November is now upon us, Bored Surfer.

Of course, that means Thanksgiving and shopping/football day, but it is also time to celebrate(?) such observances as All Saints Day and All Souls Day (on the 1st and 2nd, respectively), the birthday of the Marine Corps (on the 10th), Veterans Day (aka Armistice Day in honor of the Armistice with Germany that officially ended the major hostilities of WWI on the 11th day of the 11th month at the 11th hour). On a happier note, Nov 8 is Tongue Twister day, which is a good excuse (in case you need one) to read Fox in Socks. The 20th is “national absurdity” day. Feel free to use that day to laugh at national absurdities (there is no shortage, so take your pick).

The time has come for the blog of death. This sounds like a total downer, but it needn’t be. Dia de los Muertas is the Mexican Day of the Dead holiday at the beginning of November. It is a festive occasion meant to celebrate life. And the skeleton decorations are super cute and fun. So there is precedent for me to include some moments of levity during the discussion of an otherwise dark and depressing topic.

If you are in the Omaha area, and a metalhead (or married to one), you already know that the mightiest of thrash bands will be performing on Nov 18, during their farewell tour. While they may do multiple farewell tours (ala Cher), they could probably use a rest after playing really, really fast for about 40 years. It seems fitting that I should use the name of Slayer’s guitar player for your pet’s pseudonym this month, so Kerry it shall be.

Veterinary medicine covers the entire life cycle, from birth to its inevitable conclusion. Sometimes we have time to prepare in advance, sometimes it is a complete surprise, and sometimes your elderly pet dies while you are away on holiday. No matter its particular presentation, the loss of a beloved companion is a difficult occurrence.

On some occasions death strikes quite suddenly, like an invisible dome bisecting a woodchuck. More often, however, you have at least an inkling that it is near. Kerry may be elderly and/or afflicted with a chronic disease. He may have been sick for a while, and getting worse. You may not notice a very gradual decline, you may just adapt to the changes.

Veterinarians have an obligation to relieve animal suffering. Sometimes the only way to do this is through euthanasia. The word itself comes from Greek words for good (eu) + death (thanatos) and refers to intentionally ending a life to relive pain and suffering. 

In the quest to minimize animal anguish, veterinarians have to advocate what is the best course of action for Kerry. This can be more distinct in a shelter setting, where the vet is purely considering the needs of the animal. In traditional practice, those people bonded to the animal also need to be considered. We do our best to make it minimally unpleasant for all involved and we strive to provide a loving, peaceful passage to the Great Beyond. It is not necessarily pretty, at least not in the sense of Mr. Death in a certain old Twilight Zone episode (Robert Redford circa 1962) or Joe Black (Brad Pitt, circa 1998).

The decision of when to euthanize can be quite difficult. Some pets are very stoic and their suffering may not be obvious. Frequently, Kerrys with long term ailments will alternate between good and bad days. Many older pets decline gradually, but still seem to have a good quality of life overall. You know Kerry better than anyone else does. You know what brings joy to his world. Please know we will help you determine when is the best (or least bad) time to say good-bye and the veterinary team will support you to the best of their ability when that time comes. There are several helpful brochures (from which I admit I have borrowed) available from the Ohio State University vet school. One in particular is called “How Will I Know?” and includes a Quality of Life scale you can use to assess Kerry’s situation. Find it atvet.osu.edu/HonoringtheBond.

It may seem tempting to avoid actively making the decision, and simply waiting until Kerry dies on her own. Depending on the course of the disease, this can be a long, slow process. It will happen eventually, but watching him slowly succumb can be very difficult to endure.

As far as we can tell, animals live in the moment. They are not thinking about yesterday or tomorrow. They know what they are experiencing now. One of the myriad of responsibilities you assume as a pet owner is to provide them with medical (veterinary) care. Yes, this does include end-of-life care. It is not pleasant to think about, but there may come a time when you do not have any other humane options.

If euthanasia is warranted, you can usually choose whether or not to be with Kerry in his final moments. This is a very personal decision and is in no way a reflection of the depth of the love you have for her. If you are not able to attend the euthanasia, please know that Kerry will be tended promptly, sedated if necessary, held gently and petted during the procedure, and the last thing he sees will be the face of love.

It may be very difficult (physically or emotionally) to bring Kerry to the vet clinic for euthanasia. In this situation, there are housecall euthanasia services that are available. 

Before proceeding, we always request you sign an official euthanasia form. This is to confirm the irreversible procedure that is to take place. It also states that, to the best of your knowledge, Kerry hasn’t bitten anyone in the past 10 days. If a bite did occur, we would need to discuss rabies protocols before proceeding.

If possible, we place an IV catheter to ease the administration of the euthanasia drug (it is sometimes called euthanasia solution, but to me that sounds a bit too morbid). We use pentobarbital, which at lower doses was formerly used as an anesthetic. It can be used alone, or in combination with Propofol (yes, that is what did Michael Jackson in) to cause rapid loss of consciousness, followed by cessation of breathing and heart function. Sometimes one can observe some reflexive muscle contractions afterwards. These are not conscious movements, and though unsightly, are not indicative of distress.

