Idiopathic

On Friday night, we put Toivo to sleep. After months of mobility issues and inexplicable infections, her final decline was swift and sure. Early Friday morning, Toivo was panting heavily in her kennel, so J took her outside, and she became uncharacteristically aggressive. By the time we arrived at the Angell Animal Medical Center, Toivo was listless, unable to walk, and had to be rolled into the critical care unit on a stretcher.

While at Angell, Toivo did not improve. Instead, the ER vet said Toivo’s neurological responses were “inappropriate” and indicative of meningitis, encephalitis, or a brain tumor. By evening, it was clear Toivo’s condition was dire. When we arrived for one last visit before putting her down, Toivo was awake but unresponsive, staring with glassy eyes and not reacting when the vet moved a hand quickly toward her face.

Before she died, Toivo struggled to raise her head as I got settled on the mat beside her, as I had so many times during her week-long hospitalization in April. I’d like to think that in some corner of her brain, Toivo could still recognize the familiar touch of my hand on her head, my scent, and my voice telling her she was a good girl and everything would be okay.

We had Toivo for a shockingly short period of time–roughly a year and a half–but she had become deeply embedded in our lives, and closely bonded with me in particular. When we first brought her home in February, 2018, she acclimated almost immediately, as if she’d been born and raised with us rather than arriving as an adult dog. From day one, Toivo loved playing with our other dog, Djaro, leading me to suggest the best way to tire a Belgian Malinois is to bring home a second one.

Initially, I hadn’t wanted a second Malinois. The breed is energetic and intense, and whereas J prefers tough and intelligent dogs–so-called “mean breeds”–I’ve always preferred floofy doofuses. What sold me on Toivo was her spunk. Too small to be a protection dog, Toivo was also too much of a goofball. Whereas the word that best describes Djaro is “intense,” the word that best described Toivo was “happy.” When her whole body wasn’t arthritic and painful, Toivo was a joyful, hyper little dog: a dynamo in a seal-slick coat who spun like a top when excited.

Although we’d chosen Toivo to be my walking buddy, what cemented our bond wasn’t the walks we took when she was able-bodied as much as the four months she was a Medical Mystery. Toivo was a fearlessly hardy dog for the first year we had her, eager to walk in any weather, but this past March, she was suddenly creaky and reluctant to move. It was as if she had gone overnight from being a dog of four to a dog of fourteen.

After many diagnostic deadends and weeks of physical rehab, we finally learned that Toivo had immune mediated polyarthritis (IMPA), a disorder that caused her immune system to attack her joints. When we started her on steroids and an immunosuppressant, she responded almost immediately. Within days she went from being hunched over and limping to being her old self: active, energetic, and hyperalert, like a lion caged in a dog’s body.

One word we kept hearing throughout Toivo’s veterinary odyssey was “idiopathic,” which refers to a condition with no clear cause. We never learned why Toivo developed a huge abscess on her left hind leg in April, why she developed laryngeal paralysis after her release from the hospital, or why her face swelled up for no apparent reason in May. On Saturday morning, after we’d already put Toivo down Friday night, we learned a chest X-ray had shown three masses in her lungs: the closest we came to a smoking gun. If Toivo had a brain tumor that metastasized to her lungs, no amount of physical rehab or immunosuppressants could have saved her.

But even a smoking gun can’t answer the question of why. Why did fate or chance choose this one dog–my dog–to struggle with so many medical challenges? Why did fate or chance choose to cripple then kill her so young? I’ll admit to feeling as much anger as grief these past few months. J and I would have done anything to keep Toivo safe and healthy, so why are there abusive and neglectful people whose dogs are still alive while my dog was taken in her prime?

There are no answers to these questions; ultimately, mortality itself is idiopathic. If you allow yourself to love a dog, you know how the story will end: they will die first, unless you do. Looking through the photos and videos we took while Toivo was with us, I feel cheated to have lost her so soon, but even luckier to have had her at all. Even the longest-lived dog leaves too soon. I don’t know why we continue to open ourselves to the heartbreak of loving creatures who are destined to die, other than we have no other choice.

