Cherishing the Final Days

Just before Christmas last year, when Cole started showing less interest in his food, I chalked it up to one of his normal periods of inappetence. But when he didn’t bounce back in a day or two, and I noticed I was filling his water bowl at an alarming rate, I knew something was wrong.

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What I Learned About Hospice from Caring for My Terminal Cat

Cole was a ten-year-old black cat whom I had adopted from a local rescue after he’d been found locked in an abandoned apartment. When I brought him home, we instantly bonded. As my constant companion over the past two years, his daily activities included sitting on my keyboard at the most inconvenient moments and randomly typing messages into the Zoom chat during meetings. Cole was FIV positive with a history of brief bouts of inappetence and diarrhea, but he was well maintained on daily interferon and probiotics. Except for his short-lived low periods, he was a robust eater who harassed me with relentless meows around mealtimes.

Just before Christmas last year, when he started showing less interest in his food, I chalked it up to one of his normal periods of inappetence. But when he didn’t bounce back in a day or two, and I noticed I was filling his water bowl at an alarming rate, I knew something was wrong. I scheduled him for blood work and radiographs. I desperately hoped whatever was ailing him was treatable, but the night before his appointment as I was petting his side, I palpated a misshapen mass in the area of his kidney and feared the worst.

The first lesson I learned was that blaming myself only impeded care and did nothing to help Cole.

As veterinarians, we’re often faced with the difficult task of telling a client that their beloved pet has terminal cancer. This will hopefully lead to a frank discussion about what is best for the pet—chemotherapy, palliative care, hospice, or euthanasia—as we assist our clients and patients in navigating a difficult time. This process is no easier when it’s your own pet.

As veterinarians caring for our own cherished animal companions, we can sometimes find it hard to put aside feelings of guilt and self-blame about not catching the condition sooner or choosing hospice over aggressive palliative treatment. When Cole became terminally ill, I battled feelings of grief, recrimination, and helplessness as his condition worsened while also striving to give him a good hospice experience and, finally, a peaceful passing. During our last days together, I learned some valuable lessons that helped me care for him and address his physical, emotional, and social needs.

1. Self-Blame Doesn’t Help Anyone

The first lesson I learned was that blaming myself only impeded care and did nothing to help Cole. Rather, it took my attention off him and focused it on myself at a time when he needed me the most.

At the clinic, Cole’s radiographs confirmed bilaterally enlarged kidneys, and his blood work showed concerning elevations in BUN and creatinine. His white blood cells, always borderline low, had dropped precipitously as well. A presumptive diagnosis of renal lymphoma was made—a guarded, ultimately deadly prognosis even without the added complication of FIV infection. I made the heart-wrenching decision to take him home for hospice care. On the drive home, I mentally berated myself for not noticing the signs of his illness sooner.

Cole_2.jpgOver the next few days, it was impossible not to let thoughts of blame creep in as I wondered whether I had made the right call to forgo chemotherapy for hospice care or why I hadn’t noticed his polyuria/polydipsia sooner. For many people who live with pets, these types of thoughts are not uncommon, although they may take on an added dimension for veterinarians. We have the knowledge, training, and tools to make the right decisions for animals, and when we feel we don’t, it haunts us.

I adopted some strategies that helped me break the cycle of self-blame and be wholly present for Cole in his final days. First, I realized that blaming myself was a way of deflecting the pain of the situation, by engaging in “what if” scenarios instead of dealing with my beloved cat’s imminent death. In order to properly care for Cole, I had to let go of these thought patterns and embrace the reality of losing him. I had to be fully engaged in the moment.

Second, I centered his experience rather than my own. I realized that the guilt and recrimination I was caught up in were self-involved behaviors that did not benefit Cole in any way. Instead, I chose to prioritize his comfort and feelings over my need to dissect every decision I had made.

2. Prioritize Comfort with Medications

Cole’s medication regimen on hospice included Cerenia for nausea and vomiting and mirtazapine for appetite stimulation, but it quickly became not enough. He soon stopped eating entirely. When he was presented with food, he would lick his lips and gag. Ondansetron and famotidine were added to his medications, and he started eating again shortly after the first doses.

Humans experiencing end-stage cancer often report pain, and animals are no exception.

I realized I had to relinquish perfection and prioritize comfort. As Cole became increasingly resistant to taking pills, I had to decide which medications were doing him the most good and forgo the rest.

3. Don’t Forget Pain Management

Humans experiencing end-stage cancer often report pain, and animals are no exception. To control his pain, Cole received buprenorphine twice daily. Though it became evident that he felt worse as he neared the time of his euthanasia, I realized it was important not to let consistent pain management be overshadowed by other issues like nausea and weakness. I also discovered a renewed understanding of the importance of regular reassessment, as Cole’s condition and attitude changed rapidly from day to day or even over a period of hours.

4. Fluids, Fluids, Fluids

Although he was known as a somewhat feisty cat in the clinic, Cole tolerated subcutaneous fluids well at home, and I gave them twice daily for the duration of his hospice care. I noticed a marked improvement in his demeanor after fluid administration. While not all cats may tolerate receiving subcutaneous fluids, this treatment was an important aspect of Cole’s care and subjectively seemed to improve his overall hospice experience. Cole had received a new laser pointer for Christmas (he loved playing with them), and he found some energy to briefly play chase with the laser after a couple of fluid sessions.

And that’s another lesson learned—don’t be afraid to offer your pet a treasured toy or game. I didn’t want to pressure Cole to do anything that would sap his energy or make him feel worse, but he was interested and engaged in his laser pointer game and was able to choose when he wanted to start and stop play.

6. Pause, Breathe, Cherish the Moment

The final lesson I learned was not to neglect my own self-care. Take a moment. Meditate. Stand in the fresh air and sunlight. Drink water and eat healthy food. To be a good caregiver for Cole, I had to be calm and healthy. I didn’t want to our final days together to be any more stressful than they had to be. I wanted to be the best version of myself for Cole’s sake, so when he decided he wanted to rest in my lap on the kitchen floor for over an hour, I could be there fully and unquestionably for him.

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Ingrid L. Taylor, DVM, is a veterinarian who has worked in general and emergency clinical practice and public health. She is the technical content specialist at AAHA.

 

Photo credits: Photo courtesy of Ingrid L. Taylor

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