The Impossible Decision

Some days the line blurs for a veterinarian and one of our own pets becomes our patient. It can be difficult to put on the vet hat and remain objective and provide needed care. Our delightfully weird “Purebred Dominican Street Terrier” Paloma became weak and lethargic over the weekend, progressing to complete anorexia on Sunday night.

November 2010, getting ready to leave Samana, DR

She seemed stable, so I administered some fluids and planned to take her to work the next day, assuming she made it through the night (since she’s mine, I tend to catastrophize). Also, I was expecting to find a disastrous diagnosis that would ultimately lead to euthanasia. Instead, her bloodwork, radiographs, and ultrasound, while not completely normal, didn’t have anything definitive or ultimately life threatening. She also perked right up after she was rehydrated with IV fluids. So, no euthanasia yet. Monday night, she once again wasn’t interested in eating, so I found myself facing a dilemma with no clear answer.

Normally, I’d be OK with riding this out and monitoring for a few days, giving meds and fluids time to work. But I knew I was leaving early Wednesday morning for the next 5 days. I’m actually writing this on a flight between Denver and Billings, Montana. I’ve been looking forward to this trip to work the Fort Howes endurance ride since it was scheduled a few months ago, but I hate the thought of being unavailable to help Paloma as well as leaving my husband and kids to manage a sick senior dog.

Doing what she does best, lounging on the patio and looking pitiful!

So, do I make the heartbreaking decision to let her go, knowing that she has lived a long life, has declined rapidly with weight loss and weakness, and has an underlying heart murmur and chronically elevated liver enzymes? Would I be stopping too soon, when she could very well rally and go on to have good months, or even years if we’re lucky? Paloma may want to continue to live her best life as a couch potato, suffering the annoyance of Mako and 2 loud kids, and vociferously notifying us daily that the neighbor is riding his bike AT THE EXACT SAME TIME AGAIN TODAY! I also would be putting a beloved family member to sleep and then leaving early the following morning not being there to support my kids who have never known our home without Paloma.

My other option is to boost her as much as I can with fluids and a variety of medications to encourage appetite and treat possible causes of her nebulous condition. The downside of this option is that I risk being unavailable by phone halfway across the country if she is to crash. This leaves my husband to try to manage emergency end of life care while flying solo with 2 kids and managing the rest of the circus that is our regular life.

I counsel people on end-of-life decisions for their pets on an almost daily basis. How many times are veterinarians asked “if it was your pet, what would you do?” Sometimes there is an obvious answer, but many times this is a very, very, very gray zone, and there is no right or wrong choice. Part of the Veterinarian's Oath is “the prevention and relief of animal suffering“ so I keep this in mind as I give guidance. Sometimes it is kindest to say goodbye earlier and in some cases, a little more time can be allowed while providing palliative care.

Taking a step back from my emotions to look at the situation, there was nothing that seemed imminently dire about Paloma’s condition. After rehydration and some medications, she’s happy to try some new flavors of dog food and treats, her tail still wags in greeting, and she still snarls if Mako steps out of line. I ultimately made the decision on Tuesday night to give her some time, but understanding that when I scratched her head at 4:30 this morning before driving to the airport, I may not get to see her again, and I may be leaving my friend to decline and potentially suffer.

I have the luxury of several good friends and colleagues who generously agreed to be on call and step in for me if needed in my absence. I realize that the general pet owner doesn’t have this option, so I’m incredibly grateful that I can make educated decisions and rely on friends to ensure that I am being rational and not selfish, in not yet saying goodbye to Paloma.

I don’t know if this was the right decision. Time will tell, but I know that I am doing the best I can with the knowledge I have now. And in the end, that’s all any of us can do.

Thursday morning update - she isn't eating a lot, but is still hanging in there and wagging her tail.