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Palliative care hits home… hard.

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Palliative care hits home… hard.


It’s Sunday night, 1am, and Toby has finally settled down. He has two different types of cancer, end stage, and is rapidly declining. It’s sad really that his appetite is fantastic, always has been, but after he eats he’s uncomfortable, nausea and pain for hours. He can’t find a comfortable position. We try all sorts of things. It’s never the same. His regimen of medications is extensive. His prescription diet is not cheap. I’ve been averaging five hours of sleep, interrupted, for a month now. I’m used to operating on little sleep. Insomnia has been an issue for me for years. But stressors push me off balance. And this- caring for my terminal pet- is most definitely a stressor. I’m not complaining, mind you. But the fact is that caring for a terminally ill pet is a lot of work. And it can be hard. As a house call veterinarian who sees a lot of palliative and end of life appointments, I have this conversation on almost a daily basis in some form with my clients. Is he in pain? What is going to happen? How long does he have? How will I know when it is time? Am I being fair to him? Everyone asks those questions, including me. And I don’t know the answer to most of them. And that drives me crazy.

Cancer is an evil thing. I’m watching the effects of it on Toby, who has gone from a chubby 20 pound french bulldog to 14 pounds. His favorite thing in the world is eating and his appetite is still strong. But he is painful and nauseous for hours after every meal. That is part of the evilness of it all. His favorite thing-eating- causes him discomfort and pain. Some nights are quiet and I am thankful for those. Others are not and one of us holds him for hours. He is normally very stoic, so I know he is very uncomfortable. And he gets so upset and anxious. And he isn’t an anxious dog. And I know I am doing everything I can to help. And I know it is getting worse. And I don’t know how long we can keep doing this. And of course, as soon as I have those thoughts he has a few good days in a row. So I am taking the approach of taking it one day at a time. Or at least trying.
I’m not very good at that.

One thing that has been helpful is keeping a journal. Recording his meals, his meds, his symptoms, his vitals, poos and pees, etc. He could have a very eventful or stressful day but a week later I won’t remember the details. Recording things helps keep it all together for the big picture. And you can find patterns. And gradual changes will be clearer and more visible. It helps me determine where he is, where he seems to be going, and what we can do to help him along the way. The thing I have to remember, that we all have to remember, is that they will keep going. They will keep trying. And when we can tell they are sick, they really don’t feel well. The big question is always… when do we stop? When are we doing it just for us. When are we not being fair to him? And that’s a hard one.

He still skips around a bit. Not nearly as much as he used to. But he does.

He cuddles. And just wants to sleep next to someone.

And when he is uncomfortable, he seeks attention and wants to be held. And he does seem to respond and settle down.

But it’s so hard to see him feeling so bad. Every day. Triggered by meals- his favorite thing.

And he is weak in the rear end. And occasionally incontinent.

And he is so skinny. He’s lost 25% of his body weight. He is losing weight no matter how much he eats.

And he gets so anxious. So, so anxious, when he’s feeling sick. It breaks my heart.

The pomeranian & the cat sleep next to him more and now groom him. They know something is different too.

So when my clients look at me and ask those questions, I answer as honestly as I can. And it depends on the pet and the client and the situation, of course, but I know how badly everyone wants to know. And I know how it feels to just want someone to tell you that you are doing the right thing. Every day I hear that now and I think of Toby. And I talk to my clients about him because I can relate. Most people think it must be hard to do that kind of work, especially right now. I don’t think it is hard at all. Sad and challenging sometimes, yes. But it is one of the most rewarding aspects of what I do.

I’ve been through this part of having a pet before. This part is so hard and sad. It isn’t new to me. But it’s never easier. Going through it now gives me a different perspective, or at least a fresh perspective on this part of it all. It allows me to relate on a more personal level with my clients. I think it helps them not feel so alone. I know those appointments help me not feel so alone. I see what people will do for their pets. I see all of the factors that have to be considered. I see the heartache every day.
Every day.

I feel it’s my job now to provide information, compassion, and dignity. If more can be done, I let people know. If it can’t, I help people figure out what can be done at home to provide time and comfort, for as long as possible. And what that looks like. And where is the line that shouldn’t get crossed for that pet. And I try to objectively help people figure out where that line needs to be. And how to be ready to make a decision that palliative care is no longer best for the pet. When does uncomfortable become suffering? I ask Toby that every day. If he could talk, that’d be really helpful. Instead, I use my judgment. He has such a sweet face. And it breaks my heart that we have reached this point. I look at how he is and I know that when he declines again, he won’t be able to sustain a comfortable life. I don’t know when that day will be. I look at him and I can’t bear the thought of him being in pain, unhappy, suffering. I look at him and I can’t bear the thought of losing him. Of him being gone. Both such sad scenarios. But one ends the pain for him. And that’s the only kind thing I have left to offer.

So I know we are going down that road. I don’t know how long that road is going to be. Or what we’ll encounter. I just know I love him. And I’m thankful to him for being in my life and for reminding me what my clients are feeling, and helping me connect in those moments just a little more. I try to look at it as a gift. I won’t be taking anything away except pain and discomfort that can’t be fixed. But until then, we take it one day at a time. What matters most is what we do for them at the end. And if I can help that be less scary or painful or stressful or uncomfortable, then it is my honor to do it. For Toby or for anyone. And now, at 2:00am, he is snoring by my side, so all is well.