The last act

Today I severed the bond. This is nothing new. As a veterinarian, I've euthanized animals for years. I've grown accustomed to performing this final medical act, but it never gets any easier. And some euthanasias are more difficult than others: the poodle of an elderly man who lives alone, the golden retriever surrounded by the children she adores, the diabetic schnauzer I've been managing for years. And then there was the most difficult of all: my own dog Toby.

Big heart: Toby made lots of memories during his lifetime with Dr. Melody Heath and family.

I met Toby in 1993 when his owner brought him to the clinic. Toby was an 18-month-old red dachshund, emaciated and timid. The presenting complaint was vomiting and diarrhea that had lasted for more than a year. I palpated a tender, tubular mass in the little dog's abdomen; radiographs confirmed my suspicion of an intussusception. Toby's owner requested euthanasia but reluctantly agreed to relinquishment.

Spending the time, effort, and money to save this debilitated dog may not seem like a smart use of resources, but I have a soft spot for red dachshunds. My first one, Jenny, was rescued from a shelter. She lived 14 years, after which Cleo, my second, entered my life when her owner suffered a stroke. Cleo died not long before I met Toby.

There I was, a new graduate looking for challenging cases, living alone, and dachshund-less for the first time in years. And there was Toby—scared, neglected, and left for dead. I had the skills to try to save him. After the miserable start he'd had in life, I owed him that much.

Late that evening I performed my first intestinal resection and anastomosis. Four days later I brought an even more timid, emaciated dog into my home. As time passed, Toby transformed into an outgoing, obedient, handsome companion, and we became inseparable. Toby went to work with me every day for nine years before retiring and spending his days in a sunny spot in the backyard. When the phone rang in the middle of the night, Toby ran for the door. He was always eager for emergency duty, even when my enthusiasm waned.

He loved to chase squirrels, go for long hikes, and curl up on the couch beside me to have his ears scratched. He liked children, unlike many dachshunds, and he stayed trim his entire life. He also performed a variety of tricks, such as sneezing on command. He would lie perfectly still while I trimmed his nails, scaled his teeth, or drew blood. He traveled with me, slept with me, and comforted me through major life changes. Toby was a cherished member of my family.

In his early years after the surgery, Toby was the picture of health. More recently, however, he'd developed a heart murmur, arthritis, and chronic ulcerative stomatitis. He was deaf and partially blind. At age 16, he became fecal and urinary incontinent. While any combination of these problems might have been reason enough to consider euthanasia, Toby adapted well and seemed comfortable living within his limitations. The increased demand for nursing care seemed a small price to pay in return for the endless joy and unconditional love Toby had given me for so long.

Then, seemingly overnight, Toby started to show his age more rapidly. Friends and family commented on how pitiful Toby looked. He didn't seem to enjoy life the way he used to. For the first time I began to contemplate euthanasia. I set a date, but backed out when my physician sister protested, saying it wasn't time yet.

For the next two months, the first hour of my day was the worst. It was spent cleaning floors, laundering bedding, washing Toby, and supervising him outside. Consolation came in knowing the last hour of my day would be the best. Between 10 and 11 p.m., Toby went outside to relieve himself, came in and begged for cheese by the refrigerator, then barked and followed me around until I picked him up and held him. I would pet him for an hour or so and then tuck him into bed. It was an enjoyable, relaxing way to end my often hectic days.

Toby was the only pet I'd treated in my first year out of veterinary school that was still under my care. A selfish part of me wanted to keep him alive as long as possible—and I knew I could. But I also wanted him to die a dignified, peaceful death. I worried that I might euthanize him too soon; I fretted that I might wait too long. It was impossible to be sure. Again I set the date. Once more, I backed out at the last minute.

It would have been so much easier if Toby had died naturally, preferably in his sleep. Then I wouldn't have been forced into the position of "playing God," as so many of my clients have put it. Perhaps this is why I delayed euthanasia, in hopes that he would go peacefully on his own.

