Eluding The Arrow. When Life Narrowly Escapes Death. If Only By A Few Days

I have been repeating the following to myself routinely throughout the past days;

"There is nothing more precious than this day...."

I play this on a loop because my breath can't catch my fears for long enough.

Every moment of each recent day has been an egg-shelled goosestep frenzy. A holding of my breath as I cross my fingers and mutter a silent prayer for a reprieve,,, if only for another day. All the while knowing that my luck, and the mercy from above, is on short supply from an endless demand. Fate always wins. The house always calls its players home from rehearsal. I am not fooling anyone, surely not myself. The one who witnesses, awaits, and too often yields that fateful blow. No, surely I will not be provided mercy from deaths ever tightening grip. 

I know this, and yet I, like everyone else, sit here pray-fully begging for another skipped turn. 

Just one more hour, a sunrise, a day, perhaps the upcoming holiday, to be given with my dear boy.

His name is Charleston. He's 13. All grey faced and creaky. Bones jutting from a spine that used to propel him like an antelope. Stiff gaited and slow. He wags a slow paddle when you gleam a big "hello!" and whisper into his silken silvered ears,  "I love you." He is still there. 100% mentally intact. Feeling all of his wants, his impatient protests, and the pull of a cancer that is slowly ingesting him from the inside. He moans and flops, and reminds me to beg harder. Plead more profoundly. And decide where that line is that I always propose to stop at. The veterinarians compass is full of tricks. Tools of the trade to barter with the invisible veil of fate calling him home.

Today was a night of sleepless worry. He did well yesterday. We enjoyed a full day at home, uninterrupted. Last night he paid the price for not sleeping the day away as is his usual when I work 12 hours. He tossed, turned, moaned, whimpered, and panted in small short blows to a chest that has been compressed by fluid from a tumor leaking inside his heart.

He sleeps at the foot of my bed. His dry, violent coughs jolt me out of half slumber to try to assuage the beast that rises and screams within his ribs. It was a night that brought an awakening that we couldn't do this another day. It was just too cruel to hear him pant so fast and furious and still not be able to catch a good breath. 

When my husband awoke we talked about the logistics of putting him to sleep on his bed. In just a few moments he could be at peace. I could give him that. For all the pain it brought to me. I cried to my husband hating this part of my toolbox as much as I do. I truly despise this one last act. It is the most difficult thing I force myself to do. 

Why do I euthanize my own? 

It comes down to them. My beloved pets knowing that they left with me confessing the depth of my gratitude into their ears, their being. That I loved them beyond measure and I wouldn't let anyone else tell them for me at this last moment together. It makes me nauseous. Physically ill. I cannot eat, or drink, or let myself be forgiven for my failure.

I draw imaginary lines to not cross. 

Today it was oxygen and thoracocentesis. I was not going to put him in a caged oxygen chamber, alone. Breathe better my boy, but do it surrounded by stainless steel and a plexiglass door fogged with panting pleas to be freed.

Chest tap. Drain the fluid compressing his lungs and let the air back in. Why when the tumor is just going to replace it? Maybe it will take days, or weeks (fingers crossed), but, it will come back.

Nope we were going to be grateful for our time together and say our goodbyes. 

The cancer is in his heart, his bladder and his spleen. Nasty invasive fucker holed up in the heart. The one place I can't put my surgically gloved finger on and cut out. Tentacled, maniacal, bastard.

The sun came up. The windows filled with light. The puppies made their morning ritual jump up into our bed and kissed our hands. They wag and wiggle and nuzzle into the pillows. It is their subtle "good morning!" cadence. Charlie usually starts to stir after the puppies pop in. A long exaggerated guttery yawn. A shaking of his head and church bell collar charm cockatoo. He then stretches cat-like on the carpet and trots to the bedroom door for his chaperoned walk outside.

This morning, after a full night of fitful moans he did just this.

Walked outside, peed on the holly and trotted for his morning stroll.

He walked into the kitchen, sat on his bed, and ate the steak left over from last nights green-mile dinner.

I smiled a tear-choked nod to my husband and said,

"I'm calling the troops at the clinic and we are trying different meds and a chest tap."

And so goes the line. Nudged to the corner. Redefined in another day.

The words rattle in my subconscious. The pearls passed down from the weathered vets who taught me to live by these words;

"Let no patient die without the benefit of steroids, analgesics, and an appetite stimulant."

That was the recipe for todays reprieve. And a jigger of chest tap muddler.

and to the wise words of my fellow vet friend,, because it is true that we lose our "doctor brain" when it is our own pet, sedate for sleep. We all need it, and, that mercy comes without a guilty hangover.

For those who understand. For those who still grieve with loss. And for those pet parents who have walked down this road before. You are not alone. You gave a soul a life I know they are blessed and grateful to have had. Every dog should be as lucky as Charlie is. He was loved, he remains loved eternally. What more could one ask for?

Parting wisdom; Saying goodbye never gets easier. What does make it survivable is only knowing that there are lives ahead of me to take care of, and a sense of knowing I can add his footsteps to mine on the other side of this. My life is infinitely richer for having shared the last 13 plus with him.

I will miss you Charlie, everyday.

Why are we so focused on getting our pets to eat, instead of fixing the reason they don't want to? My dad and Shelby.

