Over the past week, I’ve Googled people’s experiences in knowing when it was time to say goodbye to their companion animals, and how to do so in a way that best supported the animal. My experience, while painful, turned out as well as could be expected given the circumstances. This is the first in a series of four essays I’m writing in the hopes they will help others facing the same decision.
In the wee hours of Friday, December 2, I had a nightmare: My 20-year-old black cat, Hedda, was having a seizure. Diarrhea was flying everywhere. Her green eyes stared at me, terrified, as her body convulsed. I was powerless to help her.
A few hours later, I was awakened by the usual 6am swat to the mouth that indicated Hedda wanted her medicine and breakfast. As usual, I argued with her as though she had a snooze button. Everything seemed fine. I rubbed a dose of transdermal painkillers on the inside of her ears, gave her a treat and got up to put fresh food and water out. Then I went back to bed.
Later that morning, I heard something that sounded like a single pop of bubble wrap. Hedda had thrown up in the closet. Then I saw—and smelled—droplets of brown liquid on the old flannel pillowcase that covered her heating pad. Her sides seemed to be occasionally heaving, and I slowly realized she was straining to empty her bowels, but all that came out were droplets.
My mind began spinning. The thoughts came so fast and from every direction that I couldn’t pay attention to even one. I texted a friend in Toronto, who has known and loved Hedda almost as long as I have. I blathered on and on to him, alternating between panic and total denial. I was heading to the vet that afternoon to pick up her food for December and a new, stronger painkiller. As usual, I’d set aside money for these, plus her food and her other medications, but I wasn’t sure I had enough money for my food for the month. And yet, of course I was going to take her; in 20 years, I had never put my own needs above hers… but still, I felt panicky. My friend, perhaps intuitively understanding what was to come, was both reassuring and practical. Call the vet. He asked me to keep him posted.
I called and made an appointment for that 3:00 afternoon. The vet tech who answered the phone said it sounded like constipation—Hedda was elderly, had mid-stage kidney disease, and she was on a synthetic opioid—and she probably needed an enema. Poor Hedda, I thought. Poor vet. Giving a cat a pill is bad enough. But at least that was straightforward. It would be rough, but she’d feel better and we’d come home.
I had some puppy pads on hand—insurance for when she missed the litter box, which had been happening occasionally. I covered the bed in absorbent pads and lay down with her. She seemed to be breathing a little harder than usual, but she was still insistent on getting her food and resting against my hand. Periodically, her self-healing soft purr turned into the freight-train purr that meant she was happy. I thought about giving her subcutaneous fluids, because she had thrown up—the bag was hung on the wall over her heating pad—but she had been protesting the needle even more than usual lately, and I didn’t want to cause her any more pain. I called the vet’s office back several times, not even sure what I was asking, but wanting to do something. I texted my friend to let him know what was happening.
A half-hour later, he sent me money to help pay for the appointment. I hadn’t expected that, yet the loan was a huge relief; I could focus on Hedda instead of worrying about money.
As the hours went on, Hedda became lethargic and, for the first time, disengaged. The bedroom reeked as she soiled more puppy pads, even with small droplets. She managed to pass a couple of small lumps of stool, which I took photos of and excitedly emailed to the vet. Maybe she wouldn’t need an enema, just…like, kitty Ex-Lax or something?
The hours ticked by too slowly. I wanted her to have help now. At 2:30, I prepared the carrier with a warmed pillowcase. A year ago, I’d sworn I wouldn’t subject her to the carrier again—a soft-sided Samsonite in rich brown leather, which had been the definition of luxe when she was a kitten—it even had a slot for a flip phone. Her arthritis had become so painful that forcing her legs into any position caused pain; as long as she had control of her position, though, she seemed okay. Even back in the summer, when I still had savings, I paid extra so the vet would make a house call for her checkup.
This was an emergency, though, and for the first time in her life—even that time when we had to go to the emergency vet at 2am— Hedda didn’t resist the carrier. She didn’t growl or hiss or cry, all her usual signs of pain. Not even in the cab as it curved, lurched and bounced towards the vet’s office two miles away.
A vet tech weighed her, and then the vet came in. Hedda was exploring her surroundings, more alert than she’d been, but walking oddly on her hind legs, which were splayed like a duck’s feet.
