I’m getting Apollo’s ashes back this week. I still haven’t quite processed it yet, because his death lacked that months long painful preparation/ agonizing over a pet in the process of dying: The Infinite Hovering of the Big Hanging Clock. He woke up Wednesday morning, meowed for his food like always, and was dead 12 hours later.
Whenever you learn of a terminal diagnosis, that invisible countdown clock that all living beings share suddenly appears. And we know that it’s winding down, sooner rather than later, but we don’t know quite how long it will take. No matter how long it takes it always feels like no time at all, while also taking forever. In Kekoa’s case, 2 long months. In Apollo’s case, one unending afternoon. That hovering space between a good life and a good death is a painful, lonely place when you’re a loving pet owner trying to decide what is best for your pet.
It is, however, part of living with a pet, right? We know it happens, and with as much precision as science allows how a body winds down, so why aren’t we doing a better job of working through it?
It’s the way doctors- MDs and DVMs alike- are trained: here is how you cure. Here is how you preserve, prevent, delay, at all costs and to the last breath, we go down fighting. Play as long as you want, but the house always wins, in the end.
What are we fighting for again?
My grandfather wanted to die for at least a year before he actually did. He was very clear about this. He was done, his wife was gone, he had no interest in this world any more. I understood this. I respected it. The last day of his life, he lost consciousness and was rushed to the ER (which he never would have agreed to when conscious.) When he woke up, the doctors said they couldn’t find anything wrong with him so they were going to have him stick around for a while and be observed. He was so annoyed at this that, by what I can only assume is sheer force of will, he said, “NO!” and died. Sometimes, it’s ok to not want to fight.
Sometimes we want to, and we should fight. And in that regard, veterinary medicine has a dizzying array of weapons at its disposal, chemo and surgeons and radiation therapy. Here’s the truth from the trenches, though: most people don’t go that far. Good owners, loving owners, many people stop far short of doing everything, for a variety of excellent reasons. When looking at the inevitable certainty of death, the pendulum is swinging away from quantity of life to quality of life. Instead of preserving life at all costs, we preserve good life as long as possible, and then we accept the end. I like this. I am glad more vets are open to this approach.
I will support whatever decision you make
When I took Apollo to the specialty hospital after finding him down in the back end, I was almost certain of his diagnosis. Once I had confirmation from one other vet, I was 100% set that letting him go was the proper option. That is an educated decision based on my history with saddle thrombus and my personal beliefs, but if I were a non-vet client, I’d have been overwhelmed.
Apollo’s clock stood at 00:00:01. I knew this. I had no desire to fight for two extra minutes. The specialty hospital, doing what specialty hospitals do, assumed I was more of the “let’s throw the whole arsenal at him” camp because that is what most people who seek out a specialist want to do. I don’t blame them for that, but I did have to clarify “Nope, that’s not what I want.” As soon as the cardiologist confirmed my suspicions and also told me Apollo’s heart was enlarged, I knew all I needed to know.
I have worked with some exceptional veterinarians in my time; a couple who stand out to me tonight are an oncology resident in vet school and the cardiologist I met this month with Apollo.
They lay things out, clearly and precisely. “Your pet has this. Our options for treatment are A (everything), B (somethings), or C (nothing/palliative care.) The survival rates are this. I will support whatever decision you make.” Even though most vets really do feel this way, I wish we did a better job of letting clients know this, that A-B-C does not stand for ‘great owner- OK owner- awful owner.’
It’s actually a terrible choice of words; ‘doing nothing’ often really means “choosing not to pursue therapy and instead focusing on minimizing suffering.” That’s something. That’s huge. And clients shouldn’t feel guilty asking for that.
The Hospice Vet
If your pet has a terminal diagnosis, you have options. My friend Edie has written eloquently about her recent experience with a hospice veterinarian, and it outlines an experience I hope more people become aware of: The preparation visit. We do a great job of outlining a treatment plan for life, for managing kidney failure and cancer and liver disease, but when it comes to outlining a plan for death? Not so much. I have done these visits as part of my current work and it does so much to reduce the fear and anxiety of the unknown surrounding death.
Even if you don’t specifically use the services of a hospice veterinarian, most veterinarians can help you come up with a long-term plan if you ask for them to help. A hospice plan will help you determine several things:
- What to expect as your pet’s disease progresses.
- What quality of life means to you and your pet, which may be different than it is for someone else.
- What very specific occurrences are your signal that it is time.
- What tools are at your disposal for managing pain and keeping your pet comfortable.
Knowledge is power. Knowledge is peace. To all of you facing a tough decision, I wish you all three.