The Agony of Euthanasia Decisions
If you have owned more than one dog in your life, chances are that you have had to, as we euphemistically refer to it, "put your dog down", "put your dog to sleep", "let him go". Let us not mince words about this though, we are making a decision to end a life, very often a cherished life. This is not a decision, that once executed, we can process and undo. This is one of those life circumstances where there is no negotiation, no do overs. Done is done. A life will be over. This is a monumental responsibility and decision to make.
Let me state categorically, that I am in favor of euthanasia, as an option to create a painfree death. I don't even want to parse that. I think it's an essential component of the care and well being of our animals. I only wish we were as compassionate to humans. However, that does not mean that taking a life, should become routine or that we should diminish the difficulty of that decision, or its impact on the people and animals involved. We are making a decision about when to take a life.....that is a horrific responsibility. "Ok, golly gee, what day should I kill my dog....?? Tuesday would be a great day,"...said no dog owner ever.
I think though sometimes, because we have become accustomed to its being a part of our life with animals, that we diminish the impact and stress having to make such a decision can have on the owner. One of my dog friends and colleagues once wailed, "Why can't my dogs just die????" I completely understood what she meant. To be clear, she didn't mean that she wanted any of them to leave. She just didn't want to have to face that decision over and over and over again, as the years of our lives with animals spin by.
At 63, I have faced this decision innumerable times, dogs, cats, horses, and not only does it not get easier, it seems to get harder. And, I have had to deal with deciding and executing such a decision during the years I lived in Mexico where nice, sanitized office euthanasia is not always available. Let me just say that if you've never had to deal with such a circumstance, you don't want to. In our not so distant past, and in many other parts of the world, euthanasia is not only a personal responsibility but your job, no one else's. Many years ago, when I was learning about being back country with horses, I remember being taught how to make the x on a horse's skull above the eyes for the perfect place to aim a shot in the event of a broken leg. I have never owned a gun, nor do I plan to, but the point was that if I wanted all things "horsie", this was the non Disneyland aspect of that responsibility.
In all my years, few of my guys have just peacefully died on their own. Napitok, bless her heart, was the regal queen to the end. An elegant grey sable shepherd mix about the size of an English shepherd, Napitok had been thrown away as a young, intact bitch puppy in the arroyo that bordered our property in Mexico, like most of the strays that would end up as part of my Mexico pack. I went out to my adobe sanctuary one morning where we had temporarily put the massage table I used to work on people while we built our house, only to encounter a small growling thing peeking out from under the draped sheets of the table. Terrified, hungry and covered in rope marks I thought were blood, but turned out to be a tarry substance, Napitok would become the first of the Mexico dogs. I held her on my lap most of the day for three days as she was too terrified to put down. On the third day, she got down, looked around, moved in, and the Queen was born. With her quiet, elegant dignity, she ran the pack for a decade with nothing more than a raised head and a Look. She never ever left the ranch to wander, and I could and did travel without worry and leave her in charge along with a human caretaker.
The morning she died, we had been out on a walk, and I had come back into the house. We were by then, at the ranch in the states. I looked out the kitchen window to check on the pack and Napitok was lying on her side under the big pine tree facing away from me. I knew something was horribly, horribly wrong in that simple detail, as not once in a decade had Napitok ever not lain or sat with her eyes glued to the house to see when I would emerge. And that was it. She simply lay down and died.
As horrible and rendering as it was, that death was a gift from the Gods. The most beautiful, gentle animal death I have known. But not all transitions are so easy and making the decision of when to schedule a euthanasia can be incredibly traumatic.
What are the guideposts and signs that we can use?? I don't know the answer to that. I truly don't. I can only describe my journey through this forest of indecision and pain in hopes that it might make someone, somewhere feel less alone. My friend Liz Barene, who bred beautiful Arabians and spent the last decade of her life rescuing the unplaceable greyhounds, the elders, the whelping bitches, the aggressives (yes, there are aggressive Greyhounds), once turned to me in a fit of anguish after we put a horse down and said, "You know, I've done it both ways. I've done it too soon, and I've done it too late, but if I have to choose, I'd rather be early than late." That became our mantra ever after. But that still doesn't answer the question, when is "The Moment".
