The Gap Between What Vets Say and What Grieving Clients Hear | Dr. Christina Guttuso

Nobody teaches you how to have this conversation in veterinary school. 

Dr. Christina Guttuso has spent 23 years doing exclusively in-home euthanasia — showing up for families in their hardest moments, in their homes across Arizona. After over two decades of experience and a recent survey of over 300 pet owners about their end-of-life experiences, what she found is reshaping how veterinary professionals will think about one of the most common and most misunderstood moments in veterinary practice.

This conversation is about someone whose veterinary career is centered on pet euthanasia. But it's really about what it means to be human in a profession that trains us to stay clinical.

In This Episode

• What pet owners are really asking when they say "but he's still eating"
• Why there's a significant gap between what veterinarians communicate and what grieving clients actually hear
• The ethics of allowing animals to suffer because of human emotion
• How to hold space for a grieving family without needing to fix anything
• What any veterinarian — in any setting — can do to show up better in end-of-life conversations
• How Dr. Guttuso's survey findings are shaping a forthcoming AVMA presentation

Take Dr. Guttuso's Survey

Dr. Guttuso is actively collecting perspectives from veterinary professionals to support her research. If you work in veterinary medicine, your voice matters. Link below.

📋 Survey link for veterinary professionals.
📋 Survey link for pet families

Connect & Resources 

• Check out the video of the episode on YouTube
• Podcast Companion Substack with Podcast Club Guide

Keywords

pet euthanasia, end-of-life veterinary care, veterinary communication, compassionate care, in-home euthanasia, veterinary education, grief support, client communication, veterinary medicine podcast, Vet Life Reimagined, AVMA Convention, pet loss, veterinary wellness, compassion fatigue

Transcript

Christina Guttuso: [00:00:00] And during 2021, I started saying, "Yeah, it's really hard. I don't know if I wanna keep doing this." And that little bit of honesty, clients ... I'm getting chills. At the end of the day, you know, maybe I euthanized their pet earlier in the day, I'd get a text at the end of the day saying, "We really appreciate you still doing this."

Megan Sprinkle: There are conversations in veterinary medicine that everyone knows needs to happen and almost nobody is formally trained to have. Dr. Christina Gutuso is one of the rare veterinarians with the clinical expertise, emotional intelligence, and genuine cur-courage to speak truth in one of the most emotionally demanding parts of veterinary practice, pet euthanasia.

A Colorado State graduate who declared in high school that she would never euthanize a pet and then immediately after veterinary school, slightly accidentally, started one of the first in-home euthanasia practices in Arizona.

Dr. Christina has now spent [00:01:00] 23 years in people's homes, living rooms, and hallways showing up for families in their hardest moments. What she has discovered over those 23 years and is now sharing with the broader profession is something that I think every veterinary professional needs to hear. She surveyed over 300 pet owners and what came back surprised even her.

She's taking those findings to the AVMA convention, and today she's bringing them to us first, and she needs to hear your perspective as well, so stay tuned to hear how you can also help. In this conversation, we get into what it really means to show up for families at the end of a pet's life, why there's such a gap between what veterinarians think they're communicating and what clients are actually hearing, and what any veterinary professional in any setting can do to make one of the hardest moments in their clients' lives a little more human.

This conversation is so much more than euthanasia. Let's get to the conversation with Dr. [00:02:00] Christina Gutuso.

When did you know you were even interested in veterinary medicine?

Christina Guttuso: Well, thank you for having me on. And I have one of those typical stories. I was a kid. I used to pretend play being a vet,

Megan Sprinkle: Aw, I love that

Christina Guttuso: or 10. But the moment that I really knew I wanted to be a vet is kind of a fun story. My family, like my dad's an Italian immigrant. They weren't the type that you take pets to the vet.

You don't even put them in the house. Like, he thought they had diseases. So, but I naturally gravitated to animals. So they let me have cats outside, and they weren't surviving. So they decided they would let me have a cat inside. And so the only reason they would go to a vet was to spay and, gasp, declaw a pet.

That's, that's what my parents knew at the time. So And we didn't even have a carrier. And I came, and [00:03:00] I, I remember I was, like, in fifth grade, so I was probably, like, 11, 10 or 11. And I came with a basket and a blanket to pick up my cat after surgery, and I'll never forget the experience. I walked in, and the vet and vet techs were like, with the ba- They loved the basket.

They kissed my cat. And my little brain went, "Oh, these are my people." Because I'm, you know, being raised in a home where they don't see animals that way. And so that was the first time I thought, "Oh, this is where I belong. I should become a vet."

Megan Sprinkle: story. Yeah. I mean, it was different times when I grew up, too. We had outdoor pets. So, uh, yes. Oh, we have come a long way in really a very short time. now did you grow up in Arizona, or where did you grow up?

Christina Guttuso: I did. So, I was born in New York, but I was raised in Tucson, and

Megan Sprinkle: Okay.

Christina Guttuso: also always like to joke and say I was raised by two Italian New Yorkers in Arizona, so there's a huge cultural [00:04:00] difference 

Megan Sprinkle: Bless her heart.

Christina Guttuso: where I get my passion for what we're gonna talk about today.

Megan Sprinkle: Yeah.

Christina Guttuso: where that comes from.

Megan Sprinkle: and the only reason why I, I wondered is because that's where you did your bachelor's, was at the University of Arizona. So, um, but you ended up going to vet school in Colorado. Um, so curious, like why Colorado? and then also, when you first were applying and going into vet school, did you have an idea of what vet life looked like for you, and did that change over the period of vet school?

Christina Guttuso: Great question. So back in the day when I went to vet school, there were no vet schools in Arizona. And so the state had a deal with a couple of other states, Colorado being one of them, where they would send us as in-state students

Megan Sprinkle: Mm-hmm.

