End of life…

emergency-vet-center

As I walked out of clinic at 1am on Monday morning a family were arriving to say goodbye to their pet having been summoned by phone just 15 minutes before when he started to deteriorate so rapidly that it was obvious he only had minutes to live. They made it in time to say bye thanks to the Vets Now ECC nurse recognising what was happening early and allowing them to be summoned.

Through the weekend we’d helped countless animals who left the clinic to go home with their parents, yet there was a high proportion that was never going be leaving, whether or not their pet parents realised it when they arrived. Unfortunately our pets can never tell us how sick they are, how much pain they are in, and that they want to go on over the rainbow bridge.

This is worse as often it is not just that they are seriously ill (and sometimes even dying painfully), but is also so sudden that their parents may not have had time to come to terms with this and accept it. It is not human nature to give up and sometimes when it comes to the decision to end life it can feel this way even though it is really not.

The weekend was a mix of those that came to ask us to help them send their loved pets on over Rainbow Bridge – the request of one parent that nearly made me cry was that someone would cuddle them as they moved on. Then there were those that hadn’t realised how bad the condition was and how much pain their pet was in that let them go on pain free when realising. There were also those that just refused to give up even though it could be considered to be  the kindest thing for their pets.

Vets are legally entitled to euthanise an animal on welfare grounds if they believe the welfare is compromised and the animal is suffering. However , we realise the importance of the bond parents make with their pet and that doing so will not be easy on the parents – in fact it would be very traumatic for the parents which is something we never want.

Instead we rely on our ability to communicate with pet parents. Sometimes it is very obvious to us how bad an animal is because of our experience and training whilst it may not be to their parents. We release that the animal is never going to be able to leave alive, and whilst we may attempt to make the animal comfortable with very strong pain medications, it is the owner that we need to treat.

Euthanasia is one of the most powerful tools that a vet has – read about how it really works here.

Over the rainbow bridge…

Euthanasia - Crossing the rainbow bridge

As the vet reaches for the cats leg to give the final injection the cat lies alone on the table. She has had trauma and is not in good way, and her parents cannot stand to see her in this way. I reach out to do nothing more than stroke her as she starts her onward journey over the rainbow bridge.

As the injection goes in I see her laboured breathing stop, she looks calm and relaxed as I stroke her and wish her a safe onward journey. The injection is in and the vet removes the needle before reaching out and stroking her as well briefly before they listen for a heartbeat. I’m sure she’s gone but it is important to check, sometimes it can be difficult to tell with all the noises that occur after death so sometimes can feel like you are listening a long time.

I’m sad this cat I knew only for a short while at what is probably the worst point in her life couldn’t be saved, yet I take comfort in the fact she now gets to run free. We gently remove her IV cannula to go to the clinical waste, clean her, and then wrap her in her blanket to go home with her parents for burial.

She is not the first, and will not be the last; however she did not go alone. Even for those few minutes she took a piece of my heart with her, and she went on her final journey across the rainbow bridge loved and cared for. This is something her parents never saw and something maybe one day they will wonder about, however they should not worry. They have the memories of her running around the house not struggling to breathe unable to lift her head.

I will never judge a parent that cannot be there at the end, it’s one of those choices that is so difficult to make. There is rarely a right answer, and sometimes there is not even any time to even think about it properly. Yet these parents may say their goodbyes when it is time to bury her, I will never know. It is a choice that can only be made by you. Sometimes after trauma we will explain to parents what to expect to see as sometimes injuries look much worse after being shaved and cleaned so that the parent can make a choice.

Personally I believe saying goodbye is important, some vet practices even have rooms just for this so we can give as much time as parents need. Sometimes in a busy practice we do not have enough of these rooms so we make do with what we have. We will explain what will happen to you, and tell you what we are doing. We’ll never try to rush you, we’ll try to keep noise outside to the minimum, and we will all feel your pain.

EDIT
If you have lost a pet and are struggling with the loss then please do call the Blue Cross Pet Bereavement Helpline – 0800 096 6606 (UK Only) – or visit their website for more information at  https://www.bluecross.org.uk/pet-loss. It is a traumatic experience, and there are people that have experienced it themselves who want to listen to you.

Death, the good, bad and ugly…

An exhausted vet student

Death is one of those bad words, that we try to avoid talking about, that we ignore and hope we never have to face.

Yesterday I read a blog post called “The dirty secret about CPR in this Hospital (That Doctors Desperately Want You To Know)”. For me it was nothing new, however it made it easy to understand and got the point across in a way I never could so I would highly recommend checking it out.

