**TRIGGER WARNING** – cat illness, euthanasia
Recently I had a long conversation with a family who brought their cat into the ER. She was about 15 years old; which is, by most people’s definitions, a senior cat. They noticed she was no longer able to navigate the stairs and had not only fallen down them but also off the bed. Her pupils were noticeably dilated. The family was worried that she was blind because of how she was acting at home.
Upon physical exam, the doctor determined she was tachycardic with a heart murmur, and she was hypertensive. The vet confirmed the blindness and noted extremely low body weight. The owners stated she was constantly begging for food and said the regular vet told them her thyroid levels were too high about a month ago – but the cat was not on thyroid meds for some reason.
In hospital bloodwork was done and indeed, this kitty was hyperthyroid. She was also in kidney failure. Multiple body systems were not functioning well and the family wondered what their options were. A cardiology consult, maybe an internal medicine consult, cardiac meds, thyroid meds, SQ fluids and environmental management to prevent her from being injured at home was all discussed. They were, understandably, overwhelmed.
They loved this cat. She had grown up with their daughter and they wanted to do what was best for her. Money wasn’t a concern.
But quality of life was
Their cat loved to play with the large dogs in the house, and now would need to be kept away from them to prevent injury if they accidentally knocked her down the stairs again. She loved to watch the birds out the window, and on TV…but now she was blind. She was not easy to medicate and while the owners were more than willing to try, they worried about her becoming scared of them. They didn’t want to fight with her and ruin the (human-animal) bond they had.
VALID
The father asked, as this was his first time having a cat, how long do they normally live? If she was only halfway through her life, then they didn’t want to give up too soon. I reassured him that no, cats don’t generally live to be 30 and the life she had experienced so far was not only a good length but more importantly a good quality. They asked would she ever be able to watch the birds and be safely loose in the whole house? The vet explained it was unlikely.
We talked about giving SQ fluids at home, we brainstormed medication options like transdermal, compounded, what treats to try to use to hide the pills, etc. The mother asked if these conditions were curable; we kindly explained while they are manageable for a time, they can’t be cured. How long can they be managed the family wanted to know. There is no way to know we replied.
They asked if considering euthanasia made them bad people.
We said no. Because it does not. There are worse things than death. Getting knocked down the stairs by the dogs and breaking a leg. Throwing a clot and having her final moments be in agony because of her heart problems. The slow continued decline of her kidneys and the discomfort that comes with that.
The family opted to let her go peacefully. We supported them through it.
There are some people who will not agree with that choice. Which is, I suppose, their right. But it isn’t their choice to make. Sure, we could have sent the cat home on multiple medications, with some recommendations of ways to get the pills into her. Done a SQ fluids demonstration then packed the fluids, line and needles for them to try at home. They could have kept her in a safe room and not allowed her to be around the dogs. She could have listened to the birds, even if she couldn’t see them. They could have scheduled the cardio consult and the echocardiogram, gotten the repeat bloodwork while the thyroid meds were adjusted, monitored her blood pressure and done all the things to manage her multiple diseases. Maybe she would have responded well and gotten another 6 months, maybe a year.
Or maybe not.
Maybe she wouldn’t have responded well and her cardiac disease would have progressed rapidly. Perhaps giving pills would prove to be stressful for all involved and her final weeks would be a twice daily battle. Maybe the SQ fluids would have the owner in tears and the cat hiding under whatever furniture was in the “safe” room she was kept in. It’s possible that not being a part of the every day family life would have resulted in her being anxious and depressed.
For 15 years this cat knew warmth, food, safety and love. That is truly wonderful. We seem to want to deny that death is a natural part of life, and view it as the enemy. Science has allowed for tremendous advances and the ability to treat and cure many diseases, which is also wonderful. But eventually, death is coming. It is OK to allow for a peaceful, dignified end. We can try to “fix” medical problems with all we have – but just because we can, doesn’t mean we should.