Bonus Round Caregiver Pages
Toward better patient/caregiver communications
HANNAH, Hospice Social Worker
Index of Hannah Stories
Nine months, CHF
I was at a memorial service when my purse started ringing. Yes, I admit it. I was the jerk who forgot to turn off the cell phone. Horrified, I grabbed my purse, unzipped it, quickly glanced at an unfamiliar number showing up on the ID screen before fumbling to turn the power off. Oh my G-d, I was mortified. Simply mortified.
An hour later, I was at a stop light on my way home when I realized I hadn't checked to see if there was a message left on the voice mail. There wasn't. The caller ID screen displayed a number that I didn't recognize. I left it alone. Figured it was a wrong number since no one ever calls me on my cell phone anyway.
I got home, did my usual, futzed around and then checked my voice mail at home. That's when I got the message from my friend Rachel, who was sobbing as she explained that she was in her car, on her way to the emergency vet clinic, and that her cat Ohin (pronounced "Owen") was in trouble. She was trying to track me down to come with her or to meet her there, or to simply talk her through this. The animal was in crisis and was having difficulty breathing.
Rachel was a wreck. I could hardly understand her through her tears and her desperation. She left her cell phone number-- the mystery number I'd encountered earlier that evening. I immediately called her back, every bit shaken myself. She was still crying when she answered the phone and she explained what had happened.
She had come home from work to find her other cat meowing persistently on the window sill. Ohin was nowhere to be found. She started calling for little Ohin who normally greets her at the door and eventually found her under the bed, not moving. She had tried coaxing her out, tempting her with treats with no luck.
Rachel then realized that something was terribly wrong and she had literally lifted her bed up into the air to find poor little Ohin gasping for breath. She didn't know what was wrong, tried calling my house to have me come with her to the emergency vet, tried calling my cell, but when she couldn't reach me at either number, she grabbed a neighbor she hardly knew and asked her to come along.
Together they had rushed the listless cat to the animal emergency room where she was taken immediately for examination. The attending vet said they needed to run some tests, "could have been a number of things," possible acute onset of allergies would be the least life threatening, although if it was congestive heart failure, it could be much more serious.
They'd asked questions about what the cat may have ingested, whether she'd ever shown any signs of allergies, change in behavior, etc...all the normal things any good vet would ask. They took some x-rays and found her little lungs to be "cloudy" which explained the labored breathing, although did not provide a diagnosis, and they placed her in an incubator type cage to assist with her supply of oxygen.
The vet told Rachel they needed to keep Ohin for observation and that she should go home and they would call her when they found out what was wrong. Rachel was in her car on her way home when I had called. We talked a little longer, she said she was okay and had visibly calmed down with the telling of the story and was even able to laugh at her own superhero charge when she had lifted the bed up in the air to retrieve the cat.
The next morning I called her at 6:30 am to see if the vet had contacted her yet. When she answered the phone, I could tell she had been crying and she started sobbing again when she explained that she'd been up on the phone with the vet the entire night.
It seemed that the cat had acute (sudden) onset of congestive heart failure, which was indicative of a "bad heart" never previously diagnosed. It was rare, but as the vet explained, "it happens." She had to make a decision. There was a heart specialist that would be coming in around 9am that could do some further testing if she opted to do so. She'd been quoted a ballpark range of $300- $500 just to be evaluated by that specialist, but even then there was no guarantee of a treatment or a cure.
She wasn't ready to give up and had been on the phone with her parents asking about borrowing some money, since the cost of this visit was quickly adding up. She hated thinking that the choice she made had anything to do with money. This was her baby.
Finally she had decided that she would draw the line at $1,000. (We joked about this $30 cat she'd bought that had come with a free spay.) Around 9:30, she'd called me back. I knew as soon as I heard her voice. It was determined to be a life threatening disease and there was no cure. The most humane thing to do, according to the vet, was to euthanize the cat. Rachel asked if I would come with her. I agreed to do it. I left the nursing home where I had just been to visit my first hospice patient of the morning and went to meet Rachel. I caught up with her in the parking lot and we walked in together. What I didn't realize when I walked into the clinic with her was that I was wearing my hospice badge.
We were shown into a small examination room where moments later little Ohin was brought out, rather majestically, in the arms of a very soft-spoken and sympathetic vet assistant who seemed on the verge of tears herself. Ohin was lying on a fluffy purple towel and made no attempt to move once she was placed on the exam table. She looked just the same; bright eyed and affectionate but visibly struggling for air, demonstrated by the way that her little sides expanded and contracted in short shallow rapid movements.
Instinctively Rachel and I reached for her and as we did, she nuzzled our hands and our faces and began purring loudly. The two of us both had tears rolling down our faces and the vet assistant quietly placed a box of tissues on the table and said she'd give us some time alone.
For the next ten minutes we stood together and stroked the cat, talked to the cat, loved on the cat, cried on the cat, dripped our tears on the cat, and cleaned out that box of tissues. Neither of us could stop. Rachel kept turning to me and saying, "I'm doing the right thing." I'd say, "You're doing the right thing." Then we'd both start crying all over again.
The vet came in and looked at the two of us. He asked which one was Rachel, quickly glanced down at my badge hanging from my neck, then looked at me with raised eyebrows. When we realized he had seen that I was from hospice, we both cracked up. Rachel said through her tears, "I had to bring my hospice social worker." He looked at Rach and said, "Wow, you must have connections."
He was patient and kind and ever so gentle as he explained the procedure and asked if Rachel was ready. He reminded her that Ohin would probably be gone even before the entire dose in the syringe was "pushed". He hooked the medication into the line that was already in place in her front paw and waited for Rachel's okay. She nodded her head, he very slowly began, all the while remaining sensitive to her response. She and I were arm in arm as we both stroked the cat with our free hands.
Within a moment it was all done.
Ohin never so much as flinched. Her breathing just slowly and peacefully subsided and then she was gone.
The vet slowly nodded his head to Rachel, and carefully disconnected the line, gave us each a sympathetic pat on the shoulder and left us to cry some more in the privacy of the tiny room. We stroked the furry little body for several more minutes until the assistant came back into the room and asked Rach if she wanted a paw print. It was such a nice gesture. They took Ohin away and came back into the room a moment later with a pancake shaped piece of fresh clay with her little paw print right in the center and her name at the top. They instructed Rachel to let it dry in the sun.
The experience with Ohin will stay with me. I find it amazing what we can learn from animals when we allow them to teach us. With animals, we never hesitate. We never worry about "finding the right words" or not knowing what to say or do. We are guided by our instinct. We stroke them, we hold them, we sing to them, we coo, we reach out. We babble on a string of nonsense, we revel in their companionship, and we never doubt for an instant that our presence alone is "enough".....that our presence with them means something to them. We are fulfilled by the simple act of loving them and we understand on a very basic level that they love us back.
Why are we so often unable to see this in humans?
We couldn't dream of allowing our animals to die alone, yet we struggle to be present with the dying of our loved ones. We fear it. We shy away from it. We hesitate. We doubt our ability to be with dying. We stray so far from our instinct because we allow so much of the other stuff to get in the way. That simple act of loving unconditionly, of showing affection without words, of connecting to life forms..... this is how we care for the dying. If we pay close attention to animals, we'll find that we too can go beyond what we thought to be humanly possible.
Index of Hannah Stories
*All the names, dates and locations in Hannah's story have been changed to protect patient privacy. These stories are offered to the reader as part of our ongoing patient/caregiver communications program sponsored by Bonus Round Inc. All materials © 2001 by the author. http://www.bonusround.com.