Living longer is not always living better

Photo By Lauren Knatz

With technological advancements and a curative approach within our medical system, our elderly population are living longer but with more chronic conditions and comorbidities. As a result, death and dying has become medicalized and marginalized in Western Society. We fear it and try to outrun our mortality by denying its inevitability.  Oftentimes, after a terminal diagnosis, we find ourselves unprepared and ill equipped with few creative outlets to process our grief and loss.

My first career was in veterinary medicine. My role was to counsel pet owners whose pets had been diagnosed with a terminal condition-- to help identify quality of life concerns in an effort to make their pets’ transition more manageable. Simply stated, I was the owner’s last stop before the decision to extend life for their pet or humanely end life via euthanasia.

This was the eighties, and regardless of the parity between veterinary medicine and human medicine in terms of preserving quality of life at end of life, assisted suicide in any form was highly controversial and remains so to this day. Terms like, “playing god” overshadowed quality-of-life decisions for pets whose lifespan had reached its end date. Biologically, animals simply don’t live as long as humans,  yet many of us think of them as an integral part of our family.  A pet’s mortality was often met with the same degree of ambivalence and denial that is met by our own—making end of life decisions painfully drawn out and difficult. 

There is another very important reason why these decisions are so heartbreaking —animals are unable to verbally communicate how they feel. As a result, it’s easy to project our own emotions onto our pets' condition, making it hard to let go. 

When working with animals that were hospitalized at our veterinary clinic, music became a natural bridge to communication. I would take my guitar into the cage room and play lullabies for the pets transitioning--intuitively entraining the music to their breathing. Without the expectation of a diagnosis or a cure,  the animals appeared to be at peace, attuning their breath naturally to the rhythm of the lullaby’s 6/8 time. The song I chose to play for them was Summertime, written by George Gershwin for the opera Porgy and Bess, inspired by a Ukrainian Lullaby. Lullabies, I have discovered, are not only cross-cultural but their rhythm is soothing to animals as well. They are a part of our biorhythms. Consider your mother humming or singing as she lulled you to sleep? Or perhaps when you sang a lullaby to your children or grandchildren? Rhythm helps us connect to our bodies' wisdom.

Non-attachment and Impermanence 

Several years before moving back to Maryland and suburbia, I  worked for a large and small animal veterinarian in rural Shenandoah Valley.  Part of the vet’s time was spent with farmers, whose livelihood depended on the health of their livestock, and the other time was spent treating domestic animals in a brick and mortar veterinary clinic.

This was during the parvo epidemic, a highly contagious and deadly disease for puppies that had not been vaccinated. Because dogs ranked much lower on the farmers list of priorities, our hospital quickly became a revolving door of death and dying. 

Education on the importance of vaccines for domestic pets was met with skepticism and a blind eye.  To the farmers, providing vaccinations to a pet wasn’t economically viable.  In suburban Maryland, on the other hand, domestic animals lived mostly indoors and in many instances shared the same bed as their human counterparts. This juxtaposition between rural and suburban culture was a deep dive into two radically different philosophies regarding what constitutes humane treatment when determining the rights of non-humans. In retrospect, my experiences in both socioeconomic cultures allowed me to maintain a level of non-attachment and objectivity. This detachment was essential for self-regulation in my highly emotive role as counselor for owners and their terminally ill pets facing end of life decisions.

When hospice care was introduced I chose to leave veterinary medicine and work with people in hospice care. From my vantage point, why would you prolong the life of a pet when their quality of life was not a consideration? Was hospice a compassionate alternative to euthanasia?  Or was it motivated by veterinary hospitals preying on the emotions of grieving pet owners? 

The intensity of these end of life discussions had me questioning how we as humans subjectively define quality of life? How is it measured? And for those unable to communicate their needs, who gets to decide what is in the patient's best interest? 

For human beings there is end of life planning but it's often postponed until the person is no longer cognitively or physically able to be an active participate in these discussions. This not only undermines the patient's dignity but it also places an unnecessary burden on the caregivers and loved ones who become the end-of-life decision makers by default.

 So why, you may wonder, am I spending so much time talking about our relationship with our beloved pets? Because if you read closely you will discover that our attitude around death and dying is relative to our familiarity with death and dying. If we as pet owners are in denial of our pet’s mortality,  how then can we be accepting of our own?  To put this in perspective, Stephen P. Kiernan, author of Last Rights, Rescuing End Of Life From The Medical System, explains,

“For virtually all of human history people experienced dying at close range. They watched it occur, participated in preparing the body, constructed the coffin, dug the grave or built the pyre.  If a person performed these tasks today, far from being perceived as devoted, he or she might well be considered ghoulish.  Touching the corpse, even of a beloved, is taboo. A dead body is so alien in contemporary America that few people outside the medical field know what to do when they encounter one. From the unintentional ignorance, it is a long journey to treating a dying person with reverence. “ 

Reflection:

Chronologically, turn back the clock and consider what end- of-life was like for people a few hundred years ago? A time when vaccines were in short supply or hadn't even been invented? When medical interventions for humans offered no guarantee for the extension of life? How would this alter a person’s relationship to their own mortality?  How might it alter yours?