Wednesday, March 02, 2011

Euthanasia

Before reading this entry:  Please be aware that it may be both too graphic and too controversial for some.  Weak stomachs and hard liners will not enjoy it.  Those who enjoy pedantic thoughts that wander all over the place without resulting in any specific decisions may enjoy it with a cup of tea. 

*****

If you don't know what it means, it sounds like a wonderful, magical place that perhaps you could go to for your holidays.

"Where are you going for the holidays?"

"Oh!  We've booked a trip to Euthanasia.  I can hardly wait to relax, soak up the peacefulness and try all of the amazing, exotic food!"

The reality of it is, perhaps in the view of someone suffering from extreme clinical depression, not much different.

I say this because, in my late twenties, I suffered a very deep clinical depression and death actually equated itself with cookies baking in the kitchen.  All I would have to do was walk through the door and I would have all the comfort and peace that I experienced with eating warm chocolate chip cookies and drinking hot cocoa.

If the choice of Euthanasia had been offered to me at the time, I would have taken it, with some caveats that I'll cover later.

Of course I didn't know my middle name and I didn't know how old I was... but I knew for certain, with the kind of faith many people have in God (and other higher beings) that death would absolutely be THAT comforting.  In fact, it felt quite a bit like God was calling me, telling me it was my time to move on.

Honestly, I don't remember much about that time but I do remember how strong the pull was just to 'walk through that kitchen door' and bask in the gloriousness of warm cookies...

What has stayed with me from that experience is no fear of death.  I do have fear of pain... just not death.

Perhaps, it created even a morbid curiosity about it.  This curiosity has been such an integral part of me since then that, even though I don't speak about it much (quite frankly it freaks a lot of people out) my husband buys me books about it for Christmas, knowing I will immerse myself and enjoy them thoroughly from beginning to end.  I find them THAT interesting, along with what we do in different cultures around the world with dead people.  (Mary Roach's, "The Curious Lives of Human Cadavers" was one such book that explores Swedish experiments regarding composting the dead.  It makes sense to me.  The planet feeds us for so long, our bodies should feed the planet when we're done.)

But I digress, the reason I come to this topic today is George.  If you haven't read the notes before, George is a dog who appears to be a rottweiler/doberman cross (a very tall rottie with long, long legs).

He came to us after living for his first three years in a garage.  The people who owned him were not unkind and I don't believe they mistreated him.  But I do believe he was tremendously lonely and though they thought he could live in our yard (they were moving to the city and couldn't take him with them because fenced yards were not allowed) he has absolutely basked in the experience for the last eight (nine) years of being a house dog.

Of course, if you do the math, that means George is eleven or twelve years old.  Quite a decent age for a dog who, in his prime was just over a hundred pounds of pure muscle.  And actually, if it weren't for the cancer in his face, I think he'd be just fine for another few years.  (For those who don't know, life expectancy for a 70lb dog ie. Husky, is about 10 years.  This bigger the dog, the less years they are expected to live.)

However, he does have cancer in his face.  It grows daily.

At first, I thought he had and eye infection because his one eye was a little red.  So I picked up some Polysporin.  About a week later, he started sneezing.  These were some of the most violent sneezing fits I've ever witnessed.  It got so that if he was near a wall or piece of furniture, one of us would run over and move him away so that he didn't hit his head on anything whilst the sneeze blew its way out of his face.  After a few more days, a lump appeared to be forming on the top of his muzzle.  This brought forth my second thought was that he had sniffed a seed up his nose and got it lodged in there.

My third thought was that it was cancer.

One of the stories his previous owners told me when they dropped him off, was that to keep the flies from bothering his eyes, "just wipe some axle grease under there and he'll be just fine".  Ugh.  I say this without judgment because I know that they were doing something in the spirit of sparing him the discomfort of flies around his eyes and the threat of infection.  But Ugh.

So yeah, since it started with his eye, I couldn't but help to think of three summers of axle grease and what that might mean for the possibility of cancer to exist for him now.

So I took him to the vet.  The vet took one look at him and declared that he had a tooth abscess and this would be no big deal at all.  Relief.

It didn't feel too good to feel like I was being accused of negligence where his teeth were concerned.  Nevertheless, the alternative idea of cancer being so quickly eviscerated was quite a relief.