This is a story about how perspectives shape and influence decisions. How one small characteristic, a clinical sign, (as a veterinarian would label it), changes the quest of a pet parent and their companions’ journey. This is a story about my dad and his care of my recently deceased mom’s dog; Shelby. Shelby is 15 years old. A rat terrier by mine own expertly amassed breed-i-pedia visual inspection, a mystery by means of the trucking couple who sold her to my parents at a rest stop. 

She is short, squat, compact and spunky. She walks with a high step and a butt wiggle. A tiny stub of a tail to mark her cadence. She has always been stubbornly independent, and loyally devoted, singularly to my mom. My dad, on occasion cuddles her, but she remained the apple of my mom’s eye and the shadowed sidekick to her every move. 

My mom passed away in May. It had been a 5-month journey of surprise, horror and decline. Shelby, like all of the pets who live beside seriously sick, and/or, dying parents got left by the wayside. She was, short of the essentials of eating breakfast and dinner and the obligatory bathroom breaks, forgotten. When life gets reduced to impending imminent death the periphery gets pushed into the corners.

While my mom was struggling with her cancer and our lives were filled with obstacles and medical silent policemen causing you to halt, hinder and ponder, Shelby lost her advocate, parent and support system. She was still with us, but her needs took second place. She was still able to eat, walk, and maintain her bathroom schedule. There wasn’t anything to alert us she needed more, and we had a very sick, incapable and frightened mom to care for.

While my mom declined my sister and I began to increase our focus on Shelby. For all we could no longer do for our mom we refocused our time and attention to Shelby. It was what we knew she would want from us, and, it was most certainly what Shelby needed as my mom could no longer think, call for, or even provide any affection for her. Seeing my mom pull away from all of us, in succession of our ability to provide for her was heartbreaking. Within two weeks of her passing my mom stopped asking about Shelby. Within a week she stopped asking for anyone. As she withdrew, we refocused. It was a tiny way for us to still be taking care of her when she could no longer see anything outside of her immediate ability to breathe or stay comfortable. The moments of dying color you in a way that makes the world a murky vat of misery. There is no sky outside, and there is no future to dream of. We were all a part of the vacuum it created.

The other side of life will find you. There is an after after death. Shelby was on the other side. My dad had a two-week recession. A place he retreated to and couldn’t speak from. We all deal with grief in our own way. Shelby has become the soul we covet. The last piece of a person we all long to find, and resurrect and yet cannot. 

I see her looking for my mom, as I do too. This quest to find the thing you lost, misplaced and yet believe to be hiding. Waiting to be found again. 

Shelby is what I would call the last piece of a life I try to desperately to fan from a smoldering pile of ashes, life back into. She is the last piece of my mom that is alive. The houseplant you over water in desperate hope to grow with additional vigor, only to drown from good intentions. My dad, well, to be honest, I’m not sure how he sees her? An obligation to a promise no one can provide consequence for? A left-over piece to a chapter already finished? A companion when a couple has only one half? A broken piece from an engine with too many accessories? 

He called, texted and complained for weeks before and after my moms passing that “she was getting picky,” or, “wasn’t eating well.” All with a hint of responsibility that I, as the resident family veterinarian, had to fix. That her eating was my fault, my obligation, my responsibility to figure out. I had to have the answer to what the ‘right’ food option would be. He, left on his own, had decided that she ate the high-protein unlabeled dollar store options best. The kind of canned crap, that I seriously call ‘crap’. The stuff with gelatinous goo at both the top and the bottom, as if suspending the only product scantily considered ‘food’ in the middle section. Shelby, as I mentioned at the beginning, is 15 years old. She literally is these days, only as good as what she eats. She was eating sodium suspended protein (from yet to be determined sources) in a can, at the bargain price of 69 cents. No matter how hard I tried to argue about the short-term losses of his small victories of her eating, the long-term costs were further kidney damage. But, in the tragedy of a loved one passing, whose first true sign of demise is food refusal, the small gains are often enough to appease the immediate fears of loss.

The veterinarian inside of me has a problem separating perspectives here. I see all food refusal, “the picky eaters” the “poor eaters,” the pets who just start to eat less, select options with greater care and scrutiny as the beginning whispers for help. For many of my clients, and my dad now, the eating is a frustration met by compromises that delays our abilities to diagnose and treat. Sure, some dogs are given the latitude to become connoisseurs, choosing as a sign of stature and liberty, but, most become inappetant, hyporexic, because disease is telling them to do so. For many clients not eating is a slap in the face sign of failure. People fixate on eating as much as they do on having normal poops. It is, in absence of all other meaningful signs, the most important request from a pet parent. They don’t care why they aren’t eating, or pooping at less than desirable frequency or consistency, they just want it to be normal. Preferably, right now. (The request to the vet is; cause be damned, just fix it!).

In Shelby’s case the cause was not so clear. Shelby had bad teeth, (as every small dog over 8 does). She had needed a dental for about the last two years. Fear kept that from happening. Fear that her heart murmur would result in heart failure under general anesthesia, and death at a time of ombre dying transitions was too much for us to manage. We couldn’t risk Shelby while my mom surrendered. Shelby had her dental about one month after my mom passed away. It was overwhelmingly frightening for me to perform. I knew it would be a long procedure. I knew she wasn’t an ideal surgical candidate, and, I knew it had to be done. I knew that she would require extractions of numerous teeth, yet through the procedure there was this quiet calming peace around me. Peace that she was being watched over. That she would be safe and better on the other side of waking up. For as much as I was petrified to put her under anesthesia, pull all of those rotten teeth, get too cold, stay under just a little too long, and lose her ability to wake up, during the procedure I knew she would be ok. She was carried by mom, and I could feel her all around me, taking care of her, and me in the process to get through this last long surgical procedure to be benefited on the other side. For my dad he firmly believed that the excision of the bad teeth held the answer to her persnickety food denials. 

