Holding Dog Paw

“I’m so, so sorry. This is my fault.”

With that, the man before me began to shake and sob.

I have seen more adults cry in the past year than most people see in a lifetime. And I’m here to tell you that the saying “Real men don’t cry” is a myth. I have witnessed the toughest men you’ll ever meet bawling over the loss of a beloved pet, and I don’t blame them. I will join their tearful ranks when my dog (who is now 12) passes.

Unfortunately, sorrow is unavoidable when we own pets. They simply don’t live as long as we do, and it breaks our hearts when they leave us.

The Crying Man

I wish I could tell you medicine holds all the answers. I wish veterinarians could always speak to people with certainty when discussing their pets. The truth is that no one has a crystal ball, and we cannot know the future. We use our knowledge, diagnostic tests and personal experiences to take our best shot at clairvoyance, but ultimately, veterinarians can’t always know what will happen with a sick pet… and you can’t, either.

Two days earlier, the man sitting across from me had brought his German Shepherd, Mildred, into our clinic because she would not eat and was vomiting. It turned out Mildred had eaten a turkey truss (a long piece of thick string), and rather than the string passing through her body, Mildred’s intestines had bunched up around it. To make matters worse, the intestines' contractions had created a sawing effect, and there were now multiple holes in Mildred’s gastrointestinal tract. Mildred was in serious trouble.

Mildred went to surgery right away, and the string and damaged intestinal tissue were removed. She awoke from surgery and seemed to be recovering as well as could be expected, given the severity of her injuries and the extent of her surgery.

When Mildred’s owner picked her up that evening, we discussed what to do next. I talked through the severity of her condition, the value of IV fluids in keeping the intestine healthy and the benefits of having Mildred monitored overnight by a veterinarian. I told him that she needed to go to the emergency clinic.

If I could change what happened next, I would do it in a heartbeat — and I know Mildred’s owner would, too. He asked me, “What will happen if I take her home, watch her myself and bring her back in the morning?” and I said honestly, “I don’t know.”

Complications Were Likely

I told Mildred's owner the truth: I didn’t know what would happen overnight — no one did. I told him that Mildred might be fine at home, although the chances of her having serious postoperative problems were very real. We then reviewed all the possible surgical complications that could arise. We talked about how quickly she could get sick and what signs would indicate trouble. I told him that she was not out of the woods yet and gave him a business card for the emergency clinic, along with directions for getting there. Mildred and her owner walked out into the night, happy to be together again.

The next morning, Mildred was back, but this time she was on a stretcher. She couldn’t walk, and her blood test results were horrific. She was rushed to surgery, where she died on the operating table. That was 30 minutes before the crying man and I sat down together.

A Lesson on Guilt

I learned a lot that day.

I learned that veterinarians are not the only ones who carry guilt for health care decisions, although we have more practice in handling it. We, as doctors, are reminded constantly that there are no certainties when battling illness and disease. Medicine is a science. Practiced well, it is a reliable science. But it is not all powerful. In complex cases, answers and consequences can seem hidden from us in a shell game in which our patients pay the price if we lose. The thing I learned that day is that every time we play the shell game, a pet’s family plays right beside us. They are even more affected by the results than we are, and they are not used to coping with the guilt of a poor outcome.

I don’t blame the man for taking his dog home that night. Mildred looked a thousand times better than when she came in, and the man had made clear that the mounting cost of treatment was quickly becoming difficult to bear. I don’t know what his personal circumstances were, and I can’t say definitively that being at the emergency clinic would have changed what happened. I don’t know these things, and that’s why I don’t judge him. I carry my own guilt about not pressing him harder to go to the clinic, but I forgive him for his part in Mildred's outcome. I hope he’ll forgive himself.

The Guilt of Loss

I believe that there are many pet owners out there who have made decisions, sometimes on their own and sometimes with their veterinarians, which they regret. If you are one of those people, I want you to know that neither you nor your vet can know the future, and we all feel guilt when our pets leave us. We wonder if we could have done more or if we missed something important along the way. That is the guilt of loss.

All that pet owners and veterinarians can do is our best: try our hardest, ask questions, follow instructions and make what seems like the right decisions with the information and resources available to us. If we have done all that, then we have to put the guilt behind us, learn from our experiences and move forward.

That is what I wish I had said to the crying man. It’s what I hope I will say the next time I see guilt and sorrow in the eyes of the grieving family members of a lost pet. And I know there will be a next time, because pets just don’t live long enough.

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