Knowing When, and Saying GoodbyePosted: October 27, 2010
Today is one week that I said goodbye to Peaches, at about 11:50 a.m., so I am posting this final article in the series chronicling her battle with renal failure and about caring for a chronically ill pet. This article is rather long because it was intended to be three separate articles spread out over time, but we never really know how much time we have. Peaches’ final time was very quick and I know this was partly her decision; I didn’t want to let her go until she was ready, but I also didn’t want to watch her suffer for any length of time.
After Peaches’ last temporary decline she didn’t recover as quickly as she had in the past; usually I could get her to where she felt better in a day, and back to eating regular cat food in two. The most recent recovery took nearly a week, and though she came all the way back in diet and activity she was weaker than before and I knew there wouldn’t be many more little recoveries. We had had a good year, but I seriously had to start preparing myself for what I knew would come.
Peaches let me know on a Saturday she’d arrived at the final stage and her passing was imminent and I had begun this article about that experience, about “knowing when” and giving support at the very end of an animal’s life while not giving in to your own fears. But things move quickly for a kitty the size and age of Peaches, and I truly believe they can direct a certain amount of the process of what happens with their body. Peaches had everything organized, so I had only to be there and follow along, however unwillingly. I had no time for an article, only for Peaches. This article includes that revelation, her transition and the aftermath but it is not full of sadness; Peaches would have none of sadness.
In retrospect, it’s hard to believe Peaches was only with me for five years, and came to me at age 15—it seems as if she’s always been with me. We packed a lifetime into those years, beginning on that day as a senior foster when she decided to start a new life as part of my household.
One of the most frightening things in life is facing the unknown, and in losing your animal companion you take a big scary step into a lot of unknown territory even if you’ve been through the experience already. You may know your animal companion has a chronic illness and their death is eventual if not imminent, and you will literally have life and death decisions to make about a being very dear to you, but you have no idea where or when or how their loss will occur or what you will have to do. Your companion knows, though, and you only need to use your own human intuition and trust your bond of love.
My self-employed schedule is overbooked and erratic, and while I can often rearrange things and most of my customers understand, there are also plenty of times when I’ll be gone for most of a day and I’m really not sure what I’ll find when I get back. This year has been particularly hectic and the last thing I’d want to do is to fail Peaches at this critical time. Where would I be? Would I be ready?
Understanding the disease and symptoms
I had nursed my Stanley through nearly four years of chronic kidney failure when he was in his twenties and Peaches’ sister Cream just ten months after they joined us, and I had also nursed Moses through old-age decline including kidney failure, so I had an understanding of what was happening to Peaches and an idea what to look for as we neared what would likely be the final failure of her kidneys and her distress once that happened.
Kidneys in any mammal, including humans, have a tough job of filtering waste from the body’s fluids and producing and excreting what becomes urine. They also balance electrolytes, produce erythropoietin which helps stimulate bone marrow to build red blood cells, and renin, an enzyme that helps control blood pressure. The organs can actually perform all this with only 30% of their capacity, but once they are in chronic failure it’s easy to see what can happen to the body if the condition is not somehow treated on a regular basis; likewise when they have failed you can see how that failure will affect the body with toxins building up in the blood and circulating through the entire body, blood pressure increasing without its natural regulator and the heart and other muscles losing function with the imbalance of electrolytes. It’s paralyzing and painful, and not something you want your animal companion to endure for any length of time.
An early visitation
And as I saw Peaches moving into the end stages, needing fluids more frequently but not tolerating big doses, greater nausea, weakness, the odd temporary seizure-like activity and seeming neuropathy in her hind legs, I also had less tangible warnings.
Some time in September, for three or four mornings in a row, I sensed a kitty walking behind me as I sat on the floor and doled out breakfast. With nine hungry cats all milling around it’s hard to follow where everyone is. I thought it might be Cookie since for her own personal reasons she would often walk around behind me to eat next to the stove. I turned around to see who it was, but Cookie was accounted for, as was everyone else, and there was no kitty there.
