Sieske Valk is a Dutch social entrepreneur, ex-veterinary nurse, and End of Life Doula for pets. She recently set up Autumn Animals, a holistic palliative and hospice care organisation for London’s elderly and ill pet community. Autumn Animals offers in-home veterinary care, supplementary therapies, Quality of Life assessments and ongoing emotional support for the caregivers.

Sieske Valk

What led you to found Autumn Animals?

I had been working in veterinary medicine for almost ten years when I changed career and went into climate change research. However, even whilst being out doing fieldwork in tropical countries, I ended up doing second shifts feeding stray animals and getting them spayed by local veterinary surgeons. This eventually led to a near-burnout, feeling all that love and care for animals, and wanting to act on in, but only having a few hours per day of spare time to do so.

I knew I never wanted to go back to the clinical setting, working long shifts and feeling like a glorified cleaner with little opportunity for growth, so I ended up setting up my own business being a dog walker a few hours per day and a medical pet carer another few hours per day. After five years of setting up a solid network of animal carers, and reviewing some of my goals, I decided to actualise my dream business and I became and End of Life Doula and launched Autumn Animals in 2022.

How have your previous experiences in veterinary nursing helped you to develop this enterprise?

Having the clinical experience, both medically and socially – knowing how veterinary nurses work and are sometimes treated – really motivated me to set up a business that allows them to make the most of their skills. I also experienced first-hand the stress on time for both veterinary surgeons and nurses, creating a feeling of guilt and regret for not being able to offer proper follow up or the concern they missed something with a patient. Often, they must rely on what the pet caregiver tells them happens at home, but the pet’s caregiver may not be aware of signs of distress and discomfort. For this reason, I think it’s a benefit to have a third party involved with the animal who can liaise between the caregiver and the veterinary clinician, with knowledge of the home situation and how that can be translated to the primary veterinary surgeon to optimise the overall veterinary care given.

Palliative care Sieske Valk

Lastly, I’ve experienced that most veterinary surgeons do not have the time to talk caregivers through the end-of-life path of their pet enough times for them to truly understand what is happening. The moment they announce the diagnosis, people often stop listening and come up with all their questions over the next few days or weeks. Many clinicians are not readily accessible to talk people through the process multiple times and lots of people suffer from white coat syndrome where they are afraid to ask a “dumb” question. Having a person available to answer questions, however silly they may seem, via an accessible route such as WhatsApp or face to face in their own home or assisting them in setting up a list of questions for the veterinary surgeon for their next consult, will help both caregiver and veterinary surgeon as well as the patient.

Why do you feel a holistic approach is so important within palliative and geriatric care?

I think the patient is helped if their illness and symptoms are approached from various angles. Sometimes, medications do not alleviate discomfort completely and sometimes they only target a particular symptom. That is why we’re offering to treat patients with both conventional veterinary care and supplementary care such as osteopathy, diet, and acupuncture. Although we firmly recommend continuing with conventional veterinary care, we would advise pet carers to also look into supplementary care that looks at the body from different perspectives. In addition, we strive to improve the patient’s environment so that it’s more accessible, comfortable, safe and calmer to help relieve discomfort and stress.

And last but certainly not least, we support the primary caregiver emotionally throughout the process, from diagnosis until the final goodbye and after. Our goal is to make sure caregivers feel more in control, empowered to give the best care possible, better prepared, up to speed with what’s happening on a medical level and listened to. This will hopefully result in a less anxious caregiver and a less anxious animal. This also allows for less indecision when it’s time to say goodbye.

“When we don’t acknowledge the loss of a pet during such times, we lose the chance to deal with old grief or trauma.”

As an End of Life carer and Doula and having lost a few companion animals myself in these past few years, I am very aware of the impact grief can have on a person. It’s often not a “simple” kind of grief either. Some people have adopted their animal during hard times or together with a partner they have since lost. That companion animal can be the last link with that person, or the vessel for their old grief. When we don’t acknowledge the loss of a pet during such times, we lose the chance to deal with old grief or trauma. In addition, when pet grief is not acknowledged by loved ones or friends, one can start feeling lonely, depressed, and disenfranchised.

At Autumn Animals, we make sure that grief and loss is seen, and that people get the space to feel rather than suppress their feelings, talk about it with an individual supporter of a pet bereavement support group and create a community of supporters. We also make sure that people who need a bit more help, e.g., from a bereavement counsellor or doctor, are directed to the right services.

We don’t forget our wonderful team of carers, who also feel the loss of a patient every time. The nature of our work is to go through ups and downs with patients, and that affects staff personally. That’s why we make sure we have a strong team of supporters and an assigned sponsor per employee who checks in with them on a regular basis. After all, we cannot take care of others if we aren’t being taken care of ourselves!

