THE LAST ACT OF LOVE
by Deborah Schildkraut, Ph.D.
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The veterinarian ushers me into a back room. He turns out the overhead light and presses a switch on the x-ray viewer. What I see on the black & white film stuns me. My brain shuts down, fogged over by shock. The veterinarian points to a large round mass pressing on Timber’s heart. I hear him say the words - tumor, ultrasound, biopsy. He doesn’t say the “C” word. He doesn’t have to. I can see it for myself.
When the veterinarian tells you that your dog has a life-threatening illness, it can be a mind-numbing experience. Whether the news is foreseen such as decline due to old age or unexpected like cancer, it sets off a chain of events that will lead to some difficult decisions the final and most difficult being whether or when to opt for euthanasia. For those of us with companion animals, it is a decision that we will all eventually confront.
In my personal and professional life, I have had to face the decision many times. When one of my dogs becomes ill, I discuss treatment options with our veterinarian. Will additional tests be necessary for a diagnosis? What will each treatment entail with regard to the stress on my dog, the prognosis for a life of quality after the treatment, and the cost? Every dog is an individual and each dog’s medical history and age will be important considerations for treatment recommendations. What may work for a 4-year-old dog with no previous serious illnesses, may not work for a 13-year-old, diabetic dog. I take all this into consideration in making decisions. But the primary considerations for me are the level of suffering and quality of life.
For Timber, my 80-lb. greyhound, an ultrasound and biopsy revealed a particularly virulent, fatal cancer with no treatment options. We focused on palliative care, keeping him comfortable and pain-free. His decline was rapid. Within two weeks of the first symptoms, he struggled for every breath and we could no longer keep him free of pain. At that point we chose euthanasia.
For many years, I was not emotionally able to be present when my beloved dogs were euthanized. My husband took on that responsibility. My fears centered on ill-informed ideas that it would be horrible to watch and that I would make a fool of myself sobbing in grief. An experience with Duke, our 16-year old Labrador retriever, taught me the error of my notions. Even at his advanced age, Duke remained mentally sharp but his body was failing him. One day his body simply shut down. We made the appointment to have him euthanized. Early the next morning, I rode to the animal hospital with my husband and Duke. I sat in the back seat with Duke stretched out on my lap. I stroked his fur and talked to him in sweet, soft tones that he liked. He was calm, content. It dawned on me that Duke was benefiting from my attention. By the time we got there, I knew I would stay with Duke. Our veterinarian allowed us to come before clinic hours so that we could proceed unrushed and with privacy. I spoke quietly to Duke, and stroked his head and back. The veterinarian gave him a sedative that relaxed him. A second injection stopped his breathing. He literally went to sleep. Afterward, the vet allowed us private time with Duke. I knew then that being with Duke in the final moments of his life was the last act of love I could give to him. In the decade since, I have been with all of my dogs when euthanasia was necessary.
Until my experience with Duke, euthanasia was a mystery to me. I did not understand the procedure and had unfounded fears and misconceptions. Demystifying the process may help you consider being present with your dog when euthanasia is the humane choice for ending your dog’s pain. Your companion will benefit greatly from the comfort and security your presence provides as he passes on from this life. An objective look at the medical procedure of euthanasia will help you know what to expect and prepare you to be there when your dog needs you most.
Depending on the condition of your dog at the time of the procedure, euthanasia may involve one or two steps:
Sedation. Your veterinarian may decide to give a sedative, like Valium, to relax your dog. The sedative reduces anxiety and has a calming effect. A sedative is especially useful if the dog is restless, in pain or agitated. Once the sedative has taken effect, the second part of the process can proceed more smoothly, which will help both the dog and you. There are some circumstances when a sedative is not appropriate. For example, a sedative can lower a dog’s blood pressure making it more difficult for the veterinarian to locate a vein. If the dog is comatose or unconscious, sedation is not necessary. Before the procedure begins, you should discuss with your veterinarian whether a sedative is an appropriate first step for your dog.