Christina Guttuso: long as we came back and worked in Arizona. So I felt very lucky to go to Colorado State because I think at the time they were the number two vet school, and [00:05:00] I just lucked out to be an in-state student there, and paid in-state tuition.

So I was very, very lucky that way. When I went to vet school, I'd already-- I started working at a vet hospital. I started volunteering in high school to see if this is something I wanted to do, and continued to work in through college in different vet clinics. So I thought I was gonna just be a clinical vet. And actually halfway through vet school, which I loved every minute of school. I just loved school. I enjoyed the whole process. I studied all the time. I was a total nerd. But I started thinking, "I don't think I love being in a clinic. I don't think I'm gonna love clinic life." And so I started looking at practice management.

That started it to intrigue me. Started taking some practice management classes, considering doing a joint MBA. but do you wanna hear now how I actually...

Megan Sprinkle: Yeah.

Christina Guttuso: During vet school is then when I changed, completely changed my career idea. So [00:06:00] I went into vet school, I remember-- Actually, even before vet school, I would say-- In high school, I would, say, "I'm never euthanizing a pet. I'm not playing God." But it's wonderful I had that experience because now when clients say that to me, I get it. You know? I, I totally get where they're coming from 'cause that's where I was at too. Um, and of course the vet staff rolled their eyes at me knowing better, but I thought they're like, "What are you gonna do?"

Oh, I actually said, "I'm gonna send them down the street. Someone else is gonna euthanize a pet 'cause I am not doing that." so the joke was on me.

Megan Sprinkle: Mm-hmm.

Christina Guttuso: was senior year of vet school. Um, My first rotation was oncology, and my first patient was a greyhound with double hock osteosarcoma,

Megan Sprinkle: Wow.

Christina Guttuso: and my job as the vet student was pain management. And the only thing I could do was an epidural I mean, that was the-- I mean, this is And this, and this dog was living at the hospital 'cause the owners weren't [00:07:00] nearby. They were staying in a hotel. It was just, like, such a dramatic situation for my first case as a student. It kept me up at night thinking about that dog's pain. And it was there for palliative radiation with a 25% chance of reducing pain. Like, it just seemed ridiculous. And I went to the professor and asked if I can talk to the clients about euthanizing their pet. So my view around euthanasia drastically changed with that patient, and then CCU was the next one. I'll never-- I mean, I'll never forget these first patients that really changed my mind around euthanasia. And it was a dachshund DIC that vomited blood down my back, and I, I was there with my friend from vet school, and we were both like, "This is not okay. this is not okay. We need to do something." Interesting, when I look back, none of the professors were thinking that. You know, they were thinking, "What's the medicine? What do we do? How do we treat?" But we were like, "This is not okay," and we went to that professor and [00:08:00] asked if it was okay to talk to the client about euthanasia, and they agreed. So that changed my mind about euthanasia, and then when I came out of vet school, I had had a baby my senior year of vet school and didn't wanna work in a clinic 12 hours a day.

And so I decided I'm gonna try house calls so I can have a flexible schedule, and it took about three months to realize I do not wanna wrestle someone's cat in their living room. But I was all set up, you know, licensed and everything to do house calls, so I figured, well, I'll do euthanasias still in the home 'cause that's much nicer. And immediately, veterinarians I had never met, because when I, I grew up in Tucson, but when I came back from vet school, I was in the Phoenix area. So, I was in a new area. People did not know me, and veterinarians were giving my name out. The word was spreading, "This woman's willing to come to your home." You know, they usually don't have the time to do something like that. And, and also what came up is they're not licensed. Like, you have to be licensed to go to people's home. You can't just have the drugs in your vet [00:09:00] clinic. So that was another thing that vets felt uncomfortable bringing the drugs into someone's home. And when I realized vets I didn't even know were giving my name out, I thought, "Oh, this is a need." it really fit my personality because I was really desiring to do something more emotional and human connection-wise. So it was just perfect timing where I thought, "Gosh, this really fills that need." I, I was, like, drawn to the idea of ministry and service at that point in my life. I say at that point because I definitely have experienced compassion fatigue since then. But at that point, it really excited me to get to be there for people in that high emotional situation. I went, "Oh, I think I'm gonna do just a euthanasia service," and so kind of accidentally started that.

Megan Sprinkle: I think it's so funny that you became the vet down the street. You said y- you would never euthanize, you'll send it down the street. You're down the street. Uh,

Christina Guttuso: Everyone sends them to yes.

Megan Sprinkle: well, if you don't mind, I'd [00:10:00] love to back up 'cause there's so much in what you said, and one of the big things that stood out to me was your vet school experience.

You mentioned that you and your other colleague student were the ones that brought up the, "There's another option. Like, this doesn't seem right. that the euthanasia is an option." You said the professors didn't. So I'm curious, when you look at education, is that a potential gap when it comes to certain people going into clinical practice and having trouble understanding euthanasia?

Is that, to them, you know, from maybe a vet school perspective, and everybody has a different experience, I understand that,

Christina Guttuso: Sure.

Megan Sprinkle: if that wasn't highlighted in your training, then maybe you think you're doing something wrong if that is the outcome. Uh, do you mind speaking just a little bit more on that?

'Cause to me, that really stood out.

Christina Guttuso: I absolutely agree, and I think [00:11:00] that's where the change really should start because it'll make, you know, an exponential change if we can get to the students first. Um, yeah. So when I was in vet school, we, we didn't talk about it. I, I just remember the conversation coming up a lot when clients would say, "What would you do?" And a professor actually told us we're not allowed to say what we would do if it was our pet, which is such an interesting perspective. And I remember... I distinctly remember having that in my head when I started my home euthanasia practice, and within months said, "I'm not following that advice. " It didn't feel right, and I was just giving people permission constantly.

