To Keep in Comfort
Gus, our 16 year old cat, has been dealing with chronic kidney disease for a long time. This means that he's constantly in some degree of dehydration and not excreting the waste products in his blood very well. This also means that even though we've taken him off of all dry food, even though we mix copious amounts of water into his wet food and give him a laxative twice a day in his food, these sorts of episodes can still occur.
The vet offered hope. Besides the enemas they suggested we could take home and do ourselves, we could also give the cat fluids 2-3 times a week, subcutaneously, at home. All we had to do was learn how to do it.
Being that I am extremely attached to Gus, I decided to put on my big girl britches and give it a try. On Saturday a very friendly vet tech showed me how to do it. I made my first puncture-- right through Kitty, getting something like a small fountain of saline trickling onto his fur. Oops! No problem, the vet reassured me. It's just easy-peasy... he did the next poke, we got some fluid into Gus, and I was emboldened to do this at home. He made it look so easy.
It is NOT so easy at home. The first time we tried it, again with the Kitty Fountain. The next time I poked him, nothing. The drip wasn't moving. I did it again, and somehow, with me squeezing the bag and Joe holding onto Gus with a death grip, we got some fluids in him.
Last night, however, was just plain demoralizing for everyone. First poke. Nothing. No flow. Double-checked the lines. No kinks, just that the needle must not be in the right place. Second poke and a MEOW! Okay, bad. Third poke, and the same. Gus was fighting us, wanting to leave and probably curse us out. You know how cats can give you the worst, pissiest, "you betrayed me" look in the world? That was my cat at that moment. He knew, though. As soon as he'd seen the bag and the clear plastic tubing, he'd known.
I'd had to stop, last night. Gus is my companion. Not a pincushion. This was not working. I spent a little time last night crying with grief at what I am not able to do.
It's been a tough road for us with Gus in the past half-year or so. Last autumn, the vet noticed that he was losing weight rapidly. They'd put him on a an appetite stimulant which wigged him out, filled him up,and prompted a very expensive 'unstopping' procedure. He had fought the pills every time, sometimes to the point he'd throw them back up. When the vet insisted that the medication and dosage were fine, I dropped it by half, and was glad I did; a few weeks later he had a bad serotonin syndrome reaction and we decided that going forward, we'd do whatever we reasonably could to keep Gus comfortable, but no more pills. I had made my peace with this. Our other holisitic vet switched him to a regimen of Pepcid A/C (to quell the acid and the nausea it induced--ground up and mixed into his food), a natural digestive aid, and the laxative, and up until Friday, things had actually been fine. He was still losing weight, but maintaining in every other way.
Saturday, though, made me hope too much. If only. If only we could give him fluids (and here, I pictured a mellow cat in my lap, calm while I pushed the beveled needle in) things would be fine. And then, last night. Which makes me think this very important question:
What exactly are we doing, here?
One enormous problem I have with the medical field is that families aren't given the emotional permission or the mental space to feel okay with nature taking its course. There's always another hope, another possibility, another 'if you just do'....Even when my grandfather was dying and had kidney failure and dementia, he was diagnosed with cancer and doctors were suggesting chemo. At the vets, we are told, time and again, that cats come in for fluids sometimes two or three times a week and can live with kidney failure until their early 20s.
Where is the grace for families who have to make these hard decisions? No one mentions quality of life, only interventions. I could continue to poke Gus, but I know I am only going to end up with a cat who is miserable and distrusting. Joe's job is demanding and taking Gus to the vet for fluids multiple times a week is simply not possible. Once a week is the best we can reliably do. It's a hard choice, but I understand that if he is gone from his work and taking off early, regularly, he's less valuable to them and I appreciate that he's trying to support our entire family. And Gus hates going to the vet. The whole thing is a big pain in the butt for him and he just gives us that "eff off" look when we get home, for a little while. Goes off to his basement basket as if to say "screw you guys and your tricks. I'm pretty disgusted with you, right about now. Thanks for nothing."
We will go forward with trying to get him in to the vet for fluids once a week or so, we've decided. I feel okay with this, but also dismayed at the extent of options which are presented to us. We can keep our pets alive, but what if this is for longer than we should, perhaps? This is not a model of animal care I am used to. I am used to pets living their lives and when something which can be treated comes up, we take them to the vet. When it's something terrible, we can opt for surgeries, or we can opt to do our best to keep the animal comfortable and then have them euthanized when it is their time.
I am angry that I couldn't get the fluids/needle right, but also understand that this is not a perfect situation. If I did get it right, then what would that mean? We would have a cat who would spend the rest of his life dependent on laxatives and saline fluid. We already have limited options; we haven't traveled as a family since last summer, because someone has to be home with the cat. If we'd been gone when he'd had this last episode on Friday, if we'd been gone all day or overnight, he likely could have died due to an internal rupture. If we make plans to travel and he hasn't pooped in the past few days, then someone has to stay with him in case there's an emergency like this.
There was something simple about having pets not too, too long ago. I don't ever recall James Herriot suggesting subcutaneous fluids for pets in the books I read. I grew up in the age of "Old Yeller", where when the animal was sick, someone put it out of its misery. Now the perspective seems changed, that unless you are doing anything and everything to keep your pet alive, there's something wrong with you. You aren't utilizing the technologies. You aren't committed to your pet.
When I try to put myself in my cat's place, I don't think I would want this to go on for years and years. There is a beauty in knowing when enough is enough. When we first got him, he was sick, very nearly dying, and we did all we could. We tube fed him for six weeks. He cooperated. I had to pill him daily, and again, he cooperated. He wanted to live.
I'm not getting that message from him any more.
I'm heartsick about this. Gus is one of my best buddies. He was my snuggle-guy when I was home at the end of my pregnancy, his companionship is priceless. He is also a very proud cat, and hates having things 'done' to him. He just wants us to let him be. He's made that abundantly clear.
Wouldn't I want those same wishes respected? If I knew I was in some degree of bodily failure which was going to require intervention after intervention, which was not reversible in any way, I would likely want to live undisturbed until it got too much to handle, and then I would choose to let go. The idea of being kept alive against my will for the sake of others who can't let go would seem appalling.
I had a passing glimmer of hope last weekend. Too bright to be ignored, but when I truly contemplate it, I can't think that dragging this out for the next few years is going to be a good road to go down. So, we are back to where we were-- we'll do what we can to keep him comfortable and take the rest from there. I'll enjoy this time we have left together, just being snuggle-buddies who trust each other, and give him that gift of not forcing him to live on in a body which is failing.
We love you so much, Gus. My heart goes out to anyone who has had to make this sort of hard decision. We'll enjoy the privilege of the time we have left together--and it may still be a while, who knows?-- without making our love a burden for him.