“The Good Death”

The weird, complicated process that is ending suffering and why it’s NOT the worst part of my job.

***Since euthanasia can be a really sad subject, the pictures in this blog are animals who were saved from euthanasia***

I was going on my usual neighborhood run with the dogs and was coming up on a neighbor’s house who had a dog that I had treated recently. In my tired, oxygen deprived brain, I was thinking – like I had been for the past several weeks – “I wonder how Axle is doing? I should call them.” Then, I remembered with a sinking sensation: “Axle is gone, stupid, you euthanized him last week.” Then, of course, I spent the last agonizing miles going through all of his labs and imaging in my brain trying to figure out what had been wrong with him and if I had missed anything or if I could have done better somehow. This all got me to thinking though about the oddity that is euthanasia and all the weird components that go into it.

Merlin was brought in for euthanasia after his mother mangled his back leg when he was 3 days old. After a leg amputation that was like surgery on a chicken wing, he grew up and lived another 8.5 years before he succumbed to his joint issues.

The most common assumption about my job that I get is that euthanasias must be the hardest part of the job. For ME, for the vast majority of the cases, euthanasias are (and you’re going to hate me for this) actually one of the easier parts of the job. You don’t have to figure anything out, I have a set way I do it EVERY time, and the only challenge is hitting a vein – which I’ve gotten pretty good at. So, between the 19 year old cat that weighs 3lbs here for euthanasia or the 8 year old english bulldog with all the skin, ear, and eye problems and the owner who refuses to keep up on treatment and wanted to know why you couldn’t just give them antibiotics every 2 weeks? I’ll take that euthanasia, thank you.

Catina was brought in for euthanasia as a feral barn kitten with two ruptured eyes from a viral infection. After months of just sitting and reading a book aloud, her anger, fear, violent hissing/biting when handled went away and she is now the sweetest cat who loves attention

So, what’s wrong with me? Am I souless? Do I not care about the love and devotion people have put into their life time companion? Why do I not break down crying and sobbing with the owners every time I have to stop an animal’s heart with an injection and wonder if, when I die I will be punished or not? So, hear me out.

Penelope was saved from death after being brought in as a frozen kitten found in a ditch. Her heart stopped during revival and had to be resuscitated. Now she’s an ungrateful spicy kitty that is well loved.
  1. The vast majority of euthanasias are a good thing. Animals who have reached their limits of life’s comfort and are mostly miserable everyday. Pets and friends who no longer want to get out of bed, can’t keep food down, get confused about where they are, are becoming skeletal despite a good appetite, have a mass that is taking over their body or has ruptured and is bleeding out. Basically, giving these pets the gift of taking away their pain is almost relieving. It is difficult for the client because they are struggling with the decision to euthanize – something we don’t have to deal with (though would like to) in the human world – and are losing their best friend. But, as an outsider, looking in, all I see is a pet that has run out of options for seeking comfort and I’m just sparing them the agonizing wait of slowly withering into nothing, starving to death, bed sores, fear and anxiety as they slowly suffocate from heart failure, daily pain that prevents them from any normal functions.
  2. Vets, especially the ones who have been practicing awhile, have established deep, dark pits of space where they take hard emotions and bury them down deep. We get all the emotions thrown at us on a daily basis – happy, sad, stress, guilt, anger, frustration, irritation, self loathing, client loathing, patient loathing, public loathing, loathing (generic), annoyance, etc, etc, and if we actually take the time out of our day to process these emotions, we would never get all the patients seen that we are required to see (not to mention the ones that get shoved in when there is no time and the ones we have to send away that hate us and write terrible things about us). Therefore, to survive as a professional and a human, who then has to have functioning relationships with real people away from work, we have gotten super good at flaring with that emotion and then shoving it down into our deep dark caves of oblivion. When you’ve dealt with all that in a day and then you have to euthanize something. This is straightforward. And….
  3. We euthanize animals ALL THE TIME. All day, everyday, with extra ones being added right before holidays for some reason. Eventually, a thick callous is formed and it just becomes another task in our day. If we’ve been working with a patient for a long time, if the need for euthanasia is sudden and traumatic, sure, it’s way harder on us emotionally, we’re not monsters.
  4. If we feel that a euthanasia is NOT warranted, we will talk to the owner and try to convince them that maybe this is a treatable or completely fabricated illness (I had one cat euthanasia on a 4 yo cat who was just prancing around the euth room, purring, rubbing my hands and the complaint was she hadn’t pooped in 4 months. I finally convinced them that if that were the case, she would be dead and that she was very likely pooping in a place they haven’t found). I have stopped euthanasia on animals that were being put down for being “miserably itchy all the time” and had no hair. Turns out, they just needed flea medication. Sometimes, medications haven’t been tried and even chronic diseased patients can get several more months of relief with the introduction of these meds. Sometimes, the owner is just not equipped to care for the patient and another owner can afford and dedicate the time to give the animal a great quality of life. But, I’ll tell you what, broaching the topic is somewhat a delicate thing as the owner has likely already been stewing over this decision and introducing even a tinge of doubt can be traumatic for the owner especially if it comes down to a money issue. At the same time, we can’t afford to rescue every animal ourselves and the animal has to be pretty “sellable” (super sweet, not a sketch ball, not super complicated) to convince other people to adopt (as bad as that sounds.)
  5. Finally, yes, euthanasias affect us. We are not monsters. I can walk into a room, connect with the owners and feel their sadness, feel their depression and their guilt. I make it my priority (after confirming that the animal needs to be euthanized) to make the owner not feel guilt or regret. I talk to them and console and re and reaffirm that this IS the BEST decision they could be making and that it is the RIGHT decision. My job is to the client at this point and once they have rightfully decided to end a patient’s suffering, they need to know that a professional in this field 100% agrees with them. But the WORST euthanasias, by far, besides the obvious when you have worked with a patient for a long time and know the animal and the owner and their full life story, is when there is either an old man, a hardened Clint Eastwood type man, or children in the room. I have a very hard time when that old, withered man who looks like he hasn’t cried since he was a toddler and is ashamed of even that time, has big fat tears welling up and he doesn’t want you to see him. It’s okay, you can cry, I won’t tell anyone. Or children when they seemingly understand what’s going on and then once I say the patient has passed then they get a wild, panicked look in their eyes and ask “You mean he’s DEAD!?!” and then burst into tears or screaming.
Wicket was saved from euthanasia after she was born with no bones in her front legs.

