Commentary
My wife texted, "Tigger is having problems. Call me."
Tigger is our beloved (and bouncy) 9½-year-old boxer. My wife had just finished putting our 16-month-old son down for his nap when she heard a commotion in the foyer. She looked downstairs and saw Tigger struggling to get up. She ran down the steps and sat down beside him. It was clear that his hind legs were not working. Wide-eyed, he looked terrified to her. As she stroked his back, he eventually settled down and rested for several minutes. After about 10 minutes, he was able to get up and slowly walk around the house.
I came home from work, followed shortly thereafter by one of our friends and two of his young boys. While my wife and I had drinks and pizza with our friend, and the boys and our daughter played in the yard. Tigger, normally in the center of the action, lay off to the side of the patio. When I brought out a bowl of food for him, he did not budge. This was a first – he has never passed up a meal. Instead, he usually looks to supplement his food with anything he can steal from unsuspecting members of our family.
That evening, my wife and I had a long conversation about Tigger. We were going to take him to the vet and have him evaluated, but we were very realistic about what we might find. On average, boxers live just shy of 10 years. We’ve noticed that he had been slowing down, and the events of that evening – keeping to himself and passing up dinner – made us concerned that the end was close. We agreed that our primary goal is to keep him comfortable. He is a valued member of our family, and we do not want him to suffer.
Thankfully, Tigger rebounded from that initial episode, although he had a similar episode in the weeks that followed. We know the end is coming for him and we are working to maximize our time with him. We are retelling stories from his younger days and enjoying some of his behavioral quirks (read: stealing food) more than we had in the past. Again, our focus remains on his comfort. When he appears to be struggling too much – when his pain and discomfort exceeds – we will make that difficult decision that most every pet owner has to eventually make.
These discussions made me think of the patients I have cared for over the years who were never encouraged to think in such terms about their own lives. Many were being treated for underlying malignancies, yet had no conversations with their physicians about goals of care or end-of-life decisions.
I have written in the past about the need for these discussions and how we, as physicians, often die differently from our patients. Allow this to be a reminder to everyone to discuss goals of care with your patients. The conversations are an important investment in your relationship with that patient and are vital to providing the best possible care for them.
Dr. Pistoria is chief of hospital medicine at Coordinated Health in Bethlehem, Pa., and an adviser to Hospitalist News. He believes that the best care is always personal.