Broken Windshield

I have a nice car. It feels nice, looks nice, and when Mothe Nature is throwing her best curved ball of weather it is unsurpassed in its squirreliness to claw us out of snowdrifts. The stereo system registers on the richter scale as the ground under its wheels vibrates the tectonic plates out of their millenia's rest. But, I have had to have the windshield replaced 4 times. Once in a while the car starts raining on the inside. The last it happened was last week when my husband had it inside the drive thru car wash to de-salt its black velvet coat. How do you stop the rain inside a car wash? Four times in and I am done. I am so frustrated by the lack of resolve from the dealership that I am dumping it and trying again with a new car. I loathe cars because I so loathe the buying experience. If I could reimagine the whole process I would buy into a monthly fee that makes me a member of a car replacement program. All of the cars are sold to members at cost. We get a new one every 5years or after considered a total loss by insurance. (See I do have all of the answers!). Oh, and its woman and minority only. Back to my point, I get so emotionally exhausted I bail.

Frippie and a new car on the same day.

Does this also bleed into other parts of my psyche? Yes, of course.

Yesterday it was the 8 year old doodle who has been to another vet multiple times, had a multitude of tests done and spent thousands. No answer. No resolution, and they are being told they need a specialist who will cost them $2,000 for the exam and tests and their dog might only have 3 months to live. 

Their dog started with one or two bumps, three months ago, and now has them everywhere, along with all of the lymph nodes being golf ball sized. They have followed all of the advice they have been given.Things are deteriorating and they no longer have faith in their vets ability to help them. 

She is emotionally, and now financially, exhausted. They need veterinary help as much as they need empathic hope. Maybe I cannot provide hope that their dog has a diagnosable and curable condition, but, I absolutely can give them hope that I won't abandon them or deny the grief that comes with acknowledgement that the good, healthy time is slipping away. They are losing their love. There is a big difference in how you deliver medical advice and how you see your ethical responsibility to a life that needs,,, well,, so much. 

This is what second opinions stem from. We all should be brave enough to find that someone, or someplace that you feel good about going downhill with, even as you hope and pray you won't have to.

I will forever bear the guilty burden of giving up on Jekyll and Savannah too early. They broke me mentally, physically and emotionally. I couldn't take another night of no sleep, no easing of their bodies painful beckoning. I, the veterinarian, their mom, gave up on them. I put them to sleep so I could finally get some rest of my own so I wouldn't make an exhaustion induced mistake on someone elses beloved pet. In a country that doesn't believe in humane euthanasia for its dying humans why  can't I provide thar for my companions? Why do I feel like I failed to let them die how nature chooses them to? Why do I always have to saddle the burden of their mortality as I am suffocating under the grief of losing them?

Jekyll

My hospital manager is facing the aging and loss of function (mobility and bathroom) in her older dog. We are at that place where we know we are losing our battle. We are at that place where we are throwing everything, and the kitchen sink at her in the hopes we can recover something that helps her feel better. Her diarrhea has been going on for weeks. Diarrhea, like vomiting, and not eating are crippling to deal with. They are all symptoms of a bigger disease, and there inlies the reason we call it medicine. They are clues given to us to try to uncover what the root cause is. What is causing this? If we cannot figure this out we are very unlikely to undo the inciting cause and rectify it. Having a pet who cannot get up and walk themselves outside to make a massive smelly mess of liquid diarrhea is exhausting. You cannot sleep because you want to be able to get them to a place that is easier to clean up than your bedroom floor. 

It is very important to remember that what we see in our few minutes in an exam room doesn't always allow us to know the burden that families carry at home. 

It is very important to acknowledge the impact of exhaustion.

Is it possible to have hope, empathy, and be exhausted? 

Is it possible to make good decisions we won't look back and beat ourselves up about after the fact and be exhausted?

I asked Jenn, my hospital manager to add her thoughts. 

