Tuesday, August 3, 2010

Making the Decision to End Our Pet's Life

I still can't believe Cosmo is gone. As hard as it feels to lose him, there's something especially haunting about having been the one (along with E.) who decided to end his life.

I never thought it would come to this. While I knew that many pet owners put their ailing pets to sleep rather than allow them to suffer, I preferred to imagine that Cosmo would remain healthy until he was very old, then would simply go to sleep on his comforter beside our bed and never wake up. Unfortunately, that's not the way it happened.

By the time Cosmo reached his thirteenth birthday this past June, he had significant health issues. Controlling his seizures required ever-higher doses of medicine, which put his liver and pancreas at risk. Recently, he began showing a variety of disturbing symptoms — excessive thirst, excessive hunger, hair loss, panting, fatigue, muscle weakness, and a distended belly. In addition, he injured one of his front legs, so he had to be carried up and down the stairs.

Due to the muscle weakness and leg injury, Cosmo couldn't accompany us on long walks. We still took him for strolls around the neighborhood, but often he had to be carried most of the way. In retrospect, I can see that Cosmo's quality of life was eroding before my eyes, but the decline was gradual enough that I remained in denial for a long time.

Then Cosmo began showing signs of incontinence. His excessive thirst, which led to excessive drinking and an over-full bladder, was taking its toll. This new symptom couldn't be ignored. Cosmo had been totally house-trained by the time he was eight days old and had never had an accident in thirteen years. A little Googling regarding the incontinence revealed that, combined with all his other symptoms, Cosmo probably had Cushing's Syndrome, which is caused by excess production of cortisol, a steroid. I took him to the vet, where tests confirmed that he indeed had Cushing's.

Cushing's is an awful disease when left untreated, but the vet told me that a new medication, trilostane, could treat Cushing's with great success by suppressing production of cortisol. She was optimistic that if we could get both the Cushing's and Cosmo's seizures under control, he would feel well and function well again. So, we started him on the trilostane.

We'll never know exactly what happened on that fateful morning to cause a seizure a hundred times worse than the mild partial seizures Cosmo had always experienced before. The massive seizure took place on the fourth day after we began the trilostane, just as it was reaching effective levels. Apparently, the suppression of cortisol due to the trilostane had a catastrophic affect on Cosmo's body's ability to regulate his seizures.

Once Cosmo began seizing, at around 7:45 a.m., he didn't stop. Despite the seizure's severity, Cosmo appeared to be conscious, making the situation all the more heartrending.

I felt immediately that the trilostane had something to do with the seizure, since absolutely nothing else had changed in his treatment. I realized we faced a terrible choice — if we were able to get the seizure under control (a big if), we could stop giving Cosmo the trilostane, but then the Cushing's Syndrome would continue to worsen. On the other hand, if we kept Cosmo on the trilostane, we risked another horrible seizure, something I couldn't bear to think about, for Cosmo or for myself, either.

At 8:30, when my vet's office opened, I called her. Cosmo's seizure hadn't stopped. While she offered a couple of treatment options, like trying a different seizure medication, she felt that it made sense to consider putting Cosmo to sleep. But, of course, she left the decision to E. and me. We agonized for a while, then called and arranged to bring Cosmo to her office at 10:30 a.m.

Though I had always hoped Cosmo would live a long, healthy life and pass away painlessly in his sleep, during his last weeks I had faced the fact that if I wanted to prevent him from suffering, I might have to intervene and have him euthanized. I wondered how I would know if and when the time came. Despite Cosmo's worsening health, he still sometimes acted like his normal, adorable self. How could I choose to put him to sleep while he still had a reasonable quality of life?

But that was exactly the point. I didn't want Cosmo to suffer. I wanted him to die before his life lost all joy. As it was, I wasn't really sure whether or not Cosmo was in pain. A few years earlier, he'd had a terrible tooth abscess that was discovered during a routine dental cleaning. As far as I could tell, Cosmo hadn't been in any pain from the abscess, yet the dental vet told me it probably hurt him a great deal.
"Dogs are stoics," he said.

During the week before his death, I did have one indication that Cosmo was in pain. When holding him, I was always careful not to put pressure on his distended belly. Nevertheless, during that last week of his life, when I picked Cosmo up, he would sometimes breathe in with a catch in his throat and then emit a long sigh. He sounded sad, as if he were hurting.

In the end, the magnitude of Cosmo's final seizure made it clear that the time had come. I'm grateful that I was home when it occurred, so I could hold him and offer some small comfort to alleviate the terror he must have been feeling. I'm also grateful for the loving care he received from my vet. She sedated him so that he fell gently asleep in our arms, then took him from us to administer the fatal dose of barbiturate that would end his life.

Despite believing that we made the right decision at the right time, I nevertheless have experienced guilt in addition to grief. It's hard playing God. But I'm comforted by my conviction that Cosmo wouldn't blame me. He loved me unconditionally. An old New Yorker cartoon expresses my feelings perfectly — "Please God, help me be as good a person as my dog thinks I am."

Cosmo in better days


  1. Feel no guilt Barbara. Everything has to die in the end, and far better to help him go now, then to let him continue in sickness. There are things worse than death.

  2. I read that we make decisions 1/10 of a second before we know it... or before we "think it." You knew that this was the only way to relieve his suffering. That's enough. And you don't need any help being that person Cosmo thought you were. He knew.

    A heard a beautiful talk today about a monk who had been told by his teacher that the essence of meditation (in one word) was "spaciousness." That space that we are is really the same space that others are, as this moment is in the same space as that moment. Cosmo is here and there, in your heart, in your memory and, last but not least, in our space via your blog. Thanks!

  3. When we had to put our beloved cat Josephine to sleep after she had a stroke, we just couldn't figure out what to do with ourselves. My kids are 10 years apart in age, and nothing seemed right for both. It happened that "Fast, Cheap and Out of Control" was playing at the Film Forum--and it turned out to be the perfect way to be together on that day. If you haven't seen it, you might want to now ...