I saw it as I'm the expert here. They were so lost and confused. I've really understood people with pet loss in such a deep way, which we can come back to. I do wanna talk about the vet school stuff. But I also did, I volunteered with our local Hospice of the Valley, pet loss group, and I learned so much from the people and the bereavement counselor there.

That was an [00:12:00] amazing experience, too. That was the first couple years out of school. But back to school, about... And I have, I have a colleague who's a dean, at a new vet school, and I notice even when I talk to him, everything is so academic. Like, I feel like I have to prove what I'm saying about euthanasia when really- When we get into the results of the survey that I did, it's not about evidence, it's about emotions, it's about permission. I mean, CSU I think is an amazing progressive school and with what they do with medicine, and I think they were just so focused on what we can do with medicine. And I do believe sometimes clients think vets just wanna make a lot of money and that's why they keep pushing. But I think vets are just so trained to keep pushing, keep doing the medicine, and that's where the disconnect is.

Megan Sprinkle: You said the E word, emotion. that can be hard for, uh, certain people, especially, like, a, a very academically trained [00:13:00] profession where we are trained to, like, give me the data. it is kind of a prove it kind of profession. Which also coming from the nutrition side of things, there's that disconnect it's, it's emotion, yes, there's some things you can look at, but a lot of it is, i- is that emotional support, which of course is not for every veterinarian, and that's perfectly fine. Find what what fits you.

But to understand whether it is to send it down the street, uh, refer or, you know, at least acknowledge that this is part of the process. and then also , you mentioned, working with the, the pet loss organization, which you're, you learned a lot from the, the counselor, and I'm sure they're like, they're all emotion.

Um...

Christina Guttuso: and that's a human... It was a human hospice

the best in the Valley.

Megan Sprinkle: Interesting.

And the bereavement counselor went through pet loss, and she went to their organization and said, "Can I start pet loss group? Because it surprised me how much [00:14:00] this affected me." And so she took the lead, Marty Townsley. She's retired, but she still has an online, grief support presence and, um, and still occasionally asks me questions. So 

Christina Guttuso: I was just there for them to answer the medical questions they had during their pet loss experience, whether the pet died naturally or with a euthanasia, and I was just there to kind of reassure and, and that was my job. but it was amazing to listen To both the pets and the bereavement counselor.

I mean, I think that really gave me a good foundation for my career. And the number one thing I heard repeated over and over was fear and guilt. Fear and guilt. That's what every pet parent experienced around the pet loss, whether it was, again-- And w- it didn't matter if it was, you know, if the pet died in the vet clinic by an accident like drowning or with euthanasia, it was the same emotions.

Megan Sprinkle: When you say fear, like guilt for some reason, [00:15:00] like, it, it seems str-straightforward to me, and maybe that's-- this is all a personal thing. When you say fear, what is it that they're most afraid of? Ca-- Did you get that?

Christina Guttuso: good question. Yes. well, it's fear of making the wrong decision. It's the fear, uh, y- that's the biggest thing. It's also the fear of death, which is... I talked a lot with that bereavement counselor about that. You know, our culture is not comfortable with death and dying.

Megan Sprinkle: Mm-mm.

Christina Guttuso: lot of other cultures do a better job than America with that.

So we wanna avoid it, and now we're head-on with something that is very, it's a very scary topic in general. But yeah, definitely the fear of doing it wrong, and even many times the fear, in my personal experience, I would say the fear of watching someone die. They're watching, they're, they're often scared, and then s- I love that after we're done with the euthanasia, they're so relieved.

They don't realize it's not as scary as they thought. It is okay, and that's a very rewarding feeling.

Megan Sprinkle: Yeah, that makes sense. Thank you for, elaborating on that. [00:16:00] And so all the things that we've just talked about, you're doing this right out of vet school.

Christina Guttuso: I know.

Megan Sprinkle: for someone who just graduated vet school and you're, figuring out all sorts of things. You're a new mom, you're a new vet, you're doing something that-- And it, by the way, we haven't even clarified that, that the...

You're the first person to really do this, right? Like, th- this is-- It seems kind of normal now, but there, there were no Laps of Love at this time, right?

Christina Guttuso: Mm-mm.

Megan Sprinkle: you're doing a whole new business model and all sorts of things. That's-- I wanna step back and show how impressive that is. But like, how, how did you handle all of the doing a new business model?

I mean, obviously if you figured out you have to whole, have a whole another type of legal process with having business license and stuff. But like, yeah, h- how did you do both business but also like the emotional part of it, and again, being that middle person between probably the people who are referring [00:17:00] and then also the pet parent?

Christina Guttuso: Yeah. Thank you. That's a great question. So I joke and say it's, it was almost good that I was totally ignorant and young. Like, you know, we can be kind of perfectionists, I think, as vets, and if I had known, I probably would've overthought and overplanned and never did it. So because I had started the house call service, I already kind of had just jumped in, and a lot of my service was honestly trial and error. So I was lucky enough that I had a local vet who, he was a house call vet. He did alternative medicine, and he's like, "Let me take you around and help you get started." Such a beautiful part of our profession when we help each other like that. so that helped me get started just with the basics of, like, getting the premise license and knowing how to do that, that. But I will tell you, I didn't know I was also supposed to have a city license. Like, that happened by accident. I got caught not having a city license. I thought, "Well, I have the state license." but it was a good experience. My whole career has been a good [00:18:00] experience as a recovering perfectionist to see you can make mistakes and you can survive. You just fix them. Like, nothing horrible happens. So a lot of that was, the structure was kind of trial by error. And, the emotional part is something I've always just naturally been interested in.

