Saying Goodbye is Never Easy

by Christopher Forsythe, DVM

Hello, readers. Welcome to Health Matters. My name is Dr. Christopher Forsythe. I am a small-animal veterinarian practicing in Sonoma. Each month I will contribute a pet veterinary care topic with the hope of tweaking your interest, making you smile, and educating you about your pets.

During this time of the year, we have a chance to think about faith, hope and healing, and to count our blessings for the good things we have in life. For me, one of the biggest blessings are pets, those I have at home, and those who fill my professional life.

As a veterinary hospital team member, my most difficult yet intimate duty is to send pets on their way and help people say goodbye with dignity. It is clearly a heart-wrenching part of what I do, yet in some ways rewarding and bonding for me and clients because this is when they most need their veterinarian’s strength, support, love, kindness, and caring. It’s the most tender and difficult decision they will ever face with their beloved pet. Euthanasia is a unique process that offers people an opportunity to say goodbye when the time is right. This moment can be a comforting experience rather than a traumatic one.

Many Novembers ago, when I was fresh out of veterinary school, I was faced with the dreadful and scary decision I often now see in my practice. My dear old lilac point Siamese cat, Dame Edna, the crusty old feline I’d had for 15 years, was very sick: she was drinking a lot, urinating constantly, losing weight, vomiting, and wasting away. I knew something was seriously wrong, so I asked the other doctor at work to run some tests. Dreading cancer, kidney disease or diabetes, I thought about my long, wonderfully-happy past with Dame Edna.

I bought Dame Edna when I was in college 15 years earlier. I drove to a very poor section of town and went into the house, where I met a pitiful little six--week-old kitten tied by a short tether to a coffee table leg. I paid 50 bucks for her; the man tossed my money into a suitcase that had a sawed-off shotgun in it! I took the little wide-eyed pussy cat and ran (for my life).

Despite a scary start in life, Dame Edna saw me through many adventures and events, including dorm life, living in Hollywood, getting married, and a cross-country move to New York City. Dame Edna even meowed at us once when our U-Haul was not closed properly. She was a solid companion and little crusty creature who helped me pursue my dreams. The idea of something going wrong with her was unacceptable. I hoped that with my veterinary education I could fix anything failing in her body.

The test results were numbing. Dame Edna’s kidneys were shutting down. Her urine was extremely dilute, which meant her kidneys were not able to concentrate urine and eliminate nitrogen waste from her body. The diagnosis was clear: end stage renal failure. I now realized that Dame Edna’s body was worn out. My education had crammed enough cold, hard science into me to make me know the gravity of the situation.

Nevertheless, my heart was not such an easy sell. Fight or flight took over, and I went into a panic mode, desperate to save my little friend, this little companion who had helped me get so far in life. My craggy little blue-haired friend who had stood by me while so many of my dreams came true would not, could not, die; it just wasn’t an option.

In short I was, like so many clients, in complete denial, so much so that I used my lunch break that day to go purchase the most beautiful and expensive pair of shoes I had ever gotten. But sure enough, Dame Edna was still sick after lunch, and getting worse. That’s when my colleague, Judy, told me it was time to wake up and smell the ammonia. "Are you really thinking about what is best for her, or thinking about yourself?" she asked. That’s when it hit me: my shopping bag fell to the floor and my tears came. After that, I came realize that the most humane thing I could do was give her the proper send-off she deserved, with dignity and grace, and no more suffering.

Gauging quality of life

Often the best way for veterinarians and clients to gauge whether or not a pet is still living well or descending into a substandard existence is to create a quality of life checklist that includes activities your pet enjoys as part of a happy, full life. Some popular items on such a list include:

• Eating
• Playing with a ball or toy
• Going for a walk (dogs, and maybe a few cats)
• Sunning in a favorite window (cats)
• Jumping on the couch to cuddle
• Tug of war
• Chewing a Greenie
• Self grooming, purring

Many doctors advocate measuring a pet’s ability to enjoy the activities he once did; when the list shrinks to just a few, it is most likely time to euthanize.

Dame Edna’s list was down to zero. She didn’t eat, sun, groom, or purr; she was not enjoying her life. Why couldn’t I see that? Why didn’t I want to see that? It must have been my own fear, not wanting to let her down, or being able to say goodbye, or not knowing what she was really thinking, or perhaps not accepting my own human limitations. But when I looked into her powder blue eyes, and she gave me the slow deliberate blink and the crackly old Siamese meow, she really was letting me know it was time to go.

A farewell gift

As you can see, the decision about when to euthanize is excruciating, as I learned when Dame Edna got sick. Veterinarians can offer guidance and comfort, because of their own personal experiences, to people with pets who are really ill. Some people wish to be present at the end while others do not. For those who do, a further decision is whether to be with their pet as she takes her final breath or loses consciousness. Your veterinarian, as well the many other people on your support team, can help you make such decisions.

In a ritual I now offer my clients with self assuredness, my colleague gently got our kitty exam room ready for the euthanasia. Thankfully I would get to be the client on this one, and it was a good thing. As a blithering mass of blubbering vet, this was way too much for me to be in charge of. Suddenly my legs were like Jell-O and tears streamed down my face like I was watching a Hallmark commercial.

Judy gave Dame Edna an intramuscular injection of Telazol, an induction agent anesthetic that would cause my kitty to go under anesthesia in my arms. This would allow me to hold her, love her, thank her and say so long for about 5 minutes in quiet solitude, in peace and quiet, in the dimly-lit exam room of the first pet hospital I worked in after finally achieving our dream of my becoming a vet.

As I stroked her matted, oily, blue tinged hair, the years zoomed by, and we both knew this was the right thing. Dame Edna purred, for the first time in a month, finally knowing she was getting to go where she needed to. I calmed down too, confident that starting this process for her was "halfway home." In the background, Mozart was playing softly. This was the same music Dame Edna loved listening to when I played the piano. My only regret was all the times I’d fussed at her about for getting footprints on the high-gloss ebony finish of my piano. As she finally drifted off into a coma, I kissed her fuzzy nose and told her I loved her.

As if she was reading my mind, Judy snuck in and gently asked if I was "ready." "Yes," I lied. I was, and I wasn’t. But Edna was, and that was all that really mattered. So together, Judy and I, with newly found strong legs, and steady hands, held off Dame Edna’s back leg vein, and I injected some sodium pentothal into her tiny, fragile vein. As the solution went in, all I could say to my little companion was "Have a safe journey, my friend." As she took her last little breath, I knew she was well on her way, and I felt a sense of hope, and faith, and somehow even healing.