Veterinary teams, especially working in palliative and end-of-life care, can be vulnerable to compassion fatigue. How is it possible to reduce the risk of this and related challenges to wellbeing for veterinary personnel?

As veterinary professionals we encounter strong emotions – our own or others’ – on an almost daily basis. Most of us have come to the profession because we care and want to heal patients, so losing them can feel like failing. The veterinary team has the final say about an animal being euthanised, whilst also playing the role of a salesperson, a shoulder to cry on, a beacon of boundless information, an employer and, to put it bluntly, the person that “killed” the pet.  The team try to deal with all of that within 10-20 minutes while the waiting room is filling up with more patients.

Palliative care Sieske Valk

It’s important to first and foremost take care of yourself. We are often reminded to practise self-care during times of high stress, but that can be the worst time to try to make a start. Your nervous system is already in overdrive, and new routines can seem like just another task you really don’t have the time for. This is why I veto the term “self-care” and instead call it non-negotiable hygiene. We should practise certain things daily that keep us centred and balanced so that when it gets tough, we have trained our “hygiene” muscle and it doesn’t feel too daunting to continue practising it.

A few of my personal non-negotiables for daily hygiene are taking time to start my day with a wholesome breakfast, yoga, and a grooming regime for me – and my cat. When I come home in the afternoon, I decompress with a cup of tea, respond to any messages and have a shower to wash the day off. That way I set myself up for a whole evening of feeling relaxed. I use tools like ‘do not disturb’ on my phone so that only my family can reach me after 8pm. And I try to read one book per week.

“You know, life just happens… but I know what brings me back to centre.”

Another non-negotiable is to make sure I get at least 8 hours of sleep every night, and doing the chores together with my husband because I refuse to take all of the physical and mental load in our household. And finally, I have collected a solid network of strong women that support and inspire me. I make sure to meet up with friends regularly and book in the next date straight after the previous one finished.

It has taken time to build up a routine that works for me and I’m constantly trying to find a balance because you know, life just happens. But I now know what brings me back to the centre and that tilting away from it for too long will tip me over into not feeling right. If you’d like to get more practical tips on how to make sure you are a resilient carer, please go to the BVA Live 2022 page to check out the talk I gave for BVA Live.

Can providing pet bereavement support to your clients help your staff to maintain their own wellbeing?

Pet bereavement support starts the moment an animal receives a diagnosis. That is when people start thinking about the demise of their companion, even if it’s ’just’ osteoarthritis and the animal can still be around for years to come. Having staff trained to be good listeners and supporters, without actively soaking up the client’s emotions and trying to remedy the unfixable, can not only be paramount for the client, but also the carer. Once you learn to listen and support with ‘unconditional positive regard’ (the idea that every individual has the strength to find a solution to their own problem), you’ll start to notice that cases that would previously feel draining don’t feel as heavy. You don’t feel like you need to carry the conversation, fill in the gaps and share your own experiences, you are just witnessing another person coming to terms with the situation and solving their own mental puzzle.

Palliative care Sieske Valk

For practices who don’t have access to specialist services like Autumn Animals, have you got any tips about how veterinary teams can make a positive difference to their clients within palliative and geriatric care?

The first thing I would do is to train reception and veterinary nursing staff to become Pet Bereavement Supporters. The course is offered by the Blue Cross, is very affordable and even more insightful.  Your Supporters can then disseminate the knowledge to their colleagues, making sure they all know how to ask the right open questions, how to listen with intent and where to refer clients when they are going through a tough time.

Reach out to any good local pet sitters who are good at communication both to the client and veterinary team. If you have a professional you can recommend clients to for in-home care, that will help a client who might be a bit hesitant to leave their beloved pet in the hands of a stranger.

Try to see if you can find the space for an experienced nurse to set aside an hour per day to check in with clients and patients whose cases are on the difficult side. Clients appreciate these check- ins, and probably have questions ruminating in their heads. Being proactive likely to result in them being more engaged with their pet’s case, feeling more in control and signalling symptoms they might have brushed over otherwise.

What do you feel are the most important ways that employers can support the wellbeing of their veterinary teams?

Listen to your employees. Sit with them, ask for honest feedback and really listen, without already preparing what you’re going to say next. Don’t just do this once, do it regularly. Make it a non-negotiable practise. Oh, and let’s not forget: find ways to implement what they’re asking for!

You can see more from Sieske at: @autumnanimalslondon

Next month, Sieske talks about achieving sustainability, diversity and personal growth in veterinary businesses in part 2 of our interview.

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