My Bella

 This is probably the hardest post I've written. I started with the title and am already in tears.

Bella was my dog- not originally, but she became so. She was given to my mom as a gift from my step dad. She was about a year and a half old when he was in a car accident with my brother. On Christmas Eve, to make things more dramatic. They were in a small, 2 door coup, and a truck came around a corner and ended up right on top of them. My brother was unharmed, luckily, but my step dad had his foot and knee crushed. His heel was completely broken, and after multiple surgeries he ended up pretty much wheel chair bound from then until his death last year. 

I ended up with Bella after the accident- I was at Virginia Tech at the time, and my parents did not have a fenced in yard. The dogs had to be walked to go to the bathroom, and they had 2- Bella and Kenzie. M<y step dad was going to be in the hospital for some time, so I offered to take whichever dog would be harder for my mom to walk by herself to help out while I was at school, and that was Bella. She was always a strong girl, physically- well, until the last year of her life. 

She was very much a lab- food motivated, would eat almost anything. My niece handed her rocks and she tried to eat them. She loved trying to chase birds and squirrels- she would try to climb trees to go after them, running up to the base and jumping up, nearly falling over backwards. She was also not the brightest bulb in the box- on the occasions she escaped, she would sometimes get lost or stuck if she didn't run back the way she ran away.  And she hated having her nails trimmed. She used to love car rides, and travelled back and from first from Blacksburg to Poquoson, then from Middleburg. Though at one point she got really anxious and chewed 2 seatbelts before I realized what was happening, and boy are those more expensive to replace than you'd imagine. Because of that nervousness- and the fact I lived on campus- she did not come to vet school with me. Instead she stayed with my parents, and when she heard my car come home she would wait by the door- the would have to let her out to show her it wasn't me there. She came to recognize my suit cases, and would whine and cry as soon as they came out. 

The last time she made it upstairs was after she saw the suitcases come out, and she came upstairs, whining. It was July 2020. We went to visit my boyfriend's family for his mother's first chemo treatment. Shortly after we returned home she had a bad bout of diarrhea, was not walking for a few days, and just really struggled to come regain her strength. I seriously thought I would have to euthanize her. That was what sparked her rehab therapy. This is her the first day well after that episode:

 

She came home from a day of fluids at the clinic, and walked on her own. Her rehab therapy went great- when I kept up with her exercises. She got so much strength back, though she never came upstairs again.

I've been writing all this, trying to think about the good times, before I think about the worst time. Bella developed a cough- and being a vet's pet, and having a heart murmur I waited to get her in. She had a cardio appointment coming up in a few weeks, she was doing OK- it could wait, right? Seemed to be in the mornings right after she ate. No big deal, not bothering her. Then it became more frequent. And she had trouble breathing.

I took her to work, and took rads, and she had pleural effusion. Our wonderful mobile ultrasonographer came out the same day, fitting her in as a favor, and diagnosed a mass around her heart and pericardial effusion. We took some of the fluid off her chest, but not from around her heart. Based on the location of the tumor, the most likely diagnosis was hemangiosarcoma- or so I thought at the time. I called the oncologist treating Kenzie, and they were able to get her in the next day to start treatment for hemangiosarcoma. And the day after that, I had a cardiologist look at her with the idea of tapping the fluid around her heart. And I felt I made a terrible mistake- he said the mass was in a different location, more likely to be a benign chemodectoma, than hemangiosarcoma. Sampling heart based masses is not commonly done, and the locations are usually pretty pathognomonic for diagnosis. On the plus side, she did not have enough fluid that he felt tapping was worth it. And a benign mass! A much better diagnosis. 

But I had rushed her treatment, concerned for hemangiosarcoma- and I feel like that was a huge mistake. Bella did not do well with that dose of chemo. It started with a decreased appetite, and diarrhea. Then she couldn't stand up with out aid- weakened from losing fluids with the diarrhea, and not eating. I did fluids under the skin for her at home, but she was not improving. She stopped walking without aid, and stopped urinating on her own. I had to express her bladder, and it was difficult to do- but she couldn't go days without urinating- I let her go 1 day before I started the expressions, and I gave her 2 days to improve. And I feel like that was the second mistake I made. Maybe if she had been male, and I could have placed a urinary catheter to empty her bladder, I could have tried longer. But she was a 70 lb lab, and she couldn't walk without aid, or even stand unassisted, and expressing her bladder was tough- on her, and me. My arms were killing me after 1 day of nursing care for her.

