Today I cried.
I started my day with a text from one on my teammates that one of my all-time favorite clients walked in for a euthanasia appointment. While I knew this was going to be coming, today was not the day I had planned for. I rushed to get ready in record time as I was not due into the clinic for another hour. I walked into the clinic without my coffee (my much needed fuel for the day), no makeup, and partially wet hair. I literally dumped my purse and backpack on the first person I saw.
I then went in the exam room to sit with this client, a man I have known for more than 20 years. He sat alone today, patiently waiting for what was to come. I walked into the room and sat on the bench, reaching for his hand to hold in mine. His wife had passed the previous year due to a battle with multiple illnesses. As we sat together, we remembered when his dog Scout (literally, the best sheltie ever) was young and his wife was healthy. Time had robbed him and his family of the things that meant the most to him.
At almost 12 years old, while still young in years, Scout had multiple issues and had been rapidly declining over the past few weeks. At his last appointment we had tearfully discussed Scout's quality of life and euthanasia if she did not improve. To add to this man's plate, his wife had been diagnosed with dementia and Parkinson's. Over the last few years we had watched her decline from the amazing, vibrant woman she once was to a virtual stranger. The DVM came in to do Scout's euthanasia, and, as we always hope, the procedure was peaceful. I took Scout out of the room with the promise to take good care of her.
Moments later. I stepped back into the room to say goodbye to Mr. Bell and ended up sitting with him on the bench in the room for almost an hour. We held hands and cried together remembering Scout and the impact she had on her family. How good of a dog she was and the friend he needed when he thought everything else was falling apart in his life. She was his constant companion through COVID and his wife's illnesses.
We talked about his wife and the stranger he had become to her. His loss as a husband and partner, not just as Scout's owner. He kissed me on the cheek and hugged me. Thanking me for all I had done for them over the years. I truly love that man and his family. After 28 years into the profession, not many euthanasia appointments make me cry anymore. This one hit me hard. He sent an email later in the day, thanking me for all I have done for them over the years. I cried again. As hard as it gets, as busy as our days are, this is why I do what I do each and every day.
Helping with the decision
Being able to connect with a client during a euthanasia is one of the most important parts of my job. When it is time for an owner to make a decision about end of life care for their pet, I am always more than willing to help them with that process. Making a decision to euthanize a pet is a hard decision that comes with many different emotions as well as experiences that are always going to be memorable to our clients.
The decision to euthanize a pet does not come easy, nor should it be taken lightly. Pets are family members to our clients and hold a special place in their lives. When a pet is injured and they are obviously suffering, the decision to euthanize is somewhat easier for a client. If their pet has something going on that is deadly and there is no other choice in the matter, the decision to euthanize their pet is, in a way, made for them. They have to make this decision and there is nothing else that can be done for their pet. While no more easy a decision to make, the deciding factors are more obvious and there may be a different peace of mind when making it.
When you have a pet that has a chronic illness that can no longer be treated or controlled, the decision to euthanize your pet comes down to its overall quality of life. While the deciding factors of the pet's quality of life may vary depending on one's own beliefs, your veterinary staff can help with this and offer counseling services of a sort to help make the decision clearer and allow one to realize when the time is right.
There is much we can do to assure that the last months and years of life are full and happy. Even for patients with terminal disease, hospice care provides so much life at the end. A quality of life scale can help owners make decisions on how their companion is feeling, when hospice care is not enough, and the time for humane euthanasia. The scale helps you take into account all aspects of discomfort to get a clear picture of how much a pet is enjoying life, what can be done to improve it, and when it is "time."
Quality of life infographic for clients |
| Download this client-focused tool to help them make objective assessments of their pet during this most challenging time. |
Quality of life assessment
I evaluate a pet's quality of life in the following areas:
Pain—Adequate pain control is first and foremost on the scale. Pain control may include oral, transdermal, and injectable medications, which will control part or all of the pain associated with the dog's condition. Pain also includes the pet's ability to breathe properly. In some cases, oxygen therapy can be supplied at home by prescription through a medical supply house. Vomiting, seizures, or severe weakness are also included in this category.
Hunger—Many conditions result in the pet's inability to take in adequate nutrition. Heating food, hand feeding, or getting creative with ingredients will improve this, but not eating can be a very painful way to spend the end of life. When I have a patient in hospice care nearing the end, I call it "ice cream time." On the other side of this issue is obesity will make most conditions worse, so if the patient is eating enough to maintain weight, be careful not to overfeed out of guilt or sadness.
