Saying Goodbye to Hedda, Part One: Facing the Possibility of Euthanasia

hedda-euthanasia

Guest post by Sarah Chauncey

This is the first post in a three-part series. Sarah Chauncey is the author of an upcoming book for adults grieving the loss of their cat. We will feature part two, Making the Euthanasia Decision, next week, and part three, Creating an End of Life Ritual, the following week.

In the wee hours of a winter Friday morning in 2016, I had a nightmare: My 20-year-old black cat, Hedda, was having a seizure. Diarrhea was flying everywhere. Her green eyes stared at me, terrified, as her body convulsed. I was powerless to help her.

I was awakened by the usual 6am swat to the mouth that indicated Hedda wanted her medicine and breakfast. I rubbed a dose of transdermal painkillers on the inside of her ears, got up to put out fresh food and water, then went back to bed.

A few hours later, I saw—and smelled—droplets of brown liquid on the old flannel pillowcase that covered her heating pad. Hedda’s sides seemed to be occasionally heaving, and I realized she was straining to empty her bowels.

My mind began spinning. The thoughts came so fast and from every direction that I couldn’t pay attention to even one. I called a friend in Toronto, who had known and loved Hedda almost as long as I had. I blathered on and on to him, alternating between panic and total denial. My friend, perhaps intuitively understanding what was to come, was both reassuring and practical: Call the vet.

We couldn’t get in until mid-afternoon. The vet tech who answered the phone said it sounded like constipation—Hedda was elderly, had mid-stage kidney disease, and she was on a synthetic opioid. She probably needed an enema. Poor Hedda, I thought. Poor vet. Giving a cat a pill is bad enough. But at least that was straightforward. It would be rough, but she’d feel better and we’d come home.

As the hours went on, Hedda became lethargic and, for the first time, disengaged. The bedroom reeked as she soiled the puppy pads I’d placed on the bed, even with small droplets. She managed to pass a couple of small lumps of stool, which I took photos of and excitedly emailed to the vet. Maybe she wouldn’t need an enema, just…like, kitty Ex-Lax or something?

The vet stood across the examining table from me. She spoke firmly, almost angrily, as Hedda explored the new environment. “This isn’t constipation; it’s diarrhea,” the vet said. I asked what might be causing it; her guess was hyperthyroidism. Hedda had lost more than two pounds in the previous six months.

“What do we do?” I asked, and my voice cracked. She laid out the options of treating the symptoms without doing any tests, or doing blood and urine tests to find the underlying cause. Then she paused.

“Have you thought about euthanasia?”

In the past, I wouldn’t have allowed anyone to utter that word in the same room as Hedda. It was a cold, wet slap across my heart.

I had always felt strongly that ‘quality of life’ should be defined on Hedda’s terms—not arbitrary indicators of whether she could still act like a younger cat, but whether she still wanted to be alive. Even if her pleasures were simple: Eating, watching birds out the window, snuggling with me…simply being. I didn’t believe her life was mine to take, unless I was certain that she felt death would be preferable.

The vet looked at me in a way that I interpreted as half-grim, half compassionate. I burst into tears.

Her tone softened a bit. “People worry about doing it too soon. I want to tell you, it’s not too soon.”

I am grateful to her for being so direct. I knew we were coming from different belief systems, possibly different definitions of “quality of life,” but even in my mental fog, she forced open a door I’d been keeping locked. We both were coming from a place of compassion.

“Let’s do tests, treat the symptoms, and see how it goes over the weekend,” I said.

“She may not make it through the weekend,” the vet replied in a soft voice. “She might go downhill.”

I blinked. Nodded. My brain wasn’t computing any of this. I knew that if anything happened, I didn’t have the funds to take her to the emergency vet. Was that what my nightmare had been about? But I couldn’t just kill her right now.

