Monday, April 17, 2006

Getting Ready

"I hear you're burning out on this."

"Yes," he mouths, no longer able to speak from the effects of invasive cancer.

"I love and admire you so much," I told him. "We'll do everything we can to keep you comfortable and at home." We shook hands, the sound of the oxygen compressor filling the room in the vast silence that followed that simple exchange.

Then I called hospice and let them know that it's time to get their services on board. We're all getting ready.

From there, I went back to the office, took care of some business, and then went over to the local animal hospital, where my 13-year-old dog has been since yesterday. I sat in his little cage/cubicle with him. Renal failure manifests as vomiting and anorexia in dogs. He vomited so much on Sunday, and then he could barely stand. We packed him in the car and sped to the animal ER.

Interestingly, two years ago on Easter Sunday---the very same day two years ago---I rushed him to the same animal hospital, and it was acute pancreatitis. At that time, he had not yet begun failing in earnest, and I wanted them to do everything they could, even in the face of respiratory arrest. This time is different. The poor old guy is DNR/DNI. I visited him in the ICU after work today. He didn't even get up to greet me, though he licked my nose as I talked to him, looked him in the eye, and brushed him down, removing large amounts of winter undercoat. I sat in that cubicle for an hour, the IV whirring as it instilled fluids in his canine veins. I told him I loved him more times than I could count.

I guess we're always getting ready, be we canine or human. We're getting ready from the moment we leave the womb. We hope the journey will be gentle. We hope there will be joy along the way. We hope we will not suffer, nor will our loved ones. We hope to die in peace.

My first dog, my dear friend, will come home tomorrow and begin a final chapter of his life's winter. We will love him and feed him and give him IV fluids as long as he seems to not suffer. And when the time comes, when we're all ready and the signs are clear, we'll call the vet, she'll come to our home, and we'll tenderly hold Sparkey in our arms as he leaves this sweet earth.

Meanwhile, my patient, unable to have his life end so mercifully, will see it through to the bitter end, hopefully in the comfort of his sweet and lovely home. Which is better? Which is more "humane"? Who will experience the least suffering?

All beings deserve to die with dignity and freedom from suffering. May we be willing midwives to them all.


Shig said...

Keith, have you ever heard of the story of the boy and the starfish? A man was walking on the beach the day after a storm. Scattered along the sand were hundreds of starfish that had been washed up and were now drying in the sun. Coming toward him was a young boy who would, every few feet, stoop down, pick up a starfish and toss it in the sea. The man approached and asked him,"What does it matter? You can't possibly save them all." The boy smiled at him, picked up another one and said, "It matters to this one."

Kim said...

Oh man.

I have a "Sparky" and a "Samantha" and seven cats.

My cats live to old age - around 18 or so. One of them was named Deanna. She was in renal failure and for the first time, I didn't take a dying cat to the vet.

My vet had given her some valium to increase her appetite. One mg for a 5 pound cat. I gave her one. She became lethargic, but not in pain that I could see. I knew she was dying. I wrapped her up and held her next to me. She put a paw on my face and purred. We went to sleep and the next morning when I woke up she was gone.

It seems as though when it is finally time, it goes fast. My Tasha, who we put to sleep in August, was 18. She was old, but eating and using the catbox and getting carried everywhere because she was 'Queen Bee" of the house.

Then she suddenly stopped being able to walk. We took her to the local animal ER (no home visits here). They gave her a sedative first and then gave it time to work and time for us to be with her. She went peacefully. We brought her home and the prettiest flowers in the garden are where she and Deanna are buried.

I truly believe that we can give patients medications to stop their suffering without active euthanasia.

But I agree. Painless and with dignity.

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Yes, dignity is paramount. Thanks for sharing a personal story, and for the support from you both.