The vet stood across the examining table from me. Usually a warm woman, on this afternoon, she seemed more stressed than usual, and she spoke firmly, almost angrily, as Hedda explored the new environment. “This isn’t constipation; it’s diarrhea,” the vet said. I was confused, because there was so little, but the vet was certain. I asked what might be causing it. She didn’t know, but her guess was hyperthyroidism, a condition that affects many older cats. That would account for the voracious appetite, too—she was eating at least one can of Hills KD a day. The vet waved her hand in front of Hedda’s clouded eyes. “Is she blind?” she asked me.
“She tracks me,” I said. “Especially when I have toys or treats. And she looks out the window.” I strongly suspected that Hedda was simply ignoring the vet. It was a high compliment if Hedda didn’t ignore someone.
“She’s lost a full kilogram since June,” the vet said. My mind spun more; I didn’t know how to respond, but apparently I wasn’t expressive enough. “That’s 2.2 pounds, or a full third of her body weight.” I think I nodded. I don’t think she felt I was truly appreciating how drastic that was, but sometimes when I’m in emotional situations, my face becomes paralyzed. I don’t react visibly, but it doesn’t mean I’m not crumbling inside.
“What do we do?” I asked, and my voice cracked. She laid out the options of treating the symptoms without doing any tests, or doing blood and urine tests to find the underlying cause. Then she paused.
“Have you thought about euthanasia?”
In the past, I wouldn’t have allowed anyone to utter that word in the same room as Hedda. It was a cold, wet slap across my heart.
The previous fall, I had told the vet techs that I was not entirely opposed to euthanasia, but that I felt strongly that ‘quality of life’ should be defined on Hedda’s terms—not arbitrary indicators of whether she could still act like a younger cat, but whether she still wanted to be alive. Even if her pleasures were simple: Eating, watching birds out the window, snuggling with me…simply being, because I believe that’s the ultimate purpose of life: witnessing other expressions of consciousness, and experiencing the world through the senses. I didn’t know how to explain that I saw Hedda and me as equal expressions of consciousness, that I didn’t believe her life was mine to take, unless I was certain that she felt death would be preferable.
In the clinic, all I could do was swallow hard and reply, “If I’d been seeing what you’re seeing here—what we’re seeing—for a week, I would agree with you. But this is not what I’ve been seeing at home. This—“ I gestured to her hindquarters “—has only shown up in the past few hours.” The vet nodded in a way that I interpreted as half-grim, half compassionate. I burst into tears.
Her tone softened a bit. “People worry about doing it too soon. I want to tell you, it’s not too soon.”
I am grateful to her for being so direct. First, I have trusted this woman to tell me her opinion for a couple of years now (she has a 21-year-old cat herself). Second, after every round of tests, I’ve asked her, “What would you do if this were your cat?” I knew we were coming from different belief systems, possibly different definitions of ‘quality of life’ but even in my fugue state, she forced open a door I’d been keeping locked. We both were coming from a place of compassion.
“Let’s do tests, treat the symptoms, and see how it goes over the weekend,” I said.
“She may not make it through the weekend,” the vet replied in a soft voice. “She might go downhill.”
I blinked. Nodded. My brain wasn’t computing any of this. I knew that if anything happened, I wouldn’t be able to take her to the emergency vet. Was that what my nightmare had been about? But I couldn’t just kill her right now.
For a few minutes, I was alone with Hedda in the examining room. I stroked her and with a shaky voice said, “Hey sweetie. We’ll be home soon.” I lifted her onto the examining table so that I could hold her closer, and I repeated the line I’d often told her. “Everybody loves Hedda. James loves Hedda and Dianna loves Hedda and Susan loves Hedda and Phaedra loves Hedda and Valerie loves Hedda…” and I continued until I’d worn out everybody who had ever met her. “Everybody loves Hedda. Hedda is Love.” I placed her back on the floor.
A different, more brusque vet tech came in with a treatment cost breakdown. After she placed the estimate on the exam table, she looked pityingly at Hedda and said, “You know, my cats never disengaged, and they never stopped eating.” It took all my self-restraint not to say, “Well, maybe you acted too soon.”
To deflect her, I said, “I’m also trying to reconcile my spiritual beliefs—“ and she cut me off.
“Well, my spiritual beliefs are—“
“I DON’T WANT TO HEAR IT.” My body trembled with rage.
She raised her eyebrows. “O-kay.”
She left the room.
We think we know what decisions we’d make in a given moment, but that assumes we can predict what our mindset will be in such a moment, that our brains will be functioning at the same level as when life is flowing smoothly. That’s rarely the case.
I called my friend in Ontario and gave him a recap. I asked if my plan—test, treat, see what happens—sounded rational (and more importantly, compassionate) to him. My brain wasn’t working, and I needed help. He said yes.
