Artificially Prolonging Life: The Gawande Condundrum

Shadow on his window sill

Shadow on his window sill

Have you read Being Mortal by Atul Gawande?

If not, you should! Everyone should. This remarkable book describes how dying has become medicalized.

It used to be that people got sick and died. They were killed by influenza and TB and heat attacks, cancer and strokes. These things happened to them and, well, they just died.

But now, someone has a stroke or a heart attack or cancer and off to the doctor they go to be cured. Or, if not to be cured, to have their lives extended and extended and, sometimes, extended.

Dr. Gawande, in his beautifully written and thoughtful book examines the complicated relationship between medicine and dying or, more accurately, prolonging life.

Our Kitty, Shadow, is Dying

Shortly after I finished the book, my lovely 16 year old white cat, Shadow, showed signs of not being well. His voracious appetite waned. He stopped knocking things off my desk when he wanted attention. Instead, he started hiding behind the couch and looking tired.

X-Ray of Shadow's heart and lungs

X-Ray of Shadow’s heart and lungs

I packed him up in the little kitty carrier and off we went to the vet.

She listened to his heart which was “galloping” and heard his labored breathing. And she suggested that she take some chest x-rays to see what was going on.

Diagnosis: Congestive Heart Failure

Shadow has congestive heart failure. His heart is enlarged and fluid is filling his lungs.

The solution? Pills!

Pills to reduce his fluids and stabilize his heart. Seven pills each day. Three in the morning, four in the afternoon.

Now, if you have a cat, you know they don’t like to take pills. It’s an unseemly invasion to have little tablets rammed down their throats.

But in the hopes of making Shadow more comfortable, I did it. And he rallied for a few days. Until I noticed that he was drinking lots of water had very stinky breath and really didn’t look happier.

What was I doing? Shadow is an old cat. Does he deserve to have me trying to keep him alive?

The Gawande Conundrum

I was face to face what I think of as the Gawande Conundrum.

Is it more important to prolong life or to help make the end comfortable and fulfilling? When is it time to stop treating dying like a curable disease?

Our sweet kitty, Shadow, is dying. The vet says that even with medication he’ll be lucky to live another 3 months. Doesn’t he deserve to die in peace without my ramming pills down his throat that make him thirsty and stress his kidneys?

We’ve decided to stop giving Shadow medication and to let him live out his life in peace.

We’ll make sure he has everything he needs to be comfortable. He’ll have his favorite foods, special treats, warm places to sleep. We’ll give him plenty of petting, and I’m sure that as long as he can, he’ll keep purring.

And when he stops breathing, though we will be very sad, we’ll know that we treated him with the love and respect he deserves right to the very end.

I hope that when I or the people I love are ill, we will have the courage to see dying for what it is, a natural end to life.

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How do you want to die?

It’s not comfortable to think about dying. We don’t want to die. Nor do we want our loved ones, friends, family members or pets to die. But I think it’s wise to consider the matter beforehand so that when you are up against it, you have a sense of what you believe and you’ve made the necessary preparations.

How would you handle Shadow’s illness?

If you have experience with end-of-life decisions, would you share them here? Each and every one of us will face death. Sharing your experiences might help someone else.

  • NorthernBorder

    Beautiful and moving. Yes, I have read Atul Gwande’s book Being Mortal.

  • Brian Brolin

    From our Persian Jezebel, whom we recently helped find peace
    through euthanasia, to Christobel, a cat who I opted not to euthanize and let
    die naturally at home (which she did, a week later, right in my arms), I’ve
    seen both ends of the spectrum. Which choice people make depends on the
    circumstances and quality of life, I think. But it’s nice to know that at
    least we have the option of euthanasia for our animal companions, if not for our human ones.

  • amy

    Lucky cat…peace out on the soft sweet road to the eternal cat nap in the sky

  • Beth Raps

    http://davidmichie.com/blog/2015/02/24/how-to-be-with-your-pet-during-the-death-process-tibetan-buddhist-practices/

    has received more mail responses than any other of his posts I have seen. It is a beautiful post to read in response to your situation and your questions…much better I feel than my own reflections on sitting with my mother as she died, which was very powerful.(I felt like a midwife.) Thank you for this important post!

  • We belong to an organization called Compassion and Choices, that supports the right to die with dignity. Some of that is about proactively speeding your own death in circumstances where you don’t want to keep living, but most of it is about persuading the medicalizing establishment to just leave you alone. (Hospices can be wonderful allies in that fight, as I learned when my Dad “lost his fight” with cancer at age 64.)

    You are giving Shadow the death with dignity that I believe most of us want. Hugs to you, Tyko, and Shadow.

  • Michael

    I just finished Gawande’s book. It is so hard to accept that our people (and our pets) all will die. Thanks for sharing your moving story.

  • Pamela

    Our dearly beloved kitty (affectionately called a kitty, although she was 14 years old,) Griselda Durga Lakshmi, whom we loved and took superb care of, became clearly ill in the Summer of 2010. We found a Vet who did house calls and who was deeply versed in Functional Medicine, which draws on deep knowledge of the therapeutic value of nutrition. It is an established therapy in the Pacific Northwest, where we live. The vet did some of her exam in the back yard next to Gris’s favorite Catnip plant. We showered Gris with more love than ever. We began to feed her raw food, including venison, and herbs and vitamins recommended by the Vet. She improved greatly and quickly on the raw food, and for a few weeks she looked more healthy than she had in years. Her coat was more silky. She had a deeper inner serenity and looked like a Queen. We rejoiced and thought we had made it through. Suddenly she showed serious symptoms again, different from the ones that were apparently healed, and ate less and less. The Vet said that we could go the route of expensive tests and treatments, but it looked like Gris was weakened and that this intervention was not going to help in a significant way. The Vet’s focus is on restoring health through nutrition, not on drugs and probably useless high tech interventions. In the space of 20 days she showed rapid decline. We showered love on her again. We wondered if we should have her “put to sleep” (what a painful euphemism) and we did not want to. To us, that would be killing her. One night she looked very weak, and I stayed awake and held her almost all night long. In the morning we brought her out onto the deck and lay down next to her, one on each side of her, as her breathing became labored. She became weaker and weaker, with increasingly labored breathing, while we petted her and told her we loved her. Then she lifted her head and looked deeply into my eyes for many seconds that felt like an eternity, with the greatest love I have ever felt from anyone, including Holy People giving Darshan. Then she peacefully laid down her head and drew her last breath. To me, the energy we shared in her last moments was sacred and deeply meaningful. I am glad that we trusted the processes of Nature and Life and the Universe and held her with complete love while she left her body and embarked on her new adventures. It was so loving and pure. We buried her next to the Catnip plant, and planted a rosebush over her. Blessings to you and Shadow. Love is eternal.