It turned out that this wasn’t so simple. Shelby woke up from her dental, slept for a few days a little more than she had before, and went back to turning her nose up at the offerings he proposed. Rotisserie chicken was nibbled at for about a week, maybe two. Then sliced turkey was plated, about a week there. To canned cat food, then hamburger or steak, but, only if it was freshly prepared. All the while, all these weeks, my dad texted requests for food options to save her.

Shelby had a thorough exam, a full blood work panel and every other diagnostic I could provide. X-rays, x-ray evaluations, blood, urine, fecal and every possible ancillary test from these. All were normal, or at least very close to perfect for a 15-year-old. There wasn’t a medical explanation for the inappetence. As each test was taken and passed, I tried to remind my dad that there was more to her health than bleeding and numbers. As with so many cases I see people forget, or omit to admit that we are all our own beings. That Shelby is more than a being with a mouth and an ability to urinate and defecate... they the ways in which we measure her, and her abilities are much more than our observations. Shelby was a soul who was confused and now grieving. Her world although still geographically located in the same place was no longer her own in the way that matters to her. It was upside down, inside out and missing its most imperatives pieces. She, just like me, was lost in the searching for the foundation of who defined us. With out my mom we had a tough time realizing who we still are. 

Shelby came to stay at my home for about a week last week. My dad, as he has been consumed with, was so worried about her poor appetite while away from home. Shelby, like all dogs, is resilient. She is capable of so much more than many of us give them credit for. My dad arrived early the morning of his departure with her in hand. He dropped off cans of food, the ones he had most recently had success with, her bed, a leash and her harness. He fretted, as my mom had always done also, about leaving her here, in my pack of three much larger dogs, and the four opinionated and bossy cats. 

“Just put her down dad, she will be fine. She knows where she is.” I said. She had been here for weeks when my dad was in the hospital about 8 months ago. She quickly adapted to our routine. Embedded herself in the pack that is our home. After a few days of adjusting she followed step on the daily walks. She took pride in being fed in her own space on her own time. She did very well with all of the activity a full house brings. 

“She’s suffering from boredom.” My words falling on deaf ears as he sorted through his own grief.

While my dad was away, she fell right back into our routine. Walks, bedtimes, carried to our bedroom to be sleeping next to all of the others. There is life here. She ate full bowls twice a day. Had long walks where she, like the rest, can smell the diet. Process the scents of the world she lives in. there are not the quick ins-and-outs of rushed bathroom breaks. She gets to explore, find questions in her head and answers in her feet, nose and sounds. She gets to be a dog, a family member and a companion again.

Here’s where my dad forgot what the life of a dog is about. 

Shelby, like all of us, needs, and thrives on being acknowledged at every single interaction. Her vision is failing, but she knows there are people around her. We always approach slowly, kindly and with a “hello.” She will lower her ears, bow her head, stand still, and we always (always!) take a moment to stop and pet her. Where she used o fear footsteps, fear being in the way, too close underfoot, she now revels in the affection. 

Your pets want to be your pets. Loved, cherished and acknowledged. 

This has to be the basis for everything that follows. It was the simple reason Shelby isn’t eating. She is bored, she is lonely and she is lost.

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COVID's prisoners. Dying in the age of a pandemic. My moms story.

Vacuuming ants off the table. It’s what I do now. Daily, let me add. They are there not because of the flowers I cut for her yesterday, (as she chooses to believe), but, because there is always food on the table, or, around the table, or, under the table, (found a half an orange there yesterday, desiccated and chewed clear of its pulp). Food lies in small unbitten nibbles everywhere around her make shift hospital bed. All have been placed there sporadically, sprinkled throughout the day. There for encouragement. Should the fancy strike her. Which these days it rarely does. The ants keep her honest at least.

The hyporexic is my mom. She has stage 4 metastatic breast cancer. She needs a lot of help these days. The whole COVID crap has made dying a much lonelier event than anticipated. I have become the nurse and the house cleaner. My dad and my husband are the only others on her visitation list. It’s a small tight group. We all know too much about each other. It leads to fighting most of the time.

Hence, I vacuum. Or bide my oversight time cleaning, often.

Like all things in these days nothing is easy. To get to the vacuum I had to beat back the dust around and within the broom closet. To get it to turn on it had to unbury it from the cobwebs that quarantined it. To get to that I had to uncover the post Katrina WHO deposit of stacked bottled water that could serve Flint for the remainder of the year. This is the broom closet of a husband who never had to do housework before his wife fell ill, and, the paranoid couple who refuse to drink tap water after moving from a farm with well water. Trying to convince them that there is at least some oversight on the town water supply versus the farm well that I once saw a dead ground hog floating in is like yelling at the tornado to stop at your doorstep’s threshold. There is a mole hills mountain of poetic justice and politically driven pardons sitting here at my feet these days. I too often have to find the comic relief in the utter aging madness I have fallen into.

Quarantined with a dying person inside their house is a never-ending loop of t.v., feedings, medications, questions about if its ‘time again?” for medications, and self-checking her vital signs. The t.v. is tuned to CNN non-stop. It is her way she will tell you, of “still being a part of the world.” To which I remind her that that’s going to shit too. Maybe don’t turn there for joining society and being a part of the whole we left soo many weeks ago.

