Wednesday, April 21, 2010

4/21/2010 Euthanasia

 Vet tip of the Day: Thinking about Euthanasia
I would like to introduce the topic of euthanasia with a few stories.  The first is one about an experience I had as a resident, and the second is about PipSqueak, a wonderful patient of mine

I completed a large animal internal medicine residency at the University of Georgia School of Veterinary Medicine.  I was on call to receive emergency patients into the hospital every 3rd weeknight and every other weekend for 5 consecutive years.  That's a lot of emergency admissions.  The sad reality of referral equine medicine is that we see a lot of very sick horses and many of them don't make it out of the hospital.

One weekend early in the first year of my residency I didn't sleep for 48 hours.  During that time I received 8 emergency patients.  Four of them were critically ill and over the course of two days I administered a lethal dose of sodium pentobarbital (euthanasia) to all four when it became clear that they had no hope of survival. Right there you come up against one of the more difficult concepts in the decision for euthanasia: no hope.  We all know that there always is hope, we just choose under certain circumstances to consider that hope too small to warrant the continued suffering of the really sick or the really old.  And let's face it, economic concerns and practical concerns influence the decision to end animal's lives as well.

That particular weekend in 1989 when I was a resident was very difficult for me. In the five subsequent years I never had to face the death of some many horses in such a short period of time.  I was exhausted, I was a new resident and I didn't have a lot of experience coping with the grief, guilt and confusion often experienced by owners when making the decision for euthanasia of an animal they love. At that stage of my career I also didn't have a lot of experience pushing the plunger on the syringe of "blue juice" that ends an animal's life.  I don't really remember all the details of that weekend.  I do remember that moment, just before performing each injection, when I wondered if perhaps there was hope, if perhaps I had misinformed the clients, if in fact the horse might survive if I could just do one more thing to turn its condition around, if I was making a terrible mistake.  None of these things was true, but the thoughts ran through my head nevertheless.  And I remember on Sunday afternoon, after I had humanely destroyed the fourth horse, sitting on the floor of the recovery stall outside the equine surgery suite and thinking, if one more horse comes in and requires euthanasia before tomorrow morning, someone else is going to have to push the plunger, I just can't take any more life today.

The second story is about PipSqueak.  PipSqueak was a grey arabian gelding who I took care of for 13 years, from the time he was 14 until his death.  Over these years PipSqueak belonged to 4 different owners, all of whom he taught the skill of riding after hounds, or foxhunting.  PipSqueak was a remarkable horse, an outstanding athlete, and a very wise soul.  Toward the last years of his life he was retired and turned out to pasture by his then owner.  His care was not adequate and he lost weight and began to have trouble getting up.  One of his previous owners, who by now was a teenage girl, saw PipSqueak's condition and reclaimed him.  She had owned PipSqueak when she was 8-12 years old and had ridden him all over the desert of Northern Nevada.  Now 15 years old, she brought PipSqueak home and fattened him up and took great care of him for another 9 months.

Although he was back in great body condition, PipSqueak's degenerative joint disease progressed to the point that he sometimes struggled for as long as 20 minutes attempting to rise, raising himself on his front legs but unable to lift his hind end to a standing position.  He was treated with joint supplements and anti-inflammatories, his hocks were injected, he was put on special footing and had special foot care, but his condition continued to deteriorate.  Finally his owner's grandmother called me one day to schedule an appointment for PipSqueak's elective euthanasia.

I arrived at the appointed time to find the entire family waiting with PipSqueak.  The horse had been bathed, his mane and tail brushed to a shimmering white, hoof dressing applied to all four feet, and he wore a beautiful new halter.  We all walked out with PipSqueak to the area where he was to be buried.  PipSqueak walked comfortably because his owner had given him one last whopping dose of bute that morning along with a bucket of grain so that he would be comfortable and feel especially spoiled in his final hours.  As we walked we shared stories of PipSqeak's many exploits over the years.

PipSqueak stood patiently while everyone said their goodbyes.  As I injected the sodium pentobarbital PipSqueak's family stood close by, speaking to him gently.  As soon as he fell to the ground we followed his descent, everyone keeping a hand somewhere on his neck or head.  We were very quiet,  his young owner began to cry and arms encircled her in her grief.  PipSqueak passed from life to death very swiftly, in the company of humans who loved and respected him, and who took the responsibility of ending his life squarely on their own shoulders, with compassion and grace.

I find the topic of euthanasia very complex, and will discuss it in more theoretical, and practical terms, over the next few days.  Please feel free to comment on this blog entry with your own thoughts and experiences concerning this topic.

I believe that education is the key to evolution.
I believe that learning never stops.

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