It’s true that I’ve never considered myself a deeply religious person. Yet I also fancy myself unusually tolerant of others’ beliefs. This past week’s case of a dying puppy, however, put this latter claim to the test. Here’s the story:
A litter of three foundling puppies arrived at the hospital six months ago. Two robust boys with one scrawny girl rounding out the bunch. Sickly though they all were in an upper-respiratory kind of way, the boys recovered nicely from their rough start. The little girl, however, required continuous respiratory treatments for over a month to make it past her severely depleted state.
They all went on to live in and around a clean, two-horse stable surrounded by a family of healthy cats. The owner declined vaccination based on their rough start (and, truth be told, because she has a penchant for homeopathic approaches anyway).
Last week all three fell ill again—this time with a nasty case of unrelenting diarrhea. The boys appeared to power through nicely with treatment. The girl faded and fell ill enough to hospitalize. Her bloodwork showed that her white blood cell count was negligible—estimated at less than 300 cells in her circulation (normal is more like five to fifteen thousand).
This seven month-old puppy’s diarrhea wasn’t even the worst of it. She began showing neurologic signs—a little head tremor, in her case.
By now, some of you might have guessed that she was suffering some overwhelming viral infection—distemper, anyone?
Spiraling out of control by the hour, the little girl finally devolved into a pathetic lump of a pup with a condition I couldn’t manage at all. Yet her owner was hell-bent on saving her in my makeshift ICU isolation unit (where there was no way I could care for her properly overnight) instead of at the specialist’s 24-hour facility.
This was when I finally begged her to let me euthanize her—to no avail. No, instead I was told that, “God would take care of her.”
But is it His will to let her suffer, I wonder?
Proof, yet again, that my boyfriend and I are cosmically linked in an animal sort of way, arrived in the guise of his own patient from the same day. His case, however, dealt with a surgically manageable malady—a generally 100% curable one. Yet the owners refused to operate based on their belief that, “God is the one who cures.”
OK, so WHY are you here, again?
Because we live in Miami (not exactly a hotbed of fundamental religiosity), vets here don’t often find themselves in this situation. We’re not frequently in a position to wonder how best to manage these extremely trying ethical dilemmas, though I’m sure vets elsewhere deal with this on a more regular basis.
Ultimately, my boyfriend’s not-to-treat scenario resolved itself when the clients had a change of heart and opted to save their dog’s life through surgery. This patient is now doing very well and is expected to make a complete recovery. Unfortunately, God took care of my case, too. She died overnight.
Try as I might to square this with my tolerant worldview, I truly can’t. Accepting a belief in the power of God to give and to take away in ways that allow for extremes of needless suffering is just not on my moral radar screen. Doing so would invalidate everything I’ve come to believe when it comes to why I practice veterinary medicine.
Of course, I feel tremendous guilt over this puppy’s terrible death. Should I have been more forceful with the owner? Not that she was conscious when I last looked in on her, but should I have sent her home so at least she wouldn’t have expired alone in a cold hospital?
These are the cases that keep me up at night. It’s times like these when I have great faith in my boyfriend’s credo: You do your best and then you go home and have a beer.
I’ve got to say, that’s the most tolerant religion I ever heard of. Sign me up for the Fellowship.
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This is the scenario that breaks my heart more than any other, a pet dying alone in a cage, and the avoidance of the owner to step up and stand by her dog to prevent suffering. How she could have claimed "God's will" is ludicrous. Obviously, she believed in veterinary medical care and not in pure "miracles" or the puppy wouldn't have been there in the first place.
You did your best to inform her of the reality of puppy's condition and suggested the best alternative, which was to let her go humanely.
As far as the fellowship of an occassional beer, well, that can be understandable as long as it doesn't become habit-forming!
Barbara A. Albright/New Hampshire October 14th, 2008 10:25:00 AM
A few years ago, my parish priest told us this story:
There was a man living in a coastal community who was deeply religious and trusted in God. TV and radio weather reports started bringing news of a major storm that was likely to hit the community, and said that evacuation might be necessary. The man said, "God will protect me."
The storm got closer, and authorities issued an evacuation order. The man refused to leave, saying, "God will protect me."
Buses came, to help evacuate people who didn't have their own transportation, and the driver asked the man to come with them. He refused. "God will protect me."
The streets flooded. The man had to retreat to the upper floor of his house. A boat came, with a rescue crew looking to evacuate anyone who'd been missed earlier. They asked the man to come with them. "God will protect me."
The waters rose higher, and he had to retreat to his roof. A helicopter came--"God will protect me."
