Dr. Khuly and Tika, the dearly missed malinois. Photo courtesy Patty Khuly When you’re a sensitive veterinarian who is especially enamored over her extremely geriatric pet, you risk seeing every patient through the private lens of your impending loss. Older patients appear more endearing, end-of-life conversations become more emotionally relevant, and the stakes at work seem higher overall. The ‘time bomb’ I’m sure you know what it’s like from firsthand experience. I like to call it the “time bomb” factor. It’s what happens when your pet is so old you find yourself compulsively obsessing over her breathing. Has she always slept with her eyes half-open? Is she significantly more sluggish today? And when she dreams vigorously at night, you startle awake, somehow convinced she’s having a seizure. It’s like she’s a grenade waiting to go off. The act of holding it invites morbidly intrusive, pin-pulling thoughts that become harder to shake with each passing day. How can a fundamentally empathetic person fail to recognize the same signs of distress in her own clients? How does he effectively compartmentalize so patients at work don’t remind him of the one he left at home? It’s especially acute given the minefield of triggers we brave every day in the line of duty: Consider the ancient miniature poodle whose Crypt Keeper oral cavity reminds you that decay is as repulsive as it is progressive … or the limb-splayed, mouth-breathing Lab whose gray-muzzled, doe-eyed mug evokes thoughts of your own pet. Given the emotional proximity to our own household geriatrics, is it any wonder when geriatric patients, no matter how decrepit, become inexplicably attractive? Like when a veterinarian who’s braved her own cat’s bout with hyperthyroidism starts to find all skinny cats inexplicably cute … or when a Cushingoid dog’s pot belly stirs warm, nostalgic sentiments many years beyond her own’ dog’s passing. One school of thought suggests this affinity is the result of our own impending fragility. Could our own inexorable approximation to mortality be driving us—however subconsciously—toward geriatric medicine? I think that’s too simplistic (and too counterintuitive) to be true. I’ll argue it’s the affectionate familiarity with decrepitude in our own pets that most informs this preference. The older we get, the more experience we accrue with death among our own pets, which, in turn, makes us more adept at accepting their mortality. I’ll posit this is a good thing. It’s about developing the basic emotional self-preservation skills our profession demands. After all, reminders are everywhere: in nutritional consultations, osteoarthritis discussions, oncology diagnoses, hospice protocols, and, of course, euthanasia. All of which might explain why so many of us in general practice start to welcome euthanasia appointments and might even find ourselves attracted to the chronic cases, hospice patients, and house call euthanasias we once avoided like the plague. Closer to home According to this line of thinking, my recent loss should have been easier to bear. Instead, she turned out to be somewhat of an anomaly. Tika was a retired working dog I adopted at middle age. After her glory days she became the designated “bed dog” and even traveled everywhere with me after I’d suffered some airport-induced panic attacks. Ever the working malinois, this dog took her job seriously and never so much as stepped one paw out of line in a public setting. She was the perfect dog. I was lucky enough to see her live well beyond her 15th birthday. This means I got to treat her through a lengthy stint as a geriatric with many of its typical trappings, including canine cognitive dysfunction, chronic vestibular disease, severe osteoarthritis, hearing loss, etc. When I started to notice that every old, dying dog started to look a lot like Tika, I realized I’d have to hone my coping skills in advance of her loss. I’ll admit, it was a little extreme and potentially unhealthy. So I developed a few strategies to make it all a little more bearable. Here’s a list of those that seemed to help the most, in (mostly) chronological order: No. 1. Commissioning a portrait of her: When she turned 10, I had her portrait painted by a local artist and hung it in a prominent location. Not sure why this helped, but it was both celebratory and sweet. No. 2. Tattooing her name on my wrist: In advance of her 14th birthday, I traveled to India and had her name indelibly etched on my skin. Plenty of veterinary pros I know swear by this memento, I just advanced it a bit… to help prepare myself, I guess. No. 3. Celebrating her birthdays in style: When you know each might be her last, you do it up! Her 15th birthday was especially festive. At that point in their lives, the food orders start to get smaller. Any day might be their last. Why not live in the moment? No. 4. Using her as an example for all my geriatric patients: I videoed all of her ailments and shared these with my clients whose pets were suffering similar circumstances. I’d even parade her into an exam room to show off her arthritis, nystagmus, head tilt, root canal … whatever relevant clinical detail the moment called for. No. 5. Revising my quality of life (QOL) scale to include more details: Have you ever felt the QOL scale too limited? I did. So I fleshed it out to include more specifics. After all, clients willing to quantify their pets’ quality of life are always willing to answer more questions. They’re grateful for anything that will help them make up their grasping, tortured minds. I know it helped mine. No. 6. Casting her nose print in silver: On Etsy I found artists designing all manner of memento moris. A silver nose print pendant was just my speed. I also thought long and hard about collecting bags and bags of Furminated malinois haircoat after coming across a fiber artist specializing in spinning dog hair into yarn (I’m a knitter). Thankfully, I decided against this approach, figuring I’d eventually come to regret a scratchy garment. No. 7. Developing a geriatric package for my patients: In her memory, I put together an annual geriatric package, adding a UA, abdominal ultrasound, and chest rads to our routine yearly bloodwork (which already includes a T4 and an SDMA). No. 8. Seeing a therapist: Most importantly, I made sure to keep all my therapy appointments and never failed to raise the issue of pre-emptive grief whenever it threatened to overwhelm any enjoyment of our day-to-day relationship. Taking these active steps to address the massive “time bomb” living in my home and accompanying me to work every day made being a veterinarian an asset when it could have been a liability. Moreover, it made being a geriatric pet’s person as rewarding an experience as any I’d ever experienced before. I’m pretty sure it did the same for her. What more can you ask for? Patty Khuly, VMD, MBA, owns a small animal practice in Miami and is a passionate blogger at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.