 

Impossibly beautiful

This morning we put Bobbi the cat to sleep. For the past four years, we’d successfully managed her diabetes, but recently she had inexplicably lost weight, and after two stays in the critical care unit for hypoglycemia, pancreatitis, and liver lipidosis, this morning Bobbi was unable to walk, stand, or control her bodily functions: a sure sign her fight was done.

When you have euthanized as many pets as J and I have, there is nothing surprising about the process itself. There’s the same quiet drive to Angell, the sad transaction as you pay for the procedure, and the solemn walk to a euphemistically named meditation room, where you can cry and say goodbye in private.

In the meditation room, you reenact the familiar ritual of getting the pet comfortably settled until the on-duty emergency vet comes in, offers her condolences, and then carries the animal off to receive an IV catheter. When today’s vet brought Bobbi back to us, she was swaddled in a blanket, only her head and the end of an IV tube visible. I held Bobbi in my lap as the medication was administered and she went from being a small, compliant bundle to Gone. With the plunge of two syringes, a beloved but suffering creature went to whatever rest awaits her.

After all this time, I still don’t believe in the Rainbow Bridge or other euphemisms of immortality; to me, it is enough to be free from suffering, a slate wiped completely clean. I don’t believe in the resurrection of the body; why would Bobbi (or any of us) want to return to a vessel that was failed and failing? When Bobbi died, she still had sprouting from her neck the esophagostomy tube J had faithfully used to keep her alive over the weekend: pureed food, water, and so many medicines pumped into her four times a day. Why would any creature want to return to that?

I have no wish for a feline afterlife or for some magically mythic realm where old souls return to young bodies. What sense would there be with so many creatures congregating in confusion, the lives that were lost mingling with ones that replaced them? It is the necessary and unapologetic way of this world that life goes on. Once the arrow has been released, it never returns to its quiver.

Whatever comfort I find in the aftermath of another pet death lies not in an imagined future but in this stone-sure truth: for a brief and precious time, Bobbi knew moments of pleasure and peace: the bliss of a head-scratch, the delights of a sunny windowsill. Forever and ever, amen, such simple pleasures will be–must be–amply and abundantly enough.

When we put Reggie the dog to sleep seven years ago last week, the window of Angell’s meditation room revealed a square of blue sky on an impossibly beautiful spring day; the next day, I remember, our backyard tulips bloomed. We haven’t had tulips in our yard for years–the neighborhood rabbits find them too tasty–but this morning, I saw a cluster of daffodils ready to bloom by our birdbath. How fitting that flowers–nature’s most ephemeral expression–are the universal language of condolence. As go these blooms, so go the rest of us, eventually.

It was an impossibly beautiful day when Reggie died, and today–Bobbi’s last day–the sun also shines. On the drive home from Angell, everything I saw seemed transfigured by the miracle of April light: so many people headed off to work, their heads cram-packed with worry as if any of this matters. Looking up at the morning light basking upon a brick facade, I had to wonder why the Universe, which is merely temporary, would waste so much precious time on useless beauty. Knowing the ultimate end of all our days, why bother?

Bobbi was the first pet we adopted with a known diagnosis of diabetes. Before her, Snowflake the cat had become diabetic in old age, and realizing we could care for one diabetic cat, we adopted Bobbi in June, 2015, when her medical condition made hope of a forever home seem unlikely. Snowflake was a large, lovable lug; when it was time for his insulin injections, I’d spread a towel on my lap, and he’d climb on it, luxuriating in the petting that came after the prick. But Bobbi was different. A grumpy, feisty calico, Bobbi had no tolerance for cuddling: the best approach at insulin time was to distract her with food, then grab the scruff of her neck and jab her quickly. In her younger days, Bobbi kept the veterinary staff at Angell on guard…but more recently, her temper somewhat softened and she would occasionally crawl into my lap and press her head into my hand.

Today, as I mentioned, is an impossibly beautiful day: impossible because beauty seems unlikely in a world intent on impermanence, and impossible because beauty insists on existing alongside heartbreak. Sitting at an intersection on the drive home, I saw a tattered plastic bag snagged on a stoplight, flowing and flapping in the spring breeze. The sight seemed too profound for words: a bit of rubbish caught and temporarily transformed into something unspeakably lovely. If you live gently and kindly enough in this ephemeral world, you eventually see our brief time here as enough, our souls snagged and tattered until they eventually float away.

