veterinary hospice and realized it was the field that I wanted to devote my life to, I knew that it was a new and emerging area of medicine, but I had no idea of how new.  As I researched, studied, and spoke to other doctors in the field, I came to realize that I had become part of something that was still in the process of defining itself – that we were all building an area of study together – and that I was incredibly lucky to be part of such an endeavor.

Part of what I love about hospice medicine is just how collaborative it is at the professional level.  I love my clients and my patients, that goes without saying.  But I also love conferences that are equal parts give and take, where attendees are invited to share their experiences and practices in the hopes of improving the field overall, where everyone is learning and growing and practicing, and where the fact that we have so much room to explore, improve, and educate is celebrated.

To that end, the International Association of Animal Hospice and Palliative Care has just this year put together a certification program in Veterinary Hospice and Palliative Care.  For the first time, there will be a set of standards determined for those of us who practice hospice medicine – guidelines of what resources we should have, what skills and facets of medicine we need to be trained in, what are the best ways to provide for the comfort of our patients and the well-being of the people who care for them.  It will focus on providing a team of support for clients and patients, on communication as well as technical skill, on end-of-life care, and on pain management.  It draws from human hospice and prioritizes educating caregivers and practicing cooperative medicine The program will take over a year, and those of us who complete it will have the honor of becoming Certified Hospice and Palliative Care Veterinarians.

In particular, those of us enrolled in this year’s program will be the first-ever CHPVs.  And I have been lucky enough to be accepted into this first class.

I have no words for how honored and grateful and excited I am to be part of this.  It’s an amazing feeling to know that I am helping define an entire area of medicine for future veterinarians; that I am helping build something that will bring comfort to so many people and pets as the field continues to grow and gain recognition.  I’m looking forward to learning from amazing instructors who are pioneers in the practice, and to writing my own case studies.  And most of all, I’m glad beyond words at the opportunity to learn how to take even better care of the pets and people who trust me with their emotional and physical well-being at this most vulnerable and critical stage of life.

A common adage about medicine is that it’s called a practice because we’re never done learning and bettering ourselves, and I can’t wait to take this next step forward on my path as a doctor and caretaker!

Making Choices

Recently, when I asked folks what topics I should write about here, someone asked, ‘When your vet prescribes a new diet or treatment for your pet, how long should you attempt it before you give up and go back to what you were doing before?’  And I realized that this question brought up something more important than the request itself – and that is the fundamental mindset behind it, and the difference between traditional Western medicine’s classical approach to treatment and the mindset of hospice medicine.  And this mindset is one that can get in the way of successful care for many patients.

The challenge with this question is threefold.  First, by phrasing it that way and considering treatment from that approach, it assumes that the treatment itself is difficult, challenging, unpleasant, and generally something the pet is going to dislike and the client is going to struggle with.  It sets the asker in a frame of mind where the automatic assumption is that the treatment is going to fail or be impossible to carry out, and the only question is how long to go through the motions before getting permission to stop, instead of considering the potential for easy treatment, positive experiences for the caregiver, and success.

Second, it frames the question of treatment into an either/or situation.  Either you are treating with one specific plan or you are doing nothing.  It creates a false dichotomy, instead of allowing for a spectrum of options including multiple levels and methods of treatment.

Finally, it is based upon a total absence of communication between the client and their veterinarian.  It sets forth a situation where, when a client undertakes a treatment path and then faces challenges along that path, rather than talking to their pet’s health care team to let them know they’re having difficulty, they decide to cease all treatment.

In hospice, communication and choice are two of the core concepts of our practice.  The most important tool we have, both as pet caretakers and as doctors, is communication.  If a particular treatment is suggested – whether that be a special diet, an oral medication, a form of physical therapy, or any other intervention – and that treatment is either too challenging for the pet or caregiver or isn’t improving the pet’s quality of life, it’s critical that we know.  While we as doctors have a wealth of knowledge, resources, and experience at hand to offer to our patients, none of that can help if we’re not aware that it’s needed.

Having these resources also means that, if one plan isn’t working, we can help form another.  That may mean suggesting a second diet if the first isn’t palatable, a different medication if the first isn’t effective (or a different formulation if the pet isn’t willing or able to take the first), offering assistance or training to help implement specific treatments, or making a decision as a team to discontinue a particular treatment.

