It Bleeds Without Stopping (The Heart)
I am the person whose job it is to hold the dogs as they die. You take one arm under the mid-abdomen and the other wrapped around the neck, wrist turned out so that if the animal is to jerk their head to bite they will only reach you, not the doctor. Then you pull them towards you and lean all your body weight into their shaking frame. It will look like a hug.
I learned my first week that you must control your heart rate when you are doing this. The last thing an animal will feel when being euthanized is the steady beat of your heart coinciding with theirs. The average BPM for a dog over 50 pounds is the same as a person's. If you are tachycardic with nerves, they will begin to yelp and struggle. This will raise both your heart rates and those of everyone else in the room. You owe it to the animal, if nothing else, this final calmness, an apology of slow and deliberate deception. It is a debt you are pre-paying, a default on the karmic loan you have taken out for choosing to be here, so close to it all that you couldn't look away if you tried. Your heart tells them: It is alright. You are safe here in my arms. Minutes later, they are dead.
But for the owners watching on, my calmness is a gift. The polite clip of pre-filled-out paperwork, the deeper sympathy to my smile, these acts come from somewhere. We have three options for condolence cards and I will choose the more expensive one, with the real-glitter rainbow bridge on the front, if you are nice or especially pitiable. Or if your cat looked like mine. Nobody really wants to acknowledge that the crux of medicine is judgment. But it is true. Beyond all else, the day to day job of a veterinary assistant is to judge. If an animal needs emergency or urgent treatment over a panicked phone call relay, if the frothing bull terrier with harness marks from pulling away from his owner can be approached for P.E. without a muzzle, if the doctor really needs a third bladder-stone-blocked cat in her schedule on a Wednesday night even if that client has been coming here forever without means to afford elsewhere.
These decisions are sometimes life and death. Sometimes they are of convenience. And sometimes they spring from personal grudges. We want so badly to believe that medicine is an objective field. People are fallible, quirky, flawed, and diverse. So often we learn in the most painful ways how they will disappoint us. Thus a doctor is a concept first and a person second. This allows us the room to have our emotions. To scream at the doctor how life is not fair and Harry should have had more years to frolic in the grass. To grab the tech's wrist because Furbuzz jumped at the cold injection of sedative. You couldn't do that if they were people.
A client came in with a two year old black Labrador retriever. He was rambunctious, not house-trained, and chewing up the carpets. They'd taken him to a behaviorist, a urologist, multiple trainers, but nothing had worked and they wanted to put him down. Our doctor refused. He was only two years old. He wasn't aggressive. He was wagging his tail so happy to be here while the client scrolled their Instagram. His life was begged for, bargained on behalf of, and they still said no. The client was certain they wanted it over with. But in the end, it's the doctor's call. She told them she wouldn't do it and we sent them away to a different hospital, spending the rest of our day sniping comments to each other in the back about their audacity to commit to killing a perfectly healthy young dog. We got an email two weeks later from the hospital down the road telling us the pup had been euthanized. The owner had denied the option of surrendering him to a shelter. All our staff usually sign the condolence card before sending it off to a client. Barely anybody signed that one. I do not remember if our doctor relented to protocol and signed it, but I know she was angry.
There are the choices of the clients and of the doctors, but the core of any veterinary hospital euthanasia process is the techs and assistants. Although we don't make the decision itself, if your pet has been coming in a lot recently: going downhill with something complicated or just being OAS (Old As Shit), or if you've ever scheduled what we call a QOL (Quality of Life) discussion, then most certainly the techs in the back have already decided on whether or not they believe your pet should have been euthed by now and are gossiping about it between half-skipped lunches sprawled on the radiograph table because if you eat back in the break room, you could miss the next emergency.
I think this is a horrifying thing to most people, to realize that we talk about you as clients after you're gone. Sure, a lot of it is discussing how cute your dog is. Most of it is discussing how cute your dog is. But I need you to know that we also are talking about how much of a raging asshole you are for letting your terminal cancer beagle shrivel away for 5 months before coming in for PTS (Put To Sleep). For insisting "no, Tiptoe doesn't bite, he's so good" regarding your non-rabies-vaxxed cat with a death glare in its eyes. It is important to me that you know this is not a judgment-free zone. The responsibility of the pet owner includes civility. Right up until the end. We will always try to meet you with kindness. We beyond all others know how hard it is to lose your animal. But you need to control your heartbeat. Your dog can hear it across the room too. You need to do this for them as it is the only thing you can do.
My co-worker Sarah, the smartest woman and best tech I know, cries herself to sleep every time we euthanize a cat. She loves cats. She is not cut out for this line of work. But she did show me something important when I had just started: "See this stack of blankets? These are the ones you lay down on the exam table before PTS. You always make sure there is a blanket down before the client comes into the room. Choose a nice one. It matters to them." So I do.
