I’ve been a veterinarian for 36 years and an animal lover much, much longer than that. Certainly, over the course of my career, I have advised and supported others in end of life decision making and facilitated the passing of patients – especially in the early years before becoming an ophthalmologist. And I have learned so much more on this topic in recent years. I only wish I’d had this knowledge early on in my career. I’m talking about quality of life assessments, talking about end of life with clients, euthanasia best practices, as well as a deeper understanding of the human-animal bond and the grief associated with pet loss. Most importantly, I am grateful for being able to couple that knowledge with wisdom gleaned from past personal experiences. It’s never too late to learn and grow.
In my adulthood I’ve owned and cared for three dogs and one cat. My first dog was gifted to me way back in 1985 - upon graduating college and starting veterinary school. She was my companion for over 13 years – moving with me around the country throughout my early career - vet school, internship, then residency, and my first job working as a specialist in NYC. I learned a lot from that dog. She had all sorts of problems at all stages of her life. At age twelve, she started to manifest the signs of Wobbler syndrome (cervical vertebral instability) and, one day, acutely ruptured a disc in her neck. She was immediately rendered paralyzed, unable to walk, and was given just a fair prognosis for a complete recovery with surgery. There were just two options before me – euthanasia or surgery, and I didn’t have time to think about it. A decision needed to be made now. She was twelve but otherwise doing okay, so I decided to pursue surgery. Given the location of the ruptured disc, she actually went into respiratory arrest just as they were getting ready to begin her procedure. She survived that surgery and, a month post-op, started to walk again. Around 18 months later she had a fall and that exacerbated her neurologic problems. I had no choice than to euthanize her. How often do we hear (and wonder ourselves) ... “how will I know when it’s time?” Well – this was a no-brainer. It was my time to say goodbye and her time to go. It was just a few years ago (some 20+ years later) that I came to the realization that the last year and a half of her life was not good. That's not a good feeling and I have thought a lot about that ever since. Now, I certainly didn’t have a crystal ball and couldn’t have known how things would turn out after that surgery. And I don’t regret the decision that I made at the time. But, I learned a lot from that experience. It would be years before that wisdom would manifest and guide me.
A second dog came into my life two years after she passed away. That dog died acutely and unexpectedly after a fairly “routine” surgery. She was just nine years old. I was devastated by her loss – I’d had no forethought of an impending loss or time to prepare. It was sudden and it happened on Christmas Eve. It was awful and I felt cheated and powerless.
A few months after her loss, a third dog came my way. He was just two or three months old when he’d been brought into the veterinary ER “in a coma.” The doctors suspected head trauma and traumatic brain injury. The owners didn’t have any money but agreed to a limited level of care. He was hospitalized, stabilized, and regained consciousness. He survived and wound up being “a dump.” His owners never responded to phone calls from the hospital or checked back for updates. He needed a new forever home. That would wind up being my home. Fortunately - for us both - my career had taken a turn and work was largely based out of a home office. My schedule came to include fulfilling on his needs, and tending to him meant trading “me time” for “our time.”
At this juncture, the telling of our story and life together could go in a few different directions, but I want to focus on just one. The end. His end. Our end. I share this because it may be helpful to someone else one day. He was 14 ½ years old and it’s been two months since I said goodbye. He’d been “slowing down.” And it was very slowly progressive. I can recall that in 2022, he was starting to show a reluctance for certain outdoor activities. He didn’t have the same gusto for long walks. But that would come and go. His blood work was picture perfect. I had him evaluated for “pain,” but nothing was revealed. I did some pain med trials and never really thought that they helped. So, time marched on and it was more of the same. Good days interspersed with “not so good” or “off” days. Two years ago, he started showing some sporadic changes in mentation and had episodes of wobbliness. I took him to see a neurologist. On MRI, a cystic mass lesion was seen in his brain. The neurologist didn’t think it was anything of significant concern. She said he’d likely had it his entire life and that perhaps, because of age, he was having problems compensating from its effects. After that, I really started paying attention to subtleties and preparing myself for a decision that might soon need to be made. A decision to let him go.
In early February of this year – I thought the time had arrived. He had a string of “not so good” and a few “bad” days. But, he was eating like a champ (3 times a day), would jump up for treats, and wanted to spend time in the backyard sniffing about. But there were times he looked tired. He would stare into my eyes and his expression told me his head hurt. He was no longer following me to the chair we’d share when I’d settle in to watch television. I promised him that I would not let him suffer. But so it went ... on and on for another few months – because he’d always seem to rally just enough for me to believe he wasn’t ready to leave. And I would check in with myself and ask, "what is going to be 'the sign'? What’s going to be the trigger for me to finally say 'this is it'?" By September and into October, he started to have some fecal incontinence – when he’d rise after sleeping (and at other times) poop would inadvertently come out. It just was a little here and there but it was significant because it was something new. But, did that warrant a decision to euthanize? Maybe. Maybe not. He was having more issues with balance – here and there. He was wobbly and had a choppy gait, but not all of the time.
I’ll cut to the chase. His blood work was still okay. On paper, this dog was healthy. He may very well have gone on and on for a prolonged period of time. I have no idea how much longer. And I’m not sure he was ready to go. What happened is that on a Sunday morning, as I was going to help him down off of my bed, he pooped. A lot. He simply couldn’t keep it in. He looked at me – mortified. The next day, something similar happened in the middle of the day. I took a break for lunch and spent that time laying with him as he napped. After a couple of hours of deep reflection, I picked up the phone and scheduled an appointment for an in-home euthanasia. It was set up for Wednesday afternoon. Over those next 48 hours I focused on remaining present in life with him and struggled to avert thoughts about the impending loss. On Tuesday, I tried to go about my day as usual. I wasn’t second guessing myself, but part of me wondered, should I give him a little more time? As was typical, I had music streaming throughout the house while I worked in my office. I got up to take a break and picked up my phone. When I opened it up, the song that was playing at that moment in time displayed. It was kismet.
His last day was actually one of his better days. He ate treats literally up to the end. I was heartbroken and still am. Although I’m left with a huge void – in so many aspects of each and every day – I do not regret the decision I made on his behalf. I gleaned a lot of wisdom from the end of life experience with my first dog. And I’m so grateful that I had the wherewithal and could provide my bestie with a graceful and peaceful departure from this world - before something traumatizing or catastrophic occurred. Over the past couple of weeks I’ve spent some time viewing Ring video footage that was captured over the last days and weeks of his life. Videos of us coming and going from walks. Objectively speaking, he was not living his best life – as evidenced by those videos. Yes, he was still eating and loving his treats. But his zest for life was waning and he was physically struggling. I’m mindful that a dog’s life is a dog’s life - not a human’s life. In the wild, he never would have survived. I was able to provide him the best quality of life that I could for as long as I could, and as good a death as anyone could hope for. He had a good life. We had a wonderful life together. He was blessing and so are my memories of him. But the biggest blessing was to be able to hold him, lovingly in my arms, as he painlessly took his last breath in the comfort of his own home.
Contributed by Sheri L. Berger, DVM, DACVO
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