For a few minutes, I was alone with Hedda in the examining room. I stroked her and with a shaky voice said, “Hey sweetie. We’ll be home soon.” I lifted her onto the examining table so that I could hold her closer, and I repeated the line I’d often told her. “Everybody loves Hedda. James loves Hedda and Dianna loves Hedda and Susan loves Hedda…” and I continued until I’d worn out everybody who had ever met her. “Everybody loves Hedda. Hedda is Love.” I placed her back on the floor.

We think we know what decisions we’d make in a given moment, but that assumes we can predict what our mindset will be, that our brains will be functioning at the same level as when life is flowing smoothly. That’s rarely the case.

***

My insides were a jumble—like, a drawing a toddler might make if he only had a black crayon. On some level, I knew the end was near. Yet I felt that, in this moment, I was being pressured to euthanize, and I knew that if I did make that decision, it had to come from my heart, not other people’s minds. And my heart was very much not on board.

Like many guardians, I expected that Hedda would communicate to me when she was ready to die. But I hadn’t been getting those signs. She still engaged with me, although her eye contact had been less frequent. She went up and down her ramp beside the bed a dozen or more times a day, and although I’d noticed that she was skinnier, she was eating as voraciously as ever.

Over the weekend, Hedda’s diarrhea subsided. We settled back into our comfortable routine, though this time, I had some decisions to make.

Coming next Wednesday: Saying Goodbye to Hedda, Part Two: Making the Euthanasia Decision

Sarah Chauncey is the author of P.S. I Love You More Than Tuna, an upcoming gift book for adults grieving their cat. She runs @morethantuna on Instagram and Facebook, “a celebration of nine lives,” and she started #tunatributes, a support community for people grieving their cat. She lives on Vancouver Island.

26 Comments on Saying Goodbye to Hedda, Part One: Facing the Possibility of Euthanasia

  1. Marge
    April 3, 2018 at 5:53 pm (6 months ago)

    Sorry about the blank “Comment” message – I was too focused on loss of a not-so-old good cat buddy today and getting my name and email right.

    So, per my previous comments, I have been preparing myself for eventual issues with CKD in my 19yo. It still would be hard, having had her since she was a kitten, but at least I could possibly plan ahead, and perhaps some treatments could help (she doesn’t need any yet.)

    Out of nowhere my ~14yo buddy (Katie’s nemesis) became ill this weekend. Without appointment, I got Chester to the vet early Monday. Exam and blood work (could not get a urine sample) showed some possible kidney issues – they wanted to do additional tests, do an ultrasound and get him started on antibiotics and fluids. hoping against all hope that perhaps this was a kidney infection not kidney failure. So I left him there, hoping for a simple fix. He wasn’t sick long and wasn’t old, by my standards!

    Ultrasound showed one kidney very small, the other seemed “okay”. By later in the day he had eaten some, so they were hopeful. By 10am when I called today, that hope had diminished. His numbers had not changed, especially the potassium (which was impacting his heart and causing twitches now and then), he was not eating and other than urine they extracted finally for testing, he was not outputting any more. They attempted Lasix to combat the potassium and maybe get the urine flowing. I went there anyway to at least visit him and see if there were any updates (cancelled all plans/appts.)

    I ended up spending about 1.5 hours with him. They took him at 2pm for more blood work and there was no improvement in the potassium. At this point it was pretty much hopeless. Meanwhile he tried several times to get away from me, was still having some more twitching and made several pitiful meows… so yes, I had to now make that awful decision, with no time to plan ahead. Wish that he was closer to 20yo and we had time to plan or try to fight this, but literally out of nowhere this hit! They gave me more time to be with him alone. Eventually, despite wanting to give in, I thought it might be best to let go. Between how he seemed and the fear that he would experience more pain and/or die alone in their cage, I chose to let him go while I could be with him. It doesn’t make it any easier, except in that knowledge that he was not alone. I suggested taking him home, but the vet advised against it, as he might go into heart failure and suffer (no 24/7 and at least 40m away.)

