How Much is Too Much to Save a Dying Cat?

A series of losses prompts s.e. smith to wonder why, if it’s inevitable, we tend to view death as failure.

s.e. smith | Longreads | November 2017 | 17 minutes (4,363 words)

The veterinarian looks anxious as she enters the room, clearly dreading the conversation she must have many times a night on the late shift at the emergency clinic.

Yes, your pet is dying. No, I’m afraid there’s not much we can do, she is bracing herself to say.

Her scrubs are a rich maroon, coordinating with the jewel-toned surroundings of the hushed exam room in the swanky clinic. Thick doors block the sound from outside, the interstitial space where they’ve left me alone in an echoing silence with a grim steel table and a box of tissues after the technician rushed my cat to the back, somewhere in the bowels of the hospital. The last time I saw her she was gasping for air, eyes huge, expression: betrayed.

I wonder if I will see her again.

It’s the largest veterinary clinic I’ve ever been in and it feels more like a spa, down to the powder blue polo shirts the receptionists all wear. The stack of euthanasia authorizations left out on the counter are the only sign this place is perhaps not what it seems. I have driven a long way to come here, because it is Easter weekend and my vet isn’t in the office, but this cannot wait.

Oddly, I find myself wanting to reassure the vet, to tuck her loose strand of hair behind her ear and offer her a cup of tea from the space-age machine out in the horrifically depressing lobby, filled with people sitting in little clumps with strained faces.

“I know,” I say as she sits opposite me, searching for words, and her shoulders slump in relief. “I knew the cancer would spread eventually, but is there anything we can do to make her comfortable?”

On my way in, struggling with the weight of my cat’s carrier and my bag, I passed a couple carrying one of those cardboard boxes they use to send cats home from the shelter, the takeout container that is supposed to presage many years of happy life together, cartoon kittens and puppies stenciled along the sides. It swung with a peculiar, empty lightness, bouncing in an almost sprightly way that felt at odds with the stricken looks on their faces.

There is a stark finality in the empty cat carrier.

You can take this, your cat won’t be needing it anymore.

* * *

I adopt Leila in 2012, on a sunny day in early January when I walk into the feed store to buy food for my cat Loki. Between the register and the stacks of hamster bedding, I see her in the cage the Humane Society installed there for just that purpose. As I fill out the paperwork, the clerk tells me Leila had been found along with her brother in a foreclosed home after they’d been abandoned there. The two cats somehow survived for a month before the sheriff finally broke into the house to rescue them after repeated calls from the neighbors.

When I flip through her medical records from the Humane Society, they are an unsettling chronicle of parasites and sores, wildly skewing blood pressure and refusal to eat, antibiotics and a cold estimate by the harried shelter vet that she probably wouldn’t live long enough to be put up for adoption. Yet, somehow, she persisted.

When I get her, she is seven years old.

At home that first night I sit cross-legged on the floor as she tours my office cautiously, sniffing everything, before settling in the middle of the floor and slowly rolling over, gazing at me with clear blue eyes, waiting for something. I hesitantly brush her belly and she starts purring to herself, worming closer and closer across the floor until she collides with my leg and tucks her head under my knee. It comes to be one of her favorite places.

The technician rushed my cat to the back, somewhere in the bowels of the hospital. The last time I saw her she was gasping for air, eyes huge, expression: betrayed. I wonder if I will see her again.

My other cat, Loki, hates her from the start. Their rivalry becomes a subject of some internet fame as I try every conceivable combination of coaxing and pleading and bizarre cat anxiety products to convince them to get along. Eventually, Leila winds up on Ativan and the two cats rule over opposite ends of the house, tolerating each other with extreme distaste when they accidentally find themselves in the same room. I try to evenhandedly pass out affection, Loki glaring with jealous fury when Leila sits on my lap, Leila hissing at Loki when he leaps up next to me on the couch.

“You should just bring her back,” someone says.

“I can’t do that,” I say.

How do you abandon an animal who has already been abandoned once, but still maintained her faith in humanity?

* * *

One of the most common emotions that seems to haunt people with dying pets is guilt — guilt that they didn’t catch whatever it was sooner, guilt that they didn’t do enough, guilt that their aggressive treatment is causing more suffering, and, in the end, guilt that they waited too long. Veterinarians tell me this over a procession of dying pets, that often their clients seek not just a miracle cure, but absolution, too.