 

The last dose of love

On Friday night, J and I put Rocco the cat to sleep after a two-year battle with small cell lymphoma. We’d lost our cat Groucho to the same disease in November, 2015, so we were familiar with the typical progression: weight loss leading to diagnosis, sudden improvement and weight gain with chemotherapy, then a gradual and irreversible decline when the drugs stop working. In our experience, feline chemotherapy works very well until it suddenly doesn’t.

Although Rocco had been gradually losing weight for the past few months, until Friday he hadn’t acted sick. All through the summer, he was still eating, interacting with our other cats, and pestering for attention. But on Friday, Rocco was lethargic and aloof, and when he finally defecated on himself and didn’t even try to clean himself, we knew his spirit had given up before his body had.

This is the third pet we’ve euthanized this year: we put Cassie the dog to sleep on New Year’s Day, before the start of spring semester, and we euthanized Gumbo the cat at the end of April, as the semester was ending. I don’t know why so many of our pets die at the beginning or end of my academic semesters or why their final throes so often happen on nights and weekends, when only emergency vets are on duty. As another fresh-faced vet–we never seem to see the same one twice–prepped Rocco for the procedure, she asked if we’d ever been present for a euthanasia. I had to stop myself from saying, “We’ve probably been present for more pet deaths than you have.”

The passing of a pet is an emotional and even spiritual experience: a journey to the border between the Here and the Hereafter. Watching a pet slip away at the quiet push of a plunger makes you realize how tenuous and ephemeral this mortal life is, and the quiet absence you face when you get home reminds you of how outsize even the smallest creature’s soul can be.

Rocco was the last remaining pet that J had when I first met him in 2007: the end of an era. When I met J and did not (due to allergies) think myself a cat person, it was Rocco who helped win me over.

Anyone who thinks cats don’t have personalities should have met Rocco, who was positively dog-like in his gregarious, goofy, and (yes) dogged demeanor. Rocco was not a shy or retiring creature; like a dog, Rocco would come right up to anyone who entered the house, walking on bowed legs that made him look like a hockey goalie in leg pads. When Rocco reached you, he’d collapse in a furry heap right under your feet, forcing you to either pet or push him away. One of the final signs that Rocco was not long for this world, in fact, was his complete indifference when I dried the dishes on Friday afternoon. Healthy Rocco would have pestered me by rubbing my legs, flopping at my feet, or trying to climb into the dishwasher, curious.

People who have never euthanized a pet sometimes wonder how you will know it’s time, but in my experience it it always abundantly clear when an animal is ready to die. If you know how your pet usually acts–if you know their most basic and obvious joys–you will notice when they no longer are interested in those things. If you listen deeply to your pet, you can’t fail to notice when their spirit leaves and it is time for you to help their body follow. Throughout his life, Rocco pushed and pestered for affection, and on Friday night we gave him the last dose of love he needed to cross to the other shore.

 

The fullness of time

On Monday morning–New Year’s Day–we put our white German shepherd, Cassie, to sleep. She’d been diagnosed with hemangiosarcoma, an aggressively metastatic cancer, the week before Christmas, after our vet found a large mass on her spleen. When we brought Cassie home after having her spleen removed, we knew our task was to make the rest of her life as comfortable as possible, no matter how long or short.

J and I have ushered too many pets from this world to the next: countless cats and now four dogs. Our commitment to stay with a pet until their final breath–to be present during their passing rather than handing over the leash and walking away–is one we both take very seriously. We’ve grown all-too-familiar with the the euphemistically named “Meditation Room” at the Angell Animal Medical Center, where families can gather on couches or on the floor while their pet slips quietly away. We know the Meditation Room and the routine that goes with it because it’s a scene we’ve repeated with pet after pet after pet. After spending so much time, energy, and worry tending to an ailing or elderly pet’s final days, suddenly they are gone.

When Cassie was in surgery two weeks ago and her surgeon saw her cancer had spread, our vet called and gave us the option of euthanizing Cassie right there on the operating table. Without batting an eye, I said no. There is no need to prolong the inevitable–neither J nor I believe in extraordinary measures–but there also isn’t any reason to hasten it. After her surgery, Cassie had a good, comfortable week at home surrounded by the familiar rituals of her daily routine. Without a bleeding mass on her spleen, she felt more energetic than she had before surgery–almost as good as new–and we plied her with cold cuts for Christmas and spent a lot of time petting, brushing, and fussing over her.