But eventually Toby's appetite plummeted; his already atrophied body grew thinner. He slept nearly 20 hours a day. He stumbled on tufts of grass in the pasture and barked for me to carry him back to the house. He fell helplessly into his water bowl and got stuck climbing out of his bed. He stopped begging for cheese.

He did, however, continue to insist on being held each night. I ran lab work looking for confirmation that the time was finally here. The results came back normal. I palpated his body, searching for tumors: negative. I ausculted him. His lungs were clear; I heard the same heart murmur I had listened to for more than three years. I found no medical evidence that clearly warranted euthanasia. Toby was simply old. I decided to give him a few more days, in which I vowed to spend more time with him. Not for Toby's sake, but for mine.

Euthanasia had always seemed so cut-and-dried with my clients' pets. They'd seemed so certain—and so had I. When pet owners would ask for my professional opinion, I could usually pronounce within 15 minutes whether it was time to euthanize. I would examine the animal, review lab work, and listen to the owner. But with Toby I lost my objectivity. The blacks and whites became grays, the line between acceptable and unacceptable quality of life became a continuum. I found myriad justifications for keeping him alive when he really wasn't living at all.

As a veterinarian, I'd forgotten the enormity of this end-of-life decision—not only how difficult it was, but the choices that came with it: When should I do it? Where? What would I do with the body? Who should be present? Should I tell my young children? Until now, I hadn't fully appreciated the courage and strength my clients had displayed as they calmly followed through with their decisions to end their pet's life.

I set the date once again. I would do it tonight, for Toby's sake. No excuses, no backing out—even though I knew that tomorrow my house would be hauntingly empty. Toby's bed would be vacant. His sunny spot in the backyard would be empty. My heart would ache. I knew, too, that although I am perfectly sane, in the weeks to come I'd catch glimpses of Toby out of the corner of my eye. I'd hear the familiar clicking of his toenails on the tile floor, the jingling of his tags, or his hoarse bark on the other side of the door. I'd miss that first hour of cleanup in my day, the very one I'd dreaded the past few months. I'd want that hour back. I'd sit on the couch by myself late at night, painfully alone.

On the night I have chosen, my children say their final goodbyes to Toby. My husband goes to bed. Toby and I are alone. I conjure up reasons why I should postpone again, but then I look at Toby. He's thin, weak, and depressed. My memory travels back to a rainy August day 15 years ago, when I was a new veterinary graduate. I'd been furious with Toby's previous owner for letting this happy, healthy dog deteriorate to such a lamentable condition. I realize I've become that person.

I gently lift Toby and put him on my lap as I've done every night for months. I hold him and tell him, in great detail, the remarkable story of his life. I tell him how much I love him and how sorely I will miss him. I promise to never forget him. I thank him for being a loyal and loving friend, for enriching my life in immeasurable ways. I tell him he has made me a better veterinarian and a better person. Then I sit quietly and stroke him for hours, his last hours. I try to engrave into my memory his long, loving face and the peaceful feeling that holding him gives me. Toby falls asleep on my lap, oblivious to the overwhelming crisis raging in my mind and body.

In the wee hours of the morning, I give Toby a gentle shake and he wakes up. He looks up at me. His old, trusting eyes meet mine. I hug him and whisper "I love you" one last time. He taps his tail gently as if to tell me he understands and it's OK.

I administer a sedative. His body relaxes. I hold him for another hour, but it seems like only minutes. Then I take a deep breath and do what I was called on to do 15 years before. With blurry eyes and a pounding heart, I take Toby's soft, gray paw into the palm of my trembling hand and manage to locate a vein. I tenderly insert the needle and slowly inject the pink solution. Toby draws one last breath and drifts off peacefully. I cradle his limp body tightly against my chest until it's no longer warm. As the first rays of sunlight peek through my window, I rise and place Toby in his bed one final time. I cover him softly with his blue fleece blanket, just as I have done every night for years.

Today I secured the bond. After all Toby gave me over the years, I owed him that much.

Dr. Melody Heath is an associate at Viewmont Animal Hospital in Hickory, N.C. Tell us about the most important pets in your life on the message board at dvm360.com, or send comments to ve@advanstar.com