Initially, I thought that whether Zoe recovered or not, I would want to forget everything about these last days. But as soon as I reflected on it I realized I want to remember it all. I began writing some of this while I sat by her side.
I guess I first need to just write down the sequence of events, the answer to the question I've been asked many times: what happened?
First, I must make a disclaimer. I've left out the names of the vet hospitals we went to because the second one made the most compassionate exceptions to their policies to allow me to spend so much time with Zoe and to be so involved in her care. There is no way to express my gratitude to this hospital, and I would love to give them rave reviews, but no one should ever expect to be given the gift I was lucky enough to receive. Indeed, it would have been irresponsible for them to give this gift until I had proven while just visiting Zoe, following the rules, that I would not interfere with their work. I will share my recommendation with friends privately if anyone in the area asks, but it would be a betrayal to advertise this in a semi-public way.
Zoe vomited early (about 4:30am) on Thursday, May 8th. She seemed to be okay though, so we went back to sleep. When I woke up later in the morning it was clear that she was feeling pretty lousy, and luckily our normal vet had an appointment available later that morning. Zoe stayed there Thursday until about 4:30pm, when they had me transfer her to one of the 24-hour vet hospitals in town. She spent Thursday night there, and I managed to get a little bit of sleep at home, since she did not appear to be deathly ill. On Friday morning the vets at that hospital decided she needed an ultrasound. We believed she had eaten something bad and had developed pancreatitis, but before treating her for that we needed to rule out the possibility of an intestinal blockage. I had to take Zoe to another emergency vet hospital to get the ultrasound.
I was called back to that hospital early that afternoon, and they explained to me that Zoe must have eaten something toxic. We still don't know for sure what it was, but we suspect it was a poisonous plant at the Douglas Family Preserve, where we take off-leash walks almost every day. She was experiencing acute liver failure. Things looked very bleak, but under the vet's guidance we decided to proceed with treatment for several reasons: (1) she was so young, not even two years old yet; (2) depending on the type of toxin she ingested, dogs can recover from this kind of liver failure, even dogs in much worse shape than Zoe; (3) there were clear signs that her body was fighting and she was not ready to give up; (4) they had been able to get her pain under control, so the vet estimated that her level of discomfort was most likely 1 on a scale of 1-5 where 5 is the worst, and we would likely be able to keep her at that level or better most of the time with treatment; (5) after Millie's lifetime of expensive medical disasters, I bought veterinary insurance for Zoe quite a while ago, making even prolonged, intensive treatment financially possible; and (6) have you met Zoe? She is not the kind of dog you just give up on unless it is clearly in her best interest and experts advise you to do so.
So Friday afternoon they gave her a plasma transfusion to give her blood-clotting factors. I was very fortunate that the people at this vet hospital allowed me to stand by her cage and cradle her in my arms while she got the first transfusion, followed by more IV fluids and then a variety of tests to determine the transfusion's efficacy. She was awake and clearly comforted by my presence. Ultimately she responded well to the transfusion, so they immediately gave her a second one. I never left her side. I helped during most of the procedures, just giving the staff an extra set of hands. By the end of the day Friday, the hospital staff recognized that Zoe and I simply needed to be together and that my presence would not interfere with their ability to care for Zoe and their other critically ill patients. Indeed, they thanked me for being so helpful, so they made a very special exception to the rules and set Zoe up on a bed in an exam room, where I could sleep (theoretically) on a pad beside her. This brought me tremendous comfort, because we all knew there was a definitely possibility that she would die that night, and after losing Millie the way I did, I felt so strongly that I needed to be with Zoe if and when she died. Her heart rate was in the 40s (a normal heart rate for her would be three times that), and she was not able to maintain her body temperature. So I curled up next to her and spent the night with a hand on her back, monitoring her breathing, her body temperature, and her heart rate. I learned quickly that a particular change in her breathing indicated that she was about to urinate (she had little or no bladder control), so I could immediately clean her up and change the pad she was on.
We were all a little surprised and encouraged when she survived the night. I went home and slept for about two or three hours. Then the vet called and told me that Zoe's condition had been steadily declining since I left, and I should return immediately. When I got there Zoe was "stuporous," meaning that mentally she was basically gone. There was no life in her eyes, and she was hardly breathing at all. I sat with her, expecting to see her simply die right then and there, and trying to decide if it was time to euthanize her if she didn't die naturally then. The vet told me that there was still hope, so we started another plasma transfusion. Again, I was allowed to hold her for another two hours or so while they did the transfusion. During that time the life came back into her eyes, just a bit. After the transfusion was over, while we waited for the post-transfusion test results, Jackson came and took me to dinner, which was very helpful even though my anxiety began to climb any time I left Zoe's side. When I got back, she was very much mentally present and was doing much better. I sat with her for another hour or so before the vet came to tell me that they had decided to allow me to stay with Zoe overnight again. They got us set up on the floor in the exam room again, just in time for my mom to arrive (she had flown in from Colorado). When my mom walked in the room, the look on Zoe's face was priceless. She looked like a child who had stopped believing in Santa, only to have Santa walk through the door. With Mom there, I felt comfortable enough to run home and grab my tooth brush and a change of clothes, and then I rushed back to the vet to spend another night on floor with Zoe.