At her house I clean, like a mad person. It's my ADD that I cannot apply to CNN and the myriad of measured pills in their clock driven doses. Providing some degree of order, civility and modicum of acceptance that the world will go on around me is placed in sanitizing swipes at cobwebs too distant for her to see never the less attempt to reach.

Food is a battle. Like all aspects of her life now. She’s is wasting away. She is so thin and weak she can no longer stand without metallic wrap around support and hand grips. Shuffling from across the room to the small bathroom she exists between. My mom wants endless hours of all-day small talk. The escape she yearns for outside of the destruction her body is catabolizing. I am not a chatterer. I never have been, and asking me to figure that out for the last inning of the last game is too hard to go back to parochial school for. There is no room for normalcy here. I cannot seem to embed it in the cleaning to provide relief to the endless news cycles. And yet I continue to clean. Keep moving. Try to be productive and helpful as I uncover artifacts from a once functional home. Small items cause major melt downs. A half-eaten pie sitting useless in the fridge is a day long discussion on appropriate resolution. Obsessing on triviality and the time consumption it fills the day with is the reality of four people in too close proximity for too long already and no end in sight.

My mom's painting of Lilly.

“I cannot always be just as you want me to be.” I know it is not what she wants to hear. She wants me to be like the rest of her cheering squad. Professing love, sending her peace and Gods warm embrace. Telling her ‘this too shall pass’ and reminding her of all the beauty that surrounds her. The blissful passivity to all things holy and predetermined. The baking squad sitting on the bench proud to be sitting this one out. Gleeful to let the uniformed players who actually showed up for practice and have a discipline to put the blood sweat and tears in. I am not one of them. I don’t even know if I could become one? A spectator in her last hurrah.

This is the horrible place I am right now. Standing at the intersection of letting go and surrendering the hope I felt I would never unclench. She has stopped trying. I am not sure if it is all exhaustion that caused her to surrender her hope, or, the pain that her fear gave up. But all are gone.

Today was the day I decided I had to come to terms with goodbye being only a few moments away. For as much as we are so similar, my mother and I, I am most assuredly the human of voicing and reasoning while she is the soul of submission and omission. She won’t ever tell you what is right at the tip of her tongue. She will never confess. She will never say she is dying. She won’t give that up. She will only remind you with her every single action that she checked out a long while ago. I can look back now and know exactly when that happened. We were all sitting around her hospital bed when the doctor came in to visit, one week into her hospitalization to manage pain trip, to break the bone scan findings to her. “It is bad…. (long,,,, long pause…..)…. Really bad. She has cancer everywhere.” Yes, these were his exact words. She swallowed the words slowly and lowered her pale worn face and gave up. She had her pass to never doing anything again that she didn’t want to and she has ridden that pony into where we are today.

Cait

That discussion and discovery was over two months ago. At that time it had been over two months since her biopsy came back as cancerous. We now knew she had advanced metastic cancer in all of her bones which no longer allowed her to be candidate for chemo or radiation. They gave up on her as being too late, and she gave up on them as offering too little. She left to go home to try to come to terms with the cards dealt.

Today we are at her monthly oncology check-up. She was wheeled in, after being carried from her home to my car. COVID screening threw a new twist onto today's visit. We were met at a distance by greeting staff to check our temperature with a forehead thermal scan and provided and required to don a mask and gloves and asked a series of questions to try to insure we were not infected, or around anyone who was. Even the hospital is afraid.

4/14/2020, UPMC oncology

Two floors up we were met by the oncology nurses. Check in includes the cursory checklist on the clip board. They took her blood pressure and temp again. We collectively lifted her on to the scale and waited. As a veterinarian the scale is one of the most important diagnostic tools I rely upon. It doesn’t lie and it reveals a wealth of clues if you have been diligent in recording it. When the digital screen came to its stand still even the nurse wouldn’t say the value aloud. It was another long pause in a diagnosis of too many already. She recorded it and moved on. The scale read 76. As in 76 pounds. She is 74 years old. We started this collision course in December of 2019. Five months ago at 106 pounds.

I saw the blue numbers flash, swallowed my silence and gave up. Today I have lost hope for her. That hope for her chance to ever function again in the capacity that I have known her has passed.

It has been months of days that were up for as many times as they were down. She is painful, almost uncontrollably painful. She is on higher doses of opioids than I ever thought were humanly possible, especially for the fact that she barely ever hit a hundred pounds in her whole lifetime. She is not, as her oncologist put it today, “opioid naïve.” I was almost proud of her. It might be the first time she has ever surprised me with a title she didn’t earn from years of perfecting a skill. She is an amazing artist. She has always been an incredibly talented artist. She can sketch, paint, imagine any beauty into a canvas. Her work is all around us. At the vet clinic. Every room of my house, but a hard-core opioid aficionado I never saw destined for her resume. Today she was classified as becoming immune to their affects. Her body was acclimating to them. Starting to blow them off as inferior, paltry, innocuous. Today we carried her out of the house. Wheel chaired her into the hospital. Pushed her in a wheel chair into every room, every exam, and every treatment. She is a skeleton you can push without effort and pick up without exertion. She is bones and an oxygen pump spewing little hiccup-coughs into her nose. Her lifeline to failing lungs. She will need more drugs, at higher doses to get the pain at bay this time. Higher doses, shorter time frequencies and more side effects because of them. They will take away her pain as the collaterally steal her gut function, cognition, and conscious time.

