How Will I Know?

What follows below is a detailed look at "end-of-life" issues for our pets and the families that love them. While I may come off as self-pitying in some respects, just know that I am doing fine in recovering from our family's loss. I'm sharing this here simply because that is something I have always done in being forthright and holding no punches while discussing my experiences with my pets and fosters. The question and answers I found below might be helpful to some. If you are sensitive to the topic matter, I absolutely won't blame you for not reading past the stars. I'll have kittens for you tomorrow. Thank you for your love and support.

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"How will I know? (Don't trust your feelings) How will I know?"

~Whitney Houston, 1985

A thousand versions of this question has been dancing through my head for the past month. How will I know what to do for Norman when he has this mysterious ailment that no one can even identify, let alone treat? How will I know that he won't get any better? How will I know when enough is enough? How will I know when to let him go? How will I know that he doesn't still have life to live? How will I know that it isn't too soon? How will I know that it isn't too late?

I have been lucky enough in my adult life to have mostly been spared this vicious cycle of "How will I know" questions. The animals that we adopted in my early-to-mid twenties were still healthy, vital, and active members of our family as I closed in on my fortieth birthday. I know, as everyone knows, our time with our pets (especially our senior pets) is never guaranteed, never eternal, always finite. The price you pay for loving an animal for 15-18 years is losing them before you are ready. And while my brain knew that, my heart had yet to experience it. And when it did, there were no decisions to be made.

Grizzly was the first to make his journey to the Rainbow Bridge. He was 14 (and three-quarters) years old on June 8, 2010 when he awoke having immense difficulty pulling himself up to a standing position. (Before anyone thinks I'm ridiculous and obnoxious about dates, this one is etched into my mind because it was the day after my younger daughter's birthday and I was always incredibly grateful that his descent did not begin a day earlier) I found a golf ball sized lump on his front leg that was not there the day before. The vet diagnosed him that morning with osteosarcoma... bone cancer. He explained that the cancer was incredibly fast moving, most definitely not curable, and that we had "maybe 60 to 90 days" left with him. He also told me that most families could not stand watching their pets suffer that long and chose to humanely end things for them within a month.

We lasted six days. I remember every minute of those painful six days. I slept on the floor in the family room because he could no longer come upstairs. I put him in the car whenever I left the house and took him with me wherever I went. By the end of day four, he could not stand without help. By the end of day five, he could not sleep. He stopped eating. His pain meds weren't working. He clearly looked in my eyes and asked me to make it stop. 

On June 14, we said goodbye. And while I was a complete wreck, there was no decision to be made or "how will I know" question left to be answered. As hard as it was to do, at least I had the comfort of knowing that I did unquestionably the right thing for him.

Einstein was the next to start her journey that November. She had made it well past her seventeenth birthday and had decided at least a year prior that she had everything she needed in my bedroom... a comfy place to sleep (complete with old heating pad as seen above... PSA: This heating pad had one setting, lukewarm. Never use a real heating pad with your pets!), a litter box in the bathroom, and a Lady who spoiled her by serving meals there too. 

One day, while we were under stress due to lack of heat and an influx of heating repair people, Einstein took it upon herself to hide in the bathtub. She remained there for two days. I took her out and away, but she always ended up back there. There were other odd behaviors, one of an old lady in clear end-of-life stages. After consulting the vet, we decided to let her stay home and make her own decisions. This stubborn old lady stayed true to that until the end. She woke me up a few days later to say goodbye and passed in my arms after a few precious minutes.

I was a basket case, but again there was no decision to be made or question to be answered. The little old lady made things clear and took matters into her own paws. At least I had the comfort of knowing that it was absolutely the right time.

In Norman's case, nothing came easy. There was no bank of knowledge to consult or magic moment when everything became clear. I just didn't know what to do or when to do it.

In December, he had his first intestinal attack. It was frightening and I recognized end-of-life behaviors that had been exhibited by Einstein two years earlier. The treatment worked, however, and he bounced back... but never to the level of health that he had previously enjoyed. He started losing weight from this point on, slowly and steadily so that it was almost imperceptible to those who saw him every day. 

In March, he had his next major onset. The weight loss and dehydration became unfailingly noticeable. The diarrhea was extreme. It was at this point that the testing started pointing toward his pancreas, but nothing was certain. The treatment worked again, for a short time and as a patch against his most urgent needs. But Norman was never healthy again.

