Saturday, February 26, 2011

Worst euthanasia ever

ER work necessitates a lot of euthanasia. It just goes with the territory - very ill and injured animals, staggeringly high bills, financially strapped owners in a bad economy - all contribute to the high number of euthanasias I do. I can't really estimate how many I've done in the past 12 months, but I would say at least 200+. That would likely be a good estimate. Only two of them have stuck out as unpleasant, and last night was sure one of them.

A couple and their daughter brought in a cat. She was lying on her side, barely responsive to us. Her temperature was too low to read, her heart rate was extremely slow, and her blood pressure was negligible - all signs of a cat in shock.

She'd been seen at her veterinarian and then sent to a specialist for pleural effusion (see sidebar). Despite an exhaustive work-up, the cause of the fluid in her chest could not be determined. She'd had ultrasounds of her abdomen, her chest, her heart. The fluid had been sent to a pathologist for examination, and yet there was no diagnosis. In 1 week, her chest had been tapped 3 times to remove the fluid accumulating there.

The owners had had enough of watching her struggle and suffer, so they brought her in for me to euthanize.

My standard approach to euthanasia is to place a catheter, let the owner spend time visiting with the pet, then go in, administer a strong sedative (usually Telazol or Propofol), wait for the pet to go to sleep, then follow up with Euthasol.

Euthasol solution is usually made up of pentobarbital (a potent barbiturate), potassium chloride, and lidocaine. Thus, it is a very strong depressant of the respiratory and cardiac systems - causing the heart and breathing to stop. It is generally a very peaceful death. As I explain to the owners, it's like kitty is going to sleep to have his teeth cleaned, only he doesn't wake up. No pain, just peaceful sleep, followed by death.

In this case, I did not use my standard initial sedation because the cat was so out of it. Usually if the patient is severely compromised, sedation beforehand is not necessary.

I went through my standard spiel with the owners, flushed the catheter with saline to ensure it was patent, and then started to inject the Euthasol. For a moment, the cat seemed fine. Then her respiratory rate began to speed up, she attempted to sit up, and she started to groan. Her front legs became rigid, and she threw her head back, groaning and gasping for air. She twisted to one side, legs still rigidly extended.

Her parents seemed to take it in stride, while internally, I was freaking out. I'd never had a pet do this - whether they got pre-euthanasia sedation or not. NEVER. It seemed to last an eternity but really only probably lasted about 30 seconds, and then the cat was gone.

My theory on what happened is that she'd had fluid in her chest for so long that her body had adjusted to low oxygen levels by cranking up her respiratory rate. When I gave her pentobarbital, her breathing naturally became slower because of the drug. She then began to experience severe air hunger, which in turn caused a panicked state.

I felt and still feel terrible about it. The owners seemed unperturbed, but I was a mess (again, internally). No one wants to see a patient struggle like that and then die. I prefer the peaceful, gentle death that Euthasol provides 99% of the time. Seeing an animal thrash and cry out before death makes me feel like I have gravely under-served them at the most critical juncture of my job for them. It made me feel ill and sad for the sweet kitty that had already endured so much.


Learning said...

So sorry--we've all been there. I'm impressed that with 200+ euthanasias, you've only had 2 that stuck out as really awful. I have no idea how many I've done since graduation, but I can think of at least 5 off the top of my head that were at least as bad, if not worse, than the one you described. I think that's why I usually don't cry at euthanasias--I'm concentrating so hard on everything going smoothly.

Anonymous said...

The fact that you feel terrible about it is exactly what means that you shouldn't.

I'm sorry you had one not go so well. Thanks for posting the experience for those of us in the school phase of things.

Toronto Cat Rescue said...
This comment has been removed by the author.
Chris Bern, DVM said...

It's so hard when they go poorly, and thankfully that's not often.

Once I was euthanize a cat that was also quite sick and lethargic. Like you I place a catheter, though I don't always give a sedative. As I gave the Euthasol the cat suddenly sprang straight up in the air about a foot (no exaggeration!), screamed, then landed on the table dead. That was the absolutely worst one I've ever had, and I had no explanation for why it happened. It was over in seconds, but I'll always remember it.

Thankfully they're usually peaceful!