Being An Advocate

This is a lesson that for some reason I need to keep relearning.

I remember going to the doctor as a kid. My parents taught be to have absolute faith in the doctor; that the doctor was the expert. My job was to give the doctor as much information as possible, to answer questions honestly, and then to do whatever the doctor told me.

That strategy worked fine when I was a child. As an adult ... not so well. Most of my experiences with the medical profession have been good -- but I've also had some mediocre encounters with doctors that could have been helped by a good dose of assertiveness on my part. Doctors not listening to me; doctors jumping to conclusions and me not trying hard enough to set them straight; not getting second opinions. Fortunately it hasn't mattered too much since I've never been seriously ill.

In a broader sense, I have this fantasy that when I need services, I would like to hire good people who will listen with an open mind, and then work with me on a solution. Sure, I can learn a lot on my own, but in complex cases, such as health, car repair, veterinary issues ... I want an unbiased expert with good communication skills. But in our society, you cannot assume that you will be able to hire such a person.

Such was the case with Autumn and the cat doctor we took her too. The guy looked like a real professional; I'm sure he got good grades in vet school, and knew a hell of a lot about cats ... but I was pretty disappointed in our visit with him. I touched on some of this visit in my previous post, but want to go into a little more detail. For starters, he thought that Autumn's problems were abdominal. And maybe they were, but that really didn't feel right to us. And we spoke up, but we couldn't really swayhim. Don't know what was going on there; maybe he was just focusing on possible causes that he could do something about ... but it seemed like he was taking a very slow (and expensive) route to the truth.

I also felt like he viewed Autumn's condition as a lot less dire than we did. We were fighting against time and money for her life, but it didn't really feel like he saw it that way, that this was just a slightly-less-than-routine visit. And, well, maybe Autumn's physical condition wasn't all that dire -- we'll never know now, although I suspect it was. But, and this might sound mean -- a cat in our house that doesn't use the litter box is not going to last with us long. That's harsh, and I don't like it, but it just the way it is with where we are in our lives right now. I didn't tell that to the vet, but I should have. Not sure if it would have mattered except for me getting chewed out, but I still should have made that clear. But it either could have lit a fire under him, or maybe he could have told us we were overreacting ... the ensuing conversation could have been positive.

Well, I think there's a 90% chance that nothing we could have done short of major-league brain surgery would have mattered to Autumn in the end, but I still have the lingering feeling that we didn't really play things right. Going forward, with our remaining cat, and much much more importantly, with our kids, I need to continually remind myself that I need to monitor the situation and be a strong advocate for my family when necessary, be it with vets, doctors, teachers, or whomever.

A few pointers for myself:

1. If you find that you have to be a strong advocate with, for example, a doctor, that is probably a good sign to find a different doctor.


2. Don't sell your knowledge short. Reflecting on things, it struck me that although this vet knew a hundred times more about cats than I did, in my own way I knew a lot more about Autumn than he did, having spent literally thousands of days with her.


3. Don't be afraid to challenge authority, and to raise questions.


4. Do your own research when you don't feel satisfied with the official answers. The internet is a great place. I used to worry about things like picking up bad info or the internet turning you into a hypochondriac. Those are certainly risks, but these days I feel good enough about my ability to evaluate information.

Pet Decisions

Last December was the first time either my wife or I was involved in the decision to end a pet's life, not counting some fish I had as a kid. We'd seen other people go through it, and the pattern always seemed to be: spend lots of money on vet care in the final days, for little effect. Different people had different feelings as to whether they regretted their decisions or not, but everyone agreed that you pay a lot to extend a pet's life by a matter of days or weeks. My father's favorite story here is that a vet wanted to run an expensive set of tests on their ailing eighteen year-old cat, to see if it had condition X. My father asked what would the treatment then be for condition X. Answer: none; it was a terminal condition. But at least they'd know. End result: they didn't go for the tests.

Before our cat died, my wife occasionally tried to talk about the lengths which we would go to keep her alive, and where are limits would be. How much we would spend; how much extra burden we would be willing to take on. We thought it would be useful to have a game plan ahead of time, before we were caught up in the emotional whirlwind of a critically sick cat, when it would be hard to make good decisions. Good idea, but those talks never got us anywhere. Too many unknowns. How old is the cat? How healthy do we think he or she would be after the procedures? What would their (and our) quality of life be?

Well, we've gone through the experience for real now. I can't say we did any better than to muddle through. But we did learn a few things from the process, hopefully, and I wanted to mark them down so I can remember them for the next time.

