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Good Grief Gracefully

July 21, 2021

Good Grief Gracefully

Veterinary Teams Navigating Pet Parent Grief

Rebecca Rose, CVT
Lap of Love Veterinary Outreach Specialist

[email protected]

Overview:

It is never easy, regardless of the circumstances, to say goodbye to a loved one. It can be uncomfortable supporting a family through the loss of their pet either due to senior aging, illness, or euthanasia. Understand it can be tough and we will navigate through a few tools and tips to manage it with grace and dignity, for yourself, your team, the sake of the pet, and the family.

Thank you for joining me for this unique and enriching conversation.

Learning Objectives

  • Define the grief process
  • Differentiate between sympathy and empathy
  • Engage in empathetic statements, what to say
  • Determine the benefits of a team debrief

I am hopeful you will take away a few gems. If at any time during the program you feel anxious or uncertain, take a breath, breathe in the relief and out the anguish. We may be hitting on topics and ideas that touch your heart and it’s perfectly ok to feel a shift or two. Know we are in this together, supporting each other as veterinary team members, advocating for pets, and delivering a precious service to veterinary clients.

The topics we will be covering include:

  1. Good Grief, it is alright to grieve, in fact it is healthy.
  2. Pain and Sorrow, defining the grief journey associated with pet loss.
  3. It’s Ok to feel what you are feeling, normalizing the grief journey and why people disenfranchise it. It is OK to mourn with your families.
  4. Name it to Tame it(if it needs taming at all….)
  5. Empathy, Sympathy and Sorry, they are uniquely different and how to manage the conversations.
  6. Examples of Empathy, what to say, what not to say. The difference between heart and head-talk. We will be outlining ways empathy builds connections
  7. Team Debriefs, how to support veterinary team members working with families before during and after pet loss.  We will define the positive impact of team debriefs.
  8. Now what?Next steps, receiving resources and tools for success.

 

Grab a pen and paper. There may be items you wish to capture or thoughts worth writing out. Plus we have included time to write out an Action Item, encouraging you to stop the recording and address the theme in that section. Writing is a powerful exercise!

When thought is put to paper, becoming word, the chances of the idea becoming deed (implementation, protocol, goal) is 80% higher. The trilogy of thought, to word to deed. We want the ideas shared and received to be pivotal in your delivery of end-of-life care and connection.

Again, thank you for joining me. Let’s get started.

Good Grief, it is alright to grieve, in fact it is healthy.

Let’s face it, nobody likes to be sad yet the feeling is as equally important is being happy. In order for appreciation of the good times, we need to have experienced the sad times. You will notice I did not say “bad,” which indicates a wrong-doing. Feelings are neither right or wrong, simply an expression of and labeling our state of being.

Basically, our brains are wired to run from pain-sadness-yet we are in a profession in which we are exposed to pain-sadness-every day with the pets we heal and those we are unable to mend. Simply, we are unable to save their short, fragile lives.

 

Sometimes grief is a good thing, a healthy thing. It may be hard to deal with, for moments in our lives or to watch others going through the stages of pain and grief. Perhaps understanding the process will help.

When can grief be healthy? Seems like a legitimate question. Grief is a natural and normal response to loss.

Anyone can feel loss and it may be felt to various degrees for various reasons;

  • losing a job,
  • a loved one,
  • a relationship,
  • a pet,
  • a material object (car, house) or
  • even the move to a new community.

Grieving allows for us to ‘free-up’ energy that is attached to the person, object or pet. It provides an opportunity to reflect, acknowledge, understand the move into the next energy or relationship or attachment. It is important to realize grieving is not forgetting.

Good grief is a feeling of acceptance to remember the importance of the relationship and the loss but with a sense of peace and not pain or regret.

The benefits, the healthy part, of going through the grieving process 1:

  1. Letting go of what hurts, keeping only the good memories
  2. Creating closureto make peace with it
  3. Healing begins during the grieving
  4. Acceptance of things you can not change

Pain and Sorrow, defining the grief journey associated with pet loss.

No two people will experience grief or pain or sorrow the same. It is based on variables related to ancestry, community, family dynamics and the way our bodies function. There is no one blue-print for how the grieving process will unfold. It is neither right or wrong, it just IS.

The pain and sorrow may manifest differently to include, but certainly not limited to:

  • sleep and appetite disturbances
  • anger and irritability
  • apathy and withdrawal
  • guilt and numbness
  • intense sadness and tears
  • loneliness and loss of life’s meaning

You may be familiar with the statement, “What we resist, persists.” When people resist the expression of pain or sorrow the feelings can seem to gain a stronghold blocking the healing. The same is true for your clients and their grieving. It may bring them comfort to hear your gentle words of empathy and understanding.

