MATTERS OF LIFE & DEATH // When is it time to "help Ubu along'?

Our dog, Ubu, is dying. He's almost 15, a lab-shepherd mix. We got him as a pup. He's been a wonderful companion for all these years, and in the last nine months he's taught me a lot about life and little about dying.

The muscles in his head have atrophied so that his skull is easily palpable just beneath his skin. He can no longer walk. He doesn't bark anymore.

Hearing? He lost that a few years ago, but was (back then) otherwise unbowed. Instead of asking him whether he'd enjoy a car ride, my wife learned to pantomime a driver's grip on the steering wheel. Once he saw the sign, he'd dart to the car, tail thumping, ears back. His natural exuberance has been a delight, though occasionally it has been a distracting annoyance.

Like many dogs of his heritage, he was an enthusiastic optimist. Any sign that a human being was heading to the refrigerator prompted his alert interest. All manner of conveyance pleased him. He'd sit in the back seat of the car, head out the window, his tongue dangling and a wake of saliva cascading onto the side of the vehicle. He loved boats, airplanes and cars.

A powerful swimmer, Ubu loved going to several local "dog beaches," where he chased balls and sniffed the competition. He never did master the art of retrieval. He would swim out, apprehend the ball in his powerful jaws, turn, swim back to the shore, then, as his windmilling feet touched the bottom, he'd lose interest and drop the ball some four or five feet away from his masters as they hollered at him. Finally, we'd roll up our pant legs and wade out to start the whole dance over again.

He was not an indiscriminate dog. He had his preferences and he was true to them, whether they be his affection for broccoli or his dislike of one or two of our friends. He couldn't be bribed. He never ate to excess and was about 97 percent house trained. He possessed a noble sense of who he was. He had a point of view.

Then one night last year, we awoke to hear him thrashing in the house. It was three in the morning, and he was in a room into which he rarely ventured. When I got the lights on, he had a crazed look in his eye. He was seizing and incontinent. I hauled him into the back yard, lay him down and tried to console him. He was not calmed. My wife, Cathy, came out, and the three of us lay in the grass, crying and naked. We were sure this was the end.

An hour later, he was breathing more easily and, after we cleaned him up, we brought him into the bedroom and took turns trying to sleep with him on the floor. Our dog did not die that night.

He had a terrible stroke, I think. He could still walk, but his gait was unsteady and his movements were awkward. He kept turning his head to the left. He soon became less mobile and finally was unable to walk. I thought maybe he'd live a week or two, but that was nine months ago.

Since then, he's educated me. I work as a cancer surgeon, and matters of death and dying are not altogether unfamiliar territory, but I've learned a great deal from my dog lately. Right now, he still eats enthusiastically and usually waits to be taken outside before urinating. He does not appear to be in pain, and he tracks our movements with his head and with his eyes. He has stabilized as noble wounded creature.

Should we "put him to sleep?" We talk about the matter each day. When friends visit they appear to group themselves into two camps. Some look uncertain, then finally wonder aloud as to whether he wouldn't be better off dead. Others seem to support what we're doing. They talk about a "natural death" with reverence and care. When I think about the natural death of an animal, though, I think of a dog going off to die. You come home and he's gone. Ubu is incapacitated to the point where he can't do this. We're not supporting him with a feeding tube or a respirator, but he wouldn't survive if we didn't bring him his food and water and keep him clean. I suppose he could stop eating, but he hasn't.

I sometimes see an interesting thing in the patients I serve. When a patient and her spouse are close, still in love with each other, a curious argument sometimes comes to light. The patient, knowing she has recurrent breast cancer, say, wants to have good quality time with her husband. The husband, knowing how bereft he'll feel when she's gone, wants her to endure any therapy so as to live as long as possible, even though the quality of that longer life may be poor.

It is a sweet tactical argument, really. They love each other but see the end of life differently. One wants quality and the other wants length. When it comes to Ubu, we seem to be in the length camp.

Are we being selfish by keeping our dog fed and watered? Would I want the same treatment? I often tell Cathy that she is practicing for me. I am only kidding slightly. I know that the renowned Washington columnist, Mary McGrory, said this to a close friend after she had a stroke: "It is worse than death."

It took all her energy to make that one simple statement. I have the sense that I'd like to keep living if I've got the support and still enjoy a little steak and potatoes, but I am not there and I won't know until I get there. By then I may not be able to signal my wishes or intentions.

We went to see Dr. Arthur Caplan, a well-known ethicist from the University of Pennsylvania when he came to town a couple of weeks ago. He talked about the "persistent vegetative state," Karen Ann Quinlan and Mary Schiavo. He implored his audience to have living wills and advance directives, surrogate health care decision makers and a clear understanding with doctors.

He didn't help me much with the 65 pounds of appetite that I have at my feet right now. Dogs don't talk, and they don't have living wills _ or much use for lawyers, unless they bite somebody.

A friend of ours, who grew up on a farm, thinks it is time to "help Ubu along." I wonder if his rural upbringing, with its earthy biological realities, makes it easier for him. Farm animals die all the time. But the practice of surgery, with its relentless effort to restore and prolong life, makes it hard for me to euthanize the dog. Without pain, how could I?

I met a young woman who seemed taken aback when I told her about Ubu. She has two golden retrievers, each weighing 90 pounds or more. I know she loves dogs in general and hers in particular. She did tell me that she had them in "doggie day care" two days a week.

"I know they love the social aspects, and I feel better when I get home from work and am too tired to take them for a run," she told me.

I said to her, "If you had told me this five years ago, I would have laughed. Now I know that we do things for our dogs that can be hard for others to understand."

Are pets surrogates for the close human bonds that we seek often and find infrequently? Some posit that it's so. I know that our dog is not in a persistent vegetative state. I know that he loves peel-and-eat shrimp. I know that my wife and I have stopped planning trips together, as one of us needs to be here all the time. This does not feel burdensome. When I see a healthy, active dog, I am drawn to her. I am reminded of a satisfying relationship with another living creature; it is a good memory. In the meantime we operate a canine hospice with satisfaction.

This morning when I got up, Ubu had his head up. He devoured some salmon, and his eyes were luminescent. I asked him one more time if I was doing the right thing for him. He looked at me with those beautiful brown eyes, licked his lips and had a sip of water. I feel forgiven.

Richard Karl is the Connar professor and chairman of the Department of Surgery at the University of South Florida College of Medicine, and the author of a book of surgical stories, Across the Red Line.