The Manner of His Death; Might I Have Saved Him?

Brewsky (front) and Ollie

The vet clinic was filled with big noisy dogs and an assortment of noisy humans, so the three of us were taken to a tiny examining room in the afternoon sun. The outside temperature was 102 (39 C), yet the clinic’s staff—like all staffs at all clinics—were determined to keep the door shut. In human clinics, they do this “to protect patient confidentiality,” but a tech in Brewsky’s clinic explained that she didn’t want any Dobies or Rotties to kill our cat. I said that such an attack would at least save us the cost of euthanasia. When we finally insisted that she leave the door open, she did, plus she brought us two small fans.

Veterinarian Jenny attributed Brewsky’s rapidly deteriorating condition (two weeks earlier, he had been playing like a kitten) to something other than kidney failure, but she didn’t know what, just that it boded poorly for his odds of survival. When she pressed his belly in various places, he cried, and she and Peggy speculated that he might have cancer. Jenny said she could admit him to the hospital, start a drip, and run a great many tests, but she was clearly pessimistic. On the way to the clinic, Peggy and I had talked about what to do in the face of such a proposal, and we agreed that we wouldn’t allow it.

Because he appeared to be free of pain, I wanted Brewsky to die at home, something which I thought would occur in hours since he hadn’t had a drink of water in over two days. Jenny said that he could experience a great deal of pain in the final stages of dying, and Peggy shared her concern. It was not a situation in which I could allow myself the least possibility of error, so I agreed to have him euthanized. As with the three other pets whom we’ve had euthanized, we stayed to witness his death, which occurred with his head resting in Peggy’s hand. Peggy sobbed; I steeled myself not to cry.

When we got home, we lay Brewsky in the den so the other cats could see him, our hope being that they could handle their loss better if they saw his body as opposed to having him simply disappear. After showing an initial interest, they returned to behaving as normal. Having never seen a grieving cat, we didn’t know what to think. 

Peggy had wanted her friend, Shirley, to attend the funeral, but Shirley couldn’t come. When Peggy expressed hurt that Shirley hadn’t suggested burying him the next day, I reminded her that Shirley is both loving and generous, and that it probably didn’t occur to her make such a suggestion. Peggy then decided to go ahead with the burial without Shirley, so we wrapped Brewsky in a striped pink and white towel and put a toy between his front paws. I might have read a portion of the Episcopal burial service had I not anticipated Peggy’s disapproval. We instead simply hugged, put away our tools, and left Brewsky alone for his first night out of this house since kittenhood.

The next morning, the cats hardly ate, and all four of them sat in middle of the living room floor looking sad and distracted. On the second morning, ten-year-old Ollie (who had spent all but his first three months of life sucking Brewsky’s nipples) conducted a thorough search of the house, and Scully took Brewsky’s place by cuddling with Peggy while Peggy did her workout with dumbbells. Perhaps it’s true that even if our cats know what death is, they don’t know it’s permanent. 

We spent Brewsky’s last weekend holding moistened fingers to his lips, presenting him with various canned foods, and giving him an appetite stimulant that was prescribed on Friday, all this in a desperate attempt to get him to eat and drink. When our efforts failed, I went to the drug manufacturer’s website to check on the dosage for the appetite stimulant, and found that the only dosage listed for any cat of any size, age, or ailment, was three times what we were giving. We then tripled his dosage, but it made no difference. 

Nine days after he died, Peggy and I are wracking our brains over whether we could have saved him. During his last weekend, I must have thought a hundred times about taking him to the ER, and I’m ashamed to say that if money hadn’t been a factor, I would. Yet, money wasn’t the only factor or even the main factor. Less than a year ago, we took two cats to the ER at once, but they weren’t 15-years-old, and they hadn’t been to the vet’s twice in less than two weeks during which time Peggy had three phone conversations with the vet. If I could go back in time, would I take him to the ER? I probably would, but do I think it would saved him? No. I would mostly be doing it so I wouldn’t feel like I had failed my cat, but then I could say the same about whether I should have put him in the hospital instead of having him killed. Next to Peggy, there isn’t a creature on earth who I love more than I loved that cat, and it’s awfully sad to be without him. 

