Tuesday, October 20, 2009

Godspeed good friend, godspeed.

On Friday afternoon, a referring veterinarian called to let me know she was sending over a dog that would require oxygen therapy for the weekend. "Choco" was a 12 year old labrador mix with previously diagnosed megaesophagus, aspiration pneumonia, and possible myasthenia gravis. On top of that, he had recently been diagnosed with likely laryngeal paralysis. His owners were an elderly woman and her daughter. The mother took care of the dog while the daughter worked during the day.

The referring veterinarian confided to me that the owners just weren't ready to let the dog go, even though with the combination of a dilated esophagus and previous aspiration pneumonia, he was a very poor candidate for surgery to repair his laryngeal paralysis. Basically, Choco was going to spend the last few months of his life starving for oxygen at all times.

When the owners came in, they had many questions. We discussed Choco's condition, and I ended up spending a great deal of time with them, despite having numerous patients to care for.

I explained to them that when breathing room air, Choco's hemoglobin was only saturated with about 75% oxygen, meaning he was chronically hypoxic (oxygen-deprived). With nasal oxygen, this improved to almost 100%. Unfortunately, he couldn't live with nasal oxygen (as people can). We discussed that his problems weren't going to get any better, not unless surgery was attempted to help with his laryngeal disease.

They understood all this, cried when they left him in my care, but didn't make the decision to euthanize.

Through the night, I watched him struggle. Sometimes, he had to stand so that he could breathe. His harsh breathing reverberated throughout the clinic. My techs asked me again and again, couldn't I give him something? My answer was always the same : save sedation, not much could help him short of intubation and surgery. Finally, at 3am, I called the owners and asked them what they wanted to do. The daughter had many more questions, but the answer was always the same: prognosis very guarded to poor.

She told me that she would call back.

Three hours later, the front doorbell rang, and there they were. More questions followed, then tears. I gave them time to think about the options, as I checked on Choco - still laboring to breathe, despite intra-nasal oxygen and sedation.

When I went back out front, they told me - with tears in their eyes - that it was time to let him go. I felt a flood of relief for the poor old guy, but also sadness for his 2 obviously distraught owners.

As I sat and talked with them about the process, the older of the 2 confided in me that Choco had been a "good friend" and it was important that he didn't suffer.

In the end, he went quietly. The owners sat with him on the floor, crying quietly, and talked to him after he was gone.

It was painful to watch, even more painful to be a part of, but in the end, it was a relief to end his suffering and to let him go peacefully, surrounded by the people who loved him most in the world.

1 comment:

Elizabeth said...

He is so lucky to have had you as his vet that last day..