This scenario is complicated by the idiosyncrasies and mores of veterinary medicine. Unlike human medicine, which is replete with tomes of data steeped in decades of experience, our veterinarian counterparts often are left with gaping treatment holes and inadequately studied interventions. This is not a knock against the profession. In fact, I have had nothing short of fantastic experiences with the veterinary professionals with whom I’ve interacted. Rather, there just aren’t prospective, randomized, controlled trials to inform whether intervention will enhance Hogan’s quantity and quality of life.

Then there are the economic realities of the situation. As one who has rarely been ill and always been insured, I was staggered by the cost of medicine for the uninsured. Two-hundred-dollar antibiotics, $500 ultrasounds, $1,500 CT scans, and up to $10,000 operative and surgical ICU stays would have invoked, “you’re joking, right?” exclamations from me prior to this experience. Now they are just another variable that complicates this already emotionally complex discussion—the variable that makes you feel hollow inside for considering it, foolhardy for not.

Questions Abound

What price would I pay to have another few years with my best friend? What if it’s only a year, six months? Would the money be better spent funding my child’s 529 account? What if this is a benign process and intervention is for naught? What if this tumor is metastatic and intervention is futile? Should we spend the extra money on an upfront staging CT scan that has much lower sensitivity than those we routinely utilize?

If we intervene, should we attempt a costly, CT-guided biopsy to rule in malignant disease, or go straight to lobectomy? What if the surgery negatively alters his quality of life? What if he dies on the table? What do I know about the surgical outcomes of the two centers I’m considering? Should we attempt an open or laparoscopic approach to this tumor?

Can we achieve a cure? If we do, what does that mean for a dog in the twilight years of his life? Should we just let the disease progress to its natural endpoint?

What Would Hogan Want?

These are the questions that haunt me. As I stare into Hogan’s eyes, a portal to my companion’s soul, I am tormented by the cauldron of emotions, the indecision bred by incomplete information and the guilt that comes from knowing that Hogan unconditionally trusts that I will do what is right for him.

Will I? My eyes continue to ask Hogan what he would want until finally the answer becomes obvious.

Hogan wants his breakfast. TH

Dr. Glasheen is associate professor of medicine and director of the hospital medicine group and hospitalist training program at the University of Colorado at Denver.