And that last statement is, for me, the most critical one.  While it may seem like semantics, I honestly feel that there’s a difference between giving up and choosing not to continue.  Giving up carries a connotation of failure, which can also lead to guilt and blame – two emotions that can be incredibly damaging and undeserved for caregivers, especially in a hospice environment.  Making a choice, with cooperation and support, is an active decision that is still focused around the well-being of the patient.  Ultimately, when we’re facing an end-of-life situation, we know that eventually the patient is going to pass.  We can postpone that day, and we can make every day along the path more comfortable and peaceful, but we can’t delay death forever.  In that environment and mindset, I don’t feel that any considered and informed decision about treatment, or stopping treatment, is giving up – it’s just prioritizing different factors in the patient’s life.

So – I don’t think of my clients as giving up at any point in their pets’ care, and I hope sincerely that they don’t either.  It is my ultimate goal to create an environment where they feel comfortable communicating with me about any challenges they face and supported in any decisions they make.  And I hope that those of you reading this can take this mindset into your day-to-day experiences with traditional wellness care as well.

How Do You Do It?

“How do you face this sort of thing every day?”

“I don’t know how you do this job.”

“I could never do what you do – it would break my heart.”

“Isn’t that awfully depressing?”

I hear some variation on this almost every day – when I’m at an end-of-life visit, when someone asks me what I do, when I’m on the phone with a client calling to ask about how to handle an impending loss.  And they all boil down to the same thing – ‘how can you work around death and loss without being miserable?’  And the more I think about that question, the more I realize there’s a very simple answer.

My job lets me bear witness to some of the greatest acts of love that I can imagine, and reminds me every day of the goodness that people are able to hold within them.

Every person who calls me is doing so out of love, compassion, and hope.  Whether they’re looking for hospice care or looking to help their beloved pet pass peacefully, they are doing so out of kindness, and because of the deep bond that they share, and a desire to make things better – not for themselves, but for another living being.  Even knowing how hard it will be for them, they take this step because they want to make life better for another creature, or when that’s no longer possible, bring peace and an end to suffering.

Every time I step into a home I see selflessness, devotion, and love.  I see it in mattresses on the living room floor pulled up next to a dog bed so that an elderly pet who can’t climb the stairs won’t have to sleep alone.  I see it in heating pads and sun lamps arranged into nests in a cat’s favorite napping spot.   And I see friends and families coming together to support one another, sharing memories and comfort, hugs and laughter and tears.  A father lies on the floor with his daughter, telling her that it’s okay to feel what she’s feeling.  A best friend makes phone calls when the family is too broken up to speak.  A family plans to all share a toast to a pet’s memory at the same day and time, even if they can’t all be physically together.


Every death is different – and yet, the words I hear more often than any other, from person to pet?

“Thank you.”

“I love you.”


We live in a culture that does not encourage displaying or sharing our emotions – and yet every day I’m honored to share that closeness.  And right now, seemingly more than ever, we live in a world where news and social media seem to highlight the worst that humanity is capable of.  Hatred, violence, greed, selfishness, and anger are on display everywhere you look, and it can be easy to believe that this is the whole truth of the world.  But, while my job surrounds me with death, those deaths are the result of love and kindness, not intolerance, cruelty, or violence.  I am reminded every single day, with every family I help, of all the goodness in the world, the kindness that people are capable of, and the fact that every day people make decisions and take actions driven by love, compassion, and empathy.


How do I face this every day?

With gratitude for every family, every visit, and every moment of kindness I am honored to share.

Celebrating A Milestone

Today marks the one-year anniversary of Autumn Care & Crossings’ first patient, and my first official step on the path of being a hospice veterinarian.  While I had studied and planned and worked towards this in preparation, it was on this day last year that I formally became a hospice practitioner, and started stepping into people’s homes and lives to help them and their beloved pets in the final phases of their bond.

And I have learned so much in this year.  From my colleagues and the conferences I’ve attended, from the accountants and business folk who have helped me navigate the maze of small business ownership, and most importantly, from those very clients and patients.  I have learned more and nuanced details about targeted pain management and breakthrough pain and natural versus palliated death versus euthanasia.  I have learned how to reconcile Quickbooks and when not to trust Google maps.