4/3/20

There is nothing left for her to give up. There is only one last designation left to be made. No one wants to call it, although everyone mentions it. Hospice is all that is left for her. We can discuss a 24/7 assisted living home. A place that can help her with the things she can no longer do by herself. Bathe, prepare food, get water, manage stairs to get to her kitchen, her shower, or her bathroom. She is here. She won’t face it. She needs more than her family can give her. Once she lies down and cannot get up, which is likely at 75 pounds, that is the only option next to hospice. We got here so fast I cannot masticate the bitterness and the toughness of it. But the care facilities are all COVID magnets now. Sending her there surely leaves her a defenseless victim to this? Which is worse? I don’t even know?

my moms Easter canvas circa 2015

My dad is seemingly un-phased by the whole thing. The unraveling and the diminished ambulatory, unhappy being she is now. He is short tempered, over-burdened, and oblivious. I don’t know if this is a self-protective measure of avoidance? He goes through the motions and yet he doesn’t see the changes within her. “Hey, have you seen that bump on her back?” he announced yesterday.

“It’s her shoulder blade.” She is misshapen, misaligned due to a lifetime of scoliosis and the aging of osteoporosis. Her spine is “S” shaped and her shoulder has always been left elevated and prominent. She now lacks the 30 pounds to hide it.

The vacuuming leads to laundry. The monotony of never-ending laundry. Put in the dirty, smelly old people funk, and, POOF! Out it comes anew. Refreshed.

“Mom, we have to figure this out?” I implore her. I don’t think she cares to entertain my burdened inquisitive agenda. I think I am just speaking out loud. I think I am being my own therapist. She already has her plan laid out. The analytical doctor used to non-speaking patients hiding their illnesses and masking their diseases is who I am at my best. She is another patient puzzle to solve. I can solve this. It’s a cancer patient like so many I have had before.

D.C.

And yet, we haven’t figured her shit out. Not her treatments, not her desires, not her abilities, Nothing. That’s the truth. She won’t even talk about end of life stuff and I can’t let go of that. Doesn’t everyone plan? The finality exists only for me. I cannot ask her to apply any sense of wishes to an end that looms in front of us both. Her agenda is maximizing time into flowery closing scene experiences.

Ambrose

I’m venting now. I would do it aloud to try to mitigate my cortisol level, but I have to do it silently and furtively. The walker lurks too nearby to allow a release in the open forum of the room we are both imprisoned within.

No, I didn’t dissolution myself to believe this would be easy. But dying under house arrest in a pandemic that seems extra cruel. There is no way out. I could try my dads’ approach, be so caustic the best recourse is silence, and then do whatever I wanted to anyway, but then she would be completely alone. And she’s still dying without any chance of a better tomorrow so I type in hard puncture wound passes.

Easter box painting 4/3/20

There are days that are bad. Days so painfully long and full of so much demanding angst that I want this to end. Days that are full of meaningless errands. Answering a barrage of demands for things I cannot find sense in. Like removing Christmas decorations in April. Always with the same preamble “can you just do me one more favor…?” The red bow on the mantle. It should have gone weeks ago. It drives her crazy, which then in turn, of course, drives me crazy too. I have a home I haven’t vacuumed, cleaned, done laundry in in weeks, and I’m at her house cleaning it.

There is a disconnect between her preferences and her immediate, vital needs. The clock is ticking.

Yesterday was a bad day. The second in as many. It was a day full of moaning, crying, and pleading for the only relief I can give her, short of drug advice, companionship. She is alone too much. The loneliness causes anxiety which manifests into sleepless nights and further exacerbates her fear of pain and loneliness.

She is afraid to fall asleep for fear of not waking up. We should all be so lucky to die so peacefully. Me, I don’t want to wake up in the morning. Find some quiet place to bury my head under the bedclothes, a mummy wrapped for the long voyage to the underworld. She cannot find peace while awake. Her pain refuses to relent, and yet she cannot find salvation in sleep. It is a never ending roller coaster of unfair and unyielding.

It took her 30 minutes to muster the courage to sit up. Shaking, eyes closed, willing herself into moving the tiny rigid structure that used to house her options of freedom and choosing. She is now a prisoner to a broken body breaking down without any reconstructive abilities.

She is melting into nothingness. Evaporating, decaying, just crumbling. She cannot stand up straight. Cannot sit in a chair and face her dinner plate without being bent over and buckled into her own lap.

Oxygen is a commodity she obsesses over. She is hooked into a clear tubing pushing her lungs to accept what they can no longer obtain independently. She has multiple redundant units and miles of spare tubing. She checks her own oxygen levels hourly, half-hourly, obsessively. It is a race she wants to beat herself at. I have decided asking, inquiring about her obsessions merely feeds the monster that dictates them. The questions are met with anxiety ridden hostility. She has no patience for reason any longer. I try to talk about what she does with the information she collects. The nurses regimen of monitoring her own stats? This is another battle with no end point suitable to perpetuate the understanding of her data.

“Is 99 degrees too high?” She wants to be ready to alert the front line should she fall victim to COVID. It's part of her vitals monitoring ritual.

“Do you know what a normal body temperature is?” I ask.

“No,”

“Then you’re fine. Don’t worry.

