Facing difficult end-of-life decisions with acceptance and grace
When people find out I’m a veterinarian, some eagerly tell me that they shared my career dream but what held them back was the thought of seeing animals suffer or having to put them to sleep.
I’ll admit that when I think back to the day that I held my acceptance letter from the Ontario Veterinary College in my hands, those things were almost the furthest from my mind. I envisioned examining and vaccinating new puppies and kittens, imagined exciting and challenging surgeries, looked forward to watching my patients grow and thrive.
Please don’t think that I was naive to the demands of my profession. Having both volunteered and worked in a veterinary clinic prior to my OVC admission, I knew the challenges that would lie ahead. I knew euthanasia was something I’d have to do, and I assumed (perhaps here comes the naivety) that I would be taught to know when and how to do so with compassion and professionalism.
Fast-forward 12 years...
Resting at my feet is my ever-faithful English Bulldog, Emma. Princess Emma, as I like to call her. “E” to my husband. “Emmie-Bear” to my sister. My son’s first word was Emma, although I pretended to hear Mama. It sounds so similar after all. As you read this, imagine me writing this story with Emma’s rhythmic snore in the background.
My friends can’t believe we can sleep through that sound, but to me (and even to my husband, though he won’t admit it), the snoring is soothing and reassuring.
I remember the day we brought her home. I was in my first year of veterinary school and, in the midst of my finals, my husband John and I had to find a new place to live as our landlord would not allow us to have a dog in our small basement rental.
I remember the day we brought her home. I was in my first year of veterinary school and, in the midst of my finals, my husband John and I had to find a new place to live as our landlord would not allow us to have a dog in our small basement rental.
Our parents thought we were crazy, and maybe we were but we quickly found a new place to live and welcomed our beautiful, wrinkly, snorting (and sometimes stinky!) Bulldog into our home and hearts.
After surviving the challenges of puppyhood, it’s amazing how soon your forget it all. I’ve almost forgotten about the beautiful pair of boots that she destroyed, the remote control she chewed (after an urgent trip to the after-hours Emergency, we thankfully discovered the batteries had not been consumed along with it!), the many bottles of carpet cleaner we went through… all worth it in the end.
As they say, the years go by quickly. At her eighth birthday, we began discussing how lucky we were that she remained in good health. In case you are not aware, English Bulldogs are not known for their health and longevity—the average lifespan is eight to ten years. By then, Emma was already showing signs of arthritis and was taking a nutritional supplement as well as an anti-inflammatory to help her mobility.
By ten years of age, she was taking an additional two pain medications, and we lowered our bed so that she could have an easier time getting in and out. At age 11, she found herself not only dealing with a new puppy (a wiggly and neurotic French Bulldog named Oliver Frances), but being awoken from her slumber by a crying and demanding newborn baby. When I was feeding my son, Emma would sit at my feet in the nursery while I rocked him back to sleep. She took these changes in stride and has learned to tolerate (if not love) her new housemates. The dog who used to avoid children at all cost will now toddle over to lick my son on the face or see if the object he is holding in his hand might just be a tasty treat.
More recently, I lost my dad to cancer. I was fortunate to have been able to be the care provider for my dad during his palliative stage, and he passed away in my arms while Emma snored away on the floor below. My dad, like many cancer patients, suffered greatly in the weeks to months prior to his death. Looking back to when I brought Emma to meet mom and dad for the first time—my wrinkly, wiggly bundle of joy—I never dreamt that I’d say goodbye to my dad before her.
But from this experience, I’ve recognized something that brings me comfort when I think about saying goodbye to my Emma: the knowledge that I can give her a beautiful and peaceful gift when her time comes. I can let her go in peace, surrounded by those who love her, instead of watching her deteriorate and even suffer. I tried my very best to make my dad comfortable—I diligently gave him pain injections, wiped his face, wet his dry mouth—but I know he suffered. I don’t want Emma to suffer like that.