Instead of dying on an antiseptic operating table, Cassie left us at the fullness of time, after we’d spent a week consciously, intentionally loving her to death. Past midnight on New Year’s Eve, she was her usual alert and affectionate self; on New Year’s morning, she was listless and droopy, with white gums indicating an internal hemorrhage. Having discussed this inevitability with our vet–ultimately, we knew, hemangiosarcoma always wins–a difficult decision wasn’t difficult at all. Although Cassie didn’t know much less understand her diagnosis, her body told us it was time.

 

His ninth life

Earlier today, in the middle of a perfectly beautiful spring afternoon, we put Crash the cat to sleep. Like Bunny, whom we’d euthanized in January, Crash was 17 years old–a ripe age in cat years–and had been hale and healthy until he noticeably wasn’t. Whereas we’d tried to slow Bunny’s decline from kidney disease with a several-day-long hospitalization in the veterinary critical care unit that bought her only a few more weeks of quality time, we opted to keep Crash at home until the end, recognizing the signs of terminal kidney failure and opting for palliative care instead of extraordinary measures.

Each of our cats has his or her own personality, and Crash’s was the most irrepressible. He should have been named “Houdini” for his proclivity for squeezing into places he didn’t belong: if there was a door ajar anywhere in the house, Crash was there in a flash to squeeze his way through it, perpetually curious about life on the other side.

Crash was never much of a lap-cat; he was too active and athletic for that. Although he wasn’t one to sit in your lap and allow himself to be petted, he did enjoy grooming the other cats, licking their heads and necks–the spots they couldn’t easily clean themselves–with an attention that suggested he’d been a hairdresser in a previous life.

Crash had an impish personality: he was a perpetual teenager, long in leg and mischievous in attitude. When Reggie started to struggle with stairs, Crash would torment him at every step, pouncing on Reggie’s tail and batting the fur on his hind legs, a playful brat who loved to harass his elders. After I took to carrying Reggie up the stairs, Crash mellowed and began hanging out with Reggie as he lay in whatever spot I’d arranged him, too feeble to stand. One of my favorite pictures of the two of them shows Crash keeping Reggie company as he rested in a square of morning light, their similarly colored fur aglow.

There is, I’ve found, a strange sort of quiet calm that descends upon the house after one of the pets has died: Crash is the seventh pet we’ve lost since March, 2015, so I’ve come to know the drill. When you arrive home after euthanizing a pet, the house seems large and unnaturally quiet. Regardless of how large the animal was in life, in death his absence looms huge: an elephant that has left the room.

I think this oversized sense of emptiness arises because of how much care a dying pet requires. When a pet is dying, part of your mind is always devoted to him: is he fed, watered, and otherwise well-tended, and is there anything else (anything!) you can do to make him comfortable? When you come home after euthanizing a pet, there is a brief sense of shock when you realize there’s no longer anyone to fret over. You can put the IV stand with its bag of intravenous fluids away, wash the dish that had held the syringes full of medicine, and tidy up the sloven corners where your now-dead pet had been accustomed to nap.

The pillows upon which Crash had rested these past few days are in the wash now; soon enough, after the initial novelty has subsided, the remaining pets will reclaim them. Nature abhors a vacuum, and a house full of pets doesn’t stay calm and quiet for long, the remaining pets with their remaining lives expanding to fill the emptiness left by one of their own reaching the end of his ninth.

 

Traveling mercies

Yesterday morning, we put Bunny the cat to sleep. Earlier this month, after losing an alarming amount of weight, Bunny was diagnosed with kidney failure and spent a few days in the veterinary critical care unit, where our main goal was to get her healthy enough to come home. At home, we plied Bunny with food and an abundance of petting, committed to making her final days as comfortable and love-filled as possible.

This is, we’ve learned, how old cats often die. There’s the initial diagnosis, and veterinary care can extend their life long enough you can intentionally shower then with attention, making a conscious decision to (literally) love them to death. But inevitably, the disease wins: the disease always wins. You write the final chapter of a pet’s life knowing how the story ends but nevertheless fighting for every additional page, intent on cramming as much love and mercy as possible into a too-short narrative.

