Gentle Farewells

We recently had to say goodbye to our beloved Jake. He was a big fluffy Airedale Terrier.  People loved him. He had been fading for several years and nobody seemed to figure out why.  Was it age?  Was it the impact of epilepsy?  Was it the orthopedic issues?  It was getting harder and harder to get him up and out.  He would stop more and refuse to walk.  He had lost a third of his body weight over the last two years.

Thousands of dollars of veterinary care went into this dog.  Fortunately, we had pet insurance to defray the costs.  And nobody had an answer. 

Then last week, he suddenly could not get up for more than a very short period of time. He was not eating nor drinking.  The vet could not readily see the issue.  I pushed to have him imaged and there it was: aggressive metastatic spleen cancer, with metastases to the liver and lymph nodes.  Inoperable and deadly.  We spent the week with him, and he got a lot of love.  By the end of the week, it was clear that although there were interventions, there was not a lot of mileage to be gained.  If we did nothing, the risk of a really horrible and painful death was imminent. 

I took him to the beach which he loved.  Then, we went to the vet, and no other clients were there.  It was almost as though the universe made everyone else late or made them cancel so that his doctor could be there with us.  Jake wasn't in pain, and he wasn't afraid.  I stayed there with him.  The propofol put him to sleep in seconds, and then the euthanasia took his life almost immediately.  It was peaceful and kind. 

The Good Fight, the Not-so-good Fight

Jake’s passing made me think about the way so many in the medical profession approach dying and death. As medical providers, we are taught to stop at nothing to win against disease and death.  Yet at the end of the day death always wins... at some point. 

I remember seeing many patients who spent months in the hospital fighting inevitable death.  It made me think of the pain, the infections, the delirium. 

It also reminded me of the patients I saw in consults.  The consult question was "depression," "anxiety" or "suicidal ideation."  Sometimes the patient really was depressed, and sometimes the wish to die really was curable by curing the depression or the pain. 

But sometimes the patient was just exhausted, and they wanted to go home to die.  They didn't want to continue the interventions.  They did not want to fight.  One woman I had, deeply religious, said she was not worried about dying.  She was looking forward to being with her lord. 

I remember the disagreements I sometimes had with teams in conferring about goals of care ("we're not there yet") or bringing in Palliative ("we don't want to make them think we're giving up.") 

For me, when it's my turn, I hope I learn from Jake. I've seen beloved humans in my life fight for years, losing all the way.  Like my dog, I want to have a good life.  And then, I want to be with my loved ones and let go.  I want my loved ones to let me go.  I hope my providers will listen, and not call psychiatry with a consult of "depression."   I hope that they learn (as I hope I do) that sometimes "first, do no harm" means helping someone have a gentle and loving good-bye.