“I don’t know how you do it.” I’ve lost track of how many times I’ve heard those words from someone grieving the lost of their horse or faithful companion animal. “I always wanted to become a veterinarian, but I just couldn’t handle euthanasia”, is another common variation of the same sentiment. There are so many emotions wrapped up in each case. In some cases there is trauma or an acute illness, and for others it is a gradual deterioration and a diminished quality of life. In some cases there is nothing medically possible and in others, the owner’s finances prohibit further medical or surgical intervention to save the animal. You can put yourself in these different scenarios and relate to how hard each situation might be difficult for an owner.
So how do I deal with it on this side of the needle? Is there some secret that veterinarians have for coping? Not really, we all approach it differently. For me, I know what the animal needs, but I may not know the owner well enough to know what they need. Some people just need to talk and be heard, others are matter of fact and just want to get it over with so they can deal with the grief in their own way. I have to meet them exactly where they are in the process, and be gentle with their emotions.
The euthanasia procedure is somewhat of an act. We want to make everything appear peaceful, relaxed, yet efficient. Our goal is to get the animal safely restrained, comfortable, free of anxiety and free of pain. In dogs and cats, I choose to sedate the animal with drugs that I inject in the muscle of a hind leg to render them unconscious prior to administering the euthanasia drug (pentobarbital). This gives a tender moment for an owner to be with their animals as they become drowsy. It also makes the animal unaware as we find a good vein to access. Many of these animals are quite sick, dehydrated, and may have very poor veins. Euthanasia solution is most commonly given in a vein to have a quick effect. The dosage we give is an overdose of the anesthetic and essentially induces coma. When overdosed in the vein, it renders the patient unconscious and decreases the respiratory centers in the brain so much that the patient stops breathing. The body and all organs are starved of oxygen and the heart will stop within several seconds. Within a few seconds of receiving the drug into the circulatory system, the patient will take some rapid shallow breaths, then stop breathing. As the muscles are starved of oxygen, there is sometimes some involuntary movement – a leg may twitch, the neck may become stiff, the muzzle may quiver, the diaphragm may contract to make an audible gasp. The patient is unconscious and all of the movement is involuntary.
Pentobarbital is the “single drug” protocol sometimes used for lethal injection in prisons. You can see why this might be less than desirable for a witnessed execution of a prisoner, and it is the reason for using multiple drugs that include a paralyzing agent to make the death appear more calm with minimal movement in prison viewing chambers. It is not given for the patient’s benefit, they are unconscious. They are paralyzed so that people watching it are not alarmed by normal movement of a dying body. We don’t do this for our veterinary patients, so I use an anesthetic to make sure the patient is unconscious prior to giving them the euthanasia drug.
Euthanasia is a privilege that veterinarians have to help us uphold the oath to prevent and relieve suffering. In several states, physicians are able to offer a peaceful death to their patients. In the other states, the angels in hospice care provide opioids and benzodiazepines to relieve pain, anxiety, and restlessness until death. My time in veterinary medicine has certainly skewed my view on death. I see animals at their absolute worst and am able to provide a quick transition to alleviate that pain and prevent suffering. I hope someone can extend me that same mercy as I lose all semblances of dignity.
As an animal is visibly declining over days to weeks, I tell my clients to choose a good day. I encourage them to let them pass on a decent day when they still can appreciate a good treat – a day when they are still able to walk around the yard one last time, or chew a favorite toy. That is not easy. I’ve been on their side with my own animals and boy do I know how hard that is to consider. But, time and time again, I hear clients say, “I waited too long, I should’ve done it sooner.” With animals with mobility issues, there is nothing more difficult than coming home from work and finding the animal down in a bad position, struggling, lying in its own excrement. For the heart failure dog that has had its abdomen drained of fluid over and over, it is traumatic to find them down and acutely gasping to breathe, after having left them normal that morning. These acute on chronic scenarios seem to increase the level of guilt an owner experiences. Guilt is a difficult stage of the grieving process and in my experience, it seems to be harder when the owner is going through guilt at the time euthanasia is performed. This is my biggest reason for planning euthanasia as signs of deterioration are becoming more obvious.
With horses, there are some logistical issues – largely with the aftercare plans for arranging a backhoe for burial. For the older horse that is deteriorating over time, it is much easier to have a hole dug and coordinate the time for euthanasia versus getting home at 7pm and having to euthanize the horse on emergency and find someone to dig a grave quickly. The added stress is just difficult for someone who is grieving.
It is often said that animals live in the moment. That is, they only focus on their current state of being. On multiple occasions, I’ve pulled up to an emergency call to find a horse standing on three legs with a complete open fracture of one limb, and his face is down in the lush green grass chewing away. It doesn’t appear that he has any sense of the gravity of the situation and his impending death. He just sees grass that he doesn’t normally get to eat and his innate response is to eat it. Maybe it is stress eating? They don’t appear to share the same degree of anxiety that we may be having in a similar situation. We would be worried about how long we would be out of work. Would insurance cover our entire bill? Who is going to mow the lawn while we’re down? How will the mortgage be paid? On and on and on. We certainly would not be thinking, “I could kill a pizza right about now.”
I treat each patient with the dignity I believe they deserve. They are not my personal animals, so I do not grieve them equally as their owners. If I have euthanasia solution in my hands, I have gone through a history of the patient and have checked all the boxes that support this moral and humane decision. I know what must be done. I do not know all of this animal’s funny quirks. I do not know all of the specific joy and companionship they brought at just the right time in this person’s life. But, I do know how that joy feels and I certainly know how loss feels. I have made room in my heart to love many animals, and my heart is better for having loved and provided for their health and happiness.
I do not hurt for the animal. I will make that transition humane. I will make sure they experience a few pain-free concious moments with the people they love before they drift to sleep. I may or may not cry – there are no rules against it, but if that emotion happens, it will happen after they have passed. In the moment, I have a very important job to do. My nerves are calmed, my mind cleared, and my hand steadied. The patient is my only concern for the next few moments. With my patient relaxed, the owner informed of what to expect, I will ask the owner if they are ready, and I will check my vein, and infuse the drug carefully. I will empty my hands when finished and take a gentle hold of a dog’s paw, or stroke a horse’s neck waiting for the breathing to stop, and the eyes to become fixed. I will give space for the owner to have whatever emotional response they need. I will put a stethoscope in my ears and listen to the chest for a silenced heart and lungs. I will cover the eye with one hand so guard the owner’s view and touch the animal’s cornea to confirm a lack of reflex and whisper, “It is done. He (she) has passed.”
Sometimes we assist in getting a horse into a grave or wrap a small animal in a favorite blanket and help transport to a car for cremation or carry to a grave. These physical parts of the death can just be overwhelming for a grieving owner, so we try to offer a hand.
I will get back in the truck, enter the next destination in my GPS, let out a big sigh, and start driving. Sometimes the truck is just quiet, sometimes we’ll just talk about how peaceful the animal passed, share a funny story about something that happened with the animal at a previous visit, or just say something like, “I’m so sad for Jane. She tried so hard for that mare.” I try to be honest with emotions – it just seems to be the best method for me to process. I tend to finalize my thoughts in writing a sympathy card, often sharing my favorite memories of the animal, or referencing something special that an owner shared with me at the time of euthanasia or the story of how the animal came into their life.
It is a heavy part of my job, but it is not the hardest. It is one of those moments that allows for humans to relate and be present for one another. That is some sacred space. I’m grateful to be able to have those moments with people, sometimes complete strangers. To be trusted by someone at such a vulnerable time is an honor. What a blessing to be able to minister to others in such a unique way.
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