We have become better at helping our pets live.
We have not become equally good at letting them go.
As a veterinary internist for more than thirty-five years, I’ve helped thousands of people make one of the hardest decisions they’ll ever face: when to stop treating and let a beloved animal die.
Surprisingly, that decision has become more difficult.
Not because veterinary medicine has failed us. Quite the opposite. It has succeeded.
Forty years ago, the human-animal bond existed, but it didn’t even have a name. Today, our pets sleep in our beds, accompany us on vacations, they have insurance policies and, increasingly, occupy a place in our emotional lives that was once reserved almost exclusively for other people.
I don’t think our relationship with animals changed in isolation. It changed because our world changed. We became busier. More isolated. Less certain. In a chaotic world, our animals became a refuge. Every national tragedy seemed to drive us home—to the people and animals who loved us unconditionally. When I read the headlines, I hug our cat, Tommy. When I watch the evening news, I take Gracie and Eliza for a walk. I suspect I’m not alone. Nothing seems to abate stress more than to bury one’s face in a warm flank of fur. Everything is going to be all right.
My attachment to animals began early. I must have had every possible pet one can have in a New York City apartment—hamsters, rats, guinea pigs (I bred them), and when my mother developed allergies, lizards and snakes.
My second weekend in my dorm room, I got my first cat. Cats weren’t allowed in the dorms. I named her Aquarium Fish. I could talk about “Fish” all I wanted; the supervisors never suspected I meant a cat.
Fish and I spent many evenings studying Boolean Algebra together. I read it out loud to her to try to make sense of it. I don’t think either of us ever understood it. Today we say that talking with open-ended questions with your partner and pets is a good thing. It helps relationships. It tightens the bond. Maybe Boolean Algebra, not so much.
I have known countless clients who have sheepishly admitted that losing their pet was harder than losing a parent, sibling or friend. They often feel guilty saying it.
I understand why.
Our animals are with us constantly. They share our homes, our beds (I cuddled with our standard poodle just this morning), our routines. We cook for them. We talk to them. We worry about them. And they come without any of the baggage that accompanies human relationships. They don’t judge us. They don’t hold grudges. Their love is pure love.
And we are responsible for them.
That responsibility is part of the bond—and eventually, part of the burden.
Because veterinary medicine has changed dramatically, too. When I began practicing, there were things we simply couldn’t do. Today, I can stand in an examination room and offer endoscopy, ultrasound, CT, MRI, advanced blood testing, sophisticated surgery and treatments for diseases that once meant certain death. We can put some cancers into remission. We can control seizures. We can manage pain. We can treat kidney and liver failure. We can replace joints and remove cataracts.
There is enormous joy in being able to help and save a life.
These options all come with a cost, an ever-increasing cost—which further increases the stakes and expense of ownership. And the bond.
But every new possibility creates another question:
How much longer should we keep going?
And that question became personal for me with Christopher.
Christopher was my first dog—a magnificent Great Dane who weighed more than I did. I adopted him the moment I could have a dog. I still had Fish.
By the way, I’m short.
He was silly, sweet, lovable and endlessly affectionate. Everyone loved him, and he loved everyone. He would come barreling toward a person with his wonderfully ridiculous gait, then stop inches before knocking them over—as if remembering at the last possible second that he weighed more than most adults.
With me, he would lope up and place his enormous paws on my shoulders and lick my face. We could have waltzed. Okay, maybe not.
He was my shadow through veterinary school, internship and residency.
He was also the kind of dog who understood people. If a child saw his size and began to cry, Christopher would lower himself onto all fours and slowly creep toward the child, his huge dark eyes asking a simple question:
Pet me?
He could rest his enormous head on the dinner table and silently track every forkful of food, a thin strand of hopeful drool hanging from the corner of his mouth. Like most dogs, forever hopeful.
I studied for hours with that enormous head resting on my lap. Heaven.
But even a veterinarian cannot protect his own pet from the things he spends his career treating.
Christopher developed dilated cardiomyopathy at nine. By ten, he had already far exceeded his prognosis.
Then, one night, his stomach twisted. This was before the advent of prophylactic gastropexy.
I knew immediately what happened.
Technically, Christopher had already lived longer than the time we had been given. But he had not exceeded “our” time together.
My roommate was the surgeon on call—convenient, I know—and we decided to operate.
I rationalized the decision. I said this will not be painful for him. I will be there after for him to use my lap as a pillow. I was. He was not.
His heart was too sick. Despite everything we did, his post-op condition deteriorated. And my lap could not cure him.
He looked at me with those enormous, beseeching brown eyes. I could hardly see him through the salty water streaming down my face. He would fight as long as I asked him to fight.
The criticalist looked at me. She didn’t have to say much. Christopher was out of options. I knew what that meant.
Christopher did not.
His eyes seemed to ask me, now what? I had to be the one to answer.
I don’t know exactly why. Maybe because he trusted me to always do what was best for him. And now, what was the best thing for him. Not me.
With trembling hands and an agonized heart, it took everything I could to push that plunger till he relaxed into heaven. And I fell into sorrow. And longing. And knowing.
I knew I had done the right thing. I also knew I had pushed too hard—about six hours too long. And I also knew that I put him through a major surgery. For me there was no option, and I would even go so far as to say that for Christopher too, there was none. He would have wanted to try. I should have known better.
Would I make the same decision today? Probably not.
But I also know that I could not not have tried.
