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.
Part II My mother in law moved from her apartment to her daughter’s home, and the hospice people came there to give her care and manage her medications. At any hour, day or night, they’d be there if called because the pain was worse and the medications were not working. Most of the time—by far the majority—they DID work. They were not afraid of “overdoses” or “addiction” and neither were the doctors who worked with them. She lived about three months of good quality of life; all her close relatives visited at one time or another, and she was not in the–let’s face it—unpleasant hospital atmosphere.
As many know, there is a form of euthanasia in Holland, for persons in their “right mind” who can sign for it and be vetted by doctors who make sure, as I understand it, that they are not being pressured by anyone, or doing it out of fear of the unbearable pain they expect to have to endure. (In our country in MOST cases, experienced hospice doctors and nurses can control the pain, at least enough for the patient to have “good days” or even “good hours” when, for example, a close friend or relative comes to visit.) I don’t know if the Holland experiment will ever occur in this country, and I’m not advocating the Kavorkian route (in which there have been some very questionable “suicides”, some in patients known to be highly depressed but not physically ill)….
However, I have a living will as do my husband, my mother and any one else I know that I can influence. Too many families are stuck with a patient /family member unable to speak clearly and
coherently and don’t know what he/she would have wanted, and don’t have the medical expertise to help them make the decision.
Sorry to hear about the loss of the member of your family–your Golden retriever. We also had to make that hard decision about a year ago for our 15 yr old dog, as well as other dogs and cats over the years. Some have been experiences that leave you feeling you feeling you have done all you can do—in others, when I was less experienced—it was a nightmare. In one case, our beautiful “rescue cat”, a grey and white “tuxedo” cat, had to be put down. He had been terribly abused before we took him in, and was permanently afraid of strangers and especially of strange men. At the vet, I said, “he is afraid of men”, thinking that they would call in a female vet tech—but no, in came a young male tech who grabbed the cat by the scruff of the neck, hanging in the air, and took him away. I wish I’d stopped, run after him, grabbed the cat back….but instead I left in tears. I can only say a REALLY good relationship with a veterinarian BEFORE there is a crisis is paramount.
As for palliative care in humans–my mother in law had cancer…was given only 3 mos to live. She was not a medical person or very well educated but she had seen what her husband went through with chemo, etc, when his colon cancer went to his bones, his brain, and destroyed the quality of his life. He was in pain, nauseated, and his quality of life was not one that I myself or most people would want. So, therefore when my mother in law was diagnosed–and she knew the diagnosis due to hearing the doctors talking when they they thought she was still too “out of it” by the way—she decided on her own to have no “treatments”, just hospice. She moved from her apartment to her daughter’s home,not too far away
When it is my time, I hope someone considers pain and suffering more than opinions and expectations of others.
Thanks to all who sent condolence emails and related their own stories about pets that died – lots of animal lovers out there!
Thank you for sharing this thought-provoking piece, and I’m sorry for your loss.
This was a great post! Death is a part of life and should be handled much differently than we tend to. Thanks.