Since he has lived here, I have been the love of his life and he has been mine.  My husband and children may get tired of me at times, and I of them, and we may need breaks from eachother.  But not George and I.  Of all the animals I've ever had, and we've had many as country life lends itself to the ability of keeping many animals, though I have loved them all to varying degrees, George is my one true love.

When George arrived I was scared to death of him.  He was huge.  He was all muscle.  I had birds and small children about.  But if they didn't find a home for him, they were considering Euthanasia.  So, I  tethered him to me with a fairly long leash every morning for the first two weeks he was here so that he HAD to follow me around while I did my daily chores and would get to see what was considered 'normal' (like chickens that wander around the yard freely during the nicer months of the year).

After the two weeks were over, I took off the leash but he has remained at my side ever since.  He follows me from room to room.  I can't even have a shower or go to the bathroom without the company of George.  Even when I have left the house, my husband would always tell me how George would just sit by the door, or the gate (if everybody was outside) while I was gone, watching and waiting for my return.

It is the same for me.  My husband has been on a special project for work for the last six months, far away from home.  My daughter went with him because we thought it would be a cool experience for her (and it has been).  The boys and I were supposed to go visit them in February but we got to talking and I said,

"Honey, I just can't leave him.  If I'm gone for days and he dies, I will never be able to live with myself."

Thankfully my husband is a kind and understanding man.  Perhaps he is hopeful that should he be near death, I will be as vigilant.  It could happen.

Nevertheless, I'm sure you've guessed the end of the tale by now.  Indeed, it was not a tooth abscess but the tumour, taking the easiest route available I suppose, began invading his gumline.  His surgery was cancelled and the vet recommended Euthanasia.

All I could think was, "But he's loving life.  He's not anywhere near wanting to die.  And I know what wanting to die looks and feels like.  He is just nowhere near that.  Before we consider Euthanasia, he should WANT to go there."

I couldn't bring myself to do it.  And here's why.  Essentially, aside from some pain (not a lot but enough that I looked for ways to cope with it - definitely not more pain than a migraine sufferer and we don't practise euthanasia with them), his life was the same. 

He enjoyed visiting Granny's house, he enjoyed visiting with Dakota (the dog from two doors over) when he wandered by, he enjoyed his food, he ran out the door, ecstatic, whenever I arrived home from an outing.


His spirit and his love of life was not yet over.  Clearly.

And this is the dog who, at the expense of his own personal safety, saved my first born son from a severe wasp attack.  I owe him more than I can say.

So I brought him home.

That was back in October/November I think.

Two weeks later, the tumour that could be seen when I lifted his lip was about the size of a field mouse.  In four weeks, the size of two field mice, half of which he managed to chew off.  Ew.  But cool in a wierd way too.


As happens with cancer, his body has become quite emaciated while all energy seems to be pouring into this ever-growing tumour which has now almost doubled the size of his muzzle.  He's actually quite frightening to see but the love is still all there if you can look past the tumour and his ever deepening eye pockets.

About a month ago, I said to one of my co-workers, "When his legs stop working, I'll know it's time."

I said this because I've seen so many of my old animals go and the pattern seems to stay the same.  Their legs stop working, they stop eating, sleep almost all the time and pass away within 12-48 hours... Sometimes even less than that, as with our 18-year-old miniature wiener dog, Gershwin who only lived, perhaps, six hours after his legs stopped working. 

So, you guessed it,  George's legs gradually stopped working on Sunday.

He went out Sunday morning and then some time after that "had a mistake" in the sunroom, where he was lying beside my computer.  But then he got up and moved from his cushion in the sun room to his cushion in the kitchen on his own while we had company.  So I thought, "Okay, an anomally, perhaps he's fine and it was just a freak accident type of thing."

I was was going to go to my friend's house that day but asked her to come here as the few days previous to this, George was clearly becoming more and more challenged by the four steps down from the front door of the house.  So I had an idea that, at some point during the next week, his legs would stop working completely.  So I asked my girlfriend if they (she and her children) could come here instead.

This is a pretty big deal considering our house, no matter how much bleach or orange cleaner I use, since about Christmas, has smelled like death.  This is another thing that is interesting to me about death.  It has a very specific smell.  Aside from infection and feces that may accompany it, it is a completely different odour unto itself.

I remember visiting my Dad, years ago, and though his one dog had some medical challenges, they weren't expecting her to die.  However, after we left his house, I said to my husband, "That dog smells like death."   Two weeks later, the dog passed away, taking my father completely by surprise.  He was understandably devastated.

