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The Art of Knowing When It’s Time

    Show Notes

    We don’t want to think about the last day we have with our best fur friend, but as we’ve heard a couple of times from Coleen Ellis in The Art of Making Memories and The Art of Loving a Soul Dog (or Heart Dog), planning can help take some of the stress and pain away from the end.

    Today, Darlene Woodward of Pant the Town Photography in Massachusetts takes the mic to chat with her friend, Dr. Jennifer Cushing of Beloved Pet Home Euthanasia and Hospice in Reading, Massachusetts.

    Jennifer helped Darlene say goodbye last summer to her precious Kota, a Siberian husky full of spunk and sass.

    The planning and in-home euthanasia gave Darlene the perfect way to lift Kota up to the next realm … gently and peacefully with her eyes on the backyard where she spent so many years chasing squirrels.

    What to Listen For

    4:13 Jennifer finds joy in the work she does

    7:44 The difference between euthanasia at home and at the clinic

    12:41 How this moment can be a celebration of life

    19:29 The quality of life consultation

    27:06 Why we can’t wait until it’s too late

    Where to Find Jennifer

    Beloved Pet Home Euthanasia and Hospice
    Facebook

    Where to Find In-Home Euthanasia Near You

    International Association for Animal Hospice and Palliative Care

    Transcript

    Angela Schneider

    Welcome to One Last Network and the Art of Knowing When It’s Time.

    We don’t want to think about the last day we have with our best fur friend, but as we’ve heard a couple of times from Coleen Ellis in The Art of Making Memories and The Art of Loving a Soul Dog (or Heart Dog), planning can help take some of the stress and pain away from the end.

    Today, Darlene Woodward of Pant the Town Photography in Massachusetts takes the mic to chat with her friend, Dr. Jennifer Cushing of Beloved Pet Home Euthanasia and Hospice in Reading, Massachusetts.

    Jennifer helped Darlene say goodbye last summer to her precious Kota, a Siberian husky full of spunk and sass.

    The planning and in-home euthanasia gave Darlene the perfect way to lift Kota up to the next realm … gently and peacefully with her eyes on the backyard where she spent so many years chasing squirrels.

    Have a listen.

    Darlene Woodward

    I’ve never been much of a planner. I’ve always preferred a spontaneous life, just kind of letting things happen as I go. But one thing that I always wanted to have planned if it was possible, was that when the time came when I had to say goodbye to my soul, Dakota, I wanted to be right here at home, who was a homebody, I wanted her last day to be peaceful and stress free. The thought of having to put Kota into a car and drive her to the vet terrified me. I never wanted to be too late in making that decision. In March of 2022, I reached out to Dr. Jennifer Cushing to discuss the inevitable, was it time, how does one ever know when it is time? Fortunately, that day, it was not time for Kota. After that phone call. I had five more amazing months with Kota that I truly am grateful for. I would like to introduce you to my wonderful guest today, Dr. Jennifer Cushing, of Beloved Pet Home Euthanasia and Hospice. Try not to cry already. But Jennifer is an amazing, amazing person. She is a certified palliative care veterinarian. Dr. Cushing is located in North Reading Massachusetts, and she serves Eastern Massachusetts in Southern New Hampshire.

    Thank you so much for being here with us today. Welcome. And I tried to get out your story but I am ready because I absolutely love your story. So we’re here and how are you doing today?

    Dr. Jennifer Cushing

    I’m very good, Darlene. Thank you so much for that introduction. It’s an honor to be here. And it’s fantastic to be a guest for One Last Network. Thank you so much.

    Darlene

    Thank you so much. This episode with me has been a long time coming, I had to get myself together to be able to chat with Dr. Cushing. She’s just an amazing part of my life after having said goodbye to Kota and everything. So I am so happy. She’s here with me today. But first of all, before we dig deep, let’s just hear a little bit about you. Because I know it’s not all the sad, depressing type things. Tell us a little bit about who you are.

