“Ranjana, how long can Fifi live with liver cancer?”
An unexpected aspect of being an oncologist (for humans) is that you are approached for advice about pets (usually dogs) with cancer. Bruno, Marco, Maisie, Ziggy, Chloe, Tiger, Muppet, Jessie, Bella, Buddy, Johnny, Wilfred. Besides my own Odie, my friends’ dogs form the background of my life. Not all of them get cancer, but when there is a diagnosis, I know about it.
I had recently qualified as an oncologist when a neighbor told me about his cancer-stricken dog and the options for treatment, such as surgery or ‘letting him die’. My first distressed instinct was to plead that I knew very little about human disease, let alone canine oncology, but as he talked about his choices I realized that I was merely a vessel for the anticipatory grief of loss of his ‘top person’. I felt at ease here.
Since then there have been many conversations: whether to do the biopsy, remove the kidney, resect the intestine, loosen the leg, accept chemotherapy, when and where to palliate.
Now it’s Fifi’s turn. Fifi, who has lost her senses but navigates her environment with determination and conducts herself with unobtrusive gentleness, is never one to bark at guests or push her way into their laps. Fifi’s liver is shaking from cancer and the blood is terrible. Decisions weigh heavily on her owners. To treat or soothe. How to measure pain and define suffering. What’s the right thing to do for a beloved pet?
I’m going to be late for a family meeting and promise to call back.
As I enter the room, I feel the look of hope and note with dismay the average age of the room. A young woman and children. Youthful parents. And the patient? He’s too weak to get up. Strangely, his liver is also full of cancer and the blood is grim.
“What does your husband want?” I ask the woman softly.
‘Going home to die.’
“And what do you want?”
“To take him home to die.”
In an era of (rightly) tantalizing advances in cancer, it’s difficult to describe the heroism it takes for a patient to speak up. The decision to forego treatment can torment oncologists who wonder whether they could have done better. But my dying patient made an informed choice and the tears that flow are tears of relief.
When I leave, I call my boyfriend.
Fifi is lethargic and the vet has prescribed pain relief. I suspect she is actively dying.
After years of practice, I now know that there are two types of conversations: one where I am expected to solve a problem and the second where I only have to testify before the solution reveals itself.
Instead of “What does Fifi want?” I ask my friend, “What do you want for Fifi?”
This brings mature but heartbreaking insights, and a conversation with the thoughtful vet, which culminates in the decision to spare Fifi further interventions. I exhale.
What Gifts Should You Give a Dying Dog?
Food and toys are useless, flowers strange. I am writing the owners a card, in tribute to their deep love for Fifi, which is expressed in the courage to let go. Fifi is a peaceful bundle of fluff in the hallway. With a heavy heart I whisper goodbye.
My friend asks how long. A few weeks, I guess.
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“How can you do this every day?” she exclaims, shocked by my clinical nature.
In a landmark studyPeople who received chemotherapy and concurrent palliative care lived about three months longer than those who received chemotherapy alone. The survival benefit was attributed to early palliative care, achieving better quality of life and less depression.
I know of no similar research in dogs, but now that chemotherapy has been replaced by lavish love and meticulous care, Fifi survives a week, two weeks, then three. She nibbles food, responds to voice and looks for the sun! The family is cautiously excited, and I remain humbled by a doctor’s limited ability to predict in humans And animals.
Fifi lives for a full two months after her diagnosis, comfortably and amicably. Then, one day, while everyone is at work, she dies peacefully in the arms of the child who came of age in her care.
No amount of preparation can ever be enough. The family is bereft, the intellectual issue of death is no match for the avalanche of emotions.
People compare the loss of a pet to the loss of a limb, a child, a soulmate. My patients flee the hospital to reunite with their pets. Their dementia increases with the death of their pet. I’m sure if the hospital made access to pets easier it would be a happier place.
How do you comfort people who have lost a pet?
We call, text and talk about favorite books, but within the folds of our conversations lies sadness. So much sadness that I want to do more. Asking for their permission to write a column causes surprised tears because the world could care about a deaf and blind dog whose time had come.
Fifi may have been all that, but I know from the experience of others, and recently my own, that the love we have for our dogs is no ordinary love. Their unconditional loyalty and uncomplicated relationships are the stuff of human desire.
So, here’s to you, Fifi.
Thank you for the happiness you gave us. Thank you for your grace as you grew older.
Most of all, thank you for teaching us a thing or two about life, love, and how to care until the end.