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The Right Time

by on September 4, 2019

The Right Time

by Marco M. Pardi

I think very soon the right to die will become the duty to die.”  Cecily Saunders, MD. Appearing on 60 Minutes 24 July 1983

All comments are especially welcome and will receive a reply.

I first met Dr Saunders, “Cecily”, in Montreal in 1976. She was a co-presenter in a workshop on Palliative Care under the auspices of Dr. Elizabeth Kubler-Ross and the Royal Victoria Teaching Hospital.

Of course, the issues we all worked through for several days and nights were exclusively about humans. In those years the ethical twists and knots we attempted to untangle were ultimately fixed in place by laws: Frank euthanasia was then against the law in all western countries. But those discussions laid the foundations for further and deeper discussions of the nature of personal autonomy and the right to say, Enough is enough”. Of course, the phrase, Doctor’s orders, always sounded officious and binding but no doctor had the legal right to enforce an order that an ailing but competent adult submit to his treatment orders. The patient was free to withdraw, albeit with Against Medical Advise stamped on his chart. And, during these recent decades there was tacit acknowledgment that doctor’s orders could ultimately hasten death while making it more comfortable. Thus, hospice arose as a way to provide a comforting setting even with the withdrawal of any curative efforts. From there it was a short step to a huge legal hurdle: the ability of the patient to ask the doctor for assistance in bringing about the certain but still lingering death.

As we now know, several States have taken that step and allowed physicians to prescribe lethal doses of medications, along with instructions. But the patients must take the dose themselves, with no assistance from anyone else. In an earlier piece I wrote extensively of the Brittany Maynard case. You remember her as the young woman who, already in seizures from inoperable brain cancer, chose to take her lethal dose of medication before the seizures prevented her from being able to do so. Had she not done so, no one would have been legally able to administer the dose to her once she was beyond being able to do it. Yet, externally, she appeared quite healthy and vibrant as she took the dose.

I’m going to bring this closer to home. In fact, into my own home. Over thirteen years ago I could no longer tolerate living without a dog in my home. Some months before I had to take my fifteen year old Chow for her last ride to the veterinarian. Months of negotiations and even family interventions passed after that sad day. Finally, the barrier against another dog seemed to be coming down.

So a friend took me to a local shelter and I walked along the enclosures hoping to feel that certain connection, the mutual recognition that this was who I was looking for. I came to an under weight, nameless, year old male who acted as if he had been passed over too many times before. Even when we took him into the “get acquainted” yard he seemed to feel it was another useless exercise. I decided right then I was not going home without him. His seemingly philosophical acceptance of this inspired his name: (named for a philosopher).

He turned out to be quite independent but very friendly to all humans. Either he was housebroken or just very conscientious; he never has done anything in the house. He’s picky about his food but a bit sloppy when he does eat – food flies around but he cleans it up. His weight came up nicely, along with muscle tone built with several longs trips to dog parks. Those trips had to stop, however, when his confidence peaked and he started tearing into dogs that tried to mount him (he had been neutered at the shelter). He has been on several cross-country trips and travels well, favoring the La Quinta motels along the way. And he immediately recognizes other family dogs and gets along very well with them. He is also quite tolerant of little children. What kind of dog is he? Even my vet friends didn’t know, but I did. From some past activities of mine I recognized him as a Korean Jindo and, in the vets office, had them enter that in Google. His picture popped up. The description, including behavior, fit him perfectly.

So, overall he is very different from the Chow we raised from a foundling fist sized puppy to a 15 year old pumpkin colored terror. She was fiercely protective of her family, to the point where visitors had to accept certain house rules if they wanted to see her at all. I don’t recall any dog parks in those years but judging by the wide berths other dog walkers gave us that might not have gone well anyway. At around thirteen she developed some issues which the vet diagnosed as indicative of Cushing’s disease, an adrenal/kidney disorder. We put her on a maintenance program of appropriate medication but over the next two years her weight dropped to less than half and she weakened terribly. I felt the medication was harming her, and perhaps she also felt that or at least that it was prolonging her suffering. She once seriously bit me when I tried to give it to her. But I also knew there was no alternative at that time. My wife was away on a trip when I just came to the conclusion that I had been keeping her alive, lying on a mat in the living room, for too long. I felt I had been doing it for me, not for her. It had become clear that when I woke her for medicine or food she did not recognize me and may not have known even where she was. A friend helped me take her to the vet; her last trip.

Some people choose to leave their companion at the vet and pay for disposal. Some manage to wait in the waiting room. I carried my girl into the examining room and put her on the table for her shots – one to relax her and one to kill her.

