euthanasia – the chook house

March 13, 2013

Thinking about Spencer

Thinking about Spencer.

I am not supposed to be doing this. I am supposed to be studying. But somehow the picture that his owner, Janet, gave me as a thank you for my assistance in his leaving this world, has caught my attention. He is a small terrier with a big bone in his mouth. His fluffy foxtail is blurred with movement. It is a dog’s joy, is it not, that captures us?

I know she is bereft. We have done what we can do, as humans. We have given him a calm and dignified farewell. A cancer in his belly was growing like a hungry gourd. He felt nothing as he slipped off a needle of very strong anaesthetic. I recited the words the Tibetan monk gave me so many years ago on a Buddhist retreat.

Geshe-La was surprised, wide-eyed, to know, that as a vet, I routinely killed things. He had not long been in the West. He had imagined only the healing. He didn’t believe it was good for my own karma and gave me a prayer for that. At the end of each day I was to use it for purification. I have not remembered it. He gave me another for the animals, and that, I have memorized. The words are supposed to ease the transition from this life to the next. Perhaps the rebirth following will be better, more enlightened. (Of course to believe that we are more enlightened than dogs to begin with is a whole other question.) The short prayer is said in Tibetan and repeated as I inject. I don’t know how it translates and all I have is how the maroon-robed monk told me to say it. What happens if I pronounce the words incorrectly? I carry the mantra in my head. Like Chinese whispers, who knows what wish I am finally asking for and for whom I am asking it? He told me it must be said out loud to the animal as it dies. It is what I do.

Tayata om muni muni maha munaye soha. Tayata om muni muni maha munaye soha.

We clipped some fur for her to remember him by and made a paw print too. We struggled to get the print right and somehow that helped us, the room of people left behind, meddling around looking for something to do, as a spirit lifted off. She wanted to be the one to carefully slide his body into the black plastic that, necessarily, was his transport to the crematorium. There was a feeling, at that moment, that Janet might gladly climb into the bag to stay with him. Spencer had with him a favourite blanket, a squeaky ball and a saliva stained hand puppet, Collin, who had been his chew toy. A dog needs little in the way of possessions to be joyful. A week later his ashes were returned in a well-crafted wooden box. Such a small bundle in the end. The crematorium rang Janet to say, Spencer was ready to come home. What else can humans do?

Janet tells me he still feels present in the house. A collar he wore will be cherished. His bed remains where it was and she senses him. Of course she does. It is only ten days. He was as loved as a child. The loss of him is human-sized. How long do you think it will take to no longer mourn him? A new puppy is on order and perhaps this will help. After all it’s a Griffin. Its piddly, bitey ways will surely distract. But an old dog is priceless. They know us. We don’t need to learn, as I have in my behaviour course, that dogs innately read human gestures, even better than primates. Dogs just get us. They see with our eyes. Owners know dogs understand them. They have always known this.

(Thanks to Janet and Spencer for permission to retell some of their story…)

December 7, 2012

Empty Nest

The Robinia is still recovering from the storm. The edges of its fragile leaves are brown and bruised. It is not how it usually looks in summer. It is autumnal, bedraggled.

The Willy Wag tail nest is still there. Stoic and strongly harnessed to its branch. But it is empty. No longer do the busy little black and white birds make their way, back and forth, with bounty from the grass.

Where do Willy Wag tails go to grieve?

***

Mrs. W is in her seventies. She wears a polycotton blue and white floral print dress for her visit to the vet. It is a happy dress. Benny is her Jack Russell terrier with a long history of heart disease. We have battled his belly, which grows rigid and tight with oedemtaous fluid, but the belly has won. The skin is drawn tight over the gourd-like abdomen. She keeps a measure on the size of his belly with her dressmaking tape. Today it measures 60cm. I think of Elizabeth Taylor playing Scarlett O’Hara and her less than 20-inch waist.

I can tell by the quiver in her voice. The way she holds him into her chest, that she has come to say goodbye. The medication is no longer working. His heart sounds like a working washing machine. She tells me he is not eating and he looks at her as if to say, help me, I’ve had enough.

Is she anthropomorphising? Yes. No doubt. So what. He is her only close companion these days. He is human to her.

We decide that, yes, Benny has had enough and together we will be saying goodbye to him today.

I imagine her at home, before the visit, before she has rung for the appointment. She has had to build up to this. She has tried all the foods she is not supposed to feed him, to see if he will eat. Streaky bacon. She has doubled his diuretics. She has decided to ring and then waited another day. She has sat and watched him through the night. She has dialed the number and then hung up before the phone has answered. She has driven past with him in the car and even into the car park, but turned about again and gone home. He follows her around the house, into the bathroom. She sleeps with her hand on his chest, feeling it madly vibrate beneath her palm. She has prayed that he will drift off in his sleep. She wonders how big his abdomen can get. How much can one little dog belly hold? Can it pop like a overinflated balloon?

