“We’re running a cat hospice”
I hadn’t really connected the dots in that way until my wife said it out loud to friends. While I had been aware of it on an intellectual level, it was jarring to hear it framed in that way. Suddenly, we weren’t curing our 18-year-old feline’s failing kidneys or reversing her ailing liver functioning. Rather, we were making her comfortable, bearing witness, and waiting.
Waiting for the misery of living with those medical conditions to outweigh the quality of life she still derived from a cuddle on the couch or a sprawl near a roaring fire on a cold day. Waiting for her to stop walking, to self-isolate, to go outside and not come back in – any type of cue that we had reached a shift point in her health necessitating the decision that most pet owners are confronted with in the end: yes or no? Natural causes or euthanasia? Suffering or putting to sleep?
Regardless of how the question is framed, from it emerges a cruel paradox: pets, who are legally recognized as property with few rights beyond the right to be treated humanely, have more choices at the end-of-life than people, who (last I checked) are legally recognized as human beings with all the rights and privileges that come with being at the top of the food chain. Animals (through their health care proxy owners) are afforded enough freedom of choice to die with a dignity congruent with their health care situation (disease, health trajectory, personality, etc.). People, with only a few exceptions, are far more limited in their end-of-life decision making.
Apparently, when it comes to death, the less rights you have the more choices you’re provided.
There’s a part of me that wakes up each morning hoping to find Kali Ma peacefully nestled into her favorite blanket and not moving, having found a way to make peace with her body and let go. At the same time, I recognize the low likelihood of that happening due to the very nature of this vicious 6-pound package of willpower and intestinal fortitude. She has survived so many other incidents (eating poisonous plants, fighting neighborhood cats, etc.) that it’s hard to imagine her going gently into that good night.
Even now, she has been going through what I can only imagine is a rallying phase where she’s re-engaging with old routines and still – STILL – bullying our other cat who’s half her age and twice her weight. I joked with a friend the other day that some evenings we stare at one another and I imagine we’re having a psychic conversation wherein I ask her how much time she has left and she responds tartly “Screw you, Imma live forever” with the scratchy chain-smoking voice my wife and I long ago bestowed upon her.
So we wait. She mauls us when we attempt the subcutaneous fluids she needs to avoid the dehydration that comes with renal failure, loathes the low protein renal diet that she’s been prescribed, and largely refuses the pills she needs to stabilize her liver. With those options off the table, we are caring for her much as the caregivers I work with care for their dying loved ones. We prepare dietary supplements of milkshakes mixed with a phosphorus binder we hope will stimulate her appetite. We offer her favorite comfort foods of fish, fish, and (wait for it…) fish. We have adjusted the location of basic amenities like food, water, and litter to accommodate her restricted ambulation, and actively work to provide the most foundational of comforts by helping her to keep warm and providing plenty of affection.
And while we wait, our daughter is being provided the opportunity to tackle the concept of death head on. My parents lost both of their cats over the past year, which acclimated our daughter to the concept that living beings can be here today and gone tomorrow. We are careful to use words like “dying” and “death” so that the depth of those words are not lost in euphemisms, and this has in turn evoked questions about her own death and how people grieve the ones they love (her initial solution to help my parents with their own grief was “Well, we can give them one of our cats!”). We have also been careful to describe Kali Ma’s declines as a result of her body slowing down from old age rather than as a function of being sick – this has been to avoid our daughter from confusing her own common colds with Kali Ma’s system failure. While she may not fully grasp it, the distinction has been helpful for her understanding that what Kali Ma is enduring is something both natural yet distinct from most other experiences.
We have cried in front of her and allowed her to hear our expressions of pre-bereavement, and reinforce for her that it’s OK to experience a complex cocktail of emotion as this plays out. To that end most mornings she works hard in her play kitchen to prepare “water” and “food” for Kali Ma, and is learning how to provide physical affection and comfort to somebody medically fragile. The image at the top of this post was when she decided Kali Ma needed a friend to sleep with. I don’t know how the kiddo will respond when Kali Ma does die, but thinking on it draws me to the movie Inside Out and its ultimate message that grace comes from a fluid and fluent movement across the full emotional spectrum.
End-of-life work for me has, more than anything else, been defined by the privilege of being invited to contribute to one’s final chapter. There’s an overwhelming sense of honor in having any role to play at such times, and I find there to be a beautiful existential flow when integrating with the aesthetics of a patient’s dying environment. The corresponding challenge is to divorce myself from that end-of-life setting so that I can reacclimate to my home environment that is defined by a different end of the life/death spectrum. And yet now it is my own home environment being largely shaped by an end of life situation.
It’s not uncommon to hear people say of hospice work “I don’t know how you do it” but the truth is that, while the death of a client is powerful, it is not as devastating as the loss of a deep personal relationship cultivated over years (or a lifetime). It’s been a long time since I’ve experienced such loss in my personal life and yet, while this has been a sharp and exhausting pain, I have found gratitude in being in touch with the primal affective states that come with bearing witness to a loved one declining, dying, and ultimately transitioning into that great big cardboard box in the sky.
No two griefs are the same, and certainly the loss of our beloved cat does not match the depth of grief over a parent, sibling or child – yet I find myself similarly honored to have the opportunity to play a role with Kali Ma as she dies the way she lived: fiercely, proudly, and on her own terms.