Everything I know about a good death I learned from my cat
November 10, 2015 8:58 AM   Subscribe

 
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posted by Xyanthilous P. Harrierstick at 9:05 AM on November 10, 2015


most heartbreaking part of the whole pieceā€¦"Changing the tenses in this piece is a relatively simple edit; I cannot bring myself to make it."

. dottie
posted by ShawnString at 9:06 AM on November 10, 2015 [19 favorites]


I've had cats my whole life: I like cats. Right now I have one 7 year old cat.
If my cat gets sick like this, I would let her go much earlier: Living as long as possible is overrated & stingy.
posted by growabrain at 9:11 AM on November 10, 2015 [4 favorites]


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A dot for Dottie.

I will say, from the perspective of someone who has worked in emergency and specialty veterinary medicine for several years now, the ability/willingness/comfort level regarding end-of-life planning discussions is very inconsistent both on the part of veterinarians and their clients. In my experience it is especially hard for new doctors (I work in a veterinary teaching hospital) to broach this topic, but it is one that is so important for them to learn. Kudos to Dottie's vet.
posted by Rock Steady at 9:16 AM on November 10, 2015 [5 favorites]


My worry with my kitties is not that I will outlive them, but that they might outlive me since they are young and healthy and I am less so. So as part of my planning, I signed up with a "guardian" program at my local shelter. I have made a donation and they have agreed to take my girls in the event of something happening to me. They will keep them together and only adopt them as a bonded pair. I've let my family know this (they are not animal lovers and I wouldn't feel comfortable asking them to take the girls) and even put the instructions in my will (along with an additional donation). Not planning on pegging out anytime soon, but I feel better having a plan in place.
posted by agatha_magatha at 9:31 AM on November 10, 2015 [29 favorites]


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Poor kitty. Poor owner, too. I personally would choose to euthanize around the time of diagnosis, which is why I should probably never parent human children.
posted by theraflu at 9:33 AM on November 10, 2015 [3 favorites]


This piece made me cry. But I'm glad it was written. All the shit about death panels has to stop. It's so inhumane that our pets get better care than we do.
posted by FireFountain at 9:37 AM on November 10, 2015 [3 favorites]


"One of her favorite moods is murder."

This writer selects words very well. The proof is all over this piece. This is a good writer.
posted by valkane at 9:49 AM on November 10, 2015 [4 favorites]


At-home euthanasia is the best euthanasia. When one of my old cats had a sudden decline, I was really glad I was able to get a house-call vet I know to come and do the deed at home where the cat was relatively comfortable and not stressed out by travel and strange spaces.
posted by rmd1023 at 9:52 AM on November 10, 2015 [5 favorites]


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posted by Joey Michaels at 9:53 AM on November 10, 2015


Our old Roger-cat (his official name) had to be put to sleep this year. We don't know how old he was exactly; anywhere from 12 to 15. Possibly older. We were his third family thanks to divorces and deaths. He was with us for 6 years, I like to think we were his best family. He had been through various illnesses and several (very expensive) pulled teeth that meant he could only eat soft food, but he never got cranky; he was a Maine Coon who didn't know how to be angry at people. He was also probably inbred by some garage breeder, and so was a little dim mentally, and slightly cross-eyed. He could not poop inside his box to save his life so we gave up trying. But he was sweeter than most dogs I've had.

So we thought we were managing his old age fine, till he came limping into the bedroom one morning. Shattered a back leg somehow, probably jumping off the bed. Surgery would have not have made him whole but would have made him suffer. So we let him go.

I don't think I'd ever consider chemo or shots or other similar measures; I worry about the kindness of keeping sick animals going. They can't tell you how much pain they're in, and cats especially will try to hide it. I tend to err on the side of early euthanasia with animals for that reason. My thoughts being, all the dread and fear and sorrow is on my side, they have no conception of their own deaths. But they do have the pain, and I don't want to sentence them to suffering just to spare myself.

Either way, it's a terrible responsibility to be the one who has to make that call.
posted by emjaybee at 10:03 AM on November 10, 2015 [13 favorites]


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In case anybody, like me, needed something like this after reading that, here is Cassidy, who was rescued from a feral colony with missing back feet and who nearly didn't make it, demonstrating how cats with special needs can still enjoy a good quality of life and also BITE YOUR FACE RAR.
posted by Sequence at 10:17 AM on November 10, 2015 [4 favorites]


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At-home euthanasia can also help in an multiple-cat household, by showing the other cats that their companion has gone. That seemed to partly work when our Erasmus had a reoccurrence of leukemia and we finally came to the decision that it was time.

