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When it’s time….making the decision to euthanize

Companion animals are such a blessing in our lives.  They provide us with unconditional love.  We laugh at their antics, and enjoy their company.  Many of us post pictures of them on Facebook, celebrate their birthdays, and buy them presents on the holidays.  They give us friendship when we are lonely, and comfort us in our darkest hours.  In turn we adore them, feed them, clean their messes and allow them into our hearts.

It would be a wonderful world  if dogs and cats died peacefully in their sleep.  Unfortunately, very few of them do.  Instead, we are left to make the difficult, heartbreaking decision to euthanize them.  We give them the gift of a painless, peaceful death, but we still have to decide the time.

This is often an agonizing choice for owners to make.  Many of them are worried about making the decision too soon.  They will make up their minds and steel their resolve only to wake up the next day and find that their pet is having a “good” day.  They desperately wish that their pet would pass peacefully in their sleep.  They contemplate what life will be without their friend.  For some, they look ahead to coming home to an empty house, with no wagging or tails or happy meows.

Owners often ask their veterinarian when and if they should put their pet to sleep.  Most of us won’t answer this question.  We know the power that our knowledge and experience wields, and we don’t ever want to have owners feel pressured into making such a crucial choice.  We don’t want them to look back on it and feel that the vet made them do it.  I know what a heavy burden this choice is, and although I will not make the decision for them, I often will counsel owners to help them know when the time has arrived.  Here is what I usually tell them:

Trust yourself.  You will know when it is time.

The main reason I will not make the choice for owners, is because I will never know their pet like they do.  They have spent years with their dog/cat, and know their personality.  They know when they are happy, upset, angry, jealous, afraid and sad.  I also honestly believe that dogs and cats will “tell” their owners when it is time.  It is a look they have in their eyes, or a certain energy that they give off.  Through the years I have had many people tell me that they woke up one day and their pet looked at them and told them that it was time.  I tell owners to trust themselves because their instincts are almost always right.

Make a list of what defines a good quality of life for your companion animal

Decide what makes your dog or cat who they are.  What is it that they enjoy most in life?  Contemplate this, and write it all down.  Do they absolutely LOVE to eat?  Write that down.  Chase a ball?  Put that on the list.  Sleep in the sun…go to the lake…jump on your bed at night…put them all on the list.  For example, if I was making this list for my cat, Tommy, I would write the following:

 Eat.  Have his chin scratched.  Sleep in the sun.  Torment the other cats.  Chase fuzzy mice. Ruin toilet paper rolls.  Demand his food LOUDLY at 530 every morning.

Once you have your list, use it to keep track of your animal’s quality of life.  When you see things on the list disappearing, cross them off.  This can help you in the decision making process.  If you need guidance with this, ask your veterinarian.  We will always help you evaluate your animal’s quality of life.

There will be good days, there will be bad days

Aging animals, and animals suffering from terminal illness will have waxing and waning health.  There will be days where they act like the puppy or kitten they once were, and days that it is obvious they are in pain.  It is very common that when you have decided to euthanize that your animal will have a “good” day.  When this happens, ask yourself if one good day outnumbers the bad days.  Consult  your quality of life list.  If your pet has one good day after a week of bad days, ask yourself how you really feel your pet is doing.  Remember that dogs and cats live utterly in the moment.  Unlike us, they don’t contemplate having another day, week or month of life.  They know what is happening right now.  If they are in pain, and their now moments are bad, the kindest gift you can give them is to relieve their suffering.

Remember that animals don’t always show us when they are in pain

A few months ago I saw an 18 year old cat.  She had not been eating or really drinking, or moving for about a week.  I diagnosed her with end stage kidney failure, and discussed the options with the owner.  At that point it was to hospitilize her, knowing the prognosis was grave, or to put her to sleep.  The owner was shocked I brought up the option of euthanasia.  “But she’s not in pain,” she said “She is not crying or meowing.”

Animals usually don’t cry, whimper or vocalize, even if they are in immense pain.  It is in their nature to hide signs of illness and discomfort to the very end.  It is a protective mechanism…in the wild it is the animals that are obviously suffering that are easily spotted by predators.  Animals that are in pain will do other things, like stop eating, become lethargic, vomit, drool, stop drinking, and stop doing other things on their quality of life list.