I sedate him, and while the medication takes effect, Mrs W tells me about her old mum who recently passed away. Her mum was in a coma for days, being given morphine and not able to communicate, but, before she died she opened her eyes and looked around. She saw her daughter there and then turned her head towards the window and in the light that beamed through her daughter was convinced that her mother saw someone waiting for her. She had a wonderful, not-often-seen, smile on her face. The daughter believed it was her brother – the boy who had died of peritonitis when he was a three-year-old infant. It gave her enormous comfort to think of her mother, who had grieved all her life for her son, as reuniting with him. She then went on to tell me the story of the boy’s illness and his death. She had been five years old. She had a memory of her mother dressing the child to take him to hospital on what would be his final visit. Before this, her memory was one of his seesawing illness and her anxious parents. She remembered her mother’s tears as she reassured the boy that he would be made well. But the small boy cried that if he went to hospital he would never come back. She promised him that he would get better. And as I am expressing my sympathy for her dear old mum and how terrible it must have been for her to lose a child she tells me that yes it is unfathomable. She says it is 2 years, 4 months and 3 days ago that, at the age of thirty six, her daughter took her own life.

Benny is feeling the effects of his sedation. His head is lowered. We both touch him. Unison of strokes. She has his head cradled in her cupped hands. She will never be ready to let him go. Wrapped up in him now is all the loss in the world. She is weeping across him. She is weeping for her mother, her brother and her daughter. She is feeling an ever enlarging whole of empty pushing its way out through her chest. Fat droplets of tears are running across her face. Blue tissues turn wet and soggy in her hand.

Now she tells me about Benny. How he came to her from a home where the children teased him and he was never allowed inside. She said he didn’t know how to play when she got him. He only knew how to hide. She asked if it was her fault that his heart was the way it was.

I held her hand and we let Benny go.

We both wondered aloud, whom Benny was off to join in the light. She thought of a previous old dog, that Benny had known, one that knew how to fetch tennis balls. He would be waiting and ready to teach him to play.

Mrs. W goes home. She takes Benny’s collar and lead. They have his smell. The lead is impregnated with his white hair. She will pick them up and holding them will remember him. His tight bellied waddle following her about the house.

April 11, 2011

This Knife Ain’t Sharp Enough

My Dad is back in the hospital. His remaining penis is like a bloated poorly-cooked pork sausage.

I am reminded of a neighbour beyond the pickets whose favourite children’s party game was called pork sausage. The children would be in a line. No smiling, laughing, giggling allowed. He would go along the line and point and grope you on the body or the face and in a heavy Welsh accent say, What’s that there? And your answer had to be pork sausage but you weren’t allowed to laugh. Laugh and you were out. I was good at this game. It seemed the saying of pork sausage was hilarious to most small children. And when coupled with a big bellied man pointing and fondling your ear lobe, and asking you what it was, and having to say it was something it wasn’t, something as ridiculous as pork sausage, it was very nearly impossible. But I could do it every time. He could pinch my nose, my ears, grapple with a roll of tummy, fiddle my fingers and I could say it straight-faced. Pork sausage, Mr Elliot. Till I was the last kid standing. Grim-faced. Thinking, not funny Mr Elliot.

Winning this game did not endear you to adults. They wanted to see kids giggling uncontrollably. They loved to tickle you till tears were welling in your eyes. A kid that didn’t find pork sausage funny was a kid with no sense of humour.

This is what we are here for; to exam the pork sausage and decide its fate. No giggles. Not funny. The nursing home GP thinks an area of tumour recurrence can be seen near the urethral opening and he has organised Dad to go back to the private hospital to be seen by the surgeon who did the partial penectomy in the first place.

The ambulance is transporting him. I meet them at the doctor’s rooms but there has been a mix up. He is to be admitted and the consultant will see him on the ward when he has finished his appointments.

In the ward they have him down for 2pm. We have nine. But they find him a room. No 13. I sit talking to him but he has his head turned away and is not answering me. I go to the other side of the bed and then he realises it is me.

Oh Nicole, what a surprise. I explain he is in the hospital to have his penis looked at. Because it is sore isn’t it Dad? That’s why we are doing this.

He starts out just a little old man, a little confused. After six hours he no longer knows what he is, where he is and he’s as mad as a cut snake.