Perhaps when this smell pervades your living space slowly, you can't smell it so well.  Or perhaps love overrides a bit of the stench.  And it IS a 'stench'.  And so I know what a true test of friendship it was that my friend came to our house.  Either she is truly a fast friend, or she really wanted our sons to have a play date or she really wanted to have her nails done since I do gel nails and that was our grown up plan for our get-together that day.

From my years volunteering for hospice with aged cancer patients, I always knew when they were close to death because the smell of their room would change. It is not a pleasant smell to walk into.  Do-able, in my view but not entirely pleasant.  The only person I didn't sense that smell with was a man whose leg had been amputated but was so profoundly and chronically infected (this seems to be part of the cancer scenario - when it's external, anyway) that the hospital kept it packed with fresh coffee grounds.  So all I could smell in his room were coffee grounds.

I do choose to believe in the fast-friendship idea though because we cannot pack George's mouth tumour with fresh coffee grounds.  And therefore, the odour of infection (though I do rinse it with salt water), along with death is truly overwhelming enough that one would be quite inclined to making alternate plans elsewhere until the source of the odour exited the building previous to one's arrival. ;)

For this I will always be grateful as she is one of the few people who dares to listen to my pontifications about life and choices and philosophies that make other people's eyes roll into the backs of their heads.  On top of that, I know she actually is listening because she gives me some pretty profound feedback.  And at this time, I really needed to talk a bunch of stuff through with someone, including solidifying in my own mind, what the heck I was going to do with George.

George stayed awake the whole time and watched everyone coming and going through the kitchen and had another mistake I had to stop and clean up.  Yet another stench for my friend to endure. Nevermind putting up with me do a complete-with-visuals-show-and-tell regarding the latest development of George's tumour. :D

But he did move from one spot to another in the kitchen again while we were visiting.  Not much for the hours that we socializing but still some independent movement.  When our company left, I thanked them for coming and  waved their car off sans George.  He made no effort to follow me outside, for the first time in eight/nine years.

Later that Sunday evening, I said to the boys, "George's body is emptying itself and his legs are not working well.  By the end of the week they may have stopped working altogether.  So take time to say goodbye and some prayers for his spirit's journey to be quick and kind."

Monday, he did not move from his spot.  What puzzled me though, was that he stayed awake for most of the day and relished his meals and slurped his water throughout the day.  And when I came in from feeding and watering the birds, his ears perked and his tail wagged violently as he seemed tremendously excited that I was "Home again, hooray!".

Hmm.

Before leaving for work the next day, I set him up with a water dish within reach and his bum in a corner, as he seems to shuffle himself backwards and ends up too far from his water dish.

This is another thing puzzling me.  He is drinking quite normal quantities of water and busies himself often with cleaning his front legs.  The entire drive to work (30 minutes) I puzzled over what was different with him that his legs would not be working but that he was still finding purpose, enjoyment and desire in life.

At work, one of my co-workers said, "Maybe he's waiting to be alone to die."  I thought she might be right because he had started moving out of my room at night and sleeping in the kitchen a couple of weeks ago, even though his cushion in the bedroom is four times bigger than the one in the kitchen.  And he has NEVER chosen to sleep away from me in all the years we've been together.

I came home from work to that ever wagging tail and ears perking up, down and all around.  He was as excited as ever to see me and not looking anywhere near death or wishing for it.  So, I cleaned him up, shifted him away from the corner and proceeded to make dinner wondering, "Does God send everyone these philosophical challenges or is it just me?"

After all, I had drawn my line in the sand.  When his legs stopped working, I was going to give him 48 hours and then bring him in since I figured he would be ready for Euthanasia at that point.

As often happens, God has rained on my line in the sand and wreaked havoc with its definition.  So now I'm back in the Gray Zone again.

Are his legs not working due to a nutritional deficiency?  What with the cancer taking everything and his body becoming so emaciated, his muscle mass is almost completely gone.  So I have bumped up his vitamin regimen to therapeutic levels for a 100 lb dog, even though he is no longer anywhere near that weight. (100mg B complex, 25 mg zinc, 3000 mcg methylcobalamin - Do dogs have conversion issues the same as humans?- higher magnesium, C, etc.)

If this vitamin therapy should get him up and ambulatory again, I will be extremely relieved that I did not consider Euthanasia too soon!

