Favorite Rainy Day Topic: euthanasia

A vet friend just told a story (and she might blog about it at some point) that reminded me of an experience I had several years ago.  I was working as an emergency vet at some tiny EC and a couple brought in a tiny doggie with some sort of very fixable issue.  I don't even remember the issue, just that it was a no-brainer and would be a happy end for the family.

Now, this couple was engaged and they were kind of planning to start attempting to have a baby soon after getting married.  As with all smart couples, they discussed how this addition would change their lives.  The happy, wriggling canine on the table, all 5 lbs of him, was friendly and openly interested in making new friends.  But not everyone in the house was like that.

The woman had a cat, one that she loved dearly, that was....honestly, nuts.  The cat was fine with her, but would attack the fiancee, even charging the WINDOWS and tearing up blinds if she saw him coming up the stairs, before he had even entered the house.  She had attacked him, unprovoked,  on multiple occasions, but was mostly fine for the female.  It sounded like there might be some displaced aggression issues, along with over stimulation issues, plus some other psycho babble that I will not bore you with.

It was obvious from the stricken look on the woman's face, that she loved this cat.  And the husband to be loved his wife to be.  They had talked to multiple vets and veterinary technicians about this cat and how to help her adjust.  They had done metabolic testing, tried drugs, and behavioral modification....and all had failed so far.  I mentioned referral to a veterinary behaviorist, and might have been more enthusiastic about it, save one issue:  the possible future baby.

Now, if a cat sized animal is dangerous to an adult, it usually ends up with some biting/scratching wounds for the adult and perhaps a punting injury to the animal.   If something is attacking my leg, the first thing that snaps to mind is to get that thing OFF OF ME.  I do admit to throwing a lizard into a bathtub wall as a kid when I slung my hand in an effort to GET IT OFF OF ME as it chomped down between my thumb and finger.  Around Easter, a chihuahua tried to attack my 6 year old (who loves most animals BTW), and that dog almost got punted across the yard...a well placed kick/shove and my daughter would have been safe (soccer, those skilz are useful when being attacked).  It is pretty much instinct and, while I do not agree with kicking animals, I would have to qualms about it in that situation.

Well, a cat hopped up on pure crazy could do some serious damage to a baby.  Even just infected scratches, lacerated eye balls, scaring the child so that the mere mention of "meow" sends it running and hiding under at desk at the tender age of 26....that is trauma.  And I felt like it warranted, "the talk."  Now, keep in mind, the happy dog was technically my patient, but the owners were really torn up about this cat thing.  They wanted to help her, but they also didn't want to put the future groom and risk, much less a theoretical baby.

Every vet and vet tech they had talked to made them feel guilty.  As a new mother with a timid, possible biting dog on my personal hands, I could easily place myself in their shoes.  I told them that if they were looking for permission to euthanize the cat, I gave it to them, that I would do it for them.  I said that the cat was mentally ill and perhaps years of drugs and therapy might help, but in that time, they and future fruit 'o the loins could be hurt.  If they wanted to euthanize, I would pre-medicate the cat and allow her to fall asleep before really putting a hand on her to minimize stress.  I would not make them feel guilty about it because I knew I was facing something similar at home with my dog and daughter.

I was not going to shame them into a position of attempting to "help" the cat, only to get a call in a couple of years about how it attacked their baby or a guest.  There are so few times that I will literally say, "If this was my animal, I would euthanize," but this was one of those times.  It was agonizing for the woman who loved her cat and I could see the pain in the man's eyes as he watched his future bride think about it.  I told them that they needed to go home and discuss it.  If they wanted me to euthanize, they just had to call back to the EC to make sure I was working that night and I would do it for them.

When they did come back in with the kitty, it was rough on everyone.  I sedated her until she was pretty much asleep, allowing "mom" to let the kitty fall asleep while she was petting her.  The couple chose to leave the room once the kitty was asleep, but before I actually euthanized her.  It was tough on me, on them, and on my staff, even though we all knew that it was the best decision for everyone.

The next time I saw the couple was a happy day visit at a regular clinic where I did relief.  The happy puppy had grown to 7 lbs doggie and was still as happy and wriggly.  The couple was married and the wife was pregnant.  And the relief was palpable.  The family unit was intact, and though any pet, even a well adjusted little dog, can hurt someone (especially a baby), the risk was so much lower.

Not a fun rainy day topic, but my friend's case made me think about this one.  Yes, I euthanized the cat: one that could not be re-homed due to aggression, one that might have hurt someone in the family.  But perhaps I took away that cat's mental pain and saved a child from a scar or a scare or worse.  It sounds like an unhappy thing at first: euthanizing a "healthy" animal, but I would do it if I felt like I could save a little kid in the process.  Most vets have had to face this issue on multiple occasions.  Some owners will have to face this decision.

And as someone who has been on both sides of that table, I can tell you it is hard.  But once my dog finally bit my daughter (by the time she was 3, I could no longer control all of their interactions), I knew  that it was time.  He snapped at her when she bumped into him because he was afraid...but an inch to the center and she might have lost an eye as his tooth scraped her face.  I could not deal with that.  And though I still look at my pictures of him and keep his urn on my shelf, it took about a week before I realized I was no longer worried about a bomb going off in my house and taking out my daughter.

Ruminations

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.