I was ridiculous in high school. I read "The 7 Habits of Highly Effective People." Like, I'm unique that way, so I was studying, like, Tony Robbins and visualization in high school, and remember, I went to high school in the '90s. This was a long time ago. And so that wasn't mainstream. We had no social media where everyone was looking at this. It really intrigued me. So I think that actually helped me with the grit to be like, "I'm gonna figure this out." A lot of it was a mentality. As a new vet, hitting a vein was very difficult. That was probably the most challenging out of everything I did because was so committed to not making this clinical. the [00:19:00] dog maybe fell and couldn't get up, and they're, like, slouched in the corner of a hallway. I'm laying down on my belly sometimes hitting a vein. I'm in someone's closet under their clothes doing a cat vein. Like, I'm hitting veins in very difficult situations, and I'm a new vet who can hardly hit veins.

Like, you know, shout out to every vet tech who helped me learn how to hit veins. What I realized when things weren't going well, say I wasn't hitting a vein or blowing a vein, And this is good for all of the vet audience to learn, I think, is that we panic and think, "This client's gonna be so upset with me.

I'm failing..." Cause we're so in our technical mind. But I learned two things early on, that whole fake it till you make it. If I started getting worried I wasn't gonna do it, oh my gosh, I watched them get really worried. I saw they were mirroring my emotions. So I just started faking it and just getting that grit and being like, we're going to figure this out. This is going to happen." Just changing that... I remember [00:20:00] consciously making that decision. I have to come with that attitude if this is gonna go well. Radical difference. People were started getting relaxed, the more confident. I was like, "This is gonna happen." The other thing, again, I'd love the vet audience to learn, whether it's euthanasia or any other medical procedure, we think that clients are judging us the way we judge ourselves.

So, the patient that helped me change this mindset was I could not hit a vein for... Like, I was blowing everything. It was all four legs type of situation. Very nice clients. We were chatting, and I'm there for a long time. Now, what I do is I do a sub-Q total, like, anesthetic sleep. So what I've learned is clients care about different things than we do. So as long as their pet is peacefully calm, laying there, not suffering, they're fine. I'm stressing out, you know, but they were fine. And I thought, "Ugh." I walked out, remember, you know, this is really early days thinking that was, like, the worst euthanasia. And they sent me a card with their dog's [00:21:00] picture and told me how lovely the experience was. So those were the beginning signs of, like, clients and vets see things very differently. And I've always been like, I want to be this liaison between the two because both mean well. Both, even though they can get frustrated with each other, at the end of the day, love each other. Even clients who tell me, "I wish my vet guided me more," they quickly go, "But I love my vet." They don't want me to go and reprimand their vet if they tell me something. So it's just a matter of miscommunication. And what I love about the survey that I also... I guess I do a lot of things by accident that kind of just accidentally hit a chord. But, um, what I love about the survey is that it really says exactly that, you know?

It really helps see what's the miscommunication between the vet and the client.

Megan Sprinkle: So, you kind of alluded, you took a survey to really understand both sides of this [00:22:00] experience to see. And it's very timely, at least for me and my discovery, because I have heard several surveys, se- several things that have come up where the conversation is that there is a disconnect between the veterinarian and the pet owner experience.

Um, they think this, this person hears this, right? Like, all the problems in life are communication, right? Uh,

and, and so this is another great example, another opportunity, and I'm super excited because you're like, "Luckily, the solution is so simple." But before we get there, that, that's the little teaser. I mean, you've been doing in-home euthanasia for, I think, 20-ish years.

So you've learned a lot and you're just now doing a survey. So I, I wanna gather what were you observing and learning, and what has kept you doing it for two decades? That's a long time to do one thing. And I'm sure, like, it's evolved and... But, like, [00:23:00] w- what is it that kind of keeps you going? 'Cause I, I think that's also important for people to hear, especially someone who went from, "I'm never euthanizing a pet," to like, "This is what you do."

Like you, there's something that keeps you in it, and so I would love to hear a little bit more of that before we get to the survey.

Christina Guttuso: Yeah, thanks for asking that. So when I first started doing it, it was-- I mean, it would just fill me up. People would say: "How do you do that? Like, doesn't it drain you?" But it was so emotionally rewarding. Like, people were so grateful. And especially early days, like These were special clients. I also had, like, this really special, unique group that would have done this because it, it wasn't really well known to, to euthanize in your home. I felt like in the beginning, I got to meet the best of the best clients, which was really rewarding. They just loved their pet, And it was just such a intimate... I know-- I think a lot of people are scared of intimacy, and I lean in. I love it. Like, let's get [00:24:00] close. I walk into your home, and I'm your best friend.

Like, I'm here for you. know, people always say: "Isn't it hard to see people cry?" And it is not hard for me to see people cry, not because I have no feeling, but because I think it's a very normal experience, and I, I love that people feel safe enough to do that in front of me. I see that as a privilege.

I'm very comfortable having space for that. That's also advice I'd give to the vet staff, is that you don't have to fix the emotions. I think that's what causes stress and makes it feel like a drain. But your job is simply to have the presence of, "I'm okay right now." That's the biggest thing you can do for someone in grief, any grief. If you can hold your presence that, "I'm okay with your grief," that is such a relief. That's when people can relax and unload. So that's, that's the number one way, actually, it's super easy to support someone, is just take care of your own anxiety that's happening when someone's upset. Don't try to make them stop so you feel [00:25:00] better. But it was very emotionally rewarding early on. these pets needed to be euthanized. What I found also early on is, it was almost like this little secret. It was a weird experience. It was like: " c-come into my home. I'm gonna show you my pet.