Pancreatic Cancer Part 8: Never a Happy Day: Preparing to Bury Our Beloved

Our world turned upside down on May 19, when a physician’s assistant silently walked into an examining room, handed Peggy the results of an MRI which contained the words “probable metastatic process,” and walked out. That day marked the end of either of us being happy for more than minutes at a time. Ours is such a hard way to live that I've often had the thought that there probably aren’t many ways that are harder. 

Then, two weeks ago, things got harder when our fifteen-year-old tabby, Brewsky (the big cat in the photos), was diagnosed with stage two kidney failure. Before adopting him, Peggy so hated cats that she had nightmares of being pursued by unstoppable cat demons. Then our little black schnauzer died, and Peggy surprised me by suggesting that we visit the pound the very next day to look for a new dog. When the pound had nothing that suited us, Peggy surprised me a second time by saying. “Let’s visit the cattery.” Six-month-old Brewsky was the first cat we saw, and Peggy had no interest in seeing see another. Her nightmares of cats never returned.

August 6, marked fourteen years and six months that Brewsky has spent every day of his life under this roof. Peggy was working evenings when he moved-in, and while she was at the hospital, he would often scare the wits out of me, dog person that I was, by yowling and running circuits through the house, a practice that he continued until recently. He was also so troublesome as an adolescent that he would stare me in the eye while doing things I had just told for the fortieth time not to do. This always resulted in him running through the house in apparent terror while I chased him while cursing and slapping furniture with a yard stick.  

Despite doing everything that I could do short of violence, his disobedience continued. Then came the night that he suddenly stopped running, rolled onto his back, and looked me in the eye as if to ask, “What are you going to do now, Mr. Bad Man, beat me to death with your yardstick?” “You bastard, I never scared you for a moment did I?” I said as I dropped the stick and lay on the floor to pet him. Thus began a nightly ritual that continued for many months until he lost interest. 

Brewsky soon matured into a mellow and confident 15-pounder who has since foster parented four other kittens, one of whom he has literally “nursed” since 2015. He has also, at times, served as a parent to the humans of the household, which might be why, after being diagnosed with pancreatic cancer, Peggy said to him and him alone, “Brewsky, you’ve got to help me beat this thing.” Two weeks ago, we took him to the vet with what we thought was a simple respiratory infection and were told that he also had stage two kidney failure. After telling the vet of her own illness, bald-headed Peggy, said, “You’ve got to save my cat; I need my cat to survive.” Since then, Brewsky has stopped bathing, vomited blood, become incontinent, and stopped eating or drinking. 

Tomorrow, we’ll take him to the vet for what might be his last visit. I started digging his grave yesterday but had to stop because every shovelful was harder than a day’s work. The only good thing I can say about losing Brewsky is that neither Peggy nor I will have to grieve alone, as will happen when she and our other cats die, assuming, of course, that I don’t die first. As much as she would hate to lose me, Peggy wouldn’t choose to die in my place, as I would for her. That’s how nature intended for husbands and wives to behave, and I’m very sorry that I can’t let nature have its way. 

When Peggy is gone, I will have no one to share my days with; no bald head to kiss; no one to call beautiful; no one to share meals and music with; no one to watch old movies and TV shows with; no one to hold me in bed when I cry; and no one with whom to share decades of memories. People might bring food, tell me how sorry they are for my loss, and ask what they can do, but I can hardly ask for the thing I need most, which is for someone to stay with me indefinitely, to listen to my memories of 54 years of marriage, and to hold me in bed when my heart is breaking. I can’t think of a single person who would do that. This makes the other things that people do seem scripted, as though they are playing a role that says, “You can go close but not too close.”

When Brewsky dies, mine and Peggy’s spiritual father and the adopted father of our other cats’ will be gone for all time, and the nightmare that we are already facing will be many times more painful. And to think that we got cats in the belief that we wouldn’t suffer much when they died, the way we had with dogs.

Pancreatic Cancer Part 7: Discouraging News: the Horrors of Chemo

As most of you know, my wife, Peggy, has pancreatic cancer. Among her oncologist's first words were: “It would be reasonable for you to choose palliative care only. If you go that route, you will probably die within six months.” Had she chosen palliative care only, she would have now exhausted a third of her remaining time on earth. (Our photo dates from 1973.)

