Owie.
I transcribe acute care, heavily skewed toward ICU patients, STAT admissions, Code Blue events, and emergency procedures. Many of these patients are frequent flyers, meaning they're in often and usually for a long time. Some are 90 years old, some are homeless drunks with liver failure, noncompliant diabetics, smokers with their 14th cancer recurrence, and many of them sporting ventilators, PEG tubes, wound VACs, constant dialysis, and pharmacologic support to the nth degree.
By the time you've transcribed the same people day after day for a month or two, it becomes a kind of a morbid soap opera. It doesn't really bother me to see them head out to hospice or fail that final CPR, though I occasionally wince a little at necrotizing fasciitis (my son lost a leg to "flesh-eating bacteria" and nearly lost his life) or tragic miscarriages (had two). What really bothers me is when I see these families fighting for every break in an effort to keep grandpa going--forget that he can't speak because he's on a vent, can't eat so they've got a tube through his belly to force feed him, a Foley and FlexiSeal because he can't go to the bathroom, and they're running out of antibiotics to try because he's colonized every bug possible. It makes me angry that there are people who can't afford to get health care--many of whom are actually insured, but their coverage stinks so badly that they can only afford to keep it "in case" of a catastrophic illness, and even then, they're still going to lose everything because their insurance company puts a cap on payouts. Meanwhile, there is this huge subset of acute care patients being kept alive at horrific expense, with no quality of life, simply because Medicine has the technology to do so. I've always thought I would prefer to go quickly than to be subjected to such a fate, both for my own sake as well as my family, who would benefit much more if I actually had something left to leave them. Better to rip the bandage off quickly than to prolong the misery and drag everyone down the abyss together.
So with this mindset, I found myself on the other side of this scenario. Those of you who aren't eccentric old lady types will just have to take my word that pets can be children, too. One of mine--my Westie--decided last weekend she was going to feel puny. Within a handful of days, she went from gleeful tormentor of cats to sad little girl. Very subtle at first, not eating so much, then not eating at all, finally not even drinking. Of course, veterinary care is pretty much a M-F deal here, so when she really started looking ill, we were still eight hours away from a doctor. Longest shift of my life--transcribe a report, hold the dog, transcribe a report, force feed her some water, transcribe a report, beg her to hold on until 7 in the morning and I'd rush her to the doctor and make it all better. The girl was only 9 years old, and never sick a day in her life. If this was a bowel obstruction, it was serious. Four in the morning and she was breathing badly. The clock moved in slow motion.
I've never been glad to run out of work (an increasingly common occurrence of late), but was thrilled when it happened 20 minutes before my shift was up. I punched out, threw myself together, and off we flew to the new vet, half a mile up the road. We waited an hour for the vet, who apparently routinely arrives an hour after they open. My dog panted, I held her, the receptionist looked edgy, and it just felt like we were standing on a precipice I didn't want to acknowledge. It felt heavy. When the vet made her first assessment, she had tears in her eyes and I knew it was going to be bad.
They printed out a price list so I could okay what I was willing to have them do. IV hydration, x-rays, barium study, enemas, suction, surgery. Could she even survive surgery in this state? Do we try to hydrate her and see if that's enough to get things moving? Then we find masses, which weren't there at her last grooming; this makes the prognosis very grim. As the vet and I are blubbering over whether I should euthanize my little girl, she finally sits down, looks up at me, and gives her last sigh--making the decision for me. It was the obvious decision, no matter who made it. Not only would it have been insane to hand over a couple thousand dollars I don't have to prolong her life, it wouldn't have bought her a quality of life worth living. She was hurting. Now, she's not. Except for the last couple days, she lived a happy, healthy, energetic life, so her end was very quick and as merciful for all of us as it can ever be.
I don't understand why we as a society are willing to grant our pets this dignity, but not our family members. The odd juxtaposition of sentimentality forcing an artificial and protracted death is just not right. Will we get over it sooner if we can tell ourselves "at least we tried everything possible" or "at least she went quickly," and does the answer pertain to their comfort or ours? Are we any better prepared when it happens? Are we any less gutted? I've had family die both ways--human and pets--and I think I can say with some authority that it hurts as badly every time when you're the one suddenly left behind. For the ones crossing the Rainbow Bridge, I think we're often holding them back longer than they'd like, and at the very real and practical expense of others who could benefit more. Our society is too afraid of death to accept it as the natural part of things that it is.
Ailís Fiona MacGregor, my little one who got away, I hope I can go as bravely and cleanly as you did--even though my world is now a whole lot smaller and will be shaky ground for quite some time in the aftermath.