Content note: This post contains discussion of euthanasia and physician-assisted suicide. If you are in a moment of crisis, please call the suicide hotline at 988 if in the United States or Canada, or the hotline that is available in your country.
Note: Well, I didn't see it coming. One post about grieving the sudden loss of my therapist, Oren, ultimately became the first in a trilogy of entries about death.
*As always, names are changed to protect people's privacy
When I was in fifth grade, my teacher read our class Tuck Everlasting, a children's novel in which a ten-year-old girl named Winnie befriends the Tuck family, whose members are immortal. Eighty-seven years prior, the Tucks-- Angus, Mae, Jesse, and Miles-- had inadvertently drunk from a spring that made them not only indestructible, but unable to age. Winnie is tempted to drink the water herself, but the Tucks will not allow her to leave until she agrees to keep their secret and not drink it. Although not suffering in the traditional sense, the Tucks have long tired of life and do not see immortality as a blessing.
One day, after reading a chapter from the book, the teacher began a discussion that I cannot imagine happening today in a classroom of fifth graders: she asked us if we would want to live forever. I remember being very surprised that most of the other kids gave an emphatic no. One boy said, "I would just want to get it over with," an answer I clearly recall finding disturbing. The teacher also said that she imagined that life would eventually get boring. I couldn't understand it. Why would death be preferable to life-- ever?
I have since changed my views on this issue, with the caveat that my position is that I would like to live indefinitely-- so long as I'm not suffering-- but I would not like to be indestructible. If futurist Ray Kurzweil's predictions about scientific advances are to be believed, this very well might be possible one day. Scientists have already found a way to reverse aging in mice. If this is eventually transferred to humans, then you could theoretically live indefinitely and decide on your own terms when to stop the clock. Of course, there are practical and ethical implications for this, but that's another discussion for another day.
So when did I change my mind about death ever being preferable to life? The events that forced me to rethink my position happened about six months later when my dog, a Doberman mix named Smoky, died a protracted and horrific death.
One evening when I was twelve, Smoky, who was prone to epilepsy, had a seizure, his body thrashing about violently. I didn't witness it, but my parents told me it was especially intense. He couldn't stand up, so I urged my parents to take him to the vet. They thought he was just exhausted from the seizure, so they decided to wait it out. After a couple days, Smoky was both vomiting and defecating blood. To this day, I can still vividly recall the putrid, fetid smell.
Now that the situation was clearly an emergency, my parents brought Smoky to the vet.
I was terrified as my dad drove the car, my brother and me in tow. Immediately, I feared the worst, that the vet was going to put Smoky to sleep. I knew what euthanasia was, and I had always found it disturbing that people would ever have their pet killed. Instead, the vet kept him at the office for a few nights to run tests and attempt treatments. He later told us that Smoky had acidosis, a condition in which there is too much acid in relation to base in his system, and it might have been caused by a bacterial infection. At first, treatment seemed to be working. But it was not without its setbacks-- at one point during Smoky's stay, he went into a coma. However, he woke up, started to improve, and we brought him home to recover.
My dog was never the same.
Smoky's behavior proved erratic. We had to confine him to the garage because his instinct to avoid sitting in his own waste was apparently gone. The vet wasn't sure if this issue would resolve. Smoky would tremble violently when approached, and sometimes he would even bite. Most disturbingly, over the next two-and-a-half months, he began to rapidly lose weight and was constantly hungry, devouring a month's worth of dog food in a week and constantly defecating. One time, when left alone in the garage while my brother and I were at school and my parents at work, he was so desperately hungry that he tried to eat a wrench.
Once again, Dad consulted the vet. During the course of those couple months, there were one or two more overnight stays at the veterinary office for monitoring and attempts at treatment. The vet suspected that Smoky had brain damage. As for the weight loss, he said it was possible that Smoky's intestines-- injured from his illness-- might have healed in scar tissue and would never be able to absorb food again. Another possibility was that his pancreas wasn't working properly. Finally, he said that he would try one more treatment that would target pancreatic function. If there was no improvement within two weeks, it would mean that the problem was in his intestines and we would have to put him to sleep.
Smoky was suffering horrifically. I can only imagine what it must have been like for him to be literally starving to death, and the terror he must have felt was likely exacerbated due to the brain damage. But I was suffering too. I loved that dog. The two of us were very close. We spent a lot of time playing together, and he slept on my bed every night. He also was a very loving and compassionate dog. If he saw me crying, he jumped in my lap and licked my face. We had had him for a little over five years, and when you're a kid, five years is a long time. I couldn't fathom losing him.
The ambiguity throughout this ordeal was the worst. Some days, it seemed like Smoky was getting better. Other days, he clearly wasn't. I was constantly plagued with the question as to whether my dog would ever recover and if things would get back to normal. I cried several times a week during those couple months. I recall one evening, during one of those crying episodes, being in the car with Dad, who was desperately trying to get me to understand why euthanasia would be the humane and compassionate choice if treatment didn't work. He finally said, "If you really love that dog, you will let him go if the vet says that there's nothing he can do." I remember nodding in reluctant resignation, even as I cried. I was starting to get it-- sort of.