We made changes to his diet, but none of these changes reversed or even seemed to treat his symptoms (let alone the disease). His body processed nothing. He received no nutritional value from his food as it all ended up back in the litter box. He continued to lose weight, but through all of this... Norman was still Norman. His character and personality remained unchanged and we dealt with the litter box and cleaning his feet for the sake of loving him.

In April, he went through another round of tests which were as inconclusive as the last. We made the decision to stop intervening to find a diagnosis, to stop heroic measures to save him, and instead chose to concentrate on making him feel comfortable and loved for as long as he had left.

In May, I found a website on the pancreatic condition EPI which seemed at the time to be a Godsend of information and a way to battle his disease and possibly save him after all. While I firmly believe that Norman had a form of EPI, but that the information that I discovered and the recommended treatment came along too late for him. If anything, his condition deteriorated even more. 

In June, things became more desperate as his digestive system could not process even the smallest amounts of meat. Any feeding of canned food, raw food, any kind of "high end" or quality cat food brought on litter box explosions of incredible size and intensity. I could time them from the point he had eaten and began to plan feeding Norman around being able to clean the litter box 30 minutes later. I could smell it two rooms away and it was burning the fur from his legs and toes.

By mid June, I had given up making him healthy and had just decided to make him happy. "Give him what he wants" became the household mantra. He wanted Kitten Chow, straight up. He wanted people food (which we allowed in small portions). All of the things that the experts say not to give an adult cat with digestive issues? He wanted. The crazy thing was that giving Norman what he wanted also made his diarrhea better. While his movements were still no walk in the park to clean up after, the mess was minimal and the smell was manageable. But he had still started deteriorating in other ways as well.

By June, Norman's balance and jumping ability started to fail. He couldn't make it over the baby gate that I keep in the laundry room doorway (to keep the dog from redecorating the house with the contents of the litter boxes). I raised the gate so that he could walk under it instead of jumping over it. He couldn't jump onto the kitchen counter (where I kept his bottomless bowl of Kitten Chow to keep the dog from finding the bottom). I brought a step-stool up from the basement and left it next to the counter, thereby providing him with a staircase instead.

His kidneys were failing him too. While he could always make it to the box for his bowel movements, he started to never be able to get there in time to urinate. He stopped in the bathroom along the way and used the shower. To his credit, he always seemed to be on the lookout for a suitable place to go, somewhere that wasn't on the floor. Shoes were banned from the house. Dirty clothes and towels were scooped up off the floor. He had a spot in the hallway that seemed to be his "end of the line" where I frequently found puddles. When the light finally clicked on above my head, I provided him with puppy pads and he used them exclusively from that point on.

I was willing to live with gates I couldn't cross, step-stools blocking my counter, and pee pads in the hallway. But in the back of my mind, I always knew we were coming fast to the end of the line. I lived in hope that Norman, like Grizzly and Einstein before him, would have a telling moment where I suddenly knew the correct answer. When we discussed the end of his life, our prevailing sentiment was to "let him go on his own terms with dignity". Which would have been great, if it wasn't for the street cat in Norman getting in his own way.

Our boy unquestionably spent time on the streets in survival mode. In July, his survival mode instincts kicked in once more. His disease was starving him to death and he knew it. He began to battle for food. The gentle, easy-going cat I knew (the one without the strength to reach the counter or the litter box on his own) had the strength of a lion if he thought he might be denied the morsel he wanted. He bulldozed his way into the kitten room. He smacked down Simba and Ruby for their share of dinner. I noticed that the other two cats stayed away at meal time until Norman had his fill. People food became for stealing instead of sharing. What's more? He wasn't enjoying the food. He ate as quickly as he could, nearly choking himself in the process, and spent his life looking for more. He slept on the floor in the kitchen lest he miss something. 

I had asked myself the "How will I know" questions since March. The truth is that I still wasn't sure that I knew much of anything. Norman was clearly sick, but still also clearly in his head. He enjoyed attention and was still loving, purring all of the time for us. He had the ability to move, and quickly too if he had a mind to do it. He was obviously strong enough to fight for what he wanted.

Last week, as I looked through photographs on my laptop, I noticed something. I am shocked it took me this long to process. I saw the evidence with my own eyes. Sweet Norman, round and fluffy Norman, was wasting away. The difference in him from January 2012 (when he came home from the shelter) and July 2013 was astronomical and heartbreaking. He looked thinner in March and April 2013, but statelier and more regal. The photographs from this June and July show an emaciated mess. He was gaunt and skeleton-like. No wonder he was fighting to survive. 

