We Let Them Go When the Time Has Come

Tuesday, March 8, 2016 - 5:32am
Photo by Sal

We Let Them Go When the Time Has Come

I say this out loud at my peril: my dog hasn’t been to the vet in almost two weeks. The last time he was there, the bill was $173.25 for a urinary catheterization and an aerobic culture, plus $31.50 for antibiotics when the results were positive.

The time before that it was $350 for a non-sterile urine sample (which didn’t tell us what we needed to know) and a full physical, with special attention to the abdominal region because after 11 years of only doing his business outdoors he had suddenly taken a liking to a wildly expensive oriental rug.

I discovered this unfortunate new habit early one morning, on my bleary way to the coffee maker, when I stepped in it, barefooted. The same thing happened the next day, in exactly the same place. At the vet’s suggestion I bought a spray bottle of Anti-Icky-Poo, despite reservations about a product named by a moron or a five-year-old. It was supposed to disguise the odor and dissuade his return to the same spot but didn’t work. The next step was rolling up the rugs since at least an accident on a bare wood floor would be easier to clean up.

My annoyance shamed me. For 11 years, Henry, a regal Standard Poodle, had been my devoted companion, as only a dog can be. Now here I was obsessed about vet bills, disgusted to start my day stepping in poop, resentful I had to walk him in the dead of night, and so house-proud that rolled-up rugs were an aesthetic offense. Also, I was surprised at my own surprise that a sick dog was a costly bother.

Last year Henry was diagnosed with liver cancer, when a sonogram revealed a tumor of about one centimeter. Three months later, a second sonogram showed the mass had doubled in size. Removing it meant major surgery, a risky business for a dog this age. There was no way of telling if it had spread to other organs without further invasive procedures.

Assuming I took these next steps, then what? Would I subject a dog whose normal lifespan is 12-14 years to ongoing cancer treatment? I decided I wouldn’t and thus didn’t need a map to a place I wasn’t going.

The plan was the doggy equivalent of palliative care: do only what would keep him comfortable and happy. One example was eschewing routine periodontal care and possible extractions, both requiring anesthesia. If he didn’t have a toothache, why bother? Presuming the tumor would likely at some point put pressure on his abdominal organs, we’d monitor whether he ate well, drank normal amounts of water, had typical bladder and bowel function, and remained alert and frisky.

For a year, but for changing his diet, all was stable. Being a worrying sort, I nevertheless investigated what to do if a dog falls gravely ill when the vet is closed and how to get him there since he’s way too big to carry. All of this information is in a manila folder on my desk marked "DOG."

The last few months, calm has given way to one canine crisis after another until the current veterinary reprieve, which will end when he’s finished the course of antibiotics. Then we’ll test if the infection is gone. My hunch is “yes,’’ but I’ve been wrong before. And if the next culture is still abnormal, there’s another decision tree. Test for this. Test for that. Sonogram or endoscopy. Maybe nothing at all. This dog has had nine lives already and maybe will have a tenth.

From the day of diagnosis, the vet and all my friends with a lifetime of experience of dogs and their dying, have told me I’d know when Henry’s time was up. His suffering would be obvious and then I’d put him down, they said. But what if it isn’t obvious? I’ve always loved that he didn’t talk, his silence a key component of his peaceful companionship, but now I wish he did.

You don’t euthanize a dog because his digestive system is not tip-top. You don’t euthanize a dog because the rugs are rolled up and company is coming. You don’t euthanize a dog because his medical care is straining the budget. You harshly judge yourself for even thinking about this. You watch and you wait and you wonder how you’ll be sure.

My vet is right around the corner, and Henry and I pass there on our regular morning and evening walks. When they are open for business, through the plate glass windows, he charms whoever is behind the desk to open the door and give him a treat. After hours, when they are dark and shuttered, he sniffs around the concrete foundation or stares imploringly inside.

Maybe he is silently suffering and needs a doctor. Maybe he’s hoping for a treat. Maybe he’s just messing with my mind. The vet tells me poodles are as smart as eight-year-olds. Messing with my mind is something an eight-year-old might do.

Why, you might ask, does this end-of-life muddle surprise me?

Largely it’s because so many suffering elderly people, my late mother among them, comment repeatedly that we are kinder to our pets than to people since we let them go when the time has come. That remark has become a cliché, which usually happens with oft-repeated remarks that are true. But this cliché, I find, watching a dying dog take one step forward and two steps back, is not actually true.

Yes, we have the capacity to put our pets to sleep with a single merciful injection. Yes, it’s legal to do that to animals while assisted suicide for human beings is against the law in the vast majority of states. But for pets and people both, it’s not always clear when the time has come. The process is not always linear. I know Henry is dying. But I haven’t a clue how I’ll know when Henry would be better off dead.

The author, and her dog Henry at a younger age.