Let’s call it what it is. I did not have her “put to sleep”; I had her killed. Even the term “euthanasia” is barely acceptable. Eu from the Greek root for good, as in euphoria; thanasia from the Greek thanatos – death. We use it because it makes us feel better, like that other term, making love, dreamed up by a panel of idiots to disguise having sexual intercourse.

I’m not a believer; even the term disgusts me. I know or I don’t know. What I know is that non-humans have a non-corporeal existence – call it a spirit if you want – just as humans do. In my world that’s not religious nonsense and it doesn’t require make-believe gods; it’s simple fact. So I can say she was glad to be released from the agony of her body. And, later experiences I had with her and with other, preceding companion animals satisfied my standards of evidence.

But before we get too comfortable let’s look at another piece of common wisdom: “They will tell you when it’s time.” If you have read any materials on caring for pets you have certainly come across this. I’m sure I’ve repeated it at some sorrowful point in the past. It’s an odd stimulant. It can make one feel better about making the decision. Or, it can make one feel terrible about missing or even refusing the message. Since my first encounters with non-human animals as a small child I have always had an attunement to their feelings. That’s probably the most frequently said comment about me (or so I hope), a trait others considered odd about me but I considered normal. Yet in all the years I have had dogs, cats and horses as close companions I do not recall a single time when one of them told me it was time. Yes, there will be those people who will say I actually did get the message on a subconscious level and acted on what I only thought was my own volition. I have no answer to that. I can only say I know I will certainly be facing this again. It’s only a matter of time.

My Jindo companion of nearly fourteen years recently developed a thumb sized growth on his shoulder. It was almost black in color and had a narrow stem. So, the vet and I agreed it did not look cancerous. But when we decided on removal and we talked about a biopsy the vet said, “At his age I don’t know what we would do even if it is cancer.” We removed it in early May.

I have always been very attentive to my companions, feeling under the fur, checking pads and teeth, inspecting hooves no matter their age. My Jindo has some of the fat globules that develop in older dogs. They are easy to identify. But almost as soon as the fur was growing back and recent excision was gone from sight I felt a lump unlike a fat globule developing in the same spot. From July to now (early September) it has grown beyond the fur larger than a golf ball, hard, and with visible blood vessels. In sum, it looks exactly like carcinoma I’ve seen in humans.

I consulted my daughter, one of the most highly competent medical professionals I know and greatly experienced with dogs, cats and horses. I consulted a next door neighbor, a research veterinarian experienced with dogs and cancer. We all agreed my Jindo’s age precluded “full bore” surgery, chemotherapy, and radiation. Given that I could take only the comfort care approach, even a needle biopsy might stimulate metastasis unnecessarily.

So, today we went in for a thorough clinical examination. The tumor is malignant though it shows no sign as yet of metastasis. He is too old to withstand aggressive surgery, chemotherapy, and radiation. The current risk is that the tumor ruptures, in which case we rush him in to get it closed. However, an internal rupture would suddenly begin uncontrolled metastasis. So this is now a case of comfort care. And I do have a 24/7 emergency number should I need it.

In a way we are back to where I started this column; choices and hospice care. In this case I do have a choice, but obviously the time is not right. All my Jindo told me at the vet’s office was that he wanted to go home. So we did. And here we are.

This column is read in dozens of countries from Sweden to New Zealand, China to South Africa. And, even here in the United States. I have made sure the site has plenty of space for anyone’s comments. If you have read this far and feel like sharing some feelings and thoughts, or even if you just want to state a global tribute to your companion, please consider yourself most welcome to do so. Comments from new contributors are sometimes held in moderation, but I will get them and post them.

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16 Comments
  1. My heart weeps for you; for what is now, and what is yet to come. There are no easy answers. Each day that we know a loved one suffers is one which breaks our hearts. Having made this decision myself, I know how difficult it is. To say you will know when the time comes is trite, because the time will never come when you are ready to let go. All these years later, I still question whether there was some other option, but deep down I know there was not. You and your Jindo are in my mind and in my heart; may you both find peace. Rose

    Liked by 1 person

    • Thank you so much, Rose. He seems to be in no pain for now, except his arthritis for which I give him Truprophin and Cosyquil every day. But you are right; there will never be a right time, just an appropriate and necessary time. And, each of the previous ones is still with me.

      Liked by 1 person

  2. I’m glad you have such sympathetic and knowledgeable people at hand to help you make these painful decisions. It’s so hard to do this alone, to weigh up the many factors whether physical, practical, psychological or existential. A sad time for you, nonetheless.

    Like

    • Thank you, Rachel. That’s the beauty of true friendship. I’m sure you have also been through these events, and have found how they help us all reflect on mortality.