Another question that crossed my mind:  Are his legs not working due to pressure on a message centre in his brain?  When I lift him, his toes point.  And when I put him in a standing position, as when I drape him over the side of the tub to wash him off, I have to actually reach down and put the pads of his paws in the proper position, as though he has no sense of where his pads are located or what they are touching.  I have seen this in one of my antique dogs whose breed is prone to myelin issues that stop the message centre in the brain from working effectively, thereby resulting in a loss of control of the legs, specifically leading to this 'pointed' or 'curled' toe position.

This could also explain why he is still enjoying life, though his legs are no longer cooperating.  So do I wait until he seems to not have enjoyment in his life any longer?  Is it misery to just lie there?  Honestly, it really doesn't seem to be a misery for him.  He seems to enjoy watching the day go by.

I remember, working for the Provincial Government (Property Management Division), doing rounds and coming across old men sitting on our benches.  They had been dropped off by their families as this was where they chose to socialize.  They would sit there, all day long, just watching people and the day go by.  I would talk to them sometimes.  They truly seemed to enjoy this lifestyle day after day.

I miss my Grandmother.  She passed away last fall and because she was quite old (in my view), I used to always ask her perspective was on what I should do with my old animals.  I think her advice was always well thought out and almost always followed it.  Actually, I can't think of when I didn't follow it, since I figured she'd know better than I what it felt like to be old and exactly how much meds/surgery/illness was tolerable for old 'folks'.

And so this morning, here I sit, with a quadriplegic dog, who I draped over the side of the tub this morning to give his back end a good washing, who is now all clean and blow dried and smelling better than he has in months, who is not sleeping much, who is revelling in his breakfast, enjoying his water, washing his front legs and warning away any other animals who come near his food... Essentially, doing all the things that an animal waiting for death does not do.

You might remember that my philosophy about the pain was that for migraine sufferers and cancer sufferers, we don't euthanize them.  We find pain therapies for them.  And so at first, we decided we wouldn't euthanize George, we would look for pain therapies.

And so by extension, we don't euthanize quadriplegics, we take care of their physical needs for them and they continue on, finding enjoyment and a sense of purpose within their lives, sometimes, as with all humans, even achieving great things.

Of course this brings to issue the whole idea of human Euthanasia.  I know there will be people out there who think... but it's a DOG.  I quite realize this.  However, I've always believed in the right of my family members to have a certain influence in the household decisions that are made that will affect their lives.  He is a member of our family and his life choice does not appear to be that of one who is preparing to die.

And if you follow the Desmond Morris theory in "The Naked Ape", an animal's primary desire is to survive.  This is what kept me alive in my late twenties.  I knew there was something innately wrong with wanting to die.  It had to be an anomally.  And also, I couldn't leave my dog (my big bouvier-cross, Sonja, back then) and cat unprotected in what I viewed to be a big, bad, horrible, not-worth-being-in-world.  I had to stay and suffer, even if only to protect them as best I could.

Also, I couldn't kill them first to put them out of their misery because I didn't want to take that choice away from them (life or death) and it was clear to me while I was not wanting to be alive at all, they seemed to be doing quite fine with it.

In fact, it was the dog who finally bugged me enough to get me up off the couch and running again (endorphins and transcendental meditation are powerful healing tools when combined with some pretty strong anti-depressants) albeit in the rain, at 3:30 in the morning to begin with, thereby reducing any chance meetings with other humans, who were clearly the scourge of all evil on this planet.


And so, since George is still seeming to enjoy watching the world go by and finding a sense of purpose for himself, how can I bring myself to think about Euthanasia?  How can I bring myself to take that choice away from him?

This is why we don't have human Euthanasia and why the argument about it is so profound.

Who gets to decide if a person gets euthanized?

Doctors?  If that were so, George would have missed out on some wonderful days that he has had since last fall. Though highly trained, they are, in the end, both human and fallible.

Relatives?  Who may just want the life insurance policy to kick in?  Or who are just sick of having you around because you're too much trouble?

Patients?  How can we be sure that they are not just suffering from clinical depression that can be overcome?


Honestly, I'm not against Euthanasia altogether.  In face, I'm all for it.  I'm just puzzled about who gets to decide and when the time is right.

