8/10/2010
Rolf, at age 16, dying of kidney failure, granted a precipitous recovery with two weeks of daily subcutaneous fluids and yucky medicine forcibly squirted into his mouth, sees the side door and asks to go outside.
Always a strictly indoor cat—for at least ten years sealed inside apartments with only carpeted halls or concrete walkways outside, this driveway and this CURB and this PATCH OF GRASS explode his world and blow his mind.
He was made to roll and scratch his back and shoulders on surfaces like this.
The smell of dirt—real dirt, concentrated and up close, not just teasing traces on shoes by the door, worm carcasses and rodent droppings, must remind him that something was stolen from him, something that was never quite right about carpets and walls and furniture and the same bland food day after day.
He wobbles like a kitten through the grass, distracted by a new stimulus at least twice per second.
Horrendous cars roar by on the next road. I’ve heard crickets before, but My God, listen to those crickets.
“You will always be my kitty,” is what I always told him.
He always was, but now he is an old, old man.
“What did curiosity kill?” I often asked. “Was it the rat?”
“Was it the bat? Did curiosity kill the bat?”
It was my job to keep the external world as boring and irrelevant as it was forbidden.
He always was his own man—loyal, my best friend, but unrelenting and unapologetic for his autonomy and sovereignty.
If approached and there was an easy escape, he would usually take it—but at least once a day, he would find me, rub his face on my hand and ask to be held. He liked to hide his eyes under my arms and, since he was a kitten, covering him in a blanket was the best way to make him hold still and purr. I was clearly a poor but acceptable substitute for his mom.
9/7/2010
After three weeks of treatment, Rolf’s recovery seemed complete. He now provides abundant reminders of how his endearing grumpiness is just one facet of his complex personality. He now finds me several times/day to jump on my lap, or if I am lying down, on my chest. His purr is audible again after being gone or nearly so for a month. His outdoor privilege is now apparently his animal right, which he demands aggressively, so I escort him around the front yard for 5-10 minutes twice/day. It thrills him like nothing I’ve ever seen.
(Soon after, I gave up on chaperoning him around, and discovered that he nearly never wandered past the upper level of the front yard.)
7/25/2011
The first sign of Rolf’s impending senility might have been the exponential increase in his quite, sweet, appreciative, affectionate behavior, which started around February this year. Where he used to have a hard wired five-minute counter for lying there purring on my chest, he now has to be gently pushed away which he mildly protests. Like with Koki’s near death episodes, one perceives that Rolf knows that an exceptional amount of care and love have been focused on him and perhaps, he is humbled and awed. Or perhaps, the right amygdala of his brain has corroded so far that his fight or flight reflex can no longer be triggered.
8/24/2011
About six weeks ago, I designed Rolf’s “senile cat habitat” by moving most of my dining room furniture to the front porch, and covering the entire carpeted floor with a layer of plastic. This, after renting a Rug Doctor to try to remediate some of the damage he’d done. He was then restricted from the other two vulnerable carpeted rooms, the bedroom and the living room, except when I was there to supervise. This restriction of range was a minor but significant decline in his quality of life, but we took it with a sense of humor.
Then, about a month ago, he stopped eating solid food, and lost strength and weight until I switched to canned food. At first, he seemed to eat it with such enthusiasm that I thought he might gain weight and, in fact, he did regain some strength. He also seemed to precipitously lose nearly 100% of his hearing, and would appear to sleep like a stone. Banging a plate with a knife over his head wouldn’t rouse him but he’d quickly respond to gently patting his head. It gradually dawned on me that this was a significant loss of his quality of life. Two cat people friends suggested his teeth might be hurting, and Dr. Walters confirmed that she had seen some dental disease. Meanwhile, the $140 trifluridine eye drops we switched to because the ~$80 idoxuridine eye drops didn’t work, seemed to work worse than the idoxuridine. By his appointment tonight, the herpes simplex lesion in his left eye had more than doubled since his last exam. Dr. Walters inspected his mouth and described his dental disease as “severe.” Clearly, Rolf’s mouth is in serious pain, and one can only imagine what his eye infection must feel like. The surgery required to fix his teeth would be relatively major for his fragile state, and Dr. Walters has concerns about how well or whether he would recover from both the anesthesia and the surgical trauma, in addition to the likelihood of toxic damage to his little remaining kidney function. This ~$400 procedure would not, meanwhile, address the worsening eye infection, which might require a ~$1500 skin graft surgery with the same potential for complications from the anesthesia.
We did a good job stabilizing his kidney function and anemia. I had imagined one of these two problems would eventually do him in, and it does appear that his hearing, eye, and senile incontinence problems are complications of compromised blood chemistry. In addition to the pain he is in, it might be anthropomorphizing, but it breaks my heart that he can no longer hear me calling his name, or telling him I love him, or calling him nasty names to chase him to his bowl—which he always believed was a magical safe space.
He is still enthusiastic about breakfast and dinner time, and we share precious moments on the love seat on the front porch or, in his usual dominant spot lying on my chest. I do not feel that he also has to lose these simple pleasures for me to see that he has experienced a significant and substantial loss in his quality of life. It is, finally, clear to me that I am now prolonging his life more for my benefit than for his benefit. So, I have decided that the Friday before I leave for my conference on September 13, is the day I will have Rolf put to sleep.