    So you can now count me in again among the losses (last one was 2 years ago to a dental cleaning, also no warning, but the previous losses were 8+ years ago, and they were only 10yo.)

    Reply
    • Ingrid
      April 4, 2018 at 5:41 am (6 months ago)

      I’m so sorry, Marge. I’m glad you were with Chester when he passed. No matter how many times we go through this, it never gets any easier. My heart goes out to you.

      Reply
  2. Yelena Aronson
    March 7, 2018 at 5:03 pm (7 months ago)

    Reading this with a tears. My cat Tulip in almost the same situation, she lost a lot of weight (her weight now around 5lb), skin and bones, we did everything we could, nothing helps. We stopped a diarrhea and vomiting, she is eating normal, but still loosing weight. She is very weak can’t jump on a bed anymore. I don’t know how much time left for her, but I think I don’t have a rights to take her life… Can’t even imagine, that one day she’ll not be around. Crying non stop and nothing can be done. She would be dead by now, if my husband didn’t try to save her (he is a doctor, knows a lot), but nothing worked a 100%. She just turned 8 years and she live with us only a 9 month, we adapted her in June 2017. I wish she was with us all this years.

    Reply
    • Marge
      March 7, 2018 at 5:06 pm (7 months ago)

      Have you had her checked by a vet?

      Reply
      • Yelena Aronson
        March 7, 2018 at 7:56 pm (7 months ago)

        Of course we did (6 vets) plus surgery, the vets told us she might have a lymphoma or IBD (symptoms pretty much is the same), we did a lot of different tests and none of them confirm a lymphoma, we also kept her on steroids and antibiotics, helped a little bit. Some vets offered an euthanasia, but I don’t want to hear about it. She is not in pain, but I know I’m losing her, just about a time.

        Reply
        • Sarah
          March 8, 2018 at 2:59 pm (7 months ago)

          I’m sorry, Yelena. Hold her close. The anticipation–knowing that it’s coming, and not knowing when–is painful.

          Reply
    • Marge
      March 8, 2018 at 5:38 pm (7 months ago)

      hmmm, not a vet myself, but seems like in both lymphoma and IBD there is often a decrease in appetite (seems a bit young for IBD to kick in so severe too). What about testing for hyperthyroid? The symptoms for that are very similar (vomit, diarrhea, weight loss, but normal or increased appetite)? If they have done that, then I’m out of ideas. I do feel for you Yelena! I dislike losing ANY never mind those who have shared life with us longer. So sad for such a young kitty to be suffering… I hope something comes up that might help…

      Reply
  3. Marge
    March 7, 2018 at 2:42 pm (7 months ago)

    Although we do not have the whole story here yet, I, like Carol, am a little surprised (no not really, some vets just don’t get it) that 1) the hyperthyroidism was not detected sooner and 2) treatment was not offered. A cat that old should be examined at LEAST once/year, preferably twice, and from what I know about it, hyperthyroid doesn’t just boom magically appear one day!!

    In my case, my then 17 yo had the senior screening and exam (T4 not included at that time), and vet blathered on about heart murmur and early signs of kidney issues, in particular not well concentrated (dilute) urine. She was drinking a lot. We started with cardiologist, who indicated what he found and said no treatment needed at this time, recheck in 6 months. There was a delay (neither cardiologist was available) in the next check, but between those exams I eliminated dry food for everyone in the household (it cured one with hypercalcemia and solved very loose stools in two sisters who were adopted with this at 4yo to me – they are now 12 with normal BMs!) Surprise at her recheck? No more heart issue… Hmmm… But shortly after that we found the hyperthyroid issue. Had I known what I know now (that damn thyroid can cause these issues!!!), I would have done the one and done iodine treatment instead of the transdermal. Being worried about the heart and kidneys, I was reluctant to put her through that – since then I have recommended to my vet that if you have an elderly cat who is showing the kidney and heart issues, a T4 test would be CHEAPER and QUICKER to do to rule that out!!! Unless they have an on-site cardiologist (most places do not) a T4 test can rule that out in a day! If borderline, there is another test that can be done, likely also a day – traveling cardiologist can take a long time before there are enough pets scheduled.