I asked the kinder, gentler tech what I should do if Hedda crashed over the weekend.
“Wrap her in a blanket. Talk to her. Keep her as comfortable as you can.” My cheeks were wet as I nodded.
While they took her into the back to draw blood, I ran to a dollar store to pick up more puppy pads, and I called my sister. I packed up the prescriptions: probiotic paste for the diarrhea and anti-nausea pills, along with the new painkillers and food—this time, only a 10-day supply.
My insides were a jumble—like, a drawing a toddler might make if he only had a black crayon. On some level, I knew the end was near. Yet I felt that, in this moment, I was being pressured to euthanize, and I knew that if I did make that decision, it had to come from my heart, not other people’s minds. And my heart was very much not on board. I was also still hoping to get a clear sign from Hedda.
Like many people who share their lives with animals, I expected that Hedda would communicate to me when she was ready to die. If any cat and human have ever been more attuned to each other, it hasn’t been by much. After 20 years, I knew every facial expression, every body posture, every vocalization from “come watch me eat” to “it’s time for bed.” (Seriously, if I was in the office past 10pm, she’d come in and “yell” at me until I went to bed. Cat Lady, who?).
But I hadn’t been getting signs that she wanted to die. She still engaged with me, although her eye contact had been less frequent. The painkillers must have been working, because she went up and down her ramp beside the bed 20 or more times a day. I’d noticed that she was skinnier, despite eating a full can of wet food every day, but I admit, I hadn’t realized she was down to 6.6 pounds. That was half of what she weighed at age 12. I could feel every one of her vertebrae. The other biggest change was that she’d gone through a 30lb bag of litter in a month, whereas a year earlier, the same size bag had lasted three months. I attributed this to declining kidney health.
When we got home from the vet, Hedda went straight for the food bowl. Aside from a year during which she was diabetic and I had to monitor her food, I’d never been good at saying no…and she would give me no peace until I gave in. Which, when you work from home and hear the demands 24/7… it’s pretty easy to leave the food bowl out, just to keep her quiet.
While she ate, I put puppy pads all over the floor. Even though these were tiny droplets, I rent my apartment, and I didn’t want to find out how difficult it was to remove stool from hardwood floors. I placed a dropcloth on the rest of the bed. She found comfort in places that smelled like me, and pretty much the whole bed was her playground…and, that day, her litter box.
Saturday and Sunday
Hedda’s vomiting disappeared and, with the exception of two or three drops, so did the diarrhea. I had some feline antacid in the fridge, and I added that to her food. We settled back into our comfortable routine, though this time, I had some decisions to make.
Then I wondered: Am I in denial? If people I respect, including the vet and (whether or not they said it) a couple of my friends felt it was time, did that mean I was somehow ignoring clear signals that Hedda was already giving me? Or were they projecting onto me? Was I projecting onto them, or onto Hedda, or not at all? I was certain I wasn’t holding onto her for selfish reasons. I’ve been through devastating grief and loss before, and as awful as I knew it would be, I also knew I’d survive. Was I rushing to get it over with, because I couldn’t stand the anticipation? That would be selfish.
I decided that if the tests showed she was hyperthyroid, I wouldn’t treat it. I would adjust her meds to make her as comfortable as possible, but I was done trying to prolong her life. I knew we were, as my sister had put it with her dog, on borrowed time. But maybe we still had a month or two.
On Saturday, a client and his wife drove up to take me to lunch and talk about his manuscript. They are incredibly compassionate and understanding people, and I was able to talk to them about Hedda. I was away from her for a few hours, but from the time I returned that afternoon, until the following Wednesday, I was mostly glued to her side.
Saturday night, she burrowed under the covers with me and curled up against my stomach. She’d done this nightly for years, but I couldn’t remember the last time. Maybe four years ago? I didn’t—couldn’t—move, for fear of disturbing her. My shoulder and arms went numb, but I stayed still. This felt like it might be a sign.
By Sunday, I was in a fugue state. I went to the grocery store and stared at items without registering what they were. I left the stove on too long. I forgot my keys.
I was relieved at my (in)decision, though: She wasn’t in acute distress; I didn’t have to make a decision right away. I knew the end was coming, but the pressure was off.
Every so often, a wave of grief would rise up from seemingly nowhere. I’d go the bathroom and sob into my towels. There was a glimmer of awareness as I watched my emotions arise, release and subside again. I remembered that sadness was natural, that this was life, and it didn’t mean anything was wrong. It just hurt. A lot.
On Monday morning, Hedda began straining again. The probiotic paste had worked, but as soon as it was finished, her system acted up again.
