Will you know when the time is right?

“You’ll know when the time is right.”

This is something that is often said to people when they are facing the heartbreaking decision of saying goodbye to their dog. Or not. Sadly in my experience you don’t always know when the time is right. And it’s something I am struggling with right now.

My Jack Russell Terrier Ella has been with me for almost 12 years. Her gotcha day is 2nd November. She is a delight. She’s the jrt that proves all the stereotypes wrong. She loves people. Loves other dogs. Isn’t vocal. She’s not anxious in the car, worried about fireworks or of being left home alone. She’s the dream dog.

Background

But she’s very ill. In January 2024 it was discovered during a routine health check in preparation for a dental, that she had a heart murmur. There had been no symptoms and she appeared healthy and happy in every other way. 18 months later when X-raying her back legs, my vet suggested that they take some X-rays of her heart too, just to check what was happening since she was already going to be under anaesthetic. Her hips came back great, but the heart was huge. It filled her chest. This was not good news.

For anyone reading this wondering what her symptoms were – there were none. No breathlessness. No coughing. She was fit as a fiddle and living life to the full. But all this time her heart was growing bigger and bigger.

The mystery of her lameness, the reason for the X-ray, was solved by an orthopaedic specialist who, the instant her put his hands on her leg, diagnosed a ruptured cruciate ligament. In consideration of a potential TPLO (a common operation to fix the cruciate) he wanted Ella to see a cardiologist to check if she would be able to survive the operation. After scans and exams it was deemed that she stood a fair chance. But by then, having been rested for 6 months, the last two of which had been strict rest as I’d decided to treat her as if she did have a ruptured cruciate despite having no diagnosis at that time, she was relatively sound. At that point I made the decision to treat her conservatively. No op, just rest and physio.

I only share this history with you so that you understand the background that brought us to where we are now. Her heart continues to enlarge and she now coughs when playing or exercising. Not due to fluid build up – her meds have prevented that so far – but as a result of her left atrium pressing upwards onto her windpipe. (A common issue with small dogs with enlarged hearts.) Her heart beats so loudly that you can clearly hear it whooshing when she sits beside you. I can hear it now as I type.

She’s also suffering from cachexia. This term was new to me. It’s a great word, but not a great condition. This is a severe, involuntary loss of lean body mass and muscle tissue driven by chronic congestive heart failure (also other inflammatory diseases like cancer and kidney failure). So she’s losing weight, mostly muscle. Her appetite waxes and wanes. Her little face when she comes through to the kitchen for dinner but as she puts her head in the bowl backs off looking upset and disappointed. She’s hungry but can’t face it. We try again later and, of late, she’s been enjoying her meals more often.

But worst of all are her legs. As often happens with cruciate ruptures, once one goes, so does the other. This happened before her first leg was fully healed and strong, resulting in both legs now being weak and painful.

Make the call

I wonder if you’re reading this thinking “Well, the decision is easy. The dog is obviously at the end of her life.” ? I wish it was easy. And obvious. But it’s not.

She is mostly happy. Her pain is well controlled. She goes for drives in the car instead of walks. She snuggles with me on the sofa. She plays with Ettie. She’s mostly happy. But on her bad days, on the days when she struggles to walk. Or can’t eat. Those are the days when I’ve made the decision to say goodbye. I resolve to call the vet in the morning and make the dreaded PTS appointment. But we wake and she gulps down her breakfast and has the zoomies up and down the hall. Now what?!

Ella and I have been in this limbo for the last week. I’d guess that about 20 times a day I make the decision and then change my mind. At the end of last week I’d resolved to call the vet on Monday morning. But despite all the odds, she’s had a great weekend. She been in such good form. Yes she’s still lame. Yes, she’s on a cocktail of drugs. But she’s not ready to go yet.

I’ve made the life ending decision many times in both my private and my professional life. And I can tell you that it really does not get easier. Every dog and every situation is unique. For my own dogs I’ve had to give permission over the phone for Toby who was on the operating table – that was awful and unexpected but clear cut. I’ve had to make the call in person with Archie in hospital which heartbreaking but was also clear cut. I’ve had to make the decision with Solo when his back end had given up the ghost. That was trickier because he was still so full of life mentally. He wasn’t ‘ill’ as such. But I could see he wasn’t enjoying his life, he was frustrated and weak and likely in pain. But Megan was one of the toughest. And despite the common saying of ‘Better a day too soon than a day too late.’ I’ve always regretted going a day too soon with her.

Getting help

I don’t want to rob Ella of any good days. But I don’t want her to suffer any more bad days. The balance is on the edge. I’ve used my experience. Talked to friends and colleagues. I’ve used Quality of Life Scales to help with my decision. There are lots out there. It seems that one of the most commonly used is the HHHHHMM Quality of Life Scale designed by Dr. Alice Villalobos (you can download it here: https://caringpathways.com/wp-content/uploads/2018/02/QualityofLifeScale.pdf. ) This looks at Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More good days than bad.

All the scales I tried came back with her being on the cusp between saying goodbye and not saying goodbye. So not that helpful. One friend said that perhaps if I’m worried about saying goodbye too soon, then it’s not time. In the end, I think that’s the case. The only time I’ve ever not felt at peace with the decision was with Megan. Even though in my head I’ve shouted ‘Stop, I’ve changed my mind!’ mid procedure with more than one dog, Megan is the only one about which I feel regret. She was at the end of her life and she was almost ready, but I think she had a day or two more in her. That might not seem like much but it weighs heavily on my heart. The decision was, and is again, mine and mine alone. I have to live with it. And I think that’s what makes this extra hard. Nobody else can make the decision for me.

Limbo

And so here we are, in limbo, waiting for the time to be right. Not wishing Ella’s life away, not rushing to a decision, but taking each hour, each day as it comes. It’s emotionally exhausting. And heartbreaking knowing I have her life and death in my hands. Selfishly I’d hoped her heart might give out during a fun day at the beach. Or that she’d slip away in the night as she lay beside me. For now, she continues to whoosh away by my side, comforted by my touch as her back is pushed against my leg. I think she has days not weeks left. And I am grateful for every extra day we can spend together.

I know I’m not alone in making this decision. Most people who have the privilege of sharing their lives with an animal will go through it. I hope the decision is, was, black and white. But if you’ve been where I am now, reach out to your vet and professionals who can help guide you to a decision. Speak to those closest to you who understand how difficult it is to even consider making this life ending call. Use the quality of life guides. Do whatever you need to make a good decision made for all the right reasons. It all helps.

Ella may well be gone by the time you read this. Rest assured that when the time came, she would have gone lying in my arms knowing that she was loved more than any dog could be.

Update

Ella and I said our final goodbyes two days after I posted this. I still didn’t know for sure that the time was right. She went quickly and peacefully which helped the decision sit well with me. And that’s all I could ask for.