It's really bad." That's what was happening over and over because there was a lapse between when they went to the vet and when they made the euthanasia decision, and in that period they had no guidance, they had no support, and they were just on their own, and this pet was getting in really bad shape, and they knew it. And so they often e- they felt, first of all, guilty of making the euthanasia decision, but by the time I came, sometimes I felt guilty for the situation I was about to see. And so the euthanasia wasn't It was such a relief for everybody. I was seeing active suffering and ending it. So that was my perspective on that. also, honest, I stayed in this career [00:26:00] because it helped me be a mom who could be really involved with my kids, which was my number one priority. So this job gave me a lot of flexibility, for a lot of years. I now, I have one daughter out of the house and one in high school, so I'm becoming an empty nester, which is also kind of fun because I can put more time into my career than I did in the early days, and that's why like being able to provide some of this education and training. but that also kept me in the career for a long time, was it really worked for my lifestyle. It was emotionally rewarding. And during my worst compassion fatigue, which I would say was COVID, you know, that was challenging for a lot of reasons. doing this kind of job in that because I think I was also seeing every type of client at that point because they couldn't be seen by the vet, so we were slammed, and I was seeing clients that maybe weren't the best pet parents. so that added to the challenge. Besides the fact that we were no longer allowed... [00:27:00] Oftentimes I'm hugging clients afterward. I didn't realize how much that was helping me, was that physical touch and connection, and now we're both wearing masks and that all added, I realized later, to the compassion fatigue. And I really thought about leaving the profession during that time. It was like, you know, 2021 was when I was like... I started googling, "What else can you do with a DVM?" And I started getting honest with my clients. So clients, um... I hope this also helps the vets maybe, you know. Maybe it's not necessarily just in euthanasia, but I was trying to protect clients from my real feelings 'cause I would think that's not professional, right?

I'm not gonna unload on my clients. But during that time, I got a little more honest, and I got a lot more support. So clients would often say, "How do you do what you do?" And sometimes in this really almost, they didn't mean it rude, but it was like, "What's wrong with you? How do you do what you do?" They would often, often ask that, and I'd say this, a beautiful [00:28:00] answer like, you know, "Well, I'm ending pet suffering," which for years that's what it was. And during 2021 I started saying, "Yeah, it's really hard." I don't know if I wanna keep doing this. And that little bit of honesty, clients, I'm getting chills.

At the end of the day, you know, maybe I euthanized their pet earlier in the day, I'd get a text at the end of the day saying, "We really appreciate you still doing this." And I have repeat clients now after this many years, and so some of them saw me go through that period, and they'll just re- remind me, "We're so glad you're still here.

This is not an easy job. We're so glad you're willing to do it." And on a lot of days, that's what keeps me doing it.

Megan Sprinkle: Yeah. I was just talking to somebody how the veterinary industry and what we do is so much of a relationship. It really is between,

Christina Guttuso: Hmm.

Megan Sprinkle: the-- we care about the pets. That's, why most of us are here is we, we first fell [00:29:00] in love with animals and how wonderful they are, and then we get in and we realize, oh, wow, there's like so much of a human element to this.

And I think being okay with being human is a big part of, being happier in veterinary medicine. Like, you know, acknowledging that part, being 

Christina Guttuso: Mm-hmm. 

Megan Sprinkle: There's some times where you don't have to share everything you know.

Christina Guttuso: So, there's some you emotional intelligence involved.

Megan Sprinkle: Like, like you said before, it's not as scary as it initially sounds. 

Christina Guttuso: That's a good

Megan Sprinkle: yeah. Yeah.

Christina Guttuso: know, the... I, I... That's a really good point that, that you just made. Like I talked about, it's not as scary doing the, you know, the death part for the clients. But for the vets, if you just practice that presence, you'll see it's not as scary. It's very natural for people to work through their grief. We're scared it's never gonna end. I've heard from people they don't wanna emote 'cause they're afraid it will never end, but that's not how emotions work. They're very short-lived. You [00:30:00] let them have a life, and they move on.

Megan Sprinkle: Well, you even said that you were starting to see clients that maybe weren't the best clients or the easiest to work with, we'll call it that. And yet you also had the clients that heard what you said and like maybe even more so intentionally tried to show appreciation, and it kind of reiterates that there are still good people, and that can be what makes the job rewarding.

Christina Guttuso: Absolutely, yeah. They really make the difference.

Megan Sprinkle: Okay. So you end up doing this survey, which you're gonna share some really interesting insights in this, but what prompted it?

Christina Guttuso: So I started teaching continuing education here in Arizona through the AZVMA, probably like 15 years ago. And I would teach about both end of life decisions, but also the compassion fatigue and the emotions 'cause that's kind of my wheelhouse. So they were like, "Yeah, we'll take you teaching [00:31:00] that." so I've been doing that for a while, and there's no doubt I never have to convince the vet teams that this is a problem. When I say this, I mean people are not euthanizing at maybe the most appropriate timing. No one questions that, and I've always thought that's so interesting. I don't have to convince anyone of that, which is nice. But I do seem to have to convince them that they need to do something different. That's been my hurdle. I think vets think they're doing a great job, and I think they are doing a great job with what they think the problem is, is what I realize. but I even had, uh... You know, I have a vet mentor who's retired, and we were just having lunch in her community one day, and she's a big fan and she wants to support me.

