From Cradle to Grave

There is a term in human medicine,  "cradle to grave care", which refers to the family practitioner.   He or she sees patients of all ages from newborn to geriatric.  Your general practice veterinarian is the "cradle to grave" provider of the pet world.  Unlike our human counterparts, however, we often see the SAME patients from cradle to grave.  For those like myself who choose long term employment at the same practice over emergency medicine, research, relief work, or frequent job changes, there comes a point in our careers where we begin seeing the former playful kittens and bouncy puppies come through our door as thin kitties with unkempt fur and creaky limbs or grey faced dogs with cloudy eyes who need a helping hand to jump into the car.

It usually starts around the 8th year in practice.   That is the time when diseases of middle age, such as diabetes and cancer begin to claim our patients.   This is also the time when our largest patients reach the end of their natural lives.  Shorter lived breeds such as St. Bernards and Irish Wolfhounds have a life expectancy of only 7-9 years.   It reaches a peak around 10-16 years in practice when most of our dog and cat patients die of age related disease.   Cancer, arthritis, kidney failure, and heart failure are among the most common causes of death in senior pets.  

Those of us who choose general practice find satisfaction in bonding with pets and owners over a lifetime.    Watching patients transition from cute puppy or kitten to mischievous adolescent is at times amusing or charming, and at times frustrating.   Next, they move into the young adult stage where, with proper guidance, they have finally figured out what is expected of them as a family member, settled into a comfortable routine within the family, and developed a sense of loyalty to the family.      Their humans have suffered through chewed shoes, scratched furniture, and countless 'accidents' on the carpet and furniture.    They have often wondered if they'd survive the crazy puppy or kitten stage, but are generally glad they stuck it out and are now reaping the rewards.    Middle age brings some challenges.    Previously healthy animals may begin to show signs of disease or mobility problems which require time, money, and dedication to manage.   Owners willing and able to handle the challenges may manage disease for years, and the pets often thrive under proper care.

Living with a senior pet is a mixture of heartache and joy.   Few things are as dignified as a 16 year old cat who curls regally up by your side (or on your lap if she deems your worthy!) or a white faced old Golden Retriever who still greets you at the door with a wagging tail and is still eager to go for a walk even though he is slower and tires more easily.    Few things are as heartbreaking as when that regal cat tries to jump onto the counter for the first time and can't quite make it.   Every dog owner knows about the lump in the throat the first time your senior dog tries and fails to stand up after a nap or stares at the wall and barks at night as dementia clouds her once sharp brain.   

The last treatment a 'cradle to grave' veterinarian gives his or her patient is a gentle death, usually while the pet is surrounded by loved ones.     That act is a mixture of heartache and relief.     We are sad to lose a patient we have treated for a decade or more, frustrated at the limits of medicine, but relieved that we can offer an end to pain.    Do we bond with all of our patients?  Honestly, no we don't, and that is fortunate for our emotional health.    We care about them, but we don't suffer the same level of pain as the owner does in most cases.  What we feel is empathy for the client, because most of us have been there with our own pets.   For those patients with whom we truly feel a bond, the loss is more profound.     One of my current patients is a senior dog who is suffering from terminal cancer.    He was, quite literally, born into my hands.   I was the first human to touch him when I delivered him by c-section.    Yesterday, I became one of the last humans to touch him.   I treated him for problems associated with suspected cancer.  Today, the diagnostic test results came in, and cancer was confirmed.    Treatment options were discussed, none of which would allow him to live out his breed's average life expectancy of another 2-5 years.   He will die sooner than he should, but he will die gently and with his family by his side.    Such is the life of a "cradle to grave" veterinarian.