It isn't the money. It isn't the dog's age. It isn't that I believe her age has been underestimated. It isn't the time commitment. It isn't the dog's overall health. It isn't longevity versus quality of life. It isn't the effects that the treatment might have on her. It isn't her inability to tell me what she wants. It isn't that she is an absolutely awesome dog. It is everything.
After loosing my oldest dog a few months ago, my now-oldest has been diagnosed with cancer. This is pretty devastating as I was anticipating her living as long as the last two did. Even without cancer, that would be unlikely.
The veterinarian noticed a small growth during an annual check up. The vet didn't seem too concerned, but suggested it be removed and tested just to be sure. "Within the next few weeks." Once I knew where it was, it bothered me and removal came sooner rather than later.
It was probably a good thing it was removed as the histology report stated it was a rather aggressive form of cancer. I was shocked by this; I had anticipated it would be just another benign growth - all my dogs have had these to at least some extent.
My vet referred me to a veterinarian oncologist. I made an appointment and took her to see the cancer doctor. The oncologist laid out some of the options, and none of them sounded very good to me. The best option would likely give her several additional months to live, with a high degree of variability. It would not cure her, but it would not be impossible for her life to be extended by years. Maybe. But maybe it would do nothing. Digging into this option told a very incomplete story. There are few good controlled studies, and the studies that have been done have shown a lot of variability with some conflicting results. While several months is a huge advancement to the medical profession in the face of a terminal diagnosis, it is small comfort in the big picture. Quite frankly, this best option sounded like only a few steps removed from an uncontrolled medical experiment. I guess that is why it is called a medical practice and not a medical certainty. I wish I could say that cost was not a factor, but it was.
Questioning financial motivation of a pet's owner is easy. Questioning the morality of spending tens of thousands of dollars on an aging pet when there are people without health care is easy too. Does anyone question the financial motives of the veterinarian and the clinic? That nice new building is being paid for by someone though. The vet is only there to help - right?
I was there with my dog to see the oncologist, but was feeling judged at some point through the conversation.
Surgery - what was already done and may be needed again is a treatment. Our usual veterinarian was able to completely remove the tumor with some margins. Success does not necessarily mean cure.
More judgement was seeping into the small examination room.
Radiation was not a good option on this type of cancer and would likely come with a significant reduction in the quality of life.
Chemotherapy, while well tolerated by most dogs has not historically been very effective on this type of cancer either. "So would chemo be that much better than not treating at all?" after much discussion about that as an option.
"Not in my opinion," the Oncologist replied.
More judgement.
A veterinarian's job is to heal the patient. A veterinarian's job is not to do nothing. I've yet to meet a vet who I didn't believe was compassionate. While personable and friendly, the oncologist was compassionate in the same perfunctory way that a vending machine is - there are all these options, all will be bad for me.
Maybe I'm judging the oncologist as well.
My dog was resting on the floor staring at the wall. She didn't want cancer. She didn't want aggressive or expensive treatments. She wanted to be back in her familiar back yard. She really just wanted to be at home on the sofa.
"We could start treatment today," the oncologist said.
But it was too much to think about right then. There was too much information and not enough at the same time. These decisions are never, ever easy; there is no help in making them. I needed time to think.
The judgement was hanging thick in the silent room.
I looked away from the oncologist. The freshly painted walls were done poorly; the judgement made it hard to see the small paint drips on the floor.
The only thing I could be sure of was that my dog was not judging either one of us.
"The cold compassion of bartenders, he came to see, was like that of priests: universal rather than personal, with charity for all and malice toward almost none. Firmly situated … between sacrament and communicant, they commanded rather than earned love, trust, dependence." - John Crowley