I've had situations where The Moment was in fact, crystal clear: the morning after the interminably long night when Nagi had his stroke. The seizures hit him, he voided, much to his profound embarassment, and then couldn't stand up. His face was anguished. I cleaned him up, carried my beautiful boy outside onto a pile of blankets and we spent that long Sonoran night under the vast glittering sweep of the Milky Way, as we had spent so many nights at the ranch in Mexico. Nagi was a magnificent grey sable Shiloh shepherd who never met a human he didn't love and who didn't love him. He had been copilot with Napitok for a decade after his rehab, and trained hundreds and hundreds of dogs to stability. There was no way in hell that I was going to let that magnificent dog suffer one more second of indignity than necessary. We were at the vet's office when they opened, and even my old curmudgeon of a vet wept.
My bright light Melissa was a lot tougher. Her kidneys were going downhill, but there was affordable treatment protocol I could do to relieve her condition. I learned how to give subcutaneous fluids, and we rigged her bags on a hook on the back of the door, that's there to this day. I poked needles in her and sat on the floor with her for weeks while the bags of fluids created great lumpy masses under the skin that gradually resorbed over the course of the day.
Towards the end of my time in Mexico, I had had to make an extremely tough decision about my beloved first shepherd, Angie, a magnificent black and tan, the spitting image of Rin Tin Tin, who had a growth on her leg that caused pain and which steadfastly refused diagnosis despite trips to the states, biopsies and lab work. I wasn't even sure that my extremely Catholic vet would discuss euthanasia with me, until I broke down one day during one of Angie's office visits. He looked at me, and said, "There has to be a quality of life for everyone involved, both you and the dog." Those were the second set of words to sear themselves into my soul as a measuring device for this most awful of decisions.
As time went on with Melissa, we both dreaded more and more our twice daily needle time. I was good at the needles, I had been the shot giver in my barrio in Mexico for humans, horses, dogs, and cats and had given hundreds. But those recipients weren't my little brindle shmoo Melissa with the sherry brown eyes, and the teardrop body shape, found abandoned at a Chapel outside of Magdalena. She began to shake when I came near her. She had been the dog who always and ever came pelting down the driveway of the ranch to greet me as soon as she heard my car crossing the wash. Never one day in her life, until needles entered our life, did she not greet me at the gate with full adoring mouth gaping, and wiggling fit to beat the band.
For a while, we soldiered on, with me adopting a "this is for your own good" attitude, squishing down what I felt about the looks she gave me. There came a day when as I approached her to put the needle in and run fluids, she shook so hard I couldn't insert the needle first because of her trembling, and second because I couldn't see through the tears. I sobbed to her, "I just can't do this anymore. I'm so sorry. I just can't do this anymore." She looked at me and I knew without any doubt in my mind she couldn't do it anymore either. I gave her a few days of peace at the ranch with her beloved pack around her, but we had found her moment. The quality of life for both of us had become strained to the breaking point. Decision made, we were able to enjoy, for lack of a better word, an honoring of our last time together, all of us, the six dogs who were left when I had come back to the states who formed such a tight knit group it was truly hard to say where one dog's personality ended and another's began.
Petunia, the little timid scruffy terrier, Melissa's best friend, got into poison a short time later. I took her to the vet and we did everything necessary. She rebounded for a while and then started declining rapidly. I was still raw from nursing Melissa, funds were stretched from a variety of dog emergencies, and Petunia's prognosis was not good. In her case, an imperfect storm of life, practicality, my gaping wounds and the dismalness of prognosis came together to compel The Decision.
Like other deaths where life's reality raises it's ugly head, her euthanasia felt awkward. Could I have done more? Should I have done more?? Did I fail her? Did I do less because she was an awkward timid dog, perfectly functioning within the pack, but never really my dog? To this day, I don't know. To say I did the best I could under the circumstances is facile, and I don't know if it's remotely correct. Nor has any approximation of that notion ever given me solace. I don't know if I did the best I could. Many factors coincided and collided. I think in the end, she wanted to join her pack and my gut instinct was ok, but that's a feeling, not a knowing.If that is the case, she was my second dog to choose to leave after the death of a pack mate.