I always tell clients that I hear people say they waited too long and their pets suffered, and they wish they had euthanized sooner. And I try to be really supportive of euthanasias no matter how things may look, because once someone has made that decision, it needs to be taken seriously. I have only refused to euthanize in 1 case,  where it wasn't medically indicated in the slightest. Euthanasia is the most difficult choice you can make for your pet, and support from your veterinarian is important, in my eyes.  

This time, I was the one who had waited. My dog suffered, because I made poor choices. Rushing her chemo before having a cardiologist see her and better localize the mass. Not having insurance on her. I have it for my youngest dog (my brother's, actually) but not Kenzie or Bella- I always figured I could treat them myself. I did not realize the lengths I would go to for them, and the financial constraints. And how much the cost of treatment for some things has gone up- geez, is the protocol for lymphoma more than twice what I was told in vet school! If I had any idea the lengths I was willing to go to, I would have had insurance. Heck, if I had just gotten insurance after I started Kenzie's chemo, for Bella... But anyway. My mistakes: starting chemo too early, before letting a cardiologist look at her. Not going to a tertiary referral center like Virginia Tech or NC State, though there are downsides to that- incredibly expensive very quickly, not able to be with my dog (both because you can't in an ICU setting and COVID was in full swing) and not being able to stay in the area because I had to go back to work. Bella really only  got so much care and time those last few days because I happened to have taken some time off to use up PTO, just some random days that looked good on the calendar to me in January (this was all happening in April/May).

And my final mistake- waiting too long. Letting Bella's last week be miserable- she seemed interested in food, sniffing at it, but unwilling to eat. Suffering with diarrhea- bed bound, unable to move out of it, just oozing out of her the last few days, not improving with medication. And since she was not eating, she had to be pilled at the end, and she HATED it. She hated the appetite stimulant I tried, she fought getting pills, she was developing fecal scald around her back end. Her last week on earth looked like misery to me, and it was my fault.

This is her, at the end- getting SQ fluids, laying on a bed on a tarp incase the diarrhea leaked off the towels and puppy potty pads we had her on. Help em up harness left on her front end so we could get her to stand- I would attach the back end when we got her up, or just use a towel. Those SQ fluids- a full liter- went into her super quick, in minutes, she was so dehydrated.  And I made her suffer. I made the decision to euthanize her on Sunday, but was unable to do so until Monday, since I was not allowed into the hospital over the weekend, and I debated transporting her to another hospital to euthanize her, but I wanted her last moments to be at home, as comfortable as I could make them. 

So I woke up Monday morning, and told my mom it was today. She wanted to be there too, but needed to go to work for a bit. So I put a catheter in Bella, having some supplies left over from her issue in July the previous year. Then I waited, a few hours, until my mom was able to get off work. And when the time came, I pushed the drugs myself. I had considered, but never really knew, if I would be able to do it myself or if I would have someone else do it. I had wondered, would I want her ashes back or not? In the moment- I wanted to be her vet in her last moments, as I had been most of her life- and be with her at the end, even though I felt I had failed her. And I found I did want her ashes back, though I also understand keeping memories over momentos of time with pets. 

And I don't cry any more, when I do a thing and look for Bella to be there, waiting- for an ice cube when she hears the freezer, to be waiting for me at the bottom of the stairs in the morning, to greet me when I get home. 

I try to remember Bella like this- trying to trade me her kongs for part of my sandwich, happy. 

And that is the story of what I feel is my personal biggest failure as a vet, for my own pet. I am hoping that writing this, getting it all straight in my mind, will help me move past it. Never forgetting, but accepting my mistakes and learning from them, so I don't fail other pets in the future.