I stood leaning against the stove contemplating the visitor while Peaches continued happily with her breakfast. I wondered which of my kitties who’d transitioned might be visiting as that happened now and then, but I felt I’d recognize any of them and I did not recognize this visitor. I knew then that it had to do with Peaches and that her time would be soon, I can’t explain why or say that this has ever clearly happened this far in advance with my other cats, though it has happened on the day they transitioned. I just knew that the kitty was coming to welcome Peaches to the other side, and perhaps to reassure me. I wondered if it might have been her sister, Cream, but the visitor didn’t give me the sense of her; Peaches had 15 years before she came to me and it could have been any kitty from all those years. I remembered that I was visualizing a rather small kitty, perhaps dark in color, putting its tail in the air as it walked behind me and I realized the visitor seemed a lot like Peaches herself and thought it might have been her mother.
The unexpected sign
Peaches had been eating well, was very active and alert and even that embarrassing issue, bowel movements, hadn’t been too much of a problem for the first time in a long time. First thing Saturday morning she was milling around in the bathroom upstairs with everyone else, drinking at all the water bowls and looking at me, blinking, to inquire about breakfast. We all went downstairs together and it still amazed me as it had from the beginning that she ran with the big cats, literally, and tiny as she was and playful as they were she’d never been even accidentally hurt. She had a great breakfast, jumping up onto the food tin then to the table and to her position on the cabinet to pace around making her little “hmmpf” noises that were as close as she ever came to a meow, leaning off the edge with her ears and whiskers at full alert and her big round pea green eyes focused on the can of food, even swatting at it and nearly falling—“Give me that now!” She always ate one good serving then several smaller servings through the rest of the day until dinner (every 42 minutes), coming to find me and lead me into the kitchen if I wasn’t aware her food alarm had sounded.
In the early afternoon she trotted up to the bathroom and curled up in the cat bed, though on a Saturday she’d normally be in the kitchen or she’d follow me around as long as she had patience for it.
Because she was always near me or would come to find me I could easily and frequently check her condition through the day, but by late afternoon I realized she was still sleeping in the bathroom and hadn’t come to ask for food. This meant something was the matter, whether she was experiencing nausea and reflux again or she was constipated again, if she’d vomited and her throat hurt, all symptoms that were part of her advanced kidney failure. This was what had happened two weeks before, and if these conditions weren’t somewhat resolved within hours she would begin to lose ground rapidly, quickly dehydrating, developing greater nausea, physically weakening and losing a little more normal kidney function.
She was very dehydrated and her breath smelled strong, that particular uremic odor that is associated with renal failure in animals as well as humans. I gave her 75cc of fluids—she’d been having some difficulty absorbing 100cc of fluids, and I could give her more later—one quarter of a Pepcid, took her temperature (normal) and invited her downstairs to eat. I preferred to see how they moved when I was trying to assess their condition so I wanted her to walk, to watch her movements and see if she followed her usual routine.
She sat on the landing, a little crouched, and her fur had that peculiar sticky look of an animal who is ill, her eyes not fully open and a little glazed and unfocused. Yes, she was feeling pretty bad, but I’d seen this before and it would just take some gentle nurturing and nutrition to bring her around to feeling well again.
Eventually following me down the stairs and across the living room though not at her usual brisk trot, she hesitated as she passed through each room and again when she reached her little stepping sequence of food tin-table-counter, but eventually made it up and stood and looked at me. This was actually a good sign; even if she didn’t eat, or didn’t eat much, she was showing up which meant she was willing to work on it.
I started with the food I’d opened that morning which she’d eaten with gusto a few hours before, but she just sniffed it and looked at me. Okay, maybe it wasn’t fresh enough, next food. I have never been successful with any renal diet so I prefer to feed my usual brand of food, but in Peaches’ condition she often needed something a little more enticing so I had little cans of salmon pate on hand in various brands because that was her favorite. As my veterinarian had always said, eating something, even of questionable quality, was better than not eating at all. Beyond these little cans of food I also had several jars of turkey or chicken and broth baby food, and I also had just enough raw venison, salmon and free-range turkey in the freezer to shave off and thaw in my fingers for small meals. And as supplements to these I had NutriCal, a high-calorie paste nutrition supplement in a tube, and CatSure, a milk-based caloric supplement.