(Jane Gross)
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Jane Gross

is a retired New York Times correspondent, who spent 30 years there covering all manner of subjects from sports to autism, aging and major earthquakes and wild fires in California. She is the author of A Bittersweet Season: Caring for Our Aging Parents — And Ourselves and creator of the "New Old Age” blog, now defunct, at the Times.

Prior to joining the Times, Ms. Gross worked for Long Island Newsday and Sports Illustrated magazine. Post-retirement, she volunteers mentoring New York City high school students and is trying her hand at ceramics.

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I understand. My last dog had a degenerative spinal condition that eventually caused him to lose control of his back legs. We tried a dog-wheelchair but he refused to be strapped into it. I assisted him with his mobility for about a year, with pain meds, acupuncture and laser treatments to control his pain, and he seemed much his same self, but with mobility issues. He was always food motivated, and when he heard the refrigerator door open, he would manage to drag himself to the kitchen to see if there might be something in it for him. Then he became incontinent and he was so embarrassed about it (he was a proud chow mix), he became depressed and no longer even cared about food. At that point I began to feel strongly that I was I was doing this "heroic" regimen more for my benefit, to avoid the pain of losing him, than for his, and I made the decision to end it. It was the hardest thing I have ever done in my life. I knew.

Thank you for writing this. We do pet owners a huge disservice when we tell them they'll "just know" when it's time. Many of us don't (and then we feel embarrassed that we can't just intuit the right choice).

There is a Quality of Life scale for pets that can help us make that hard decision with a bit more clarity:

And there are more resources included here:

Wishing you and Henry peace.

Jessica - i think you intended to insert a link. I do not see it. Perhaps the webmaster removed it? Or, it's an oversight? If you can insert the link, please do so. Thanks for your insight/comment.

I find myself in the same situation. Palliative care hoping I will know when it is time to say good-bye to my furbaby who has been at my side through pain and joy. All I know is when my last Golden's time came, I DID know and pray I will this time. I wish you the same. My Bentley also has cancer and since I would not subject my body to cancer treatments that rob quality of life for a now 76 year old woman....I won't do that for my now (in human years) 87 year old pup.

Jane,

I don't know you of course but the story makes me sad. I have had to make this decision 5 times now and I can say that even though each time was different, the pain was still the same. The shame of being relieved that the process is over is always present. Nothing makes any of it any better. I would only add that you really do know when it is time but that doesn't guarantee that you are doing it in time, if that makes sense. I waited much too long with my last friend. And that is what they are, friends, and as such I feel obligated to do the best I can.

Take Care,
Libby

I'm going through a similar experience with my 13-year-old poodle mix. I've had to get my previous poodle put down before -- he was 16 and in bad condition at that point, so the right choice was apparent, though rough. When your dog is ailing yet still gets joy out of life, though, it's tough to know what to do. Of course, it varies for everyone and every dog, in the end.

Why is life "better" than death? With death a consenting adult would be free of worries regarding resources and failing health. One would be able to plan and even help the economy by spending their resources before they die. I would gladly accept a defined departure date so I could control the remainder of my life to some degree and not have to fear outliving my resources or becoming a shadow of my former self, unable to enjoy life.

A dog park friend gave me one sentence which really helped me when I was in this situation.
"It is better to end your dog's suffering a week too early, than a day too late".

I also recommend having 'the procedure' done in your home if at all possible. I was lucky enough to live in a community which has a couple groups of veterinarians which do nothing else than 'end of life' animal care. If you've ever met a hospice nurse, someone who can help you embrace the end in a peaceful and loving way, you'll know what I'm talking about. They helped me create a loving, and actually beautiful, send off for my dear friend.

This is absolutely profound: "It is better to end your dog's suffering a week too early, than a day too late". Thanks so much for sharing that bit of wisdom.

Your dog park friend gave you very good advice. The last thing I wanted for my dog, Clive, at the end of his life was to have him die from an emergency event - resulting in severe pain and death in an animal hospital - because I had waited too long. Clive had been declining for quite some time. I decided to put him down when he could no longer go on even short walks, was very anxious, could not get comfortable or sleep well, and lost control of his bowels frequently. When I cried on the phone to a veterinarian service that provided home euthanasia, Clive struggled to his feet, walked over to me, and put his head on my thigh. He looked at me as if to say, "It's okay. It's time." Clive's passing was very touching. He died in my lap, surrounded by family and he got to eat lots of his favorite cheese beforehand. I still feel I might have waited too long, but it is so hard to let go of a beloved and loyal friend. I miss him dearly. Thank you for the posting and please be gentle with yourself.

