(Reprinted from my PetMD Blog:)
Today is my day off and on my day off I try not to think about work stuff. But yesterday was one of those days with slimy tentacles that wrapped around me and wouldn’t let go. You know, the type of day that makes you pick the big glass of wine when you get home.
It seemed like any other Thursday at first, maybe even a little on the slow side. Then a dog named France came in and sort of changed the tone for the whole day.
The dog’s name isn’t really France. She’s actually named after another European country, but I’m using an alias to protect her identity.
Anyhow, France was a beautiful 11-year-old black Lab who actually looked just like an older version of my lab Mia. She was happy and wonderful and came in about a month or two ago with a lump under her eye.
Typically, the type of swelling she had is consistent with an abscess associated with a crack in the fourth upper premolar. The tooth has big roots that go up into the dog’s sinuses. If a dog chews something too hard and breaks that tooth, bacteria can travel right up the now-exposed root and into the sinus, causing a bulge below the eye on that side. Sometimes it will even rupture and drain.
So, France came in with this bulge and I figured: Home run, I get to “wow” the client with this revelation that the swelling under the eye is actually caused by a bad tooth and the problem will be easily solved by extracting the tooth. Yay me, I get to be a (minor) hero.
Au contraire, mon frère. I lifted that lip and the tooth looked normal. Well that’s just great, I thought. Now what?
My home run just turned into something more complicated that I don’t have a sports analogy for because I don’t play sports.
Well, when you don’t know what’s going on, start running tests. I figured it could still be some kind of tooth problem (just not visible from the outside), or other infection, or tumor, etc.
I discussed the case with the clients and we proceeded to sedate the dog to get X-rays of the face and teeth.
As luck would have it, I happened to have a boarded radiologist in the building when the X-rays were taken. I was pretty sure I knew what I was seeing, but it was nice to have the second opinion handy. The consensus: “Primary Bone Tumor.”
France actually had a tumor in her cheek bone that was eating away at the bone, causing the swelling.
I was torn. The academic voice in my head wanted to biopsy the tumor. The common sense voice in my head said: Why? Clearly it’s an aggressive tumor on the face of this dog; it’s eaten away at about a third of the zygomatic arch (cheek bone). It’s bad. So you biopsy it, then what? Send the dog to the surgeon to remove half the dogs face? Radiation below the eye that would cause blindness in that eye and be palliative at best?
It wasn’t my decision to make.
I gave the clients the facts, had several long discussions and let them decide.
They decided to just ride it out and put her to sleep when her quality of life started to decline. I put her on pain medication that would hopefully slow the development of the tumor.
About a month or so passed without word from the clients. Part of me hoped they went for a second opinion and received better news.
I finally worked up the nerve to call them last Saturday to see how things were going. The owner said she was doing fine. They had switched her to wet food because it seemed to be hurting her to eat dry. The tumor was bigger, pushing her eye back into her head, but she seemed happy still.
Great news (well, relatively so … at least she was happy).
And then the clients woke up Thursday morning to find blood all over the place. They rushed France to the clinic.
The tumor had grown from the size of maybe a nickel to that of an egg. Her mouth was full of blood. I was pretty sure the tumor had broken into her mouth thorough the palate and was bleeding.
Meanwhile, France is looking at me with her goofy lab grin, acting perfectly normal.
Clients often ask if euthanizing pets is the worst part of my job. Usually it’s not; it’s just part of what I do. Usually the dogs are suffering and it’s time and I’m just helping things along.
Moments like this though, when the pets are acting totally normal, except for some stupid tumor on a body part that’s big and ugly and bleeding, kill me. They are probably the most difficult euthanasias I perform.
This one was especially a doozie.
Such a nice dog and nice family.
I sedated her, and once she was asleep, the client told her he loved her and listed the names of all the people who loved her too. She was sleeping peacefully, but let out a big snore when he mentioned the kids’ names, as if in acknowledgment.
Then he said a prayer for her.
That was where I lost it. I’m not an overly religious person, but the sweetness and poignancy of the moment made me lose my professional resolve.
Heaven got a good dog yesterday.
The whole thing reminded me of one of my favorite quotes:
“If there are no dogs in Heaven, then when I die, I want to go where they went.” — Will Rogers