    Jennifer

    Well, I think that my job actually is not super sad and depressing. I feel very honored to be able to be of so much help to my patients. So I guess I don’t look at my job as sad and depressing. But it is. I do see a lot of sad people. And it’s a lot of kind of heavy feelings that I am in and around all day long. So I think that it’s pretty important to have a little bit of an outlet. So one of my major hobbies is actually ballroom dancing, and I get so much you know, it’s a completely different headspace as it is with doing my appointments. So it is so rewarding to be able to do like a sport that has something that is beautiful, a beautiful outcome. And I just love the, the sparkly rhinestone dresses and the competitions that are so glamorous. So it’s such a rewarding hobby, and such a nice outlet. And completely different from my day job.

    Darlene

    I love that. And if any of you would like to stalk Dr. Cushing, she has posted every now and again, I see on Facebook, some of her ballroom dancing videos and pictures. She’s absolutely stunning with the sparkly dresses. And it seems like you have that whole self care thing down with that. So that is so important in what we do to have those outlets and find that joy.

    Jennifer

    You have to. You have to have a balance you have to be in order to be to be your best self in offer. You know, to be completely present with my clients, I really have to have be sort of my best self and so it’s important.

    Darlene

    No, that’s amazing. Awesome. So where does one get into what you do? Because that’s a tough one, what you do, and I love that you try to bring the joy into it and keep it as more of a positive experience. How did you get started in this?

    Jennifer 

    Yes, it is. It’s such a unique niche of veterinary medicine that’s actually quite new. It’s such an old fashioned service to be offering home veterinary care. But it’s really been maybe in the last 10 to 15 years, that end of life care has become sort of a specialty. And especially in the home setting, so I didn’t really know much about it until I was going through end of life preparations with my own dog and my, my beagle was diagnosed with bladder cancer. And that is, there’s a certain timeframe that you have, from time of diagnosis to time when they’re really sick and euthanasia should be considered and usually about like four to six months. So I had that sort of preparation time to really, like you said, plan for how you want the goodbye to go. And one of my good friends and classmates from veterinary school practices end of life care, had practiced end of life care in Virginia Beach for many years.

    And I always thought that that was a very depressing job. But I, I asked her about the way that her appointments go, what medication she uses, and I followed her guidelines and the euthanasia for my beagle, it was so beautiful it was she just fell asleep in her favorite comfy spot in the sunshine in her little bed. And it was so nice, and it was so peaceful. I, it totally changed my perception about the way that euthanasia could be my previous experience as a general practitioner in Animal Hospital, the pets would come into the Animal Hospital, a place where they’ve never liked to be, more afraid of, and they’re having their last moments in a place that they’ve never liked to be. And that was heartbreaking to me. Really, euthanasia was such a kind of a dreaded appointment for me when I would say euthanasia on my let me schedule it would make me so sad because the pets were so stressed.

    But home euthanasia is it’s completely different. The pets are so relaxed, they’re usually you know, enjoying their their snacks as they are enjoying their medication that I give them to help them drift into a completely sleeping pain free state. And it is this beautiful passing. And oftentimes in that timeframe, which usually is about like five or 10 minutes for the pets to fall asleep. That’s a time this like beautiful moment where I can usually hear the stories about that pet and it’s just this wonderful time to actually memorialize the patent feels more like, like a week to me, rather than an up like a celebration of life to me, rather than this, like terrible gut wrenching, traumatic experience, like it often is at the animal hospital. So these appointments, to me are really life affirming, because I see how much people love pets, they love them so much. Like that is just really just so fulfilling to be able to help people in that stage of things.

    Darlene

    And so in the vet’s office, they’re, they’re doing the best they can in the situation, they try hard, but still, there’s nothing like being at home. And from personal experience now, I cannot imagine doing it any other way. But unfortunately, we don’t always have any other way.

    Jennifer 

    Right? Sometimes emergent things happen and you’re at the ER with a very sick pet. And it’s appropriate to say goodbye in that setting. And to not you know, had any layers of stress to get home with a critical path that’s so the ER and the animal hospital when your, your pet is so very sick, that is totally appropriate for them to be, to have the goodbye there. But if you can plan for it. And if you do have a little bit more of a slower decline type of disease process that you’re going through with your pet to be able to really kind of think forward and think about, well, how do I want this last day to be? It’s hard. It’s really, it’s gut wrenching really, to, you know, make the plans, but to, we’ve made plans for our pets every step of the way of their lives. And this is one of the most important moments that I think plan for if you can.