    The delay in finally getting this done (she was 18 by then) caused her to lose about 5 pounds – this despite “treating” the condition with medication. I am also concerned about how this might have impacted her heart and kidneys as well (if she was still losing weight, what havoc was it wreaking on her body that we could not see!?!?!?!) It is VERY difficult to get weight back onto an elderly cat, and in the year since she only gained back less than 1 pound. Vet was impressed that she was able to gain that much… However, she has gained not lost and is looking/feeling much better.

    At last check, almost a year post-treatment, 19 yo, BP is good, T4 is good and while some values have been slowly creeping up (BUN, Creatinine, Phosphorus), they are mainly still in the “normal” range, albeit on the high side. She is still mostly in the “pre” CKD, perhaps level 1 or 2, but still “okay”. SDMA, which is supposed to be an early diagnosis for CKD, actually went down by 1 this last time (and is still in the “ok” range.)

    As for making that decision – no it is not easy. At least not for me and certainly not after my previous vet. They decided it was just as easy (read probably cheaper and quicker for them!) to give the sedative and lethal dose in one shot. I was not told/warned and was HORRIFIED when they did this – that poor cat, and my last memory of her still remains with me, 9 years later – she hated the vet office, and so was pinned down to the table to do the injection!! NEVER again I said. That same office was treating another cat for a heart condition. They never told me about the hospital available 24/7 and she went into heart failure at night on a holiday. The best I could do was hold her. When her bed-mate (adopted together but not siblings) was going downhill with lymphoma (I had to go to a specialty place to get the right dx, that vet again was useless, including a staff person who answers the phone suggesting euthanasia and we did not even know what was wrong!!! BTW, both of those cats were only 10yo), it was my decision he would go on HIS terms. That he did. He was very agitated that last night, had trouble walking, so I scooped him up and stayed with him. He passed sometime during the night, quietly. I would NEVER allow another vet to do what that vet did. The first time ever we had to put one cat down (and with proper treatment, he might have been able to live longer, and better, but that vet was NFG), they sedated him and after he was asleep, they took him away for the lethal dose. THAT is how it should be done… except maybe stay even during the lethal… I think she spared my daughter for that. The other one who was pinned down, was done in front of me and my son too!

    Hearing the rest of this story might help and might clear up some questions, but reading about anyone’s loss can be painful to me and bring back these awful memories… Even if this was the right thing to do for this woman, every case has to weigh the pros and cons. There is no one right answer.

    Reply
    • Sarah
      March 8, 2018 at 2:58 pm (7 months ago)

      I’m sorry you (and your cat) had to go through that, Marge. I’m glad your 19yo is doing well. (By the way, I responded to Carol’s comment below)

      Reply
      • Marge
        March 8, 2018 at 7:19 pm (7 months ago)

        Sarah – I see your comment. I did note that Hedda was 20yo, had some level of CKD and some condition being treated with pain meds, but there ARE still vets whose first approach is ‘hey, this cat is old and sick, something else is going on, might as well put him/her down’. They ARE still out there! I’ve heard the shelter staff talk about their vet wanting to put a cat down, although it might be treatable. I was waiting to see what your next post had to reveal.
        At least the vet I have now doesn’t go that route – the latest addition here, added last April, was somewhere between 11-14, 10 years in shelter, limited people contact. I got him to have a new roomie for one cat who does not get along with the others (her brother was lost the previous year to dental), not intending for a “lap cat”, but if we can be friends, great! He also had one eye lost to unknown reason. I brought him for a dental a few weeks ago – turns out his jaw had been broken, several teeth sheared off at the gumline and one canine was out of whack – they suspect he was hit by a car, causing all the damage, including the eye. Poor kid! Anyway, during dental she called to report a small growth on his lip and wanted to know how “aggressive” I wanted to be, given his age, and pre-op test results showing *maybe* some early kidney and/or thyroid issues… DO IT! He’s not exactly on death’s door! We will cross that bridge later – monitor and treat as best we can.
        Given what we do know about Hedda, I would have felt the same as you -let’s at least give something a try!

