The Veterinarian – Exchanges and Dealing with the Fear Behind it All (Part 2 of 3)

He walks into the exam room to perform a euthanasia. He knows that the patient is a large old dog that has suffered from arthritis for a while and has finally progressed to the point of not being able to walk anymore. He knows that this is one of the more common issues that tend to eventually “get” the large and giant breed dogs before natural death, requiring appropriate and intervening euthanasia. It is a sad but true fact that must be accepted under certain circumstances. Sometimes though, people tend to create their own circumstances, and they can be quite creative and convincing in this seeming self-delusion. He knows that the more a person tries to sell him on the euthanasia of their own pet, the more likely it is that they have had to sell themselves on the same product. He doesn’t like hearing that sales pitch. Death is natural and pure and a necessity of existence. It should be respected and acknowledged for the actual product it is. It should not be marketed or sold.

The veterinarian walks into the room and makes some small talk with the owners. He reaches out to them with a mixture of empathy, understanding, and support. Then, he changes gears a little and reviews the basic information with them that pertains to the act itself and what they should expect as the process unfolds. He is caught somewhat off guard when the wife excitedly volunteers “We tried to give him the medicine you gave us for his arthritis, but it made him SO sick…..he just acted ALL DRUGGED OUT…ALL THE TIME..and he didn’t do well with it at all….at all. He just couldn’t take it….AT ALL.”

The veterinarian silently sighs to himself. Marketing…..marketing, he thinks…I really hate marketing. He knows that the whole charade may sound like an innocent and factual statement to those who don’t witness the patterns over and over and over, but also that to those that do, the marketing and the sales pitch become blatantly obvious and excruciatingly painful to entertain in their eager-to-infect-delusion. He could literally finish their marketing sentences for them if he wanted to. And typically preceding the actual euthanasia marketing, you always get the “WE DID EVERYTHING we could, but the medicine YOU gave us didn’t work…..it actually was HIGHLY INEFFECTIVE and it made him WORSE” marketing. The veterinarian knows that sometimes this dynamic is factual and just the objective limitation of life coupled with the failure of reasonable intervention. Other times, with simpler diseases and in less pathologic states, it is just an excuse to say “we can’t afford the medicine” or “we really don’t care enough about our pet to go to the trouble of giving the meds.” The veterinarian can accept these facts no matter how unpleasant they may sometimes be. The facts aren’t the real problem. The real problem for him is the noisy tormenting sales pitch that just obliterates all true respect for a life that was supposedly loved. He tries to clear the knowledge from his mind. He tries, but a few related words slip from his mouth “When was that? How long ago did we try the meds? And it didn’t help at all?”

The wife replies ” Maybe a year or so ago. He just did…SO, SO bad on those meds. They really missed him up. We decided to just take him off of them and not give him anything at all. He slowly got worse and over the last week or two, he hasn’t been able to really walk or get up at all.” The veterinarian is intimately familiar with the drug that the owner claims adversely affected her dog. He knows the drug is safe and effective. It is the most effective drug in his practice in regards to improving the quality of life of any of his patients. Oh, but he also knows that the worshippers of the internet, seeking the sacrament for their own fear or apathy in action, can certainly find enough digital speculation to blasphemy any drug on the market….even as they crucify their own dog while they do so.

The veterinarian yields. All of the rational rebuttals in the world are not enough. All of the logical questions about what specifically happened to the dog when the meds were given and why no one informed the veterinarian of the situation a year ago, are not enough. The excuses fabricated through marketing and delusion, have no desire to be challenged or investigated in any way with rational logic. The veterinarian says “I’m sorry that the meds did not help him before and that you have to say goodbye today, but we are going to get through this together and make sure he doesn’t suffer anymore in any way. My assistant and I are going to sit down next to you and Boomer to perform the euthanasia. You don’t need to move at all. Feel free to hug or pet him the whole time if you want to. We are just going to gently hold his head and his leg during the injection. Once I give him the solution, he will pass in about 30-60 seconds and just fall asleep. My assistant will leave after we give the injection, but I am going to sit in here with you and Boomer for a little while afterward.”

The euthanasia is performed without complication or adverse event, and Boomer falls gracefully asleep. The assistant quietly leaves the exam room while the veterinarian remains seated immediately next to the body. The veterinarian is calm and relaxed in his posture. He looks at Boomer’s body and pets his head and neck a few times before resting both of his hands in his own lap. The owners sit close by, touching Boomer’s body, each in their own meaningful way. This solace lasts about sixty seconds.

“When will he pass? How long will it take? How do you know?” sputters from the wife’s lips as she breaks the solace.

The veterinarian replies softly and compassionately “They usually pass within thirty seconds to a minute after the injection, but it can vary a little. I always like to sit with them for a short while afterwards, and then check their heart with the stethoscope. I am pretty sure Boomer has already passed. He went very easily…..very peacefully.”

Boomer’s mom snaps back quickly and reflexively. It was almost like she had been waiting for the opportunity. “I don’t think so. I’m sure he’s still alive.” She hastily moves her hand to Boomer’s chest and presses downward. “I can still feel his heart beating.”

Her husband has somewhat of a blank and numb look on his face, but you can see his will of empathy attempting to be expressed, attempting to connect with her. Sadly, it has a tainted timid aura of fear from previous rejection. He does not challenge the previous suggestion of the veterinarian either.

