A few days ago, I had the opportunity to ease the passing of a long-time patient of mine. I'd been seeing this dog for >10 years in my practice, and we got along pretty well. In the past six months or so he'd been in a decline, and for multiple reasons his owner chose this past weekend to end it.
These occasions always make me think.
I think about death. What does it mean to die? Is it really true that sometimes, dying is better than living? I think so, but can I really be sure? It just about kills me (no pun intended) that I can't be sure. No one can show me the evidence. I have to take it on faith. I am not a person for whom that comes easily. I don't really believe in faith.
I think about my part in the process. Do I have "the right" to end anyone's life? Is there any person, group of people, or supernatural power that can grant me that right, or am I allowed to grant it to myself? Regardless, I feel a responsibility to end suffering when possible. Sometimes any continued life will mean continued suffering. So.
I think about the impact my patient's death will have on the people in his or her life. The owner. The extended family. Me. My staff. Sometimes it is very very hard. Other times, not so much. I'll come out and say it: given the opportunity to euthanize a particularly nasty-tempered animal, I have sometimes felt pretty good about never having to see that animal alive again. I believe the phrase "don't let the freezer door hit your ass on the way in" may have been uttered, in jest, even. More often it's sad, though. Sometimes devastatingly so, as when octagenarian or even nonagenarian pet owners have to say goodbye to their companions, and feel it would be unethical or inhumane of them to get a new pet, if they have no trusted friend or family who agrees to take it in should they, the owner, predecease the new pet. Those people always seem so terribly lonely - sometimes, we call them every few weeks just to say hi... sometimes, they just slip away and are never heard from again.
Anyway, all of this is just an aside. This past weekend, my patient was accompanied by his owner, a man of about 35 or 40 years old. The patient was quite large and we elected not to put him on a table, but to spread a blanket on the floor and let him lie down comfortably before I injected the euthanasia solution. Afterwards, the man laid down next to him and hugged him and cried, in a way that generally men of this age in this society do not do in public, unless experiencing overwhelming tragedy. I put the tissue box near them both, told him how very sorry I was, and left them to have a private goodbye.
The man ended up leaving the building while I was occupied in the other exam room, before I could come back in and say anything else. Not that I had any great prepared words of wisdom, but usually I'll offer a final "I'm so sorry," a handshake or hand on the shoulder, a "please let me know if there's anything else we can do for you," that kind of thing. For a long-time client like this, we'll follow up by sending flowers or a charitable donation or something in memory of the pet, depending on what we think would be best appreciated. I flagged the patient's chart to make sure the staff would have me personally sign whatever card might be sent. I'm not always around when they are preparing those to go out.
My very next patient was an adorable so-cute-it-hurt puppy. On the one hand - yay, puppy! Cycle of life, to everything there is a season, yada yada yada. On the other hand - pet store puppy. Fake/made-up pseudo-designer "breed." Entropion. Luxating patellae. HUGE inguinal hernia. No vaccine history. No deworming history. Serious case of craniorectal inversion in the owners! So, essentially, no heartwarming take-home message here. Just another day at the office.