“We did everything we could” is no longer an acceptable answer to anguish. There is a peculiar sort of selfishness that snarls itself with love as we struggle to navigate what is possible and what is right.

Guilt sometimes turns to cruelty as people struggle to assuage it by asking “what can we do,” rather than “should it be done at all?” It plays out on the pages of sites like GoFundMe as people plead for money, their sick and injured animals dolefully staring out at the reader. What they really want is more time; better yet, to turn back time and avert the inevitable.

The veterinary profession has come leaps and bounds from the James Herriot memoirs I read as an animal-obsessed child. My series of cancer-riddled cats were offered chemotherapy and radiation, my cat in kidney failure could get a transplant, the vet explained. We’d have to send him to the University of California, Davis, she added, where staff at the world-renowned veterinary school did things like feline kidney transplants, apparently. She looked away as she said it, studying the X-ray films on the wall, leaving unsaid that “could” didn’t mean “should.”

At the emergency clinic in the dark hours of the night, desperate people mob the counter with tragic but repetitive stories — a cat in sudden paralysis, a dog struck by a car. The receptionists are sympathetic but efficient. A baby screams in a stroller as a parent rocks it stoically back and forth, looking somewhere into the middle distance. The room is heavy with fear but also guilt, and the desperate hope that someone will emerge from a back room and tell them it’s all right, there’s something to be done, this can be fixed, it’s not too late, because the alternative, a sense of helplessness, is too awful to contemplate.

In veterinary medicine as in human medicine, death has become an indicator of failure. We have made tremendous advances in medicine that make the formerly unimaginable endurable; we can transplant organs, revive the seemingly dead, assail cancer with heady cocktails of chemicals, but the only thing we’ve never been able to do is put a stopper in death. Physicians and patients alike struggle with this, with the reality that sometimes, your number is up. The family wants to know why there’s nothing more to be done, wants a second opinion, wants more time. The family doesn’t want to leave with a plastic bag full of grandpa’s things, or an empty pet carrier, a collar that seems somehow smaller and dirtier now, tags jingling.

* * *

Leila’s favorite sleeping position is the faceplant, her neck canted at a strange angle. Her preferred toy is her catnip mousie, which she stole from Loki — possibly why she likes it so much. Late at night, I hear the rattle inside as she chases it up and down the hall. She loves people, despite her start in life, and she will settle herself on any lap left open, worm her way under the covers of the guest bed. Her unfortunate penchant for stress urination means that her presence isn’t always welcomed.

Sitting on the couch with her one night, I notice a small lump, perhaps a cyst, perhaps something else. The veterinarian biopsies it.

“I’m sorry,” she says, in a torn voice on the phone. She is probably tired of telling me that my cats are dying.

We’ve caught it early, the radiologist says. We could do a mammary chain removal, the feline equivalent of a mastectomy, radiation, chemotherapy. Recommendations confident and assertive — of course I will want to do everything I can. Never mind that I will have to drive two hours to reach a clinic that offers feline oncology, for weeks on end, back and forth. Unlike in humans, the goal isn’t curative, but palliative. Maybe you can get six more months, the vet says, petting Leila in the exam room as she relays the radiologist’s words. I feel dizzy, but also guilty, as I ask myself whether I am a bad person for not wanting to do any of these things.

My other cat, Loki, hates Leila from the start. Their rivalry becomes a subject of some internet fame as I try every conceivable combination of coaxing and pleading and bizarre cat anxiety products to convince them to get along.

I’ve pored through study after study on clinical outcomes. “Could” strikes me as more analgesic for human than pet, a sense of doing something, buying time, at a high cost of misery and stress, nausea and fatigue and confusion. For the low, low price of hours of agonizing car rides and long anxious waiting in the lobbies of veterinary clinics while doleful barks and terrified meows filter through the halls, here’s six more months. The monetary cost, which could run to $6,000 or $7,000, seems almost beside the point. Your cat won’t understand why she’s being tormented, but at least you did something instead of just giving up. This is your last chance to show your love.

