Would You Have Euthanized This Patient?
Posted: Monday, December 21, 2009 12-21-2009
I just lost a patient. And I am devastated.
Cuddles was a 13-year- old Maltese with right periocular swelling and enophtalmos. MRI revealed a nasal mass causing lysis of the right orbit. The mass extended in the periocular tissues. The owner was clearly informed that the mass was probably malignant.
Surgery entailed enucleation and debulking of the mass through the eroded orbital bone. After surgery, the owner was told that the procedure went well but was reminded that the mass was likely malignant. The biopsies would confirm the suspicion.
During Cuddles’ discharge, the owner couldn’t stop repeating how great the surgical site looked. During “call backs,” she sounded thrilled, and raved about how cosmetic the incision looked.
About a week later, when I called the owner to discuss the confirmed diagnosis--nasal carcinoma--she seemed in shock. This isn't unusual.
Before the biopsy, we could only share an impression, based on advanced imaging, gross appearance intraop and experience. But now, we had an actual diagnosis.
Radiation therapy was mentioned as an option for follow up treatment.
The owner opened up and explained that she “just went through that” with her mother. She had had surgery, chemo and radiation.
But unlike the owner’s mother, Cuddles had an acceptable quality of life, was eating well and was comfortable.
The next day, the owner left a brief message: “Cuddles was euthanized at the referring vet.”
My nurses and I couldn’t believe it! In a matter of hours, the owner went from cheering up to giving up. The skin sutures were still in!
I asked Sara Fiocchi, a board - eligible oncologist at Veterinary Cancer Group in Tustin, Calif., what she thought. She basically agreed that the owner probably made an irrational decision.
“Such reactions are driven by prior personal experiences associated with strong negative emotions," she says. "She may still be grieving her mother and may not be able to make rational decisions--or at least what you and I would consider a rational decision.”
I also asked for comments from Candace Carter, an internist at our hospital in Whitehall, Pa., who treats cancer patients daily.
“I have accepted that the owner's interpretation of a poor outcome and mine often differ," she says. "The fact is, the dog did have a terminal condition, and there is something to be said about allowing for some dignity in death.”
Our colleagues are right. Our personal reaction to this owner’s decision is necessarily subjective, shaped by our beliefs, emotions and past experiences. And no matter how we feel about it, we must, as professionals, support and respect the owner decision.
Now, how would you have reacted if this client had asked you to euthanize her dog?