    Darlene

    And one thing I always tried to remember Is everything we do for our pets is out of love for them. And that’s why we do them. When you said goodbye to your pup was … you were by yourself? Were you by yourself?

    Jennifer 

    Thankfully, I, my family was there, my mom and dad and my sister there, it was such a … and that was the time where we were able to share the stories about her being a naughty beagle and getting up and spread around spreading around five pounds of flour all around the house. She was, so it was just, it was that time of her, you know, having that moment with her it was all these memories of all of these good times and thinking about her in her heyday really, really positive, it was just this positive experience to share that with my family.

    Darlene

    Oh I love that.

    Jennifer

    So lucky, really felt lucky, you know.

    Darlen

    Yeah, to be able to bring everyone together and celebrate that time, it just again makes it so different. And that was the, I think the first time I ever experienced the home euthanasia, maybe eight or nine years ago, when I had a dog walking business, one of my dog walk clients, the owners invited me to their home, when they were going to say goodbye to their little dog because I had spent five days a week walking that dog and knew that dog over the years. And just being there because he was such a part of my life too. And just having those last moments together. That was when I had first learned about home euthanasia. And I remember saying to myself, you know what, this is how it really should be.

    Jennifer

    Right?

    Darlene

    It’s so meaningful.

    Jennifer 

    So meaningful, it really is. And it is it’s so nice to be able to have a family and friends be there. I’ve been to some appointments where there have been like 10 or 15 people, and it’s just touching to see how this pet was so important to so many people. And each one of those individuals had a great story that, about, about that, that pet and that’s what I really love, I hope that I can bring a little bit more of a upbeat type of atmosphere to my appointments, because that’s the moments that I really love is to, it’s to really understand how this pet is so important to these people.

    And I feel like I have been a general practitioner for many years. And I feel like I learned a lot more about my end of life care patients who I’m usually meeting for the very first time at that appointment. But I feel like I’ve learned more about those patients than I, than I do when I’ve been seeing pets for many, many years at the animal hospital. So it’s a special, special time to be able to have in that appointment if you can.

    Darlene

    I do remember when we were chatting, you had mentioned that you learned more in that 45 minutes, then possibly 14 years of that dog you know in and out just that short amount of time because there’s so much love in the room. So many stories that are told, it’s so meaningful that I just think that’s wonderful.

    Jennifer 

    That is it is. So that part is the rewarding part is so there’s there’s a lot a lot of kind of sadness that goes along with it as well, because of course having the goodbye part is really tough. But I think it’s the least worst way is, I think what somebody described it to me.

    Darlene

    The least worse. I like that because if there’s no, it’s just not a good, it’s the most difficult decision we have to make for our pets. It’s so so hard that yeah …

    Jennifer 

    Yes. Part of it too is even just coming to the decision for euthanasia is it’s really tough and it does … now there’s more resources available for there’s businesses, like I offer quality of life phone consults in advance of the euthanasia appointment, and I offer hospice care appointments as well. So there’s a lot, a lot more resources for preparation for end of life care than there previously were. The International Association of Animal Hospice and Palliative Care has been a organization that has been around for about 15 years now and they offer now certification and for, for veterinarians and social workers, and veterinary technicians and nurses for certification, and palliative care, and that’s something that I think will be really big in the future.

    I think eventually, a hospice and palliative care will be boarded specialty, much like it is in human medicine. And there’ll be a lot more resources for pet owners walking that oftentimes tough end of a disease process with their pet. And getting to the point of, of making a euthanasia decision is sometimes right now a very unsupported area for people. And oftentimes, they people will get a diagnosis from their general practitioner of a life-threatening condition that their pet has. And sometimes they get the advice like, you’ll know when it’s time, or you’ll call us back when they stop eating, or some, something that is kind of vague.