After my first shepherd Angie was put down, Aleuchi, the golden hound, sat on her grave for a week. There were no fences at the ranch in Mexico, no crates, no kennels. The dogs were ranch dogs and stayed at the ranch of their own volition. My voice, hands, and food were the only training tools. Aleuchi's choice to camp out on Angie's grave was chilling and obvious. He mourned hard for a week, and then he set about dying. Within 10 days he had manifested a lump on the side of his face. We treated this with antibiotics and assumed an easy resolution. Ten days later it was not only not responding to antibiotics, his face was swollen half again its size. I drove him up to the states for potential surgery, to get in there and see what sort of abscess was going on. The vet and I figured tooth/foxtail/thorn....something. Oh no, it was cancer, a major mass. Through all the tests and procedures, he was his eternally sweet, loving self. The staff fell in love. I have written of this elsewhere. My vet closed him up gently, and got ahold of me. I came back, held him, said goodby and we honored his wishes to leave. He was a dog who chose his own moment of leaving. I am utterly convinced of that. Angie left, and he left to go with her. Simple as that.
Which brings me to this last year, where after all this time, all the many critters, I faced the worst euthanasia decision I have ever had to confront. This one had no boundaries. No margins. No signposts. No guiding lights. No intuitions. Very very gently said, the absolute worst advice, which I was given over and over and over was, "You'll know... you'll know when it's the right moment." Well what if you don't know? What if, after a lifetime lived within nature, within dog pack, you don't know? What if you feel like you are the most horrible person on the planet to even be thinking about euthanasia?? What if the potential for lingering in a grey twilight zone of sort of functioning had the potential to go on for years?? What then?? What if, you know, from having been through it with many others over 60 years, that you suck at being a nurse?? Trash yourself back in a back canyon?? I'm the medic you want at your side. Never fluster. Never lose focus. Never slip. Never let down, until it's all over. But water on limestone, the drip, drip, drip of prolonged ongoing nursing -- my worst nightmare.
Ah Rusty, my foster fail. Rusty was a small, sesame colored (red with black tipping) Shiba Inu who I first took in as a foster, when he was about 2 years old. Lily, my other shiba, was about 1 at the time. Rusty was severely OCD. He was a spinner. He apparently had never ever been in a house as everything was new to him: lights, refrigerator doors, toilets flushing, cabinet doors opening -- everything made him spin. It took a year, millions of treats, and thousands of sits to interrupt the spinning to manageable levels. I placed him out and he lasted about 2 months and started spinning again. He came back never to leave again.
At his very worst in the beginning, Rusty was the sweetest dog on God's green earth. He could have been Melissa's soul mate. I untrained the spinning but he arrived and departed our lives uniquely Rusty. I didn't create that. He came sweet and left sweet. I cannot tell you how many hundreds of people's lives he touched by his simple loving presence. He was an eternally happy traveling companion. He, Lily and I, and the shepherds, first Nagi and later Rajah, have hiked a million miles together through the west from northern California to New Mexico, Colorado, and a thousand, thousand hours throughout my home away from home, the White Mountains here in Arizona.
Rusty's one failing was that he believed himself to be the mighty mongoose Riki Tiki Tavi of Kipling fame. He was convinced that if only he were a little faster he could take out the Great Enemy, Mr. Rattlesnake. He was snake trained. They all are, and all are super functional except Rusty. Rusty believed it to be his mission to kill Mr. Snake, with disastrous consequences. The first bite was handled speedily and well by my emergency vets in Tucson. Anti-venom, a 24 hr. stay, a few days recovery, and life was good. My pocket book was empty but I had an intact dog with minimal to no sequellae from the incident. Two years later, not so good.
I was out of town this time when he got bit. A young local vet, off shore trained, gave incorrect advice to my caregiver and I, no anti-venom was administered and by the time I got to him the next morning, he was on death's doorstep with rock bottom blood pressure, albumin levels completely awry and his blood components in a complete tailspin. A week later, after heroic efforts on the part of my emergency vets in Tucson, and a whole community of people who came together to help support the effort, Rusty came home, shaky but alive. He was never quite the same after that, although he recovered enough to do nearly another four years of adventuring.