On Sunday morning the vet decided that Zoe and I could stay in the exam room both day and night, again disregarding so many hospital policies. Zoe showed some of the strongest signs of improvement that day. Her heart rate was holding steady in the 80s, she was able to maintain normal body temperature on her own, and she was able to maintain her blood glucose level with half the supplementation she had previously been getting. She was very present mentally. She slept most of the time, but she looked and acted very much like her normal self when she was awake. She was able to change her position when she got uncomfortable, and she even stood all the way up at one point. She seemed to be comfortable most of the time as long as I was able to get her cleaned up right away any time she urinated or defecated, and she seemed to be mostly just annoyed to be hooked up to so many tubes and wanted to be close to me. At some point during the day on Sunday I managed to run home and take a shower while my mom stayed with her, but I could not stand to leave her any longer than that and I rushed back to the vet ready to spend my third night there. Even though she was showing signs of improvement in some ways, she was still not producing her own clotting-factors, and she was bleeding in her digestive tract, meaning that she was relying entirely on the plasma transfusions. Another problem was the buildup of toxic substances in her colon, like ammonia. To try to counteract that, she had to receive medicated enemas on a regular basis.
Around 12:30am on Monday I assisted the vet in administering another enema. Basically the vet put in the medication, and then I monitored Zoe closely for 20 minutes before it was removed. Something changed drastically during this time. After maybe five minutes she became extremely distraught and uncomfortable, and she urinated and released a lot of digested blood. I stepped out the door to call for help, and in that moment Zoe actually pushed out the enema and began crawling toward the door. The nurse came running and we began to clean Zoe up. She began to vomit, so I held her with her face tilted down so that the vomit would come out of her mouth instead of going down her trachea and choking her. With my hand on her chest I felt her heart begin to race. The nurse unhooked her from all of the machines, scooped her up, and told me to stay put for a minute while she took her to the ICU where they would have access to anything they might need. As I waited, I was convinced that this was the end. But the vet came in a few minutes later and told me--shockingly--that she was very encouraged by all of this. She explained that while it was very alarming to see such a sudden change in Zoe's condition, and to see Zoe in such distress, this was the first time that Zoe was responding to her situation the way that a normal dog would. When I felt her heart rate shoot up, it shot up to about 160, which is normal for a stressed and upset dog, and then it slowed and hung out between 120 and 130, which is exactly where it should be. She was also even more mentally present than ever. That meant she was in a lot more pain, and the vet explained that this, too, was a good sign. For most of the previous maybe 36 hours she had been on an incredibly low dose of pain medication. She hadn't needed more than that because her nervous system was hardly processing pain. So all of the sudden, in terms of her heart and her brain, Zoe was a normal dog. And since she had been on so little pain medication, there was plenty of room to safely increase the dose. Within ten minutes they had boosted her pain medication and gotten her comfortable again.
Even though it ultimately was a sign of Zoe's increasing strength, what happened at 12:30 that morning terrified me. I didn't need the vet to tell me that she was in more pain than she had ever been before, and I was shocked and horrified to see her in such a terrible state. This made it clear to me that she needed to be in the ICU with the vet and the nurse, and I needed to sleep. It took a couple hours for the adrenaline from that moment to wear off, and then I crashed in the exam room where Zoe and I had been staying, and I slept for about three hours. During that time, Zoe apparently slept peacefully and comfortably, doped up on plenty of pain medication. The nurse even took a photo of her looking so peaceful and sweet.
At about 5:30am (Monday, 5/12) the nurse woke me up. Zoe had just taken a hard turn for the worse. When I got to her I could tell she was bleeding much more than she had at any other time, and she was very uncomfortable. I needed to authorize another transfusion. I hesitated. Fortunately my mom was there to help me process the information the vet was giving us and to help me make decisions. The vet said that it would not be unreasonable to let Zoe go at that point, but that there was also still a chance (perhaps 10-20%) that she would make a full recovery if we continued. So we increased her pain medication further and went forward with the transfusion. I held her in my arms through the transfusion once again, but we were not able to keep her comfortable. She seemed to be able to rest comfortably for 3-4 minutes, but then she would begin to cry and more blood would come out. By the time the transfusion was over it was evident that it was not helping at all. For the first time, her body stopped responding to treatment. If pumping clotting factors directly into her body didn't stop the bleeding and make her more comfortable, nothing would. We spoke with the vet and we all agreed that there was nothing to do but deliver mercy. We immediately euthanized her. She did not fight it, as some animals do. She was ready to go, and she died in my arms in less than a minute.
I'm deeply grateful that I was able to see her through this process to the very end. I'm glad it was so clear when she was ready to stop fighting and that we allowed her to fight as long as she wanted to. I'm glad that the last thing she saw was my face and the last thing she heard was my voice telling her I love her and that it was time to let go.
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