Hydration—Many health conditions result in various degrees of dehydration, which can cause nausea and headaches. This can be easily addressed by infusing fluids under the pet's skin, which most owners can be taught to give at home.
Hygiene—Dogs and cats that are used to being clean can get demoralized quickly when they smell of urine, feces, wounds, or are covered in mats pulling on their skin. The odor associated with necrotic tumors can also cause social rejection by family members, which is very upsetting to a loyal companion. Antibiotics can help reduce this foul smell for some time. Keeping hair short or well brushed and clean is very important.
Happiness—Is the pet able to experience any joy or mental stimulation? Is the ailing companion willing to interact with the family and be responsive to things going on around him? Are they able to enjoy being on the bed or in the owner's lap? Can the ailing pet enjoy the upbeat greetings and petting of loving family members? Is the pet depressed, lonely, anxious, bored, or afraid? Be sure the pet's bed is close to the family's activities and not isolated, so you can observe these traits and your companion can enjoy the strength from your proximity.
Mobility—Is the dog able to move around on its own or with help in order to satisfy its needs and desires. Does he feel like going out for his regular walk? Are there central nervous system problems, seizures, or stumbling? Can the pet be taken outdoors to eliminate alone or with assistance? Harnesses, slings, or carts can be helpful. Obesity is a big component of this. The nursing care of large immobile dogs is very demanding. A schedule of regularly changing sides and massage is critical to prevent skin sores and pneumonia.
Look at the numbers
Overall, I average all the above categories into a simple 1-10 quality of life score and compare it to how would I enjoy life at each level. A quality of life score of 1 to 3 would be good, 4 to 7 would be entering the "poor" area. When you are reaching a score of 8 up to a 9 is when the difficult decision time comes. There will be good days and bad days, so you have to average them out (honestly) to help deciding when it should be the end.
A pet scored at a 10 in my practice is considered to be suffering. Everyone will rate their pets differently. Discussing these guidelines with a client will help them make a more informed decision on what is best for their pet. Taking the time to talk to clients to get as much information as possible on what is happening at home will allow better, more individualized advice to be given. More good days than bad should be the big deciding factor in making an end of life decision. There are going to be some days that are better than others. When there are more bad days than good, it has a huge impact on quality of life.
Making a decision about when it is best for life to end is one of the most difficult decisions any of us has to make. It is by far one of the more important things that pet owners have to deal with and largely dread having to make a decision on.
To have to make that decision for someone else brings with it the fear of making the wrong decision and stopping too early, but also the fear of going too far and causing unnecessary suffering. While we can give our opinion or input to a client, the decision is their own to make. All any of us can do is to use the tools available to us to try to understand what our companion is experiencing and trust our hearts to know the right time.
I am often asked by clients if performing euthanasia is the hardest part of my job. Or they will say they cannot imagine what I do each day and mention how hard it must be to have to euthanize a patient. My answer is the hardest part of my job is not being able to stop pain and suffering. Most times, the process of euthanasia is painless physically for our patients. We can help alleviate physical pain with medications as end of life comes near. Whether oral or injectable medications, for the most part, we have endless options to choose from. We can tailor these medications to help with anxiety, stress, and pain as end of life is approaching as well as to make the actual euthanasia appointment smoother.
The emotional pain our clients deal with is a bigger burden for them to carry. We want to make sure that we are doing everything in our power to make the euthanasia experience the least painful as possible for our clients and their pets. While a medical diagnosis may seem black and white, the reality of what needs to be done in a loved pet's best interest may not always seem clear.
In veterinary medicine we wear many hats. Some days they are as a veterinarian or technician, helping physically care for a pet, treat them for an ailment, or even perform surgery to make them better in some way. Other days, our job is to be a friend to our clients when they need us. To provide compassion and guidance to help them make these important decisions that impact them and their families. I feel strongly that when faced with a painful end and no hope of any more quality life, euthanasia is the greatest gift we have to give to say thank you for all that they have given us.
Jamie Rauscher is a licensed veterinary technician at a 24/7 GP/ER practice in Atlanta. She has been at this practice for more than 20 years and is part owner of the practice, as well as the medical manager. She is the current president of NAVTA and the vice president of the Georgia Veterinary Technician and Assistant Association. Her interests in include anesthesia, pain management, emergency and critical care as well as hospice and palliative care.
