Our Cat is on Hospice Care

On the heartbreakingly humane decision to forgo cancer treatment

“I have felt cats rubbing their faces against mine and touching my cheek with claws carefully sheathed. These things, to me, are expressions of love.” — James Herriot

Being a pet parent involves extreme joy and a hefty dose of responsibility. After all, the little (or not so little) companions that share our homes rely on us to meet their every need — food, water, companionship, litter boxes, exercise, playtime.

Making decisions about our pets’ health can be the most difficult — and agonizing— aspect of caring for them. We take them to the veterinarian for preventative care, and when we’re informed of medical issues, we must weigh out the options.

Our cat Emily, who turned 18 back in September, was diagnosed with diffuse cancer following her last semi-annual checkup. After considering all angles, including her numerous other medical issues, we made the heart-wrenching decision to keep her comfortable with prednisolone, but to forgo any other treatment.

It’s not our first time at this rodeo, sadly. We lost our Nikoli to the Big C back in 2014, and Emily’s brother Tommy to what was likely a highly aggressive and fast-moving cancer in early 2015.

Nikoli was quite possibly 20 years old when he was diagnosed, and we had no desire to put him through ravaging chemotherapy during what would likely be the last few months of his life anyway. Our veterinarian thought he’d live three months without treatment; our Little Man gave us a good solid six, and we were grateful for the time to prepare for goodbye.

Tommy, on the other hand, was only 13. He’d already survived a stroke but was fine at his semi-annual checkup in August. Suddenly, the following January, he wasn’t. Two days after my father died, we took Tommy to the vet and shockingly never had the chance to bring him home. I’ll never forget how I told him it would be ok when I dropped him off for tests that morning, and then it wasn’t. It wasn’t ok at all.

I’d like to say these decisions get easier the more you navigate them, but they really don’t. I’m constantly questioning whether we’re doing right by Emily, even though she’s a geriatric cat who also has thyroid disease, arthritis, high blood pressure, kidney disease, anemia, and dementia. She’s always been highly sensitive, and would absolutely hate trips to a veterinary hospital for treatments.

If it were merely a lump, something that could be surgically removed, I would say yes in a heartbeat, but her cancer doesn’t lend itself to surgery. Putting my beloved girl on chemo to try to prolong her life for what would likely amount to a few months seems more about me refusing to let go than about what’s right for her.

Meanwhile, we’ll baby her with her favorite foods, with soft music playing in her room, with the most comfortable of beds, with brushing and snuggles and treats.

We’ll continue to crush her myriad medications up with warm water to make them easy to consume in her canned food, just as we have been for years.

I’ll hold her, gently wrapped in a towel for her own comfort and in case she pees on me (it’s happened more than once!) while my husband administers the subcutaneous fluids that have effectively managed her kidney disease for far longer than we ever dreamed possible.

We know we’ll be faced with the most difficult decision of all, soon enough. Fortunately, we have a checklist to help us monitor Emily’s happiness and comfort.

The Feline Quality of Life (QoL) Scale was developed by Alice Villalobos, a respected veterinary oncologist, in 2004, to help vets and families monitor the health of terminally ill pets.

Seven basic factors (Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility and More Good Days Than Bad) are assessed on a scale from 1 to 10, with 10 being the highest score. If the total score falls above 35, the quality of life is deemed good enough to continue hospice.

I’d put Emily around a 46 on the QoL Scale. I ask myself regularly if she’s declining, largely because she seems so frail and confused. Lately, for some reason I cannot ascertain, she’s taken to sleeping on my nightstand during the day, facing the wall.

But as soon as I climb into bed at night, she chirps, stands up, stretches, and hops down to cuddle with me. Sometimes I wake to her staring at me, her face inches from mine. When I scratch her lower back, she raises her butt in the air (an exercise our veterinarian uses to monitor happiness/responsiveness).

She drinks plenty of water and eats like a little piggy, even though she’s always had a hard time putting on weight. She uses her litter box regularly and with minimal problems.

I don’t think she’s ready to say goodbye, just yet.

When it comes down to it, we might be willing to quit our jobs, to go into debt, to spend our last dime caring for our pets, prolonging their lives. But if their quality of life has declined to the point where they’re in substantial pain, aren’t eating sufficiently, aren’t hydrating, have significant mobility issues, then we’re being selfish in the most insidious of ways.

These decisions are the last, best gifts we can give our cherished pets.

They’ll help us know when it’s time.

Update: We said goodbye to our darling girl on January 21, 2020. As we’d hoped, she did let us know when it was time, and we were strong enough to make the right decision. There’s an Emily-sized hole in my heart, but I am comforted knowing she had a good long life, surrounded by people who loved her, and that we gave her the last, best gift we could, in the end. RIP sweet kitty. ❤

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Kathryn Dillon is a 40-something Cleveland Heights, Ohio-based author, rekindling her passion for writing after a 20-year hiatus. She resides with her husband and their very spoiled cats in a ridiculously large 1910-built home that they are slowly attempting to renovate. She is a product manager by day and holds an MBA from Roosevelt University and a BS in Magazine Journalism from Ohio University. She believes life should be lived to the fullest, and particularly loves baseball games, craft beer, rock concerts, art museums, and the symphony, not necessarily in that order.