We spent months trying to identify the source of her pain while we also tried to get it under control. We are back at square one. She has returned to that place where everything is impossible. Moving is too painful to do. We are here this time with 5 medications, three of them opioids, and drugs to chase the side effects of the drugs. “It wasn’t any fun there the first time around. Was it?” She nodded with a dejection of reluctant silent admission. We can’t go back there. Back to that place without answers, suffering met but a struggle to plea for anyone listen, hoping without precedence that one person will stop their busy over burdened life and actually hold her hand and invest their talents, dare even themselves, into her cause. There is an impressive amount of competence and excellence in her doctors, but,, there isn’t much in the way of genuine heart break for her plight. Maybe they have seen too many before her? Made themselves into little fortresses of medical indifference? A short dismissive hello, here’s what we can offer, a keep in touch, and a farewell to another time. The only thing left is to increase the doses of everything. Add an anti-depressant to help her sleep. Make the fear of not waking up a thing forgotten. Sedate her. Medicate and sedate is all that is left. What will that cost her I wonder? It will cost her everything she has left. And she will willingly surrender it. Pain is unacceptable. Pain and fear is her deaths last demand. We gave in to it as I surrendered hope today for anything else.

I can tell you a few things about this journey. I didn’t expect it to be easy. I knew it would be grueling, but I had no idea how alone we would both feel within it. Helpless, well, I haven’t accepted that one yet. We both have some coming to terms with the cards life has dealt us.

For more on my moms journey see the previous blogs here;

Silver Linings Of COVID-19.

The Journey. Missed Pit Stops and The Pile Of Regret Souvenirs.

For more information on me, my vet clinic Jarrettsville Veterinary Center in Jarrettsville MD, or for our Facebook page, or, free pet care help please go to Pawbly.com.

Me and my girl Seraphina, COVID 19 PPE prepared.

Thank you to all of my dear friends and family for helping me through this. I sincerely appreciate everyone's support.

krista

This Time Around. Coming To Terms With The Death of My Beloved Pup..

Veteran territory. I have been here before. The wound is soo deep it seems fresh, draining, life threatening. Death has been to visit me before. We haven't come to terms with each others presence, nor purpose. IT is still an unwelcome intruder. Albeit, ominous and undeniable, still IT calls, I collude, and yet, IT always wins, as I feign fractured and defeated. Again, and, again.

Our pets never live long enough. You can try to push the limits of pet-mortality with purchasing a parrot,, get yourself a good chance at a millennia, but dogs, if you stay mainstream canine, are lucky to see their teenage years, incredibly blessed if they hit two decades, and if you like to go big, or even "giant" you may not ever see double digits together.

I have learned that my heart can barely handle this pain every 10 years. I need, want, choose, hope, pray, beg, for a decade of longevity. Turns out my track record reflects this. "The older I get, the smaller my pets get." It is a hard-learned trade secret to try to spare me the loss every 5 years, or so, and it allows me to be able to carry them when their winter starts to wither and their bones can no longer support their ambulatory requirements.

The last few years has marred me with the loss of two beagles; Jekyll (just last month), and Savannah, a few years ago.

It took me weeks to get out of the grey fog I was flailing in with Savannah's loss. I just couldn't get out of the programmed repetitive daily motion I had become so accustomed to. The getting up at all times of the night. The managing her hysteria, messes, and failing functions. Undoing the habitual duties she set into my daily life took time. All the while desperate to go back to that place of interrupted sleep that her deprived mania brought just to have her back with me. But her loss was explainable, excusable, sensible. She had made it to 16. A ripe old age. A respectable age for any dog. She could be grieved but not denied a silver lining sentiment for surpassing the acceptable tenure. I could complain that her loss hurt, but I couldn't expect sympathy that she hadn't been afforded a long loving life.

Savannah

Jekyll, my most recent loss, another beagle, passed away at 8. He got cheated. I have anger lining that grief. Bitter shards to embalm him in. Seething pain to intern him with. Dust to damnation. A cursed cruel loss.

jek

The pit of my grief with his death lies here. The time frame cut too tragically short. The agony of desperate attempts to buy another "good" day for him. The exhaustion in losing the big battle. The responsibility I feel as having been the ultimate master of his destiny and purveyor of his curtain call. It is a terribly painful place to be. The ultimate responsibility can leave you with the lifetime of despair in second guessing and brow beating every previous decision. Sad couldn't begin to capture my angry bitterness. Except to mar it with also feeling responsible. That little fact made it crushing to swallow, impossible to move on, and fraught with such self doubting so that no piece of me was big enough to reassemble.

The days after his passing were simply about getting up, getting dressed, crying in the car to work, choking on grief and visible despair , all the while attempting to trudge into a day I dreaded facing. It also brought me back to why. The why of this profession? The immense magnitude of the responsibility we carry. The joy and the pain and the immeasurable grief it brings when you build a life around another.

The why we let them into our homes and hearts? The why we incorporate them into all parts of our lives? The why it is so easy to love them and yet so impossibly hard to lose them?
The why is the reason for everything we do as a parent and a veterinarian. It is important to always remember the WHY's?

I can love this pup, let him go knowing life too often works in its unfair ways, and not be ashamed, embarrassed or surprised when it repeats itself in my clients lives. If you can't feel a loss you cannot love. They are inseparable. It is what makes a vet a real person in the right profession for the right reasons.

I know this. I believe this. The tough part is living this when my own heart is shattered after losing the little one I loved so completely. It is grieving. Understandably. Grieving without withdrawal from ever opening your heart again is what I believe to be the most devastating part of pet loss. This is where I spend time talking to clients. It is normal to grieve. Grieve, however you need to, for you. Take time for yourself. Make a place to memorialize your pets life. A place to know you can go to to tell them how much you miss and love them. Live in the memories of your time together. But, try to not blame yourself. Try not to get stuck here. I know it is hard. I spent weeks here feeling like I, me the great powerful veterinary healer, could surely have saved my beloved boy. I had time, financial resources, access to the best specialists. Every tool to make him survive even the worst disease. It didn't happen, He left too soon. I lost him. I failed him.