But not completely. Afterwards, one of his daughters would often stand at the door, waiting for him to come back, as he had every previous time when we took him for chemotherapy. It wasn't until we moved house that she stopped waiting for him.
posted by metaquarry at 10:37 AM on November 10, 2015 [5 favorites]


This was a lovely article, but in a way I don't see how this vet care differs from a lot of human care. Yes, the vet communicated options well, but I do feel the vet (often like human doctors) strung out the life of this poor cat much too long. Prednisone is really harmful over the long term, along with the chemo and other drugs (and the likely rehydration via IV drips that that I'm assuming were often needed, though not mentioned). A lot of suffering to keep a sick cat going. And to die 70% less than her normal weight. Though I may be wrong but had the owner done nothing, the cat may have lived a year less but much more comfortably and died at a time it chose. I own both cats and dogs and have always found intense medical intervention has always been easier and better with our dogs as they like going to the vet and put up better with whatever intervention is being done. When our cats get sick, we've decided it's best to do the minimum to keep pain minimized and let nature take its course.
posted by SA456 at 10:49 AM on November 10, 2015


I'm not sure the decision of when to end an animal's suffering should be analyzed by how much it minds going to the vet. Cats are going to lose in that equation every time for reasons that are not necessarily related to pain. Or, from another angle, dogs are going to lose every time because of their tolerance for people, not pain.
posted by maryr at 10:56 AM on November 10, 2015 [5 favorites]


Sequence: "here is Cassidy, who was rescued from a feral colony with missing back feet and who nearly didn't make it"

I've been talking with another MeFite about Cassidy, whose vet is apparently consulting with an orthopedic surgeon at my facility about possible prosthetic implants.

SA456: "This was a lovely article, but in a way I don't see how this vet care differs from a lot of human care."

The fact that there even was the possibility of an end-of-life decision is markedly different from human medicine, but perhaps you are in a jurisdiction where euthanasia is legal?

SA456: "Prednisone is really harmful over the long term"

One good thing about palliative care is that you don't have to worry about the long term.
posted by Rock Steady at 10:56 AM on November 10, 2015 [10 favorites]


I love animals. It is really hard for me to understand spending big money to prolong the life of a house pet. The first paragraph, describing chemotherapy for her cat every two days, left me at a loss, and I couldn't really get too much further. I just kept thinking about how much that must cost, and that there is a huge group of people on the planet who cannot afford that level of end of life care.
posted by Meatbomb at 10:57 AM on November 10, 2015 [2 favorites]


I don't know what kind of chemotherapy medication she had for her cat, but my cat's Chlorambucil is $40 for a month's supply (15 pills), delivered. My veterinarian explained that veterinary chemotherapy is palliative -- it's about managing symptoms, not trying to cure cancer. It doesn't seem to make him feel sick, or tired, it just made him stop having poop explosions every few days.
posted by amarynth at 11:05 AM on November 10, 2015 [4 favorites]


This was some elegant writing. I was afraid to read the article at first but am glad that I did. I had to euthanize my oldest kitty a few years ago and still remember the pain acutely. I had brought him to the vet because he was laboring to breathe. It happened quickly. He was fine one day and clearly struggling the next. The thing that kept me anchored was how kind the vet was. I don't remember what the vet said, but I do recall the gentleness in his voice. I have never heard that tone from a doctor when dealing with loved ones at the end of their lives.
posted by batbat at 11:05 AM on November 10, 2015 [1 favorite]


Maryr, that's true what you say. I'm just speaking of my own experience. The two times we did a lot of medical intervention for our cats, they were miserable and stressed every moment due to the vet visits, medicines, injections, and IVs, and it got to the point they wouldn't want to come near us out of fear. Their last months were misery for them. On the other hand, we had an 18 year old cat who became ill and we decided to nothing except the occasional rehydration when necessary.He lived comfortably and happily with us until 23 years old. It all depends on our assessment of their quality of life. And Amarynth, thanks for explaining the veterinary chemotherapy as an affordable, palliative measure.
posted by SA456 at 11:25 AM on November 10, 2015


SA456 - I should also make clear that I don't think you are a terrible person or cat-hater or anything like that. I may have been misreading what "intense medical intervention" meant (I read it as 'acute' and that isn't necessarily what you meant). I was also a bit het up at the prednisone comment because we had an older dog with a skin problem who's health was OK except for all of her fur falling out and her itching all the time, and I'm damn glad we had prednisone to ameliorate that. Yes, it cost some long term liver function, but she was a happier dog for it.
posted by maryr at 11:35 AM on November 10, 2015


I spent at least $4000 on my epileptic cat last year. We had been intending to use the money for a vacation, and when I thought, "$4000 for a week in Paris, or $4000 for more time with this cat?" - well. It was a no-brainer.