I learned something from him that I have carried throughout my career: Love, like tears, can cloud your judgment. Sometimes love makes us want to do everything. Sometimes love requires us to stop.
And sometimes, when we are the ones who love the animal, we are the least qualified people to decide when that moment has arrived. That is why I tell people to seek help. Ask your veterinarian. Ask a hospice veterinarian. Talk to the veterinary technician. Ask someone who can look at the situation with a little more objectivity than you can.
Because you will be looking at the face of the being you love. You will be thinking about all the good days you have had. You will be remembering your favorite moments you shared. And you will be thinking: Surely there is one more thing we can try.
There often is. That is the problem. The more medicine can do, the more we wish.
Years later, I learned this lesson with Murphy, a perfect Standard Poodle and my husband’s first dog.
One day I felt his lymph nodes—actually, every day I felt his lymph nodes, the benefits and perils of belonging to an internist—it just happened that one day they suddenly got larger and I knew what the next months held.
We agreed we would treat him as long as he tolerated chemotherapy and was not suffering. We agreed there would be no heroics.
It wasn’t me, it was my husband who said enough. And thank heavens. He was the one who desperately tried to get him to eat while I was at work. We fought and failed to keep weight on him. The day we euthanized him, which graciously went well, I vomited because I knew I had procrastinated. My husband had been right—for Murphy’s sake it should have happened sooner. I had allowed my hope—and perhaps my profession—to get in the way of what I already knew.
That experience changed something fundamental in the way I practiced medicine. When I graduated, my job seemed simple: cure disease. Keep patients alive. Somewhere along the way, I realized I had the wrong patient. I wasn’t treating the dog or the cat. I was treating the relationship between the dog and the person who loved him. That relationship became sacred to me.
My job was not simply to maximize the length of my patient’s life. It was to maximize the quality of that life—and to protect the bond that made that life meaningful.
I was treating a family member who could not speak in words, but who communicated constantly if you knew how to listen.
And I was treating the owner, too.
I wanted the animal to leave treatment still trusting the person who loved them. And above all, I had to be absolutely certain that at the end of the day or at the end of the treatment, that pet still loved and trusted its owner. That their relationship remained integral.
I didn’t want the cat hiding under the bed because every interaction had become a battle over medication. Thank heavens there are systems now for facilitating giving meds.
I didn’t want the dog to spend its final days undergoing procedures simply because there was one more test we could run to find out…
And most of all, I didn’t want an owner to look back and say, “I waited too long.”
I have heard those words many times when clients speak of past experiences. I have said them myself. The tragedy is that our pets cannot make the decision for us. We have to make it on their behalf because they will hold on for us. And because we love them so deeply, we often confuse keeping them alive with doing what is best for them.
So what have I learned?
First, don’t wait for your pet to tell you they are ready. They may never tell you. Animals are remarkably stoic, and they often hide pain until they simply can’t.
Second, pay attention to appetite. Most animals love to eat. When that changes significantly, pay attention.
Third, keep a tangible quality-of-life calendar. Each night, give your pet a number from one to ten. There are several online charts that make this objective; I try to keep it more simple. Ten is a wonderful day. One is a terrible one. Write it down. Look at the trend. If the number keeps falling, you are approaching a decision. Because, likely, the trend does not reverse.
And fourth, look into their eyes. This is the test I failed with Christopher.
Ask them how they feel. And then be willing to hear the answer.
The hardest lesson is also the simplest: Don’t wait too long.
We tend to imagine death as a peaceful moment that arrives when an animal simply closes its eyes and drifts away. Sometimes it does. Often it doesn’t. There may be pain, anxiety, vomiting, seizures, difficulty breathing, loss of bladder or bowel control. Death is rarely pretty. But we can make the end less frightening.
We can choose to prevent suffering rather than wait for it. We can ask for help. We can make the decision before a crisis forces it upon us. And then we can grieve.
Our grief should never be guilt. It should be evidence of our love for them.
For most of human history, pet loss was treated as a private matter. There are few rituals for it. Few traditions. Few socially accepted ways to say, “I am devastated because my dog died.”
Our relationships with animals are worthy of mourning.
They are worthy of remembrance.
They are worthy of ritual.
A friend’s final wish was to have the ashes of her three English Setters scattered over the Pacific Ocean. She had saved their ashes, as so many of us do. It took me three years to finally do it.
I can’t fully explain why I did. I just knew it was the right thing to do. Perhaps because those dogs had mattered. And perhaps because when someone loves an animal that deeply, the relationship deserves to be honored.
I have had the extraordinary privilege of seeing, up close, what animals do for us. They make us laugh. They comfort us. They teach us patience. They give us routine and purpose. They sit beside us when we’re sick. And they love us without asking us to become someone else first.
I have spent my career caring for them. Now, as a playwright, I have begun trying to honor the bond itself—to explore what animals give us and what we owe them in return. Perhaps that is the real bargain we make when we bring an animal into our lives.
We agree to love them. We agree to care for them. And eventually, we agree to let them go.
It is a terrible bargain. It is also one I would make again.
And again.
If I looked at it as a Boolean algebra equation, I suppose the answer would be obvious. I would do it all again. That’s logic.
But anyone who has ever loved an animal knows that logic has very little to do with it.
I ask how I’ll be with Gracie, Eliza or Tommy. With everything I learned. With everything I know. How will I be?
I don’t know.