Me and Jek at the oncologist's office.

That was exactly how I felt. Can you imagine how everyone else who doesn't have a decade of being a doctor, a clinic at their disposal, an Army of specialists, a bank account dedicated to dog care feels?

We will all lose a love because life always meets death. But giving up on loving again, ever having a pet again, that's where the real tragedy for me is.

So many clients give up after their pet dies. I think they feel it is too painful to go through again, or, like me they feel as if they will never find another pet who fills the shoes, measures up to the caliber of loyal/obedient/dedicated/wonderful there pet did. It is natural to not want to feel awful again. But not feel again? That's a loss that costs more than any heart should endure.

You cannot go through life living it if you try to not feel it,, good, bad and everything in between.

We all write the chapters of our own book. My book, each deep rich chapter of it has always been delineated and defined by the four legged family who made the tapestry the vivid, meaningful experience it was. The many homes, the varied geography, assorted jobs, were all the background that set my stage for each chapter whose central characters were always the dogs, cats, and pigs who made this life colorful and rich. They were, and are, the most important and meaningful pieces of the life I created and treasure. Some took up hundreds of pages. Some saw me through decades of questions trying to create the adult the kid was dreaming of. Some were short poems, a life too little, too fragile and too small to last past a haiku on an abbreviated page. But I am a richer, wiser, more content and accomplished thanks to their acceptance, love and wisdom.

You would think that with all of these chapters, all of the times I have been through loving and losing them that I would be better at grieving? My previous practice would make perfect assembly line efficiency of recovery? Yeah, not so much. I still invest whole heart immersed, drown in despair with loss, and trudge ugly through getting over it. Practice has not made perfect, unless that perfect implies pitiful.

The loss of Jekyll and Savannah took me weeks, months, longer/forever, to come to terms with. I will never "get over them." They were too monumental for that. All I wanted from myself when getting through their loss was to not give up. It was all I could hope for. They were loved. (I can say that with total conviction). There are millions (millions) of equally deserving (I can say that with complete honesty also) who never know a kind hand. I still have that to give. I may be broken and hurt, but I can still be kind to a furry face. I have to think beyond me. Society, civilization rests on this. It does transcend past human to human. Anyone who has ever loved a pet knows that. The world is better for all of us because we can love each other, regardless of size, shape, color, claws, fur, or fins. Love that is compassion is the key to life. All life and all living. This is what I believe, and remind myself of when reeling in loss.

Here's what happened to me after Jekyll passed away. I cried a lot, for days, weeks.  I told the people around me that while I appreciated their sympathy I couldn't talk about it at work. I had to stay busy and focused around the grief.

After two weeks I started trying to put my toes back in the water. I started looking at the pets in the shelters and at the local rescues. None of them were Jekyll. None of them pulled me into compulsion to step forward for them to come home with me. None of them were Jekyll. I was looking for that face. That smile. Those ears. Some tiny resemblance to jar me into adoption and out of affliction. I realized that obviously I wasn't really ready. I wanted to be ready. I just wasn't. I started spending loads of time with Charleston, my other dog. The left behind dog while we were all so focused on Jekyll. He had been neglected while Jek took so much of my time to monitor, treat, and obsess on. I owed him help in his grieving to. He was as heart broken as I was. We went on lots of walks, changed the room around. Got new toys. A little distracting helps pets adjust to a different routine and life. He got quiet and withdrawn. He missed his instigator and boisterous beagle brother. He was always the shadow behind that dynamic personality. He never saw his own sunshine  without Jekyll pointing the way.

Charlie was depressed.. But, he seemed more than withdrawn. He seemed deflated.. Vet mode mom kicked in (although it felt like paranoid vet mom). What would I do if he was dying too? Charlie's blood work revealed a low thyroid. I put him on medication to see if this would help resolve his lethargy, depression and sadness. It helped quite a lot. He started to wag again.

The next set of events changed everything. It added a new chapter and pulled me out of isolation and despair. A hurricane hit. Storm landed. (more on him soon). Hurricane Florence lands.

I added two very sick puppies within 3 weeks. We needed each other. I remembered I had a purpose outside sadness. I am alive again with them. I can go on. Being needed and loved helped me remember to start writing the next chapter, again. I was pulled out of grief by two sick puppies. I reinvested my energy into them, constructive caring, versus my grief soaked couch. Charlie, well it took about a week to realize they were residents, but when he could no longer ignore their incesant chew-bite instigation, he started to play. Within two weeks we stopped his thyroid meds (there is no medical study to back this, but its true). Charlie, and I, were back with the living.

I wasn't ready. I have no idea how long we will get together. But the time with them is far better than the wallowing in despair. We need each other, all of us. Loneliness is the gateway to despair and my puppies are waiting for me at home.

To all of those out there drowning in grief I hear you. I know. There is a way out. Reinvest your whole self in a pet. They need you as much as you need them. You can help each other to the shore. I send you all love and support.

For more information on who Jarrettsville Veterinary Center is please visit our Facebook page, or our website.

If you have a pet question or a story about your pet to share so we can start to help others who might be in the same situation you are (or were), please visit us at Pawbly.com. It is free to use and open to everyone.

