I’ve written before about the difficulty we all face in Making the Decision to let our pets go.
As the technology of veterinary medicine grows exponentially, I believe that the biggest challenge in our future as a profession is keeping our heart engaged so that we can help you, the client, make a decision during a difficult time.
Simply put, just because we have technology that can extend life doesn’t mean we should use it.
I personally believe that this is as true on the human side as it is in veterinary medicine.
But the access to technology is newer to us.
…and Damnit Jim, I’m a veterinarian, not a physician.
I never considered this question as deeply as I did last year. ..the story I tell you is true, but the names have been changed. Each of us makes the best decisions we can with the emotion and information that we have.
But this was hard to experience.
Jasmine was a 14 year old Lab that presented to me walking unsteadily. She had been acting strange for the past few weeks and her owner, Norman, was concerned.
My physical exam and blood tests showed nothing out of the ordinary. On neurological exam though, Jasmine was clearly unsteady. She acted like she had a vestibular disease, but lacked the neurological signs (a darting of the eyes known as nystagmus).
Norman made it clear to me that money was no object, he wanted to get to the bottom of Jasmine’s problem.
I referred her to a neurologist in the Portland area for further tests.
When the neurologist called me with a follow up the next week, she had discovered the source of Jasmine’s problem. Not only did she have a brain tumor in the cerebellum, which is responsible for coordination of movement, but she also had one in the forebrain or cerebrum. The MRI showed the masses were moderate in size and she believed that she could remove one and have another neurosurgeon remove the other.
I had concerns about a 14 year old Lab undergoing brain surgery twice, but Norman was interested in giving Jasmine every chance possible. The first surgery was scheduled.
Jasmine came out of the first surgery great. Her balance had improved greatly, and other than having her head shaved, she was none the worse for wear.
The second surgery was not as straightforward. The neurosurgeon could not get all of the tumor and there was still some present on the MRI. Norman was referred to a Veterinary Oncology group in New England for discussion of radiation.
Norman brought Jasmine to the Oncology Center for Radiation therapy the following week. She was weakened from the second surgery, but he stayed with her for over a week as she underwent daily radiation to destroy the remaining tumor.
Upon returning from the oncologist, Norman called me to give me an update and discuss the plan. He was to recheck with the neurologist in a week. Jasmine was having trouble breathing, and I encouraged him to visit the emergency Vet on the way back.
The next day I got a call from the Emergency Vet in Portland. Jasmine had a secondary pneumonia and was being hospitalized until she was stable. She was getting IV fluids and antibiotics in the intensive care ward.
2 days later they repeated Xrays to see if the pneumonia was improving. Although it was getting better, the Xray showed that Jasmine had a tumor on her heart.
They scheduled an ultrasound with a cardiologist.
The cardiologist confirmed that Jasmine had a heart tumor and that it was inoperable. His recommendation was to give her the time she had left, expecting that we would have to put her to sleep if she had symptoms from the heart tumor like difficulty breathing.
I spoke with Norman. He was very anxious and asked me again if this tumor could be removed. I know he had been through so much. I explained that the tumor was part of the heart wall and that she had been through so much, she was 14. She had been a beloved part of his life. He needed to prepare to let go.
A week later he called because she was having trouble breathing. I told him to bring her in. An xray confirmed her pericardial sac (around the heart) had filled with fluid, likely blood.
It was time.
Norman was not ready. He brought Jasmine to another vet who tapped the fluid to relieve the emergency. He repeated this 4 times over the next week. The other vet offered a surgery to cut a hole in the pericardial sac and allow the fluid to drain into the chest. Norman agreed.
Jasmine died 4 days after the surgery, having been hospitalized the entire time.
I’m still reliving this more than a year later.
On the one hand, I know from experience that we all struggle with when is the right time to let go. Fact is there is no moral absolute that we must put a pet to sleep at all. Each of us will pass on without euthanasia, and this type of story is probably one that one of you reading this will have had a family member go through.
But one of the things that I appreciate about in veterinary medicine is that we have the option to make the passing a gentle one when the path is rocky. Plus, access to this level of care is something that has only been available relatively recently…and it came with a huge price tag.
Jasmine’s care from start to finish cost Norman greater than $45,000.
…and she lived 2 1/2 months from when I originally saw her for the unsteady gait.
I’ve avoided writing this story for many months for several reasons. First, I know that it will cause some emotional responses from those who read it. Perhaps its sadness, perhaps its anger, perhaps its indignation. Some would have made the decision to let Jasmine go before the referral to the neurologist. Some would have after the diagnosis of brain tumors. A few would have had the surgeries. Fewer still would have tapped the pericardial sac, I’m not sure if anyone would have had the chest surgery performed.
One thing I’ve learned is that until you walk in someone’s shoes, its hard to know how you would respond in a similar situation. But this kind of technology and expense is something that is new to us as vets. Jasmine’s case by far is more costly than any patient that I have had a hand in the care of. That wasn’t a problem for Norman, but it would have been for most people I know.
But cost aside, was the right thing done by Jasmine?
I do not think so.