The waters kept rising, and with nowhere else to retreat, the man drowned. He was a good man, if a tad stubborn, and he was soon within the Pearly Gates, where he took the first opportunity to confront God. "God, I was faithful to you all my life, and trusted in you. Why didn't you save me?"
And God replied, "I sent weather reports, evacuation orders, buses, boats, and helicopters. WHAT MORE DID YOU WANT ME TO DO?!
I'm glad the owners of your boyfriend's patient, at least, finally listened to the voice of God whispering in their ears. I'm sorry the owners of your patient couldn't quite manage to hear Him.
And no, you can't actually force them to listen if they're determined not to.
Lis October 14th, 2008 10:30:00 AM
Thanks, Lis. I just read Dr. Khuly's blog and was signing on to tell this very story, and you did it way better than I'd have been able to recall. I too am a big believer in religious tolerance (along with so many other kinds we seem to be abandoning lately), but it is impossible for me to understand this kind of attitude. If they truly believed it was all up to God, why did they bring the animal in in the first place? Clearly their concept of God's will, if not of His capacities, is somewhat fuzzy!
Seems to me this is one of those times you just have to remind yourself, as I so often do when looking upon all the suffering in the world, "I'm not in charge of this." Which I suppose, is exactly what your boyfriend's credo is saying.
Judy October 14th, 2008 10:54:00 AM
Well if G-d didn't want you to have to make choices, (s)he wouldn't have given you a brain capable of making those choices now would (s)he?
Invoking G-d's will is really a cop out (unless you are a member of a religion that believes this for human beings as well. Then its not a cop out just a bad belief).
Homeopathic remedies are fine as far as they go. But letting an animal die in pain when you have the ability to prevent suffering is not natural or saintly.
2CatMom October 14th, 2008 12:17:00 PM
Where I grew up, we learned early on that God helps those who help themselves.
Anything else is a cop out.
eli October 14th, 2008 12:18:00 PM
I think that in cases like this - where the pet owners obviously believe in seeking medical care rather than (or maybe in addition to) praying for a miracle cure - when they opt out of euthanasia or surgery they're probably really doing it for the same reason other pet owners do (cost, denial) but putting the blame on God. IMO it's reprehensible.
What about the other side of this coin? Medical practitioners (vets, doctors, pharmacists) who refuse to provide certain services because they claim those services conflict with their beliefs? I have heard of vets who wouldn't spay pregnant cats or dogs - even when feral, or when owned by someone who can't afford to raise a litter, and when it wouldn't be particularly risky for the mother - because they were so opposed to abortion.
To me, just like I think that the pet owner who is seeking medical advice shouldn't suddenly put the brakes on at a crucial point and "leave it up to God", I think that if someone wants to practice medicine or pharmacology they should be willing to adhere to medical ethical guidelines and leave their personal beliefs out of it. If they can't do that, then they should go into another line of work.
Barb October 14th, 2008 01:03:00 PM
Barb: Thank you for your comment! Looking at this in the reverse, of course this makes entire sense to do so. And to add to your spay comment, I recall when scheduling my last for a spay, about 7 yrs. old never-bred Sealy----the consent form did indeed spell out re: possible abortion/death of fetuses as a complication/side issue. And why shouldn't it? Unless the spay is performed pre-puberty at 2-4 mos of age (shudder!)
Barbara A. Albright/New Hampshire October 14th, 2008 01:21:00 PM
Although I haven't gone to church in years I consider myself a religous person...or at least a person of faith. And your story of owners not helping that puppy is awful. God gave us a will and the ability to make decisions. You mention about the puppy passing in a cold hospital and as an owner I would want the hospital to call me so I could be with my friend in his last hours - either at the hospital or at home. The person that should feel guilty is the owner....for not caring to spend time with the puppy during her last hours, for not letting her pass gracefully, and perhaps for not giving them their basic puppy vaccinations (not know whether they were still comprimised or not).
Jenny October 14th, 2008 01:22:00 PM
My basic math has always gone something like this:
1. By definition, God (if he exists in the way most monotheistic religions want us to believe) must be both Good and Omnipotent.
2. Living in the world, however, seeing so much unjustified, senseless suffering of harmless and helpless beings (both human and non), as well as the prosperity of the unjust and cruel, I must conclude that if there is a God . . .
He (it) is either NOT all-powerful,
OR
He (it) is NOT good
Therefore, he/it is not God.