If you want to learn more about pet care visit my YouTube channel here. 

Slipping Back Into Dying. When Remission Slips Away.

We got what we wished for. We got him back, for a while. An amazing, surprising, blessed few moments. It was more than I had hoped. It was everything I needed. Yes, as selfish and maniacal as it sounds, it was a miracle we wished for, bought, and had for a little while. Just a little while.

My dog Jekyll is the little beagle who stole my heart all of those years ago. He has always been a bit of a lemon. Always a little broken, a little fragile, and for 8 years a beagle hell bent on finding, exploiting and reveling in trouble. Running for hours on the lamb, bunny-drugged and possessed to be their shadow. He was his own pup. Loving a dog on their own terms is a challenge. Always. Always who he wanted to be, rarely who I wanted him to be.

Jekyll stumbled in November 2017 with an odd pain I couldn't quite identify among his lifelong of physical inadequacies. It took me 8 weeks of looking, hunting and knowing he wasn't quite right. It was January 2018 when his cancer was hunted to the ground: TCC, transitional cell carcinoma of the urethra. This cancer grows until it cuts off the passage of urine out of the bladder. You gotta pee, and when you can't long enough you die. Jekyll was dying. I was reeling with the quickness and mercilessness of the diagnosis. He had days, maybe weeks to live.

I wanted more time. I wasn't (yes, more selfish "me's" here) ready. I just couldn't believe it, and I wasn't going to accept it if I had any choice in the matter. I made desperate phone calls. The kind a frantic mom does when her kid is dying. Chemotherapy started in late January 2018. Jekyll had nine rounds of weekly chemo. Some worked, most didn't: but the ones that did he faced without pause or hesitation. He faced every day of those i.v. catheters, drugs, anesthesia and strangers poking him bravely and fiercely. He walked away from 4 months of drugs a dog with a new life. All of the pieces of him that had started to surrender to dying retreated. They stayed out of our life for two months of blissful, puppy-playtime joy. He was back to himself and I was left knowing that the beast we slayed was merely sleeping. We hadn't banished him, we had maimed him, but, he would be back. BUT, OH THOSE AMAZING MONTHS! I cannot tell you how wonderful they were. I cannot express how perfect life was again, and, how grateful I was to be watching him so full of life. His old troublesome, untrustworthy to stay at home self. He was his own destiny, life was all his to be whatever he wanted it to be. It was miraculous. Simply that.

The grip of cancer is creeping back into his life. I see it in small glances and ever increasing straining to urinate, sleep through the night, and leaking urine in his bed.

He is surrendering slower this time. The beast within is not as big and mighty this time around. But it is still there. Insidious, unrelenting, ever present if you look closely. I cannot, we cannot, escape him, that beast of cancer that dwells within.

Jekyll had a magnificent reprieve. A time of running, sniffing, playing, being happy. Really, truly, blissfully happy. Happy to be a beagle in a world of beings to discover and uncover. The truth is that I am/was most fulfilled to be the mom, the vet, and the person to help get him to that place of youth again. It is the essence of a veterinarian. To alleviate. To understand, dissect and unravel to make the patient whole again.

This is the curse you are given at some point on the journey of life. The plot always has an end. For me, what I have learned, is that what you put into this life is what you get out of it. Trying to thwart the ending, the tragedy that the end brings is cutting the corners. Negating the path of a long journey for the road that might be paved in good intentions but cheats you on the little joys that hardship, challenges, and grit built doesn't ever get you to utopia. And really, who wants to be anywhere else? You have to be really careful in protecting your heart if your heart is all in. I have failed being reasonable, finding peaceful passage when the road looks rocky, dark, uncharted and even treacherous. You walk on. Me, and Jek, we walk on. For today, hopefully tomorrow, but always grateful we had the time we did together. It is the life, unfettered, unforgiving, and never promised for tomorrow.

There are two important life lessons for me here, at this place where an end is still looming;

My job, my life, my purpose, is to help the suffering (the four legged kind). There is, and always should be much more to this quest to end suffering than a pink injection syringe. Right or wrong veterinary medicine does a lot of final mercy judgement in killing. We "end suffering" a lot more than we extend our necks to provide a brief respite for our patients and their family. Far too much to remind us to be compassionate and generous. Giving up too soon, or without a fight, a plan, a list of options, sells our profession short. It makes us able to euthanize without stopping our day to recognize the loss it brings. We have become hardened to euthanasia to the point we validate it for almost every possible condition and reason. It is the easy way out, and too often at our patients expense. What if it wasn't on the table as an option? What if?

There is life within dying. Little pieces left to cherish. I cherish every single one on a different level today than I did last year. What if every human cherished life to this extent? What if?

Lastly, I have to remind myself at the end of this there is a beginning awaiting. I have to. There is another beagle out there who needs me. Whom I need to be reminded why I am so dedicated to animals and the beauty they bring to our lives. I cannot shut down. I cannot bury myself in this grief, as comforting and consoling as it feels to be there. Wrapped in the memories of my beloved pup.

More on Jekyll here;

The Turmoil Of Contemplating and Deciding How Long To Fight For Your Pets Life.

If you are a pet parent in need there are lots of ways to get help, and even help others. You can find me, answering pet questions, providing support to pet parents, and building a place for others like us, here at Pawbly.com.

I am also at the clinic, JarrettsvilleVet.com and Facebook. Or see my helpful videos on YouTube.

Be well. Live Life. And GO ON.