Goodbye

Holly, May 18, 1996 – October 18, 2012

Holly had a couple really good days last weekend, but she had a serious coughing fit last Sunday night, and by Monday, her breathing had gotten pretty bad. On Tuesday, the vet drained some fluid from her chest, and her breathing got a little better — but it still wasn’t normal, and apparently her tumors had grown even more since the previous week. The vet increased her diuretic prescription (to help get rid of some of the fluid) but said that the remaining breathing problems were mostly caused by the solid masses, not by fluids.

I took most of the week off work. On Wednesday night, she seemed to rally. She’d been lying beside me on the couch, and then she did something that she’d done a thousand times before. She went into the bedroom, found Thunder lying on the bed, and meowed loudly. I came in and sat on the bed; Holly jumped up and walked over to Thunder, who proceeded to groom her thoroughly while she purred. It was the most normal moment we’d had since she’d gotten sick. Then she slept all night in her usual spot, curled up next to me.

On Thursday, she just seemed really exhausted. She did eat a couple times, but she spent most of the day either on my lap or right next to me, sleeping or just focusing on breathing. Thursday night, I had a vet come to the house and euthanize her.

Holly and Thunder in better days

I miss Holly’s purr, and I miss seeing her and Thunder play together. Thunder was pretty depressed that first night, but he seems to be doing okay and possibly even enjoying the extra attention I’m giving him. Every so often, though, he’ll go to a chair she spent a lot of her time on or to one of the cave-like cat beds I bought for her when she was sick and just sniff it thoroughly. They weren’t inseparable, but they were friends, and he’d lived with her since he was ten weeks old.

Decisions

I’ve been spending a lot of time trying to decide how to decide when the end should come for Holly. It seems like the only way to find the right time is to wait too long and then look back and say to yourself “I wish I’d done this three days ago.”

Holly in the cave-like cat bed I bought to encourage her to stay out of the closet.

I turned to the Internet for help, because that’s what I do when I obsess over things. Many sites link to this Quality of Life Scale, which asks you to rate seven aspects of your pet’s life (pain, happiness, etc.) on a scale of 1-10. The highest possible score is 70, and anything above 35 is considered “acceptable”. I think this scale is deeply flawed: the categories overlap, the judging is subjective, and equal weight is given to things that aren’t equally important. One category (“more good days than bad”, which is separate from “happiness”) seems more relevant to humans than to cats; I don’t know what cats think about, but I don’t believe they really have a concept of “good days” or “bad days” or spend a lot of time comparing the present to the past. The scale also leaves out one important issue: reactions to medications, vet visits, and other medical procedures. Still, it asks some good questions and is worth looking at, if you ignore the scoring and just think about each question individually.

That seems to be the approach taken by the research study described in this journal paper. People who brought their cats and dogs for cancer treatment were given a questionnaire with questions similar to those on the Quality of Life Scale linked to above, but more specific, plus a few questions about their pets’ overall health and quality of life. Then they and their veterinarians were given a second questionnaire asking them to rate and comment on the usefulness of the first one. Finally, the researchers calculated how the answers to each question correlated with the owners’ perceptions of overall quality of life and looked at all the suggestions for improvement. This looks like it could be developed into a useful tool for tracking how the quality of a cat’s (or dog’s) life is changing over time.

I started out looking for a magic formula that would tell me when it was time to euthanize Holly. I didn’t find one. The next best thing would have been to find a study that asked people who’d had a cat euthanized (or who’d decided to let their cat die naturally) about the decisions they’d made and what they wished they’d done differently. I didn’t find that either. I did get some insight into my own attitude, though — I decided it would be better to err on the side of shortening her life by a few days than to have her suffer. And I came up with my own private, Holly-centric set of questions:

1. How’s her breathing?
2. Is she dehydrated?
3. Is she in pain?
4. How much is she eating?
5. Is the Insta-Purr™ still functioning?
6. How much time is she spending in the closet?
7. How much time is she spending looking out the window?
8. Can she still jump, or at least climb, on furniture?
9. How is she getting along with my other cat, Thunder?
10. Are her twice-daily medications just annoying or traumatic? How about her visits to the vet?

In the end, though, it came down to this: I was watching her breathe, and I thought: this looks so tiring; if she stops now, that’s okay.

Progress

Today was a good day in Holly-land:

• Her morning dose of medicine annoyed her but didn’t traumatize her.
• Aside from a couple hours spent hiding in the closet immediately after her morning drugs, she spent the whole day doing normal cat activities: window-sitting, couch-sitting, lap-sitting, and even a little catnip-sniffing.
• Since she got sick, the only things I’ve been able to get her to eat are Hill’s a/d and Whiskas Temptations. This morning, she suddenly decided she wanted some regular cat food.
• Remember how sad I was that Thunder had stopped grooming her? They had two full-fledged grooming sessions today.
• Tonight I had to give her all three medications. I managed to get most of them inside her. She glared at me for awhile afterwards, but then instead of hiding in the closet, she demanded a snack and ate real cat food for the second time today.