The veterinarian tries to keep the peace and take the bullet for the husband without destabilizing himself. “I am pretty sure Boomer has passed. I really believe that. He may be displaying some normal postmortem muscle spasm activity and you may have felt some twitching with your hand, but on the off-chance that his heart is still beating, it will stop very soon. Again, that is why I am sitting in here with you and Boomer. I always do this just to be sure and in a minute or so, I will check his heart and confirm that he has passed.”

The hand of Boomer’s mom is guarding Boomer’s carcass and again like a spring board on the immediate heal of the veterinarians words, “I don’t think so. He’s still alive. I can see that he is. I can feel his heart beating.”

Point accepted, no matter how unlikely or how improbable or how delusional, the possibility must still be accepted at present by the veterinarian. The veterinarian struggles to stomach the delivery of another patient and tolerant counterpoint to Boomer’s mom as gently as he is humanly able. “Boomer has not been breathing since about ten seconds after I gave him the injection. I have been watching him very closely as I sit here with you and your husband. He passed very easily and he will not suffer anym….”

“How do you know? How do you know he isn’t breathing?”, higher in pitch and emotion that her previous words. She looks at the veterinarian like he is a dumbfounded simpleton. The husband catches her glance and obviously recognizes her approach towards another all too well.

The veterinarian feels sorry for both of them, but for each in a different way. He gently directs his words once more to Boomer’s mom. “I have been watching Boomer’s chest the whole time. When a dog breathes, his chest moves in and out or up and down. You can easily see the movement when it occurs. His chest has not been moving at all for some time.”

“But I can feel his heart. Have you ever been wrong? God, that would be terrible. Have you ever been wrong? Has that ever happened? What would you do? What would you do? God, that would be terrible.”

The husband turns towards his wife with a little more purpose than he has displayed previously and speaks in a level manner. “I think you might be feeling your own pulse that’s in your hand when you press down like that. I don’t think he has taken a breath or moved in any way for a while.”

Her eyes pivot anxiously back to the veterinarian. “But have you ever been wrong? I mean ever? Have you ever been wrong? That would just be SO, SO terrible. What would YOU do?”

He answers the same question for what seems like the thousandth time. “I don’t believe that I have ever been wrong in the exact same situation as this. The reason I always sit here for a while after giving the injection is just to make sure of everything. That takes a little time and a little observation. I don’t want to make a snap judgement about any of it. It is too important to me.”

The veterinarian slowly inserts the earpieces of his stethoscope into his auditory canals, he cradles its tympanum in the sensitive touch of his dominant right hand, and with a firm grace of solid and controlled movement, he connects himself to Boomer’s body. As the tympanum contacts Boomer’s chest wall, the veterinarian closes his eyes. It might look like a gesture of prayer or respect, but it is not……not in the commonly perceived way. He closes his eyes because it focuses and directs his awareness to concentrating on the most important task at hand. He loses himself. He loses his sight of the owners and of the room and even of Boomer’s body. He becomes only a combination of auditory nerves of perception and tactile nerves of sensation. Almost unconsciously, the tympanum sweeps the relevant region of the chest wall twice without rush or hurry. The auditory nerves also complete their sensitive mission and fail to capture anything with their enhanced focus. He then knows without a doubt that he is connected to death. He stays there for just a moment before severing that pure connection. His hand slides back into his lap and his eyes open. The wife is looking intently at his new gaze and she seems to get something from it. Her anxiety and nervous energy still lurk in the embers, but her flames have been snuffed. He says “Boomer is definitely gone. There is no doubt. I promise you that’s true.”

The wife says “Okay. Thank you” with true acceptance, and her husband is very soon to follow in his own words of appreciation for what has been done. The veterinarian replies “You are both welcome. It is very hard to say goodbye. I wish I could make it easier for you, but perhaps it isn’t really meant to be that easy. I hope you understand that Boomer passed in a very peaceful manner. I am glad he left in such a way.”

 •

 At some point later that day, the veterinarian finds himself pondering this event and what possible lessons might be gleaned from such an experience. It seems like a simple matter of fact to him that the euthanasia was a mixture of significant frustration mixed with a tiny victory…..perhaps a tiny success. And he knows it will be a very limited success for the person who finally yielded to acceptance and trust. He damn well knows that he will have to wage very similar wars with this person in the future and perhaps, forevermore. It isn’t an insult. It is just a law of human behavior. But regardless, in the end, there was a success. There was a moment of peaceful acceptance, a moment of trust related to a brief connection, and sometimes that is just as good as it can get. Maybe, he chances, the lessons for himself are to be thankful for even the smallest victories that help to bring a person to even the briefest state of grace, to remember that all of us must walk our own path in our own timing and not in any other’s, to accept that maybe all of his efforts aren’t meant to be easy either, and to remember that he himself has to be eternally vigilant of his own tendency to look for his own punching bag. It always comes down to it: If you really… really want to help another or lift them up, if you really want to be a healer, it isn’t about anger, excuses, critique, or required effort. It is about controlling your own demons, your own excuses, and first and foremost, lifting yourself up and out of your own cycle of temptation towards destabilizing behavior of any sort.

To be continued…

Cribb          2015

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