Thursday, September 1, 2011

My first euthanasia

I had my first euthanasia case on Urgent Care today.

Oliver was an elderly long-haired terrier who had never been to the VTH before. His presenting complaint was "mass in mouth/possible euthanasia."

On presentation, he looked to be a definite euthanasia. His long tan-and-silver hair was badly matted over his entire body. His eyes were cloudy with sticky green discharge. He smelled like a sewer. He was recumbent and unwilling to move.

And, most notably, he did indeed have a mass in his mouth -- a mass that had spread from his mouth to engulf and deform his entire palate, nose, and muzzle. He was bleeding from his mouth, kept coughing and gagging, and seemed to be having a lot of trouble breathing.

Oh, and maggots were crawling in and out of his nostrils.

Oliver's owner conveyed to me that they had noticed a small oral mass about 6 months ago, and it had just kept growing since then. Over the last 3-4 days, Oliver had stopped eating, seemed to be in respiratory distress, and started to smell really bad. Her husband wasn't sure it was "time" yet, but she was pretty convinced.

Oliver's owner said, "Do you think it might be cancer?" which gave me some idea that poor Oliver had never seen a vet since developing this tumor. My reply was, "Yes, these types of things are usually cancer." I was stupefied enough not to know what else to say.

After some brief discussion, Oliver's owner elected not to be present for his euthanasia, and requested that we bring him to the back for the procedure. We obliged after she signed the consent forms to permit the euthanasia, as well as an "educational post-mortem examination" (aka necropsy). She did not want his body or ashes back, but thought a clay paw print would be nice.

We carried little Oliver to the Urgent Care treatment room, where I struggled for about 5 minutes to get the clippers through the thickly matted hair on his front leg, then placed an IV cathether (on my first try!). Oliver immediately received a heavy sedative injection IV, followed by euthanasia solution. All in all, it went quickly and peacefully. After his death, we discovered that Oliver had many other large masses over his entire body, and toenails about 2 inches long (on a 15 pound dog).

I had been quite nervous about my first euthanasia, since I know what a difficult thing it can be for owners (and for the veterinary team). I guess it turned out well that (a) Oliver's need for euthanasia was not at all ambiguous, and (b) Oliver's owner did not wish to be present when he was euthanized. That meant that I got to skip the whole part about "When Oliver's body relaxes as his heart stops, you may see some muscle twitching. He may vocalize. His eyes may not close. He may leak stool or urine," etc.

But I can't bring myself to even begin to think about what Oliver went through for the last few months, and especially the last few days. I mean, who among us can say what it feels like to have maggots crawling around inside your nose, eating bits and pieces of you? How about a huge tumor in your mouth so large that you can't even close your jaws? Spending several days gagging on the blood that is constantly running down your throat?

In the end, I feel that you can't be too hard on anyone who eventually seeks veterinary care for their pet. I don't think Oliver's owners had any idea how badly he must have been suffering. Their ignorance probably led to a lot of pain on Oliver's part, but at least they brought him to us for a peaceful ending instead of letting him die a miserable death from dehydration, suffocation, and sepsis at home. Did they wait too long? Yes. Should they have sought veterinary care long ago? Of course. But will it do Oliver or his owners any good for us to scold and shame them? Probably not. I think once they hear the results of Oliver's necropsy (which they requested we tell them), they will have a better understanding of what he went through at the end.

The power of euthanasia is one of the greatest gifts we have as veterinarians, which is lacking in human medicine. It's hard to describe the feeling I get when participating in a euthanasia that is well done and appropriately timed -- emotionally satisfying, gratifying, relieving, comforting... (I still haven't found the right words). It's a good feeling to help a well-loved pet die peacefully and painlessly when you know you've done all you can and that ending the pet's suffering is the best thing to do. My feelings are a little more mixed than that in Oliver's case. All in all, it made for an introspective, pensive sort of day.

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