Just because we can doesn’t mean we should…
Those words are heard in ICUs around the country – for animal and people alike. We have reached a point where medicine can do amazing things, but it may not always be working for us. Sometimes the scope of medical miracles exceeds our understanding of the aftermath.
I think about this often, especially living in Oregon, which is a ‘right to die’ state. In cases of terminal illness doctors can prescribe a lethal dose of medicine, that, if the patient desires, can take (as an oral medication) to end their life before things get REALLY bad. I’m on board. Dying a slow painful death isn’t for me. Medicine CAN keep me alive, but should it? My work in an animal ICU has helped frame this opinion. I am involved with euthanasia on a frequent basis, and while it is a difficult decision and weighty act, I believe it is the end of suffering and the last great gift that we can give to our pets.
But this isn’t a blog about euthanasia. It’s a blog about treatment and finding that line. The line between can and should. Sometimes that line is 6 feet thick and 10 feet tall. We can remove that gastric foreign body on the two year old Labrador, but should we? Finances willing, of course we should! We’re all on board with that decision. What about the 6 year old cat in heart failure with a saddle thrombus? We can work to get him out of failure and provide pain management to the best of our ability, but should we? Is it fair to try? Sometimes those patients do recover and return home – are we giving false hope to owners? What about the 15 year old dog with pulmonary nodules and a shopping list of medical problems who is struggling to breathe? We can hospitalize, but should we? To what end? What about the geriatric, overweight, arthritic dog who needs a limb amputation due to osteosarcoma? We can certainly perform that surgery, but what are the chances that dog will return to mobility? Obviously these are not always our decisions to make, but are we giving owners the necessary information to make them?
Are we having this conversation with owners prior to jumping in? We can perform orthopedic miracles: we can replace hips, change knee angles, repair bones that were in many pieces. That is the easy part. Then we send that animal home with owners and expect them to keep bandages clean, keep pets crate rested, deliver medications on time. Then we freak out when something goes wrong. Did we stress the importance of orthopedic rehab to these owners? I know people that can barely keep an e-collar on their dog – can they honestly keep him crated for six weeks? Before we embark on thousands of dollars and hours upon hours of work in the hospital, we need to have a frank conversation with what it all means when the dog returns home. It means hours upon hours of work from the owners, and they need to be up for it. All of it. The diabetic animal needs a set schedule for eating and insulin injections. As someone who lives alone, that presents a significant challenge. We can correct the DKA in the hospital, but can the owner maintain a strict schedule at home to keep that cat in a happy glucose range? That conversation should happen right away, not five days later during the patient discharge instructions. Is it fair to put the animal through hospitalization if they’re going to end up in the same place two weeks later? Is it fair to put the owner through that stress and financial commitment only to learn they cannot perform the necessary home care?
With the option of euthanasia on the table for animals I find myself thinking about can vs. should with my own pets. I have two cats, one of them just this side of feral. He’s lived with me for all five of his years and now, finally allows me to pet him when he’s eating. If he develops a urinary obstruction we can certainly treat it, but should I put him through that? He’d have to be significantly debilitated for me to even catch him to bring him to the hospital in the first place. Is it fair to him? What about medicating him afterwards? If I can’t catch him I can’t medicate him, do I put him through the horrifying terror of days in the hospital only to fail in my ability to follow up with medications? Can I realistically reduce his stress at home during recovery? What about diabetes? Heart disease? As an owner, my compliance is necessary to keep things moving in the right direction. I need to know what I’m looking at and honestly assess my ability to do my part for this animal.
I don’t know the answers to any of these questions. But asking these questions will hopefully challenge all of us to have honest conversations with owners and not sugar-coat the sometimes difficult realities of home care. The even bigger challenge is to withhold our judgment when people decide that even though we can, they decide not to. I am sure some people in my position would do everything they could for the mostly feral freaky cat. People have paid ICU costs to hospitalize a CRF feral cat who has been living on their property for years but never was really ‘their cat’. Are they any more or less ‘good’ pet owners? Are those owners who are willing to do anything and everything for their dog to keep him going, quality of life issues notwithstanding, through one more holiday season any more or less ‘good’ pet owners?
It is not only our responsibility to provide excellent care to patients while they are in the hospital, but to ensure that they receive equally awesome care while out of the hospital. This is our opportunity to educate, reassure, offer tips, support, and set expectations. Yes we can, but make sure the owner is on board with everything that means, before we actually do. And when that potentially fixable issue doesn’t get fixed on that mostly feral cat – assume good intent from that owner.
When we take on a pet, we take on the responsibility to care for them, chronic medical conditions and all. I am in no way advocating euthanasia when the going gets a little rough. I am advocating that we be honest with our clients, and with ourselves, and look beyond the medical miracle, look beyond the hospital stay, and look at the long term commitments and quality of life issues and have those conversations. Don’t be afraid to discuss these things with your coworkers – hearing a different perspective may help you with your feelings about the situation.