She had absolutely no interest in the salmon pate, licked a little NutriCal off the tube, turned her back on the CatSure, which really shocked me because she would lap that up no matter how she felt. This was very unusual since she would usually eat just a little of each thing before she turned away, if only to get me to stop pestering her. I was considering what was in the freezer but gave her another try at the food, adding warm water and waving it under her nose.
She turned her head completely away then looked back up at me. “I’m not going to eat any more,” she said, holding my gaze. These were not words, but I understood it as clearly as if she had said it in that particular way my Kublai had taught me years ago.
And just as clearly as that, I knew we weren’t going to turn this one around. She was aware of her body’s own function and knew that to fight it would be pointless. Time was now finite.
I reached out to pet her, to let her know I understood and agreed and would do all I could to keep her comfortable; this I could do before the reality penetrated my shock. Starting at the top of her head and running my hand down her spine had become like petting a picket fence, her hip bones protruded, she couldn’t keep her fur clean any more, even standing she was practically sitting because of the weakness in her hind legs. Up to now she was willing to let my palliative care soothe and heal her body as far as it could be, but she had no interest in suffering or forcing her body to do something it no longer could. In all practicality she would simply wait for the end.
And in that moment I was filled with wonder at the courage of a little cat who could so bravely face this decision and share it with me.
And though I’d been practicing for the past month or so, I began seriously imagining my home, my daily routine, without Peaches. She would be the strong one, but I would be damned if I’d break down and cry every time I looked at her—that would distance me from her and I might not hear some important communication from her. These were our last days, and they would be as good as they could be, I would love her all the more while she was still here. As I had also done during the past few months, I thanked all those who had gone before Peaches who taught me the importance of this.
And though Peaches didn’t like to be picked up and hugged and kissed, I gently picked her up and held her close, burying my face into the top of her head and kissing her little cheek. She was so tiny she was lost in my embrace. She understood and let me persist for a few seconds, then struggled to get her own footing again. We shared a long look.
End of life palliative care
That didn’t mean I’d just let her starve and sink deeper into the pain of her illness. The effects of end-stage renal failure are painful as the toxins slowly build up in the body, so for as long as she would want to get up and go about her day, however minimal, I’d keep her comfortable. That meant managing her nausea with Pepcid and slippery elm bark tea, continued doses of fluids, and even small doses of prednisone to help her manage her pain and move around more easily.
Through Saturday night and Sunday I regularly offered her the cat food, baby food, raw meat and supplements, but she only licked a little NutriCal and seemed to enjoy it. She hadn’t been able to sleep with me because she was uncomfortable on my bed, and I’d been putting her and Kelly in the bathroom overnight with canned food so they could eat at will and Kelly could keep her company. That weekend I sat with her for a while in the bathroom each night and even put out a little food, though I’m sure Kelly ate it, but I got up early and brought her into my bed for a nap together in the morning, a compromise, but sleeping on me or next to me had always been one of her pleasures.
On Monday I called my veterinarian to report this recent change and ask what her schedule was at the end of the week to schedule an appointment for euthanasia, assuming I’d have that much time. I’d need another bag of fluids to get me through the week, which I’d pick up the next day, and I’d keep in touch with her through the week.
An amazing coincidence of supportive events
It isn’t Peaches’ fault I’ve been keeping late hours and early mornings lately, just an overload of work for which I’m grateful; it’s been a slow year. I was up late Sunday night preparing for the Monday morning deluge of calls and faxes at my desk, and Peaches was on my lap for as long as she was comfortable. I slept briefly, then went through my Monday while keeping an eye on her condition.