Yeah, I am very fortunate to have had the $4000 so that I could make that choice. But after years of sort of silently judging people who put their dogs through chemo and similar, I discovered that my decisions in a similar situation were not what I thought they might have been. I just could not fathom driving home from the vet without at least trying to get my beloved buddy healthy.

We had put him down about 15 months later, at only five years old, when the medication stopped working and the dosages necessary to keep him from seizing would have been prohibitively sedating and hard on his organs. So I got 15 months of Bananacat for my $4000, and I would make that same decision again every single time. I did meet lots of people in those 15 months whose epileptic cats were in much worse shape, who had been on a constantly changing cocktail of medication for years and still seized frequently anyway, and I would think to myself, "I would never go to those lengths." But I never thought I'd have a feline neurologist on my speed dial, either, so.
posted by something something at 11:36 AM on November 10, 2015 [18 favorites]


My aging father and I have frequent discussions about how he hopes and prays that when he does get "down like that" that the laws will have changed to where we can treat him like we would the family dog or cat.

Having put both a cat and a dog down in the last 5 years, as painful as that was and as much as I hope the next cat goes out on his own, I can safely say that I too, pray and hope that when my parents near the end of their lives that we will have the option, as a family, to think and act compassionately about death.

It's something that we need to seriously consider as a society and a culture.
posted by teleri025 at 11:38 AM on November 10, 2015 [4 favorites]


My mother has Alzheimer's and she knows her mind is going. She's not that far gone as these things go (I've seen and heard about far worse). But when she says to me "I wish I could just die," I have no idea what to do. She's healthy as a horse except for a touch of blood sugar problems, occasional UTIs, and the fact that her conscious mind is failing her. I've had to put down old cats before with kidney failure and other diseases of old age, and I hope to $DEITY that they didn't want to die the way my mother says she does on her bad days.
posted by immlass at 12:10 PM on November 10, 2015


immlass: ((hugs))

dersins: darn you all to heck for posting this. I was just getting over (I thought!) having to put my Fritzie down. You've now reduced me to a 300-pound blubbering mass again.
posted by pjern at 12:38 PM on November 10, 2015


Sigh... My two siblings are 17. These are the last of a too large indoor population. Started life on the side of the road where country road crew found them after the roadside had been sprayed. My two were the only survivors and we didn't hold much hope for a long life. I've had to put down too many cats and I'm not looking forward to these two.

Rudy and Sybil
posted by jgaiser at 1:04 PM on November 10, 2015 [2 favorites]


amarynth: "My veterinarian explained that veterinary chemotherapy is palliative -- it's about managing symptoms, not trying to cure cancer."

I have to disagree with that as a blanket statement. We have an Oncology service here at my hospital, and while they sometimes perform palliative chemotherapy, they are looking for lasting remission in almost all cases. Now, what "lasting" means is different in pets from what it means in humans - survival of 2 years is considered very good, but for many dogs, 2 years is a significant chunk of their lifespan.

There are many factors that should go into making decisions about advanced medical treatments for pets, and I've seen more than my share of decisions that should have gone the other way - clients who gave up on pets with very manageable conditions because of financial concerns or other issues as well as people who put their pets through grueling treatment regimens without a very good prognosis. I can think of a couple instances where a vet I worked with had to refuse to provide further treatments on an ethical basis. The vast majority of the time, vets are able to appropriately counsel their clients about when euthanasia might be the kindest and best option, but sometimes the clients can't or won't hear that message, and that's one of the hardest things to deal with in the profession.
posted by Rock Steady at 1:09 PM on November 10, 2015 [1 favorite]


Yeah, I realized as I was re-reading some comments upthread that I was probably applying something my vet said about this specific medicine and specific cancer to all veterinary chemo. Sorry about that, everyone.
posted by amarynth at 2:21 PM on November 10, 2015 [1 favorite]


About that last sentence in the by-line, I don't think cats or dog or any beloved pet (or person for that matter) is really entirely in the past tense while people who loved them are still alive. I lost my two favorite-to-that-point pets (including the best cat ever, Kitty Michaels) three years ago and they're still everywhere in my life. I still say hi to them whenever I see a rainbow.