Euthanasia is easily the saddest part of the human/animal bond. Whether it’s saying goodbye to a best friend you’ve had since you were a child, or the only thing left you have to link you to your husband who died last year, or even in an unexpected emergency, it’s never any easier, but it is also a sense of relief. Our job as veterinarians is to make sure you make the best decision for the animal and make sure you feel okay with it. When it’s clear cut, nothing could be easier for me than to decide to end the suffering of the animal and to be it’s advocate when the owner’s mind and heart are understandably muddled with emotion.

Heggie – saved from euthanasia and rehomed with a clinic employee.

That all being said, it still sucks.

Anything but bad luck for Dan, the office cat. Saved from euthanasia after being hit by a car and left at the clinic with a broken tail and jaw. Now demands attention (and food) all day from employees and clients alike.

Goodbye to Merlin (Merman, Schmermles, Myrtle, Schmermilator) and I love you

Merlin on a short hike at Island Park in Mount Pleasant, MI

I never in my life thought about owning a Saint Bernard. They just weren’t on my radar, just like Michigan was never there for me to live.

Getting to be an old man in Virginia

One day, while working at my first job in South Carolina, a local dairy farmer brought in a new born puppy. She owned a dairy and had a very small Saint Bernard breeding kennel on the side. Her bitch had just whelped and had killed all but two of the puppies and had mangled one of those puppies’ back legs. At first, it appeared as just a puncture on the out side of the hind leg. We cleaned it and sent home antibiotics.

3 days old

The next day, the farmer brought the puppy back in. The leg wound was now bigger, draining pus, and the foot was stiff and cold. We gave the puppy a guarded to poor prognosis with infection set in and a dead leg in a newborn, frail baby. The farmer, with all of her responsibilities as a dairy woman, did not have the time to dedicate to this sickly puppy. She decided it would be best for him to euthanize as he was not getting better.

10 days old

I looked down at this beautiful, perfect except for a mangled rear leg, and could not picture myself sticking his tiny heart with a needle and then tossing him in the freezer where we kept dead animals. Now, at this point, I was just exiting my first trimester of my very first pregnancy (with India). We had just moved to this town, not 5 months ago, we were renting, and already had 2 dogs, 2 cats, and 2 horses. I was absolutely not in the right place to even think about taking on a new dog, let alone one that would need intensive care for 5 weeks and would grow to over 100lb. I talked it over with my best friend working there with me, Kim, and she encouraged me to take on this (currently) 1lb project.

