I had only spent maybe an hour with Violet before this day. She was referred to me for my hospice care services. I saw her for a couple of appointments discussing how we could disguise her failing joints with the best cocktail that modern medicine had to offer. And it worked. Until it didn’t.
Today I am with Violet and her Dad, Ron, on the front porch of their house. I see a defined circular area where the deck stain has worn off. “That is her spot”, Ron says, tears already spilling down his cheeks.
“She fell down the stairs last week, she can’t squat to pee.”
“It’s time”, I agree.
As a house call veterinarian, I have become an expert of sorts on death and dying. Now don’t get me wrong, I still love (and need) a healthy puppy visit thrown into my day. But I can also say, and I know this sounds strange, that I enjoy performing euthanasia.
Now, before you write me off as a weirdo, hear me out. Like other veterinarians, I grew up feeling a deeper connection with animals than with people. After graduation, I was chomping at the bit to start improving the lives of animals. Their owners were an afterthought.
Ironically, I have found that through doing euthanasia, I have nurtured my love of human beings. The bond people have with their animals; the deep soul-wrenching struggles they have making decisions for their animals; the raw emotion that erupts from people surrounding their pet’s last moments. In bearing witness to this hidden, beautiful, unfiltered side of humanity, which breaks down to the simplicity of a man loving his dog, I feel deep gratitude for unearthing something that was not visible to me in my earlier life. It affirms my yearning to be part of the human race.
Atul Gawande’s book “Being Mortal: Medicine and What Matters in the End” highlights the growing chasm between the increasingly sophisticated diagnostic and therapeutic options available in human medicine and what patients themselves actually want. The option of having a good death and electing not to put oneself through those other options is often ignored and looked down upon, much to the detriment of the patient.
It is exciting that in veterinary medicine, we also have more technologies, procedures, and treatments at our fingertips than we ever have had before. When I make a diagnosis such as cancer, I consider it my job to go through all options and their associated risks, benefits, and costs. Euthanasia, while not fancy or advanced, is an option that I always include in the conversation. If I don’t, then pet owners may feel guilty for thinking it or may go somewhere else to discuss it. Or worse, they may actually go through with an option they don’t believe in, and they, their pet, and/or their wallet suffer as a result. Choosing death is often portrayed in our society as “giving up” and it shouldn’t be. Suffering is overrated.
I find it fascinating and supremely disappointing how in my four years of veterinary school, which boasts one of the most intense curriculums one can find in graduate school, that there was not one mention of how to perform euthanasia. I remember entering my internship after graduation and being petrified of this task. There are so many facets of the whole process: Guiding people through the decision of euthanasia, end-of-life hospice care options, how to best explain the process, sedating vs. not sedating, what drugs work best, what to expect during the process, how to deal with the remains of an animal, how to give the owners a lasting memory of their animal, how to deal with a person’s grief, how to deal with your own grief. None of these topics were taught! And I can tell you - there is much to learn.
I believe mastering the art of euthanasia is a huge part of being a great vet. Most animals have a much shorter life span than humans so dealing with death will inevitably be a part of our practice. If the end-of-life experience isn’t good, that pet owner will have a negative association with that vet forever. Talk about pressure! Just as we study about diseases and treatments, so should we study how to best provide a peaceful loving death to our patients.
I feel there is a great calling for veterinarians who specialize in end-of-life care. Most veterinarians went to veterinary school to learn how to heal animals. I can therefore understand how on paper, end-of-life care may seem like a bummer. But I can tell you, relieving suffering and providing a peaceful way to leave this earth is the most gratifying thing I do both for the animal who is dying and for the loved ones surrounding them. It seems counterintuitive but the lasting reminder of a good death is truly a gift that keeps on giving.
I get an IV into Violet’s wiggly, dehydrated vein. That is the hardest part, both for her and me. The rest is easy, and that is the beauty of it.
Violet looks at me with eyes that are bright, which belie her failing body. She clumsily but earnestly circles around twice and nestles right into her spot. As her Dad scratches behind her ears, his body heaving from sobs, he says “I love you my sweet Violet”. I inject the solution. I feel the familiar lump in my throat. She drifts off to sleep. I listen with my stethoscope; her heart has stopped. No more life but no more pain either and that is the deliberate and loving choice which we have made for her.
I put my stethoscope back in my bag and hear “Thank you so much, Deirdre. Thank you.” It fills my heart every time. These are the words that keep me going.