So, my grandmother is in the hospital, things are looking pretty grim. I was there over the weekend to lend some moral support to my family & perhaps to say goodbye. The whole situation got me thinking. In veterinary medicine, we deal with death on a very regular basis. We strive to enhance and lengthen the quantity of days our patients have with us, but our first priority is to preserve the quality of those days.
I have a tendency to get bogged down in difficult cases, I want to figure things out at all cost. Often, I reach a moment where I realize I need to stop, look around, go back to basics and assess the quality of life of the patient.What is this all for, and where are we heading?Am I just trying to diagnose something for my curiosity, or is it going to change how I handle this case? What’s the endgame here? If I get this pet better, how long will he be better? Weeks? Months? Years? What are the pets basic quality of life parameters? Is the pet happy? Interacting? Pain free? Clean? Resting comfortably? Is he getting any joy out of life? (Even if it’s just going for that 5 minute walk, or basking in the sun.) All this has to be discussed with the client.
These are not easy or quick discussions. However, in the end, if the pet is suffering, and there is no appreciable positive outcome (where he’s happy, clean, warm, interacting, etc.) then we have to have the totally crappy talk about letting the pet go.
Human medicine hasn’t quite gotten to where veterinary medicine has always been. MD’s have been extensively, expertly, and thoroughly trained to prolong life at all cost. “The way we saw it, the purpose of medical schooling was to teach how to save lives, not how to tend their demise”, writes the brilliant Atul Gawande, in his book “Being Mortal” (Which I have been reading, a little at a time, for about a year now as it’s kind of heavy and amazing, yet simultaneously kind of depressing. Best taken in small doses.)
Human medicine is technologically superior to veterinary medicine, they work miracles every day. However, I feel that the human docs have a thing or two to learn from us vets about patient care. It’s more than just keeping them alive at all cost. It’s prioritizing the emotional and physical wellbeing of patients over mere survival.
To be honest, I find it to be an honor and a privilege to try and ensure that the time you spend with your pet at the end of his life is the best time possible, however long or short that may be.
“Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.”
― Atul Gawande, Being Mortal: Medicine and What Matters in the End
Sorry for the heavy post. On a more upbeat note, “Gambino”, now known as Tony, has settled in beautifully into his forever home in Austin.
Here’s a pic: