We all have a group of friends who adore the work of Nicholas Sparks. Perhaps his most popular story was captured in a film in 2004 entitled The Notebook. In this tale, an elderly woman is played by Geena Rowlands, is at the end of her life and is plagued by dementia. She is taken care of by her husband. This husband, James Garner, is a dashing and unusual caregiver to his frail spouse. We see the backdrop of their lives as young lovers, followed by their later years. At the end of the film, the couple is found intertwined in one single bed, both dead simultaneously.
If we can translate this seemingly unreasonable tale into today’s standards, a couple can die together. I do not know if Nicholas Sparks himself felt this to be plausible, but it happens. It typically does not happen in one evening, but when two souls have spent their waking lives together, one often dies shortly after the other one is gone. This actually makes sense, and as a person who has worked with the dying, I have to give Mr. Sparks a little bit of credit here. (Even if the romanticism of The Notebook is a bit effusive for my taste, this author writes about what we all ultimately crave. Few of us would want to outlive our best friends).
I once owned two dogs. They had always known each other. Their names are Mitzy and Ruben. About three months ago, I had the sense that Mitzy was dying and recognized her diagnosis of Congestive Heart Failure. Having witnessed the course of this disease in the humans that I treat in the world of healthcare, I decided against the use of heart medication to prolong her life. I knew that my dog would be prescribed diuretics and urinate all of over the house. I also knew that it would not buy Mitzy a lot of extra time with me and did not want to be one of those people who prolong the lives of others to ease my own conscience.
Yet on the three days leading up to the death of my female dog Mitzy, my male dog became listless. Ruben drooled uncontrollably, he draped his body upon his sister to console her. I wondered what would happen next. I knew one of my dogs had to be put down, but could I afford to lose the other? What if these dogs were the best friends that I knew them to be? What if they needed to die together?
After euthanizing Mitzy, which equaled the identical heartbreak of anyone who has ever put down an animal, I took her brother to the veterinarian. The vet told me that Ruben, the one dog I had left, was in Stage IV heart failure. I wrestled with my next decision. During the next 24 hours after Ruben’s visit to the vet, I watched Ruben like a mother hawk. I took his pulse. I tried to estimate his water intake. So that Ruben would not feel alone without his sister, with whom he shared a doggie bed for years, I carried him up to my room and placed him in my bed. My sole remaining dog looked at me oddly, as if to say, Where did she go? Where is my sister?
I drove back to the vet later that day. I asked her what I could do to help Ruben live. He needed a cardiac workup. After a cardiac ultrasound, for the low, low price of $700, Ruben was prescribed three heart medications for his Congestive Heart Failure. The very same diagnosis that I refused to treat in his sister Mitzy. I was given the medication that very day. I placed the three pills on the countertop, mixed them with a dollop of peanut butter, and reached down to feed them to Ruben. He wagged his tail and licked his chops.
Only two weeks later, Ruben was bounding about like a teenager. This reminded me of the earlier part of the movie The Notebook. Before the senile dementia of the elderly heroine, she was a tempestuous and shockingly beautiful woman, played by the actress Rachel McAdams. She was in love with a man from across town, a man of disparate upbringing and social standing. Ryan Gosling was the ideal rugged counterpart for a woman with white gloves, and as much as this movie might tip towards a cliché of Disney’s Lady and the Tramp, one cannot help but feel a little ping at the pericardium while watching these two actors face all odds and fall in love.
I have always liked the ending of The Notebook. Soulmates who die together are fortunate in that there is no grieving widow/widower, nobody is left to reconcile the debts/wealth/estate, and as much as the surviving friends and family are grieving doubly, there is a sense of finality that the two souls are at rest together.
I do not think Ruben has forgotten his sister. Rather, I think he delights in all of the attention focused on him, in the succulent duck meat that has become his breakfast, and in the energy of the living. For it is now that I watch the buds awaken, young lovers grasp hands in the park and the chest of my dog rise and fall, as we await another day. We have this. That is why Ruben is still around. We keep on going. He has taught me everything I need to know about losing something and getting it all back somehow.
I got my first King Charles cavalier spaniel in 2007. I was going through a divorce and didn’t want to come home to an empty house. I drove to a farm in Quakertown, Pennsylvania to pick up a male named Ruben. I had seen a picture of Ruben online; he looked like a black Adonis. I did not know if we would get along. There is a chemistry between dogs and people and I was concerned that he and I might not be a good match.
Life was idyllic. In spite of my pending divorce, I had a steadfast companion in a dog and the company of a child who came over every weekend. There was Peace in the Kingdom at last. So, what could be the harm in taking Ruben back to the farm exactly one year later, so that he could see his other dog friends again? I offered this plan to Caroline, and she snatched it up like a golden egg nestled in a garden of sweet peonies.
I know what you are thinking already. Looking back on this idea, I must agree. What kind of imbecile would take a dog-loving child back to a farm where there are dogs? Well, it was a lovely drive in early fall and I knew that I was going to give my niece and my dog a cool experience. The sticking point occurred when Caroline was informed that Ruben’s sister Mitzy just “happened” to be up for adoption. Mitzy had birthed two litters of puppies and was retiring from her job at age 3. This gave me further assurance on what I had already believed about this particular farm. They were ethical people and did not overbreed dogs, which is a common problem in today’s world. And that was great! Ethical dog breeders were becoming popular. How enchanting!
Mitzy did not have Ruben’s Adonis-like looks, so classic of this breed. No, she was overweight from stealing food from the other dogs at the farm and had an atrocious haircut, rendered by a handheld buzzer. Mitzy had large, bug-like eyes and a small head. It was not her appearance that had won Caroline over, however; she had the sweetest personality and burrowed her body into the chest of anyone upon whose lap she sat. Did I really need two dogs? This was a bit ridiculous. During the drive home from Pennsylvania after my foolish mission, with TWO dogs in the car, Caroline turned to me and stated with authority, “You HAD to get this dog, Mitzy. Because you don’t say no to wonderful.” I had been hoodwinked, and I knew it.
A few years later, both of the dogs began going grey on their muzzles. I took them faithfully to their vet appointments. They both had heart murmurs, but were healthy as seniors. It was not until this past Thanksgiving in 2017 that I began to notice Mitzy’s breathing change. She had forced exhalations and her ribcage began to flare and become barrel-like. This is characteristic of Congestive Heart Failure. I had witnessed the course of this disease in humans for years at the nursing home. Excess fluid builds up around the heart and lungs, and carbon dioxide cannot be expelled from the body in an efficient manner. The standard medical treatment for this condition is heart medication and diuretics, so that the body can release the fluid buildup.
When Caroline observed Mitzy’s new breathing pattern, she commanded, “Something must be done!” She was now 17 and full of opinions on everything. I explained to my niece that I was not going to treat this disorder in an animal. That Mitzy’s life would not be prolonged much if I did and that she would urinate all over the house if I put her on diuretics. That she would feel demoralized and sad. “What about diapers?” Caroline asked me. While I knew that Caroline was kidding, I strongly shook my head no.
It was merely six weeks later that things took a turn for the worse. Mitzy’s exhalations became sharper, her chest was growing in size. She ballooned with water weight and could no longer get on and off of the sofa. The dog was so uncomfortable that I knew it was likely time to take her to the vet to be put down. It was the humane thing to do. I work in healthcare, and have watched people starve for air in their final hours. I was never going to allow things to get that bad for Mitzy.
Only on the very same morning that I came to this realization, a blizzard hit the area. People were warned to stay off of the roads. I knew that shoveling us out would be an impossibility and the roads were too dangerous to get to the vet’s office. My plan to spare Mitzy from starving for air was rapidly failing. She sat next to me as she huffed and coughed. Her brother Ruben, ever her protector, looked up at me as if to say, I am letting her down. I cannot fix what is wrong. What are we going to do?
It was a horrible span of time. I stayed up all night through the storm with both dogs. Mitzy began pacing with agitation; this is common with the dying. Ruben tried to get close to her; at some moments she would allow it, but at others she just gasped and squirmed, longing to be set free from her agony.
It was not until the next day that I bundled up Mitzy to take her to the vet. I put Ruben in his crate alone, as I knew he could not endure being around for what would happen next. I heard his whimpering cry in my ears all the way to the vet’s office. The office took in Mitzy immediately to Treatment Room Number 6. A lovely animal tech named Diana listened as I sobbed. She told me that she would get the on-call vet right away.
The vet was an enormous man. It was not his being overweight that made him so heavy. He had a barrel chest and panted with the slightest of exertion. Even talking made him gasp. “I believe your dog has Congestive Heart Failure,” he announced. No shit, I longed to reply. You appear to have a case of it yourself.
“Are you aware that there is medication for this disease?” The vet continued. “I have a chihuahua who is on eight pills every day to treat this same condition.” It must be so nice that you do not have to pay for all of that medication given your line of work. Or the vet visits, for that matter.
I said none of these things. I simply requested that we move things along to get Mitzy out of her suffering. The vet left the room to get ready for the procedure. Diana gave Mitzy a shot in her rump to sedate her for the next ten minutes. It was then that I heard Mitzy snore like she was a young puppy again. She closed her eyes and let me hold her.
The vet returned with a few butterfly needles and some vials of sodium pentobarbital. He tried to find a vein in all four of Mitzy’s limbs and couldn’t. This was because the dog’s organs were shutting down and fluid was flooding her system. There was no direct route to get the medicine inside her to stop her heart.
It was Diana who saved the day. She carefully shaved Mitzy’s right hind leg and felt for her vein, like strumming a very delicate guitar string. She inserted the smallest of needles, attached the vial of sodium pentobarbital and pushed the fluid inside. For some people, this is the most awful moment during the process of euthanasia. For me, it was the finest. I felt joy for dear Mitzy. She had been freed from a body that could no longer contain her exuberant spirit.
After this strangely poignant and glorious goodbye to my female dog, I returned home to her despondent brother Ruben. I felt his sadness, but even he seemed to understand the horror of the last 24 hours and that fear was now gone. We were all going to be okay. But wait…I had not told Caroline the news. During the prior weeks, I had carefully tried to warn my niece of Mitzy’s declining health. But Caroline insisted that I was being overly dramatic and that I was around death too much to see the situation clearly.
On the same day that Mitzy’s heart had stopped, I drove to Caroline’s house with Ruben in the backseat. I entered the home to talk to my sister and we waited for Caroline to return from swim practice. As I opened the front door for Caroline, she knew instantly what had happened. I hugged her and smelled the chlorine in her wet hair as she wept soundly.
Looking back at all of this, I am grateful that Mitzy only had a really bad span of time on this earth which lasted no more than 36 hours. Had it not been for the blizzard, she would have suffered for less than one day. But that was not up to me. The blizzard had arrived, and I had no choice but to kneel before Mother Nature.
This is perhaps, one of the trickiest lessons in life. When do we tinker with nature? Should we medicate dogs or people for Congestive Heart Failure? What do we do for creatures who cannot talk to us and tell us how they feel, whether they be animals or adults with dementia? All of these questions weighed on my mind after I lost Mitzy.
It was not until today, when the ferocious weather broke and the sun began to shine and warm the Earth that I came to peace with all of it. I had tried to respect nature, by giving Mitzy a brief and organic finale to her life. But I had also needed the help of some sodium pentobarbital. And from the lovely Diana, who saved Mitzy when the huffing vet could not.
It had all come down to one simple secret that Caroline had told me years ago. It has become my mantra during the last week. As I grieve this loss and assist my patients in the numerous losses and storms that shall always find us, I say it out loud. You don’t say no to wonderful. It had all been worth it; and I will never say no to wonderful again.