I had a display of 14 photos to frame to be hung on Tuesday in time for a Wednesday business mixer at my local public library. I had the frames and went to Costco to get the photos in the afternoon.
I also had an appointment with a new portrait customer who had contacted me through Deb Chebatoris at Chartiers Custom Pet Cremation where a few of my portraits hang. The man had lost his two Himalayan half-sisters and finally decided he’d get their portrait done. From what he was describing the portrait would be beautiful, and I looked forward to meeting him and his wife and talking to them about their cats and their portrait and Deb. Indeed the meeting was wonderful, hearing about the two beautiful girls and how they’d been so loved, telling them that I was one of Deb’s families as well, and that my little Peaches, right there on my desk, would soon join the others. Their sympathy and understanding were very comforting.
Then I set up the work table and boxes of frames to let everyone explore them before I began working, sat down with Peaches to finish off a few design assignments before I began framing, which I knew would take me into the wee hours. I could have been doing many other things not so enjoyable that particular night, but arranging my photos, making final decisions on which was in and which was out, and seeing them in their frames as the night went on and visualizing the display was probably the most calming activity for a long night of work and vigilance.
And Peaches was there on my desk chair, watching me and receiving her pets when I took breaks, even jumping from the chair to the table while I was finishing things up to investigate all my tools and rub her little face on the corners of frames. It seemed to me that she wasn’t sleeping either though all the others had long since found comfortable places in the room, but was staying up all night with me. This would actually be our last night together, and I will always treasure the memory of her attention to me, her gentle curiosity, and being a part of whatever I did.
More design work the next day, then I fed them dinner before I packed off to hang the photos. Peaches still went into the kitchen for dinner, up on the tin, the table, the counter, even though she didn’t eat. Before I left I put her and Kelly into the bathroom, knowing I’d be gone for hours and she was just weak enough that I didn’t want to risk a fall.
The beginning of the end
When I returned home around 11:00 that night I could see the change had come. Peaches was curled in the bed, but barely lifted her head when I came in. She made brief eye contact, but put her head back down, breathing easily but with no intention to get up. The final process had started and I had only to be with her, watch and wait for signs.
I left the bathroom door open and sat on the floor next to the bed, petting her in the dim light I kept in there at night. The others wandered in and out and sniffed her and with the exhaustion from several late nights I dozed off and on, leaning against the wall, my hand on her shoulder. At one point she woke up, got up on very wobbly legs, peed on the rug in her favorite spot, visited the water bowl then wandered out the door. With me close behind she visited the water bowl on the landing, looked down the steps, wandered around my room, then stood looking into the spare bedroom, my studio, where she’d started out here, then went back into the bathroom, curled up in the bed again and laid there, not sleeping, just breathing and blinking her eyes, and never left the bed again. I would guess she was saying goodbye to her house.
Had it been daytime I would have called my vet right then, and I considered her condition and a drive to the emergency clinic, but decided that unless she showed some extreme symptoms she was better off here, and I would stay with her. Having been with the others at this point, she could go for hours or even days like this. Cookie curled on my lap and purred, touching my face to comfort me. At one point I went to lie on my bed and came back to find her the same.
My veterinarian’s hours for phone calls begin at 9:00 a.m. and I was waiting for that hour when I noticed that Peaches’ breathing had become more rapid and shallow, and her tail, which had been curled in the bed was now leaning out of the bed, stiffly twisted with the tip twitching.
I had learned from my veterinarian that these sorts of things were sometimes the only signs of pain we might see, this and the rapid, shallow breathing meant she had reached a painful state. I paged my veterinarian, who, though her van was in the shop, agreed to stop by around 11:00 or so that morning as she’d still be doing her calls.
Then I called Deb, and while I always kid when I call her—“Don’t need your services today, just calling about the website” or some such—“Deb, it’s Peaches’ time,” was all I could manage. I gave her the appointment time and couldn’t say any more. “So it’s finally the day,” she said, “I’m so sorry, but I’m glad I could be here for you.” I had started to cry at having to say it out loud, and I just whispered I’d see her later.