Consider the feelings you have experienced in the past. We have all felt loss in the past and will experience it in the future.

Action 1: Take a few moments to write out your feelings associated with grief or even the grief you saw others go through. We are not wanting to block the feelings, simply recognize them, labeling them.

For me, when my father passed away, I recall moments of great sadness. I allowed tears to well up and flow down my face, regardless of where I was at the time, because it was a way to accept, cleanse and respect the love we shared. I didn’t ask anyone to fix my tears or my feelings. There was no way of fixing the illness or the death of my father. What I did need was for my friends and family to allow me to feel the loss, for the tears to flow, without being ‘fixed’ or their uneasiness with my crying.

When my sweet dog, Teika, was euthanized, I invited my son, his girlfriend and my husband to be by my side. Teika and I had spent a loving decade together. My son cherished Teika, too. She was a puppy when he was in his early teens and they shared precious time together growing up through his college years. It was a moment of sadness yet a celebration of his childhood, my 40’s and our time together.

The grief journey may include, but not limited to:

  • denial, a common defense mechanism to ease the pain
  • anger, an expression to hide resentment
  • bargaining, the “if only” game, often postponing the grief
  • depression, may be experienced as the “silent stage,” living in the past without a vision for the future
  • acceptance, moved on past the grief and loss

Depending on a person’s level of consciousness (emotional intelligence) or life experience, grief will manifest differently. It may be long lived, expressed outwardly, or processed inwardly. Both expressions are correct for the person going through it. We are not to judge or anticipate the timing, simply support, and recognize the grief for what it is, natural and normal.

It’s Ok to feel what you are feeling, normalizing the grief journey. It is OK to mourn with your families.

What may appear to be awkward is showing of emotions and to what degree. In years past, it may have been appropriate for veterinary colleagues to remain “stoically professional,” curbing their expressions of strong interpersonal relationships and connections. That may not be the case, now.

In the mid 1980’s the Denver Area Veterinary Medical Association began the Human-Animal Bond Trust creating a Pet Loss Support Group. This organization has been meeting on a regular basis, celebrating their 30th anniversary, providing a valuable space supporting pet parents and veterinary professionals.

“Pet bereavement is potentially complicated because it is largely an unrecognized loss in most white Western societies, resulting in what psychologists term ‘disenfranchised grief’ i.e. thoughts, feelings and emotions that are not recognized, accepted or understood by others, particularly some non-pet owners. For example, whilst compassionate leave for the death of a human family member would be automatic, most employers would not allow time off to grieve the death of a pet. This lack of recognition of how intense pet bereavement can be can result in grievers feeling they are sentimental, over-reacting and even cause self-reproach and guilt for feeling so bad,” writes Dr. Susan Dawson, psychologist, in her article Pet Bereavement, Understanding Loss and Euthanasia.

 

It’s interesting to consider how times are shifting and pet loss is being accepted, slowly but surely.

“Even though pet loss is not legally a protected category of family leave, Price encourages businesses to explore ways to give workers time off to heal, such as flexible paid time off policies,” reports Elisa Boxer in her forward thinking blog More Companies are Offering Time Off for Pet Bereavement and It’s Increasing Loyalty and Productivity.6

Maybe with the shifts we are seeing in pet ownership and pets being a part of the family, more than ever before, there will be changes in accepting pet loss as a family loss as well. In a recent survey reported in How Millennials Spend on their Pets 7 we discover:

  • Most millennials (67 percent) see their pet as part of the family and would refer to them as a “fur baby.”
  • A majority of millennial pet owners (68 percent) would take leave from work to care for a new pet if their employer offered it.

 

I am hopeful pet owners will make big changes in our approach and delivery of pet care and pet loss. Our veterinary clients do dictate the delivery of our services.

 

I remember supporting families and friends during the end-of-life care and being vulnerable with them. Crying with them as we hugged in the room, after lighting a ceremonial candle and witnessing the last exhale as their furry companion’s spirit transitioning.

It’s OK to mourn with your families. It is OK to sigh and cry with them. It’s alright to sit with them as they tell their stories or ask their young children to witness the moment. At first you may not realize the gift we are giving them, to be present and attentive. To share in the moment.

It truly is a gift.

