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Saturday, September 15, 2012

Euthanasia Nightmares

One of the toughest parts of our job as veterinarians is euthanizing pets.  Even if we know that it's the best thing for the animal and is humane, there are still a lot of emotions running through the situation.  Owners are sad that their pets are leaving them and may be questioning their decision to euthanize.  Some are bawling and breaking down in tears while others are very stoic.  Even with our experience it can also be hard on us and emotinally draining. 

That's with everything going smoothly.  And things don't always go smoothly.

On the surface it's pretty put a catheter or needle in the vein, inject the solution, and in a few seconds brain activity stops.  The huge majority of the time it really is this quick and simple and the pets fall asleep quietly, not waking up.  But when you're dealing with physiology and chemicals you can't predict every single outcome.  Every vet can tell you stories of routine euthanasias gone horribly wrong. 

Today my associate saw a cat we had been treating this week for renal failure.  She wasn't getting any better and the client elected euthanasia.  They placed the IV catheter since the owner wanted to be present, which wasn't an easy task considering that the cat was aggressive, severely dehydrated, and had poor blood circulation.  In the room she gave the injection into the catheter in front of the owner.  Nothing happened.  So she gave some more.  Still nothing.  She ended up giving enough euthanasia solution to kill a 60 pound animal, and this cat was only 8 pounds.  And it wouldn't die!  As this was happening the husband was becoming very upset and even irate that it wasn't happening quickly.  My associate came to the back to get an intramuscular sedative (not deemed necessary at first because a catheter was in place) and the husband came into the back, grabbed her arm, and said that she needed to find someone "who knows what they are doing."  I was busy so she eneded up giving the sedative and then once the cat was out giving an injection directly into the heart.  Definitely NOT a smooth procedure, and it resulted in a very mad client.

There was nothing she did wrong and this was an unusual outcome.  The catheter was placed properly, the solution didn't come out of the vein, and she used far more than is typically necessary.  She has been practicing for longer than I have, has worked at emergency clinics, and is a very skilled doctor.  We think that the cat's circulation was just so poor due to the disease that the solution was having a hard time reaching the brain.  It was tragic but not something that could be helped.

I've had similar things happen to me.  One time a cat lept into the air screaming as I gave the injection, then landed hard on the table dead.  I've had pets suddenly jerk, causing the needle or catheter to pull out, necessitating further pokes.  Sometimes the calcuated dose isn't enough and the pet doesn't pass away quickly, requiring additional dosing.  In rare cases there will be significant disorientation, causing the pet to cry out or thrash as the drug takes effect.  These situations don't mean that the doctor did anything wrong or is somehow incompetent.  They are rare and bother us as much as they bother the client.  It's also hard for us because we have both our own discomfort as well as the client's obvious sorrow to work through. 

Thankfully these "nightmares" are rare even though every vet can tell you times when they have happened.  Almost every time it will be quick, smooth, and easy with a very peaceful, painless passing.  I also don't want to discount the cases where the doctor does make a mistake or do something they shouldn't (I'm sure I'll get comments about those).  But there are times when everything is done correctly and it still goes wrong.  Those things are bad enough normally, but it's even worse of an emotional impact when someone is going through the passing of their pet.