One Tuesday afternoon, after only a week of treatment, I came home from school to find Smoky gone. Dad explained that that morning, Smoky's back legs weren't working and he couldn't get up, so he took him to the vet and left him there for another overnight stay. Because Smoky had stayed overnight at the vet before, I didn't question it.
A few days later, on Saturday morning, it was over. My parents called my brother and me to the living room to break the news. "I just got off the phone with the vet," Dad said softly. "Smoky died last night." As my eyes widened in horror, I asked what happened. Dad said, "A blood vessel burst in his brain."
Inconsolable, I ran upstairs to my room, locked the door, and once again collapsed into tears. It was one of the longest days of my life. I remember my parents taking my brother and me to the arcade to give us something to distract us from the grief we were both feeling. I played video games on autopilot, not really enjoying them as much as my parents probably hoped I would.
As the months passed, Smoky's death proved to be a crystallizing event in my life. Losing him was intense, but in hindsight, after I cried it out, there was one emotion that dominated: relief. His suffering was over, as was mine as a result. Several months later, we got a new dog, a yellow Lab named Savannah, who lived to be fourteen and a half, a decent lifespan for a dog that size. She also died via euthanasia when her severe arthritis (common in her breed) was no longer manageable.
It was about a year after Smoky died that I first heard the name "Dr. Kevorkian." I didn't pay attention to the news, but on occasion I heard people mention him and what he was famous for. At the time, I assumed he was just some doctor at a hospital doing his job, and I didn't give it a second thought. By then, I had come to realize that Dad was right: there are things worse than death, and in that time I came to appreciate that it was for the best that Smoky had died. Euthanasia was done for animals, so I assumed it was done for people too. I remember being surprised to learn that this wasn't the case, and after that I strongly supported euthanasia for suffering people with no hope of recovery. Even at that young age, I thought it made absolute sense, and I couldn't understand why it was such a controversial issue. I had learned my lesson at age twelve, so why did so many adults not understand it? It seemed odd in light of my fifth-grade group discussion in which most kids said they would not want to live forever. I felt so strongly about the issue that I wrote a position paper in support of it for my eighth-grade social studies class. My parents supported euthanasia as an option for ending suffering from severe illness, and my dad was especially vocal about it.
In fact, a few years after Smoky died, Dad eventually confessed to me what you probably already guessed from reading this: Smoky didn't die from a brain hemorrhage. Dad had him put to sleep. That morning when he saw that Smoky couldn't stand up, Dad decided that enough was enough, and that it would be cruel to let this continue. On the way to work that morning, he took him to the vet to be euthanized. He and Mom waited until Saturday to tell me that the dog "died last night" so that grief wouldn't interfere with school.
In any case, I appreciate more than ever the horrific-- but humane-- decision my dad had to make. One day when I was twenty-seven and living in Brooklyn, my first cat, Ditmas, who was only two and a half years old, began gasping for air and dragging her back legs along the floor. I brought her to the vet, who took one look at her, listened to her heart, and said, "She's in trouble. Get her to the animal hospital in Manhattan, and don't waste any time." I got into a cab and rushed to the hospital, where the vet said that Ditmas could have bronchitis-- which was treatable-- or she could have heart disease. I left her overnight so that they could run some tests.
The following evening, the vet called me and said, "Ditmas has severe heart disease." She explained that my cat had dilated cardiomyopathy, in which the heart fails to pump efficiently and increases in size to try to compensate, which only makes things worse. She also explained that Ditmas was behaving erratically and forming blood clots in her brain. I immediately thought to myself, "I can't in good conscience keep her alive like this," and then I said aloud, "And I have to put her down?" but it came out more like a statement than a question. The vet said, "Yes," and I said, "Okay. Just keep her comfortable. I'll be right there." They told me they would keep her in an oxygen chamber until I arrived.
If there was any doubt that euthanasia was the right decision, it was torpedoed when I saw Ditmas. This was not the cat I knew. She wasn't herself at all, was clearly terrified, and even something in her eyes looked off. I cradled Ditmas and told her that I loved her as the vet administered the anesthesia, and then the euthanasia. She died in my arms.
My current cat, Neptune, is eighteen years old. He has chronic kidney disease, hyperthyroidism, and elevated liver enzymes. His conditions are somewhat manageable through a prescription diet and medication. However, I know that within a couple years-- or maybe even a couple months (kidney disease is notoriously unpredictable), I am going to have to make a difficult decision. My one consolation is that, unlike Smoky and Ditmas, Neptune will have lived a long life; the average lifespan for a cat is fifteen years. It will be difficult to lose him, but not in the same way as it was with my other two pets that died young. I am glad that this decision will be available, because I would never want Neptune to suffer. I would want that decision available for people too, because I wouldn't want them to suffer.
And it was Smoky that made me understand that.