She loves my message. She totally agrees, And then we, uh, run into one of her neighbors who their dog had been diagnosed with osteosarcoma at some point, and she asks them, "How's it going?" Or [00:32:00] something, and they say to my ear very clearly, what they say "It is time." And I can't remember exactly what they say, but oh my gosh, like he took a turn and things are bad, you know. My ear, and what I hope every vet who hears this goes, "That's the time you give them the permission." When you hear that, you say, it's definitely time." You also give them a stern warning. You do not want to wait. They don't wanna wait. They don't wanna get into a bad situation. They don't wanna watch their pet suffer. They're looking for that permission, and that's what I would do. What was interesting was watching this vet who totally supports my message, 

Megan Sprinkle: her 

Christina Guttuso: natural inclination was to say, "Oh, I hope you don't have to do it too soon." Which she saw my look on my face and immediately went to, "Oh, but..." And she started doing, saying all the things. But it was helpful for, for me to see because she believed in the message But her natural, [00:33:00] I don't know what it is, like, you know, our politeness, our like we don't, "Oh, I hope you don't have to do that." That's what we would just say to someone 'cause we don't want them to go through it. But we forget when we're saying it as a veterinary expert, we just added a lot of confusion, and we put the whole burden on them. Um, so what we thought was a compassionate answer becomes harmful. And it was, it was really good to see again. so it's not even about convincing veterinarians. They know the problem, it's how do we handle the problem? and it also comes back to are we comfortable with people's grief and death? we wanna take that away even from our clients.

We just go into that natural, "Ooh, I hope you don't have to feel pain," versus leaning in, "I'm here with you. You're going to feel pain. I'm here with you. I'm support. We're gonna do this together" mindset that's way more, helpful to the client.

Megan Sprinkle: So just to clarify, when you said you didn't have to [00:34:00] convince veterinarians that pet parents were euthanizing at suboptimal times, you meant that veterinarians believe that pet parents wait too long?

Christina Guttuso: Yeah. And I'd like to read a couple of quotes from...

Megan Sprinkle: Yeah?

Christina Guttuso: we do ha- We did get 20

Megan Sprinkle: Okay.

Christina Guttuso: Within 24 hours, we had over 200 clients jump on this survey, and I thought, "Oh, wow, they had something to say." But we only got 20 vets so far. Hopefully, we're gonna change that. But some of the things that they said were the hardest part for them around this topic was having the conversation, dealing with the client's fear, but also watching the pet suffer. that's what I'm seeing. They are watching the pet suffer. They said convincing pet owners is hard for them, and I know that just from regular conversations with vets too. They're, frustrated. They believe this is a [00:35:00] client problem. They believe that overall, in the patterns I've seen, and it's also shown in the survey, they believe clients are not emotionally ready, and so they feel stalled by that. And I strongly believe - this might hurt some feelings. I strongly believe it's an ethical issue. I don't believe as a veterinarian practicing medicine you ever put a person's emotions over doing the right thing for the pet, ever. That's, that's what I stand on. So it does bother me. I understand as a fellow human why they do it, but you cannot practice medicine based on how a person feels. and because I've heard vets say, well, they wanna do a alternative, and I'm all for alternative and integrative medicine, but sometimes that can look a little hokey, you know? You gotta ... What is that? I was surprised, I took an ethics course that said, that's [00:36:00] also what gave me the confidence to start saying this out loud, how I feel, that said, "That's unethical." You know? If a dog has a broken leg, you cannot give it over to the pet parent who says, "I wanna treat this," you know, holistically or so- you know, something where you're like, that is not gonna get the proper treatment. That's an ethical issue on the vet's part. And I started thinking about that, you know, with, with this.

It really bothers me. And in fact, I'm going to be doing a talk at the AVMA with Dr. Michelle Schack, a dairy vet, because she often says, "We would never allow cow to experience what we allow a small animal to experience." And we have lots of dialogue around this all the time, and we discovered it's because people feel bad. We allow them to let their pets suffer because of the people's emotions. So in terms of animal welfare, we have certain [00:37:00] regulations where a cow would never get to experience what a small animal experiences, and we justify that because of people's emotions. Something's off there. We have to fix that. So that was a problem I saw clearly, and then once I started working with Dr. Michelle Schack, it was amazing to see how much more regulated we are about animal welfare with cows, and we started thinking, "Something's wrong there." So we started figuring that out. So that kind of ... You know, this has been percolating for a long time. You mentioned, like I've, I think I'll be 23 years this summer practicing my home euthanasia service. And I'm always trying to figure out, how am I gonna get this message across? And it was kind of a fluke.

I thought, "I'm just gonna put this survey out to my own clients and see what they say." just a five-question survey. I know, you know, no one has time. and then I thought, "Well, I should probably also ask the vet," so I came out with a kind of a, a mirror survey. And, like I said, I was shocked [00:38:00] when I mean, within a couple of hours I had over 150 of the clients, and I thought, "You know, if it's gonna make someone stop and fill it out right then, it's important to them." And I think it also says a lot that I, I cannot get vets to, to do the survey. Now, we know they don't have time and they're

Megan Sprinkle: Yeah

Christina Guttuso: but everyone doesn't have time and is busy, and for these clients, it was really important that they be heard about this topic.

Megan Sprinkle: How did you advertise the survey? I'm kinda curious in how it was worded or, like, ex- how you were positioning it that got such a rapid, response.

Christina Guttuso: From the clients?

Megan Sprinkle: Like, did you-- how did you title it? How did, how did you present it to them?

Christina Guttuso: It was basically like your pet's experience could help us. And

Megan Sprinkle: Okay. General.

Christina Guttuso: Uh, yeah. And then I said, because I am gonna be talking at the AVMA this year, I said that, you know, their results could affect the profession through that experience, through me [00:39:00] sharing there, so then they felt like, you know, it had weight, it had value. That was it. It was very short, like I know people don't have time to read a lot. That was it. That was the headline and a little blurb and...

Megan Sprinkle: Did it mention, like, end of life 

Christina Guttuso: Oh, yeah. Well, So in the blurb it, yeah, it It was specifically vet's guidance during end of life,

Megan Sprinkle: Okay. Okay.

Christina Guttuso: vet guided you during end of life. Yeah. That was the... Yeah. Good question. That's, that's important. Yeah. That

Megan Sprinkle: Yeah.

Christina Guttuso: the thing that made them click.