I currently have a fifteen year old Giant Schnauzer/Standard Poodle Mix rescue who is slowing down very much. My concern is that I won't just know when she is ready to go.
I also share the care of my 85 year old mother who has Dementia by staying with her for a week every three weeks. I enjoy following your Blog and learned a lot from your book "A Bittersweet Season".

i dont know either. i am going through the same thing at the moment with my havana, my 17 year old spirit dog.
oddly enough, this came up today while i am quietly hysterical, wondering if it is time, struggling with playing god, not wanting her to struggle herself...thank you for this.

The first time I had to euthanize my companion was in 1985 and it was devastating. I had found this dog in the middle of a busy street hit by a car, despite knowing the dangers of an injured animal reactions I stopped and managed to pick him up and take him home. I could tell his broken and since I knew of a vet that had just opened a new practice in an old house near me I took him there. He had a broken leg but was otherwise ok. The vet knew his owner, the dog was a guard dog in a local construction yard, and he said he was surprised I had been able to pick him up as he was pretty aggressive normally. He fixed him up I told the dog, named Falstaff goodbye, he licked my hand, and was sad to leave him.
Six weeks later on my return from work I was surprised and to see Falstaff sitting on my porch, regretfully I knew I had to take him back to his owner. It was obvious he didn't want to go, but it was apparent he was fed and cared for so I felt beholden to take him back. The owner thanked and assured me he would check his fences closely and also told me he was surprised the behaved so well for as he an excellent guard dog and not normally friendly to people. I thanked him and told him he was lucky to have this dog.
Less than another month later I come home and he was there again, I called the owner and told him that Falstaff was back again, and he said to keep him, it seems meant to be. This story would be too long to explain all the adventures we had together, I was single at the time and he was my constant companion, we traveled all over the country camping and hiking, his guard experience helped catch a burglar, his favorite hobby was finding turtles and bringing them home, he never hurt them he was just fascinated by them. His favorite treat was a White Castle hamburger, he would carefully remove the bun, nose the pickles and onions off, put the bun back on and then eat it. I was hilarious to watch. He eventually became so crippled that I walked him with a sling under his backs legs, and it became obvious the pain was to much it had to be done. On the way to the vet we stopped at White Castle for his last meal, to this day I smile when I think of that last meal but the tears come as I write this article

Dave, that is beautiful.

Having had the experience as caregiver to both--beloved parent and beloved pet--it IS difficult. And different, obviously. Interestingly enough, though, there were times my cancer-stricken Mother couldn't communicate any more than our SuperSenior cat in their respective last days. With the cat, we had to decide when it was time. In the beginning of his endtime with us, he had difficulty eating and started losing weight. After food, medicine, and a rally or two, one day it just looked like everything was a struggle. One night he seemed to want our affection but he also seemed agitated and his eyes were distant. I felt like I recognized that "look" from caregiving for my Mom. While the cat's bloody drooling was kinda gross, we wiped his face frequently and gently. But when he could no longer close his mouth or keep his little tongue from sticking out, the culmination of behaviors told me it was time. Time for me to step up and help him out of his severely dimished world of pain and suffering. I wish he would have been able to slip away quietly in his sleep--that would have been SO much easier for our family. But we made the euthanasia appointment with the vet and did what we needed to do. And it still haunts me a little, even to this day.

I have been fortunate to have four best dogs in the world and three cats, at least two of whom were superb. I can say with certainty that sometimes the animal tells you they are done, and sometimes they just dwindle and you have to decide. In just the last year, the last dog and the last cat both told me finito. Both were ill and I had done what I, and modern medicine, could do. I spent the summer of 2015 with a sweet corgi mutt named Roxie, who had endured Cushing's Disease for 5 years with grace and abandon. I had to keep her quiet as her esophagus irrevocably closed up. I was told that for her it was like breathing through a straw, and on hot days I carried her outside to the shade for brief periods. In the evening we sat on the lawn across the street while she sniffed the grass and enjoyed herself. Until she didn't. One day she went outside, lay down in the corner of the yard and basically said "I quit." That was exactly what the last cat had done when his lymphoma got too bad and I wondered if she knew or remembered, as they both went to the same corner of the yard to retire. That is my hope for you and Henry. It will be devastating but it will also be clear. Of the three other dogs in my lifetime, one had organ failure and I knew when it was time. The others just hung in there week after week until I had to decide and that was awful – far worse. They were both staying alive for me (said the vet) and so it was up to me to let them go. The vet reminded me that dogs’ bodies are still designed for the wild, where they would be offed by another animal as prey. In our comfy world, they can hang on far too long. He told me in no uncertain terms that this dog had stayed alive for me through thick and thin and now I owed it to him to help him depart this life that his body would not leave of its own accord. “He needs you to help him let go.” I found that comforting and so I offer it to you in case you need to do same.

