Family Goodbyes

There are many things that make being a veterinarian a unique experience. One of the more profound for me is this: that on occasion I have the opportunity to care for a pet from its earliest weeks of puppy- or kitten-hood through it’s geriatric years. You won’t find this in the human medical professions, for better or worse. In my practice, being in both a tourist location and close to two large military complexes, there are clients that come, go, and move away. There are pets that I see one or two times, maybe already in their twilight years, or for a second opinion, soon to return to their regular veterinarian. So, it’s a special occurrence when I have the benefit of following a pet from its first weeks of life into its last days

Having been in practice for more than 20 years, I’ve seen some of these pets in recent years. Such was the case with Sadie. She came to me as a young yellow lab puppy. She was typical for the breed—wild, stubborn, happy, and energetic. For most her her life, her visits were for routine services—vaccinations, examinations, her spay surgery, an occasional ear infection, GI upset, etc. From the first visit, her family was like many others, consisting of a mother, father, and two young children of elementary school age.

Over the years, I rarely saw the children, who I’m sure had their own activities and the commitments of childhood and adolescence. But I did get to know her mother and father rather—as well as one gets to know the family of the pet you care for. Sadie’s visits were most commonly characterized by exhaustion for me and the staff, given her unbounded energy, excitability, and what might have been interpreted as ADHD.

In her 10th year, she developed type 1 diabetes. She lost substantial weight during a prolonged stay in a nearby boarding facility. The diagnosis, once I examined her and we performed a few tests, was simple and straightforward. Every visit she had at our office (her longevity as a patient of ours means she was with us in our original location and our new office) had been replete with jumping, panting, kissing, licking, and at least two staff members needing to control her for whatever was being done. When she can into the office after having lost over 20 lbs, not only was she emaciated, but she was lethargic and depressed. The first words out of my mouth—“That can’t be Sadie. No way. Are you positive?”

Insulin therapy and diet change were instituted, and she soon returned to a healthy weight. Months later, she developed cataracts in both eyes and lost her vision. Fortunately for her, her parents were devoted and loved her dearly. She visited a veterinary ophthalmologist, and surgery to remove her cataractic lenses successfully restored her vision. More recently she developed a nasty skin infection, the canine equivalent of MRSA (known as MRSP). Therapy was intense, but she made substantial progress within several weeks.

At one of her rechecks for the skin infection, I noticed (inadvertently glancing at her gums) that she was likely quite anemic. After a simple blood test, anemia (a low red blood cell count) was confirmed. On examination and palpation of her abdomen, I suspected the presence of a mass within the abdominal cavity. An ultrasound scan of her abdomen revealed a large irregular mass on the spleen. Most likely, this was a malignancy of the spleen called hemangiosarcoma.

Hemangiosarcoma is, in my opinion, the worst type of cancer a dog can have. By the time we diagnose these tumors, most dogs have very little time remaining, with or without surgery, with or without chemotherapy. After some discussion with Sadie’s parents, we decided against aggressive therapies. We would focus on keeping her comfortable, supporting her appetite, and enjoying the remaining time her family had with her. At the time of the diagnosis, the now college-aged children had just gone back to their respective schools, the youngest just starting her freshman year. I knew that some difficult decisions would need to be made in the near future. A short time later she would return to the office, demonstrating jaundice, likely resulting from damage to her red blood cells, or possibly resulting from concurrent liver failure. Her disease was advancing.

Soon thereafter, Sadie’s mom called our office. Sadie had started vomiting, had stopped eating, and had developed bloody diarrhea. She couldn’t get upon her own. She came to the office in the afternoon, thin and tired. Sadie’s dad was out of town. The children were away at school, so this task fell on mom, accompanied by a few caring neighbors.

After examining Sadie, I tried not to mince my words. I’ve found it’s best to be direct when the path and choices are clear. It was time for Sadie to let go and stop fighting. It was time for her mother to let go of her. She knew this was the right decision. Often, the pet owners know before they walk in the door. Such was the case that afternoon. Sadie’s mom called her husband, and with the phone to Sadie’s ear, he said his goodbyes via speakerphone.

There she lay on the exam room floor, being ravaged by the effects of cancer, insisting on giving me as many kisses as I would allow, wagging her tail throughout. It was then that I was hit by the proverbial brick. Not that euthanasia was anything new—not by a long shot. It is a nearly daily occurrence in our office. I manage to stay fairly composed in most cases. Not uncaring, but professional. But, as I thought of Sadie, having provided her family with 12 years of companionship, helping “raise” and mold two children, and having had a positive, lasting impact on those of us that were fortunate enough to be with her for only a few minutes each year, I lost my composure.

This was goodbye for Sadie, goodbye for her family (those present and those far away), and it was goodbye for me. It takes a special pet to deeply touch those with whom she has limited contact, including her veterinary care caregivers. Sadie was such a dog, such a pet, and such a wonderful spirit. She will be sorely missed, not the least by her former veterinarian.

Todd Worrell, DVM