The only thing - really, the only thing - that makes me hope there might be an afterlife and that I'm wrong about this world being the only world is the hope that I might get to spend just a little more time with them.

Kitty lasted about 13 months longer than predicted with his various medicines, but one day I decided that it was time to stop ruining his mealtimes by hiding pills in his food. He just didn't want to eat food with medicine in it anymore and eating was his great joy. So I just stopped with all the medicines (except for a maintenance medicine for hypothyroidism which went in his ear not his food). He started eating like a horse again and, even as he lost weight and slipped away, loved his meals and loved me and enjoyed not having to eat the shitty tasting medicine. I cried for three months when we put him down, but it was time and even then he didn't want to go. He just wanted to be with us and he had no idea anything was wrong, even though in his last 48 hours he lost the ability to walk or use the litter box by himself.

Anyhow, Grey Cat (in contrast) went from healthy to gone in about five days. Both of them were near 20.

Our three current wonderful kitties are young and healthy but I still sometimes get a twinge inside seeing them careening around the house like demons, knowing that this time is brief and glorious and that the sadness will come later. Much later, I hope.

I miss them terribly but don't regret in the least making the decisions to ease them off this world when the time came. The end is sad, but the suffering is worse.

---

here is Cassidy, who was rescued from a feral colony with missing back feet and who nearly didn't make it"

I have been following the TinyKittens cams since Metafilter linked to Eve and her little a few months back. Cassidy is a huge success story and watching his progress has been a joy. He's a little rascally monster and just the kind of cat I love.
posted by Joey Michaels at 3:17 PM on November 10, 2015 [5 favorites]


I feel like all the analysis and second-guessing of this cat's end-of-life care is a bit icky. Do people really think that they are in a better position to assess Dottie's quality of life than her owner and her vet? Just because the cat was clearly very ill doesn't mean she was miserable.

My parents have hung onto and cared for some quite sick animals over the years. In each case, the decision to euthanize or not has been based on the apparent quality of life of the cat or dog. They will provide whatever medical care they are comfortable providing for as long as the animal seems to be generally at ease, mentally sound, and able to enjoy some semblance of its normal daily routine. This has led to some rather tired, skinny, hairless critters toward their ends, but always ones that are happy to see their people, be pet and played with, go for walks (even if they have to be shortened for the sake of flagging energy levels), etc. When they start going downhill fast, it's always been obvious that the end has arrived and it's time to say goodbye.

To me, this looks like the principle the writer was following with Dottie. She was clearly very sick and the writer acknowledged that the end was probably very close (which turned out to be sadly more true than she knew when she sat down to write) but I read nothing to say that the cat was miserable except when she was at the vet, which was something that the writer spoke of trying to minimize.

I find the whole cost of care argument a bit disingenuous, as well. Well and good to point out that those medical dollars could have been going toward a human in a part of the world with poor healthcare, but who here has ever been faced with the prospect of providing costly care for an animal and said "No, I think I'll donate that money to Doctors without Borders instead?" No. What people do is decide to take that money which they might have spent on their pet and just keep it. That can certainly be a very valid choice and on some level it's one that even very wealthy pet owners who care deeply about their animals make at some point, but let's not kid ourselves that that vet money was ever going to go to a human. Much more likely in this case, the human made some personal financial sacrifices in order to try and maximize the length and quality of life of a beloved non-human family member. Was it done perfectly? Who knows? Dying is messy and complicated, and animals can't talk. It sounds like she did the best she could with the information and resources at hand.

In tough situations like this, we do the best we can and try not to worry about whether we're doing a perfect job. Not all decisions can be made with perfect information, and not all decisions must be made with the goal of maximizing some narrowly-defined concept of utility. What the hell, people.
posted by Anticipation Of A New Lover's Arrival, The at 4:59 PM on November 10, 2015 [7 favorites]


You just don't know what you'll do, even when you're in the thick of it.