The two memories that are etched in my mind were that of dear friends and their pets. I lived in a small mountain town, 30 miles from the continental divide in rural Colorado. I worked at the mixed animal practice and many of our clients were my friends. Not unusual to build relationships that included family birthday gatherings, summer barbeques and celebrating their pet’s lives.

My girlfriend’s mother was at home in hospice care. Their family cat was in renal failure and it was time to end the cat’s suffering from the disease. I was honored to go to their home, where her mother was lying in her hospice bed and help them bring that service to them. It was a gentle, loving service. It was a true gift.

Another euthanasia was performed on the back deck of a friend’s home. We celebrated the cat’s life with cheese and crackers while soaking up the afternoon sun then Magic was laid to rest under the aspen tree in the backyard.

You and others on your veterinary team have similar stories to share with dear clients, supporting them during end-of-life care, defining quality of life and helping both pet and pet parent through the loving process.

Action 2: Please take a moment to write out some of your memorable experiences with clients and families. Locate the thank you cards because I bet the majority of the cards you receive are in gratitude of the end-of-life care delivered with compassion and care.

 Name it to Tame it

Within my sphere of influence, we are continually focusing on the idea “Name it to Tame it”! Whether the conversation is linked with difficult conversations, conflict and resolution or pet loss. Naming it as a frustration, an event or even a feeling helps to diffuse it, puts the feeling into perspective to move into it, accept it and settle into it with acceptance.

We have mentioned ideas in:

  • awkward to be in the presence of someone who may be grieving
  • uncomfortableto be a part of the service
  • apathyor indifference to their (your client’s) grief
  • sad to see others sad

What is difficult is to realize every one of our patients will be passing in a short period of time. Their lives are simply shorter, on average 10-15 years. For each client, they could conceivably experience the loss of a pet 3-5 times in their lifetime, yet they choose to bring another furry friend (or fish or horse or reptile) into their lives. It is a choice to love and lose. It is a choice to be friended by a spirit that is meant to show unconditional love and loss. It is our ability to help them in those final moments that we are not use to accepting.

When we begin to name our feelings, possibly our inability to accept the truth of their pet’s short lives, is when we can best embrace the gift we can offer. It is neither in rejection nor succumbing to the grief can we deliver compassionate care. It’s in accepting the circle of life and cherished moments can we find peace in the services we provide.

No other medical profession endures the delivery of the service, end-of life care and euthanasia, yet we are rarely taught how to prepare in our studies. Thank you for wanting to learn and transform in your understanding and in the gift.

Action: As you consider the way you feel when engaging with families during end-of-life care, write them down, now. Don’t over think this, simply allow for the words to flow to the paper.

Empathy, Sympathy and Sorry, they are uniquely different and how to manage the conversations.

Death and dying are simply uncomfortable subjects for people. The discomfort may come from the experience of past losses or the recognition of mortality.  The acceptance of death and dying is as varied as the people experiencing it. How, in that precious moment, can we support our clients?

What does your client need, empathy, sympathy or sorry? Let’s define the terms before we fully answer the question.

Empathy is defined as having the same experience as another person and feeling the same pain, anguish, joy, exuberance as they did. For example: If you lost a beloved pet and there was a family in the exam room who recently euthanized their beloved pet, then you could empathize with them.

The confusion lies with sympathy. For example: If you have never had a spouse come home from the war then you could not empathize with the wife of a soldier that just returned. You could sympathize with her; however, you could not empathize with her.

 

Sympathy is defined as caring for the suffering of others (may not have experienced it). It is a feeling of concern for the other person, sometimes a feeling of pity. It is based on a comprehension of the unfortunate situation or emotional state of another person.

Sorry

The first time I sat down with a team of receptionists to have a discussion around the overuse of “Sorry,” I didn’t realize I would touch so many heart-strings. I remember it vividly, like it was yesterday, even though it was two decades ago.

As an example, we discussed how stating, “Sorry, we are unable to see Fluffy this morning,” could be stated in a more empowering way, even if a client had asked for a morning appointment and all were booked. Alternatives included, “Yes, we are happy to get Fluffy in. Available appointment options include 1:00, 1:30 or 2:00.” OR “Thank you for entrusting us with Fluffy’s annual exam. We can see him later in the day.”

Once the receptionists became conscious of their use of “Sorry,” there was an increase in their ability to be more effective and respected team members, both in the eyes of the clients and their co-workers.

 

Please don’t get me wrong, I am all for being polite and sincere! I feel it is time to bring greater awareness to the overuse of “Sorry,” for everyone on the veterinary team.