 

Peggy has now received five radiation treatments to her right hip and two chemotherapy treatments through a port on her upper chest. With her first chemo infusion, she also received a bone strengthener. As we left the clinic, she said she had a bad taste in her mouth and felt like heat was coursing through her body. She later complained that her supper tasted bad, but at least she could eat, which was more than she could do after 3:00 a.m. when fatigue, nausea, joint soreness, stomach cramps, abdominal bloating, and diarrhea (which changed to constipation), hit so hard that she spent much of the next four days in bed. We should have taken her chemo nurse's advice and started her on Smooth Move Tea sooner, because by the time we did, she was so desperate that she took a second dose hours later and ended up screaming on the floor while I hugged her. 

 

She had her second chemo on Thursday, July 10th, and her hair started falling out the next day. I told her that I would abandon her and the cats and move to Indiana (the first faraway state that came to mind), if she loses her good looks, but the truth is that I'm honored to be with her. I only I wish I could die when she does. I'm not the first man to feel this about his wife, and I know of one man (Robert E. Howard, the author of Conan the Barbarian), who shot himself in the head when his mother died. You can interpret the fact that men appear to need women more than women need me to mean that men are weaker or that they're more sensitive. (Peggy is in chemo in the second photo.)

 

Yesterday, I stayed in bed because I was too depressed to get up. Today, I cried throughout mass at my Episcopal church because I was touched by the beauty of the ancient music and the chanted liturgy; because I was sad for Peggy; and because I was terrified for myself. My life has become like a bad drug trip except that drug trips end while what I'm facing will frame my existence until I die. I can only escape my grief and terror when I'm asleep, but even then it's the first thing I think of when I get up to use the bathroom, and it keeps me from going back to sleep. I so want to die that it scares me, because I don't know how much sorrow I can take before something within me breaks. (The third photo was made after her second chemo when Peggy was in bed with our five cats.)

I don't want that to happen, but if I can scarcely trust myself now, what will my life be like when, after 54-years together, Peggy is no longer here to share my life cuddling; shopping; cleaning house; watching birds; enjoying our cats; doing home improvement projects; taking walks on Mt. Pisgah; watching old movies; going to doctor and veterinary appointments; sharing good times and bad; and, most of all, listening to one another talk about his or her day. Since she retired, I'm almost never alone, but if she dies before I do, the house will remain silent and the loneliness constant.

 

It would be unconscionable for me to kill myself because Peggy needs me now, and our cats will need me when she's gone (other people would mourn my passing, but only our cats' would lose their home, their human family, and their cat family). I'm reading a book entitled A Matter of Death and Life, by Irvin and Marilyn Yalom, a couple who had been married 65-years when Marilyn was diagnosed with terminal cancer. They wrote together until she died, and he finished the book when she was gone. So much of what they experienced, Peggy and I are experiencing. 

 

For instance, Irvin and Marilyn didn't believe in an afterlife; like Peggy, Marilyn considered the option of a medically-assisted death from the outset; and like I, Irvin seemed more upset by his wife's approaching death than she did. He and I are also alike in that he too considered killing himself when she died, but rejected it for the effect it would have on others. Yet, I'm afraid that, even if I attempt to live, my body might weaken and die, which is common for men my age. Clearly, men need their wives more than wives need their husbands.  As to why this is, I suspect that men feel some emotions more deeply than women. I say this based upon my marriage and upon the writings of the Yaloms.

 

Peggy gets chemo and blood tests every two weeks, and she also visits with Mark (her oncologist) or Betty, his PA (physician’s assistant) every two weeks. Several days after her first chemo, we had our first visit with Betty. We were having a bad day already, and it was worsened by the three hours that we spent at the cancer clinic, most of it waiting for Betty. It seemed like every bruised, shrunken, and emaciated cancer patient in Eugene was there that day, and this led Peggy to ask Betty if she would come to look like that. She also asked if she would get less ill when her body was used to chemo; and how often she would be able to take a break from it. 

 

Betty said that Peggy could expect to lose weight; that each successive chemo treatment would make her sicker than the last; and that she would have to take chemo every two weeks for as long as she lives unless every drug fails or she refuses treatment. Peggy then asked Betty through her tears if there was truly no hope whatsoever of beating the disease, and Betty answered that she would have to fight it for as long as she lives. Betty might have been wrong about this. Here is a relevant quotation from the Onco Library site (https://oncodaily.com/oncolibrary/pancreatic-cancer-remission-rate):

“Long-term remission in advanced disease is still rare but not impossible, particularly for fit patients treated at high-volume centers with access to clinical trials and personalized therapy... Although traditionally seen as incurable, a small but growing number of patients with metastatic pancreatic cancer are achieving partial or even complete remission with modern systemic therapies.”