The vet called.
It wasn’t hyperthyroidism. Her kidneys were still in mid-Stage 2 (of 4)—all other things being equal, a cat in Stage 2 can still live comfortably for several years. The special diet and phosphorus binder (Epikitin) were working. Her blood sugar, however, was through the roof. Her diabetes, which we’d vanquished with a year of twice-daily Lantus injections and a special diet, had returned with a vengeance. That explained the diarrhea, the vomiting and the urine output. She also had pancreatitis, likely tied to the diabetes, and there was almost no calcium in her blood.
The vet began talking about doing a test to confirm diabetes. I’d need to pick up a glucometer to test her blood sugar twice a day, as well as Lantus and needles. I was confused—I’d come to some peace over the weekend, and now I had to recalibrate. My mind was trying to calculate the cost of all this, while my heart was sinking through the floor at the idea of subjecting her to four skin pricks a day on top of fluids. She hated needles. I wanted Hedda to live as long as she wanted to be alive, but I didn’t want to put her through this.
Diabetes is different than hyperthyroid. Not treating diabetes isn’t really an option. Diabetic cats (like humans) can have seizures or go into comas triggered by low blood sugar. I remembered my nightmare.
“—But these aren’t my beliefs,” I heard the vet say.
“You believe…I should say goodbye,” I said, more a statement than a question.
My mind was that empty hamster wheel, spinning. “I can’t decide right now. Can I have a few hours?”
I still felt, on some level, as though I were acquiescing. I needed to find a way to make a decision I could live with for the rest of my life, one way or the other. And that meant taking time. Time I didn’t have.
I dug through my cupboard and found a packet of honey I kept “just in case” during the Hedda’s first go-round with diabetes. Thank god honey doesn’t go bad. I placed it on my bedside table. Just in case.
I wanted a second opinion. I wanted to find a holistic vet (despite the fact that this vet was pretty progressive). I wanted someone to talk to, which made no sense. By now, I was texting nonstop with six different friends and family members, all of whom I trusted, yet none of whom could make this decision for me. I watched Hedda follow the birds with her eyes, her ears pricked like a kitten. She swatted at her stuffed frog, then leaned against me with her freight-train purr. I couldn’t do this.
I Googled “how to support a dying animal” and found an animal hospice in California. They had a support line. I called. I cried. The conversation was not all that helpful—though it gave me an opportunity to hear how off-the-wall I must’ve sounded to other people. Mostly, the woman on the other end talked to me about taking care of her father’s dog—at least, that’s what I remember. It was odd, and a bit refreshing, to feel like I was being judged for considering euthanasia, rather than for not considering it. I needed that other extreme to help me find where, in the middle, my heart stood.
If I’d had unlimited means to provide complete palliative care—stronger pain meds, full physical and ‘bedpan’ support, a vet tech on call 24/7—I might have decided to try to help her live out the last month or two of her natural life. Or at least a bit longer. But I didn’t have unlimited means, and half-measures, in this case, wouldn’t suffice.
I called the vet and asked for a refill of the probiotic paste. I tried to make The Appointment but broke down crying. The tech gently said I should take some time. When I went to pick up the paste, a few hours later, I tried once again to make an appointment, but I couldn’t stop crying. The tech then said the most helpful thing anyone said during this entire process (and many people said many helpful things): “Take time to let your emotions catch up to your decision. If you don’t, it will take a long, long, long time afterwards. Much better to work through your feelings before, if you can.”
“Take time to let your emotions catch up to your decision. If you don’t, it will take a long, long, long time afterwards. Much better to work through your feelings before, if you can.”
I raced home to be with Hedda. I wanted every possible second with her. I talked to her, and I told her that she didn’t have to hang on, that she could let go if she wanted. Of course I’d miss her and I’d be sad, but I’d be okay…and she gave me a bright-eyed, curious look, as if to ask, “Can I have a treat?” This wasn’t helping.
In August, she’d had maybe one bad day a month. Then, by October, it was one bad day every two weeks, to every week, to days that were a blend of struggle and peace. In those last few days, after Friday’s trip to the vet, there were stretches of alertness and engagement, but there were also moments where she pressed her forehead down, or gave a soft cry when I touched her.
I still wanted a sign, at the same time I was wondering whether the nightmare was a sign, the illness was a sign, the vet’s comment was a sign, or her cuddling with me was a goodbye. And if she wanted to stick around, I needed a sign of that, too.
On Monday night, she stumbled and fell down the ramp. The next morning, I called the vet.