4 weeks old

I talked to the farmer about surrendering him and letting us try to amputate the leg and save him. She was in tears. She was a tough woman, running a dairy farm, but she had a fantastic heart. She was so upset that she was going to put him to sleep, but was thankful that we would at least give him a chance. I had him signed over and was now the owner of a very sickly infant St. Bernard. What had I done? What was Tony going to say when I came home? I knew he would understand. He knows who he married, but he would likely shake his head a little.

4 weeks

I brought him home, honestly under the impression that even if he survived to, and then through surgery, that he would likely die sometime after from infection, or fading puppy syndrome. I had 0-0.5 hope of his survival (#naturalpessimist), but I had to try.

5 weeks
6 weeks

The next day, we were to do the surgery. I had to meet my boss at a dairy to continue to learn how to efficiently palpate cattle for pregnancy. I went over and over the surgery in my head. Finally, we were done palpating cows and I would drive to the clinic to cut on this three day old puppy. We put him under with just some valium and then masked with gas. There were three people gathered around this 1 lb patient. Kim, our assistant, the other Dr. at the clinic running/monitoring anesthesia, and me, carving on what felt like a chicken wing from KFC. I dissected down to the femur, at some point severing the femoral artery that was so small, it never bled. I used a heavy pair of surgical scissors called Mayo scissors to score a shallow cut around the bone, like a glass cutter, then the bone broke easily in half.

8 weeks and type of bottle we had used to feed him, but this particular bottle was for a baby goat

I, then filed the end of the bone so it wouldn’t be rough on the muscles, closed the muscles around the tip of the bone, and finally, closed the skin over the muscle. Whew! We were done! We took him off of gas, and put him on oxygen only and waited for him to wake up. And we waited. And waited. He wasn’t waking up. That’s it, I knew this was stupid, but at least we tried, right? Then, the doctor helping me got some injectable dextrose and just put a couple of drops in his mouth. He woke up! Thankfully, she was able to keep her calm and remembered that neonatal patients will get hypoglycemic under anesthesia.

We took the puppy home, now named “Doomed puppy” because of my pessimism and superstition all rolled into one. We had to bottle feed him. The little bottle that came with the formula had a nipple that was way too small for his mouth. We ended up having to get a soda bottle and put the smallest goat nipple we could find on it. We also had to stimulate him to pee and poop until he was a certain age. He slept in a cardboard box on a heating pad in our bathroom for the first few days of his life and came with me everyday to work. We had to set alarms to get up every few hours to feed him.

10 weeks

One weekend we were travelling back to Georgia to announce my pregnancy to the families. We would take our dogs with us when we travelled and had the two big dogs in the backseat with the box of puppy in the back as well. He was about 2lbs at this point. Along the way, we stopped at Subway to get dinner but didn’t want to leave the puppy in the car alone with the two dog aggressive dogs, so I picked him up and placed him in an inside pocket in my coat and carried him inside. The workers there never knew I had a Saint Bernard in my coat pocket.

12 weeks

Eventually, we settled on a name “Merlin” and he continued to live in our bathroom, he particularly loved the bath tub. Every night, when it was bed time, he would just shuffle into the bathroom and lop himself into the bathtub to sleep. Having only had three legs his whole life, we always just figured that he would have no trouble learning to walk with three legs. Just like four-legged dogs who get an amputation later in life seem to do just fine, and to “not miss a step,” we thought that he would have even less trouble learning the ways. We were wrong.

13 weeks

Having basically been born with just the three legs and having never learned to walk properly, he would just scramble. He would pull his body along with his front legs and kind of paddle with his one hind leg. Thanks to the advice from my friend, Kim, we sought a Veterinary specialist in rehabilitation in Columbia, SC. She was able to make some chiropractic adjustments, and fit him for a cart for us to borrow. He hated that cart. We would harness him up and he would freak out and run around the room, getting caught on furniture and knocking over everything. We were finally able to harness him up and take him on walks in the neighborhood. It took a lot of practice, and he grew quickly and eventually had to return the cart, but by then, he had learned better how to get up on that back leg.

