Not the way I would write the ending

Last week a long time patient of ours was finally euthanized. It was time - past time - but unfortunately when he crashed his usual doctor was out. When his kidney values reached astronomic levels, another doctor had to tell his owners it was time. "But you don't know what he's been through! You don't know what he's come back from!" they countered. True, but when the kidney levels are that high, there is no recovery. Of course, you could tell that from looking at the poor cat, but the owners, blinded by love (in this case, literally), could not see how dire it was. Finally, they permitted a swift, peaceful death, even though it was about a week too late.

A dachsund is on my schedule; "dragging back legs," is the complaint. It's an eleven year old dog who hasn't received any veterinary care in over two years. Even worse: he has a history of back problems, and hasn't been walking since the day before. And had been wobbly on his feet a few days before.

Here's how spinal injury in dogs works: a disk from between the vertebrae protrudes and puts pressure on the spinal cord. The disks of a dachsund are more brittle so it happens frequently in this breed. The resulting pressure and inflammation makes the cord swell. Since the cord is in a confined space (the vertebral column), it cuts off its own blood supply. No blood = no oxygen = cord death. Time is of the essence. When they're wobbly, you can reverse the swelling with steroids and rest. The longer they are down, the more likely they are to need surgery, and the worse the prognosis.

With a history of previous episodes, this owner knew time was an issue. And despite her elaborate show of tears, it was obvious to me and the staff that she had long given up on this dog. I mentioned surgery ("I can't do that!") and medical management (he still had a chance), but she sobbed and said, "I think we're just going to have to let him go."

Poor dog. He had periodontal disease, large fleas trucking across his body, and now back pain and paralysis. A fast painless death wasn't the worst outcome, I supposed. She signed the paperwork like a heartbroken soap star, then handed him to me, saying, "We're doing the right thing..."

I couldn't tell if it was a statement or a question. I didn't reply. As she gathered her purse, dabbing her eyes, she spotted a folded newspaper on the bench. "Can I take this?" she asked, clear voiced, indicating the crossword. Sure. Could you work a crossword the same day your dog died? I couldn't.

Later the same day, I heard the distraught voice of a client, bringing a limp animal into the clinic. I quickly ended my appointment and helped carry the patient to the back. I saw a beautiful bird dog, blue mucus membranes, warm and robust but unresponsive. We intubated, administered CPR, oxygen, epinephrine -- it was too late. Her body temp was 96 - whatever had happened was too far gone; her brain was dead. She looked familiar, then I realized I'd seen her for a simple ear infection two weeks before. I remember how sweet she'd been, lifting her muzzle up to me, her hindend wiggling. Her distraught owner said she'd been normal all day when she left for an errand. Two hours later, she found her unresponsive, curled up on the bed.

There was no outward reason for her to die. She'd had a normal exam (except for a minor ear malady) two weeks prior. It was beyond explanation. Although I wish I knew why she died, I was relieved the owner declined autopsy -- I'm no pathologist, my schedule was full, and it doesn't change the outcome. A beautiful, beloved companion was gone.

Sometimes people hear of my job and think that caring for my patients at the end of their lives is the worst part. They are wrong. Helping my patients have a calm, peaceful end to their suffering can be very rewarding, although it is always gut-wrenching. When the end comes too late, or too soon, with contrived emotions or lack of caring, then it is unsettling. Losing a pet always feels painful, but these three in the same week all seemed so wrong, in so many ways.