Here's exactly what happens when we put an animal to sleep. You've filled out the paperwork and waited in the exam room. I take the Beuth AKA Beuthasol AKA "pink juice" AKA euthanasia-solution from the controlled drug cabinet and log how much gets drawn into a syringe. Always take more than you think you are going to need. There could be nothing worse than not taking enough. Besides that, I dilute it 50/50 with tap water. The color of the solution diluted is beautiful. I would paint a room that shade of rose. The doctor draws up the sedative and I hand her the pink juice.
I go in ahead and position your pup on the table. I hug them close, smelling the dog-scent, and the doctor gives them a sedative into the musculature of their hindquarters. The end procedure is explained to you while the dog begins to sag in my arms. They get limp and I extend a front leg, my hand just behind the equivalent elbow joint. We do not use tourniquets in veterinary medicine. We use our own hands to hold off, mainly the thumb rolled across the cephalic vein and pushed down to create pressure and give the doctor a clear entry point. The doctor will warn you before she does it. Oftentimes people will look away, pinned down to the chair in the furthest corner of the room as if they could hide from it. I watch their pets looking for them. Less often, the client will be there right by the table, caressing the head, stroking the fur, bumping into me. I never mind that. The Beuth stings, which is why we dilute it, almost like an apology.
When the doctor is finished with the injection, she will indicate for me to put my finger down where her needle is sliding out. We often forgo bandages in the veterinary world. Many patients won't sit still or tolerate them so when doing routine pokes such as for blood work or medication injection, the tech will put their finger down and apply direct pressure to prevent bleeding. There are so few barriers in this field between you and the animal. I used to be afraid of pressing down when doing euthanasias. I had a terrible anxiety that while putting my finger directly where the syringe would exit, the doctor would jerk or the patient would move, and I'd be stuck through my skin with a second-hand death. Or to a lesser degree, that simply by having my thumb over where the injection had occurred, that somehow, through some imperceptible cut or imperfect dermatological pore, I would encounter Beuthasol in my own system and drop dead myself. A bleed-over of mortality.
Then, the stethoscope confirmation. The doctor exits. I leave you to your grief. We give people as long as they need.
When you leave, I will have laid out the purple plastic bag, which comes in two sizes: smaller than a pillow or larger than a pillow, a sticky bingo blotter, medical tape, a stapler only used for this purpose, and a condolence card in advance on the dental table. If it isn't busy I'll process your pet in the room where they died. If it is busy and the exam room is needed, I'll move my co-worker's salads and do it on the x-ray table. Finding the small detail clippers is always a chore but once I have them, I will shave the fur between your dog's cold toes and aggressively blot black bingo ink onto the paw pad. Our blotter is sort of broken so it sucks to do this, but the end result, a pretty black paw print on the inside center of your condolence card, is worth it. Then, I shimmy your pet halfway into the purple bag and pull all the way so that they slide fully in. There will be a little poop from the dog on the bag. It is borderline omnipresent here. I tie and tape the end and then staple the appropriate paperwork to the side of the plastic. I lift your pet the same way I carry too many groceries and waddle into the back to deposit them into the very large freezer.
They will wait maybe a few days to up to a week until the crematory service comes to pick them up. We always give our crematory truck driver a cookie if we have them out on the pharmacy desk when he swings by. He's a nice dude but we always make him come through the back. Then, when your pet's ashes return to us in a few weeks, we'll give you a call and present them to you with two hands. The sales representative for the crematory service we use, who bought us all chicken parm for lunch one day, told the techs "never hold a cremains bag with one hand. Always use two. You're not shopping at the T.J. Maxx." So I do.
But I guess I forgot one thing. Sometimes people bring their own blankets, their own special towels, or sometimes the dog's full bed with them for the euthanasia. It brings a new meaning to the phrase "put to sleep". I forgot to tell you that we ask if you are going to want it back before you leave. Most people say no. They surrender it to us, not willing to hold it again and see the fur but no dog, to wash it in their own machine and lose the scent of their love unreplenishable. So we keep the blankets. We wash them, put them in a stack, and sometimes they are used to birth kittens or warm up a shivering pup after successful surgery. But most often they are used for euthanasia. And I remember who came in with each one and what their good-bye looked like.
So when a stray cat comes in with no one to his name but the old lady who's been feeding him but can't afford it anymore, or the emaciated bulldog whose owner is on a vacation in the Bahamas and made the babysitter take him in alone, I choose carefully. I make a judgement call in finding the pink Sleeping Beauty blanket from the family who crowded in eight whole people into the tiny exam room to all say goodbye to their bloated, geriatric chihuahua Bingo, or the pale green towel from the father who howled like his own heart was stopping when his gorgeous old hunting dog Mollie had to go. I take the blankets with the most love in them and I lay them down, smoothing out all the wrinkles. I was never told to, but I have to do it like this. I am very good at my job and so I have to believe that the love will bleed over.