“If it was my kitty, I wouldn’t do it,” my vet says, and that’s that. We opt for conservative surgery and watchful waiting, follow-up X-rays to see if it’s spreading. A few months later, the radiologist sees a small white spot on the bottom of her right lung. Could be anything, the vet says, but we both know what it is. In a way, there is a sense of relieved finality to it. Even the radiologist doesn’t bother recommending a traumatic and likely unsuccessful surgery to remove the metastasis.

* * *

Late at night in the waiting room, there is none of the awkward small talk that plagues veterinary clinics in the daylight hours, no curious faces peering into carriers or petting waiting dogs, no “nothing too serious, I hope.” If it wasn’t serious, we wouldn’t be here, seated as far away from each other as possible in a complicated calculus disturbed only when someone is called to the back, or a new client arrives, setting off a ripple effect. Bland music floats by overhead and no one speaks.

As the hours pass, the clinic enters a lull, leaving me alone with a middle-aged man who twists a leash loosely in his fingers while watching the clock. I leaf through a scrapbook of thank you cards from clients. They are, I realize with a sinking sensation, mostly thank yous for “doing everything you could” before euthanizing a parade of sick and injured pets, pictures from happier days plastered onto the pages.

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A big gray cat named Bear, a smiling golden lab. I flip faster and faster, trying to find a happy story, but there aren’t any.

“If you’d like to step out and get some dinner, it’s probably going to be a while,” the desk clerk says. He tells me later that he’s off to medical school in the fall, and when I ask him why he’s working at a veterinary clinic if he’s planning to treat people, he tilts his head. “It’s not so different, after all,” he says.

* * *

The vet speaks in a soft voice as we look at the X-rays, highlighting the bloom of tumors that I had feared across Leila’s lungs. By sparing her the need to be the bearer of bad tidings, I have become in a sense a sort of confidante, and we scrutinize the images as though they can tell the future. She is relieved that I understand there is only one right thing to do here, as she tells me she can prescribe steroids to prevent inflammation, to give Leila a final few comfortable days.

She cannot tell me how many days there will be before fluid begins building up in the space between Leila’s lungs and her chest wall again, before her breathing becomes more and more labored as her lungs push against the swell of fluid. I ask what it feels like and she struggles for a tactful response, as I imagine a hand crushing Leila’s lungs, smaller and smaller, while they flutter in desperate spasms. Several months later, I get a pneumothorax, a collapsed lung, and I understand firsthand what it might have been like for her.

The vet had told me it was uncomfortable and confusing, but not painful. She was wrong. It is agonizing, like having my chest caught in a vice, lungs flailing desperately for air. I wake up writhing in agony, tangled in the bedsheets, losing all sense of space and time, as everything narrows down to this, the desperate struggle for air.

Sitting on the couch with her one night, I notice a small lump. The veterinarian biopsies it. ‘I’m sorry,’ she says, in a torn voice on the phone. She is probably tired of telling me that my cats are dying.

The vet wants to keep her overnight to monitor her.

“If she crashes,” the vet says, trying to choose her words carefully, “do you want me to…”

“No,” I say, and when I’m finally allowed back into the ICU to see her later, there is a bright orange sticker on her chart, “DNR.”

* * *

“Sometimes I think people go too far,” the vet’s voice echoes in my ears as I drive back, alone, leaving Leila wide-eyed in the ICU while a lilac-haired vet tech coos over her. Great swaths of hair have been shaved away along her ribs, where they inserted needles to drain a shocking amount of fluid.

“It’s guilt, I suppose,” I said to her.

At home, Loki is looking curiously around the house, wondering where Leila has gone. When I open the door with nothing in hand he peers out into the darkness for a moment before directing my attention to his empty food bowl.

“It’s just you and me, I guess,” I say, watching him eat. The next day, I will pick up Leila, and the waiting will begin, but oddly, I don’t feel guilty.

* * *

Several weeks before I noticed that Leila was having difficulty breathing and felt an uneasy chill, knowing what it meant, knowing that picking up the phone at 4:30pm on the Friday before Easter would likely get me the answering service, I get the call. It is bright and sunny, the daffodils nodding in the yard, Leila sprawled in the warmth in the living room while Loki camps on my desk. He looks affronted when the phone rings and I answer, sorting through email with half my brain while saying, “Hello?”

It is a voice that feels known, if broken, and my hand falls away from the trackpad as familiar words in unfamiliar order emerge. It is my aunt, calling to tell me my grandfather is dying.