At 5:30 this morning when I heard George huffing and yuffing and wuffing (if you've ever heard Bill Cosby's imitation of a woman in labour, you'll know the sound of which I speak) I ran to the sunroom as these are the sounds he makes when he is in pain or uncomfortable.  I thought perhaps he was calling me to be with him while he passed.  In all honesty, I was hoping it was for that reason he was making those sounds.  Then I would not have to do all these mental gymnastics anymore.  The choice would have been made and the end result would not be any responsibility of mine.

Indeed, this was not the case.  He had shuffled his way off his pillow and away from his water and he had gone to the bathroom.  (Thank you Pergo for being so easily cleanable!)  I shifted his front end onto his cushion and got him some fresh water.  He had a big drink and then proceeded to clean his front paws, all sounds of discomfort ceasing to exist.

I proceeded to fold a large towel that could be bleached into eight layers, draped it over the edge of the tub and picked up George to drape him over the side of the tub to get him lovely and clean again.  Once I finished, I turned him around and did his front legs, thinking perhaps he would enjoy having them well and truly clean (in my view).

I put him back in his spot in the kitchen, cleaned up the bathroom, the sunroom, put the towels in a bleach wash, blow dried his back legs while he was busy grooming/drying his front legs and proceeded to wash his face.

Oh!  I forgot about washing his face.  As the tumour pulls his eye sockets out of shape and since the infection in his sinuses has to go somewhere, it generally gunks up his eyes.  So, I clean all that up.  And he clearly looks forward to it.  Not the cleaning itself, I think, so much as the rubbing.  I'm not sure if it's itchy or what, since he doesn't appear to be in any pain at all anymore.  But when I clean his face, he closes his eyes, makes mph-ing sounds and pushes into my hand when I clean his eyes and face.  It appears to be quite heavenly for him.

It's kind of the same as it used to be, scratching his bum above his tail, as it is for many dogs.  He would do his rottie-rumble and do a dance with his back legs that shifted his rear end back and forth while you gave him a vigorous scratching.  Essentially, he is doing the same with his face now.

From start to finish cleaning up him and the rooms, took about an hour.  Honestly, it was a lot of trouble.  And one more hour-long chore is just not what I need as any full time/part time [remember I've got two at home and one living in another city who I track with her cell phone and Skype :)] Mom who also works inside and outside the home can tell you.

And all that bleach and hot water is going to ruin-my-nails-before-their-time that I just finished doing yesterday.  Although again, gel nails are awesome so they're still fairly passable.  But the skin on my hands is chapping from all the cleaners and though I wouldn't call it painful, I'm quite aware of some not-positive-sensation emanating around them.  And even way back in grade one, my best friend Cathy told me my hands looked like old lady hands.  This is really helping.

A bit fickle sounding, isn't it?

Which brings me back to the last part of my developing theory around death and Euthanasia.  (I know, finally, is it really all coming to an end???)

What if part of the process of saying goodbye for both parties is the gradually increasing test of endurance that just becomes too overwhelming. So that at the very end, emotionally and perhaps chemically, something in the brain occurs that says, "Okay.  We're just done.  You're ready to go and I'm ready for you to go."  Kind of like a team decides together whether they should forfeit the game.

Perhaps it's even a chemical synchronization, so-to-speak.  Like how women in the same household will eventually have synchronized periods and how you can sub-consciously smell the difference between someone who is a compatible mate and someone who is not.  What if part of the process is the synchronization of brain chemstry between the dying and those-who-are-caring-for-the-dying?

With my other old animals, this was the case.  They were ready to go and honestly, it was more with relief than regret that I met with their end.  It seemed the same for them too.  It was not that they were in any kind of pain.  It was just as though they were too tremendously tired to put up with any of this anymore.

And I don't have the same level of profound regret and sadness that I experience if an animal dies as a result of an accident.  As an example, I can think of one animal in particular, a dog, almost ten years ago, who died too young.  And though the feeling is fading, it is still, over ten years later, still quite profound.


So I worry about my decision-making abilities with regard to our 'team forfeiture'.  I began to think.  If I decide upon Euthanasia now, will it be for his sake?  Or for mine?

Continuing with the greyness... in the Gray Zone.

*****

Links for further reading about composting, for those so inclined. ;)
Bring Out Your Dead and Compost Them
The Humanure Handbook  (There are some very funny bits in this one.)
Overview of Mary Roach's book about human cadavers and what we do with them.
Composting:  A Unique Solution to Animal Waste Management  A rather nuts and bolts article about 'how to' with safety mechanisms and their reasoning.

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