There are many options for the care of Kerry’s remains. By far the most common is cremation. This can be a done as a so-called private cremation, where Kerry is cremated individually and his ashes are returned in a container of your choice. A less expensive alternative is a communal (aka general) cremation, where multiple animals are cremated together. In the latter scenario, the ashes are co-mingled and not returned to the respective owners.

You may also take the body for burial, but you should probably check local ordinances before doing so. It may not be strictly legal in your jurisdiction. 

There are preservation options available, but not commonly undertaken (pun intended, as usual), such as taxidermy and freeze drying. There is even a company that will turn Kerry’s ashes into diamonds. That way diamonds can literally be a girl’s best friend.

You need to consider what to tell the kids, and more importantly, what not to tell them. Death can be a difficult topic to discuss with your children, but it does need to be addressed. There is no shortage of books on the subject (my kids once found one at the dentist’s office), ranging from Mr. Rogers to a coloring book.

The details of the conversation will vary with the age of your children. Very young children may not understand that Kerry is not coming back. Teenagers who have known Kerry their entire life may be quite depressed by the turn of events (or maybe it’s puberty?). Avoid the term “put to sleep” as little kids may worry that when they go to sleep, they may not wake up. Also don’t lie and tell them that Kerry went to go live at a farm upstate. You may be subjected to an intense line of existential inquiry. For example, do pets go to Heaven? Is it the same place as people Heaven? If not, why not? How could Heaven be a happy place without pets? Are there mice in cat Heaven, would that also be mouse Hell? Answer these questions as honestly as possible, according to your personal beliefs and the development level of the one asking.

Some 50 years ago, Dr. Elisabeth Kuebler-Ross (sorry, my keyboard doesn’t have an umlaut) outlined 5 common stages of grief, based on her observations of how people cope with illness and dying. Grieving people are not limited to these stages or the order in which they are presented. As near as I can tell, the Dr. Ross in the name of the Kuebler-Ross model was her husband at the time; the theory of Denial/Anger/Bargaining/Depression/Acceptance was all hers.

Denial ain’t just a river in Egypt. It can be difficult to accept bad news, especially when it is first presented. If you need some time to process a poor prognosis, we can usually provide Kerry some temporary palliative pain relief. However, it is not fair to leave Kerry is a state of severe distress for several days while waiting for out-of-town relatives to come and say good- bye.

People are understandably upset when a beloved pet gets very ill or dies. Sometimes this takes the unhealthy form of anger directed at the veterinary staff. As a profession, we are all too often accused of not loving animals. The most common scenario is an ailing Kerry who needs diagnostic tests or treatments that exceed the owner’s financial limitations. Obviously, we would not have chosen this profession if we did not adore other species. Also obvious is the fact that we would go out of business very quickly if we did not charge for our services, but that is another story (or perhaps the topic of a future BLOG blog).

Bargaining is usually an internal struggle. It is traditionally portrayed as trying to make a deal with the Great Spirit to exchange good behavior for an extension of life. It has also been portrayed as playing a game of chess (or Twister) with the Grim Reaper.

Depression is likewise not typically visible in the vet’s office. Great sadness is not unexpected or inappropriate but it is not commonly on full display. Major depressive episodes may necessitate medical treatment. Do not be embarrassed to seek help.

Acceptance is usually the point where someone brings Kerry in for euthanasia. They have come to terms with the necessity for the procedure, and made their peace with it. With great power comes great responsibility (according to Stan Lee). We are obligated to use our powers to ease suffering when all palliative options have been exhausted.

If the grief is overwhelming, you may consider grief counseling. There are many resources available, including, but not limited to: hotlines, chat rooms, local support groups and personal counseling. One place to start is lapoflove.com/community/pet-loss-support. You do not have to suffer in silence.

The right time to consider getting another pet will vary greatly, depending on your personal circumstances. You cannot replace Kerry but you may need to hire someone else to fill the position, and the big empty spot on your couch, bed etc. If Kerry was your only pet, you may find yourself in great need of that quiet, unconditional love that is a specialty of pets. You may not be ready to take on a puppy or kitten, but there are plenty of rescues that are already house trained. If you are not ready for commitment, you can consider fostering to provide some short-term gratification.

I am repeatedly astounded by the lengths people will go to for their pets. The human- animal bond is truly a thing of beauty. It is also devastating to have to tell these devoted caregivers that there is no hope and their choices are watching the pet linger or euthanizing it. There is some consolation in that the chronic cases have had some time to process. It is painfully difficult to tell someone whose pet seemed fine yesterday that lo and behold, Kerry has a horrible untreatable (or not realistically treatable) ailment.

Veterinary professionals do not have the power to soak up all the pain and then breathe it out like a bunch of bugs. If we did, a whole lot of pets would live a whole lot longer. Sometimes all we can offer is a peaceful passage over the Rainbow Bridge. We try to comfort people, but we cannot completely relieve their distress. We do absorb a little of it, hopefully enough to make the loss bearable.

Euthanasias can be difficult to perform, but they are not without merit. It is difficult to see the people experiencing such great loss, but we take comfort in knowing Kerry is out of pain and at peace.

This concludes the BLOG blog look on the side of death. Thank you, Bored Surfer, for reading my ramblings. I hope you did not find this trip through the valley of death too heinous. Also, I need to extend a Dankeschoen (still no umlaut!) to Dr. Emily Burbach who provided me some additional insight.

Dr. Debbie Appleby