There Are No Nursing Homes For Dogs

The unacknowledged grief and guilt of caring for aging and ailing pets

Photo by Karsten Winegeart on Unsplash

I began writing this from the tiny waiting room of a veterinary dentist, while waiting for my 11-year-old dog Penny to be sedated. We were there to biopsy a mass that had grown at an alarming rate in the back of her tiny mouth. Less than a year ago, a different vet extracted the remainder of my dog’s teeth due to advanced decay. At that point, I thought we were done spending money to care for my dog’s mouth. Unfortunately, I was wrong.

After our regular vet appeared flummoxed by the gnarly growth that had appeared in Penny’s mouth, I went searching for a specialist that could see her as soon as possible. Animal dentists are a rarity, which is how I found myself leaving before the sun rose on a Monday morning to drive 90 minutes out of state to see a specialist that could squeeze us in.

I was exhausted and anxious, but not nearly as nervous as Penny, who cowered in my lap as we waited for the doctor. The tiny room was decorated with photographs of cats and dogs in dated picture frames, which clashed with the more modern style area rug beneath the exam table. It seemed awfully brave to put an area rug in a veterinary office. There was a wooden sign by the sink that says, “Cats are like potato chips, you can’t have just one.” I thought about snapping a photo, because this I agreed with.

Soon the dentist joined us. He introduced himself, kneeling as if to approach Penny on my lap. He balanced on one knee, as if he might propose. “So…who pulled her teeth?”

I explained that our regular vet performed that procedure, but the problematic lump popped up later. But the doctor was not satisfied. “What was your vet’s credentials to perform dentistry? Did you ask?” I was caught off guard and stumbled over my answers. To clarify his point, he asked me pointedly, “Would you want your dental hygienist pulling your teeth?”

I don’t know if his intent was to reprimand me, but I felt admonished and judged. I understood very well the point that he was trying to make, even through the fog of his poor bedside manner. As a specialist, he was used to having pets come to him with botched dental work and misdiagnoses from well-intentioned but under-qualified general practitioners. As a psychologist, I have similar complaints. Just because I have a psychology license does not make me qualified to treat anything and everything that could walk through the door. Much of the work of becoming a specialist happens with advanced training beyond the receipt of your degree and license. Any healthcare provider, for any species, can do harm by working outside their scope.

The dentist was preaching to the converted. Given that I had already spent a good chunk of change at our general veterinarian who was not able to give us any answers at all, I also wish we had come to the specialist straightaway. But his exasperated tone made me feel like I was the one who had done something wrong. The shame was compounded by the fact that I was already sweating about the cost of the appointment, not to mention future treatment for whatever the heck was growing in my poor dog’s mouth.

After the dentist was finished lecturing me about veterinary scope of practice, the discussion turned to the matter of my dog’s pending diagnosis and treatment. “Once we know what this is, you will make the decision that makes the most sense for you, based on your head, your heart, your gut, and your pocketbook” he said. I could already promise you that those 4 things; my head, heart, gut, and pocketbook, were not on the same page.

We made it through the appointment. The procedure was less than an hour, but by the time we made our way back to the car, Penny was disoriented by the anesthesia and I was mildly dissociated with financial anxiety and anticipatory grief.

I have read a lot about grieving the loss of a pet recently, because I lost my beloved senior dog Buster just last Summer. He was suffering from old age and kidney failure, and when he was no longer interested in eating, we decided it was time to say goodbye. I’ve noticed that when we talk about pet grief, we do not often talk about the financial tension that is present when making decisions about our pet’s care.

I’ve found that when facing a medical crisis for a pet, I am juggling a number of uncertainties. One, I am tasked with the immense responsibility of speaking for a living creature, who cannot advocate on behalf of herself. If presented with the choice of how to proceed, I never know for sure what my pet would choose. I must make decisions about how intensive, invasive, painful, and prolonged. Weighing pros and cons; risks and possibilities. Although not an expert in veterinary medicine, I am the expert on my pet, and I’m the one that has the best chance of reflecting her wishes, if she were able to vocalize them. When extended or repeated, this process leads to decision-fatigue, especially when decisions are time-sensitive or made during a crisis.

I am also considering the limits of what I can provide, emotionally and logistically, for continued care. Elderly or injured pets, or those with chronic illnesses, may demand significant amounts of supervision, time, or travel.

And lastly, as the doctor stated, my decisions are tethered by my metaphorical purse strings. I wish cost was no concern, but my financial reality is such that money does matter.

I know that I cannot be alone with this reality and the cruel tension that I feel around the high costs of caring for my elderly or injured animals. It’s a terrible feeling to have to consider making medical decisions for my furry family member based on something as superficial as cost. Many people go into debt to cover the costs of care for pets, while others have to forgo further care because they cannot afford it.

