Our biggest blessing… Our worst curse
Damn I was tired! Ken Johnson’s three year old Gelding coliced last evening. All went well but it did make for a long night. Then as I opened the door to the clinic this morning I was greeted by Amber my receptionist, “Mrs. Jenkins was bringing in her very cute and very pregnant Yorkie, Tessie for dystocia. She would be arriving any moment”. It was 10:00 o’clock when I stepped out of surgery to face my full schedule, which I was supposed to have started facing at 8:00 o’clock. The day was so hectic that I did not notice an additional appointment was made for the end of the day. “EQUINE EXAMINATION, POSSIBLE EUTHANASIA.”
It was 6:00 o’clock; the techs had prepped the truck, when I sat out for my last call. As I pulled away from the clinic, suddenly the potential task I was leaving for invaded my full consciousness; I was dragged to a distant time and almost forgotten memories. It was the first day of our senior year in veterinary college. We, the students, were so full of ourselves. We had completed three years of classes and now we would be in clinics; making diagnoses and recommending treatments…we had arrived! Dr. Michael Schaer, our mentor and Chief of Staff at the Veterinary Hospital, greeted the senior class that morning. Dr. Schaer ushered all of us into the hospital seminar room. He said he wished to discuss a specific topic with us before we embarked upon our glorious Senior Year. He said he wanted to discuss the topic of “euthanasia” with us. You could have heard a pin drop. No subject could have been further from our collective minds as we sat in that cramped classroom. Heck, we were soon to be doctors. We were to be life and health givers. If we did not respectfully fear Dr. Schaer as a ruthless teacher who could convey knowledge with the greatest dictatorial style, we would have bulked and thought that this was a cruel joke. But, Dr. Schaer never joked. I have long forgotten most aspects of my Senior Year’s first day, but I have never forgotten Dr. Schaer’s lecture on the subject of euthanasia. Dr. Schaer started by saying; “I want to talk to you about euthanasia. It will be a responsibility that you will have; a service you will provide and a procedure that will test your medical proficiency; emotional stability; and ethical honesty.” Then that veteran doctor stared at us coldly and said, “Ladies and gentlemen understand that this responsibility is a service that even human medical doctors are not entrusted with. Each time you are forced to deal with it, it will be your biggest blessing and your worst curse, ladies and gentlemen, if you cannot handle it, then I suggest you find a new profession.”
I found myself reaching for the record as I drove. The record index read Jacobs, “Beauty”…Damn! As I turn on 561 towards Sugarloaf Mountain, I started to flip through the record. I first saw Beauty ten years ago. She was a rescue horse that the Jacobs took in. At that time Beauty was a sorry sight. She was a six hundred fifty pound skeleton mare. She had a poor coat, poor hooves and a poor attitude….so noted in the record. I hesitated and let my memory fill in what was not in the record. It was a November day when I first saw Beauty. She stood in the front pasture as I approached the Jacob farm. My first impression as I drove up the driveway was, “what a poor excuse for a horse; the Jacobs and I will have a challenge with this one.” As I pulled up to the barn, a little freckled face girl sitting on the fence greeted me. Her name was Katie. She was the Jacob’s youngest daughter. Katie called out, Dr. Z., you seen my new horse…she’s a beauty. That’s why I’m calling her Beauty. Did you see her?” So began a wonderful relationship between youngster and horse. Beauty would indeed become a beauty. It took a year of deworming; nutritional modification; teeth floating; farrier intensive care and a whole lot of love from a little girl. I looked further in the record. It showed mostly routine exams, vaccinations, teeth and hoof care. ‘May 2001, “colic.” I remembered it was Katie, now thirteen years old, frantically calling and waking me up that early morning. “Dr. Z., Dr. Z. Beauty is down…she isn’t getting up, please come as fast as you can…this is Katie Jacob, please come!” The colic was treated and resolved. Katie baked a dozen oatmeal raisin cookies for me, thanking me. Raisin oatmeal cookies are my favorite. I have been given few honors since that have meant as much to me. I flipped further in the record…August 2006, “Exam for lethargy.” The physical examination showed a one hundred pound weight loss. A rectal palpation showed the spleen to be possibly enlarged. There were no infectious