Today in Life
Today I witnessed something my veterinary training hadn’t prepared me for. I have an elderly aunt who fell down a flight of stairs over the weekend, and suffered a massive concussion with significant intracranial hemorrhaging. She was unconconscious since the moment of her fall. For the next couple of days she was in the ICU, being monitored and kept on life support. They had a tube in her mouth, which kept her breathing, she was getting fluids in her vein, to keep her hydrated and to give her cells nutrients to survive. Fed with oxygen, fluid and nutrients, her heart would have very little reason to quit pumping blood, and her cells could continue to survive in that state indefinitely. But she was long gone.
The doctors were reluctant to give bad news, but had no good news to offer. Fortunately my aunt had a living will, and had previously determined that she didn’t want this to be her fate. Within a few days of the accident, family members came to accept that the prognosis would not change; she was gone, the only medical miracle is that they were able to keep her body going this long. She was not coming back into our lives the way she had been before. I was able to explain to my family members, none of whom had any medical training, that the skull is a hard shell, and any extra fluid inside that shell would push into the spongy brain, not against the shell. The vacuum system had pulled an orange juice pitcher of blood out of her skull the last couple days, and there was no way for the brain to ever function, with that much pressure.
The decision was made to discontinue her intravenous drip, and pull the tube that was doing most of the breathing for her. I knew from euthanizing animals in my profession, that there is often an unpleasant moment, when the cells controlling the respiratory center of the brain are still alive, even though the animal is unconscious, that a few last involuntary gasps of breath take place, which can be fairly unsettling, but then the body goes still, and the pulse fades to nothing. I prepare owners for this moment, if they have made the decision to be present at that time.
Unfortunately the medical team, who had been doing a great job, and seemed very sensitive to the family, did not prepare us for what happens when a tube is pulled. In this case, my aunt started breathing on her own. The deep, irregular involuntary gasps that I had seen before. I waited a moment for them to end, so that my grandmother’s agony could come under control, and the moment could pass, as gently as we had imagined my aunt’s soul slipping from her body and ascending effortlessly into the heavens. Instead, it kept going. Many unpleasant minutes passed, her breaths rattling the fluid that was trapped in the back of her throat, and the grief my family was suffering was compounded by the horror of the moment. Realizing what was going on (the cells in her respiratory center had not yet run out of oxygen/ nutrients), I stepped out to the nurse’s station to see how long this part of the process usually takes. I was concerned that my grandmother, whose greatest contribution to mankind has been the size of her heart, and doesn’t come equipped with the ability to process things analytically, would begin to question whether we made the right decision. I worried that if the breathing continued, she would see it as evidence our patient was trying desperately to hang onto life, and ask that we reinitiate life saving procedures. The nurse’s answer: “They’re all different. Some take 15 minutes. Some can go for many hours.” I went back into the room, sat down with my family, and explained in medical terms what was happening. Her body as a whole was dying, but parts of her body were not yet completely dead, and they were doing involuntary things that we normally associate with conscious signs of life. I told them that this could go on for quite some time, but our loved one was in fact no longer with us.
This gave them comfort, and made the process easier. I began to wonder about all the families in America who are losing a loved one today, but who don’t have a family member with medical training to explain what’s going on in real terms, and prepare them for the next unpleasant moment. I felt very good about being able to provide to my family solace through understanding, but I simultaneously grieved for families who have to go through this process without someone to walk them through it.
My experience has left me with three take home points:
1. Write a living will. Today. Be as specific as possible. If you don’t want to be kept on life support, how much time do you want to give family members to prepare themselves, knowing every day is very expensive? How many doctors do you need to agree on a poor prognosis if you don’t want to be kept alive?
2. The medical professionals need to be better at educating families in terms that can help them make intelligent decisions, and be better prepared emotionally for what is likely to happen next and why. There are very few medical surprises anymore, there is just exciting improvement in condition, and disappointing deterioration in condition. If the nurses and doctors aren’t surprised by what happens next, why should the family be surprised?
3. I believe the greatest gift we have as veterinarians, is the ability to provide for a humane ending to life. We have medications which are engineered to make the animal comfortable at the same time that it takes their life. It is quick, humane, and if there is an unpleasant moment it is usually very brief. Without getting into the ethical debate of taking the life of those who don’t want to live any longer, can’t we at least agree that if a body is within moments of expiring, that we can give drugs to expedite the moment, if only for those loved ones who are there? Biology is not always the most pleasant subject. It’s a shame we have to come so shockingly face to face with its cruel reality, if we have the technology to minimize our grief.


















Dr. Emerson provides sports medicine services for Rood and Riddle Equine Hospital in Lexington, KY and Wellington, FL.
(Views expressed here do not necessarily reflect those of other veterinarians at RREH.)
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