Doing Death Right

A conversation with Lynn Hendrix, DVM, CHPV, on rethinking palliative and hospice care

By Katie Berlin

A Conversation with Lynn Hendrix, DVM, CHPV

The terms “hospice” and “palliative care” are often used interchangeably, but they’re not synonyms. In the words of Lynn Hendrix, DVM, CHPV: “One of the big differences between palliative medicine and animal hospice is that palliative medicine can be done anytime. You can have a dog seeing the oncologist and still have a palliative medicine person on your side. We’re there to support, to build that relationship, to take over as the curative medicine starts backing away.”

And those relationships aren’t just between veterinary teams and pet owners.

In a conversation for Central Line: The AAHA Podcast, Hendrix shares why a pet’s healthcare team extends far beyond the people in the room during her house calls, what she hopes to give others in the profession in her new book, Animal Hospice and Palliative Care for the House Call Veterinarian, and some of what she’s learned about life from spending so much time in such close quarters with death.

Lynn Hendrix: I started having an interest in end-of-life care in 1993 when my mom passed away, and that was my first experience with death in hospice. At the time I was a vet tech and I thought, “We’re not really doing death right for our patients.” Really it became about, how can we do this better? How can we bridge that gap between “Your pet has a terminal illness” and euthanasia?

“We’re not really doing death right for our patients.”



So often, I hear from students and from colleagues that they don’t really feel prepared for those conversations coming out of vet school or even now in practice. I’m sure older vets are probably more practiced at it, because they have more life experience. But none of us really had education around end-of-life care… And they’re still not doing a lot of conversations about what happens if the client says, “I don’t really see what you’re seeing,” or “I don’t really think that it’s time for euthanasia, my dog’s still eating,” or “I don’t really think they’re in pain. How can you convince me otherwise?” And we all call that denial. But it’s not really denial. It’s just a different perception of what’s going on.

I’ve found, as I built my business, that I don’t really like a lot of the quality-of-life tools that we have, because they’re general and basic. And the questions that we get around euthanasia are not general and basic, they’re deep and emotional and meaningful. And there’s not just one party involved. There are multiple parties involved.

GettyImages-1303833933.jpgKatie Berlin: In your own words, “We all practice end-of-life care.” But what can veterinary teams in general learn from somebody who’s been working in this area of veterinary medicine for so long?

LH: When I wrote about teams, I started with who’s on the team: veterinary technicians, mental health professionals, groomers, pet sitters, compounding pharmacies, regular pharmacies, online pharmacies… Spiritual leaders, religious folks. So really your team can be quite large… anybody who can help the individual family and their pet. A lot of [palliative care] is individualizing that. And crisis hotlines, pet loss support hotlines, and mental health professionals for those who need additional support in bereavement.

That’s one of the things that we don’t really talk about as far as palliative medicine, but there’s bereavement after a loss, any loss. But often with [the loss of] animals, it’s disenfranchised grief, meaning that we don’t have a lot of support in our community. [People still say] things like, “Oh, it’s just a dog, why are you still grieving? It’s been three days.”

And so really, it is building out that team. When I started, that’s what I did. I just found people in my community that could help support my clients… so I didn’t feel like I had to take on everything, which veterinarians tend to like to do.

KB: So… a team [doesn’t just] mean you and your veterinary technician and your veterinary assistant and your CSR. It means everybody involved in taking care of that pet, so that could be all the family members that may not even live with that pet. That could be a groomer or a close friend who’s advising or the pet sitter that comes in once a day and sees things the owner may not see… And I think that’s a really big lesson for us, that the healthcare team of that pet is so much larger than the very insular world of our hospital.

How do you handle relationships with all of those team members when you don’t get to talk to them directly?


LH: I do check-ins with clients, and that may be daily, weekly, maybe monthly, maybe bi-weekly. It just depends on the disease process and what their needs are, because they are directing this care to some extent. And… they will convey, “Hey, my groomer said my dog has an ear infection,” right? They always find the ear infections for us.

…I can’t stop my clients from seeing other people, but [it helps to have people] I could refer to. I had one pet sitting company that were fantastic. They would go in and they would call me immediately if there was something going on with the dog or cat.

KB: We [often] think, well, the groomer can’t possibly know more than us and the pet sitter probably isn’t saying what we would say. And we want the client to just listen to us. And A, that’s never going to happen. We’re never going to be the only voice in that client’s ear. But B, we really do discount, I think, what other people in other environments can see. And especially if that pet is in a different state of mind when they see that person or the client is in a different state of mind when they talk to that person, they might know something we don’t.

LH: Well, the client knows their pet best because they live with them. Right? And so most of the people that I go and visit, I set them up with tools. Here’s what you’re looking for for this particular disease. What do you understand about the disease? Let’s talk about that for a little bit. Here’s when you need to call me.