And that's when I realized that the street-cat in Norman would never allow him to stop fighting. He would never give up or tip his hand. We were going to have to make that decision for him.

After consulting the vet, we came up with a date that made us comfortable. The vet was surprised that we were willing to wait that long, but something in the back of my mind still kept hoping that Norman would give us a sign between now and then... one that said it was still too soon for him to go, or one that said he understood that it was his time. He never did.

I surprised myself during the two weeks we had given ourselves for that sign. Once I saw clearly what Norman's body was doing to him, once I knew beyond a shadow of a doubt that his time was imminent, I couldn't make him wait any longer. Once I had accepted what needed to be done, it seemed cruel to both him and us to keep that appointment two weeks in the future. We threw a family farewell party for Norman and served all of his favorites... hot dogs and ice cream were on the top of the list. The next morning we said goodbye.

He went quickly and quietly on Thursday morning. In the few moments we had left together, he did indeed give me that sign as we looked into each other's eyes. I knew he was at peace and that's all I needed.

On Thursday afternoon, we planted a garden. When we moved in to our house two summers ago, the only landscaping present was grass and a few hostas in the backyard garden. During our first summer there, we planted trees out front and a row of bushes along the gable windows that look out from the kitten room. This summer we were determined to add flowers and other plants to the landscape. We had been planting for a week... four magnolia trees and a dwarf lilac in the backyard; seven rose bushes, seven pygmy barberry bushes, three hydrangeas, and several flats of petunias and other assorted flowers in the front yard. 

We completed our task on Thursday and added a few more touches. Before spreading the final layer of mulch, we finally committed to a resting place for the ashes that had lived in my closet for nearly three years. Grizzly now lives among the magnolias and Einstein is underneath the roses (where, as my youngest daughter says, is the perfect place for her because the roses bite too). Norman has a special place of honor...

My son and I visited a local statuary looking for the right garden statue for the occasion. We settled on this one:

His name is Norman. He overlooks the spot where Einstein in buried. He's also in position to greet everyone who comes to our door (which was a Norman duty while he was still alive). The roses will grow around him as the garden grows. His spot will be colorful and bring joy to me in the years to come.

We've named the front patio garden area, "The Norman J. Botkin Memorial Garden". I think he would approve.

PS--- The hydrangeas moved this morning to an area with lighter morning sun and more shade. That barrel will move as soon as someone strong enough (ahem... the husband) comes home to dig it out. I have hated it since we moved in. What does one plant in a tipped-sideways barrel that survives? Nothing I've tried, that's for sure.

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There are still times that I question whether or not we did the right thing. I worry that we stopped looking for answers too soon. I wonder if he still had life to live. But more than anything I now find a way to beat myself up about letting him suffer too long. Perhaps we should have helped him travel to the bridge sooner than we did. But all I will really know is that I loved him desperately and somehow that has to be enough for now.

I would say that I have one foot firmly in the guilt stage and another planted in acceptance. I know that I did the best I could for Norman, but still question whether it was enough.

I spent my day off on Saturday cleaning... scrubbing the last traces of Norman's disease from our house. Each step brought me closer to acceptance, but farther away from him. My house is free from puppy pads and diarrhea. Meal time was the easiest it has been in months. But it didn't make me feel any better.

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I know I bring you many songs and earworms you wish I never had as I write this blog. But I'll share a couple more anyway just to torture you. Besides the Whitney Houston song above, a few others were dancing through my head with changed lyrics yesterday. As a 70s baby, my music hallmarks are definitely in the 80s. But my head skewed strangely Christopher Cross as I cleaned. More than one of his songs made it into my brain's playlist, but this one kept coming back (with lyrics altered as I heard it):

"Hey Norman...

Where are you now?

Are you far away from here?

I don't think so.

I think you're here...

Taking my tears away."

and

"When you think of Norman,

Laugh don't cry.

I know he'd want it that way."

also something about being between the moon and New York City, but it doesn't seem to have any relevance to Norman. ;)

It's my mission to take my memories of this sweet boy and turn them into something positive... the garden for my family, loving care for my seniors Simba and Charlie, and perhaps a renewed vigor in letting the world know that senior animals deserve to be home instead of in shelters. I knew I was taking a risk with my heart to bring home an old man. He was worth it in a million ways, even if that's the number of pieces my heart is in today.

Thank you for putting up with my introspective navel-gazing today. I'll be back with kittens on Monday evening.