        Reply
  4. Steven Howard
    March 7, 2018 at 11:59 am (7 months ago)

    Very touching but so sad.

    Reply
  5. Alyce Schmid
    March 7, 2018 at 9:57 am (7 months ago)

    This is the hardest part of living with our fur babies. We love them so much and often there comes of time we have to love them enough to put an end to their suffering and give them a peaceful journey over the rainbow bridge. You can usually tell when the joy is leaving their eyes and we have to remind ourselves are we at a point we are going through extreme measures for ourselves or for our babies. Love them enough to let them go when it is time.

    Reply
  6. Pat Gibson
    March 7, 2018 at 9:23 am (7 months ago)

    I am still crying. Hedda looks like my Midnight who also has kidney disease. I lost another last November to cancer. I wish they could live as long as we do. Animals should never be made to suffer. God bless.

    Reply
    • Sarah
      March 8, 2018 at 2:55 pm (7 months ago)

      I am so sorry for your loss, Pat.

      Reply
  7. Janine
    March 7, 2018 at 8:53 am (7 months ago)

    This is so hard to read. We are probably close to the end with our Pono and trying to wait until we really feels his quality of life has really changed. He has lost so much weight and basically skin and bones. He throw up most of what he eats. We are cancelling going to a out of town wedding this weekend because we don’t want to leave him with someone else to take care of. It would be right for either of them.

    Reply
    • Ingrid
      March 7, 2018 at 9:00 am (7 months ago)

      I’m so sorry, Janine. It’s such a hard time. I totally understand not wanting to leave Pono.

      Reply
    • Sarah
      March 8, 2018 at 2:54 pm (7 months ago)

      I’m so sorry, Janine. I also understand not wanting to leave Pono–I was the same way with Hedda.

      Reply
  8. Carol
    March 7, 2018 at 7:56 am (7 months ago)

    I know there may be more regarding Hedda’s condition, but when I read that the vet said it might be hyperthyroidism…, I was a bit shocked that the vet went straight to euthanasia.

    My cat had that same condition about 4 years ago (lost weight rapidly and was diagnosed by a vet). The vet suggested medication, but I opted for the radio-iodine one time treatment. My cat is sleeping by my side on the couch right now and at her last checkup, her thyroid was 100% healthy. She’s also 16 years old.

    Please note, I am not judging, but was a little taken back…

    Reply
    • Scarlett and JD
      March 7, 2018 at 1:32 pm (7 months ago)

      I am so with you on being taken aback about jumping to euthanasia to ‘cure’ hyperthyroidism. THAT being said, you also have to read the ‘fine print’ when doing the radio-iodine. I had the funds to do that procedure, thinking that pilling everyday my sweet, sweet boy would be much worse than a couple of days at an away vet, and the iodine treatment. Driving home, I DID read the fine print that said it could throw him into kidney disease. And it did. We had him for two more years after that treatment. And no, if faced with the choice again, I will not do it.

      Reply
      • Marge
        March 8, 2018 at 6:12 pm (7 months ago)

        Scarlett (and anyone treating hyperthyroid):

        If the fine print did indeed say it could CAUSE CKD, it is worded wrong. The issue is that the hyperthyroidism can MASK existing kidney disease and the one-and-done iodine treatment can then UNMASK the condition. With hyperthyroid, the whole body is running in overdrive, so the kidneys are flushed (they tend to drink a lot with either condition) more and kidney issues won’t really appear until after that treatment. Once the thyroid is treated, it SEEMS like CKD just appears, but it was there along with (and perhaps precipitated by) the hyperthyroid. It is hard to detect or determine the level of CKD (hence why I did not do the treatment right away, although I had the funds too.)