    And that’s sometimes really tough for people. So I’m glad now there are more resources for people and for pets, to improve the quality of life that they do have. Leading up to when euthanasia, or natural death is being … this supporting natural death is being kind of decided upon. So the, the, my phone consults are so helpful, because I hear so much more about the pet and their life that I could ever hear in like a 15 minute office visit at the animal hospital. So being able to set aside a good like 30 minutes to really talk about what people are seeing with their pet is so important for euthanasia decision-making. Because oftentimes people are concerned about certain things that they’re seeing. And sometimes though, those issues that are coming up can be supported with hospice, sometimes there’s medication options, that really comes up that can be really helpful to extend the quality of life that that pet has.

    And sometimes it’s quite the opposite, where they have done all the things, they’ve done all the medication and their pet is still struggling. But you know, sometimes somebody like me to kind of, kind of summarize that, yes, you’re right to be concerned about what you’re seeing and your pet is struggling and that euthanasia is appropriate. That sometimes doesn’t happen, unfortunately, with the, you know, a typical general practice situation occasionally.

    Darlene

    That is so true. They will not necessarily take that time to spend. And I’m glad you started talking about the quality of life phone call, because that is when I mentioned in the beginning, I first reached out to you. And I scheduled that hour phone call, I thought it was the day Kota was saying, and when you sort of that, they’ll let you know, you don’t always know you don’t know when it’s time necessarily. And I thought, oh my god, maybe she’s telling me it’s time, she doesn’t want to walk anymore. Kota is lying on the ground, she’s done walking. And it wasn’t that it was me, it was me missing my walks is what it was. Kota just needed a break from walking and everything.

    But I remember that time you took with me on the phone just was so it was just so meaningful. And it helped me walk through everything in my head. And you know, we looked at Kota’s vet records together. And I wasn’t going to get an hour with my vet in his office going over Kota’s medical records and going over different things to do with So just the fact that we were able to go through that is an amazing service that you offer to pet parents.

    Jennifer 

    Yeah, I’m glad that you feel that way. Because it is, it’s sometimes it’s just a really kind of focused, targeted discussion about you know, what, what is the pet’s mobility, like and what what, are they enjoying eating anymore? What do they really like to do and sometimes is oh, they still like to walk in? They’re very engaged. They really like to be with the family. And it’s oftentimes that will lead into oh, well, maybe we should schedule a palliative care consult, which I will then go to a person’s home, do an exam, kind of see what the pet’s life is like in their regular surroundings, which is also so informative because oftentimes, I get so much more information, but then I would ever get in an animal hospital setting in an exam room.

    Because oftentimes they come to the exam room and they’re kind of jazzed up with, you know, address them and you see them sort of in their a little more of a better state than they are showing at home. So sometimes at home, they’re really struggling with mobility, or I go to the home, and it’s just complete, like hardwood floor and tile that an old dog is struggling to stand up. And there’s many, many things that can be done to help with improving traction in those types of environments, raising both food and water bowls, so that an arthritic dog doesn’t need to really lean down too much to really comfortably eat and drink. It’s small little things like adding yoga mats to an area where there’s a stretch of hardwood that they’re always sliding on.

    And even just basic pain management medication that is sometimes overlooked in general practice setting because sometimes, the pets look so much better and not painful. But then when you talk to pet owners, when what they’re seeing is sometimes a lot of restlessness and panting, and kind of struggling to go up and down stairs, that you’d never kind of know much about that in the exam room. But once you see them at home, it’s very clear that that a lot of pets do need help. And basic pain management sometimes helps so many dogs to really improve their quality of life for so much longer than they would ever have otherwise. I love

    Darlene

    This meant the world to me and I know you’ll know who I’m talking about. But in January, I got a phone call. It was very last minute for an end of life pet photo session. And they had just come from their veterinary office where the vet had wanted them to leave the dog and have them say their goodbyes right then and there. And that was not expected. So the owner called me and she was in tears. And I dropped everything that day to do that end of life photo session. The dog did absolutely amazing. We went up to Salisbury Beach, it was with Mom and Dad, it was just a gorgeous evening, everything just couldn’t be more perfect.

