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.
Until Edie wrote about her hospice visit, I didn’t know such quality-of-life consults existed. Such an important service!
So sorry for you loss. We recently lost our English Shepherd from a sudden attack (vet said possible blood clot). Having to let go is hard, but when you have an animal that is suffering and you know you’re only going to prolong that suffering you have to do what is best for them. Very informative post.
Mason
Thoughts in Progress
When we found out about Bailey’s cancer (mast cell at the base of her tail), they originally recommended not only surgery but also radiation. I opted for the surgery (twice) but wasn’t about to put her through radiation, especially in that area. I still can’t quite get rid of the guilt for deciding on the second surgery, even though I know I did it for the right reasons, but I’m SO thankful that we didn’t do the radiation as we (I, my husband, her vet, and her specialist) were completely unaware of just how little time she had left with us. I think that, as long as pet owners make their decisions from a place of love, no one should judge, ever.
An excellent article – my biggest takeaway was that I – that is ME – need to be proactive in ASKING what my options are and ACTING upon what my vet and my gut tells me is right for my beloved pet. Our pets give us so much for so long; they deserve to be treated with the SAME respect and care that any of our people friends would get from us. Thanks so much, Dr. V for telling the layman just what they need to do/say/act.
Well written post — my takeaway was that A-B-C does not stand for great owner – OK owner – awful owner. We really shouldn’t feel guilty about choosing quality over quantity of time. You helped hit this point home.
What an awesome article. Not so often spoken about subject of end of life care for pets. Thanks for such a well thought out and empathetic perspective.
I am so sory for you loss. I have been in your shoes in regards to the sudden death to the long treatment situation. I had a beloved cat die right at midnight on Christmas eve. Yes, my husband found her before any of the children did! Thank you so very much for a great article. Having been loved by over 10 different furchildren, I have gone down this road each time. And you were spot on about “good owner, bad ower, worse owner”. To me, it is as simple as quality of life. And now, one must also factor in money. I had a wonderful, young (5 years old) cat that had kidney failure. We did everything, including me giving her sub-q fluids for 2 years and 11 months. Up until the day before she died, she was playing, eating and purring. The cost was unbelieviable. My vet was wonderful as was the ER animal hospital that she ended up in a few times. As you said, I wish death was discussed more openly. I talked to the vets everytime about quality of her life. Only two made it clear that they would be “disappointed in my decision” if I didn’t continue on with her treatment. I made sure that I didn’t have those vets treat her again. You are the right person in the right job at the right time. Love your blog and keep going! I read everything you write. My thoughts are with you and Apollo. Your furchildren are lucky to have you as a mommy. I will give all mine a super hug with thoughts of you and yours.
Another excellent post, Dr. V. I know it was difficult, but as a fellow vet I believe you made the right decision for Apollo. I absolutely agree with you that sometimes the best thing for our pets is to preserve end of life quality instead of throwing everything in the book at them. I actually just wrote my own blog post about this subject and I too use the terminology ‘Option A,B,and C’ when outlining possible treatment plans for my clients. (http://drttales.blogspot.com/2013/10/to-treat-or-not-to-treat-making-right.html)
We have a house call/hospice vet in my area who has done such a great job with this new ‘specialty’; providing a much needed service to my end of life patients.
I’m so sorry for your losses, both with Apollo and Kekoa . Thank you also for this article… We lost our kitty in late May, and we faced a decision that was tough… The specialists offered to fight with every option, but we knew that the cost of the treatments and the likeliness of a good outcome (or her even surviving) weren’t great. We chose to let her go, and we both faced a lot of guilt for making that decision. It’ll never stop hurting, but it helps to have someone who sees situations like this a lot say that it’s okay to place the quality of life above the ability to just survive.
I had to take some time before reading this because, like you Dr. V, I’ve been through too many deaths recently. I’ve experienced the long, painful, drawn-out death (which was only 8 weeks, but still comprised of daily assessments and wondering “Is this the day?”). I’ve also had the sudden failing, with my beloved Brianne, and I still feel the pain of that rushed decision – though I know it was the right thing at the time. We had the option of 1) maybe another night, but in the hospital with supportive care, and 2) letting her go that day, because the most time we could buy her would be a week or two. It was a devastating decision, but I appreciated our veterinarian working through the options with me, giving me her recommendation, and then supporting me in my decision. It was also devastating to say goodbye after two months of fighting, but I knew it was time to stop fighting, for my kitty’s sake.
It’s never easy to lose to a pet, but having a veterinarian who can help you through the painful process, offering support, advice, healthcare options, and everything else that goes into it, is invaluable.