“Isn’t he already dead?” my catsitter asks when I explain why I need to leave, and I don’t blame him. I’ve been estranged from that side of the family for almost 15 years — I am dead to them, in a way, and they were dead to me, only now one of them is actually dying, and it has triggered a strange sort of Christmas Truce.

I get stuck in roadwork on my way to the hospital, and when I turn up my aunt is all alone by the elevator, anxious that I might lose my way between the nurse’s station and his room. She takes my hand and we walk along the dull green hallway. I feel 7 again, gripping her fingers as we crossed the street, and the room is filled with people who seem to have aged in fast forward, looking nothing like I remember. Then again, the last time they saw me I was a teenager with golden hair, not an adult in ill-fitting clothes with rapidly receding, steadily graying hair in a close, practical crop.

My grandfather is asleep but not asleep. “Nonresponsive,” they call it, in a mint green hospital gown, his neck canted at a strange angle. I sit next to him and take his hand, warm and clammy, and everyone looks at me expectantly.

“Hello,” I say.

* * *

On the way home, I stop in the redwoods and take out Leila’s carrier, bring her down to the banks of the river. Her nose presses against the grate, her eyes still dilated from the narcotics, blinking in the harsh light. I spent many hours here in my youth and for some reason I feel a compulsion to show her, my eyes prickling as I open the door. She slinks out to sit on the sand and looks at me questioningly, not understanding why we are here.

Her breathing is easier than it has been in days, but she curls her lip. She doesn’t like the smells and sounds here, and she retreats back into her carrier with a plaintive meow. I close the door and take her home, where she promptly jumps on the bed, daring me to kick her off, like I always do, but instead I lay out an absorbent pad and leave her there.

I think it is then that she understands something is wrong. After years of being summarily tipped off the bed no matter how cautiously she tried to slink up, to be allowed to sit there at last seems like a Pyrrhic victory for her. Loki follows her there, confused about why she is permitted, and she’s too tired to hiss at him, sprawling on her side with a confused, defeated expression.

She will spend much of the next two weeks on the bed, unaware that a clock is ticking somewhere just beyond her comprehension. Loki, who has been through this before, begins to treat her with utter disinterest, like a piece of inconvenient furniture, as though she is already gone and he is adjusting accordingly.

Later, while interviewing a psychiatrist about complicated grief, she comments that people “often have an easier time” when the dying is slow, when you watch your loved one slowly disintegrate. In a sense, she says, the mourning begins before death knocks on the door, when someone is dead before they’re truly dead.

* * *

Looking around the hospital room, I think, These people do not know me. Most of the cousins who slowly crowd in were born after I left, and don’t recognize this stranger who looks nothing like them. They are emotional; I am ruthlessly practical.

Through some series of events I do not fully understand, I have become the person who Takes Care of Things, the one who is organized, and it’s a role I slot effortlessly into no matter where I am. I am the one with the first aid kit in my bag, the one who thinks three steps ahead with “arrangements,” the one with the flash charger for dying cell phones, the one who picks up a case of water and brings it back to the room, where people fall upon it thirstily in between bites of the takeout my aunt has collected. We are an awkward family dinner hunched around the bed of a dying man, people telling stories from their childhood.

The nurses seem surprised that we are all still there — in the morning, they will move him to a bigger room to accommodate the sprawling family, but by then, it will be too late.

I never knew my grandfather well, though I still remember the distinctive smell of my grandparents’ apartment on Vallejo Street in San Francisco from my childhood. It is a uniquely San Francisco apartment smell, with notes of dust and copper and old carpet and something acrid. Sometimes I will walk through the door of a friend’s new house and it will assault me, wrapping around a flight of carpeted steps, a throwback that has me expecting to see my grandparents at the top of the stairs, ready for us to take off our shoes and give them our bags.

Several weeks before I noticed that Leila was having difficulty breathing and felt an uneasy chill, I get the call. It is my aunt, calling to tell me my grandfather is dying.

Sometimes he seems to turn his head, but he doesn’t respond to the secrets people whisper in his ears or the stories people tell. Over time, it feels like an odd family reunion, everyone politely pretending that the stranger in their midst is supposed to be there, because my presence is less odd than the dying man; the cause for our gathering recedes into the background, melting away into his bed.

