Remember when I got lost in the mountains? How you sat down in the snow and wouldn’t budge? You were always so willing to go anywhere with me; so, trusting, but not at that panicky moment, dusk coming on.
Did I shout at you? Bark commands? If so, I apologize. Thank the Mountain God, you finally won out, leading me through gathering shadows to the trailhead parking lot.
I hope you didn’t suffer. The vet gave you two hours to live, tops, with that tumor. I’m sorry. 14 years, man. I’ll be keeping you with me; no worries about that.
Here you are with Snowpea. What love. Mochi (2008-2022)
I began this letter when I knew we were in the final ten days of your life. Now, as I work to complete it, we have mere hours left, and as I read it aloud – minutes.
Your entry into this world should have cued us to the journey you would take us on. You were born January 1, 2020, ushering in a transformative year that has drastically altered life as we know it. You came home March 2020. As we drove to pick you up less than 2 years ago, Maggie told me: “you have to love her even if she’s not cute,” and I promised that I would, although I did not yet know what it would entail. Luckily for me, you were beyond adorable, although I am not sure it would have mattered. Once you ran towards us (and then away from us and into the cow pasture), everything changed for me completely. You introduced me to a love I had never experienced and helped me unlock a gentle tenderness within myself that I did not know existed. You challenged my patience and tested my commitment and resolve for two years, but you rewarded me with incredible love and an unbreakable bond. I have scarcely ever felt more connected to another being, identifying your needs and desires without words, and understanding and anticipating your reactions to the world. I have always felt like our souls are inextricably connected. You have kept me laughing, kept me guessing, and even on my worst days, you have kept me going.
You have not been an easy dog by any means. You passed unexpected milestones, learning tricks like waking up all your roommates by rattling the doorknob at 6 in the morning, honking the actual car horn because we left you in there (with the heat on and car running), performing a high lateral jump onto the kitchen counters (from the ground!) to get involved in the breakfast sandwich situation, chewing through an actual wire crate to make a hole in the drywall at your school (hello, you were ahead of your time on the expansion project!) and conning your moms into roasting you a whole ass chicken for broth because supply chain shortages left the shelves bare of the kinds without garlic and onion. But your persistent behavioral challenges introduced us to an amazing community of people who gave us the tools and support to communicate better with you and reminded us to loosen up and have fun with you too. Your attendance at school introduced us to a neighborhood that we loved and prompted us to buy our first home together in the same place.
Bow, you have been a catalyst for us. While Maggie and I have loved each other for years, you turned us into a family, two adults dedicated to the care of one (complicated) being – prompting the additions of a car, house, and sweet little Cubby. You helped our little family find a community. While some dogs give that love back in an obvious, tail wagging, licking your face manner, your reciprocation was more subtle (except any time when we came back from leaving you at home). Your gentle resting of your head on our legs while snuggled up on the couch, your bouncy steps on our walks and adventures, and your ability to just be still and completely relaxed with us at home when you struggled to exist in so many places out in the world were the bountiful rewards that accompanied loving you.
Bow, we have always said that you would leave people wanting more. This was part of your charm – you scarcely accepted pets from people outside of a small circle, and your signature greeting to houseguests was to jump up, tap them on the behind, and run away. You gave us snuggles and so much love, but always on your own terms. It took a long time for you to warm up to anyone. Somehow you still made *many* friends – or at least you helped us initiate most of the friendships we have cultivated in the past
two years. Your very colorful personality always kept people guessing. It fits in in some ways, that we are losing you after such a brief life – we always imagined that you would stay with us for the next decade, and yet here we are, mourning the time we wanted and did not have with you. But maybe you lived so much, you loved so hard, your flair for the dramatic burned so bright, and you transformed our lives so dramatically in your two short years that your work here in the earthly realm was done – and you had to choose a tragic, novel way to go, befitting of the life you led. Or maybe life is just cruel and unfair, and this is a bout of terrible luck. Either way, although your time in your body is ending, we will love you tremendously for rest of our lives. We will be forever grateful to you for upending our lives and teaching us how to love when love is difficult, painful, and challenging. Love grows where our Bowbina goes, and thank you for changing everything, sweet girl.
The gifted Dr. Becky helped us say goodbye to this incredibly sweet 16-year-old girl, putting her to sleep in the most peaceful way imaginable here at home.As my partner Joaquim always said, Madi was so respectful and polite. She checked all the cat boxes – she was a fierce huntress, a carnivore who came running at the sound of Jo sharpening his Chef’s knives in hopes that he’d share some meat, which he always did. She was a lap cat when it suited her, a foot-warmer and extra floofy pillow on our bed in the fall, winter and spring. She took over our new apartment as fully her territory, finally putting her rival Toby (our blind cat) in his place, and had probably the most contented year of her life this year until illness started to rob her of her spirit. She was the loudest cat I can remember having, always speaking to us with her “prowrs,” a raspy mix of purr and meow that resounded through the house. She liked to meow at every single pat and rub, and we were constantly petting her, so that was a lot of “prowrs”! She was only with us for the last 5 years of her life but I know with every fiber of my being that she was transformed by that time, and so, so happy with us. She thanked us every day for our love by reflecting it back to us a hundred times over. We will miss her forever. Goodbye Miss Madi, Madi Girl, Madi Love, Miss Madi from Cincinnati (our 4 year old and my mom’s recent nickname for her).