    And I gave them Dr Cushing’s information. And I said, Please give her a call. And you went to their home the following weekend and did a palliative care visit and a quality of life, full consult and all of that. They were so grateful to have even those extra few days with their dog at home, enjoying the beach, enjoying snuggling on the couch, all of those things. And those few days just mean everything. So thank you for doing that.

    Jennifer 

    It’s so rewarding. So she she was diagnosed with a cancer that … totally blindsided by that diagnosis, it’s one of those tough situations because, of course, in the hospital setting, you want to be able to have the patient as comfortable as possible. And it sometimes is hard for the vet that’s making the diagnosis to be a proponent of going home. But with hospice-assisted medication that that little dog was comfortable in the time that she had left, I increased her pain management and I left her with a comfort kit which was with medication that if she was to experience a crisis could be administered to perhaps if there was like an emergency where she could go back to the animal hospital she could go in comfort and peace.

    So many things that can be done to improve that time. And had of course it was super, super sad goodbye but the time that that bonus time that that that family had with their little dog. It was just, it was such a gift. So it was so such an honor to be able to assist with that and improve her little bit of bonus time that she had before. She had to say goodbye.

    Darlene

    It is a gift. Each, each moment, each second every extra time we have with our pets is definitely a gift. So yeah, and thank you so much for being there with that one. So the quality of life phone call, I think that has to be one of the hardest calls for a person to make because it means they’re coming to terms with … it is almost the time, it’s almost like they’re finally accepting, okay, I’m making this phone call. So it’s time to say goodbye. But with that call, it doesn’t necessarily mean that today’s the day, right?

    Jennifer 

    It’s so, it’s so variable. So they’re oftentimes our major diagnoses that have already made by their regular vet. And they’re seeing sort of end stage disease processes, a very lethargic dog, a dog that’s not eating anymore, a dog that’s really not enjoying life anymore, and is not really socially engaged anymore. Those are sort of the big things that, that and hygiene, if they’re unable to get up and really have a bathroom activity, those are have independent mobility, those are really the big things that really kind of are the big categories that I’m kind of looking for to see whether they are able to do those things and enjoy those things anymore, and can do them under their own power. Oftentimes, they’re not.

    Sometimes … I’d say that anytime anybody’s making the phone call to me, it is I often hear the … it’s taken a lot of time for them to actually even pick up to pick up the phone, because it is, it’s a big, emotional decision even just to have the conversation. And sometimes they’re weak, we have the conversation. And it’s very clear that this is there’s lots of room for ways to medically manage the condition. Sometimes it’s a matter of starting medication that will improve things. And then oftentimes the … they’re exactly right where they’re concerned about their pets, lack of quality of life, and they are completely right.

    They’re off … most of the time people are like within the window of where euthanasia is appropriate. There’s not one marker that says that if your dog does this, then it’s, it’s end of times it’s really a collective decision and a collective kind of gathering of information that will really indicate that euthanasia is really appropriate. And I’m such a believer in the old saying that better a week too soon, rather than a moment too late. Because I’ve seen a moment too late all the time. I’ve seen dogs struggling.

    And euthanasia does not have to be a thing that is pursued on the pet’s worst day. And in fact, I think a well-timed euthanasia is really when euthanasia is being pursued, when it’s the worst day, you know when there is maybe so like a couple of things that they still enjoy doing. But the bulk of their quality is compromised. That’s really, really when euthanasia really should be considered. Because I think that euthanasia is such a gift that veterinary medicine has that they don’t have to struggle to the bitter end of their … pets don’t have to struggle to the bitter end of their disease process like person would. They, they really, if you have a lot of indicators that they’re not enjoying life anymore. It’s … they don’t need to stop eating and really have not been eating for days in order to really have that because that’s the thing that everyone thinks about as the indicator that euthanasia should be considered. But oftentimes, especially for that Labrador, that has always been food motivated, they’re going to eat even if they cannot stand up under their own power at all anymore. So that is sometimes a really common mistake that people make that they’re looking for that stopping eating point, and it’s so much more of a bigger decision than that.