Euthanasia. The part of the process that will end your dog’s suffering is an intravenous injection of a euthanasia agent usually a form of the drug pentobarbital. Rarely, a dog may react with a yelp to the actual insertion of the needle, but within seconds of the injection, loss of consciousness will occur. The drug works on the breathing center in the brain and results in respiratory arrest. The time it takes for this to occur depends on the condition of the dog. If the dog is dehydrated or has low blood pressure, it may take a few minutes for the drug to circulate and the breathing to cease. Once the breathing has stopped it may take another few minutes for cardiac arrest. The dog is not conscious during this entire time and is in no pain. The veterinarian will use a stethoscope to determine that the heart has stopped and the dog is at peace.
Post-mortem events. Arguably what people fear, with the most misconceptions, are the postmortem events. It is easy to misconstrue these events as pain and suffering when in reality they are physiological responses to the drug that can occur after life has ceased. The most common ones are minor muscle twitching and noises. The noises may sound distressful but they are the result of diaphragmatic spasms or lungs expelling air. They are not conscious moans of pain or signs that the dog is still alive.
When you have made the decision to have your dog humanely euthanized, there are several things that you can do to make the process less stressful for yourself. Talk to your veterinarian by phone to set up a time when you will not have to wait once you arrive. This is not a procedure to be hurried, and setting an appointment time when the veterinarian can devote complete attention to your dog and you is a must. Ask if your clinic or hospital has a special room for euthanasia, one that is private and comfortable, not clinical or sterile. Many clinics or hospitals have such accommodations. When you arrive, make arrangements to pay ahead of time or to be billed so that once the procedure is finished, you can leave immediately. There is nothing worse than standing at the desk to pay your bill when you have just lost your best friend.
You may also choose to have the euthanasia done at your home, although not all veterinarians provide the option. This is helpful if you have large dogs or a dog in great pain where transporting the dog would be difficult and traumatic. Being in familiar surroundings also helps reduce stress, and makes you and your dog more comfortable. A home visit is more expensive than an office visit because of the time and travel required. It may not be possible for the veterinarian to come to your home immediately. In cases of severe trauma or suffering, taking your dog to the clinic may a better course of action.
Your presence in moments of distress is a great comfort to your dog. And no moment can be more stressful than the final moment of life. If you are considering being present with your dog during euthanasia, but still have fears, it may help to take a friend or family member with you who has been through the procedure before. It helped me to have my husband present when I accompanied Duke. I have since helped many of my dogs leave this life in peace through euthanasia. I have never once regretted my decision to be with them.
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Timber sleeps on his fuzzy green bed. He is heavily sedated with pain medication. I lay next to him for most of the night, monitoring his pain level and keeping him warm. Early in the morning, the veterinarian arrives at the house. The other dogs are in the backyard, except for Jasper who senses my sadness and remains quietly by my side. I sit with Timber’s head in my lap, patting him and whispering words of love. The veterinarian wipes the injection site on Timber’s leg with alcohol. The large tumor is pressing on Timber’s heart and his circulation is poor. His veins are difficult to find, and he cringes at the prick of the needle. In a flash he is unconscious. I continue to rub his ears, for my benefit now more than his. In minutes, his chest ceases to rise. The veterinarian puts the stethoscope over his heart and listens for several minutes more until it finally stops beating. I thank her for coming to the house. She packs her bag and lets herself out. I remain with Timber taking all the time I need to say goodbye, taking comfort in his peace and solace that in the final moments of his life, I could provide this last act of love.
Deborah Schildkraut, Ph.D. is an animal behaviorist and educator. She shares her home in Cerrillos with her husband, five rescued dogs (three greyhounds, two corgi/terriers) and three horses.
This column is Part 1 of a two-part series on end-of-life issues. Part 2 will focus on respectful options for the body after death. Mil gracias to Carolyn Fletcher, DVM for her valuable input. Thank you to Kathy Dobesh, DVM for her compassionate help with Timber. For more about Timber: Timber