The decision to euthanize: Tybalt's final day (updated)

Part One: Written Before

Probably the cat's last day. Erika is home from work, and we've been exploring euthanasia options - there are services like Lifting Stars, which a friend used, who will send a vet out to your home and give the cat a peaceful injection, but with the transportation costs and a cremation (without urn), it will come to over $500 - though that's not the decisive factor, which is that they don't have any slots open until Monday, which might just be prolonging the cat's discomfort. We can bundle him in a blanket and get him to his usual vet without much trouble. It will still cost $250 (including cremation), but it can happen later today - though they will check the cat to make sure it is appropriate. We're both pretty convinced, after six days of very visible discomfort and behaviour change, that it is. 

People on Facebook have suggested lots of things, from force-feeding the cat (which I've done a bit of) to rubbing mirtazapine, an appetite stimulant that comes in ointment form, in his ears, but everything here points to his kidneys having shut down, after three or four years of giving him subcutaneous fluids (I think I had said IV fluids, previously, because they're from an IV bag, but they just go under his skin). He can barely walk - probably from kidney pain, which can be really intense - and we have been lifting him onto his favourite places to sit for the last few days, because he can no longer leap (a big change from even ten days ago, when he was shaky and twitchy and a little wobbly, but still able to get'er done). And he really isn't inclined towards food or liquid at all. He perks up when I rattle the Temptations box - his favourite treat - but when I bring him some, he turns his head and, if I don't take it away, makes movements to leave the area. I have squirted some nutrients (and a bit of homemade CBD/ almond milk concoction) in his mouth with a syringe, but that's about it - forcing him to eat won't make his kidneys start working again, if that's indeed what is going on. He had maybe one or two treats a day from Sunday to Wednesday - this from a Temptations addict who would demand treats every few hours, if we were stingy - but yesterday, his sole voluntary intake was a few laps of tuna juice. Today, bringing him tuna juice (fresh from a new can I opened, because he doesn't seem to like cold tuna juice and the other stuff had been sitting out all night), I got a dramatic gag reaction, his mouth opening and gullet working. He stood up - which we've been taking as a signifier that he wants to go to his litter box - and I carried him there and placed him inside, and he gave a foamy white barf (and peed a tiny bit).  The appetite loss is only a symptom of the larger problem, but it seems to be terminal: the vet will not even prescribe mirtazapine, saying bluntly that "with kidney failure, if they stop eating and drinking, you have to put them down."  

Erika and I both have known this was coming, but it's still striking how big a change it has been, how fast it has happened. Tybalt's regular routine, most mornings, even into last week - right up to his last day before our island trip, Friday the 2nd of September, has been to be at the bedside, waiting for me to wake up. If I've slept late, he'd come up behind my head, meow, and even run his foreclaws through my beard (a rather amazing way to be awoken, really). He's been less inclined to be bossy these past few weeks, since maybe mid-August - a little less demanding, maybe - but even then, he would, every morning, leap down from his bedside perch, get ahead of me, and saunter slowly (but assuredly) towards the kitchen. I would usually break left, in fact, and go the opposite direction, towards the washroom, partially to thin down his treats and force him to be a bit patient, but mostly because I generally need to pee when I wake up. But he would wait in the entrance to the kitchen, where the treats were dispensed, and sometimes meow at me (or yowl angrily) while posturing to block my entrance to the living room - like a barrier, so that I would turn into the kitchen. There's the saying about trying to herd cats, but in terms of his morning treats, the cat has been the one herding me. 

Occasionally at such times, as a variant on the ritual, I have stepped around him, gone to the living room to inspect for barfs or poops (which wouldn't really impact my giving him treats, but we've tried to sort of discourage his fouling the furniture where we can, and I liked conveying the message that his treats were a reward for not having made a mess. After some accident-free months, in mid-August, he pooped almost every day in the wrong place, which probably was the sign that things were getting worse). But normally, I would just follow him into the kitchen, with his slow saunter ahead of me (and choice of stopping point) sometimes delaying my reaching the treat box: "You have to take a few more steps, buddy, if you want me to give you those." (This is a cat who, if he finds himself upstairs, will go to the neighbour's door above our apartment and meow at it to be let in, because - even if he's climbed the stairs himself - he doesn't get how apartments work and thinks the door is ours; he's not the most "spatially intelligent" animal out there, but then again, neither am I). Eventually, I would throw him three to six treats, sometimes one at a time for the first couple, sometimes all in a bunch, and as they scattered on the dining area hardwood, he would run to get them, sometimes "hockeying" them, swatting at them with a paw as they slid past on the floor. Occasionally they'd go under a surface and he'd stretch or scratch to get to them; and if a treat had landed next to a table leg or something, he would have a bit of a hard time seeing it, and reach out to CATCH it with his paw, a decisive little whomp, dragging it over to him like it had been trying to hide, eating them one at a time then looking for the next. No matter how many or how few treats I gave him - even if I'd just thrown him one - he'd sniff the whole kitchen down in case he'd missed something (another thing I understand now was a sign that things were getting worse is that he DID miss a few treats, last week, just leaving them in plain sight on the floor) . The vet has long said not to give him too many treats - which are high in proteins and not great if the cat has kidney issues - but these were really his only chances to hunt, to seek prey, to catch and "kill" and eat something (the odd floor prawn - AKA silverfish - aside). Then a few hours later, I'd get up to go into the other room and see the cat waiting expectantly in the area between the kitchen and dining area, which would be where the treats would end up, sitting up, alert and perky, waiting for his next fix.

