Off the Charts

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

Sam in his hospice quilt

Last week, we took Sam, our ailing 14-year-old Labrador Retriever, on what became his last trip to the vet. Sam had been diagnosed with bone cancer in February after we noticed the right half of his head enlarging. Because of where the tumor was, it was inoperable. We felt that at his age chemotherapy wasn’t a realistic option, and we didn’t want the last few months of his life to be bad ones.

His veterinarian, who’d treated Sam since his puppy days, supported the decision, saying she would make the same choice for her dog. And so we spent the last few months adjusting doses of steroids and pain meds to enable him to live as normally as possible. For Sam, “normal” was being able to greet all comers to our door, to be the leader on his walks, to be smack in the middle of where his family was. (If people were in the basement and on the second floor, he would lie equidistant from where everyone in the house was. If we were in the same room, he sat, front legs crossed in his “elegant dog” pose, where he could see us all.)

So last month, when we saw that he would no longer get up to greet visitors or his family; was reluctant to go on walks (he did, but with a great sigh and lots of panting after even the shortest walk); and, finally, stayed in a corner of the back hallway, no longer making the effort to be part of the family, we realized Sam’s quality of life was diminishing. It became abundantly clear when he wouldn’t eat his normal food or even cookies, his favorite, that Sam was suffering.

When we took him to the vet, secretly my husband and I were hoping the vet would give us a different regimen that would restore Sam to the dog of a few months ago. But the vet pointed out that, at most, any measures we could take would only gain us another few weeks—and there was no guarantee of even that. She also asked us about our motives. Clearly, prolonging Sam’s life meant prolonging his discomfort. It became obvious that “keeping him going” would be only for our benefit and not for Sam’s. And so we decided it was time to say goodbye.

The technician brought out a quilt for Sam to lie on, and we fed him cookies and petted him and talked to him while the vet gave him a large dose, an overdose, of sedative. It was all very peaceful, and we were grateful for the support and guidance of the vet and her staff in helping us let Sam go.

I couldn’t help contrasting Sam’s death with Theresa Brown’s story of her oncology patient in her recent opinion piece, “A Dying Patient is Not a Battlefield.” Yes, I know Sam was a dog, and I’m not advocating euthanasia, but I am advocating that people deserve a good death and shouldn’t be cajoled into decisions for the benefit of others.

I worked as a chemotherapy nurse during graduate school, and I remember discussions with patients who made treatment decisions they really didn’t want to make but made anyway—because they didn’t “get” that things were not going to get much better, or they didn’t want to let their families down or, worse, felt they “owed it” to the physicians and staff who were working hard to keep them alive. What messages are we giving to patients and to families if they feel they owe us anything? What happened to what we learned from the work of Cicely Saunders or Florence Wald in creating hospice care? What happened to those of us who are charged to be advocates for our patients? Brown’s piece is a reminder to make sure our patients have the right information to make informed decisions, and then to listen and support their decisions.