As he aged, we began to wrestle with weird sequellae that we traced back to the bite, head tremors, some ataxia, muscle contraction, and a level of proprioceptive impairment. We put him on occasional gabapentin, and that settled things down for a while. Then the fecal incontinence started. Shibas are meticulously clean dogs. They clean themselves like cats, and given their druthers, poop at the farthest point from the house your property will allow. Lily potties at literally the furthest diagonal corner of the ranch from the house. Rusty always pottied out on trail as well, far from the house. Suddenly, I kept finding feces all over the house. It was so odd that it took me days to actually figure out who was doing it. I suspected Rusty, but never caught him in the act, until I did. At first, I thought this was just an aberration, a bad day, and modified management protocols to put him back on a puppy schedule, get him out more and try and prevent the accidents. Thankfully, during the whole course of the year long nightmare, he never had diarrhea. It was always small, discrete balls, that were after all, fairly easy to clean up. But the accidents became more frequent. Now it was at least twice a day, nearly every day and often in the middle of the night in my bedroom.
There is nothing quite like waking up at 2 am to the smell of feces in your bedroom. But this was Rusty. Other than the fecal incontinence and some weird tremors if you touched his head wrong, he was fine. Still coming on pack walks. Still happy. Still silly. Still sweet. I learned to pick up the poop, flush it down the toilet, clean and go back to bed. We had a new routine. I tried crating him in the other room, but that made him frantic and left a feces spattered mess. We upped the gabapentin and saw some small level of benefit.Then he started having urinary incontinence. Proen nipped that in the bud, but now he was on two maintenance meds to get through the day and I was starting to feel the tremors of anxiety at the back of my neck.
We actually all thought at the start that he had tweaked his back somehow, and that we would pull him through this incident that was causing the hind end dysfunction. Shibas are very long lived and he was only 10. Perhaps Rajah, the shepherd, had bumped into him, or he had taken a wrong step, or jumped off of something awkwardly. Along with the meds we did bodywork, acupuncture, laser, you name it. Hey, I was the queen of canine bodywork, I had helped many other elder dogs regain a higher quality of life. Of course Rusty was going to respond. But of all we did with him over the next year and a half, while it all made him feel better and bouncier, nothing impacted one iota the fecal incontinence.
Time spun on, months rolled by, and we settled into a sort of routine. It worked, he was happy, but I could feel the tremors of anxiety in me becoming full fledged waves of panic. How long was this going to last for I wondered?? Is he going to get well, or is this it? Are we condemned to linger in this twilight place forever?? My sleep patterns became constantly interrupted as the sounds of his restlessness penetrated my mom alert brain button. His gait pattern became more and more aberrant by teeny, teeny tiny degrees. One silly micromillimeter at a time he declined.
A summer passed, and you could see him struggle with the heat even on short walks. That winter we went on vacation to the snow. He loved the adventures but was conspicuously intolerant of the cold and stayed wrapped in dog sweaters, jackets, and blankets the whole time. I felt us edging closer towards some edge, but he was very much still present and still Rusty. I felt horrifically guilty that the constant clean up was beginning to take its toll on me. I thought about euthanasia a lot. It became a daily internal conversation. I had been a long time dog pro by then, knew a lot more about care, had more resources at my disposal, but my essential nature had not changed. I was not a nurse. I hated it. Really really hated it. But this was Rusty. So I brought everything to bear, and the internal dialogue raged on.
What are my landmarks here I wondered?? When decline is so slow and gradual and the essential nature of the dog is still there how can I even be thinking like this? I felt abysmally guilty, and torn in half. One part of me felt I needed to be the very best caregiver I could possibly be to this precious creature who had become so much a part of my soul. I needed to just suck it up and get on with it. The other part was like yuck, phooey, I can't deal with this. I felt like even having those yuck/phooey thoughts made me the most horrible dog owner in the world. I began to flounder.
I talked to colleagues and friends. A lot. I began to obsess. I think towards the end I inflicted euthanasia conversations on anyone who paused for breath anywhere in the vicinity of my life. What I found was that nearly everyone was horrifically uncomfortable with the discussion at the level that I wanted to engage. There was that, "You'll know the right time" bit again, and a shift to other topics. "But when, when is the moment??, my soul was shrieking. "When is the moment to kill my dog, when there are no clear markers but everything feels wrong??"
Euthanasia is a tough enough decision, but with no clear markers?What then? I have lived close to nature for a long time, and I could feel the disharmony that was beginning to fill the ranch. But my cognitive brain just thought my emotional body was being a lazy, selfish wuss. I began to enter into what I can only describe as the nightmare period. Rusty was still chugging along, mostly still a semblance of his Rusty self, albeit deteriorating drop by drop, while I was starting to crash and burn.
