“This must be the hardest part of your job.” That’s what people always say when we are about to euthanize an animal. My reply is almost always the same: “No. It’s not.” And in many ways, I am almost always telling the truth. I am blessed in many ways. As a young veterinarian, when the Island used to slow to a sleepy winter pace, I would go off a few weeks at a time to do relief work, filling in for solo vets across New England in need of vacation. I would stay in their houses, care for their pets, see their patients. I experienced a wide variety of practices, and went skiing on the weekends. A fun life for a young, single veterinarian.
Except when it wasn’t. At one of my early jobs, the practice also served as the local pound. The day I arrived I was told by the head technician there was a golden retriever with a litter of puppies that had finished their 10-day waiting period. Since no one had adopted them, I was supposed to euthanize them. I was aghast. If that happened to me today, I would know all kinds of resources to call in to rehome them, but this was 1983. No internet. No social media. I was just two years out of school, without a personal network or knowledge of rescue organizations. So I simply refused to do it. The head tech was disgusted with me. It was my job. There were too many dogs, not enough homes. That night, after I left the clinic, she did my job for me. It still makes me sad 40 years later.
But I am blessed in many ways. After that experience, I vowed to never take another job that would require me to do such a thing. Nevertheless, throughout my career, I have been faced with difficult choices. People bringing animals to be euthanized because they were moving to apartments that wouldn’t take pets. People bringing animals to be euthanized with all kinds of rationalizations about why. So for a while, I would only euthanize an animal if I believed it was absolutely necessary medically. Then an elderly woman I didn’t know brought in her cat. I honestly don’t remember all the details. The cat was middle-aged. I think it may have been hyperthyroidism, and needed daily medication. What I do remember is the cat, a thin but lovely long-haired gray that waltzed out of his carrier and strolled around the exam room. He responded to my pats with a quintessential feline arch of his back, and generally looked content. I reviewed his history,then declined to euthanize him. The woman stormed out with her cat.
The following week I received an painful, angry letter saying how hard it had been for her to come to the decision for euthanasia, and then have me refuse her request. I still don’t know if what I did was right for the cat, but I know I did real emotional harm to that elderly lady. After that experience I vowed to think harder about the people as well as the pets. I have more resources now, more life experience. I know sometimes there is no perfect solution. I have since euthanized animals that, if they were mine, I would have kept going longer, but knowing I cannot judge the struggles others are going through. I do my due diligence, make sure there are no obvious alternatives or opportunities for easy, affordable treatment, but then usually respect an owner’s wishes.
So what is the hardest part of my job? It varies. This week, it was Vesper, a middle-aged intact female dog who presented for lethargy and not eating. As soon as I looked at her gums, I knew something was wrong. They were pale and muddy. Her belly was round and difficult to palpate, but felt unusually full. A small amount of pus dripped from her vulva. I asked when Vesper had last been in heat. Six weeks ago.
Pyometra — a common condition in older intact female dogs typically occurring four to eight weeks after the heat cycle. During heat, ther cervix relaxes to allow sperm into the uterus. Unfortunately this also allows bacteria in. The uterus becomes infected and fills with pus. Bacteria and toxins may enter the bloodstream. Eventually the uterus becomes necrotic, or ruptures, and the dog dies. The condition can be “closed,” in which the cervix has shut back down and no vaginal discharge is noted. Or it can be “open,” in which the cervix stays partially open and some pus drips out of the vulva. The definitive treatment is emergency surgery to remove the infected uterus. It is a difficult procedure, far more so than a typical spay, and much more dangerous. I have seen cases where each horn of the dog’s uterus was the size of my forearm, filled with pus. Although medical treatment can be attempted with open pyometras, it is generally not considered a good option. Even with the use of hormones like prostaglandins to stimulate uterine contractions to expel the infection, success is rare, and recurrence rates extremely high.
This week the hardest part of my job was knowing I had to be very, very sure of my diagnosis, knowing it could be a death sentence for this sweet dog, knowing it would cause her owner immense grief, and leave them with difficult decisions to make. Pyometra is not always easy to diagnose definitively. What if I was wrong? Radiographs do not always give a decisive answer, and I do not have ultrasound at my practice. In this case, however, x-rays and lab work were conclusive. Vesper was gravely ill with advanced pyometra. She also had mammary tumors. Her owner weighed the factors: her age, the prognosis, not wanting her to be in pain. Yes, euthanasia is a hard part of my job, but when it spares an animal suffering, it can also be a sad but necessary blessing.