Since reading this it has remained stuck in my mind throughout the day, I think being in the veterinary profession gives me the other side of the picture. Unfortunately I have been in the position of watching someone I loved die slowly in a hospital bed – it was never what I expected – I expected to turn up one day and find them in their garden or home after a heart attack. It took several days for the die under the Liverpool Pathway (since then I am much more clued up as to why this may not always be the right thing) however the alternative was open heart surgery with very very very small odds of a meaningful recoveryEven at that point in time, without realising I was thinking about the quality of life and not the quantity – the chance of them doing what they loved and leaving the hospital after this surgery was near zero. The quality of life would be zero, even though the quantity would be increased (if you can consider it as life).

Whenever this person had spoken about death to me I had tried to change the subject as I was scared to think about it. I was scared of losing them. I didn’t want to think about it.

So moving forward 5 years with a lot more education and experience I am writing this. Over the past two years I’ve been seeing practice I have been around death, caused death, and prevented death. Some days it seems to be all I deal with, last Tuesday by the last patient I’d seen so many patients die or euthanized that I was no longer surprised when I confirmed another death.

Let’s talk about some death – from the perspective of a vet student… These have all happened to me…

It is 1am, my phone goes, one word – “torsion” – and I am out of bed and running for the door, 10 minutes after this phone call I am scrubbing into surgery. A torsion (GDV or bloat where the stomach swells up with gas) is a surgical emergency. The dog will die without a vet and surgery. An hour or so later the dog is in recovery, and a few days later it goes home.

Last Tuesday at 6:45pm when I was walking out the door to go to lunch a call came in… “torsion”… the owners were on their way about 20 minutes out. That’s 20 minutes for me to prepare. Operating Theatre set up, preparation for stabilisation, emergency fluids, decompression. Car drives up to the door, owner says I think he’s dead… I’m in the back of the car listening to nothing, feeling no pulse, no breathing. This dog didn’t even make it in the doors.

Is a torsion painful? Yes. Can it be fixed with surgery? Sometimes. Will the dog have quality of life after surgery? Yes. Is it a painful way to die? I would not like to die like this.

I am in surgery, normally opening the abdomen is pretty routine, however this time we are struggling. If I hadn’t opened the scalpel blade myself I would have thought it was blunt and old. Opening the abdomen finally it is like all the organs have melted together… There is nothing there, and nothing that is possible, I am wondering how the dog was still alive. We were not sure what we were going find, however I would have never expected this… The owners chose never to allow this dog to wake up.

We’ve got what is expected to be a pyometra – however there is a large mass in the abdomen along with lots of fluid. The owners know that it may be bad – and are waiting by the phone. I am running anaesthesia, the patient is having some problems to breathe so I have placed them onto a ventilator to help them. The abdomen is opened and the right liver lobe the size of the dogs head is removed from the abdomen – the breathing becomes easier. There are changes to other organs as well – it is not a pyometra however there are tumours on the uterus. We call the owners, and they give permission to euthanise on the table. I administer the drugs that will end this life – and relieve the suffering.

In human medicine – these patients would be closed and taken to recovery – they would be given drugs for pain and potentially kept sedated until they die. There is no guarantee of when this would be, they’d be trapped there in a hospital bed hooked up to machines.

A horse – unable to stand, with fluid on its lungs, anemia. The condition is getting worse… There is no quality of life, and the chance of recovery is very slim. We make the decision to euthanise and administer the drugs to do so. The horse is peaceful, out of pain, and no longer drowning inside out.

In human medicine this patient would be treated – humans are lighter than horses, the anatomy is different, and the lungs are like bags of crisps instead of sacks of potatoes. Its treatable – and there is a chance of recovery to a quality of life.

I will end on a puppy, this puppy had a deformity in its leg that was surgically correctable – however it was not showable and not breeding material. I cuddled this puppy on my lap when it was sedated, and held it when it was given the final injection. Not to relieve its suffering, simply because it was unwanted. We tried to encourage the owners to sign it over to be rehomed, tried to talk about the surgical options. That is the danger of euthanasia – that it can be used for ends other than relieving suffering.

We may not be able to pick when, however you can choose how you want to die. Where you want to die. It’s a conversation that should be had, and you can even find online guides like the Five Wishes (https://agingwithdignity.org/docs/default-source/default-document-library/product-samples/fwsample.pdf?sfvrsn=2 ) to help you.