And as we do it, we hold the hands of distraught owners and help them make that last painful decision. We offer words of comfort and listen to sacred stories. And we meet each pet’s eyes in those last moments, and what we see again and again is not fear but relief. Relaxation. The end of suffering has come at last. I have seen it firsthand, time and time again. The wordless thank you, as a beloved pet slips into whatever awaits us in the next life. The light dims and then is extinguished. As animal physicians, we are not afraid to acknowledge that death comes for us all and that we possess the ability to ease its final agonies.
As veterinarians, we do what human doctors are not allowed to do. We all know that humans cannot win against death, not forever. Sometimes, when patients approach the end, doctors can offer a salve, buy time. But for many, there comes a time when the salve no longer soothes and doctors can do nothing but harm. And yet, in most states, there is nothing to offer in this moment. Doctors’ hands are tied. They can try to make their patients comfortable, but they cannot help them through that final door. They must go alone.
Thursday, August 16, 2018
Wednesday, August 1, 2018
Under palliative sedation, a doctor gives a terminally ill patient enough sedatives to induce unconsciousness. The goal is to reduce or eliminate suffering, but in many cases the patient dies without regaining consciousness....While aid-in-dying, or “death with dignity,” is legal in seven states and the District [of Columbia], medically assisted suicide retains tough opposition. Palliative sedation, though, has been administered since the hospice care movement began in the 1960s and is legal everywhere....
Because there are no laws barring palliative sedation, the dilemma facing doctors who use it is moral rather than legal, said Timothy Quill, who teaches psychiatry, bioethics and palliative-care medicine at the University of Rochester Medical Center in New York.
Some doctors are hesitant about using it “because it brings them right up to the edge of euthanasia,” Quill said.
But Quill believes that any doctor who treats terminally ill patients has an obligation to consider palliative sedation. “If you are going to practice palliative care, you have to practice some sedation because of the overwhelming physical suffering of some patients under your charge.”
Monday, July 30, 2018
[T]he biggest impact they left on me was not reprioritization but being okay with aging. I confess that prior to my conversations, I had an intense fear about growing old. This, I realize, was what motivated me to begin this research in the first place. I assumed the elderly lost their vibrancy and thirst for life. That couldn’t be further from the truth. They still laugh like crazy, fall in love like mad and pursue happiness fiercely.
Wednesday, July 18, 2018
Barring significant abuse, it is your responsibility as a daughter to support your mother as she has supported you. End-of-life care is draining and overwhelming. Losing a parent is absolutely devastating, and doing so while parenting your own children will, at least in my experience, probably be the most emotionally wrenching thing you will ever experience. And yet it’s what you will do.
I was once listening to a radio program where a combat veteran was interviewed, and he said the biggest thing he learned in war was to “embrace the suck.” The phrase stuck with me. When I remember the year that I spent with my own dying mother living with us, my toddler children crawling and creating messes everywhere, our finances struggling, our marriage hanging on by a thread, it was, to put it mildly, horrendous. But if I could go back and give myself any advice, it would be that. To embrace the suck. I was trying to get it to go smoothly. I was trying to avoid discomfort or pain. And as a result, every moment of difficulty was doubly hard. It hurt and, because I was trying to get it to not hurt, it hurt that it hurt. I now realize that I was like a person standing in a monsoon trying not to get wet.
Thursday, July 12, 2018
The man I was seeing died suddenly last week. I found out through an urgent call from a good friend in the minutes after I landed overseas for a monthlong vacation. I’m grieving in a beautiful country, where I feel so far from the people who knew him. Thankfully, I am with good friends, who are giving me space, but I feel guilty that I wasn’t there to help pack up his apartment or take part in memorials with our mutual friends, and guiltier that I am bringing down this trip for everyone. We had only been dating for two months, but it was intense, and we had known each other for a few years as friends and colleagues in our grad program. He helped me through treatments of a major illness. He was supposed to come join on this vacation.
Now I don’t know whether to come back early for the funeral, or if that would be overstepping. I’ve talked to his mom and we’ve stayed in contact, but she didn’t know me before. I am drowning my grief in bad ways, drinking and smoking more than I would like. I am trying to devote myself to more productive things, drawing him and working on a video compilation of his work for his family, but they are making me feel almost worse, since they aren’t very good yet. I feel like my talent has left and all I have is empty effort. I want to reach out to friends, and I have to a few and to family, but I don’t have the words right now for social media, and most people either don’t know what’s happened or don’t know that we were dating. The posts I see about him mostly make me sad or angry, with people I know he wasn’t close to, especially an ex-girlfriend, milking his sudden death for attention. I don’t want to be this way, and I don’t want to make his passing about me. I’ve just stopped looking at Facebook and Instagram. I want to reach out, but I don’t know how to find the words to memorialize him. I’ve been waiting until I had a drawing that I could share, but I don’t know how long it will take to finish one that’s actually good. If I have to make the choice, do you think I should cut my trip short and go home to the funeral? Do you have resources for dealing with grief?
Ortberg's wise response says in part:
Fly home, call on your friends for support, attend his funeral, and don’t rush the project you’re working on or beat yourself up for not making something perfect. This is a huge, devastating, sudden shock, and you should be as kind to yourself as possible, and reach out as much as you can.
The funerals are over.
We said goodbye to John McNamara on Tuesday at the University of Maryland. In the 13 days since the rampage in the Capital Gazette offices that killed John, Rebecca Smith, Wendi Winters, Gerald Fischman and Rob Hiaasen, family, friends and colleagues have gathered to say a final farewell.
We have many regrets, but perhaps none greater than this one: We regret we didn’t know our friends better.
Of all the regrets to have, this should be the easiest to prevent.
Friday, July 6, 2018
Every generation must have more or less the same experience of life—updated to current times, that is. The basic life cycle couldn’t have changed all that much, except that we generally live a lot longer now. We obviously all get born—a shared experience that I don’t think anybody can remember. As little children, our brains aren’t developed enough to receive all the complicated transmissions, navigate “reality,” or fill up with lots of (mostly useless) “important” stuff for a while yet. I think that’s why so many little kids appear to be so endearingly insane. For a little while at least, they’re free of the complicated world of “who you are supposed to be.” They haven’t yet reached that threshold of sanity that we call being “grown-up” (which some of us never truly reach) and which always tragically tends to interrupt our ability to perceive the simplest magic of Life. That can be our critical loss of innocence, I suppose.
It isn’t until you get a little older that a slightly more adult perception starts to form and you also first begin to notice the seriousness of death, perhaps with the loss of a beloved pet—a loss that never gets any easier because of the shared innocence of our animal partners. Then maybe a grandparent passes away. Sometimes there’s an illness or an accident involving a young friend or acquaintance, and occasionally the loss of another person now and then throughout your life. Then your second generational wave of deaths arrives: an uncle, a friend’s parent, and on into your own parents’ generation. It’s a far more involving wave, that one, because it sets you firmly into a middle age when you begin to lose your parents and mentors, and when you first begin to sense that “ultimate” wave that’s drawing ever nearer to your own generation—and, most important, to you.