I have a list that I developed of distress points. Every client in 11+ years has said to me, “I don’t want them to suffer.” Every single one of them. Nobody has raised their hand and said, “Can I please sign my animal up for the suffering plan and not the nonsuffering plan?” They all want them not to suffer. But if I just walk away and say, well, call me when they are, which is one of the things I heard a lot—I don’t really know what that means. I still see them eating. I still see them doing things. What does it mean?

…So I have a sheet that is just signs of distress. If your animal is in distress, then we need to have a call. It may not be the end of that animal’s life. Maybe we just need to adjust meds. Maybe they just had a flare up of pain or whatever, but I want you to call me, so we can have that conversation. Now that I have a team, we still utilize that, because I want them to call in and say, “Hey, I’m seeing this thing.” Now I’ve turned it into a checklist.


“I don’t really like a lot of the quality-of-life tools that we have, because they’re general and basic. And the questions that we get around euthanasia are not general and basic, they’re deep and emotional and meaningful.”



KB: As a palliative medicine provider, you are very used to giving support to pet owners and to the pets and to all the people around them. Do you see parallels between how you provide that support to these people and these pets and how we could support our veterinary teams in general practice?

LH: Yes, absolutely. We don’t always see that in general practice. In fact, oftentimes we see the opposite; we’re overwhelmed, and they’re overwhelmed, and we don’t know how to build that support. I see palliative medicine as not only about supporting people and the pet, but about comforting them and connecting with them. It’s not just about the support, it’s about the connection that we build. And that’s a connection that we can’t do in 10 minutes.

KB: And we can’t do in a five-minute pizza break in the break room on a busy day, right?

LH: Right. In palliative medicine, we’re emotionally, psychologically, physically, and spiritually supporting these people. And we don’t [each] have to do all of that; we can build a team. You come at it from who you are, and where you’re at in the moment, and you build from there. And you meet people where they are, [and you’re] also meeting them for who they are in the moment. And I think that if we can do that for our team members, that is going to build a team better and stronger than maybe we currently have.

I think in veterinary medicine, we have some unique stressors. We have a system that tends to set us up for being overwhelmed and for failure. And we sometimes develop an adversarial relationship with clients and with team members. You don’t have to be 24/7 in order to be a hospice or a palliative practitioner. You know who does that in human medicine? Teams, teams of humans.

One of the things that I advocate for with the profession is to set boundaries to take care of yourself. But if I don’t give people practical skills on how to do that, then it’s just lip service, right? We can say it all we want to. What we really need to do is work on that shift of thinking, in our own selves. I was dropping [my daughter] off to go to an appointment at a friend’s house. And she said, “Why don’t you want to spend any time with me?”

I might tear up now just thinking about it, because that was not my goal at all. My goal was to be there for her. So I started scheduling myself time to be just me. I put it on my schedule.

And then I had to get there in my own head, because people will call and say, “I want you there 24/7.” And I got the words “My next available appointment is…” down. Because it didn’t matter if I was sitting in my bed eating bonbons watching a movie. It didn’t matter if I was hanging out with my daughter at a school play. It didn’t matter what I was scheduled for. I was scheduled. And I had to get there in my own head. And that’s the key really for each individual is that we have to develop whatever tool works for us. But that’s one of the things that I did for me, just develop those tools so that I stopped scheduling myself during times that were important to me, because that takes away from who you are. It starts pulling pieces of your heart out.


…One of the things that I have learned being around death is about life. Nobody goes to their deathbed saying, “Gosh darn, I wish I made more money.” “Gosh darn, I wish I had spent more time at work.” “Gosh darn, I wish I’d saved that one last dog,” or cat, or horse or spider, whatever species they’re seeing. They say, “I wish I spent more time with friends and family.” That’s their big regret. “I wish I had more time to travel.” Big regret. “I wish I had spent more time not working.”

So if I want to live my life in the moment and I want to live my life for my family, I need to do things to create that and spend time with my family. It’s not an easy journey. And it’s a constant journey. It’s constant shift in thinking and how we can do better. You can’t get there if you’re being overwhelmed all the time. And that’s what I see now. The drive for corporations and money, the drive for trying to help every single pet who comes your way, the drive to do better. Those are all built-in things that we strive for, but those are not things that will go to our deathbed wishing we’d done.

KB: I totally agree with you. That’s the essence of why we’re talking today. And I really think there’s a message in there that our profession really needs to hear over and over again, because that’s my personal philosophy too. I lost my mom very early. She was just a little older than I am now. And I think my whole adult life I’ve thought about that—what would it be like if she had known that that was all the time she got. We have to think first about ourselves and our families and what we really want to be saying at the end of that, wherever it might come. And I don’t think that’s morbid—I think it’s hopeful and beautiful, because it means you’re not going to waste time doing things that aren’t right for you that could be hurting you in the long run.

LH: Right. We have to have money in order to survive. We have to meet basic care needs. If you meet those, then you can start working on other things.

This episode was made possible with generous support from CareCredit.


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Photo credits: SeventyFour/iStock via Getty Images Plus, Westhoff/E+ via Getty Images, Eric Ward on Unsplash, Liam Bell/iStock via Getty Images Plus



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