Veterinary research defines “economic euthanasia” as euthanasia that is chosen primarily due to an inability to afford further diagnostics and treatment. Given that costs for veterinary care can easily reach thousands of dollars, it’s not uncommon for families to find themselves facing this heart wrenching decision. Research suggests that making end of life decisions based on financial constraints increases the likelihood that pet owners will experience guilt and shame along with their grief. Economic euthanasia also takes a toll on the emotional well-being of veterinary staff.

For many, the loss of a pet is on par with the loss of a human family member. And yet when a beloved pet dies, family members often find that the intensity of their grief is largely unrecognized or minimized by the world around them. In psychology, we call this experience “disenfranchised grief.” The discussion of money, and the lack there of, is also taboo. Therefore, navigating financial stress and medical decision making for pets can be isolating and possibly shame-inducing.

As I stated, I recently said goodbye to a pet via euthanasia. I have also watched many friends and loved ones go through the process. It is immensely challenging to know when it is the right time to assist our pets in this way. Many vets advise “better a day too soon than a day too late.” Understandably, we agonize over making that distinction.

Afterwards, it is common to second guess our decision. With Buster, I still wonder if I should have been more aggressive with treating his kidney disease, which in his case, meant providing intravenous fluids at home several times a week. I second guess whether I should have asked more questions on that last day, instead of being so certain that it was time. Maybe there would have been options, had I asked. Who was I to make this decision? Who am I?

But of course, no one is better suited. It must be me. I was recently delighted to learn that in Hawaiian, a pet keeper is referred to as a “Kahu” which means a protector, guardian, or steward. The word reflects the privilege and responsibility of inviting an animal into our lives and homes. I believe that most loving pet families feel the gravity of that commitment, especially in times of hardship and at the end of life. Perhaps one of the most important stages of that commitment is those final days, when you are the one tasked with deciding how to best guide your companion out of this life and into whatever comes next. A burden that we agree to shoulder, and the ultimate, most intimate gift that we can give our furry loved one when the time comes.

I admit that I had not previously considered that perhaps we should be taking our pets to veterinary dentists when the need for dental care arises. And unfortunately, I do not have the financial freedom to say that cost is not a consideration when making treatment decisions for my pets. But I take comfort in knowing how far my knowledge and compassion for animal care has grown over my lifetime. And I continue to learn. I’m already experimenting with special toothbrushes and toothpaste for my younger pets, the ones who still have all their teeth. I’m learning about water additives and special treats to help with tartar.  I want to give them the best chance of avoiding the future dental discomfort that my elderly pets are currently dealing with. As Maya Angelou says, “Do the best you can until you know better. Then when you know better, do better.”

When I began crafting this essay in the waiting room, I was beginning from a place of anger and defensiveness, which masked the fear and guilt that boiled beneath. I wanted to write about the rudeness of the dentist that made me feel ashamed in such a vulnerable and distressing moment. I secretly hoped the next dog to visit would pee on the bizarre exam room rug.

But the process of translating my feelings onto paper has helped soften the sharp edges of all those emotions, and I no longer feel the need to lash out with my words. I can appreciate the passion of the doctor, who I now believe was simply advocating for the most ethical and high-quality care for all pets, mine included. He was not judging me. My own anxiety primed the pump; made me hypervigilant for any sign of criticism.

As I’ve been crafting my story, I remembered that veterinarians have a demanding and often underappreciated career, that takes a considerable emotional toll. As a matter of fact, veterinarians are significantly more likely to die by suicide than adults in other professions. Financial stress, burnout, and compassion fatigue are cited as potential contributing factors (all of which are familiar stressors for a therapist!)

I am not ending this essay with expert advice and insight. I’m simply noticing my own feelings of grief; including anger, sadness, and confusion. I am noticing the wince of guilt that accompanies the financial considerations of my pet’s care, and how in our culture, we don’t always talk enough about the realities of finances. I want to acknowledge the shared experience of disenfranchised grief that animal lovers will likely experience at some point.  I hope to model compassion for myself and others, in a world that encourages anger and divisiveness.

I know that if I am experiencing these emotions, then I am most certainly not alone. Sometimes the most helpful guidance is not a list of steps of what to do, but simply saying, “I see you. It hurts. I feel that too.”

You can read more about pet grief in the article “We Lost a Member of the Family: Predictors of the Grief Experience Following the Loss of a Pet” (Behler, Green, and Joy-Gaba, 2020). If you are making end of life decisions for an animal in your care, you may want to check out Dr. Samantha Morici, DVM who discusses euthanasia in her article “The Biggest Mistake People Make When Deciding To Euthanize Their Pet (And How To Avoid It)”

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Disclosure: Dr. Amber_Writes is a newsletter designed to be informational, entertaining, and engaging. It is not therapy. Following this newsletter does not establish a therapeutic relationship with me. Dr. Amber_Writes, and other written communication by Amber Groomes on Substack, is not a substitute for treatment, diagnosis, or consultation with a licensed mental health professional. I assume no liability for any action taken in reliance on my writing here at Dr. Amber_Writes.