Emma’s comfort and happiness is what my husband and I wish most for her. As a veterinarian, I try to educate my clients so that they can also make informed decisions as to their pets’ wellbeing. Having to coach a family about making the decision to euthanize is hard—harder than the euthanasia itself.
Everyone has different beliefs; euthanasia is not accepted in all faiths and many people have a very difficult ethical struggle about end of life.
I can’t speak for what is right and wrong for everyone, only for what I believe and practice in my daily life. I don’t judge my clients (or anyone else) as they make their journey through this emotional process. Sometimes the decision is easy, such as when a patient has refractory disease or illness, and often the more visible problems (for example, a large tumor on a leg of a dog, or a cat in renal failure struggling to eat and maintain weight and hydration) make it easier. The hardest is when the decision is a bit of an ‘unknown,’ which is often the case with a senior pet that is declining but may not be ‘sick.’
Thus is the case in question, my Emma. At 12 (almost 12 and a half now), her hearing is going, she sleeps more than she ever did (which is a lot for a Bulldog!), and, most notably, she has difficulty with arthritis. She limps every day—despite her medications and treatments. And as a veterinarian, I know that she limps because something hurts.
For Emma, the sore spots are her hips and elbows. My husband and I carry her up and down stairs and help her into bed at night. We keep a diligent watch on our son so that he doesn’t accidentally grab her near any of her sore spots. My husband jokes that it takes more time to make her dinner than ours—we faithfully mix in two joint supplements and four different types of pain medications twice daily. She has received laser therapy, acupuncture, and even stem cell therapy. If a cart would help her she’d have one, but unfortunately her arthritis is widespread and a cart or brace would not solve her discomfort.
Initially, neither John nor I wanted to say the word euthanasia. But it’s inevitable. It’s coming. And I have shed a lot of tears thinking about it. But her time hasn’t come yet. She still greets us at the door (not every time, but some of the time). She still loves a good bum scratch. She loves her Kongs and Timbits. She loves to stretch out on the grass in the sunshine. She occasionally loves her little fur brother Oliver and will still initiate play with him. She gets very excited to see my mom when she visits. She still puts other dogs in their place. She seems to have some affection for my son, which is saying a lot for a dog that was never properly socialized with children. It is these types of things that give her happiness. She hasn’t been able to jog around the block for years but that’s ok for a dog like Emma. It is these types of behaviours and habits that I suggest pet owners watch for. Any absence of or change in normal behaviours that indicate your dog is happy and comfortable will help you to decide when that time is approaching. If Emma ever refuses a Kong, I believe our decision is made for us. \
As I’m sure you can imagine Emma has helped me in more ways than I can count during my life and career. In a way she is my muse. It is through learning how to keep her as comfortable and healthy as possible that I have discovered my passion for analgesia (pain control) for pets. I’m currently working towards my CVPP designation—Certified Veterinary Pain Practitioner. Emma has enriched my life, both professionally and personally. She has been the best companion and I absolutely adore her. When her time comes we will miss her terribly and I often tell my little Frenchie that he has big paws to fill.
As I finish writing this, Emma is still at my feet (although she’s now happily chomping away on a cheese-stuffed Kong). It’s not her time today and hopefully not tomorrow or next week. John and I notice her really good days and take note of her not so good ones. I spent a fantastic day this past winter with her and a very talented local photographer, Ilona from Scruffy Dog Photography, for what Ilona calls an “honour session.” We captured Emma’s personality and “adore-abullness” and I had a blast hiking with Emma along the trails.
I carried her when she needed it, and gave her extra pain medication to help her through her adventurous trek. I’ve been sneaking her some extra Kongs, a few more Timbits (much to Dr. Flemings' colleauge, Dr. Rob Butler's dismay), and doing my best to let her know that she is the most wonderful companion that we could ever have been lucky enough to share our lives with. And when her time comes, I will be the one who helps her find the rainbow bridge, because I owe her that much for all that she has given to me.
http://moderndogmagazine.com/articles/knowing-when-its-time-say-goodbye-beloved-dog/91736
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