Our sweet smart ginger cat has been anemic since at least September and hasn't been responding to prednisone. As I write this, his red blood cell count is at 9%. Impossibly low. And yet this morning he purred and kissed me, and he just ate three dinners in a row. He is tired but he is alert and he recognises me. He is washing his face. In a few hours he will wake me up at some ungodly dark hour because he will be thirsty and I will stumble my way into the bathroom to turn the tap on for him, like the lovestruck servant I am. I will indulge his pickiness.

What is the more cruel choice? To give up on him, when he's pulled out of similar jams in the past? To give him a new prescription on faith? To take my specialist's advice to schedule a cardiologist and a blood transfusion to make sure it is safe enough to put him under anesthetic and take a bone marrow sample to get a more solid diagnosis?

I keep hoping he'll pull another miracle out of his crazy little butt. The fact that he's even awake and demanding things is a miracle at this point. I think he will tell us when it is time. At least his vets are excellent people, thorough and caring and totally mystified and honest about that.

(I really hope it isn't time. My shadow, my cuddlebug, my sneaky bastard.)
posted by sadmadglad at 5:21 PM on November 10, 2015 [9 favorites]


sadmadglad: They do let you know when its time. You'll know.
posted by Joey Michaels at 5:31 PM on November 10, 2015


Joey Michaels: Thanks. He just had a massive upside down purring session with belly rubs and chin scratching requested, so it seems to not quite be time yet. Test results, shmest results. The kitty abides.
posted by sadmadglad at 6:29 PM on November 10, 2015 [7 favorites]


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posted by radwolf76 at 7:01 PM on November 10, 2015


The best metric I've heard for state of the pet is the "Three A's" metric: appetite, activity, affection. If the pet has all three of those (well, "activity" means different things for a 19 year old cat than a 10 year old cat, but still), then you're in pretty good shape.

I knew Vague was on her way out, but she was still happily purring up a storm and being social and happily chomping on her tasty wet food, so I figured we still had all three A's going on. And then in less than a day she went from that to not wanting her food, not purring like usual, and not really leaving her favorite spot. So, then, we figured she was telling us it was time.
posted by rmd1023 at 7:01 PM on November 10, 2015 [3 favorites]


With Kitty Michaels we followed the three A concept also. The very told us to look for when good days out numbered bad days. I'm happy to report that he had many, many good days up until his final week. We make them as happy as we can and when that's no longer possible is time no matter how much we want to hang on.

Saying goodbye to Kitty was maybe the hardest thing I've ever done in my life, but it was also one of the best things I've ever done because I knew it was the last, greatest favor I could do for him. He was the best cat ever and he didn't deserve even one more second of suffering.

After he was gone, I picked up his tiny body and wailed from my soul. His bladder immediately released on me. Kitty had the last laugh after all. Good boy. Such a good boy.
posted by Joey Michaels at 11:49 PM on November 10, 2015 [4 favorites]


My aunt is dying of cancer. She was moved to hospice this week, 12 hours away from me. I hadn't cried yet, but I'm crying now.
posted by arcticwoman at 7:29 AM on November 11, 2015 [1 favorite]


We lost both of our kitties this year, and it was a month ago today that we had to say goodbye to the younger of the two. She was 10 and had been diagnosed with lymphoma in September. We had a month together after her diagnosis, with help of our great vet and his staff, who were so supportive and understanding. She was on prednisone, got fluids twice a week, and got some supplemental syringe feeding from me every day, and she had mostly good days....keeping her routine, eating some on her own, seeking us out for snuggles...even as she was clearly slowing down overall. Even with that, the turn for the worse was obvious.

That month of hospice gave us more time to love and be loved. I'm at peace with how we managed the process, though not yet with losing her. In time.
posted by percolatrix at 9:45 AM on November 11, 2015 [1 favorite]


This article strikes home. I had to bury my 13 yo Shirley just yesterday. Squamous Cell Carcinoma had grown from behind her tongue down her throat and she no longer purred, only gargled and choked.

As I repeated as much to myself as to my wife, "This is a good death and with any luck our passing will be as painless."

Still not ready to refer to Shirley in the past tense.
posted by endotoxin at 12:19 PM on November 12, 2015


We had to put down my kitty a week after my last comment here. He wanted belly rubs and purr sessions even on the last day when he had very little energy to spare. He never got grumpy or mean. What a sweet kitty. He could barely walk, but he still kissed me.

But oh, it was time. I finally knew. It was hard to see. Harder to do.

Thanks again for sharing this article. It helped.
posted by sadmadglad at 7:17 AM on December 5, 2015 [3 favorites]


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