I couldn’t imagine how this would be without her and my veterinarian both standing as my main supports.
So now it was a matter of hours, though as Peaches’ condition progressed I could feel her slipping away. I continued sitting with her, little by little preparing myself for the day; I noticed that she already felt cold, a certain sign her kidneys had completely failed as her body temperature dropped.
I left briefly to e-mail Judi that I couldn’t be at the shop for my Wednesday hours. I called a friend and asked if he could finish the final details I’d left for hanging the last two photos as I’d run out of wire. I let my friend Maggie at the Library know someone else would be finishing things up but I’d still be there that night, and what was happening. I posted a quick post on my blog and Facebook, all the while crying, hoping I’d get it out of my system so I wouldn’t cry in the room with Peaches.
Then I sat with her for the last time and all the other cats except Mimi came in and checked on us, the three boys standing guard outside the door, a little confused and concerned. I watched the shadows of leaves on the wooden door right in front of me, light and shadow and shape ever changing. Watching it greatly comforted me, and it seemed to describe what was happening with Peaches just then.
My veterinarian arrived and came upstairs. We shuffled around in the tiny little bathroom, and Peaches opened her eyes one last time and looked in my direction as she administered the first injection. When it had taken effect we moved Peaches to my bed where Mewsette and Mr. Sunshine supervised the second injection, and she was gone in just moments. We sat with her for a short while, then Mewsette kept watch as I walked them out the door.
I returned and sat with Peaches, joined by Cookie who curled up next to her. All the others, again except Mimi, came to see her. Soon enough it would be time to drive to CCPC, and after all the late nights and vigilance and emotion and crying I was suddenly famished and had a comforting bowl of oatmeal for strength.
I visit Deb’s place so often as we work on projects together, but when I am there as a customer it’s quite different. Deb is her quiet comforting self, willing to sit for a while as I stroke my beloved companion for the last times and tell her stories. But even though I’ve now lost 13 cats and visited Deb six times before Peaches, and I knew Peaches wasn’t in her body anymore and I’d done my best to prepare myself, I still know that when I hand Peaches to Deb it’s the last time I’ll see Peaches, and this truly feels like the final moment. After this, I’ll only have my paintings, sketches, photos and memories, and while they are many, giving up that physical connection for me is the hardest part of letting go. I’m so glad I trust Deb as I do. I left Deb joking that she had now received seven of the thirteen pets I’d lost and she was “winning”.
Time on my hands
One of the aftereffects I will always remember from my first losses is that void which had been previously filled with physical and emotional caretaking. It’s only then we realize how much time we were spending doing something for our pet, thinking about them and just being with them, and suddenly the object of all that good intention is gone to be filled with our thoughts and memories, and often that’s when the true sadness starts unless we find some way to deal with that void and turn our thoughts to good memories and positive things. I left everything around the house as it was for a few days, but I wasn’t here much, finding reasons to be out more than usual, and adjusting to the change in my household a little at a time. I was also pretty stiff after sitting on a cold tile floor leaning against the wall for many nights and needed some physical activity to loosen up.
Mealtimes are always worst after a loss, but with Peaches’ constant joy at the event all the years she was with me they were suddenly very quiet so I decided to thaw and feed the meats in the freezer and get some special canned food to fill the silence.
Not feeling guilty about care and cleanup ending
At the end of your companion’s life, along with whatever palliative care you are offering and time you are generally spending with your companion, you’ll often find yourself cleaning up a lot of little messes that are a result of their physical condition. It’s easy to feel frustrated with the amount of time you’re spending, the things that aren’t getting done, the things being ruined, extra money you may be spending on special food that’s wasted, and a long list of other things that may even make you resentful, which in turn makes you feel guilty. This intense caretaking isn’t meant to last forever, it’s physically and emotionally exhausting and while you win small battles you know the end is that your pet will die.
