One of the hardest things about my job is knowing when to tell a client to stop hoping. It goes against my spirit and entire operating base, and besides, I simply hate telling anybody something they don’t want to hear.
About 24 years ago, I solemnly swore in the Veterinarian’s Oath to use my knowledge and skills to prevent and relieve animal suffering. Preparing for this article, I looked at that concise and eloquent vow for the first time since then and marveled at the pride and inspiration I felt. I am grateful to those whose words uplift and carry me when I trudge through the dark veterinary valleys for which there are no dress rehearsals.
A Friend’s Tale
An old friend wrote to me that her geriatric dog died. The patient had been on prednisone and was diagnosed with Cushing’s disease. Around that time, he started on ursodiol for liver nodules, which a referral veterinarian discovered on ultrasound. One of the veterinarians prescribed trilostane for the hyperadrenocorticism and substituted cyclosporine for the prednisone.
“He developed a slight fever, so the vet gave him an antibiotic shot,” wrote my friend. “By this point, he was supposed to take 15 pills a day, so we worked out a priority list so I could give him the most important pills first since sometimes I could only get two or three (if any) down him.”
The dog was barely eating and was ultimately hospitalized for hypoalbuminemia.
“Over the next few days,” the letter continued, “they kept him fed and nourished via a tube through his nose and stabilized blood pressure with a machine. He was mostly lethargic and didn’t react much when I visited him every day.”
I must stop here because my heart goes out to my friend, my loyalty lies with my profession, and I was miles away when all this went down. The intersection between animal advocacy, client compassion and common sense is tricky to navigate, but we all face it. Knowing when to call it quits is personal to each veterinarian.
No More Suffering
A petite, elfin lady sat on the floor of our hospital, cradling her moaning pit bulldog’s head on her lap. Everyone was splitting for the clinic’s much-anticipated lunchtime, but a couple of staff members hung back with me. The patient had come in the day before during the other work shift, but I had been briefed on the case.
The story was a couple of strange dogs had come onto the client’s property and knocked the living daylights out of her dog. She didn’t have much money and was trying to come up with more. Meanwhile, her dog’s hind leg was so deeply savaged at the medial coxofemoral junction that it looked and smelled like rotten meat.
Despite a fentanyl patch, carprofen and buprenorphine (while waiting for the fentanyl to kick in), the dog was in agony.
“Tell me what happened,” I gently said as I knelt beside them. The client described the horrible ordeal.
I told her the dog was suffering greatly and that its rehabilitation would be long, expensive and uncertain. I said her dog might lose the leg. I told her the kindest thing to do would be to end his pain. Then, I stepped away so she could consider my words.
When I returned, she had decided that euthanasia would be best. Her face was the picture of pure agony. As I sent her pit bulldog to the Rainbow Bridge, I told her I could imagine her dog’s relief at being able to fly free. She thanked me, and I thought about the power of my words and the responsibility I feel as a veterinarian to be strong, true and supportive of my clients.
No-Go
In another instance, I was scanning the short computer medical record of an elderly pug that arrived in a wagon pulled by a client. I could tell the patient’s veterinary visits had been seldom. After taking a history and determining the need for bloodwork and a urinalysis, I diagnosed the pug with diabetic ketoacidosis and began the arduous task of explaining the condition and making an estimate for hospitalization and treatment.
I printed two lengthy handouts as props, but the client was uncomprehending. He said the dog was still drinking water and, therefore, wasn’t dehydrated and didn’t need IV fluids. He tried hard to simplify the problem and wanted an easy fix. He swore that the dog was his world and that he wanted to do anything for her, yet he couldn’t afford hospitalization. Scratchpay and CareCredit apparently weren’t options.
He left with a bottle of insulin and instructions to return the ailing pug for a recheck. Exasperated, I watched them go and choked back indignation at what I considered to be his stubborn denial of reality and rejection of my expertise.
A Change of Heart
A couple of weeks later in the lobby, I was surprised to notice the man with the pug in the wagon. A different veterinarian saw them that day, and my caseload diverted my attention. I fleetingly wondered how the dog had endured, then figured maybe my dire predictions didn’t come true and that she was maintaining a simple program of twice-daily Vetsulin insulin.
Some two weeks later, the client, pug and wagon were back as I drew the check-in sheet from a box. The patient was failing. She was lethargic and inappetant. Bloodwork showed the pug was in renal failure.
Burying my scorn as deeply as possible, I adjusted my attitude to soft directness and gave the news straight to the client. I told him his dog was suffering and that it was time to let her go. He pleaded with me to give her an antibiotic injection, but I told him it was not going to cure her. I told him we needed to euthanize her. He finally relented, and we went through with it. I left the room and waited for him to finish paying his respects.
On impulse, I returned a few moments later. “I know your heart is breaking, but you did that for her,” I said, knowing he had lost a major piece of his heart.
As I emerged from the exam room for the second time, one of my colleagues looked at me quizzically.
“That dog was his world,” I said with a shrug.
“You always go the extra mile,” she responded, and with that, she paid me the highest possible compliment.
Closer to Home
Sometimes, in my determination to do everything possible for an end-stage patient, I have to slow down and consider the reality. Whether from disease or old age, bodies wear out. Would I want my dog or cat to spend their final hours on artificial life support surrounded by strangers? The answer is absolutely not. Somebody’s got to say it, and sometimes that’s me.
One day, three different clients thanked me for euthanizing their animals. Then, a few months ago, I walked in their shoes as I held my dog, Gus, and released him to my higher power.
I practiced what I preach. I cried my eyes out that day, and I still have the napkin I used to wipe the drool from Gus’s muzzle as I drove him to the clinic. His life mattered to me, just as a hundred clients’ pets matter to them. I never forget that.
DID YOU KNOW?
The American Veterinary Medical Association’s House of Delegates adopted the Veterinarian’s Oath in 1954. A 2010 revision emphasized animal welfare. That section now reads, “I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.”