Later, my vet who would be Rusty's death midwife, for lack of a better way to describe the extraordinary care and ceremony that was given, provided yet another set of words to use in making the euthanasia decision. He quoted a colleague as saying, "When four out of the five essential behaviors of the animal, that make that animal uniquely themself are gone, that's a marker." Another set of words now indelibly emblazoned in my soul. Although in Rusty's case, even at the end, all the markers of his life were still there, they were just very muted.
Through it all he remained very much Rusty. Slower, but still Rusty. Same shiny, shoe button eyes, same alert little head, cocked, crooked tail, prancing silliness in off moments when life would engage him again. What my decision to end his life finally came down to was back to that assessment of the quality of the whole. It had been a year and a half of dealing with nightime interruptions and fecal incontinence. There has always been an integrity of calm, and healthfulness at my ranches. Through divorce, changes in location, and various people generated crises, the core cycles of critter care and our life lived in rhythm with nature have always remained intact. While I grieved a divorce, for the dogs, pack walk still came in the am and pm along with food and pets. They had no notion of the monumental logistics in moving us from one location to another. They climbed in the car at one end, got out at the other and resumed the same patterns. We had a collective entity that survived and surpassed the flurries of the individual components. What we had all created together, and by now, several generations in, was greater than the sum of the parts, but it was in danger of shredding.
For the first time ever, the center did not hold. I could no longer maintain the integrity of the whole. I was the weak link. I just could not function at the center of the puzzle, doing daily care, up and down all night, and have all of us, horse, and remaining dogs be as integral as possible. I began to look at the quality of the whole as opposed to just looking at Rusty, or me and Rusty. I realized that everything that was important to me about living in rhythm was in danger of being permanently compromised. I hadn't taken time with my horse in ages. I was constantly tired and getting increasingly cranky with my other dogs, friends, and colleagues. I had no more to give to the nursing care. I took a deep breath and made the phone call. For better or worse I had made The Decision.
I shook the entire 1.5 hr drive over to my vet who had known Rusty since I adopted him. My soul was still a battlezone, not at all eased by having taken steps towards a definitive position. I took the other two dogs with me. Their lack of stress or reaction, throughout the ride and the procedure, as they were in the office with us, was telltale and evocative. I expected some level of reaction when Rusty's body eased into death. They sniffed and lay down. That was it. Not exactly validation for the storms inside of me, but a hint of that. My colleagues there, who knew both myself and all the dogs, confirmed my assessment of his deteriorating condition, and again, not precisely validation -- "Yes, this was a great time to kill your dog." -- but a gentling into living with the most difficult decision I have ever made. Dogs, horse and I have come to a semblance of peace around the decision, but the hole he made in leaving is still a large one. Inside, as a friend put it, it feels as if the storm has ended. There are definitely branches down, and debris, but the storm has passed.
Every euthanasia decision is intensely personal. I have had to make too many. In the end, (leaving aside the ill considered isolated cases which pop up on one's social media feed from time to time) there is no absolute right or wrong, there really is perhaps only the best we can do under the life circumstances that confront us in that moment, and nobody lives inside of that truth but ourselves. Had resources been unlimited, I probably would have taken Angie for a 3rd and 4th opinion. She was not ready to leave and wanted solutions to the growth in her leg I didn't have at the time. Too soon? If I knew then, what I know now, I would never have had 18 yo Patches put down in Mexico, as they didn't have the drugs then to handle the procedure correctly. Too late? Those scars I will live with for the rest of my life.
At the best of times and under the best of circumstances, it is an extraordinary responsibility making life decisions about another living creature. Rarely is life so perfect without the additional pressures of life, work, family, money, or health impinging to cloud the picture in a thousand ways. It is important that we acknowledge and validate the enormity of these decisions with each other. There is no such thing as a routine euthanasia. Choosing to end an animal's life is monumental. All we can do is try and gather signposts along the way, like slats on the Iditarod trail, to help provide reference in the middle of the storm.
Living with animals, loving them, and losing them carves craters in our soul, but for many of us, a life without them is unthinkable. Ever and always, I am reminded of the poem,
"We who choose to live our lives,
surrounded by those whose lives
are ever so much more fragile than our own,
still we would choose to live no other way."
Suckers for punishment, we muddle on.
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