That statement "God helps those who help themselves" doesn't seem quite fair when the "self" we are talking about is a baby born with severe congenital heart defects, causing him to live 2 miserable poorly oxegenated years involving painful surgeries, repeated hospitalizations, life attached to an oxygen tank, and then death at 2 1/2. It doesn't work so well when you talk about women living in cultures where they are totally dominated and can't help themselves.
It doesn't work for little sick kitties who are at our mercy, either.
I see compassionate humans everywhere. As for God, that's a different story.
Stefani October 14th, 2008 01:32:00 PM
I once had an owner refuse to spay her dog because "that's how God made her."
I reminded her that God made mammary and ovarian cancer, too.
beth October 14th, 2008 01:41:00 PM
Regarding Barb's remark about spaying pregnant animals (which I do by the way) I think the individual Veterinarian's beliefs and values should be respected. We use these every day when we either accept or decline to do ear cropping, declaws, tail docks, or convenience euthanasia.
Hobson October 14th, 2008 04:20:00 PM
Beth you comment reminded me of one of the strangest conversations I've had with a member of the public at a pet adoption event. These were perfectly healthy, well behaved shelter pets who were at risk of euthanasia simply for being homeless, so we could not have had before us a more concrete reminder of how human decisions, both wise and careless, determine life or death for our animals.
A man asked about adopting an intact dog and upon being told they would all be spayed or neutered prior to going to new homes, he told me that it was interference with God's creation and he was against it. I responded that thousands of dogs were being killed because there were already so many unwanted pets, and he said - I am not making this up - "isn't that better than their never being born at all?"
Anne October 14th, 2008 04:25:00 PM
Beth: I've actually heard the one about "God making her that way," though usually it's in the masculine. Rest assured, I'll be employing a version of your slightly snippy rejoinder the next time I hear it.
Dr. Patty Khuly October 14th, 2008 05:39:00 PM
What a great post, Dr. Khuly. And a version of this topic would make a great column for your colleagues who read the veterinary trade magazines.
In practice as a technician I've been presented with clients who use religion in making medical decisions. Even for the most diplomatic person it can take you off guard, and I often found myself without a diplomatic response. How do you argue with someone's god?
It also reminds me of the Rainbow Bridge books that were very popular when I was in practice, but I often got the opposite response. I would offer one of those books to every owner faced with their pet's euthanasia. I intended to offer comfort, but found that many people were seriously offended by my book offering. The Rainbow Bridge, an interpretation of a heaven for pets, was offensive to those without religion. Can't win 'em all.
Somyr October 14th, 2008 06:09:00 PM
I am not religious. At all. And I admit to not being overwhelmingly tolerant or understanding of these kinds of views when they're used as an excuse for allowing an animal to suffer. God provided you with the means to give your pet either the treatment s/he needs or the relief for suffering s/he deserves. Use it.
Part of my intolerance doubtless comes from dealing with so many Amish/Mennonite puppymillers who use the line that God gave man dominion over animals as an excuse for their deplorable breeding operations. God also gave us the abilities to be both ethical and humane. So many of those millers are neither.
katie October 14th, 2008 08:45:00 PM
sigh. kinda like the story i heard about a jehovah's witness mom dying the day she gave birth to her third child b/c she hemorraged and refused life-saving blood products. no one has been able to explain why that religion believes it is preferable to die than be transfused. i believe that the not all powerful god wants us to accept the help of modern medicine.
Sarah October 14th, 2008 09:53:00 PM
I want to give a resounding "Amen" to your boyfriend's credo. You do the best you can, then yo go home and have a beer. He's a genius.
kate7047 October 14th, 2008 10:16:00 PM
You did everything you could. God, higher power, universal spirit or whatever anyone want to call it, gave us brains with the ability to reason. The owners were so entrenched with God will take care of everything, they gave away their ability to reason - the man on the roof story tells it all. You could have talked all night and they would not have changed their minds.
Maybe you should rig a sound system where you hit a secret button and a booming voice announces, male of course, "Put this suffering animal in the hands of thou healer."
Of course we all know that God spelled backwards is Dog.
Keep up the good work, Dr. Khuly.
Karen October 15th, 2008 07:31:00 AM
Somyr: We're so on the same wavelength. I was thinking of submitting a longer, more vet-centric version of this post for Vet Practice News.
Dr. Patty Khuly October 15th, 2008 08:59:00 AM
"That statement "God helps those who help themselves" doesn't seem quite fair when the "self" we are talking about is a baby born with severe congenital heart defects, causing him to live 2 miserable poorly oxegenated years involving painful surgeries, repeated hospitalizations, life attached to an oxygen tank, and then death at 2 1/2. It doesn't work so well when you talk about women living in cultures where they are totally dominated and can't help themselves.