Six years ago AC&C opened our doors, metaphorically speaking, and saw our first patient. Since then, things have changed in so many ways – for this practice, for me, and – especially in the past year – for the world.
This past year has seen so many challenges for all of us, as families, as caregivers, and as veterinarians. It was a year ago today that the American Veterinary Medical Association released guidelines that we should cease seeing all but the most urgent cases. Those guidelines have since been walked back, but for several months I was afraid that I wouldn’t be able to help my clients, and that house call medicine wouldn’t be able to survive.
But my clients and my colleagues are creative, wise, and compassionate, and the crises we’ve faced have given rise to so much ingenuity and collaboration. We’ve adapted in ways that I never would have imagined – telemedicine, borrowing empty apartments, even moving favorite chairs out onto back porches so a pet can still pass peacefully in his favorite seat while keeping the family safe.
Every year I try to find a way to improve and grow as as a doctor, to find new ways to help my patients and clients. In past years this has taken the shape of certification in hospice medicine, or training in Western herbal medicine. This past year, it was learning how to navigate a pandemic and continue to provide care while keeping families safe.
I have no idea what this coming year will bring, but I know that with the help of my amazing clients and the veterinary field in general, it will be better, and I will be both grateful and lucky to be part of it. May this year be better for all of you, as well.
One of the most important facets of having end-of-life care happen outside of the veterinary office, for me, is the ability to make that passing special for both the pet and the family. Ritual and ceremony are incredibly important to us, and creating a personal, unique event to honor the passing of a family member can be both a comfort and a cultural touchstone.
Often, people aren’t sure quite how to do this for a belovet pet – our culture doesn’t have a framework for the passing of a pet, as it does for other humans. There are so many ways to create something unique to yourself and your family, though. Sometimes this can be as simple as reading a favorite poem or saying a prayer; other times I’ve attended parties or sat in as families shared honored memories at a passing. Recently I was honored to be present at one of the most beautiful passings I’ve ever attended, though, and I’m going to share her story there for anyone wondering how to create a special last day and farewell.
Bella started out the day with her favorite meal….
Then she got to go for a drive around the city.
When she got home, she was allowed to share a piece of chocolate (a stolen treat when she was a puppy!)
A toast was shared, to a life well-lived….
Her brother and sister couldn’t be there in person, but her sister visited via FaceTime and her stuffed soldier stood in for her big brother….
Finally, Bella curled up in mom’s arms and fell asleep listening to her favorite song, and passed from this life.
And a much younger Bella, on her first day at home. Thank you so much, Princess, for a beautiful life and a memorable passing. You will always be loved and missed.
In many ways, veterinary hospice is greatly informed by, and based on, human hospice medicine. We learn from our human colleagues, we adapt their priorities and focuses, and we strive to practice as they do, supporting comfort and quality of life for both the patient and the family.
There is one way, though, in which those of us who work with animals – and our patients – are luckier than our human counterparts. In human medicine (in the United States, at least), a patient must choose between pursuing curative care and entering hospice; they can’t receive the benefits of hospice care while still receiving traditional medical treatment for their condition. Our pets, thankfully, do not need to make this decision – a pet patient can begin hospice and palliative care while still also being treated by general practice vets and/or specialists, and often benefits significantly from this decision.
Hospice care functions best when it’s part of an integrative approach that includes a team of professionals to give the best, and most well-rounded, support to both the pet and the people caring for them. Far from replacing your regular veterinarian, a hospice veterinarian is joining them, and adding to the resources you have at hand.
This teamwork can take many shapes. Some pets have multiple chronic health conditions, some of which may be better managed at home by a hospice veterinarian while others are more easily handled with in-clinic care. A pet diagnosed with a potentially manageable but progressive condition may benefit from seeing both a specialist (such as an oncologist or internal medicine specialist) to help manage the primary disease as well as a hospice veterinarian to make sure that, in the course of treatment, quality of life is still prioritized and the family gets the support they need. And even for families who decide to avoid any further office visits, general practice vets are still part of the team, providing historical information, helping with medications, and being available for support.
Hospice cases are often complex, and demand a lot from the people caring for the beings in need. Hospice’s greatest purpose, ultimately, is to make sure that you have the best possible team supporting you and your loved one along this journey.
We lost our sweet, silly, crazy, dearly beloved Jack Russell terrier, Maggie, on August 15, 2018. She was 19 years old. Although our hearts are broken, we are grateful for so many things: We had been working with Becky to manage Maggie’s arthritis and other age-related issues for nearly a year before she died, so we had a plan in place for what we wanted when the time came to say goodbye to her. She had a good last day at home, with treats, yard walks, and visits from friends. We had the whole day to say goodbye to her. It was beyond comforting to have Becky there to help our little girl pass peacefully, with us by her side.
We got Maggie when she was 3 months old. She was a typical Jack Russell terrier in her puppyhood: smart, willful, and overflowing with energy. Although she wasn’t always a fan of other dogs, she made many canine friends in the neighborhood over the years (and even a feline one), and had TONS of human admirers. She was beloved by her dog walkers, her vets, our family and friends, and most especially by us. It seems impossible that she’s gone. Her joie de vivre, even in her senior years when her sight, hearing, and mobility declined, seemed to imply (as Becky said) that she’d outlive us all. It’s hard to be without her. I know she’ll never leave my heart, but I miss her physical presence every day. There will never be another quite like her. Run over the bridge like the crazy 3-month-old puppy you were when we first got you, Maggie. We love you so much, always.