AUGUSTA'S LAST DAYS

San Francisco, Thursday, September 2, 2010. For the last week and more, our beloved fifteen-year-old cat, Augusta, has been eating less and less. She acts hungry, meows for food, but then will either take only a few bites or pass it up altogether. Her affect has been foggy, disoriented. Her eyes are not fully open and bright. She moves very slowly. And she has been losing weight quickly.

We took her to Pets Unlimited (a superb if awkwardly named veterinary hospital) at nine this this morning, to Dr. Randy Bowman, our favorite vet. She weighed 2.63 kg, or 5.8 lb., down from 7.1 lb. on July 21—only six week ago—a loss of 18 percent in six weeks. Bowman palpated her and found a hard mass in her lower abdomen. He had Elizabeth and me both feel it.

Randy then took her off to be x-rayed. It took over an hour, for some reason. Then he called us in to look at two pictures, one from the side, the other from above, both showing the mass. One possibility he had mentioned was an impacted fecal mass, but this wasn’t that. This was virtually certainly a tumor, he said. A radiologist will still be looking at the x-ray, tomorrow, and will confirm that. We could, he said, also get an ultrasound image that could further confirm that it is a tumor; but he also said that if she were his cat, he wouldn’t do it. And after all, what would be the point? The diagnosis can’t be a hundred percent confident, but everything is consistent with cancer, specifically the type most common in cats, lymphoma.

At her age, he said, surgery would be risky, and with the tumor having reached this size, the chance of success would be low. She’s going to die.

Probably pretty soon. How soon we don’t know. Meanwhile, we will see if two drugs can get her eating again and feeling better: Buprenex, a liquid to spread on her gums twice a day, for pain; and Mirtazapine every three days, an appetite stimulant. They gave her a first dose of both drugs, but while we were waiting for the prescriptions to take home, Augusta threw up white foam in her carrying case—almost certainly the Mirtazapine. So we’re going to have to give that to her again once she calms down.

It seemed as if the pain medication was making her feel somewhat better already. Perhaps it was the injection of fluids they gave her. She ate a small plateful of canteloupe and at least some regular cat food. But her affect remained dull, wan. She stayed with us awhile, then when we rose she ran away, presumably thinking we were going to put her in the box again.

She came and sniffed at her bucket bed on my desk, but didn’t stay. Elizabeth and I went out to lunch, and we don’t know where Augusta is now (1:15). The cat door is blocked, so she’s in the house somewhere, probably in Elizabeth’s closet, her latest hidey-hole.
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6:15 p.m. She remains holed up in the closet. When she sees me, she cries in a way I have never heard before. A cry of pain? A cry for help? I put out the little snacks and she comes out and sniffs at them and goes back in. I bring canteloupe and water. She comes out purring, but walking very weakly. She seems about to take a bite of caneloupe but stops, and walks about five steps toward the bedroom. Then she turns and goes back into the closet.

I’ve tried to call her downstairs to eat properly; she does not respond. Elizabeth is endlessly on the phone with a computer problem. Is Augusta dying now?

Maybe it’s just pain. It’s only two hours before she’s due for more pain medicine. I could try to give it to her, but maybe it’s all the hard handling she has endured that has made her so fearful and withdrawn, and wrestling her mouth open again would only exacerbate that. You have to rub the liquid on her gums or the inside of her cheeks.

(I have omitted that in the early afternoon I talked to the vet on the phone and he recommended going ahead with the appetite-stimulant pill. The first attempt failed: When we thought she had swallowed it, she ran away spitting it out in pieces. The second time, she did swallow it and ate a few crunchies just after. But it has obviously not worked to improve her appetite—and it is supposed to do so for three days.)
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9:25 p.m. She is dying. She looks as if it might be tonight. In any case she looks miserable. I talked to the hospital, and they’re open 24 hours, and can give her a sedative that will keep her semi-conscious for six to eight hours. If we were to decide to put her to sleep, they can do it anytime around the clock. But we’ve both checked in with her, and she still responds with purring and some evidence of gratification to schmunking and being talked to. Elizabeth thinks it best to wait till morning, and I’ve somewhat reluctantly come to agree. How after all do we know if she’s in pain?