Holly (and Thunder) eating regular cat food tonight

Setbacks

I took Holly for a follow-up vet visit yesterday; the vet checked her out, ran some blood tests, and took some new x-rays*. The bloodwork had actually improved, but there were two new nodules in her lung that hadn’t been there a week ago (and I asked — they definitely weren’t there before; it wasn’t a case of them just not being visible). The vet prescribed some new drugs to treat her symptoms and increased the frequency of her appetite stimulant, so now instead of taking one pill every three days, she’s taking one or more pills every 12 hours.**

At least, that’s the theory. One of the pills I was supposed to give her apparently tastes terrible. I gave her the first dose the same way I’ve been giving her the appetite stimulant — just sticking the pill in her mouth following the directions from every “how to pill a cat” video ever created. She spat it out a couple times; I finally managed to get her to swallow it, but she wound up foaming at the mouth afterwards (the way cats do when they have a really unpleasant taste in their mouth) and then hiding in the closet. I tried to disguise the taste when giving her the second dose, but the results were the same.

I decided I wasn’t going to do this any more — the trauma of going through this twice a day was worse than any benefit the pill could give her. There’s a kind of freedom that comes with having a cat who’s dying: you can make decisions like “I’m not going to do this any more because she hates it” without feeling guilty or conflicted. But in this case, it turns out there are more options: I called the vet, who called a compounding pharmacy, who whipped up a batch of fish-flavored liquid prednisolone. I’m going to try to give her some tomorrow. It smells like fish, but to me it tastes more bitter than fishy. Hey! Don’t look at me like that. I just tried a drop on my finger; I didn’t take a swig from the bottle.

Today’s good news is that Holly seemed to be fully recovered from her pill-related trauma by the time I got home from work tonight. And the two cats seem to be getting back to their normal level of closeness.

I got up for a moment, and Thunder stole my seat. And he’s hogging the remote. Cats can be so selfish.

*I should probably call them “radiographs”. That’s what the vet calls them, and it makes sense — if you think about it, calling a radiograph an x-ray is like calling a photograph “visible light”.

**Holly takes one medication every 12 hours, another every 24 hours, and a third every 48 hours. I half-expect the vet to prescribe additional drugs for her to take every 4 days and every 8 days.

Rejection

The nicest thing about having two cats is watching them hang out together. Holly and Thunder have a routine: Holly will walk up to Thunder and sort of shove her head into his face, he’ll start to groom her, and she’ll purr so loudly that I can hear her across the room (proving that you don’t need to be human to activate Insta-Purr™). Sometimes Thunder will initiate these sessions, but it’s always Thunder grooming Holly, never the other way around. This always struck me as a little odd, because Holly was 8 years old when I brought a tiny ten-week-old Thunder home for the first time; you’d think the adult cat would groom the kitten, not the other way around.

Holly spent several hours at one vet’s office last Monday and most of the day at another last Tuesday. At home after each of those visits, Thunder would approach her in slow motion, sniff her, hiss, and back away. Things have been improving since then, but now whenever Holly tries to get Thunder to groom her, he’ll just walk away. It’s kind of heartbreaking to watch her go to her cat friend for comfort only to be rejected. I’m not sure whether he’s just reacting to her vet visits or whether he senses that there’s something more deeply wrong.

The two cats do seem to be perfectly relaxed near each other now, so I’m somewhat hopeful that things will get back to normal between them. Holly has another vet appointment tomorrow, though, so I expect another temporary setback before that happens.

Introductions

Sixteen years ago, someone brought an adorable six-week-old calico kitten to a very nice cage-free no-kill animal shelter. A year after that, I adopted her. Soon after I brought Holly home, she taught me her favorite game. It’s called Throw. Here’s how it works:

1. Holly brings me a cat toy.
2. Holly gives me the verbal command to Throw.
3. I throw the toy.
4. Holly chases the toy, picks it up, brings it to me, and gives me positive reinforcement.
5. Steps 2-4 are repeated more times than I can count.

We’ve been playing this game pretty regularly for the last 15 years or so. The only problem is that after a year or two, Holly changed the rules. Now it goes like this:

1. Holly brings me a cat toy.
2. Holly gives me the verbal command to Throw.
3. I throw the toy.
4. Holly chases the toy, picks it up, drops it, and runs back to me.
5. Holly repeats step 2, while I try to explain that I can’t throw the toy because I don’t have it.

No matter how many times I try to explain that I can’t throw a toy that I don’t have, Holly remains optimistic that I will throw it anyway. Holly’s optimism is part of her generally sunny disposition. She’s also equipped with Insta-Purr™: she’ll start purring the moment I begin to pet her; she’ll also purr if I talk to her, or even if I pet my other cat.

Speaking of which, here’s a picture I took of Holly and my other cat, Thunder, last year.

Holly’s the calico on the left; Thunder’s the tabby on the right.

Recently, though, things have changed. About a week and a half ago, Holly started acting like she was feeling a little unwell. Last weekend, she stopped eating. On Tuesday, she was diagnosed with lung cancer.

Holly last Sunday

There’s not really much that can be done to treat her cancer (other than surgery, which would be pretty brutal), so her vet and I agreed to just give her palliative care to keep her as comfortable and happy as possible. She’s actually feeling much better now than she was a week ago — the vet gave her fluids and prescribed an appetite stimulant, and she’s eating (a little) now and seems to have perked up quite a bit.

Holly yesterday afternoon.

So for now we’re just taking it a day at a time.