Unexpected kindness

Yes, we're a jaded, cynical bunch. We've heard a lot of the muttering about how we are a bunch of bitter, burned out, bad-example-setters. Whatever.

I read this blog post today. The pharmacist author experienced an unexpected kindness from his patient, in return for something he'd done that he really hadn't considered a big deal at all.

The post reminds me of something that happened in my work life recently. Some people brought in their elderly, decrepit pet in terrible shape, actively dying, and I put him down. I didn't think too much of it. I told the people how sorry I was. Even though I had people waiting for scheduled appointments, I took the extra ten minutes to talk to these people and tell them that yes, I did think they had done the right thing. I even let them hug me on their way out - both times that they came back in to thank me again, tears in their eyes.

They were so grateful for what seemed so little from me. I did not really feel like I'd done anything extra special. They sent me a lovely notecard the following week, too. I'm keeping it in my "I don't suck" file.

Veterinarians Behaving Very Badly

We have been getting some rather nice mail from various sources, one of which is the veterinary paraprofessional staff, such as vet techs, veterinary assistants, and veterinary receptionists. Many have said that they have the same client stories with a few variations, but some have also said they would have to include some stories about doctors that had some, um, personality issues as well.

So, I thought I would share a story from my days working as a lowly veterinary assistant prior to vet school. I worked for a small clinic for a veterinarian that I had known since I was about 3. He and his family went to church with my family. Before working for him, I thought he was a pretty affable sort of guy. At church, he always seemed gracious and happy. He was well respected amongst my family's friends.

With little trepidation, I went to work for him during the summer after my first year in college. For the most part, I was ignorant of the proper way to do small animal practice, so I didn't realize that rinsing and reusing syringes AND NEEDLES was not only dangerous to the staff (would you feel safe rinsing needles or popping a dulled, overused needle in the skin of some poor animal?) it was clearly not a good idea for sterility. I didn't know that most surgeons change gowns between surgeries.

However, the first time I saw him kick a sedated dog down the hall into the surgery area, I knew there was a serious problem. He started with dragging the dog by the slip lead, in a stranglehold. Then he just kicked it down the hall. It wasn't a little push of the foot to slide it down the hall, it was a kick.

I also saw him backhand a dog that was sedated prior to a euthanasia. Why did he do this? The dog was being euthanized because it was aggressive. Hell, the dog had almost bitten me at a prior exam when I was just talking to the owner and I would have never thought to do that.

At another euthanasia, this very sweet little old lady was having to put her darling long term poodle to sleep. She told me she was looking forward to seeing him when she was dead. Once the deed was done, she turned to this doctor and asked, "Dr. Insensitive, you believe I will see Pookie in heaven, right?"

He actually answered back, "No, the Bible tells us dogs don't have a soul, therefore they cannot go to heaven."

The poor little old lady was devastated. I was horrified.

I learned many things from him. One of the most important things I learned was that just because you were an AAHA hospital and had been named practitioner of the year in your state, it did not mean that you were a good and compassionate doctor. The other thing I learned was that I would honor the emotional needs of clients even if it meant denying my own religious beliefs. As an atheist, I gladly have bowed my heads when an owner wants to say a prayer over their pet. I have assisted in many goodbyes where I told the owner that I believed that Fluffy would be waiting in the afterlife. While I do not believe in convenience euthanasias, I believe very strongly that when someone makes a decision to say goodbye to a pet, whether for financial, medical, or behavioral reasons, I will try to be as respectful and compassionate as possible.

An awkward encounter

As has been previously mentioned, veterinarians are people too (shocking, I know). However, much like young children who seem shocked and amazed when they find out that their teacher doesn't actually live at the school, so do the clients often seem, if not shocked, then at least surprised to see their veterinarian outside of the clinic, doing something as mundane as purchasing groceries, getting the car fixed, visiting the pediatrician's office, or even (gasp) standing in line at the post office.

That's cool. I mean, seeing as how I'm a person, I know how it can feel like a nice pleasant surprise to run into my physician,  pediatrician, or clarinet teacher, or whatever other professional type person I've had a pleasant ongoing relationship with somewhere other than his or her office or school. You want to say hello, maybe crack a joke, share a smile - it's all good. Sometimes, though, these encounters go horribly wrong. Last week, I had one of those.

I was at a house of worship, speaking to the administrative office staff there at a time when no services were being held, but some educational classes for children were in session. One of the teachers was planning a teaching module about how helping animals is a charitable act, or something like that, and she had asked me to drop by. So I was standing there in the office chatting with this nice lady at the desk when another woman walked in, looking vaguely familiar. She said hello to the lady at the desk and then she did a double take at me and said "DOCTOR VBB! What are you doing here?"

I said "well, I'm here to meet Ms. Kidwrangler to go over a lesson plan, actually. How are you doing?" She said to me, "oh, it's so kind of you to ask, I'm doing just fine" and then leaned over the desk and said to the receptionist, "remember how I was so depressed after Dingo passed away? Well, Dr. VBB here is the one that killed him! Whattya know?"

Of course a whole bunch of people were walking into the office just at that time.

There was an awkward silence that seemed to last forever, before my client realized what she'd said, and cleared my name, explaining that she'd brought Dingo to see me for euthanasia, after a long illness during which I'd cared for him quite well.

I'm not sure any of those people will ever look me in the eye again, though.