Peanut's lesson: Facing a hard fact of veterinary care

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The first couple of years out of veterinary school, I thought if I just studied harder and worked a tough case over and over, I'd find distinct clues-the answer to what was wrong. I wish I'd been nicer to myself when diagnoses just slipped away or patients got sicker no matter what I did. I wish I would have remembered my time on internal medicine rotation when cases failed to have succinct closure. It's still easy to wish for more-more tests, more rule-outs, more clarity.

An example in a nutshell

A few months ago, I euthanized a 15.5-year-old miniature Schnauzer-we'll call him Peanut. He had been slowly disappearing, eating less and less, dwindling over many months. He had dementia, but it was his gastrointestinal (GI) signs that we could not pin down through blood work and ultrasound.

We finally elected palliative care and worked our way through drug classes to try to get him to eat-anti-nausea meds, steroids, appetite stimulants, antacids-and a plethora of foods. The owner and I compared what types of snacks and gravies and canned food flavors my own elderly Chihuahua preferred, even after I got her inflammatory bowel disease meds right. With Peanut, it was hard to determine which medications helped and which did nothing. I shared the owner's sorrow and frustration each time we talked.

The week before Peanut died, we discussed whether it was time to euthanize. She set a mental parameter: she did not want him to starve. After Peanut did not eat all weekend, the owner called for an appointment.

Peanut was tremulous, stressed, and so thin when he came in. I gave him sedation for pain and anxiety, and we petted and talked to him as we waited for him to relax. As he settled down, Peanut's owner reached for a grocery bag on the chair behind her. She gave me his leftover medications, the jars of treats and baby food. She gave me a full container of an expensive supplement for my own dog.

She thanked me for all that I had done for Peanut, despite us not knowing what ailed him or being able to help him feel better long-term. She reached for a small box lined with tissue paper and pre-packaged treats she had made. The previous week she had also stopped by with cookies.

I thanked her and fell silent. In 10 years as a veterinarian, I had never had an owner bring gifts for the staff to a euthanasia. The owner was sad, but clear-headed and grateful. I was grateful, too, for her kindness and the ability to let Peanut go.

I had offered a feeding tube to Peanut's owner. I had offered referral. It was difficult to not hang onto the what-ifs: What if he had seen a specialist? What if we had repeated blood work? What if we had repeated an ultrasound? What if we had tried acupuncture? Where would we have ended up? She had declined further workup.

Three fundamental words

I don't know-words a veterinarian needs to carry in her pocket. This sentence is slippery and evasive. Some days it has more power, right next to your heart; sometimes it's rattling in a corner; sometimes it's far away, out of sight.

I don't love that sentence. I sometimes worry I will fall too easily into its gaze when things get tangled. But I also need it. It's a small plateau of respite from thinking you have all the answers-that the world of disease is controllable or completely fathomable. Peanut's owner gave me permission to hover there for awhile, to make not knowing a little more comfortable, to let it just be.

It was a quiet moment, being there with Peanut as he died. I pulled back the words I wanted to spill into the silence and let the drugs do their work. He was a good dog, and we told him so.

Sara Greenslit, DVM, CVA, practices at Northside Animal Hospital in Madison, Wisconsin. An author and a vet, she has published two books-As If a Bird Flew by Me and The Blue of Her Body.