Even as I said it, I knew it was ridiculous and selfish. “Just promise you’ll make it till my 30th birthday,” I said quietly to Kitty, my tiny ten-year-old cat. We were both under my bed, where she’d decamped the minute we returned home from a long day at the vet. Earlier that day, I’d found out she had a terminal heart condition. Nearly two and a half years later, she’d die from it in an emergency room in the middle of the night.
This was a longer prognosis than any vet had predicted, and yet I can’t stop wondering whether I did the right thing in delaying the inevitable. The twice-a-day pills, the bimonthly visits to the veterinary cardiologist (which almost always included a chest tap, a risky, invasive procedure), not to mention the vast sums of money spent: Were these things for her, or were they mostly, selfishly, for me?
Saying goodbye to a pet has never been easy, but advances in veterinary care can make it near impossible to know when to let go.
[pullquote]It’s a quandary that’s unsettlingly similar to issues plaguing human medicine: Just because we can extend a life, should we?[/pullquote]
Once, the biggest moral dilemma veterinarians faced was that pet owners were quick to euthanize, requesting the procedure at the first sign of age, illness, or inconvenience. Now it’s often the opposite extreme, said Bernard Rollin, a professor of philosophy and animal sciences at Colorado State University. In a 2011 paper in the journal Veterinary Clinics of North America: Small Practice, he wrote, “As animals became increasingly viewed as members of the family, the reluctance to euthanize began to enter veterinary medicine.”
A 2013 survey by the American Veterinary Medical Association found that two thirds of dog owners consider their animals part of their families. (The numbers are a bit lower for cats.) Americans spent $56 billion on their pets in 2013, according to the Federal Trade Commission; of that, $7.6 billion went to prescription and over-the-counter drugs. Many owners are willing to spend significantly on veterinary care: In a 2010 survey of more than 1,000 pet owners, 32 percent said they’d be somewhat to very likely to spend $5,000 on a single treatment.
The cost of treatment for a slow-acting illness like Kitty’s was deceptively exorbitant. I could never agree to pay $5,000 in one go, but $300 here, $75 there? It added up. By the end, I was spending about $150 per month on medication and $300 to $800 every other month on visits; once, I paid more than $2,000 for an overnight stay in a hyperbaric oxygen chamber to help her breathing. I felt equal parts panicky over the expenses and guilty over my financial anxiety, and I noticed that when discussing treatment with the vet, the question never seemed to be what was best in the long run for Kitty (or for me).
Initially for Kitty, a chest tap would buy her several months of easier breathing, so we decided the discomfort was worth the cost. I was warned she’d eventually need them more often and that the risk and distress would outweigh the benefits. But for the moment, they assured, things were OK. I focused on the moment.
If I’m ever in this situation again, though, I’ll look further ahead. We have the chance to ensure that pets get the planned exits that their human loved ones often do not. Last summer, the chest taps increased in frequency—once, Kitty needed three in a month. “These are not benign and have the potential to cause bleeding,” the vet wrote in the records. Yet even as the taps went up to every other month, the cardiologist (whom I liked very much) and I never spoke of prepping for the end of her life.
Veterinary end-of-life care comes with complications that don’t apply to humans. Animals can’t speak. They also can’t comprehend the trade-off in enduring pain now for the promise of more time later. “All they know is, This hurts now,” Rollin told me. “And they look up at you, and they want you to make it stop. And if you’re doing it for eight months to garner another three months—you see what I mean? I don’t think that’s fair to the animal. The animal doesn’t know anything about the last three months.” For some owners, a decent death means pet hospice or at-home euthanasia; for others, it’s deciding with their vet about when to euthanize before an emergency forces them to. In any case, it takes enormous courage to recognize when the animal is at the end of its life.
In surgeon Atul Gawande’s 2014 book Being Mortal, he talks about how to make final years meaningful for the aged and the ill. Before your loved one is incapacitated, Dr. Gawande suggests, clarify what makes life worth living for him or her. One man’s list was short: ice cream and college football. Again: Pets are not people. But the lesson applies. “When the animal gets very sick, particularly with a terminal disease,” Rollin said, “you consult that list, and you make sure your own needs, your own guilt, are not prolonging the animal’s suffering.”
I know what was on Kitty’s list: watching the street from the window, something she did with such focus that my boyfriend, Andrew, and I called it Cat TV; jumping on us when we went to bed, to sleep perched on our backs or sides; and wolfing down the food as soon as I dumped it in her bowl. I said earlier that pets can’t speak, but that’s not entirely true, is it? When they stop doing what they love, they’re telling us they’re getting ready to go.
I don’t know if Kitty’s health unraveled after my 30th birthday or that I forced myself to look at it. One night, she didn’t hop up on the bed with us. I couldn’t recall the last time I’d seen her unwind with Cat TV. The weekend before her death, she hardly touched her food. The following Monday, she tried to walk toward me but collapsed halfway there, and I couldn’t deny it any longer. I took her and headed with my boyfriend to the emergency vet.
The vet suggested we place her in an oxygen chamber. It wasn’t guaranteed to help, and it would bring the charges to at least $3,000. If we took her home, she’d almost certainly die, painfully, and within hours. (These were the options—even then, no explicit mention of euthanasia.) Andrew and I asked to talk it over. When the vet walked out, he left up the screen with Kitty’s records, and we saw the alarming frequency of her chest taps in recent months. We’d asked so much of her; the financial and emotional cost seemed too great to justify. We knew what we had to do, though still I made a last attempt to hang on.
Before the vet gave the initial sedative, Kitty swiveled her head wildly around. I hated that her last moments were spent in such a scary environment, but it was too late to plan for a peaceful goodbye. She had been a very good kitty, and we told her so as we stroked her. Finally, I let her go.