Don't rush your decisions - we gave ourselves a somewhat false sense of urgency. By the end, I was spending a few hours a day caring for and cleaning up after a very sick cat, which got old very fast. It was also very hard watching Autumn in her condition, unaware of things and aimlessly circling the house for hours on end. We also had a scheduled trip that was coming up soon, which added to the urgency of the situation. And, for better or for worse, all this was happening while I was on Christmas vacation. That gave us extra time to deal with everything, but that time was going to run out soon.

Looking back, though, the situation actually unfolded a lot faster than it seemed to at the time. Taking a few extra days and rescheduling the trip would not have hurt in the long run. On the other hand, I don't think it would have made a difference either, i.e. in keeping Autumn alive, but it should have been less of a factor in our decision-making.

High-level strategy. It seems like you can approach the question in vet care in one of two ways. If you can afford it, open your checkbook and pay for whatever treatment/diagnostics they suggest. This will cost you some thousands of dollars, but I'm guessing it makes the decision-making a lot easier and significantly reduces any future second-guessing. Alternatively, be an involved consumer and make decisions taking cost into account. It never really occurred to us to do the former, partly since we are cynical about vets, and partly because I'm coldly logical. We love our cats, and take great responsibility for them, but in the end, they aren't as important as our children or ourselves, and there's a limit to how much we will sacrifice for them. In the end, making the cost decisions was very hard -- and it never actually came down to the cold question of how much our cat was worth to us. The questions we had to answer were: how much was it worth funding tests that may or may not shed light on our cat's problems, which may or may not be treatable, and how long were we willing to care for the cat while we waited?

Make a choice that you can live with. If you read between the lines above, you get the idea that to some extent, I think the veterinarian industry might be playing grieving pet owners for suckers, extracting large amounts of money for meaningless operations on terminal pets. Much as the funeral industry capitalizes on grief to get families to pay out money for meaningless upgrades and accessories. I don't like being played for a sucker, but then again, in the end, I'd rather feel like a sucker than a heartless pet owner who killed his cat because he didn't want to shell out any money. Hard to find that balance, since you could be out an awful lot of money if you blindlessly search for medical solutions, but whatever you decide, the memories of that decision will be with you for a lifetime, so you need to be able to honestly justify that decision to yourself.

Be forceful with the vet, and don't be afraid to mention euthanasia if it is on your mind. My biggest failing. We talked to several different vets at different stages. The one we visited at the most critical time might have been the least helpful. He seemed to talk with the understanding that euthanasia was not an option, and that our options were to run tests of varying expense. My wife and I, after carefully watching our cat for days, thought there was a good chance that her condition was terminal, and only wanted to spent out real money if we thought it would make a difference. Not only that -- time was not on our side, or on Autumn's, and we tried but didn't get that across somehow.

Basically, I wanted some sort of sense for what the odds attached to each of our options was. Run this test; what's the likelihood that it will find something, and then what is the prognosis for whatever the tests find. I wasn't expecting something super-quantitative, and I realize that every case is different. I just figured that he's seen thousands of cats, gone over however many case studies in vet school ... he should have had at least some qualitative feel for what the probabilities were. And I just couldn't get anything out of him beyond an anecdotal case or two, which was worthless to us. We walked out of his office profoundly disappointed. I didn't feel like he really got it, that he gave us information that really helped us make a good decision.

I'm struggling to find the right words here, but maybe one way to summarize my point here is that you shouldn't trust the veterinary profession to give you good ethical guidance.

Get a second opinion. Another mistake on our part. After the unfortunate encounter with the vet above, we should have tried somewhere else. But at that point, we felt the time pressure of our upcoming trip, and a depressing sense that another visit wasn't going to matter, and that we would be throwing our money away, and delaying the inevitable.

You are your pet's best advocate. I'm saving this topic for a later post.

I'll try and keep that all in mind for the next time, which I'm completely dreading, and I hope won't be for a long, long time.

Forever Autumn

[Wrote this December 28, 2007]

We said goodbye to our cat Autumn today.

I don't know what else to do, so I will share some of our favorite stories about her.