This has been a routine that the cat has maintained for years. Now you can bring a treat to him and he might sniff it, but he'll turn his head away. There are a couple of cat treats in proximity to the places where he eats and sleeps - he hasn't gone near them. It's a huge behavioural change, as is his not being able to leap up onto the couch with us, or the footstool at Erika's bedside. But like I say, his not eating is not the problem - it's a symptom of something far deeper. He's just stayed in the bedroom the whole morning, his one barf-trip to the litterbox aside, curled up next to the hot water bottle, which seems to relieve some of his kidney discomfort. He purrs when Erika cuddles him and doesn't seem to be in pain, but that seems contingent on his not moving. Often he just puts his head down, shielding out light from his eyes ("the Blair cat," if you see what I mean) - he's been doing that a lot this week. 

So to the people who have suggested giving him appetite stimulants or force-feeding him, thank you for trying to give hope and make constructive suggestions, but it's been maybe four years - maybe five? maybe even before we were married? - since he was diagnosed with kidney failure, and the best conclusion we can come to is that it is time to put him down. He can barely walk, can barely see. There is almost no pee coming out of him, when he does use the litter box (which we have been helping him into), despite Erika giving him fluids three days in a row (Monday, Tuesday, and Wednesday - we skipped yesterday, because it just seemed to make it harder for him to walk, though we may give him more fluids today, depending on how things go with the vet). It's really sad, and both of us are crying - it comes in waves, catches us at odd moments - but unless the vet comes up with some other diagnosis or suggestion, we're going to go with euthanasia before the pain gets too bad. Just seems like the right thing to do. 

But he still purrs, especially when Erika holds him. We spent most of last night watching a show and petting him. We brought him to the bedroom in his favourite pink blanket, and set him up next to the bed on a footstool, and he stayed most of the night, Erika cuddling him until it was time to sleep (he did get up to pee around 6AM, but came right back, making it onto the footstool himself - maybe his last unassisted leap?). You can tell that  he feels really loved. 

UPDATE (Part Two: After)

Tybs is gone. The apartment feels really empty, and we're making plans to buy a new footstool, because the one we have was scratched to shit by him.

He had slept most of the day in the bed while we went about our business - including making a final appointment with our vet - with me occasionally checking in to offer him a drink of water, a bit of tuna juice (we opened a fresh can, because he doesn't care for things fresh out of the fridge - if anyone wants a tuna sandwich, feel free to drop by, because we've kind of had our fill of them). He would usually just look away from any other foods I offered, but the day prior, he'd had a few laps of the tuna. This time, the smell of the tuna juice made him gag visibly, a Bill-the-cat "ack" followed by him standing up, which we generally have been taking as a sign that he might need to pee. I carried him (soft, warm, and limp, with rear legs sticking out uselessly) to the litterbox, got him inside - gingerly lifting his back legs in for him - and he peed a bit and barfed a little white foam. Then we took him back to the bed. 

No more tuna juice, then. 

Sometime while I saw bathing, he jumped down from the bed and crawled under it. He did that a few times in his life - usually when he was afraid we were going on a trip and he didn't want to be bundled into his carrier. (One of the signs that things were going wrong, last week, was his complete passivity about being piled in when we went to the island). Erika has very reasonably been afraid that he was crawling under the bed to die, but he always looked back at me when I knelt down.

We decided, having skipped Thursday, to give him a final catwater - his subcutaneous lactated ringer solution. Erika set up his favourite pink blanket and I heated the bag of solution in a plastic juice jug, then when it was warm, reached under the bed and gently dragged him (still limp) outside. We gave him his water, finishing the bag, then sat down to watch a show, petting him. Eventually he tried to stand, so we carried him to his seat, and he napped a bit. At about 2pm, he tried to stand again, so again, we brought him to the litterbox, where he had a little pee. 

Amazingly - presumably strengthened a bit by having had fluids - he climbed out himself and went on a wobbly walk about the apartment, heading towards the dining room area. "Where are you going, buddy?" He seemed to be sniffing around. His rear haunches were raised - I gather this is a response to kidney pain - but he was able to slowly, carefully make it almost to the dining room, where he stopped and waited.

So I brought him back to his chair, getting the idea en route that maybe he had been going to look for a Temptation? He had been heading towards that area. 

I brought him the box of Temptations, giving it a rattle on the way, and he perked up and looked over, so I offered him two. He couldn't find them at first - he sniffed about with clear interest, looking for them, but though they were six inches from his face, he apparently couldn't see them. His vision has been quite poor for awhile, but - the vet explained - once the kidneys fail, other organs start shutting down; many websites that describe the final stage of renal failure in cats list "blindness" as a symptom. I adjusted the treats, brought them right up close to his face, and he ate two, chewing with difficulty but determination: "The Last Temptations of Tybalt Lax." It was the only food he had yesterday, and the only fluid that we didn't inject under his skin, but I am so glad he got to have his favourite thing one last time. 

Then he put his face to the back of the chair and closed his eyes and went back to sleep. We looked over to see if he was still breathing from time to time, while Erika finished some work and I did something-or-other, waiting for the hour to arrive to bring him to the vet. We didn't bother with the carrier - he was too weak to cause problems in the car, and sat passively, bundled in his pink blanket, looking mostly at Erika, as she drove, but also curious to see the outside world.

The vet reaffirmed that there really was no other option: "We could do tests, but there's no point. Once his kidneys fail, his other organs start failing, too." The vet put him on the table and went to get a sedative, prior to hooking him up to an IV and administering the final medicine. Erika and I were both crying and petting him. He gave a little meow of protest when the vet moved him and another when he gave him the shot, but mostly he went gently. We might have been able to keep him alive a bit longer, forcing food into him, but it would have been a cruel, slow, painful decline into the inevitable. 

It was better this way, but the apartment feels really empty without him. And how will I find my way into the kitchen in the morning without him leading me there?  

Goodbye, Tybalt. You were a class act.