Peaches never practiced proper litterbox etiquette; I always got the feeling her sister dominated Peaches and the food bowl and litterbox, so Peaches responded by not eating much and not using the box. Though she certainly learned to love her meals, she never got with the litterbox habit, using the basement floor for solids and any floor for liquids no matter how I tried to reconfigure the litterbox to meet her specifications. I always had little surprises and was always washing rugs, keeping anything important off the floor. When she went into kidney failure everything went out the window and I was constantly cleaning up, period. I actually said to Peaches, “I won’t miss this when you’re not here any more,” which didn’t make any apparent difference to her but certainly made me feel better, especially as I stepped into another little puddle, or worse…
I finally washed the rug that had been in the bathroom and replaced it with the “good” rug I’d packed away for most of this year. I also put a rug in front of the kitchen sink again, a new one I wasn’t going to use until the coast was clear.
As another part of the set of nurturing circumstances around Peaches’ transition, I was actually looking forward to the business mixer that night because I’d see so many friends, all of whom knew me and my cats and Peaches, and all of whom would be compassionate and understanding. Normally, I’d be at my desk or in my studio, alone but for my other kitties, but sometimes we need the company of members of our own species, and this was one of them. I also had the excitement of my photo exhibit to help fill some of the void. While it may have seemed like an inconvenient time with all that was going on, I thanked Peaches for choosing to leave at a time when I’d have all these comforting circumstances to help ease the first hours my grief.
The next day back in the office, I stood up from my desk in the middle of the afternoon, took two steps and stopped, trying to remember why I’d gotten up, then I remembered that for the past several months I’d now be following Peaches’ lead into the kitchen after she’d walked all over my desk and stared deep into my eyes to tell me it was time to have another little snack, or if she hadn’t alerted me to my oversight I’d go look for her, curled in the cozy bed in the bathroom. I took a moment to picture her walking ahead of me certain I was following, around the cabinet, up on the food tin, on the table, on the cabinet, her own routine which she followed every day until her last, then waiting at the corner of the cabinet for me to serve the next meal. I walked to the kitchen doorway and looked at the spot on the corner of the cabinet where she’d be looking right at me, usually flanked by Kelly and Cookie waving their tails, her tri-color partners in crime, but the cabinet was empty and the kitchen was quiet and still. I savored that moment too, remembering how close we’d become and how we’d worked together for her health and comfort, how completely she trusted me, and how lucky I was to have received her unquestioning love and trust. I wanted so badly just to touch her, but I could feel her there in that moment and I accepted just that.
Peaches dominated my lap and my desk for even longer than she’d been in kidney failure, and except for Cookie it took a day or two to realize the space was open. Everyone has been reshuffling since then, parading across my lap and filling up my desk, and everyone has started seriously playing and galloping around the house.
Because Dickie also went with his mom just a few weeks ago it’s difficult to remember sometimes how many cats I have. I am down to seven, I never got accustomed to saying “eight”, and I’ve actually caught myself saying “nine” still.
And the color composition of my household has changed too. With her pastel peach and gray and white fur, Peaches was truly the light of the clowder; now I have five black cats and two torties, and it’s a little dark in here. Where we had been the “Tri-color Trio” with Cookie, Kelly and Peaches, we’re also back to just my tortie girls, the “Two Torties”, as we were for years before Peaches came along.
Memories appear everywhere
I browse my photos every day to use for my designs and fill photo requests, and I encounter photos of Peaches all the time as I browse. It’s good to see her around the house, looking amazingly young for her years or doing something I’d forgotten she did.
I was in the grocery store this past weekend. I’m not the biggest grocery store shopper and remembered that the last time I’d been there was the weekend previous to stock up on baby food and Peaches’ favorite treat foods, she’d still been alive and not yet let me know it was time. I didn’t need to go there but I walked to the pet food aisle and looked at each of the foods that had been her favorites, remembering her and echoes of others for whom I’d made the special shopping trips.
I can replace my rugs and tile and other items around the house and gladly, because I can never replace the relationships that changed my life. What they gave me is worth more than anything I own, especially their daily inspirations. I will be painting Peaches for a long time to come.