Remember that we veterinarians are solemn and serious about euthanizing animals.  We never treat this lightly.  If your veterinarian tells you that your animal is in a great deal of pain, trust them.  This is as close as we often will come to telling you directly that the time has come to euthanize.  We would never exaggerate or be dishonest about this.

Involve the entire family in the decision making process

Some of the most stressful euthanasias I have participated in where those where there were family members that disagreed with the timing or were left out of the loop entirely.  Come together as a family, and discuss your pet’s quality of life.  Unless your children are very young, I would recommend involving them as well.  If you have a family member in complete denial, schedule an appointment with your vet to discuss quality of life.  I do not recommend simply euthanizing the animal behind their back.  Everyone needs their chance to say goodbye and you don’t want anger and resentment to be present during the grieving process.

It is rare that you will make the decision too soon

In my eight years of being a veterinarian, I have had one owner tell me she felt she euthanized her cat too soon.  She really didn’t…the cat was comatose and non responsive.  Her feelings came from the immense grief she went through after losing her companion.  Other than that, I have never had an owner tell me that they made the decision too early.  On the other hand, I have had several owners tell me they waited too long to euthanize.  Once their animal dies a painless, peaceful death and their suffering is ended, the owner will look back on it and feel that they let it go on too long.

Even in these cases, I try to ease the owner’s guilt.  This is a really, really hard decision.  You are making a conscious choice to end the life of a companion you love.  It shouldn’t come too easily.

I hope some of those suggestions help.  There are numerous other resources that your veterinarian can provide to help you through this process.  Don’t be afraid to ask for guidance.  We will answer any questions you have about the euthanasia process.  Bear in mind that by choosing to euthanize your pet, you are granting them one last loving gift of a dignified, peaceful death.  It is heartbreaking and gut wrenching, and one last way to thank them for their years of companionship.

 

 

 

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Communicating with the crazies

Good communication skills are essential for a veterinarian. If you cannot communicate with owners about their animals, it doesn’t matter if you are a kick-ass surgeon or an internal medicine whiz…they won’t like you. In fact, they may even label you as a “bad” veterinarian. The reverse is also true…you may be the world’s worst surgeon, and may treat every ailment with a shot of Depo, but if you are a good talker, many clients will label you as a “good” or even “awesome” veterinarian.

I cringe and generally want to punch something when I hear people say “Oh, I always wanted to be a vet because you don’t have to work with people!” Sometimes I think that I actually deal more with people than certain human doctors do. I mean, if a client calls wanting to talk to me, if I am not busy I will get on the phone and chat with them. I don’t know many human doctors that would do that.

As a vet, I have to be able to extract an accurate history from an owner, explain to them my exam findings, get them on board with necessary diagnostics and explain the treatment plan. This can be extremely challenging at times. The following incident happened to me about six months after vet school, and taught me a very valuable lesson in communicating with a client.

It was a fairly typical day at the clinic. I was seeing appointments and the other vet, Dr. M, who was older and wiser than me, was doing surgeries. All of a sudden an older woman, who I’ll call Mrs. Roberts, came running in with her 14 year old shih tzu, Max. He was collapsed, gasping for breath and quickly turning blue. A quick physical exam revealed a raging heart murmur and fluid in his chest. I ran Max back to the treatment room and started him on oxygen. My technician placed an IV catheter, and we took x-rays of his chest. They showed he was suffering from severe heart failure.

At that point I brought Mrs. Roberts back to the treatment area. I explained what was happening. I showed her the x-rays and pointed out Max’s enlarged heart and the fluid in his chest. I went over the options, which were to admit Max for critical care, or to consider euthanasia. I have to admit I was very proud of myself for so quickly and competently making a diagnosis, and explaining it to her in such an awesomely clear, compassionate manner.

“What is THAT?” Mrs. Roberts asked. She pointed to the oxygen mask the technician was holding on Max’s face.

“It is an oxygen mask.” I said. “He is having a hard time breathing, so we are trying to give him as much oxygen as possible.”

“TAKE IT OFF!!” She screamed. “YOU ARE POISONING HIM!”