9/1/2011
It is impossible not to notice that there is still so much about Rolf’s behavior and experience that remains intact, despite his many compromises. He seeks me out and looks up to me with that same mysterious look of curiosity, warmth and, of course, utter contempt, that he always has before. He greets mealtimes with enthusiasm and urgency. He jumps up on the bed, and sometimes the kitchen counter—he asks to go outside and lounges for hours on the front porch. I offer him my hand and he strokes it with his cheek. He leans into my hand as I pet him. A leaf drifts by on the porch, and he pounces down and attacks it viciously. When rubbed just the right way, the contentment or even joy on his face is undeniable. While his coat hangs like a loose bag on his emaciated bones, his markings and colors remain striking and miraculous. Age seems to refine more than diminish the nobility in his face. His majesty shines through his feebleness.
Yet I, the owner of this animal property, decide that this life is no longer worth living! I say that he thinks, “My mouth hurts. My eye hurts. I can’t hear anything anymore. Why can’t I sleep in the bedroom? I’ve always slept on the bed. Why do you keep chasing me out of the living room? I can’t see out of my left eye. I’m confused, weak, and sometimes I lose my balance.”
In fact, this 17-year-old cat who lives in my house shows no overt sign of pain. He primarily shows me that he is relaxed, quite, affectionate, loyal, and proud.
Possibly, the dignity in Rolf’s death will be that there is still so much of his life to be taken away. When people speak of death with dignity, certainly they mean that not all remaining shreds of dignity must first be stripped away. And yet, I also know that there is some fairly direct relationship between dignity and freedom of choice.
Koki hears me sobbing and expresses concern. However, Rolf seems almost happy go lucky at times. He is, at least, gratified by all the extra attention he is getting from me—but he seems oblivious to the gravity of his situation, and the excruciating choice I have to make.
9/3/11
As I walk through the house, Rolf stirs, gets up and follows me. When I stop he looks up to me and meows. “What’s going on?” It is like any other day.
Rolf’s kindness and loyalty and trust have only deepened as his symptoms have accumulated and worsened.
He has kidney failure, anemia, practically total hearing loss, half blindness, urinary behavioral incontinence, failure to groom or sharpen his claws, loss of balance and strength, emaciation, and “severe” dental disease and an eye infection, both of which must be painful. A daily pill, eye drops, 3X weekly subcutaneous fluids, monthly vet visits, and required institutional boarding when I am away, contribute to his distress. The hair on his back legs is matted and he complains when it is touched. His eye and dental disease could only be treated with risky and expensive surgery. He notices and protests when he is excluded from the living room—chased out a few times/day—and the bedroom, and he has lost his lifelong privilege of sleeping with me on the bed. Whatever comfort or contentment he always had from the sound of my voice is gone forever, and it is missing every day. It is not irrelevant that his care and treatment has cost me more than $300/month for more than a year, which I can barely, or cannot, afford.
I let him out on the porch while I write about him. When I am finished, I find him there, lying on the ottoman. He looks up. I scratch his head, and he rubs his whiskers on my hand. It is like any other day.
9/8/11
I took Rolf to the A-Street park overlooking the Capitol, West Valley, and the mouth of City Creek Canyon—which was silly because I can’t remember ever taking him to a park before.
After minimal complaining he became curious and started walking around in the grass. I had to retrieve him several times because he kept going for the cliff edge threatening to make for an adventurous escape. Finally, I carried him back to his crate and opened a can of his food. Any notion that this big wide open place might have been scary was surely refuted by his pleasure and passion for dinner. Then I took him to the picnic table overlooking the view, and he settled down and checked it out for a good five minutes. I had a stranger take a few pictures of us.
9/9/11
For the past two weeks, I have been adhering to the theory that cats “hide their pain.” Cats are not pack animals and in the natural world, showing weakness gets them picked on by competitors or predators. However, a deeper review of the idea on the internet suggests that this highly agnostic point of view is intended more for people who aren’t paying attention to younger pets with undiagnosed problems—not for attentive caregivers of chronically ill geriatric pets trying to make end-of-life decisions .
I think what has been most gut-wrenching about this process I have let this theory trump my my clear subjective impressions that Rolf is happy most of the time, remains interested in life, and has never been more affectionate.
I browsed web sites on cat pain and see that he lacks most of the signs, such as being reclusive, hissing, sitting with back hunched, distant or faraway look. His lack of grooming could be attributed to his loss of balance, and the urinating in the dining room could be explained by senility.
I asked Dr. Walters about his oral pain, which to me seems like the most significant factor, and she indicated the pain had to be several levels below unbearable. “There are lots of people in the world who have never been to a dentist. They may be uncomfortable but they walk around and they lead normal lives."
I filled out a pet quality of life scale and Rolf earned a 58 where 35 is the cutoff for unacceptable. On the Happiness and More Good Days Than Bad items on the scale, I could see no reason not to give Rolf 10/10 points.
Our appointment for euthanasia became a consultation about quality of life assessment, and I went home with another month’s supply of eye drops, Epogen, and the special canned food he seems to like so much. It was all $174, and I know I have $160 worth of institutional boarding for him next week. However, last night I balanced the books on my business and found that I was a lot farther ahead than I thought. I certainly can’t afford $3600/year, but I can afford $300 right now.
There might not be many, but Rolf and I still have at least some good days ahead.
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