 

A definition for sorry is feeling distress, especially through sympathy with someone else’s misfortune.

Consider how often you or your team members simply toss out the single word “sorry.” Is there true sympathy for someone else’s misfortune? Is “sorry” meant as a true apology for a wrongdoing, stress or suffering?

How frequently do you tell a client or family member you are sorry for their loss. Is it meant to comfort, or does it simply offer you a blanket statement that makes you feel better? Something to noodle on.

To answer the previous question, what do your clients need, the answer is empathy.

Examples of Empathy, The difference between heart and head-talk. We will be outlining ways empathy builds connections. What not to say. What to say.

Heart and head-talk

As we are going through this program I am essentially popping back and forth between heart and head-talk. You are receiving memories and stories from the heart and the acknowledgement of surveys and statistics to support the informational shift. Your clients may need a similar volley to support their experience and grief during this time.

 

As veterinary professionals we are driven by the medicine, the head-talk. But as we comfort and embrace the grief and end-of-life care, we are better off speaking from our heart. This can happen through consciously volleying between the two, head and heart. When you find yourself talking from your head, “It will be alright, we understand renal disease can be an illness impacting a large percentage of cats ‘Fluffy’s’ age,” it may be better to reframe the conversation. Speaking from the heart may sound like this, “It will be alright, we will be here with you every step of the way, to help you and ‘Fluffy’ through this.”

 

Feelings may be heightened at this time (yours delivering end-of-life care and that of the client and family). Words can either uplift or accidentally cause more harm. Please assess your choice of words and how to deliver them. Read your client’s body language (is it saying I am defeated, distraught, in despair, grounded, in acceptance or something different). Clue into their facial expressions, their breaths and even the way they are holding eye contact with you. All of these are subtle clues for you to appreciate and acknowledge.

 

Sometimes you can see their concern, sadness and unease. It’s perfectly fine to mention what you see. It is a connection to build upon.

 

“I can see you are sad and that is alright.”

What NOT to say-What to say 

  • Don’t say, “I know how you feel,” because you really don’t.
  • Do say, “I have felt this pain,” because you have lost a loved one, either a person or a pet in your life.
  • Don’t say, “At least you had the 15 years with him.”
  • Do say, “Their lives are so precious.”

 

  • Don’t say, “It will be alright, we understand renal disease can be an illness impacting a large percentage of cats.”
  • Do say, “It will be alright, we will be here with you.”

Now is not the time to talk about your religious beliefs. Do allow for the client and family to explore their own traditions and creating a safe space for them to create that ceremony. Remain calm and compassionate while in their presence (even though you may be busy as all-get out!). Now is the time to focus on this client, with this pet, in this moment. Be present in all ways.

In Brene’ Brown’s video on empathy, veterinary team members can get the gist of connection and disconnection. I show this video with veterinary teams because it helps to differentiate between empathy and sympathy in an easy to understand manner.

https://youtu.be/1Evwgu369Jw

 

Rarely does an empathetic statement begin with “At least.” When I first listened to Brene’ Brown’s video, I caught myself saying “At least….” And immediately reframing the delivery.

 

Empathy builds connections through an understanding without attempting to fix it. “I am glad you shared that with me,” regardless of what “that” is. Within our topic, “I am glad you shared your feelings (in relationship to your pet) with me.”

An example of sympathy, “I am sorry ‘Fluffy’ is sick. You had a great decade together,” may drive more disconnection.

Action 3: Take some time to write down a few of your own heartfelt and head-talk conversations. Write down a few sentences you do want to say.

Action 4: View the Brene’ Brown video with your team. Share the following infographic with them to encourage a conversation differentiating empathy and sympathy.

Team Debriefs, how to support veterinary team members working with families before during and after pet loss.  We will define the positive impact of team debriefs.

As briefly mentioned earlier, only in veterinary services will you find the delivery of euthanasia (although some states are beginning to allow within human services). The term euthanasia is defined as “good death.”

My first day volunteering in a veterinary hospital at the age of 16 I helped the veterinary technician euthanize a wild bunny. The small creature had been hit by a car and a client brought the bunny in for us to end its pain and suffering. It was the most humane thing we could ever do. I have seen euthanasia in the same light through all these years, as a humane, a gentle way to end pain and suffering, without judgement.