I was fairly stunned. “Mrs. Roberts,” I said. “We are not poisoning Max…we are giving him oxygen.”

“YOU ARE POISONING HIM I KNOW HOW THE GOVERNMENT POISONS PEOPLE AND PUTS LEAD IN THE DRINKING WATER. STOP POISONINING HIM RIGHT NOW OR I WILL SUE YOU MY BROTHER IS AN ATTORNEY.”

“Mrs. Roberts, Max will die if we take away oxygen.” I said. I was shaking at this point. “If you do not wish to continue treatment, then we need to consider the option of euthanasia so that Max doesn’t suffer.”

“I am going to take him home!” Mrs. Roberts said.

I shook my head. “If you take him home without treatment he is going to die a painful, stressful death.”

Mrs. Roberts shook her finger at me. “HE NEEDS TO DIE A PAINFUL DEATH TO GET TO HEAVEN!”

I was lost at this point, and getting angry. “What are you talking about?” I asked.

“I AM CATHOLIC. HE NEEDS TO SUFFER BEFORE HE DIES OR ELSE HE WON’T GO TO HEAVEN. GIVE HIM TO ME NOW SO THAT I CAN TAKE HIM HOME!!!”

At this point in the conversation I was very angry. I should have recognized that the client had jumped on board the crazy train. I should have taken deep breaths, given myself a second, and tried a different approach. Instead, I jumped on the crazy train with her.

“Do you know Saint Francis of Assisi?” I asked. I was referring to the patron saint of animals.

“YES.” Mrs. Roberts said.’

“Well, he would say it was BAD for an animal to suffer. He believed strongly in euthanasia.” I said. Of course, I had no idea if that was true, but it sounded good.

“How do you know he said that?” she asked, glaring at me.

“BECAUSE I TALK TO HIM AND HE TELLS ME THOSE THINGS!” I yelled at her. “HE WANTS YOU TO EITHER TREAT MAX OR END HIS SUFFERING!”

“HE DOESN’T TALK TO YOU, HE ONLY TALKS TO GOOD CATHOLICS!” she said.

“I TALK TO ST. FRANCIS ALL THE TIME!” I yelled.

At this point, the technician very wisely left and got Dr. M. I have a feeling she told him that his new, bright young veterinarian was arguing with a crazy woman about who really talked to a dead saint.

Dr. M walked into the room. He was the calm in the midst of Hurricane Insanity. He quietly told Mrs. Roberts that he understood that she was upset. He said he was sorry that Max was ill. He said that we either needed to treat him, or end his pain.

Mrs. Roberts at this point started to cry. She hugged Max and tearfully agreed to euthanize him. Dr. M. quietly walked her through the procedure, and ended Max’s suffering. There was no more mention of St. Francis.

I had definitely failed to communicate with her. I made an accurate diagnosis, and made very appropriate recommendations, but in the end my lack of compassion and sympathy unhinged the whole conversation. I allowed myself to get angry and irrational, instead of asking myself how this poor woman was feeling in the situation. Her dog went from being happy to dying in the course of a day, and here this young cocky vet was demanding that she make a decision NOW. I was more intent on being “right” and getting her to listen then I was on truly helping her make a good decision about Max.

Yes, Mrs. Roberts was crazy and yes she was being a wee bit irrational, but I reacted in a manner that made it much worse. I learned that day how important it is to stay calm no matter how the client is reacting, and to NOT join them in their craziness. I also learned to try to keep compassion and understanding at the forefront of all of my client interactions.

This is certainly not easy. There are certain clients that can be downright hostile, mean, abusive, non-compliant, rude and sometimes psychotic. I have had clients tell me that they don’t “trust lady doctors” or that I “don’t look like I know what I’m doing.” I have acquired a pretty darn good poker face, where I can smile and nod and NOT say the things I really, really wish I could say.

Now, as a side note to the Mrs. Roberts story…as she was checking out she informed me that she became Catholic because God saved her from being stung by 1000 fire ants that came after her, from being assaulted by a gang of Hell’s Angels that went after her, and from being injured even after she fell down a flight of 100 stairs and hit her head on EVERY single one. I nodded and said she was quite the survivor. What I REALLY wanted to tell her was that she needed to talk to St. Francis more.