The Discovery

We first met Autumn in June, 1997, at the Longmont Humane Society. We were looking to adopt two cats. My wife spied a little calico kitten, just a bundle of white, orange, and grey, and it was love at first sight. We were browsing around for the kitten who would be her companion, when a little girl, maybe seven or so, and her mother came in. They stopped at the calico's cage, and I heard the girl say "ooh Mommy, I want that one". I hustled over to Mandy and told her to haul a-- down to the administrator so we could book that kitten. She got the worker, who took the kitten and us into their "interview" room where we could check each other out. We asked the kitten if she would be a good little cat. She sniffed us, walked around, played with us a little, and let us hold her. A good enough answer. The kitten's given name was Callie, but my wife knew she would call her Autumn by the time we left the shelter.

Already Trained

We brought Autumn and her brother home, and put her in the spare bedroom that we'd outfitted as the kittens' staging room. Autumn went over to her new food bowl, and nibbled a little. She then walked over to her new scratching post and clawed it a bit. Finally she went over to the little box, and did her business. Perfect.

We Know Your Secret

One day we couldn't find Autumn. We called and searched; no luck. I finally saw her walking around the living room with a sheepish, innocent look on her face. But all of her white fur was gray, so it didn't take much to figure that her hideout was behind the fireplace.

In My Hands

Sometimes when she was little, I would carry her in the palms of my outstretched hands. Whenever I did that, I couldn't help singing or humming to the melody of "He's Got the Whole World in His Hands" -- but of course the lyrics were "I've got the little bitty kitty, in my hands".

Meow Meow Meow

Autumn and her brother were very vocal. While her brother would chirp, Autumn would bark out meow's, so to speak. My wife remembers sitting on the sofa, when Autumn came in, meowing precisely, with one meow per step.

Jumbo Shrimp

One day, we had some leftover shrimp from an Olive Garden meal. For kicks, I gave each kitten one shrimp. The kittens faced off, about two feet apart, and stared at each other, motionless. Then they started making strange groaning noises. My wife and I had never heard them make noises like that, and weren't sure what they meant. We thought we'd better make sure that they were ok, so I put my hand down to pet Autumn a little. With a lightning-quick stroke she slashed my hand pretty good with her claws. Ok, don't mess with their shrimp. We stood back to watch how it would end. After growling for a bit longer, Ajax started playing with his shrimp. Batting it into the air, picking it up with his teeth, tossing it around. Meanwhile, Autumn started eating her shrimp. Ajax kept playing with his; Autumn kept eating, and when she was done, she sneaked up on Ajax, and then grabbed his shrimp and ran.

Keep That Off the Scratching Post

Autumn didn't like anything to be put on top of her scratching posts. Once I absent-mindedly put a puff ball on top of one, and she hurled herself at the post to knock the ball off, scaring me. After that, we spent hours playing at this.

Hide the Toys

Autumn liked to bring us her favorite toys, often in the middle of the night. We'd hear a faint meowing, steadily growing stronger, then ending as she dropped the toy off at the foot of our bed, or sometimes on top. We finally had to hide her little stuffed lobster, her frog finger-puppet, and all the puff-balls, to get some sleep.

The End

Came downstairs this morning after showering. Autumn wasn't using her litter box any more, and there was a spill. Mopped it up. Wanted to put her on our comfortable easy chair, and went searching for a towel I put under her. Went rummaging through the linen closet to find a towel other than our nice guest towels (which is pretty funny to think about now, that I wasn't willing to waste a "good" towel on her). Found a purple bath towel, a utility towel by then, a little old, but still in good shape. We used to use it to line her car carrier when we took a long trip. I put the towel on the chair, and wrapped it around her. She didn't move the rest of the morning, while we got the kids up and got ready to go. Friend came to watch the kids; time for us to go.

No need to use the car carrier this trip, as she was very docile. My wife simply picked her up with the towel wrapped around, and carried her out to the car, and in her lap as we drove out. It was cold out; twenty degrees or so, and I'm glad we wrapped her. My wife told me as we drove over that we had to leave the towel there; we couldn't bring it back. They had a nice cushion on the table in the vet's office, and we just placed her down, and kept her in the towel.

The vet gave her an anaesthetic, but decided to forgo the normal sedative. They shaved off a bit of fur on the hind leg for the terminal injection. Autumn didn't even flinch; yet another sign of how far out of it she was. Then the injection, and a moment later she was gone. The vet left. We stayed there, continuing to pet her for a few minutes, then closed her eyes and left. I stopped in the next examination room to swipe some kleenexes. We'd emptied the box in our room.

I don't know if there's any significance to a purple burial shroud. We didn't consciously send her off with one. But I'm glad I did; it feels dignified. I'll never forget looking back; our last sight of our little queen Autumn lying there, peacefully, wrapped in purple.