“This is the hardest part,” I said softly at the end of my explanation. Eyes glistening, the husband nodded. His wife couldn’t look at me, and I could hear their kids out in the lobby quietly sitting with grandma. They knew something was wrong, but weren’t quite old enough to understand what. Smoky lay on the table, prostrate. He was able to thump his tail once or twice, but was too weak to raise his head. His breath was coming quickly. He stopped panting entirely and winced when I touched the large mass that used to be his left shoulder.
Smokey was a big, square-headed black Lab. He was all of 5 years old, and his disease had struck him with the suddenness of a thunderclap after a too-close explosion of lightning. Cancer is never pretty, or fair.
The catheter slid right in on the first try, as easy as standing up from a chair. Years of experience and you no longer even have to think about the mechanics of your job. It is just there, familiar like the couch in your living room. Or your pet, sprawled out on that same couch.
We put on the tape and added heart-shaped cutouts, mostly to make ourselves feel better. I don’t know if anyone really notices the details.
Crowding around him, talking to him, the family wished him a good trip, telling him that it will be better soon. They told him he doesn’t have to hurt anymore, they love him, and he was the best in the world.
It is an alien sensation, being a part of this ritual. And it was a ritual, filled with the weight of emotion, as we crowded around him. In the center of it all, I was the medicine man. I was a stranger, so alien to be a part of this most intimate family moment, shepherding a family I didn’t know through such a life-altering event.
The liquid is bright pink, clear, and thick like syrup. It sat in the syringe like a promise yet to be fulfilled. I once got some in my mouth accidentally, when a bottle of the stuff broke in my hands and I later touched my fingers to my face. It is bitter, so bitter that it stays stuck in the corners of your mouth and refuses to move for hours, standing up to every effort to be dislodged. It is bitter, and that is somehow the way it should taste, like finality. Like poison.
I had to push on the plunger quite hard against the viscous stuff, sliding it into the blood vessel just a little bit at a time, hopefully avoiding the confusion patients can feel with anesthesia. In the final moments, the ripples on the surface of Smokey’s body slowed and then stopped. His breathing ended and he became still. His life fled.
“He’s gone,” I said.
“It was that fast?” they asked.
Yes. Yes it was that fast. The body is resilient, tough, and able to stand a great deal more than what most people would imagine. But that final connection to this plane is threaded finely, and can be easy to sever.
“Take as long as you need. I am so sorry for your loss.” I have said those words so often I could not begin to count the times. “I am so sorry for your loss.” How hollow it sounds. All of a life and a death packaged up into seven words, tied with a bow of cordiality and social contract. But there is nothing else to say.
Every once in a while I’m asked “Well, do you get used to it?” No, I do not. Giving the gift of death is still killing another life, and a family member at that. There is a place in purgatory for me, if I am lucky.
I have also been asked if it is different for me with my own pets. It is. It is harder, I believe. Not that my emotions are any stronger than those other families that lose a loved one, but in the sense that my knowledge seems to protract my grief. Modern medicine is, really, quite a sham. The medical community has convinced the public that we have the answers; that we are indomitable in our abilities to ward off death and make right threatening physical weakness. But we don’t have the answers; only a foolish self-righteousness and arrogance that we could get in a fist fight against God and Death and win hands down. Don’t bet your paycheck. The more time I spend in practice, the more the answers I thought I had wash away under a tidal wave of new questions.
What happens when we are sick? At the levels that would allow us to fix every problem, we don’t know. There are places that no doctor can see or go or understand, and it is in these places that the real answers reside. They hide between the cells and in the molecules that tell them what to do and why.
Disease is, ultimately, something we understand just enough to see the possibilities of what might come next. It all boils down to two options: get better or get worse. My brother and I once got a puzzle for Christmas. It was a 24-inch round, red circle, with only three types of pieces. We couldn’t finish; we didn’t even know where to start. And this is how my profession works. I take all of the pieces to the puzzle of a disease and put them together, but I have to do it without edges or corners and I don’t have all of the pieces.
So my own pets, my own family, come to me looking for help, aid, succor, a cure for what ails them. And sometimes I can give it to them. But the personal connection I have wracks me with doubt. I may know what is happening, but I don’t know why. I may know why, but I don’t know how. And the answers dance at the edge of the firelight, but I cannot make that fire any brighter.
My own cat, Ivan, just died of acute suppurative pancreatitis, hepatic lipidosis, post-hepatic biliary obstruction, inflammatory bowel disease, and secondary peritonitis. Even I don’t know how to string these words together to make any sense of why it happened. But I knew what was coming much earlier. And I knew that, despite all I could try to do, all that I did do, and all that I was planning to do, what was coming was not going to be stopped. And so I watched it; a train wreck in slow motion, pieces flying off of the whole, the rest charging forward crippled and without much of a chance. If I could just slow it down, maybe I could stop it.
Ivan died last night. I don’t know why.
This is the hardest part.
Brian Monk works as an emergency/critical care veterinarian in south Florida. He graduated from the Virginia-Maryland Regional College of Veterinary Medicine in 1997.