* * *

I take Leila outside nearly every day. She had made a break for it a few times in her life with me and at first she is confused, and then delighted, that I allow her to wander around the garden at will. She becomes obsessed with the ferns, and she likes rolling around on the patio, feeling the warmth of the brick against her back. The fur is beginning to grow in along her chest, turning to soft velvet. Her breathing is hitched sometimes, but her eyes are bright and interested.

Her mind is willing, a friend remarks, but her body is weak.

She lives past the week the emergency veterinarian estimated, playing with her mousie, eating the special canned food that I got her — now that she is at the end, her propensity for weight gain doesn’t matter very much.

She has a seizure, but then she’s fine, though when she goes outside, she tries to burrow under the ferns, to pass beyond the edges of the garden and into the woods, and I steer her gently back toward the house. I know what it means when cats want to hide.

“I am not ready for this,” I whisper in the shower as hot water scalds my back. I do not understand how she can be so happy while her body is falling apart.

* * *

I stay with my grandmother that night, and the next morning we make awkward small talk over breakfast, the strangeness of my presence achingly obvious now, without my grandfather’s presence to mediate the room. She brings me berries from a company I’m boycotting and I smile at her and drizzle kefir over them. The fridge is filled with vegetable juices and other things. He had trouble eating solid food, at the end.

He declined all supportive care, and I wonder why he is not at home, but I do not say so. Instead I toy with the cloisonné box in the guest room and look at the tulips growing in a planter just outside the window. The garden looks slightly ragged, the fairway of the abandoned golf course just beyond turning to wild meadow.

Eventually we go back to the hospital, after the awkwardness has reached its breaking point, and when we arrive he is alone there with my oldest uncle, who holds his hand and looks up at us when we enter the room with an expression that is a strange mixture of hope and bafflement and something else undefinable. My grandfather has turned sallow and his breaths are slowing, and we stand around the bed. His breath rattles and I lean over to tell him about the tulips, and then he isn’t breathing anymore and my grandmother is closing herself off and briskly moving ahead to the next thing, calling for the doctor.

“Is he dead?” she asks, bluntly, and the doctor forms his face into appropriate lines of sorrow, taking her hands in his.

“I’m so sorry,” he says, and then he leaves and the three of us and the corpse are alone in the room. “The ring,” I say, “before his fingers swell.”

* * *

The vet’s office packs Leila’s body up with ice packs in a box for me, and I drape her in the blanket I knitted for her and tuck her mousie next to her. I am forward-thinking, purposeful, relentless, wanting only to move on to the next thing. One of the veterinary technicians cries as she carries the box out to my car and situates it carefully in my trunk, adjusting the angle just so.

She is wearing bright pink scrubs and they’re glaring in the sun. I watch her figure slowly recede as I drive away, the start of a long journey over three hours of winding roads and construction, vineyards in leaf and oak trees in bloom. At the pet cemetery, they are gruff until I tell them who my aunt is, and then they are all apologies, handling the box as though it contains fragile porcelain.

For the low, low price of hours of agonizing car rides and long anxious waiting in the lobbies of veterinary clinics while doleful barks and terrified meows filter through the halls, here’s six more months.

My aunt calls: My grandfather’s ashes are being distributed. Do I want some? I do, it turns out, and I can stop by her house if I’d like a share. It is an odd confluence of events that my aunt’s veterinary practice is in the same town as the pet cemetery, that I should be driving there with a dead cat in my trunk and leaving with some of my grandfather’s ashes in a little silver tin.

The ashes are dry, inert, smelling like nothing and looking like you would expect, chunks of bone and finely ground ash. When I return home, to my town perched on the edge of the Pacific, I take them with me on walks, scattering a little here, a little there. I wonder how many other people’s ashes have been scattered in these very spots, with their ocean views and calm woodland vistas, and I wonder what I am going to do with the tin when I run out of ashes. It seems profane to reuse it, but equally so to discard it.

When Leila’s ashes come back, they are in a cedar urn, and my house smells like sap and forests and something mysterious for days as the wood breathes. The ashes inside are more coarsely ground, I discover when I open it, and there on the top is a perfect phalange, delicate and entirely intact, and it feels surreal to hold the inside of her on the outside like this, but I still do not feel guilty.

* * *

s.e. smith is a Northern California-based journalist and writer with a focus on social justice issues.

Editor: Sari Botton