A nurse comes in and wants to take a peek downstairs. He is saying no more no more but she manages a look and with her ultrasound measures his bladder volume. It has 138mls in it and he has wet his pad in his pants. Reluctantly I call it a nappy.

He has bitten his lip or his tongue in the transport and has some blood in his mouth. I ask him about it but he doesn’t seem aware of it. I get him a choc milk and he drinks it with a straw.

He starts talking about leaving and all the things he must do to leave. He will need a bus on the highway. But where is he going to? What is his home address?

He is trying to swing his legs out of the bed and attempting to sit up. He is easy to push back down. And when I do he has to start his effort all over again. It weakens and tires him.

I wait till he is nearly up then down I push him. I think he probably doesn’t know I have done this to him half a dozen times. Each time I stop him getting up he is surprised I have stopped him.

When he is nearly upright I stop him again and he says, Oh no oh no. Exasperated. He leans back down in the bed. You have to stay Dad to see the doctor. Over and over again I say it.

I am driving myself nuts.

Oh I love you darling, but I have to go. I have so much to do at home.

He asks me why. Why must we stay for the doctor? I have him booked next week and he gives me a wink. That’s the way the cookie crumbles.

I have a lot to do at home. The dogs and cats need to be fed.

No time for yakkity yak.

He says I am trying to hoodwink him. He says the nurse is part of the secret service. Everyone is keeping stuff from him. Like information. Like addresses and where he is.

They move his bed from room 13 down the corridor close to the nurses’ station and he falls asleep. He has his glasses on. When I tried to take them off he objected. You want to hoodwink me. You know I can’t go without my glasses. Why have you taken my socks and shoes off? I can’t go without my socks.

When he wakes up he is gripping the side bar of the bed like he thinks he is moving or falling.

Dad. Dad you’re okay. I try and peel his fingers from the side bar. But he is hanging on.

No, he says. He has woken up different. More stubborn. Ready to fight.

He has woken up in another world. He starts talking about straw. You need to move the straw. Give me the pliers. You have to dig it there. When I try and move his fingers he gets snarly with me.

Okay okay. But you don’t look comfortable.

Don’t take stuff without asking.

I can recognise the consultant’s voice outside. He’s on the ward. I feel relief to know Dad will be seen soon. He is slipping into further delusion and the longer it takes the harder it will be. I hear the consultant talking to nurses and then his voice fades as he heads into another room.

I poke my head out. Only nurses. A plate of cream cupcakes on their bench top.

I tell a nurse I am worried that I won’t see the urologist. Paranoia catching. Don’t let him skip us.

No no your Dad’s on the list.

The consultant’s voice wafts in and out of ear shot.

Dad is talking gibberish. Ellen on the TV.

The urologist enters the room smiling. He has beautiful teeth and a polished head.

Righto Alex. Do you remember me? I am your doctor who did your surgery. The nursing home wants me to have a look. They’re a bit worried about it. Despite Dad’s demented state the urologist talks to him like he is compose mentis.

I wonder why he bothers. Perhaps it is for my benefit. Maybe he thinks something might get through. When I tell him about the past month and how I am struggling with it all, he tells me how when his grandmother was dying he would gets calls from his mother all the time telling him today would be the day and how badly the grandmother was faring. In the end he said to his mother don’t call me till she’s dead. By the time she finally died he had done all his grieving, it was simply a relief. I think he is trying to empathise with me. But I am like his mother. I am the one who is doing it. I can’t say don’t tell me for there is no one else to do this.

Gloves snap on. He tries to move him in the bed; to get him to let go of the rails. But Dad is resistant and starts telling him to get off him.

You don’t ask, you just do.

Dad is shouting and the doctor pulls back. But Dad keeps on shouting. Swinging fists on skinny arms.

We might give him something to settle him before we look or else it’ll come to blows.

Two haloperidol, he tells the nurse.

I’ll be back. Gloves snap off.

Dad tells the nurse to go to. He is pointing at the door. Get out. Get out. You have no manners. Ask. You should ask.

Dad you need to take the tablets. She is proffering them close to his tongue and I am fearful she will get bitten. It’s feeling very veterinary. I am thinking of chemical restraint, muzzles. When faced with an aggressive dog we get the owner to help. Like the nurse is using me. Do you think you can get him to take them? I am like the client who stands back and drops the lead when the dog begins to growl. I don’t think I can do it, I say. But it is my dog. I am required to try.

When the owner gives up in the vet clinic the dog is put in a cage and the pole needle is used. As the dog is cornered the needle advances on it through the bars and a quick hard jab to the thigh muscles is attempted. Hopefully the needle doesn’t snap off. Hopefully the whole dose gets got. Victory is a dog that can’t curl its lip, can barely lift its head.

