Friday, October 23, 2015

When It's Time To Say Goodbye...

This is a difficult post to write, but it's a frequent subject in veterinary exam rooms.

As medical technology improves (veterinary medicine mirrors human medicine, as discussed previously- see ), our pets are able to live longer, healthier lives.  Gone are the days of the farm cat living maybe 2 or 3 years.  Everyone wants better than that for their pets.  There are different lengths people are willing (or able) to go for their pets.  Some of my patients have received kidney transplants, brain surgery and heart surgery, just to name a few.

One of my most often used lines when speaking with people about end of life issues is, "Just because we can, doesn't mean we should."  Procedures like CPR, treatment of sepsis and total organ failure and other treatments that in my experience are futile just seem to prolong life.  Supportive care like reversing toxic doses, feeding tubes and hospitalization with fluids are often helpful and non-painful. I've noticed that while many people do not have the medical awareness or knowledge of specific procedures, consistently people want to know that their pet is not in pain, is not suffering.  This is the most important information for me to communicate to owners as the pet can not talk, the pet can not say "stop,  I've had enough, let me go."  In some circumstances, I've found myself strongly advocating against medical treatment for patients.  It is definitely an awkward position to be in.  Suffering is something that we just don't want to see as veterinarians.  Sometimes people make decisions that are different then what we would make.  Sometimes people have selfish motives, sometimes they are just in denial.  Sometimes they just need time to take it all in.  This is where the veterinarian's role as grief counselor and hospice consultant come in.  There are many things we can do to make animals more comfortable when they receive a terminal diagnosis.  Pain medication and hospice care are very common for our patients at the end of their life.  The most important component of hospice care though is the communication the owner gives us.

I tell people once a terminal diagnosis has been made in their pet (unless it's an emergency situation).  "Don't rush, this isn't the point where you need to euthanize, you can take some time to come to terms with the diagnosis.  Go home to your family and discuss as a family what are 3 things that your pet needs to know they have a good quality of life."  These can be things like eating their favorite meal, coming to the door to greet you and sunning in their favorite window.  Whatever makes that pet "happy" in their owner's perception.  I then tell them that they can come to me at any point and say that their pet does not have that quality of life, is there something we can do to restore that.  Once they have their written list that they decided on when their pet wasn't so sick, it's easier to make a decision that at that  time when they wrote that list they were more subjective and they are making a decision in the best interest of their pet.

Sometimes letting go is the greatest gift we can give our pets.  It's the ultimate act of selflessness to let them go peacefully and not draw things out when they are truly in pain and uncomfortable.  I've seen many patients that stay alive for their owners.  They just simply need permission to let go and not fight anymore.

What do you think?

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