Humane Euthanasia: The Gray Zone

One of my recent emergency shifts was what we in business reluctantly call”one of those shifts.” This is a shift in which almost every patient that walks through the door is here for euthanasia, or PTS (put-to-sleep) for those in the jargon know. Nights like these, no matter how the end result may benefit the owner and/or the pet, take an emotional toll on the staff and myself. The term for this is empathy fatigue.

What tends to bother me the most is when it is a problem that goes undiagnosed, but the owner feels the patient is older and usually states, “while it’s not the money, I just don’t want to put him through testing when we don’t know how much longer he has.” While that makes sense to me emotionally, as a doctor, I want to find out more. I have a need to form a diagnosis in an attempt to treat and provide a prognosis.   I also feel that maybe we owe it to the pet to try some therapies, if the condition is treatable and the animal is not currently suffering, prior to ending a life. By offering diagnostics, I hope to give the client as much important information as possible to make an informed decision. The conflict arises because the amount of information needed is a personal choice and differs for everyone; and, ultimately the owner determines the right time for an animal to pass on.

If a client has a 13 year old dog and the dog started having some respiratory issues that clinically appear mild and a low grade heart murmur is detected, is that cause in itself for euthanasia without taking x-rays?  What about if, in addition to those signs, the owner may have to undergo a long distance move?

If we suspect strongly that a portosystemic shunt is the cause of persistent hypoglycemia that is difficult to manage, is it time to give up on that puppy prior to definitive diagnosis with an ultrasound?

Some clients worry about what they will find out and prefer to remember their pet in their best condition and accept the inevitable. So where do we draw the line between treating too aggressively and not treating enough? When is the right time to let our best friend go, and when is humane euthanasia an opt out card versus a means to end suffering? These are very real and permanent choices and questions we must face as part of being a responsible and caring pet owner.  There is, of course, no right or wrong answer. However, I know after nights of numerous euthanasias I start to wonder what my role should be in the decision process.

Heathcliff tries to hide

As a veterinarian, clients will ask you all the time, (especially with respect to humane euthanasia) what would you do if this was your pet? The truth is they usually already have a decision made and sometimes your job is to support them.  After all, it is their pet, their loved one, their choice…or should it always be?

Independent Contractor …on the side

I mentioned in my prior entry that I have started training to become a part-time field representative for VPI (Veterinary Pet Insurance). This position has completely reinvigorated my passion for the veterinary profession on many levels, so I think it deserves its own blog post. Some of you may be wondering, did I sell my soul to industry or why do i need a second job? The answers to those questions are no I have not sold my soul, but inspired it. I don’t need a second job, but who turns down free travel and some extra money.  The real reason I sought this position is the intangibles, and they are plentiful.

Over three years ago I was granted a one week externship with VPI in their headquarters in Brea, CA. VPI is the oldest pet insurance company and one of the most reputable. Having a business background, I thought it was important to stay in tune with that knowledge and apply it to veterinary medicine. I was also moved by my initial encounter with VPI. VPI has a department dedicated to their veterinary college program. The company sponsors some of the best veterinary business and legal speakers at the veterinary colleges, including materials, speaker fees, and lunch.  In return they give a one hour speech on how pet insurance works with a few slides about VPI specifically. The presentation focuses on what is pet insurance and why is it important. It also lists all the major players, not just VPI, and encourages students to do their research and select some companies to recommend to clients. Most importantly, it sparks a discussion about pet insurance with the goal to make the future generation less afraid.

Most students think insurance is bad, waste of money, and that it will dictate how we provide care for our patients. They leave the presentation understanding that it is insurance, so you may not make money from it, but it provides protection for those numerous small and sometimes one time large vet bills.  More importantly clients are more compliant and see the vet more often if they have pet insurance, so it raises the standard of care for our patients. We even discuss veterinary school debt and that insurance is one of the solutions in this multi-factorial puzzle (a separate post will address the student debt problem).  I am obviously passionate about the presentation, but the truth was in the experience. When I saw this presentation given by a general practitioner,  not a VPI employee, I was blown away; I wanted to inspire other students in the same way in the future.

I have been to two vet schools now observing the presentation and the students are engaged and understand the importance. They are excited about this new tool and the energy is contagious.

VPI is also a major sponsor of the VBMA (Veterinary Business Management Association), a student-run organization that believes in providing a business foundation for future veterinarians. As a student, I was very active with this organization on the local and national level, and I miss it. In this position, I now engage in a dinner with the VBMA Chapter officers and have first hand knowledge of how the organization is evolving, Furthermore, if I continue with this position I will be a part of the National VBMA meeting as a clinician.  In fact, this position was open because the VBMA has instituted a formal business certificate for veterinary students and the VPI presentation constitutes 1 credit hour, so the requests for presentations has grown, which is where I come in.

During my VPI externship I met with the veterinary medical director and I strongly expressed my interest in presenting to the colleges in the future. She told me, “finish school, get settled in practice, call me.”  With my career becoming settled and my desire to have a broader impact, I reached out. My networking paid off and I now have a side position that allows me to interact with students and the VBMA again, and creates a path for a future in organized veterinary medicine, and perhaps even industry.

Back to the Virtual World

I have been on blog hiatus since graduating veterinary school in 2011. In my prior blog life, I authored lifeofaveterinarystudent.blogspot.com. This blog logged my jounrney from getting accepted into vet school as a second career through graduation. My hiatus has been due to a number of factors, including a veterinary internship in small animal emergency and internal medicine 2011-2012, relocating to Phoenix, AZ and starting a career as a small animal emergency clinician, and writers bloc. As I began to settle into my career and make my way up the learning curve, I found myself entering 2013 thinking, “is this it?” While I pursued veterinary medicine because I found finance an unrewarding career, I would not say that I found emergency medicine unrewarding, but something was missing.  So before my previous fans get too upset, let me explain.

I enjoy small animal emergency medicine and become more confident each day.  There are frustrations, however, and after 4 months in practice, I started to revisit my long-term career goals. I realized that I missed my connection to the broader veterinary community, as well as veterinary students. I signed up to be a mentor through the AZ VMA and joined their Young Leaders Advisory Council and PR task force committees. These groups have been invigorating and enabled me to network with veterinarians in the local community and have an impact on the larger community outside of my practice.

While hiking with my husband, I was mentioning how I’d like to compose another blog, but I had nothing to write about. Writing a blog in vet school was easy, there was always something new and exciting happening or an exam to stress on. Daily practice, even emergency, is not always that exciting once it becomes a job.  He came up with many ideas such as discussing transitioning from school to my internship into practice, inspiring cases, and the list kept going. The foundation for Veterinary Brainstorm was forming.

The excitement to start typing, however, occurred on a trip to Mississippi State veterinary school as a field representative in training for Veterinary Pet Insurance (VPI). This position will be discussed in a future blog entry, but it made me realize that a new blog would further my connection to prospective veterinarians, students, and others in the profession beyond the local level.

My prior blog inspired many people who reached out to me via email, telephone, and even spawned some in-person meetings. I hope this blog will inspire similar connections and discussions about relevant topics in veterinary medicine and my new career as it takes shape.