Seven days ago, we said goodbye to our very sweet 12-year-old Goldendoodle, Einstein.

A few weeks ago we noticed that he was having trouble maintaining his balance, his back legs sliding out from under him. A week after that, he had a seizure. It was traumatic for all of us. We took him to the emergency vet who offered admission, sedation, MRIs, and continuous IV anti-seizure medications. I sat in the sterile confines of the vet ER office with my youngest son, wearing our best ratty workout clothes (me) and PJ pants (him). With tears in our eyes, we embraced each other. “But what would we even do with that information? Keep him on medication? Put him through surgery? Prolong his suffering?” After a very compassionate and patient discussion with the ER vet, we decided to take him home with a focus on comfort and hopes that we could nurse him along for one more week so my husband, who was out of the country for business, could see him one more time. We arranged a family FaceTime so our son in Indiana, our daughter in Colorado, our younger sons in Kansas, and my husband in the Philippines, could all talk about our plans for Einstein and get to see him on video one more time. We all cried together and were all in agreement that we would focus on his comfort but not prolong any suffering. So my younger sons and I hand-fed him and carried him outside to lay in the sun (which was his favorite thing to do!). He began to drink more water and slowly started acting more like himself. Scott came home and we were hopeful that he was getting back to his baseline.

Then suddenly, he had another seizure. I rushed home from work, we cried together (again), and wrestled with what to do next. Ultimately, my youngest son, Sam (13), who was the only family member to have witnessed both seizures, said through tears, “I don’t ever want to see that again.” It was clear to me at that moment. Sam witnessed Einstein’s fear and suffering and he expressed that it was not fair to continue to allow it. We called the rest of the kids and made the hard, but peaceful decision, to proceed with letting Einstein go.

We took him to the vet where we were met with incredible compassion, dignity, and patience. We were led to a special quiet and comfortable room, replete with nice chairs and boxes of tissues, where we fed Einstein chicken nuggets and rubbed his head while the team prepared everything. We were able to stay with him until the very end, loving on him and telling him to have fun in heaven.

We came home and called some family and friends to let them know we had to say goodbye to our sweet Einstein. Everyone reassured us that we made the most loving and compassionate decision for him. Einstein lived a good life, full of walks and tennis ball tossing in the backyard. And then he died well. Peaceful, with no suffering.

While saying goodbye to a dog is hardly the same as saying goodbye to a human, I think we can learn a few things about navigating the natural process of dying from Einstein.

Unfortunately, in my line of work as a trauma surgeon and surgical critical care physician, I see death all of the time. Sometimes sudden, sometimes slow and expected. Always emotionally difficult for all involved. I have seen the spectrum of thoughtful decision-making that honors the process of death and I have seen the irrational choices made by family members who will not accept the truth of mortality and put their family members through days and weeks and months of suffering though we know the end result will be the same.

The patients and families who experience a good death are focused on comfort and dignity. In opening up the conversation about choices to be made at the end of life, I always stress the same few principles: 1. As the family, you are not choosing to give up, pull the plug, play God, or otherwise decide death. Your role, as the people who know and love the patient the best, is to be their mouthpiece. What would they want if they could tell us right now? 2. In medicine, we can do a lot of things TO a patient, but are we really doing something good FOR the patient? We should focus on doing things to bring comfort and aid, honoring the wishes of the patient, but refrain from doing something just because we can.

Every single one of us will die someday. It’s part of the human condition. I’m not fully certain what it is about American culture, but on the whole, I don’t think we die well here. We have a very myopic view, with our rugged American individualism, that we have every right to every resource regardless of the insult to public health at large, even if the chances of meaningful recovery are minuscule. As advances in healthcare prolong our ability to live with chronic illnesses which were once a death sentence (think: kidney failure (dialysis), lung failure (ventilator), heart failure (implantable devices to help the heart pump), I think we have lost some sight of what it means to embrace the reality of death because we have found ways to avert it for so long.

But when death is imminent, or seemingly imminent, I can tell you, what a good death looks like. It looks like a focus on comfort over a quantity of painful days; it looks like a family that is willing to have hard conversations together, to listen, support, and compromise; it looks like love and trust. In cases of sudden death, it looks like family and friends who have invested in healthy relationships over the years, so that even in the face of tragedy, regret over broken and battered relationships is minimized. It looks like making selfless decisions to bring dignity, comfort, and peace to the one who is dying. It looks like facing the fear of death with the knowledge that it is part of life for all of us.

Rest easy, Einstein. You showed us a good life…and a good death. We love you.

Disclaimer: My viewpoints are not necessarily reflective of my employer, or any local, regional or national organization that I belong to. As a matter of fact, I pretty much just speak for myself. Please keep that in mind.