The long goodbye.  It’s the slow decline of our beloved pet and feelings mixed with hope and defeat, a rollercoaster of emotions.  It’s a place I find myself with my beloved dog Hope.  Hope was rescued by Black Dogs & Company Rescue 12 years ago, a very pregnant stray on a dirt road in South Carolina.  She was being fed a handful of dry kibble once a day because that’s all the kind-hearted person who was helping her could afford.  The rescue intervened and tried to get her to Maryland before her puppies were born but Hope had her puppies under the safety of the wooden handicap ramp of a church.  Four little puppies entered the world in the dirt to a young emaciated mom.  Hope and the surviving three puppies made their way to Maryland when the puppies were three days old thanks to a volunteer pilot via Pilots N Paws.  Hope was our first momma and puppy foster, she was emaciated, filled with internal and external parasites, heartworm positive and pretty much feral.  It was a slow go to gain her trust but she loved my children quite literally from hello.  When her puppies were ten weeks old they all found homes, my children became her puppies.  It took a year before Hope was ready for adoption, she became our first "foster fail".  For twelve years Hope has watched my children grow.  Like a good mom you can literally see her ears that no longer hear much perk up and her cloudy eyes light up every time one of her children enters the room.  Her love for them has been unwavering.  She’s been a stoic stubborn old girl, I somehow always imagined the end would be something quick, symptoms hid.  Instead it’s been slow; arthritis that we have managed with monthly injections, then diarrhea.  Horrible, incurable, unstoppable, diarrhea.  It waxes and wanes from “soft serve” to bubbly, projectile water.  We’ve thrown every single medication at the diarrhea, tried countless foods and yet here we are.  Each day my old girl get a little more tired.  Phrases like "quality of life" and "letting them go on a good day" dance through my head on the sleepless nights.  I see the toll it takes on my family; my teen and young adult children tread lightly past her room, panicking when I’ve taken her to work with me thinking we made a decision without including them.    I see the toll it takes on my husband, his wife’s attention and thoughts on trying to get our dog through one more day of trying.  I see him bracing for the heartache that he fears will hit his household when we say goodbye, and I see a man who remembers a younger, fearful version of Hope, whom he spent so much time working through gaining her trust while I cared for her puppies.  We have an entire basket of medications, the treatment plan changes as we admidst defeat.  The wash machine runs constantly, we try to get a load or two of the family’s laundry in between.  I see the toll it takes on our other dogs. There’s Remi who was Hope’s best friend.  He had cancer removed a year and a half ago, he’s on borrowed time.  He lies with her some days.  I see how he looks at her, how he looks at me.  I see the younger dogs, their hesitation in walking past her room, how they give her great space when we walk her through the foyer to go outside….respect?  I look in the mirror and I see the toll it has taken on me, I can’t remember the last time I slept more than four and half consecutive hours.  And when I do?  Guilt jolts me from a deep slumber.  I jump up and run to the dining room that is cleared and now “Hope’s Room” afraid she needed me and I didn't hear her.  I see the bags under my eyes, my heart is caught somewhere between holding on to hope and giving up.  My body feels like I have been hit by a bus every single day, muscles hurt from lifting her in and out of my truck.  Caught in a place where I can’t plan life too beyond what lies immediately before me, that 25^th Anniversary trip? I’ve yet to buy my plane ticket.  And I see Hope, a dog that loves her children so deeply she’s caught between letting go and not wanting to let them down. 

While watching my mother die from brain cancer, I realized euthanasia is a gift we give our pets at the end, we ease their suffering.  We save them from the horrors of what lies in the final days of disease.  Each pet owner makes a very personal decision along with their vet based on what they can financially invest and physically manage to determine a time when it is appropriate to ease their pet’s suffering.  I find myself carefully watching for suffering, watching for signs that I am asking too much, watching for signs that my sweet old girl still wants to be here.  I learned that sometimes, when all we have is a single thread of hope that’s what buys us a miracle.  I’ve been there, at a place where most would euthanize to stumble upon a needle in a haystack that buys us quality time.  I found myself there when my Saleena was in kidney failure, she lived ten wonderful months.  When my shepherd mix Johnny Cash had a mystery intestinal illness that had his big 90lb body physically down for two weeks and found us seeking an oncology consult, and again when a large non-cancerous mass was crushing his lungs when he slept, we were given the gift of time as we teetered on letting go.  I found myself there with Bella, my dream come true golden girl who became suddenly very ill with a lung infection, we found a rare aggressive lesion on xray at the base of her lungs, again finding ourselves at oncology only to make a miraculous recovery.  It’s a fine line between hope and defeat.  I couldn’t imagine having given up on any of them and robbing them and us of quality years.  I’ve always known when all hope has been lost and when we are making a decision to end suffering at the end of a life well lived.  With Hope I teeter in this place, my heart torn. 

I am well aware that I am able to go to these great lengths for our pets because of the life I live.  Because I work in the veterinary field, I am able to bring my pets to work with me during these difficult times, I have access to brilliant veterinarians who see pets as part of our families.  I am sympathetic to pet owners who don’t live this life, who work long days, who have to make decisions based on what they can physically, financially and mentally manage.  My written feelings aren’t meant to make anyone feel guilty. We each make decisions for our pets based on our individual situation, and when it’s a decision made with a heart guided by love it’s never wrong.