What would you do if it was your pet?

What would you do if it was your pet?  This is a question I get asked a lot in my field, more so when I was in ER medicine, although working with an internist (we treat a lot of cancer patients) has caused this dilemma to remain.  It is a tough question to answer, because every case or situation in the veterinary field is different, but there is one commonality: determining your companion animal’s quality of life when making these decisions, And it is tough, because they cannot tell you what they want, yet they can communicate what is best for them in subtle ways-if their owners are observant and are able to take themselves out of the picture……

Which leads to another question: When is it time to let go? 

My most recent case that really touched me was several weeks ago at work. It was so draining, that I have not been able to write about it until now. No matter how burned out I feel with my profession, my patients still touch me. This is a good thing, as it lets me know that no matter how jaded I think I’ve become, I still have at least part of my soul left…
The dog’s name was Theo, a charming and rambunctious pug who presented to us with acute vomiting and pancreatitis. Theo was only 4-5 years old, but looked way beyond that; he apparently was a rescue dog, so his sketchy background perhaps aged him. When Theo came to our clinic, he was literally bouncing off the walls!  He would jump into my arms every time I’d open his cage. We did blood work and treated him with IV fluids, and were going to send him home the next day, but the vet decided to keep him one more night….that was when Theo had a seizure from which he never recovered…

I walked in on a Wed morning (Theo came to us the previous Monday) to the sound of an EKG machine and an inexperienced, harried overnight tech, anxious to give me rounds and have me take over. What on earth have I walked into, I asked myself….
I have 5+ years of experience in emergency medicine. I have seen it all, from gunshot wounds to severe trauma to abuse to sudden death; you name it and I can probably tell you a story. Yet it doesn’t get any easier, despite my experience and expertise.
So I get rounds on Theo, who is pretty much comatose and on anti-seizure meds (Valium and Phenobarbital). Throughout out the day, he does not get better, yet the owners want to pursue treatment. At this point, I cannot blame them. They want their dog to pull out of this and they also want answers. We aggressively treat Theo in an attempt to give them both…
The next morning, Theo is worse. He has had more seizure-like activity and is now a shell of a dog lying there hooked up to IV fluids ad an EKG. Looking at him, it’s hard to believe that this is the same happy go lucky dog we saw just 2 days ago. Now the question is, how far do the owners want to continue?

I am a veterinary technician. For those of you who don’t understand what I do, I am the equivalent of a nurse in a human hospital. So I carry out the doctor’s orders; I care for the patient, and report anything usual or unusual back to the doctor. I am the doctor’s eyes and ears, I am her right hand, and all too often, I become her heart. The latter is what makes my job the most difficult. While the doctor is caught up in tests, client wishes, and how to make the patient better, (which all too often becomes a “case”-see my last blog), I see firsthand the patient’s quality of life. Which makes me wonder all too often, why are the clients continuing treatment? Why are they putting their pet through this? And how do you know when is it time to stop?

Such became the case with Theo’s owner. I knew at this point that he was not coming back to us. Yet with the client’s go ahead, the doctor kept ordering more tests and coming up with more treatments; all to no avail.

This is when it becomes very difficult to do what I do. There is a point that I KNOW the animal is not getting better; I can see it, feel it, sense it….and convincing the doctor is difficult enough, but convincing the owners is a different story; most people do not feel comfortable making these decisions or do not see the big picture, and yet it is a part of being a caretaker for their pet. Some people look at this as “playing God; I see it as being a compassionate, informed and responsible caretaker. And taking yourself out of the picture.....

Theo’s owners were not ready to make that decision. And I can understand their plight. Yet additional tests revealed nothing, except that he was declining. Their once happy dog was now just a shell of his former self, lying in a cage, and they were no closer to an answer than they were when he was transferred to us 2 days ago. Except that perhaps their answer now was that they were never going to have one and that maybe it was time to let their beloved dog go. Unfortunately they couldn’t, almost up to the very end. They came to visit Theo in the afternoon and sat outside his cage, hoping for some sign, that he might come back. My heart went out to them; Here they were were, consumed in their world of grief, hoping against hope that their dying dog would turn around, amidst the hustle and bustle of well animals being discharged; an often too ironic turn of events in my field. Even more ironic was that “mom” was a nurse. So she understood all of the medical terminology. But she was just too close to the situation..….

After a painfully long visit in the treatment room, Theo’s owners elected to visit with him privately in our grief room. At this point, they had decided to discontinue treatment as death was imminent, but they still weren’t ready to let go. This makes it worse; for those of you who have never seen natural death; it is not pretty, especially when one is unprepared for it. Our greatest concern at this point was to ease the owners through what was bound to be a very difficult situation. I was on standby with an anesthetic injection, in case Theo went into respiratory arrest. This meant that I had to keep checking on them and intruding into their world of privacy and grief in the best interest of both the clients and my patient……

Finally, Theo’s owners decided to let him go quietly. After 3 grueling days, Theo died peacefully in his owner’s arms, with the help of an anesthetic overdose. This was clearly the end of a short but powerful chapter for us; the end of a long and meaningful chapter for Theo; and hopefully the start of some healing for his owners.

There are those of you who wonder why I am so private, especially as of late; why I maybe don’t volunteer much about myself; why I take so much personally. Perhaps this is one explanation; my work demands SO much of me, physically, mentally, emotionally. Lately it has consumed me. Many times I get home and find that there is nothing left of me to give. Currently, I am trying to find a balance; I'm hoping that writing about my experiences will help. All I ask is your patience, understanding, friendship and acceptance.  And when you come home at the end of the day, take time to be thankful for the way in which your companion animals have touched your lives. And give those that are still with you extra love….........for me.

Ellen  
11/22/06