      Liked by 1 person

  3. DIANNE DIAMOND permalink

    I am so sorry you must watch your dear Plato’s energy and enjoyment ebb and wonder when will be the right time to say goodbye. Here in small town Washington, the vet comes to one’s house so you can hold your pet, she/he gets to be in their own beloved home, and — in my case — I can sob away while I let each animal know how much I have loved and appreciated them. In a way their degree of pain clearly over-rides my desire to keep them alive, so in that way they do tell me when it is time. Love to you and your dear philosopher.

    Like

    • Thank you, Dianne. I am fortunate that his favorite vet has always held a great fondness for him and will come to our home when it is time. Yes, in previous cases I also expressed my emotions fully.

      Like

  4. There is never a right time…not for those who love. But Marco, try not to focus on that moment now, maybe it will come, maybe it will not. We really don`t know. It could be taken out of your hands. But in whichever way it goes, I am so sure you will do it with care and respect for the value of life, and , again, in whichever case, it will be the best you can possibly do. Which is no consolation for the grief, I know. As I know that there are no words I can truly offer you, but I hear you and I feel you. I know Plato is so lucky to have somebody like you at his side, and my guess is that Plato knows it too. Hang in there, dear friend!

    Like

    • Thank you so much, Lory. I wish you could have met Plato. I know there would be an instant bond.

      Yes, we don’t know if the tumor will stabilize for quite some time or will metastasize. But Plato knows I’m looking after him each day and night.

      Like

  5. Dana permalink

    Marco, I’m happy we have been able to share in all of our non-human animal companions’ lives. I just had a moment thinking of others who have left our group, and with that, news about their animal companions. Life has changed so much since then. Glad some of us are still connected.

    I would like to think I might see my dogs again, but I’m ever the skeptic about reuniting with the dead. On day I’ll rescue someone here who needs it. There are so many in need – cats too.

    Very sad about your news

    Like

    • Thank you, Dana. You are right to have doubts. They keep us asking questions and that’s how we learn. I’m so glad you have the courage and the determination to adopt again. There are so many who need us.

      I also think of those who have passed on in one way or another.

      Like

  6. From Pam: I’m moved anytime you write about your furry, four-legged companions.
    Missy is six. My biggest concern (heart issues) is what would happen to her if something happened to me.
    For those of us who have complicated feelings about love in general; there is no doubt about the unconditional love received from
    a pet. Missy and I have our own conversations – we understand each other’s moods. It’s the sweetest relationship! ( -;

    Like

    • Thank you, Pam. I can relate to the heart issues. Yes, few people understand the communication we have with our companions. Nonetheless, it’s there and it’s quite real. I just wish I knew more.

      Like

  7. Hi Marco, I’m so sorry to hear about your dog, he is so blessed to have you by his side, it must feel very difficult for you and I felt quite emotional reading this post. I know I’ve mentioned my two dogs before and they are quite old now, Sally has a lot of joint pain and takes time to get up and down and can’t walk very far. However having said that she comes to life with a ball outside for short periods of time every day, so I know she gets enjoyment then and the other one, Tilley loves to be near her so they are good friends. Tilley is a lot more robust even though she is a few months older than Sally. I don’t want to think about when those difficult times, that will likely one day come about. I’ll cross that bridge when I come to it. Take care of yourself and Plato? and enjoy the special connection that you share together ❤️

    Like

    • Thank you, Julie. I’m glad Sally and Tilley have each other, and you. But truthfully, I had a Siberian Husky (male) and a Samoyed (female) who spent 10 years together and had five children. When the Samoyed got sick and took her last trip to the vet the Husky followed in a few months. The vet said he grieved himself to death. As much as I always insist on having two (of any species) together, I know what can happen when the times come differently. I have been lucky to have Plato at all; it was a long fight to get him. Fortunately, he has always been a very independent person. But we do have that special connection you mention.

      Like

  8. Mike Stamm permalink

    I’ve been thinking about this since you first posted it; it’s a very thoughtful, and thought-provoking, essay. I’ve had to have pets put down–in my case, cats–a few times, and even though it was necessary, it was always a wrenching experience. More often, though, I’ve had pets die when it was their time…and that has sometimes felt better, for me, and sometimes worse. The cat I inherited from my father died just over two weeks ago, with no real warning, though her health had often been somewhat precarious, and I’m still getting used to her not waiting to come in through the patio door, or dozing in the living room late at night, or coming in to spend an evening on my lap in front of the TV. It’s one of those elements of life we have to cope with…but I really don’t like it. We’ll adopt a cat or two again, I think, but it’s going to be a little while.

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    • Thank you, Mike. My vet and I were discussing the differences between cats and dogs as they near the end. In his experience cats often do die on their own while dogs much more frequently need assistance. I can certainly empathize with your point about it sometimes feeling better when they go on their own. That eliminates much of the later questioning regarding whether we chose the right time.

      I hope you do adopt again since there are so many that are simply cycled through the system.

      Like

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