4 months
1 year – India also pictured at 9 months

He eventually got along on that back leg like it was nothing. We couldn’t take him on long hikes and I could only take him on a 1 mile “warm up walk” before my run so that he got to feel like he was part of the pack too, but he also loved to play tug-of-war – which is typically not recommended for pets because it can make them think everything is a game when you’re trying to take things from them – but this was his main method of exercising, and I could just tell him to drop it and it was over.

He loved vegetables, fruit, tissues, and baby socks. He would wait in the kitchen while I cooked, waiting eagerly for kale stems, carrot ends, strawberry leaves; would follow the kids around or sit next to me while strings of drool hung at his lips if we dared to eat an apple around him. He EXPECTED the core. He would run outside and help the horses eat watermelon rinds or try to find the scattered sweet potato skins I had just thrown out for the deer. If you left a paper towel or tissue within reach, he would stalk it because he knew he would get into trouble for eating it and the moment we weren’t paying attention, he would suck that thing down like it was a piece of cotton candy. Even when the kids were babies and we were in a complete state of chaos, if we forgot to close the baby wipes when we were done, you would catch him sucking each one down as it pulled up the next – like his own tissue Pez dispenser. His love of baby/kids socks got him in trouble too. We would constantly have to go out and buy more to make up for his dietary needs. Our kids were so trained not to leave their socks on the floor downstairs that if we went and visited another person’s house, our kids would come up to us and ask us where they could safely put their socks. Between the tissue diet and socks he consumed, once spring rolled around and we mowed the lawn for the first time the mower would spray our yard with confetti of tissue pieces and colorful sock remnants.

4 years – stealing my spot

As Merlin got older, he would go through phases where he couldn’t walk as well anymore. Most of the time, he responded to pain medication, time, or a chiropractor adjustment. I took an x-ray of his hips to see the horror that I was afraid of. His only hind leg he had was suffering from horrible hip dysplasia. I knew, even though we were very diligent about keeping his weight down, at 120lb, it was still only a matter of time before he completely tore his cruciate ligaments in his only knee and then it would be done. He was definitely MY dog. Tony would tell me that if I wasn’t home, Merlin would just lay in the corner of the dining room all day, not moving even to go outside. He did NOT appreciate the kids and as he got older, he only became more cranky with them, especially when they got crazy silly.

The circled joint is supposed to be a ball and socket joint – you see no ball or socket
Selfies

This past fall, he started having trouble walking again. We knew, at almost 9 years old, anytime could be his last. He was no longer getting up on his back leg anymore and would just scramble along the wooden floors. We would assist him outside and, at first, he would get up on the leg to go to the bathroom. We had him on three different pain medications, joint supplements he had been on his whole life plus a few more, got him some fancy Dr. Buzby’s toe grips, a Help ’em up harness, but still he dragged that stump around. Eventually, he stopped eating as much and the stump became raw and bloody. We had smears of bloody trails across our floors where he had needed to be with me. I altered his harness to pad the stump, but it wouldn’t stay where it needed to. I brought home an “After surgery wear” from work and altered that to pad his stump. That seemed to work better.

After surgery wear – so handsome!

I had been avoiding it. I was in denial. When he would use every last bit of energy in his painful body to get to where ever I was in the house, I just knew he depended on me, how could I let him down? But finally, I stayed outside to watch him go to the bathroom, because now he was soaking his after-surgery wear every time he peed. To my horror, and with tears running down my face, I saw him drag himself to a spot and just sit and pee all over himself. Then, he dragged himself to another spot and pooped while sitting, only swinging his rear away to keep the poop from sticking to him. I knew it was time.

The final day, he was so excited to get to go in the car with us, as that was a rare occurrence for him. We were feeding him Milkbones like he was starving and he just thought that was the best. My mother even met us at the clinic and brought him a porkchop wrapped in a paper towel. He chomped that down too, paper towel and all. He was just having the best day! Of course, it took me and Tony to get him out of the car and into the clinic to our euthanasia room. He required a sling to hold his hind end up. But he just dragged us in, found the few people working after-hours, his tail just flagging like the happiest pup. We finally got him to the euth room and he stumbled and collapsed on the floor. Tired, from all his happiness. I gave him the sedation, then cuddled his giant bear head in my lap as the final injection was given. He was only 3 days old when I decided it wasn’t his time to go to the freezer and even though I had given him 3,200 more days of pure love, it still felt like I had abandoned him as we gently lowered his body, finally, into the freezer.

My last picture with my Mer-man – he looks so tired

Bye buddy.

In his element