We do know that she has not responded at all to either of the drugs. I ran to Mollie Stone’s a few minutes ago for the supposedly heroin-like and notoriously un-nutritious “white food” known as Fancy Feast Medley, and Augusta wouldn’t touch that either. I had taken her downstairs in my arms—she purred the whole way—but once there she still wouldn’t even drink water, just took a weary look and trudged back upstairs to her hidey-hole in Elizabeth’s closet. She is leaving.

I went to have a brief visit with her, and she was seemingly glad to see me, although she did not get up from her little towel bed, nor was she interested in my presentation of: canteloupe, white food, regular food, or water. Her eyes are heavy and dull (Elizabeth had just said that when she last saw her, not long before, they had been bright), but she did not make the low moan of despair or pain that has been so heart-breaking earlier. Elizabeth remarked that she is not seeking the total isolation that dying cats are commonly said to seek. My response is that she has gone beyond that, and just wants to be with us. A guess, but I think I’m right. The old saw about cats attaching to a place rather than people has never been true of Augusta.

I suppose it will be tomorrow morning that we take her to be put to sleep, and it will be a gentler and kinder death than most people ever know. The suffering will be ours, not hers.
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11 p.m. Augusta seems to be demented. Elizabeth has found that she is excited by the look and sound of the crunchies bag (what we call the cat snacks branded as Pounce); and she will come out of the hidey-hole and rub against my hand—hungrily—to get at them. Then she can’t find them on the plate with regular cat food, but when I spread them on the wood floor she does, and eats...all of two. She can be lured out a couple of times more, and takes a delusively purposeful walk of five feet toward the bedroom and then turns, purpose lost, back toward and then into the closet. She is starving herself, not even drinking water.

We have been watching the end of the movie “Babel,” which we couldn’t finish a couple of nights ago because the DVD was faulty—it’s a good film—but we haven’t been able to watch long without stopping it to talk about Augusta. We had planned first to get something from the store for dinner, and then we were going to make pesto from materials at hand, but in the end we ordered sushi in. Ordinarily the smell of the raw fish would have brought Augusta downstairs pronto, and she’d have jumped onto the coffee table to prowl rather rudely at our plates, but of course tonight she did not come.

I can hear Elizabeth down the hall talking to Augusta, and I know how much Augusta loves to hear her voice.
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Friday, September 3, 2010, 12:15 p.m. Elizabeth spent the night in a sleeping bag outside the closet. Augusta seems to have spent the whole night inside without coming out. About 6:30, I got up, and Augusta did come out, acting hungry, and I wanted to see if she would follow me downstairs for some breakfast—and she did. I opened a fresh can of “white food,” and she ate at it enthusiastically, then quit after an intake of at most two tablespoons. She went and peed in her box and look out through the back door, which I opened, to see if she wanted to go out and take some morning sun. She didn’t, but when I returned to the chair next to her food bowls she came back and ate some more white food.

Then she went back upstairs—virtually running, at a healthy clip until the last three stairs, when she slowed way down. She went straight back into the closet. We have been able to lure her out several times, and she continues to be very interested in the Pounces package, but when you give her actual Pounces she doesn’t eat them. She did poop in her upstairs box, then went back later to cover it up, and she sharpened her claws on the rug, which I take as a sign of some vitality. She still responds to being petted, but she is not leaving her hidey-hole, and she cannot possibly be even maintaining her weight.

Elizabeth left a call on Bowman’s voicemail, and I have a list of talking points for him, as follows:

• First, report: no increase in appetite; we’ve stopped the pain medication because it seemed to make her cry and perhaps also to be more disoriented. Describe her current behavior: closet; brief engagement; liking to be petted; interest in food, sometimes a few bites, more often just a few sniffs, then back into closet. She has gone downstairs and can run upstairs easily, but even then all she does is head into the closet.

• What’s to be gained from waiting for the radiologist’s report?

• At this point, what is the percentage likelihood of a turnaround or even modest improvement? Are there other drugs—e.g., steroids (injected?)—that might give her a couple of weeks of comfort and also restore her appetite?

• Will you do the job [euthanasia] yourself?

• Will the hospital handle cremation?