Megan Sprinkle: Okay. So, what did they say? What was their experience working with their general practitioner?

Christina Guttuso: So some of it made total sense for me, and then I love that one thing showed me I was even off a little bit. And I always love to find out where I'm off. Don't ever be afraid to hear where you're off or where you make a mistake 'cause that's where you make the most progress. So to me, I'm like, "Oh, cool.

Now I know where I've been off." You know? So, so the biggest thing, my biggest [00:40:00] frustration with clients, and I think vets' frustration with clients, is when they give you the list of how their pet is suffering, and it's awful. Like, it's so obvious to you. You're like, "Okay." And then they say, "But he's still eating. But he still wants to go for a walk." So what I used to teach, which I'm gonna switch now, I used to say, first of all, you know, checklists, thank you. They were, they were used for a time. They are outdated. I think they are actually the cause of this problem, 'cause now we've trained clients. I used to get mad.

Why are they saying they're still eating? Oh, 'cause we asked them that.

Megan Sprinkle: Yeah

Christina Guttuso: That's the first thing on the checklist, so they're thinking, "Here's all these reasons I should euthanize." Now you gave me a checklist. He's still eating. He still likes his favorite things. He's... And you're going through the checklist, and what you did was just invalidate everything you know. That checklist has become the opposite of what it [00:41:00] started out to be. It was supposed to validate it's time to euthanize, and it now invalidates what clients know they need to do. 'Cause how can they euthanize if the checklist says they're doing those things? And it's interesting you being a nutritionist, we talked about that.

Like many failing pets are eating. It's one of the number one things I wanna stop using that as an indicator for euthanasia. and I often say you gotta also see that body condition to evaluate. So that was one of the first things I noticed a couple of years, like that light bulb went off and I went, oh, I- instead of just being frustrated with clients, I was like, we are training them to think this way with our checklists, so we gotta change that.

But what I was teaching was, so ask better questions, say better things. So like, are they eating? Okay, but what does their body condition look like? They're interested in going on walks, but how long can they walk? You had to ask that follow-up question, is what I would teach because I thought we're convincing the client. I was still on that. If the client understood, they would make the [00:42:00] decision. What the survey revealed was when the client says, "Here's the list of everything wrong, but he's still eating, but he's still drinking, he's still sleeping," They're not looking for any, like technical sign. They're not looking for any more information. They're looking for permission. 190 out of the 300 said they had already decided, but needed guidance on timing. So that was interesting to me. They had already decided. Not, you know, 'cause we think timing, means they haven't decided, right?

No, they decided, they just didn't know they were supposed to do it now. And so the simple answer is the permission, so I used to teach, which I still think is very important, at the beginning of palliative care, at the beginning of treating a terminal disease. And let's not forget, [00:43:00] in our industry, arthritis is a terminal disease, if you think about it. Where's that gonna end up? At the beginning, we need to start talking about euthanasia. We need to normalize that conversation. So here's what we're gonna do. Euthanasia is always on the table. Euthanasia is always available to you.

We need to start letting people know early. I've always been teaching that, but the difference I would say is when that client says that kind of phrasing, I would say it's, yeah, it's time to euthanize. I would clearly say, "Yeah, I agree. It's time to euthanize," knowing that they're not saying, "But we don't wanna euthanize 'cause he's eating."

That's what I heard, and I think that's what vets hear, and that's why we get frustrated with the client. Why? You know, when we say we're frustrated watching their pet suffer, we don't realize they're also frustrated watching their pet suffer. And I've heard this in many conversations in people's homes.

They're like, "Why didn't my vet tell me? We don't understand. Why [00:44:00] didn't my vet tell me?" And a few of those I've called the vet just to kinda hear what their perspective was, 'cause we talked about this communication. I'm like, maybe they did, what... They thought they did. Every one of those vets thought they did clearly tell the client. But I think it's like even the story I told you with my mentor vet who's like, "Oh, I hope you don't have to do it so soon." I mean, she had talked to them about euthanasia, but she didn't realize that little statement is not really saying it's time. You can say, "It's okay to do euthanasia at any time now." 

Megan Sprinkle: I 

Christina Guttuso: think that's a nice easy phrase that doesn't put pressure. Again, early on. And maybe you have to get comfortable with that because maybe you feel like the way I did when I was younger and was like, "Oh, you shouldn't euthanize a pet." I mean, maybe that's something you have to get comfortable with that, yeah, it is okay euthanize this pet at any time.

is okay. You don't have to be scared. You know, maybe vets are scared, I don't wanna do it a couple of months too [00:45:00] soon." You know, just like the clients are scared of that. But I think how we can time it better, there does need to be guidance and education, but it needs to be early. By the time we're saying we see all this suffering and they're still eating, That's not an education moment. That's a permission moment.

Megan Sprinkle: I, I mean, I'm kind of stepping into the shoes and thinking like it, it is intimidating from the veterinary perspective to have that conversation early because, and again, this is me just speaking.

Christina Guttuso: Yeah.

Megan Sprinkle: you worry that you will hurt their feelings if you bring it up early when you know it's not the right time, but you want to plant that seed.

Like, that's super intimidating. So I think it's good for people to continue to learn about this from you and your experience about what is the best way of doing that. How can I do that empathetically, but always coming back to [00:46:00] doing what's best for the pet? And I think that's, you know, what our mantra is, it's just, how it's expressed. 

Christina Guttuso: You make an excellent point, and it comes back to this miscommunication between vets and clients. When a vet says, I want you to know we can do euthanasia at any time," you're not gonna hurt the client's feelings. And in fact- That client is probably gonna trust every medical recommendation you make after that, 'cause now they know you're not trying to sell me on something.