I’ve learned to always keep treats and a spare pack of tissues in my bag, and that on a sunny day the dog park is an excellent place to finish a hospice call.  I’ve learned to never underestimate a child’s understanding or an adult’s devotion, when traditional medicine had always taught me to trust in the opposite balance.  I’ve learned that family is not defined by blood or by species, but by love – and that love comes in more shapes and manifestations than I had ever dreamed possible.  And I’ve learned that sometimes saying goodbye is the greatest and bravest act of love that a person can make.

It’s hard to write in a blog here when I sincerely don’t have words for how grateful I am to everyone who has been part of this year.  To my colleagues who shared their knowledge and experience with me; to the friends who helped make this practice real; to my patient and loving spouse who met the question of, ‘can I throw my career, our lives, and our home into chaos and turmoil for the sake of trying this?’ with more grace and support than I had any right to ask for, and most of all to the clients who invited me into their homes to be part of their pet’s care team.  Thank you all, more than you could ever know.

As a mark of that gratitude, and in celebration of the families and pets that I’ve been lucky enough to come to know over the past year, I’m starting what will hopefully become an annual tradition.  Autumn Care & Crossings will be making a donation to the MSPCA in honor of each pet in our care that has passed away over this past year.  It is my hope to celebrate each life passed by helping another animal become someone else’s beloved pet, and find a forever home as loving and caring as the ones my patients have been blessed to know.

Because I can’t say it enough times, thank you all again for being part of this amazing experience with me.  I look forward to many more years of laughter, tears, and learning as I help guide my patients and clients on their journey through this chapter of life.

Knowing When It’s Time

At some point in our relationship, almost every client that I’ve worked with – in both traditional practice and hospice practice – has asked me how to know when it’s time to euthanize their pet.  It’s a hard question – we want to have as much time as possible with them, but we also don’t want to allow them to suffer, and it’s natural to worry about making that difficult decision either too soon or too late.

I wish I had an easy answer here.  I wish there were an equation that we as doctors were trusted with – multiply the pet’s age by their weight, divide it by some numerical value assigned to their diagnosis, subtract a point for each day they don’t eat, and when you get to zero a timer sounds and you know.  Or, if not that, that there was some concrete point or incident that I could tell everyone to look for.  Unfortunately, that’s not the case.

Every pet is unique, and every person’s relationship with their pet is unique, and so the point of decision is going to be different for each family.  Some people want to be absolutely certain that they avoid any possibility of pain or suffering for their pet, and want to say goodbye sooner – and that’s okay.  Some people want to know that they’ve exhausted every possible treatment, and given their pet every possible moment of life – and that’s okay too.  And on top of that, every pet finds joy and happiness in different aspects of life, and so their quality of life is going to be affected by different things.

Quality of life is, ultimately, the most important factor in deciding when it’s time to help your pet pass.  And, as I said, it’s a very individual thing.   A 90-pound labrador retriever that’s used to being able to run and climb mountains with his family is going to be much more severely affected by joint disease and poor mobility than, say, a teacup chihuahua who’s used to being carried and cuddled for most of his interactions with his family.  On the other hand, that chihuahua (or an aloof kitty) is likely to be more negatively impacted by a need to take multiple medicines two or three times a day than the lab who will eat anything hidden in cream cheese or cold cuts.

One of the most important things that your veterinarian can help you do, as your pets age or confront chronic or terminal illness, is help teach you how to recognize their quality of life.  This is a deep collaboration between you, your pet, and the doctor – while they can talk you through what signs to watch for on the medical front, you know your pet’s personality.  You live with them every day, watch them, and know their favorite toys, treats, napping places, and things to do.  And it’s important to discuss these with your vet, and form a plan to pay attention to them and track them.

If your pet is seriously ill, your vet may suggest tracking their quality of life.  While there is no absolute equation, as I mentioned, there are factors that we can quantify and ways to track whether those details are getting better or worse.  If you’re having a hard time making a decision about whether your pet is suffering, having a way to look back over the past days or weeks and see objectively whether and how their condition is progressing can be a valuable aid.

There’s no way to make this decision an easy or painless one.  But by talking to your vet about quality of life, and paying attention to what your pet loves most, we can help you face this challenge with a little more confidence.