As I read this piece, my 11 year old dog lies pressed up next to me. I feel his warmth and his heartbeat. Diagnosed with cancer a month ago, I was told the big tumor could rupture at any time, killing him almost instantly and painlessly. At any time. That phrase, given to me by the vet, has me in a suspended state, a watchful state. I hold my breath when I return home. I remind myself to breathe. I wake in the dark, I listen for his breath as I hold my own, straining to know - does he live? The alternative scenario is the tumor will continue to grow, and like Henry, he will be in some type of suffering until I decide it's enough. Yesterday we walked through the woods and he had a puppy look to him. Surely today won't be his last - I won't bring him in tomorrow. Last night he moaned as he tried to navigate his way around the tumor to find a comfortable nap. Maybe tomorrow would be best.

I've learned that a dog's instinct is greater than his pain. On days when he has trouble getting up, he still finds his way to the kitchen when supper is being made. After he's taken so much time, whispered so many moans, and has finally drifted off, if he senses the cat nearby, he's up for a chase.

Each day we wake up and I am grateful he is here still. He wags his tail at the morning. Then at the end of the day, though worn and uncomfortable he wags his tail still, as I say his name. I believe his instincts will remain strong and I would not be surprised if this companion, this friend, will be up for wagging his tail even as we lay him down for his final nap. I would like to be filled with enough love in my final moment in this life to say goodbye with a wag of a tail.

Yes it's too hard. But when Henry no longer wants to take those walks or charm people for treats, that's a pretty clear sign. Count the things he loves to do, and if there are at least two or three (eating, walking, playing) he's good for now. The 'tell' my dogs have is simply not eating meals. I'm going through the same thing (right down to the rug!), with a 14 year old greyhound who had a cancerous mass removed from her throat last month so that she could breath. She's good right now, but my mind is taking lots of pictures of her happy, so that I'll recognize the change when it's time. I pride myself on not letting my dogs go out in flames... they deserve to enjoy that last trip to the vet and walk in with dignity. So yes, sometimes we go a day too soon, rather than a day too late. That's the standard advice and it's good advice, but you never feel quite right about the day you choose. I remind myself that the dog doesn't know it's over, only I do, and it's the kindest thing.

I myself keep thinking every time I read articles or comments about their fur baby "telling" them it's time: "Who knows exactly if it really is the right time?" Yet I also believe that if you are a dog parent, you'll know --- you'll feel it's what your fur baby wants because dog parents and fur babies develop a bond that their hearts and minds speak with those eye-to-eye contacts and simple gestures made by the fur baby to you. Maybe the dog/cat did speak to them in a language only parent and fur baby will understand. Maybe it was really the right time to say goodbye in the physical plane and saying "I love you!!! I'll see you next time in the rainbow bridge."

Thanks to everyone for your heart-felt comments. My beautiful Australian Shepherd/Chow, Gina Lollabrigidog came to live with me 13 years ago, after 3 incarcerations at the Humane Society. She seems healthy, and she's more excited about her daily walks since our vet prescribed Rimadyl to alleviate pain in her arthritic hip. She's usually enthusiastic about catching the kibbles I toss to her before meals, and she's always happy when meat, broth, steamed broccoli, or peanut butter are offered. However she often slips while going up or down stairs, she has a hard time jumping into the car, and she rarely sleeps by my bed any more. Because of her age (about 14 years), I'm already anticipating the day when she will not welcome me home. Therefore I'm always grateful when I come in and see her at the top of the stairs, or hear her dog tags tinkling. For now, I've decided to stop worrying, and enjoy every day we have left together.

Thank you for this. My dog is eighteen and I've been told horribly healthy for her age. She started having bathroom issues last year and I've done the vet rounds, antibiotics, tried to debate putting her down when she's still bouncing around like a ten year old, tried to find her a better home with someone who'd have better hours since randomly taking her out at night is making my health issues worse, the list is endless. You want your pet to be happy and healthy even if it means they're not with you but so far we're managing even if she spends most of the day sleeping in my kitchen since she only has accidents on the carpet and can hold it for 8 hours if in the kitchen but not if out in the house. So far she is happy and until that seems to change we'll muddle along.

Two of mine:

It's a terrifying, terrifyingly final decision to make, but honestly, they do tell you. The trick is not to second-guess yourself afterwards, but to trust them, and ultimately trust yourself, your understanding of them, your love for them. My heart goes out to you.

Dear Jane, You have lifted the words right from my heart today. I have a 12 + year old Wheaten Terrier who is showing signs of preparation for leaving. I have no idea when we can know that it is time. Does his suffering have to get so bad that it is undeniable? Or will there be something more subtle, like skipping meals? or no longer wanting to take his regular walks? Yes, the best friend I will ever have. Will that will keep me holding on for longer than I should. My grieving will come no matter when I say good bye. His suffering comes so gradually and I am so steeled from the thought of saying good bye that I predict I will not know when that time comes. He is not his old puppy-like self and neither am I. Thank you for sharing your version of the dilemma.

apples