    Darlene

    Right, because they usually say Oh, are they eating? Are they drinking water? Like that’s, that’s the tell-all sign right there. I know the day that you came to the house and Kota was eating some treats. She was, she was eating and yeah. I love that you said better a week too early than too late. Because in hindsight, that is the best thing that I personally could have done for Kota. And I don’t remember any last days of severe pain with her, anything like that, I remember some great moments, some memories, running in the yard taking pictures of her the night before. She ran to you when you came in the house, which made it a lot harder, but she did her best at being her best right till the very end.

    Jennifer 

    That’s right.

    Darlene

    It was a gift.

    Jennifer

    It is, it is and it’s, it’s harder for the family to make the decision when, you know, they still have their wag. But if collected, all of the other things have fallen away to the point that they are just, they’re clearly a sick dog that’s putting a happy face on their struggle. Because they do that, they usually don’t vocalize, they … when they’re in pain, they usually it’s more subtle, they usually are a little bit more withdrawn, they’ll sometimes do a lot of panting, there’ll be restless. And then there are the dogs that do stop eating. But it’s amazing how long a dog that is not eating can continue on in that not-eating state when you know that the reason for the not eating has gotta be a profound nauseating condition that they’re just struggling with.

    You know, you don’t have to wait until it is to the point that they’re so weak they can’t get out of bed. So that’s, that’s something that’s not fair to them. It’s true. It’s true.

    Darlene

    Oh, my goodness, wow. Ah, this has been so amazing chatting with you today. How much information do you have as we wrap things up? Do you have any other advice or something else that you’d like to share with our listeners today? Any last kind of tip?

    Jennifer 

    This will be a little bit more of an available service, I think, as time goes on, there already are a lot of Certified Hospice palliative care vets already. You can go to the IAAHPC website and actually look for a local mobile provider. And that is a way that you can figure out whether the service is available near you. And that there’s many, many services out there. But the certification program is so comprehensive and important for communication and supporting the family, both with direct medical support of their pet, but also supporting the family and their emotional needs as well. So that’s sort of a unique service that not all end of life care vets are trained to do. But the vets that have gone through the certification program that’s part of a major part of the training. So that’s a good resource for people, is to look at the IAAHPC website, and they will have access to somebody near you at that.

    Darlene

    Awesome, thank you. And what we’ll do is we will leave under the notes from this episode, the link to that site, if anybody is looking for someone to help that is located in their area. And this has been wonderful. Thank you so much for being with us today, Dr. Cushing. I appreciate you and all you do and you are just absolutely amazing.

    Jennifer 

    Thank you very much. And thank you for the opportunity to come and speak about the area that I’m so passionate about.

    Darlene

    I love it. I love it. Well, you have a wonderful day. Thank you. Thank you so much. Bye bye.

    Angela

    Oh how I wish I knew of in-home euthanasia nine years ago.

    The end of my time with Shep was … is painful. To the point where I cannot even drive past the clinic where we had to take him.

    It was a last-minute thing for us.

    There was no planning. The vet called me a day after seeing my big man and said, “Your dog’s heart is going to explode. You have to put him down today.”

    We rushed off for one last great road trip from Kelowna, B.C., to Spokane, Washington, so we could have a few last moments with my then-fiance (now husband) as the family we were planning to be in a few short months.

    We carried Shep into the clinic and laid him down on the cold floor of a cramped examination room.

    Today, I see some clinics doing things differently. A candle sits on the desk with a sign that says, “If this candle is lit, we are saying goodbye to a family’s friend. Please stay quiet.”

    And I wonder if that is enough to bring comfort to a family’s last moments with their best fur friend.

    Then I hear of people like Dr. Jennifer Cushing and local to me, Drs. Lacey Rasmussen, Meghan Yurenka and Morgan Feist at Tranquil Passing.

    And I know that when Bella’s time comes — not any time soon, please — I will be able to make a decision that lets her transition be less traumatic, more peaceful and full of the love and joy she has given us over her lifetime.

    Next week, we dig into the art of adopting older dogs as I interview Lisa Lunghofer of The Grey Muzzle.

    Until then …

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