You're okay if I even euthanize my pet. So we, we don't realize that actually doing that relieves the client to go, "Okay, they're okay with me not pushing if I don't wanna push so hard." And ironically, like I said, I think it's gonna make people trust you more and take your medical advice even better.

Megan Sprinkle: That's super interesting and that, uh, I think that's hopefully freeing for people to, to know. The-- And we don't have enough time to talk about this, so

Christina Guttuso: I

Megan Sprinkle: this out, um, which is really rude. Uh, [00:47:00] so if you do need to, uh, to answer, you know, please feel free 'cause I also, you know, having... I-I'm a nutritionist, I acknowledge my time in clinic having these conversations is pretty minimal now.

But I had a very hard internship after vet school that still scars me today. And so I, I think that when you are supporting clients that are inviting a veterinarian to come into their home to do in-home euthanasia, you are right. Like, that's a very specific type of, of client, and we all in general tend to appreciate working with them.

And these conversations are super valid. even you mentioned going through COVID and your clientele became quite diverse with how they manage these cases. So I, can just feel some people thinking of, yes, maybe I do have clients that I feel like, man, they really need to euthanize this pet, and [00:48:00] they just aren't, and, and this all relates there.

And then I still think that there's some people that see those clients that seem to be doing it inappropriately in our opinion, right? Like, that maybe they are doing it too soon, or they are doing it for, we all talk about like, uh, financial reasons that, you know. So there's like this- spectrum, of situations when it comes to euthanasia, and I, I think that's why a lot of people who do most of their work in euthanasia, where often it is in-home euthanasia, the reason why they can do it are the things that you talk about, is that it's fulfilling 'cause people feel appreciated.

These are, these are pet parents who needed that permission. They needed that support at this very important time of their life. And then the people that are, like, in emergency or are seeing these cases that come in where they're l- they're, like, coming in for euthanasia and you're like, "What?" it's hard.

So, like, there's a lot of opportunities, I think, to [00:49:00] be able to identify, understand what's going on, and better respond across the board. So I think what you're doing is super important. And again, an area where we all, can get much better at this. But I ultimately do wanna thank you for... A lot of it is better understanding, right? And I think that's what you're highlighting, is really understanding the other side of the leash of

Christina Guttuso: Mm-hmm.

Megan Sprinkle: And by understanding that, we can be so much better at our side, too. Um, but yeah, I, I'll let you respond there, and then I'll ask a final question.

Christina Guttuso: Okay. I said early on when, this is 20 years ago, I had a very elite clientele. I've had in the last 15 years, yeah, the whole spectrum, definitely, and what I would say is whether someone's affluent or not, goes to the vet or doesn't, it's the same across the board. And that is also... We were taught, right, you, you give everybody [00:50:00] the full estimate. You don't judge the client, right? It's our responsibility to give everybody the full estimate. We don't decide ahead of time if they are gonna do it or not. We have to do the same thing with euthanasia. I think our best clients deserve the resources.

I think sometimes we go, "Oh, these are our best clients." Our best clients don't understand how to as-assess quality of life and still need permission. Our best clients who are willing to do everything still would really value that. These are the people I'm having conversations with that love their vet and still want guidance. So don't be confused. Often, I love that you said that, because often when I talk, vets immediately go to their worst client, the worst situation. "How do we deal with that one person that will not euthanize their pet?" And those exist even in my world, and y-you have to let some of that go. When animal cruelty is involved, you have to be a little stronger. That's not what I'm talking about. I'm talking about a broader audience that needs your permission, that needs you to have these conversations early, They do need the guidance on what [00:51:00] qual-quality of life looks like. When you give pain medicine, I'll, I'll also send this out. When you give pain medication, you have to explain to the client what they're gonna see to know it's working. I think that should happen with every medication that's given to a client. Do not assume they know what that means. Some of them go, "Well, I'm giving the medication, so it's working," even if they see nothing. Their education is a part of it, but I think the key is they want permission. They want that burden off of their shoulders. I'm giving every veterinarian permission to say what they think. You know, like I said, in vet school, we were told we weren't allowed to. Yes, you are the expert. They wanna hear what you think.

Megan Sprinkle: Yeah. Well, I hope we haven't biased people, but I do wanna send more veterinarians to answer your survey. It, it's helpful to get a range of perspective ' cause again, like, e-everybody's coming from a different angle, and I think the more responses you get, the m- [00:52:00] clearer picture and the better that you'll be able to help both sides.

So, send people to answer this, so you'll have this all ready to present at AVMA. So if anybody's going to AVMA, they need to go to your talk and meet you. Um, then I, I always like to end on this final question.

Uh, and what is something you're-- And this can be anything. I know we've, uh, leaned in very heavily, so I wanna take a deep breath for a second. What is something that you are just super grateful for in life right now?

Christina Guttuso: Mm. My daughters, they make me so happy. I just love where they're at in life. They're 15 and 23, and it's fun to watch young women growing up.

Megan Sprinkle: That was Dr. Christina Gutuso. Whether you're a veterinarian who has struggled to find the right words in those moments, a technician who has held space for a grieving family, or someone who has simply been on the other side of that experience as a pet owner, I hope you found some inspiration and maybe comfort in this episode.

Dr. Christina still needs your voice. If you [00:53:00] are a veterinarian in practice, please complete her survey. The more perspective she has going forward, especially for her AVMA presentation, the more impact this work can have on the entire profession to know how we can be better for our clients.

The link is in the show notes. And if this episode opened something up for you, please share it with a colleague, a practice manager, a vet school professor, anyone that you feel could benefit from the conversation. For a full summary of the key takeaways and reflection questions from today's episode, head over to the Sprinkle of Wisdom sub stack for the Podcast Club guide.

Like I said, links to everything are in the show notes, so you will not miss anything. And until next time, keep reimagining what's possible in veterinary life.