As for how these characteristics apply to Peggy, prior to her disagnosis, she ate well, kept her weight down, lifted dumbbells three days a week, and took a strenuous uphill hike three days a week. She is also receiving treatment from a the Southern Willamette Valley's busiest cancer center, which offers access to personalized therapy. If anyone can tolerate the misery of chemo, Peggy is that person thanks to a strength and fortitude that have often left me in awe. (My friend, Hollis Shostrom, loaned Peggy a wheelchair, but in the photo, she is shopping for the walker that she already needs.)

 

It was impolitic of my mother to say that I married a better person than myself, but she was in some ways right. Even so, Peggy's life is now such that, as she looked at her once strong body in the mirror the other day, she said, "How low the mighty have fallen." Indeed, within two months, she went from being a the epitome of good health to being a cancer patient who groans, grimaces, limps, tires easily, sleeps a lot, can only walk slowly, and has moments of despair. Her radiation oncologist thinks she might have already broken her hip, and then there's that troubling lesion on her spine. Fortunately, she is a woman of courage and self-discipline who, to my embarrassment, is handling this crisis better than I. 

 

Peggy has received so much support from friends that thanking everyone has taken many hours over many days. They've emailed; called from far and near; offered to visit; offered to drive her to appointments; offered to make her meals; and sent cards, books, flowers, cookies, candies, tea bags, and the Pooh Bear in the third photo. Many have simply asked, "What can I do to help?" and a college friend from Houston invited Peggy to stay in her home so she could receive treatment from the nearby M.D. Anderson Cancer Center. Many of those who reached out to Peggy have also expressed support to me. Sadly, the people whom we thought would give the most have offered the least. I speak of her sisters who have never called, never sent a card, never sent a gift, never asked to visit, and never offered to help. What they have done was to accuse me of being weak when I asked that they support both of us. Aside from that, their contribution has been limited to  brief texts and heart emojis.

 

Betty speculated that Peggy might have a relatively good year left, but after that year, her health will decline so precipitously that she will need to ask herself if the cancer has taken away so much of what she loves that she no longer wants to live. Betty was wrong about this too, because another factor that will influence Peggy’s decision is her obligation to her loved ones. I just hope she won't allow her love for the cats and me to keep her alive beyond the time that she should die. I have already begun schooling myself for the day that she will say that she needs to die. When, and if, that day comes, the man in me will pick up her lethal prescription and grind the numerous pills with which she will end her life, but the child in me will silently scream, “NO! NO! NO! PLEASE DON’T LEAVE ME!” But perhaps I overestimate myself. Marilyn Yalom talked about ending her life many times, and each time thus far (I haven't finished the book), her husband, Irvin, threw himself into talking her out of it. 

 

Peggy's illness offers me the potential of becoming ever more wise, brave, and honorable. I want to care for Peggy so exquisitely that it atones for every way I've ever failed and for every bad thing I've ever done. So much of what I do and what I think also finds voice in the words of Irving Yalom:

 

“I stay constantly by her side. I hold her hand as we fall asleep. I take care of her in every possible way... When I shall be facing death, there shall be no Marilyn hovering, always available, always beside me. There will be on one holding my hand.”

 

I so wish I were more than I am, but I must at least believe that I have the capacity to become more.  Then again, perhaps I overestimate myself about this also.

Today, though, I am not just afraid or in grief. I am angry, angry that our internist of 34-years didn't catch this cancer when Peggy lost nine pounds in December (he attributed her loss to changes in her diabetes medication), and angry at the universe for pissing on a woman who took such good care of herself. I'm angry like Job when he railed against God for treating him unfairly, and I'm angry like Moses when he accused God of demanding more than he could give. Only I have no God to curse and to spit upon. Still, what these men felt speaks to me, none moreso than Jonah when he said:

 

Therefore now, O Lord, please take my life from me, for it is better for me to die than to live.” And the Lord said, “Do you do well to be angry?” And Jonah said, “Yes, I do well to be angry, angry enough to die.”