How To Help

Loss and death are always difficult, whether we’re the ones facing the loss of a beloved friend, pet, or family member ourselves or whether we’re trying to support someone we love through that process.  Every person approaches loss and grief with their own history, worries, and combination of emotions, and just like there’s no one right or wrong way to grieve, there’s no one right or wrong thing to say or do to support someone through grief.  There are, however, some things that can be generally helpful in most situations, and some that may seem helpful but can actually make things worse.

So – what should you NOT do to help someone you love through the loss of a pet?

*Don’t suggest that they get another pet.  While for some people getting a new pet may be part of their grieving and healing process, this isn’t true for everyone – and more importantly, the time to bring a new pet into the family (if they choose to do so) is different for everyone.  What may seem like a practical solution to you can come across as suggesting that pets are interchangeable and replaceable, which can seem dismissive of the pain and loss the person is feeling.

*On that same note, don’t try to reassure them by telling them it was ‘just an animal’ and that it could have been worse, by comparing it to other losses.  There’s no universal scale of loss or grief, and everyone is allowed to feel their own pain.  One person’s loss of a pet may be as traumatic to them as another person’s loss of a human.  Grief is not a contest or a zero-sum game.

*On the other hand, do not tell them “I know exactly how you feel.”  Even if you’ve been through a similar loss yourself, even if you feel that you have a deep understanding of their emotional state and want to be supportive, no two people experience grief and loss the same way.  Their emotional response is theirs and unique, just like yours was and is.  Don’t dismiss their feelings by suggesting that they’re the same as yours.

What CAN you do to be helpful?

*Listen.  This is the most important thing that a supporter and friend can do.  Let the person know that you are present, that you care, and that you’re able to be an ear and a shoulder for them.  If they want to talk, listen without judging or trying to problem-solve.  If they need reassurance, give it to them without straying into personal anecdotes of your own.  If they need quiet company, be present without pressuring them to behave in any particular way.

*Validate their feelings.  Let them know that it’s okay to grieve, and that you understand that their loss is significant to them.  While ‘I know how you feel’ is an unhelpful response, ‘I can’t imagine how difficult this must be for you’ or ‘I can only imagine how you must feel’ are open-ended, supportive statements that let your friend know that you empathize with their loss without second-guessing or hijacking their experience.

*Ask what they need or want.  What’s helpful to one person may not be helpful to someone else, and we run into the biggest problems when we assume that what we would want in a given situation would also then be best for another person in a similar situation.  Asking instead of assuming lets you give the most useful aid.  It also makes sure that the help you’re giving is focused on the grieving individual, rather than yourself.  Often in situations of caregiving we want to help in ways that will make us (the caregivers) feel better, but the most important focus should be on the person suffering the loss.  While we are hurting too, and are allowed to seek our own aid, the help we offer should be focused on those we’re helping rather than on ourselves.

*If the grieving individual isn’t able to focus enough to give you a specific answer to what they need or want, ask about specific ways you can help, but offer them as choices.  (“Would it help if I came over to keep you company?  Do you need someone to run errands for you?  Do you want me to return Smudge’s medicines to the vet so you don’t have to go back to that office so soon?”)  – and be prepared to accept whatever answer they give.  This empowers them to have some say in the help they receive while taking the burden of coming up with ways to be helpful off of their shoulders.

*Most of all, be patient.  Grieving takes time, and sometimes – as much as we want to help – there’s nothing we can do except be present, let the people we care about take the time they need to heal, and let them know that we’ll still be there, still care, and still be part of their life when they’re ready to engage with us again.

*Take care of yourself.  Even if you didn’t suffer the loss personally, having a friend or family member grieving the loss of a loved one (human or pet) can be stressful, challenging, and bring up memories of our own losses.  Make sure that you’re getting the rest and support you need – you can’t be a good caretaker and supporter if you’re not also taking care of yourself.

*If you’re concerned that your friend or family member is in danger, reach out to a professional.  Whether that’s a grief counselor, a religious leader, or a suicide hotline, if you’re seriously concerned that someone may be at risk of self-harm or falling into clinical depression or suicidal tendencies, don’t try to tackle that alone.  Encourage them to seek professional help, or if need be, reach out to a professional yourself.

Grief is something we all have to face at some point, both our own and that of our friends and loved ones – hopefully this can help make navigating that path a little easier.