diseases on the farm. Beauty appeared to be depressed. I started symptomatic treatment after pulling a blood sample for a CBC and a biochemical analysis. I remembered how concerned Katie was, and the argument she had with her Mom and Dad about her leaving for college the next day. Mr. Jacob finally convinced her that Beauty would be given all the care she needed. A few lines lower in the record I saw the laboratory results; anemia, hyperglobulinemia; and a mild neutrophilic leukocycytosis…A TYPICAL LYMPHOCYTES PRESENT POSSIBLE NEOPLASTIC. I recalled the conversation I had with Mr. Jacob. I told him how I tentatively made the diagnosis of Lymphosarcoma. We discussed the possibility of having Beauty seen by the internal medical specialists at the veterinary college. Beauty was seen at the veterinary hospital the following week. Ultrasound, radiographic, and bone marrow examinations confirmed the diagnosis of Lymphosarcoma, a malignant, neoplastic disorder of the lymphoid tissue. The prognosis was grave. I had a re-check examination of Beauty in the beginning of September. Beauty was alert and in good spirits but she lost another twenty-five pounds. I spoke to Mr. Jacob about what signs to look for to show that Beauty was getting worse or if she was in pain. I told him that most horses diagnosed with this cancer succumb within six months of the onset of clinical signs. Whether he ever told Katie about the potential of short survival I do not know. I looked down at today’s entrée, EQUINE EXAM, POSSIBLE EUTHANASIA, PATIENT IS INAPPETENT AND APPEARS TO BE IN PAIN.
There are two areas that the veterinarian and the owner must transverse when dealing with euthanasia. The first is the decision to perform euthanasia. This is determined by medical outlook for the patient; the emotional readiness of both the doctor and owner; and the ethical perimeters shared by all. The American Association of Equine Practitioners (AAEP) has developed euthanasia guidelines that can help in this phase. Included in the guidelines are some of the questions:
– Is the condition chronic or incurable?
– Does the immediate condition suggest a hopeless prognosis for life?
– Is the horse a hazard to himself or his handlers?
– Will the horse require continuous medication for the relief of pain?
The veterinarian and owner must reach emotional readiness and share ethical perimeters before the decision to perform euthanasia can be made. The second phase in dealing with euthanasia is the practical preplanning that must be accomplished. Any insurance considerations must be addressed. The owner must keep insurance providers informed of any major medical events and the consideration euthanasia. Some policies require a second opinion before euthanasia. Others require that a necropsy be performed after euthanasia. The AAEP offers additional recommendations when preparing for euthanasia:
– Decide when and where the procedure will be best carried out.
– If you board your horse, inform the stable manager of the situation.
– Decide if you wish to be present during the procedure.
– Make arrangements in advance for the prompt removal and disposal or burial of the body.
– Explain to members of your family, especially children, in sensitive but honest terms, why the decision was made.
– Allow yourself to grieve. Seek a support person to talk to.
I was now driving up to the Jacob’s barn. A young lady was sitting on the fence. It was evident that many tears had fallen down her freckled face, but she smiled and waved, saying, “Hey Dr. Z”. The examination showed Beauty to be seven hundred pounds, her breathing was labored; and she had a mild shifting leg lameness of her front feet. With Katie and the whole Jacob family present, we discussed the present situation; the grave prognosis; and my recommendation that this was the proper time to consider euthanasia. The Jacobs, Mom, Dad, brother and sister and Katie agreed. After a short preparatory time I started the procedure. First I gave a strong sedative. As Beauty dropped her head, I administered the euthanasia solution. Within a moment Beauty laid down; within another moment I confirmed with my stethoscope that she had passed.
Very few words were spoken afterwards as I loaded the truck. As I started down the drive I noticed how empty the pasture now looked. Then on the dash of the truck I saw something strange. It was a single, fresh, oatmeal raisin cookie. As I drove away, a tear or two ran down my face. Were they tears of pain and despair? Were they tears celebrating the release of pain and the joy in the dignity of life? Yes! Because we have once again dealt with euthanasia and it will forever be “our biggest blessing and worst curse.”