It is a dark place that seems to have glimmers of hope like a flickering candle off in the distance, but yet you know that one breath of air and it will be distinguished and you will be plunged into darkness again. The fear is unrelenting since we're now in an unfamiliar place and there is no road map to follow, especially in the dark. It is beyond comprehension when you look to his little face and see light shining from his eyes and you know he is still there wanting us to do something, anything at all...
We are in that dark place. I will have to start at the day we went to the oncologist. I called our vet. trying to reach her because I truly felt I needed guidance and perspective about doing the x-rays. It goes without saying that when you hear your dog snuffling and snoring when he sleeps that there is obstruction to his breathing and to imagine putting him out for even 10 minutes scared the heck out of me. I woke up at five in the morning saying, NO, we can't do this, so it was imperative that I hear from our trusted vet. She finally called about a half hour before our scheduled appointment with the oncologist and having the x-rays done and we talked. It was good to talk with her, I have felt that I could share just about anything with her from the very first day we met and she loves our dog. If she spoke from a place of love for him then I knew I could trust her judgement. I told her my concerns and she agreed, what we would find would just confirm what we already knew, that he had suffered some kind of traumatic issue within the face and that the jaw was canted off to the side for a reason. The two reasons for this were catastrophic, one, the cancer had weakened his bone structure and it just broke or the cancer was back and was forcing the malformation, or both were true. Of course these scenarios were not good. They could not be fixed. So as I walked into the appointment, I was relieved. I felt a sense of peace about my decision and I told the oncologist we were not going to do the x-rays or the CAT scans and we were going with what we surmised to be an issue that cannot be fixed.
It was then that little Mack became a hospice patient, he was given the final diagnosis, terminal. It was not as dramatic as that, but it was like giving up. It wasn't as dramatic again like that, but I felt that we had done as much as we could do for him and we were not going to find a miracle in doing more.
Hospice is really not about dying as much as living the best life you can live. I experienced that first hand with my father who really wasn't a true hospice patient because he didn't really need what they had to offer for much of the time he was under their care. It was pretty funny back then because when they would come by for a visit which was every week, he would more than likely be gone and they would say, oh, okay, well, we'll see him next time! He was off driving to his old town about a ninety minute drive away and did this up until a week before his death.
So hospice patient Mack met the hospice veterinarian, Dr. Barry and he was what you would expect from a doctor who does this kind of thing for a living. Kind, attentive, compassionate, saying the right things, explaining the things we might not understand to a tee, expressing that we were doing the right thing and we heard all of it through the ears of what we thought were pretty receptive ones, but when he suggested we consider doing it that day, we both backed off, took a step back and said no. It's not today.
I think to some degree he is right about some of the things he said, but in some ways as my vet. said when we talked the same day we met the hospice people, it's easier said than done. We can't just snap our fingers and think, yes, we will do this now. It is not an intellectual decision. It is made with our hearts and minds and spirits. We are not paper mache people with nothing making us up but paper. We bleed and cry and mourn. There is no easy answer to this and we have tried to ignore his illness for so long we just can't get past that this is the same dog we thought had beaten bone cancer.
It wasn't a shock to hear that they did not get clean margins though...I still remember her saying it and I tried not to hear it with my heart. It would have broken if I'd let it sink in. Now we are faced with too many issues to absorb and we can't get to that point where we say enough is enough. But I think we are fast approaching the end of the game.
So this morning, at the very early hour once again of 5:30AM, I'm awake, holding my little guy. He is restless and goes to the side that he never goes to and lays down but he can't get comfortable so I take him outside and we go out and he runs to pee and then he leaps up on the deck with such agility that it's amazing when you consider he hasn't really eaten much in the last few days. He slowly walks inside but then runs to the door to be let back in and yet he doesn't want me to stay out and he doesn't want to be in. Finally I put him on the bed with me and lay down to hold him again. Soon he is fast asleep and I'm trying so hard to put my arm down but can't and I'm awake now, so I get up and make coffee and leave him there to sleep. He finally gets up with Bob and then we start the game anew of what will he eat today. I manage to get him to eat a vienna sausage and I find that so weird since that happens to be the only thing my Dad could eat when he was in hospice and the last days of what he could manage to get down. I find it to be strange yet comforting...We are giving it one more go with some very expensive custom compounded pain meds for which we will probably not use much of, but that will bypass his mouth and be given transdermally. Dr. Barry suggested it as the middle ground to go on and we are hoping against hope that it's still the pain which is preventing him from eating, but I feel it's something else and can't put my finger on it and can only guess because we didn't go all out to find out the definitive diagnostic reason.
The sausage is a hit but we know it's not enough to exist on and we are concerned he will only go down hill faster given these circumstances. Hospice is really just about doing the supportive things we can do given the circumstances and as far as fluids go we can go to our vet. to have that done...but we can't do that forever and expect a good outcome.
The saddest part is watching him wanting to eat and not being able to and having him going from one end of the house to the other standing near or by his water dish or his food bowl and not being able to make the leap of eating. I've tried not to give him rich and terrible foods because it will prevent him from getting a balanced diet and he won't eat the dog food we used to use. So we know this is not supportive care that is leading to a good quality of life and as Dr. Barry said, it won't get better.
It is hard to make that final decision. It seems like a date with death. As much as I know intellectually I'm letting him be free to be happy and whole and healthy again, it is the selfish part of me that says I can't let him go. It was not ever supposed to be that way, but the last dog and the love of my life will be gone. It tears at me from all angles and I'm not sleeping. And in the dark of night I wake up and I know it's not about the pain, it's about breathing and that is what is causing all of the anxiety for him. Not the pain, just the breaths and what is that doing to him?
I will go to the pharmacy and pick up the pain meds and we will go through the motions of applying it to his little ears and we will wait and then we'll make a decision. It will be either the hospice vets we call or the regular vet. but we will have to make a decision. Even my own husband is waffling back and forth and we are at odds at times as to the time frame or the reasons. But no matter what we will have to decide for the good of the dog and not us. We will have to say our goodbyes when he's not stressed and having issues. That will be the only thing that is right about this whole thing.
We love you little guy.
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