Bunny is the fifth cat we’ve lost since last March, the litany of grief counting out like rosary beads: Scooby, Louie, Snowflake, Groucho, Bunny. Grief doesn’t get any easier with repetition, but it does grow more familiar: an unwelcome but well-known guest who keeps returning. Although Scooby died suddenly, we euthanized the others after long, debilitating illnesses that afforded ample opportunity for anticipatory grieving. When you euthanize a pet after a long illness, you experience a dizzying array of contradictory emotions. On the one hand, you’re relieved your pet is no longer suffering; on the other, you’re stunned when an all-consuming struggle ends so suddenly, with no more need for the constant care and concern you’d lavished on this small, suffering creature.

Ever since Bunny came home from the critical care unit, she and I had settled upon a new routine. In the middle of the night, after I’d taken Melony the beagle out and in, I’d spend a half hour sitting cross-legged on the floor with Bunny nestled in my lap. At first, the goal of these vigils was to coax Bunny into eating: before getting down to the serious business of petting, I’d plop Bunny in front of a bowl of fresh food and watch her eat. Her final few nights, however, Bunny showed no interest in food or even water, so I’d gather her into my lap and clean her mucus-clogged eyes with a paper towel soaked in warm water. With one hand, I’d pet Bunny, who always loved to be cuddled, and with the other, I’d turn the pages of Anne Lamott’s Traveling Mercies, which seemed an appropriate choice of reading material while tending a dying animal.

I lost a lot of sleep these past few weeks sitting up with Bunny this way; last night, with no Bunny to fret over, I crawled right back into bed after taking Melony out. But I don’t regret the hours I spent petting Bunny in my lap while I read, wept, and prayed for just a little while longer. For the past few weeks, these midnight vigils spent cross-legged in my kitchen were my spiritual practice, the time I took to contemplate face-to-face the inevitable predicaments of old age, sickness, and death.

Bunny was 17 years old when she died, and she had been remarkably healthy during that time: as so often happens with old pets and old people alike, Bunny was healthy until she wasn’t. And until the very end, Bunny retained her essential sweetness, finding the energy to climb into my lap as soon as I’d settled on the floor, wanting nothing more than to be petted even when so many other physical discomforts threatened to overcome her.

During these late-night vigils, presumably influenced by Anne Lamott and her stories of spiritual seeking, I came to a heart-felt conclusion. God isn’t, I think, a bearded man on a throne but a being who sits cross-legged in the heavens, weeping and praying over the small, suffering world she holds tenderly in her lap.

 

His last night on earth

There’s a scene in the movie Stranger Than Fiction that chokes me up no matter how many times I see it. Will Ferrell plays Harold Crick, an IRS agent whose boring existence is turned upside down when he discovers his life is being narrated by best-selling author Karen Eiffel, played to perfection by Emma Thompson. Because Eiffel lets Crick read the manuscript of his (doomed) life, Crick knows exactly how his story ends: he’ll die on his way to work, jumping in front of a bus to save the life of a young boy.

The scene that inevitably gets me teary eyed shows Crick enjoying his last night on earth. Instead of sharing his ominous knowledge of what will happen the next day, Crick enjoys an otherwise ordinary night eating dinner and watching TV with his girlfriend, Ana Pascal (played by Maggie Gyllenhaal). Instead of causing Pascal to worry about the inevitable, Crick quietly savors the simple pleasures he learned to appreciate only after he learned his days are numbered.

This morning I made a euthanasia appointment for Groucho the cat: tomorrow morning, J and I will hold Groucho in our lap while our vet puts him quietly to sleep. Monday’s trip to the vet didn’t reveal anything clearly treatable, and Groucho continues to lose weight at an alarming rate, his bones jutting this way and that out of his thinning fur. Like Harold Crick, J and I know how Groucho’s story ends, and we see no need to delay the inevitable.

Tonight is Groucho’s last night on earth, and I’ll follow our usual Tuesday routine, cleaning his and Nina’s litter box and then sitting on the loveseat to give Groucho his daily petting and head-scratches. Groucho has learned to jump onto my lap after I’ve cleaned his litter box, but he won’t know why tonight I’ll be weeping. Instead, he’ll purr under my caresses as he always does, without the burden of knowing what tomorrow brings.