I’ve been fortunate in a way to have not lost anyone yet who was significant in my life until recently. It was Mimi, my first pet, a beloved short haired tabby. In some ways, losing a pet can be more intense than losing a human companion. They are innocent, pure, and a true depiction of unconditional love. They will love you no matter what and often serve as a consistent figure in our lives. In this field of work, animals can make a world of difference in some of the most stubborn psychiatric symptoms and best of all, they are free of the dangers of polypharmacy and medication side effects.

She passed at the ripe age of 22 years old. But there is never a great time to say good bye to a loved one. The process was very painful and drawn out. She was diagnosed with malignant melanoma at the age of 21. At that point she already had hypertension, non-regenerative anemia, some cardiomyopathy, kidney disease, vision loss, and substantial arthritis all which compounded her compromise in her quality of life. Perhaps one of the most unsettling parts about making medical decisions for our pets is that they cannot express to us what they want and we hope we are making the right decision for them. I was torn between how aggressively to treat her cancer. The veterinarians all highly recommended against surgical intervention due to her age and risks of anesthesia and we opted for immunotherapy. This gave us another 10 months together and even with that, there was some guilt. She continued to appear to be in pain and ate very little. We tried numerous dietary options until we found one that she took to and she even gained weight and started to perk up a little bit. Then one day she stopped eating again, appeared quite confused and she was taken to the emergency room. She had a UTI, which we treated, and she returned to baseline. Eventually, she reached a point again where she’d stopped eating. She was due for a follow up anyways for a potential booster shot for her immunotherapy. One part of me was hoping more could be done, perhaps it was a dental issue and only a bad tooth needed to be extracted. Perhaps the immunotherapy would help. Her fur was matted and I considered perhaps she could get bathed under gentle sedation and we could nurse her back to health just a little bit more. But most of us can tell at this point and with these conditions starting to add up that she was reaching her end and likely there was denial involved.

The vet said her quality of life really deteriorated. Even when Mimi got distressed/scared when at the vet, her heart couldn’t even handle that, her oxygenation would plummet and she actually turned pale. Even eating was laborious. The idea of euthanasia admittedly sounded quite scary. I think many of us do not like the idea that we deliver the final order to have that needle placed and pump into the veins of our pets a concoction that would end their lives. I thought, “What if I just took her home and kept her comfortable and she expired on her own?” But on looking at her, it was clear she was quite uncomfortable and this was the humane thing to do. You find yourself wondering if what you did was selfish. Was she suffering the entire 10 months and denial gives us a blind eye? Maybe we could have played more together in her younger years, maybe there was just more we could have offered, maybe this, maybe that. Some pet owners find themselves getting angry at themselves. But in talking with patients, it is often clear that we all made the best decision we were able to with the information available at that time.

I held Mimi during those final breaths. As an MD, we all get trained in various specialties and just about all of us encountered death in hospitals. What always struck was in the end, the silence, stillness, and absence that is in the room. The veterinarian gave us privacy together and when she came in when we were done, it was touching to see that she too cried at the sight of this good-bye.

The following days, are the constant reminders of that loved one’s absence. Getting ready to clean the litter box, provide a feeding, etc. Many patients when losing a loved one shared experiences of potential contact with the deceased loved one and I found comfort in reading more of these stories on the net. Coming from a scientific background, it can be hard to believe in an afterlife. A part of you may eagerly hope for such an experience though.

The morning following her loss, I noticed her food bowl was empty. Getting Mimi to eat was extremely hard her final few weeks. Now, there IS a window where other animals could have had access to it, but there was comfort in that experience. Sometimes you read of stories of people who claim to have actually seen their pets and even give them a final pat. Of course, I read these stories with some skepticism but part of you wishes they were true and how nice would it be to have such a concrete encounter. To know that they are okay somewhere. The day following that thought, I headed to the car to drive to work. The head lights started to turn on and off several times, they had never done that before and the remotes were not being pressed. Nobody was in the car. Then, two days after her passing, something very economically favorable happened to the office. About a week afterwards, I found myself feeling quite calm and accepting even though the anticipation was that this process of bereavement was going to be longer and more painful. The logical explanations are that much of the grieving had already taken place prior to her passing and many of these events were a coincidence in timing. But much of it was still comforting and helpful in such a complex experience.