The choice to live, or not.

 The choice to live or the choice to die is something many of us have no say in.  When is it okay to say “I’m done” because your quality of life, is not a livable life.   

Currently, I’m in Oregon visiting my in laws.  The day before I got here my mother in law sent me an email with the sad news that their 17 year old cat (inherited after my sister in law passed away 3 years ago)  was dying from kidney failure. Summer had three cats, and Lightning will be the second to pass away.  Lightning (lighnin’ as we call her) is a spunky white cat, who used to chronically steal food, lick the butter if you forgot to cover it, perch on you daintily as you slept, and is a cat who has lead a life of service.   To understand this life of service you have to understand the mysterious myriad of illnesses that surrounded my sister in law, that eventually lead to her death, a death that taught us about what quality of life really means. 

Here is a long story from the NYTimes about Summer’s life, that you can read at your leisure.  Lightning is the white cat standing looking out a window.  In the magazine there were more pictures, and Ms. Lightning managed to push her furry head into all of them!  Read the article, or at least part of it because the abridged paragraph below doesn’t do her story any justice at all. 

http://www.nytimes.com/2009/02/22/magazine/22Diseases-t.html?pagewanted=all

Summer was a mystery that no doctor could figure out.  The time that I spent with her was when she was selected to come to the NIH (National Institute of Health) to be poked, prodded and written about.  They couldn’t cure her, but hoped that the knowledge that they could gain from studying her, might help others down the line.  She lived in chronic pain, knowing that these illnesses would eventually end her life. She was on dialysis, mobility issues, lost one eye, but she never lost her spirit.  People in chronic pain develop this biting wit and sarcasm as a defense mechanism, but from what I know of Summer that’s just how she was.  Strangely, with all of the undiagnosed diseases that Summer had, her cats seemed in some way to take them on.  Lightning occasionally had a seizure when she was younger, like Summer did and even had a touchy digestive system.    

Summer taught us about quality, or lack of quality of life.  In the end, she started bleeding, and they didn’t know where the blood came from or how to stop it. They gave her blood, and more blood and more and finally she said, ‘enough is enough.’ What is the point of being alive, when you aren’t living, stuck in a hospital bleeding out the blood that I just had injected.  What type of life do I have hooked up to these machines, incapable of doing anything more than lying here waiting for death?  She she made a choice. She chose to die.  She chose to have all her friends over to give away all her earthly possessions and tell them good-bye.  Our last conversation with her was on our wedding day (June 22) and the last thing she said before bye, was “I’ve got to go, the cat is eating my avocado!” Two days later, she passed away. On her own terms, in her own house, surrounded by family and friends. 

Lightning is 17 years old.  She’s an old cat that was the constantly companion to Summer. She hates being picked up because Summer couldn’t pick up the cats, so she never got used to being held like that. A recent vet visit determined that she was in the late stages of kidney failure, an inevitability in cats of advanced age, and the vet suggested subcutaneous saline injections. So home my father in law and the cat came, laden with a large bag of saline fluid, needles and tubing. While injections on a healthy cat with fat on it’s bones might be easy, it’s extremely difficult to ‘tent’ skin on a skinny dehydrated cat.  Let’s just say the first injection was both traumatic, probably not terribly effective and the last time we did it.  Instead when the time came to do the injection again, we decided that we would let her go on her own terms and that the trauma of the injection wasn’t worth the few days of benefit that she might gain from the injection. 

While she hadn’t been eating, she seemed to really like the small crumbles of turkey I gave her the night I arrived, so it was an issue of finding out what she could and would eat.  Actually, I only thought to feed her turkey because Newton is obsessed with smelling my food but never eats people food, and she seemed to want to both smell and eat my food.  The important thing though was that water. We started offering her water hourly in a bowl, where she was laying (rather than having to get up), and she started drinking. MY MIL ground up some cat food, added warm water and the gravy from it, and she started lapping that up.  I even suggested she get a ‘ride’ over to the litter box, and she greatly appreciated that as well.  

Lightning hasn’t given up. She will die, but she has chosen to hang on. Maybe she wants to make it until Summer’s birthday on 6/12, or the date that she passed away on 6/24, but either way she’s with us now.  She slept with me last night, which warmed my heart because the past times I visited she slept with me the entire trip.  Her quality of life isn’t bad. She’s not in pain, she’s just tired.  Similarly, Summer fought through the exhaustion,  lack of appetite, and failing kidneys until she was able to make a choice to say that enough is enough.  We can’t cure her, we can’t fix her, but we can let her make the choice of when to give up, and she’s not ready to.  

Not many people go on vacation to take people to cataract surgery (that’s in a couple of hours) or do home hospice for a cat, but I don’t mind. I didn’t think Lightning would last until this visit, and the idea of being there when my mother in law can see clearly with both eyes (without glasses) for the first time in her life,  are amazing memories that I will hold dear.