For our clients, there may be additional guilt into the choice and when is the “best time.” That is why it is important to build the connection with them during end-of-life care. To help volley between the head and heart-talks. Discussions in quality of life, anticipatory grief, possible ceremonies, and memorialization. Now we are the healer and the funeral coordinator. No other healthcare professional (human physician, dental hygienist, laboratory technician) is asked to blend the healing and funeral services, but we do in veterinary medicine. This is why debriefing difficult, traumatic cases and euthanasias is so important.

For veterinary professionals, simply being a healer can be the cause for compassion fatigue and burn out.  As caregivers (yes, you are a caregiver) taking care of yourself is of highest priority. In a way to embrace self-care, contemplate implementing veterinary team debriefs. These may be called Team Huddles or Team Pulse or simply Debriefs.

Dr. Carrie McCrudden, a Psychologist and owner of Colorado Therapy, is aware of veterinary team dynamics and offers the following four step plan as support.

“Taking care of yourself is a tricky business.  You can be doing ‘all the right things’ and still feel sideswiped by stress. It is great to establish a base of excellent self-care: healthy nutrition, enough sleep, regular exercise, enjoyable connections, a sense of spirituality, time spent outside, you know, all the basics that we keep hearing about (and hopefully practicing!),” states Dr. McCrudden.

To cope with the stress, take care of yourself, physically, mentally and spiritually.

  • Healthy eating, rest exercise, relaxation and meditation
  • Talk with your friends and family about your feelings (mood) and use a buddy system to support your fellow team members
  • Maintain as much normalcy at your home as possible
  • Keep perspective on the number of patients you can and can’t help along with the capacity of the client’s compliance

She recommends:

First, normalize your reactions. Ask other colleagues how they cope with providing end-of-life care. Understanding you are not alone in the dilemma and struggle may be comforting in and of itself.

Second, it is important let yourself feel the reaction you are actually having.  Label what is going on with you, even if it is in stages.  This looks like recognizing that you are tense, that your heart is racing, that you may feel tearful or upset, or a mixture of emotions.

Thirdly, make a plan for what you need.  Through today’s exercises maybe you have come to realize you need more support or understanding of the grief process, empathy, communication skills or some other professional services helping you to cope with end-of-life care and euthanasia. If you are going to debrief with co-workers, make sure to do it in ways that helps the whole team, and isn’t just a way to increase everyone’s stress.  This looks like giving time for venting, but also making sure to finish with either learning lessons, solutions, or a way to put the incident to rest.  Sometimes, a staff ritual can help people process their emotions.  Lighting a candle, remembering the animal in better times, or even giving each other credit for what you did try to do to help can put stressful incidents in context and allow people to move forward.

Finally, give yourself time to heal.  Be gentler with yourself and your co-workers if a day has been particularly stressful.  Remember to go back to the basics (sleep, exercise, nutrition, connection with others) and resist the urge to feel awful about everything. As always, please reach out to a licensed mental health professional if you are unable to get back to wellness on your own.

 

“Debrief traumatic team incidences within 24 hours of the incident,” may be a valuable goal or tool as stated in How Clear Mission Can Spur Purpose.

Teams that do structured retrospectives or debriefs are typically 25% more effective. The basic structure of a retrospective or debrief is to surface the following in a brief meeting of the whole team:

  1. What went well (you’ll want to keep doing these things)
  2. What could be improved (went OK, but could be better)
  3. What went badly (you want to stop doing these things, if possible, or concentrate on doing them better)
  4. A focus for the next period/sprint/month/quarter (One or two things to focus on)

-Nil Davis, All the Responsibility Podcast 11

 

Now what? Next steps, receiving resources and tools for success.

Your head may be spinning with ideas to implement or concerns in how to improve your skills in supporting your grieving pet owners. You are supported in ways to continue to grow your interpersonal skills and adapting your approach in empathy and developing a strategy that works for you and your team.

Through the exercises you may have realized you are doing better than you thought you were. GOOD FOR YOU!

Or you may have a new understanding on ways to improve, equally as exciting!

To recap the powerful exercises we asked you to complete:

Action 1: Take a few moments to write out your feelings associated with grief or even the grief you saw others go through. We are not wanting to block the feelings, simply recognize them, labeling them.

Action 2: Please take a moment to write out some of your memorable experiences with clients and families. Locate the thank you cards because I bet the majority of the cards you receive are in gratitude of the end-of-life care delivered with compassion and care.

Action 3: Take some time to write down a few of your own heartfelt and head-talk conversations. Write down a few sentences you do want to say.

Action 4: View Brene’ Brown’s video with your team. Share the infographic with them to encourage a conversation differentiating empathy and sympathy.

