What would you do, if this were your animal?
That question can be so difficult to answer at times. I have cases where the choice seems obvious and other times no so much. We are supposed to be an unbiased, objectionable third party that can give you the medical answers needed to make this decision. However, this does not account for the times that we get attached to a patient, nor does it take into account the fact that life is full of impossibilities. Patients that shouldn’t make it, sometimes do. Patients that should do very well suddenly tank and leave us spinning, wondering WHY?
Owners have the ultimate decision on this, but 99% of the time, they look to us for advice and to make the call for them. In the cases where we have to make the call, we do so with a mixture of science and gut feeling. I know I consider what medicine and science says is the most reasonable course of action but I also think with my heart. Most of the time, those two sides are in agreement. But what happens when they are in conflict with each other? My head says, “Come on, Amy. You know he is not going to get better and even if he does it will only be for a short time.” Then at the same time, my heart says, “Don’t give up. Give her a chance”. I have to say that in those times, my heart will win out 99% of the time. I let the owners make these calls, but I am not allowed to sit squarely on the fence. I have to help them make a choice. It is my job. They are looking to me for guidance. They are adrift in uncertainty and need an anchor. I have to be that anchor for them. I am the voice or advocate for their beloved that is not communicating clearly enough to tell them their answer-fight or go. I often look into their eyes and try to hear their soul speaking to me. Sounds crazy, I know. But when the medicine and heart are in conflict, I look to the animal to speak to me. They often speak clearly when you listen with the right ears.
And then when the patient becomes your own animal….you are on the other side of the fence; who do I look to for guidance….myself of course. I have to become two people. I have to play doctor and owner. I have been the one on the other side of the stethescope and push the plunger. I have had to say good-bye to my best friends, make the call and send them across the bridge with my own hands. It’s a choice that we get to make with our animal friends that we cannot make with our human ones. We have to suffer through, they do not. I will never choose to watch my best friends grow weaker or suffer in pain when I know in my heart they are only going to get worse.
The obvious choices are not the ones that this blog post is about however. Its the ones that you are just not sure about. The little ones that have so much ahead. The ones that have not lived a life yet. The ones that were never given a choice to live. You want to fight for them. You want to give them an opportunity to live and know what it feels like to be happy and well fed, even if only for a brief time. It makes little sense on paper or to our colleagues that are not in your shoes but are looking at it objectionably. It is easy to judge when you are on the outside looking in and have no piece of your heart invested. We should never get that emotionally invested in our patients I guess. Well, that’s not going to happen.
I will continue to ask myself this question so long as I am able to practice medicine. I know I will make good choices overall. I may make some choices that I will second guess, but I will keep making the ones that I can sleep with at night. If that means holding on a little longer than I should have, or ending suffering a week earlier than necessary. My conscience will be as clear as I can hope for it to be.