I suggest a needle for my Dad. The nurse thinks this might be just as hard. We persist with the little white tablets. Dad put your tongue out.

Don’t touch my nose, he shouts.

I try and give him the tablet so he can put it in his mouth himself. Perhaps it is control he wants. Trying to get him to take them from my fingers he is uncoordinated and we are not getting anywhere. Our fingers are like polar opposites on a magnet and he can’t take the tablet from me.

She gets a mini tub of ice-cream and I put the tablet in a teaspoon of vanilla. Here you go Dad. We get them down.

It has taken 30 minutes.

He is not very sedated when the doctor comes back. He is just as angry. He starts swearing. Fucking hell.

The nurse tells me not to worry. He’s not responsible. He’s not your Dad when he’s like this. Her being nice to me, tips me over and I am crying.

I am trying not to cry in front of Dad thinking this might upset him more but it doesn’t seems to effect him. He is oblivious of my noisy nose blows into paper towel. He has forgotten about me, who I am even. Why are you staring at me? he says.

The doctor tries to get him to pull down his pants but he can’t do it.

Okay Alex lift your bottom. Nothing. So in the end he yanks them. I am placating. Its Okay Dad.

You’re cruel to an old man.

Yes Dad I know.

He’s not that strong. You hold his wrists, can you? the doctor says to me. I am the client who digs in. Who says yes I can hold him, my writhing rabid dog, while you trim his nails.

Okay. I will. I grip them. They are thin. I push them down so the doctor can get a look. Dad is swearing and cursing me.

Get off me. Get off me. You brute.

The doctor is pawing down there.

He might as well be sawing it off for all the screaming Dad is doing. Is it really that sore I wonder? Is it just being restrained? Some dogs (think Cavalier King Charles Spaniel ) start to panic before a thing is done to them, screaming before anyone has touched them even. Is this Dad?

It’s thrombosed and woody but its not recurrence, the urologist says. I suspect the issue the staff is having is getting to it to clean him. But I don’t think there is benefit in doing more surgery. It might end up with a worse non-healing area. We could do some radiation for the pain. But he is still urinating. Actually if he stopped urinating it would be quick. It’s a good way to go. A potassium spike stops the heart.

We are talking about him across his woody penis while he rants and shouts. The urologist is pulling his nappy back up and we are telling him its over but he is still shouting abuse at us.

I want to hear the doctor Dad. Shh shh.

I think what we need to do is talk to the nursing home about what they see as the difficulties in managing the area. We can give him more pain relief but I think surgery is ill advised and he isn’t a good candidate. And he can’t have more clexane after the subdural bleed. We’re limited in what we can do.

I ask about a suprapubic catheter.

Hmm not necessary while he is urinating.

I just don’t want him to be in pain, I say. I don’t want him to have more intervention if it is likely to be bad for him. Tears are welling up again. I’ll be guided by you, I say. I am thinking what I want is for someone to take the responsibility out of my hands.

In my head I am thinking how crazy it is that we are talking about a urethral blockage causing a spike in blood potassium as a good way to go. Now we are imagining scenarios that are quick and painless. I think I know a quick and painless way – it’s called euthanasia and I do it to animals on a regular basis.

People don’t want to see their animals suffer and at the end of their lives they decide the time to bring them to the vet clinic. I give them a sedation that sinks their head to the table. They probably feel like they are floating. Then I clip a foreleg and put a tourniquet around the elbow. A vessel stands up. I slide the needle into the vein and a rush of blood comes into the hub, mixing with the green pentobarbitone, the red turns blue-black. I unclamp the rubber band and tell the owner I am going to inject now and they might sense their beloved pet slipping away. I inject slowly, as slowly as I can. By the time the ten mls is into the animal all breathing has stopped and the heart has slowed down. I change syringes for the next ten mls. By the end of this syringe the heart will have stopped. I say Nice and Peaceful like saying it will make it so and place a hand on the dog’s head or on the client’s hand if it is nearby. I check the heart. It is never beating but I take a minute to listen. Then I tell them their pet has passed away. Then they cry.

But my old Dad must hope for a quick and painless death some time in the future. We still don’t know how it’ll be. But this hospital business is not helping him.

We have been here six hours and the decision is made to do nothing. He can go home tomorrow. Endone might be a good thing. He’ll be more sedated.

The nurse brings me a cup of weak, luke-warm tea the colour of a muddy puddle. She had no teaspoon so she brings me a knife for which to stir. I am stirring my tea with a knife and Dad is asking me why I am staring at him.

I am thinking of how to kill you Dad, but this knife ain’t sharp enough.