 

Upon reviewing the exercises, where are your strengths? Where are your weaknesses? How can you fill in the gaps?

There are more resources at your fingertips to further explore. Following is a brief list to get you started.

  1. Pet Loss and Grief Companioning Certification from Two Hearts Pet Loss Center. 12
  2. Obtain a certification in animal hospice and palliative care through the International Association of Animal Hospice and Palliative Care. 13

You may determine you are ready for one-on-one coaching in ways to adapt and morph your approach to pet loss grief and end-of-life care. Reach out to me, Rebecca Rose, CVT and Certified Career Coach.

Maybe it is time to evaluate your team’s approach to the delivery of pet loss and end-of-life care services. We can provide you resources to transform your practice, too. CATALYST Veterinary Professional Coaches can provide you with a questionnaire, provide onsite evaluation or refer you to experts in your region.

In conclusion, there is hope. You’ve got THIS! Apply what you have learned, establish realistic goals for yourself and your team and place the wheels in motion to evaluate and improve, personally and professionally in supporting the pets you serve and their pet parents.

Remember:

  • Good Grief,it is alright to grieve, in fact it is healthy.
  • Pain and Sorrow,define the grief journey associated with pet loss.
  • It’s Ok to feel what you are feeling, normalize the grief journey and why people disenfranchise it. It is OK to mourn with your families.
  • Name it to Tame it, label your feelings without judgement. They are neither right nor wrong.
  • Empathy, Sympathy and Sorry, they are uniquely different and consciously manage the conversations.
  • Examples of Empathy, practice what to say. Differentiate between heart and head-talk.
  • Team Debriefsare crucial to individual and team success. Support veterinary team members working with families before during and after pet loss.

 

Yours in Good Grief,

Rebecca Rose, CVT

Certified Career Coach

CATALYST Veterinary Professional Coaches

www.CATALYSTVetPC.com

 

References 

  1. 8 Reasons grief is good; Lyndsie Robinson, 2011 https://allwomenstalk.com/reasons-grief-is-good/
  2. What you should know about the stages of grief; Kimberly Holland, reviewed by Dr. Timothy Legg,  HealthLine, 7.2018 https://www.healthline.com/health/stages-of-grief
  3. Seven Care Essentials While Grieving the Death a Pet; Adam Clark, LCSW, AASW, Psychology Today,   https://www.psychologytoday.com/us/blog/animal-attachment/201702/7-self-care-essentials-while-grieving-the-death-pet
  4. Pet Bereavement-Understanding Loss and Euthanasia Part 1, Dr. Susan Dawson, Oct 2013, Veterinary Expert, http://www.theveterinaryexpert.com/people-and-pets/pet-bereavement-part-1/
  5. Pet Bereavement-Understanding and Coping with Grief Part2, Dr. Susan Dawson, Oct 2013, Veterinary Expert,  http://www.theveterinaryexpert.com/people-and-pets/pet-bereavement-part-2-understanding-and-coping-with-grief/
  6. Human-Animal Bond Trust, Denver Pet Loss Support Group, https://www.humananimalbondtrust.org/
  7. More Companies are Offering Time Off for Pet Bereavement and It’s Increasing Loyalty and Productivity, Elisa Boxer, Sept 2017, Inc https://www.inc.com/elisa-boxer/more-companies-are-offering-paid-time-off-for-pet-.html
  8. How Millennials Spend On Their Pets, Carly Lintz, Pet Business, May 2018, http://www.petbusiness.com/How-Millennials-Spend-on-Their-Pets/
  9. Distinguishing Mind from Heart; Which One are you Listening To? HuffPost, HeartMath LLC, Dec 2017  https://www.huffpost.com/entry/heart-mind_b_2728398
  10. Veterinary Teams Debriefing Stressful Situations: Take Care of Yourself, Dr. Carrie McCrudden, April 2017 https://catalystvetpc.com/veterinary-teams-debriefing-stressful-situations/
  11. Retrospectives-What Went Well, What We’d Like to Improve, All the Responsibility Podcast, Nils Davis, https://alltheresponsibility.com/retrospectives-went-well-wed-like-improve-2016/
  12. TwoHearts Pet Loss Center, Pet Loss and Grief Companioning Certification, https://twoheartspetlosscenter.com/pet-loss-grief-companioning-certification/
  13. International Association of Animal Hospice and Palliative Care, Veterinary Certification (to include veterinary team), https://iaahpc.org/veterinary-certification