It doesn't work for little sick kitties who are at our mercy, either. "
"God helps those who help themselves" isn't intended to leave the helpless on their own. It's intended to express such wild 'n' crazy ideas as, "You don't turn down needed medical help when it's available," or "You don't _ignore_ the weather reports, evacuation orders, and assorted rescue vehicles, because you believe 'God will provide.' " Those things _are_ "God providing."
And the parents/guardians/responsible adults of those not able to avail themselves of such help, whether children, pets, or no-longer-capable sick or aged adults, have a responsibility to do it _for_ them.
Lis October 15th, 2008 11:11:00 AM
Somyr- as an atheist, and with my dog Julie dying just last month, I can see where there those people are coming from.
Actually, I grow up in a very religious home, so I can see both sides of the fence :)
After Julie died, some people sent me the "The Rainbow Bridge". No, I was not offended as I know that they where meaning well. But I didn't find it comforting either- it felt more childish than anything else (am I offending someone here?)
I'm very glad that my vets didn't invoke god or "The Rainbow Bridge". Instead, they did the most helpful thing I think they could have done:
We sat next to Julie, both the vet and I petting her still warm body, and we talked about Julie, I cried, and he talked both about Julie and his own dog that died some years ago.
IMO, that very real human connection over a dead pet was much more comforting than any poem can be, heaven or not.
But perhaps that is just me.
Xslf October 15th, 2008 01:22:00 PM
Xslf: I too could see where pet owners like yourself were coming from, so I became a bit more savvy about handling euthanasias by following the owner's lead. It makes for a better experience that way.
Somyr October 15th, 2008 03:02:00 PM
Shortly after my dog was diagnosed with cancer and I made the decision not to treat it, I sent out an email to a bunch of friends explaining that we'd have some changes going on in our lives. I specifically said that my dog was not a fan of the Rainbow Bridge and that she was looking for more a canine Valhalla model where she could hunt (and kill, as desired) all day, then lounge around on comfortable furniture being pampered all night. When she passed, I think all those people remembered -- not one copy of the Rainbow Bridge story came to me.
kabbage October 16th, 2008 12:47:00 AM
kabbage: Valhalla? Interesting. And sweet. Nice to see you back, btw.
Dr. Patty Khuly October 16th, 2008 09:35:00 AM
My well-loved previous vet had a policy for many years that at closing time all sick animals either went home to return first thing in the morning or went to the (near-by) emergency vet for the night, likewise to return first thing in the morning. I think it really is the optimal solution. Either the animal is well enough to go home to a situation where they can be cared for by their families and relax in a familiar atmosphere or they need veterinary supervision. At one time I spent a couple of weeks shuttling my cat complete with a port in his front paw back and forth, but he sure loved coming home at night, even if all he did was curl up in his favorite spot and sleep. And when he died, it was at home at night with me not alone at a vets office.
Juli October 19th, 2008 04:15:00 PM
Juli, Thank you for your comment. You had a compassionate vet & you are too.
As far as receiving a card or the rainbow bridge poem, I look at the thought behind the ackowledgment or sentiments. I would never take a well meaning card as offensive, whether I held a certain belief or not.
When my Mom passed, the Protestant pastor was unavailable, a Catholic priest came in for prayers, we were grateful and by far not offended, though none of us are of the Catholic faith, nor hold the rituals or same prayers. We would have been just as appreciative had a rabbi or any other spiritual denomination come in for prayer.
Barbara A. Albright/New Hampshire October 19th, 2008 04:55:00 PM
I can understand the dilemma for those that are practicing veterinary medicine, but people bring with them all sorts of reasons for their choices. Last year my dog suddenly became ill. She was vomiting and could not stand. She was suffering from respitory distress, fluctuations in her blood pressure, and an erratic heartbeat. I rushed her to my local vet who had no idea what was wrong. I then took her to an ICU with 24 hour care including a veterinarian there at all times that is considered state of the art with the best specialist in my area. I had never been to this place before as my dog had never been ill. I spent almost 3,000 for diagnostics that day and the conclusion was probably cancer, but it could not be confirmed without explorartory surgery. I was advised that my dog might not survive explorartory surgery and even if she did the prognosis was poor. I was strongly encouraged to consider euthanasia, but opted to continue to supportive care through the night. The next morning at 6am the vet at the speciality hospital called and said my dog stood up barked to go out and then ate. I brought her home that day and she is still here with me. She did not have cancer. For those of us that have experienced a miracle, its hard not to believe in them. I am really glad my dog's doctors were willing to giving me some time and admit they were wrong.
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