"What is life worth without trials and tribulations which are the salt of life." M. Gandhi
Tragedies happen every day. Certainly in veterinary medicine they are never in short supply. Where there is life there is death and swirling in between these is the cosmic array of every imaginable scenario. Between the ends of this pendulum is marked as much by luck as it is by foresightedness and preparation. Where to go when destiny is undetermined and fate seems close at hand is where tragedy can land you into utter sheer dismay. It is the place that I fear veterinary medicine fails our patients most often.
This is Murray. He died last week. He was in hospice care with my sister for a year. His original family brought him to us a year ago to be euthanized. He had a bladder tumor that made it hard for him to urinate voluntarily; therefore, he needed a diaper and belly band 24/7. His family thought that his life, the quality of his life, was over. They also didn't want to manage a dog in a diaper. My sister saw in him a flicker of the dog she lost a few years ago. That dog Daisy, was her dearest friend and she knew helping Murray was a way to keep Daisy alive a little longer. They needed each other.
Some of the most disheartening tragedies I see happen when clients get overwhelmed, confused, lost and left without guidance about what to do for their companion who lacks a living will and end of life instructions. The AVMA (American Veterinary Medical Association) provides guidelines to help pet parents through the difficult waters of making end of life decisions. The old version, although intended to provide simple assistance in the most dire hours of indecision, reduced the verdict to pennies allocated to labeled "Good Day" versus "Bad Day" jars. In the most inane, coldhearted binary method clients were suggested to make the decision to say goodbye to their pet based on which jar had the most pennies. Reducing a life to a scale based on a spate of pennies is not befitting of decision of this magnitude. Our clients deserve more than a "good/yes" or a "bad/no." We have come a long way from the days when we didn't even admit pets could feel pain. We are now more broadly focused on providing care without discriminating and dismissing that our pets are sentient beings. Like all beings who can think, feel, and love we are providing less black and white suggestions to make the grey area of end of life more empathetic. It is long over due and we still, as a profession, look at euthanasia as a too often routine procedure that denies a pet their true measure of worth in our lives. The new 2016 AAHA/IAAHPC End-of-Life Care Guidelines is far better at assisting in understanding what end of life options there are and how critical an unbiased compassionate team effort is needed to provide all options with maintenance of patient care at the forefront even in the last moments of a waning story.
We too often promote euthanasia without providing options, assistance, and empathy. Why do we offer every single line item on the robust complete treatment estimate to provide optimal chance of recovery for a disease and not do the same for end of life care? How many veterinarians, specifically, house-call-euthanasia veterinarians, one time ER visits, and the GP who has never seen the pet before, are sought to provide hospice care instead of a last treatment option syringe, in whatever time frame and capacity the situation dictates? I don't know of one. Worse yet, I don't know of any of these euthanasia-on-demand-vets who calls for a referral of the patients record before they deliver that final act. Shouldn't this be common practice? If it isn't is it because we are more concerned about how our clients view our services than whether our services are placing patient care first?
|There is adventure left to be discovered|
I think we short change pets in almost every facet of their lives. It is getting better. We, the veterinary community, are openly admonishing and endorsing the benefits of companion animals to our overall well-being. Perhaps simply motivated by the robust spending pet parents never seem to hold back from? Perhaps because we are moving away from our utilitarian view of pet care? Or, perhaps because we are finally admitting to also snuggling with our pets in our beds and not denying that it isn't inappropriate. Too often death is simply another example. Great leaders and spokespersons of our profession write long diatribes about the merciful end we provide and the gratitude that we garner from not prolonging their suffering. The one sentiment that breaks my heart more than any other is the over played "I'm so glad I didn't wait any longer. I waited too long last time. This time my pet died with dignity." It strikes me to the core because we have options for this suffering beyond the sleep of that pink syringe. We sacrifice and surrender grace, beauty, and sympathy in being a part of dying. When we deny ourselves AND our pets those last few days we negate the ability to see the full circle of what life's meaning holds. Life is not about making it easier. It is about understanding, accepting and rejoicing in the spectrum. Mercy,, well mercy, is the surrendering of self when the force of power will yield its hand regardless.
I have learned this lesson time and time again. It has brought me both pain and chastising. It has also brought me closer to the belief that we all share the same path. We all want to live surrounded by those we love, with free choice, driven by basic survival until those most basic needs are met and we can open ourselves to affection and purpose for others.
We try to cheat what is inevitable because we fear pain and suffering. Perhaps we are simply denying an emotion so profound it mirrors love and lust in its most primitive and intoxicating moments? Perhaps we are too selfish to make time for the inconveniences that end of life bring us? Why do we so willingly provide pee pads and clean ups to the not-quite-housebroken puppies, but refuse to tolerate diapers on our geriatrics? Why when life is fresh and young do we tolerate the same inconveniences that the end of life brings?
Where do we think we safeguard the sympathy as we sacrifice the compassion?
|The dealer holds all the cards|
As the sands of time slow to a trickle of grains left in the hour glass it is too often over looked as "inconvenient" for us, and "prolonging suffering" for our pets. I just don't see it as either. If you can find the time to slow yourself, and your life down, to a place where the grains of sand are not within your realm of reality you can transcend to a place where the true beauty of life resides. There is grace and peace within the last few moments of a life drifting to its close. In this tiny wrinkle of the reality of bustling day-to-day life, the stress of work, the pressure to maintain a kept house, and the worthless rituals of self-promotion that lie in hair-dos, manicures, and frivolities of superficial status that bear no true meaning of the life we get too little of.
|Multitasking JVC style|
I have begun to let go of the grip of power that medicine embrues you with. There is too much we don't know and too much we presume to be able to bend, will, and yes, ultimately decide. Too much that we don't allow to see the beauty within even if age, disease, and life has tempered it.. Too much we think we need to manage, decide, control and cheat ourselves out of.
|Pets With Santa 2016|
As much as no vet wants to admit it, sometimes we are wrong, and often we don't have enough information to be spilling the forecasts we do. Murray's life is a testament to that. He lived a year past his presumed expiration date. A year of walks, hugs, car rides (his favorite thing to do in the whole world), kids activities, face rubs, sleepy-times, and love. He had a year of being loved.
If you can't make time for the last pieces of life's puzzle to fall into place, and find the time to care for those companions who served you for so long, how do you expect others to do the same for you when your time comes. There is not a difference in value, or position, or placement in society when the times are good, don’t make them in times of hardship.
|Waiting for the bus|
Murray may not be the example for every case. But, he is not the exception either. Within the small walls of my clinic there are numerous others. Pets who we invested ourselves in, championed their plights, and fought for their second chance. But, for the most part all we had to do was not be afraid to offer options, support, and a shoulder to lean on. All, and every, to any pet we thought might need a second chance. All things are possible and miracles happen every day. If you ask for them you will find they outnumber, outweigh and surpass those tragedies, and the pennies once destined for the "Bad Day" jar.
If you have a pet question that you would like to ask me please go to Pawbly.com. Pawbly is free to use and open to all pet lovers. If you want to visit me at the clinic we are open 7 days a week. You can learn more about us on our website JarrettsvilleVet.com. We publish our prices yearly, and always put our patients and compassion FIRST. Please also follow us on Facebook, my YouTube channel and on Twitter @FreePetAdvice.