        Please see the following:
        https://endocrinevet.blogspot.com/2014/10/unmasking-kidney-disease-in.html

        Dr Mark Peterson is a well-known endocrinologist and well versed in many cat medical issues, in particular hyperthyroidism. Staying on the meds can sort of keep the thyroid in check, but it does nothing to help CKD. Neither treatment causes it. The meds, especially the oral ones, can also cause stomach upsets (we did transdermal, but despite keeping the thyroid in check, she still lost 5 POUNDS during the treatment, some just prior to dx). In my Katie’s situation, treating with the iodine did NOT result in worse kidney numbers, but she had some kidney function loss with the hyperthyroid (maybe due to age, perhaps brought on or made worse by the thyroid issue itself, but NOT changed by the treatment! As I noted it has been a year or so since treatment, and her kidney values are slowly creeping up, but did NOT jump drastically after the iodine treatment – those that do really did have CKD, it just could not really be detected because of that &^*@*$ thyroid!)

        On the flip side, not treating hyperthyroidism, as noted, will tend to mask the CKD issue (and could contribute to making it worse, even though it might not appear so from tests.) The end result is that most/all poor kitty’s organs get overtaxed and leads to early (even earlier than Scarlett’s case) death. Although the medication might “help”, it does NOT cure the hyperthyroid condition – I suspect I would have lost Katie already, had I not decided to go for the iodine treatment (when I could feel her spine, that was it for me!)

        Rather than eliminating that choice, TRY the medicine and once the happy dosage is found to get the thyroid stable (it can change and must be tested/adjusted on a regular basis), THEN do the full test for kidneys. More than likely there will be some indication, but the whole picture might still be hidden by the thyroid condition. How bad might not be known yet, but at least be aware of it. After getting the iodine treatment, once kitty stabilizes (it can take several months for the T4 levels to adjust), THEN you will have a better idea of where kitty is on the IRIS scale for CKD.

        Reply
    • Sarah
      March 8, 2018 at 2:50 pm (7 months ago)

      Hi Carol – For the record, Hedda had multiple chronic health issues. The vet’s comment was based on a combination of Hedda’s severely reduced mobility, and her dramatic weight loss. I realize it’s jarring without context (my mistake), but she wasn’t looking at an otherwise-healthy cat and recommending euthanasia.

      Reply
  9. Maria
    March 7, 2018 at 2:58 am (7 months ago)

    Death is a part of life, but my eyes are filled with tears reading this post. Three times I have understood, when taking my cats to the vet, that there was no way back – two of them were quite old (16 and 17) and had kidney failure, the third time I spent a fortune on different blood test and then learned that cat #3 had a neurological disorder that could not be treated, much like ALS. Those three times were tough, but I felt I did the right decision. But then came the fourth time I had to take a very much loved cat to the vet (Kajsa) and I never could have guessed that I would take home an empty carrier. Yes, I felt forced to euthanize her, and yes I still feel terrible about it, and feel I have no one to talk to about this.

    Reply
    • Ingrid
      March 7, 2018 at 6:52 am (7 months ago)

      My heart breaks for you every time I think about what happened to you and Kajsa, Maria.

      Reply
      • Maria
        March 7, 2018 at 11:50 am (7 months ago)

        Thank you for your sympathies and caring Ingrid, I know you understand what I am going through.

        Reply
    • Sarah
      March 8, 2018 at 2:51 pm (7 months ago)

      I am so sorry, Maria. That sounds so traumatic.

      Reply
  10. Linzy
    March 7, 2018 at 1:45 am (7 months ago)

    What a read. I have tears in my eyes.

    Reply

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