We’ve decided on cremation mainly for practical reasons. If we were in Montana—and I wish we were, it seems like the right place for her, either at the old West Boulder Ranch where she grew up or at the Langston House where she has spent her last summers—then we would bury her whole body. But here there’s so little space, and who knows what sort of pipes and other obstacles I may encounter digging even a small hole? We are going to bury her ashes right next to the back stoop (“Because she’s such a stoopey!” Elizabeth said last night), along with her favorite first two toys, the anchovy mouse and the spider ball, and the toy that in various forms has been her lifelong favorite, the plain old chasing-ribbbon. We also decided to cut out and bury with her her embroidered name from “the bucket,” the doughnut-shaped bed that sits on the old kneehole desk behind my computer table. Whenever I was working, she could sleep there feeling secure, or look out the little window at birds, or just keep watch over me.
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5:00 p.m. Elizabeth’s errands kept her away most of the afternoon. She talked to Bowman on her cell, and his answers were:

• The radiology report confirms a large solid mass consistent with a tumor. A sonogram is pointless; it would only re-confirm the same.

• An injection of steroids might give her a period of apparent improvement, but then the decline would be the same. She had actually begun losing weight three years ago, but we had begun putting prednisolone in her food, which kept her appetite up did not slow the progress of the disease. The pattern, if we gave her injected steroids now, would be the same but much faster and probably more painful because of the now greatly increased rate of tumor growth.

• Randy will do the euthanasia himself, but is booked all day tomorrow. He is willing to give up his lunch hour if that’s our decision. He doesn’t want to rush us. He will not be back till next Wednesday. Of course it doesn’t have to be done only by him, though both Elizabeth and I will feel most comfortable with him doing it.

• Cremation is done elsewhere, but the hospital takes care of it.

Meanwhile Augusta has had a somewhat decent afternoon. I’ve stayed with her constantly, mostly downstairs. She lay in the sun. She went out twice more (and had to be blocked both times from the grotty hidey-hole under the Grayson stairs). (I did inspect that, by the way: It’s not a place where she could escape from us, but it would be pretty hard, and dirty, business dragging her out, so we’ve agreed to keep her from going there.) She has eaten some hamburger, and a very few Pounces, but she is definitely not keeping up. On the other hand, lying or sitting in the sun on the kitchen rug, she did not seem like a creature who had lost all capacity for pleasure. When she moves, she does seem uncomfortable, but not in agony.

Is it too soon, because she can still have a few days of not-hellish life? Or is it time, because all that’s ahead of her is decline? We’re going to have to decide.

We made three lists to help us decide.

Things she can or will no longer do:
eat (barely)
use the cat door
get in the bucket (even with help)
do a banana
get up on loveseat and fleece
go into E’s office
play on blue paper
swat at ribbon
respond to catnip
chase anything

Things she can still do:
lie in the sun and enjoy it
enjoy petting or brushing, albeit only for a short time
come when called
use litter box, both ways
get onto the bed and come to me to be rubbed
be excited about food even when unable to eat
run upstairs, most of the way
fight hard against pills

Bad symptoms:
weight loss 18 percent since July 21 (six weeks)
wan affect
weakness
very slow movement
almost no groomy
increased startle response
no response to appetite stimulant
negative response to pain medication

We looked at her weight on our vet visit records:
9/2/10: 2.63 kg = 5.8 lb
7/21/10: 3.23 kg = 7.1 lb
4/17/09: 2.8 kg = 6.2 lb (This was when we began prednisolone)
10/7/08: 3.06 kg = 6.7 lb
12/27/07: 3.37 kg = 7.4 lb (18 percent decline in six months)
6/23/07: 4.14 kg = 9.1 lb
12/15/06: 4.14 kg = 9.1 lb
6/29/06: 4.54 kg = 10 lb
10/10/05: 10 lb
12/23/04: 9.5 lb
5/3/04: 9.25 lb
9/17/03: 10 lb
4/12/02: 9.75 lb
2/5/01: 9.75 lb

No point in drawing a graph. Clearly, something had begun happening in the second half of 2007, and we had been able to forestall the weight loss by giving her prednisolone in her food, but then in the last six weeks her weight has gone off a cliff.

We concluded that if she was better tomorrow, we would wait and see if she might start eating and feeling a little better; that if she was worse, we would go ahead and have her put to sleep that day; that if she was the same, we would have to decide then.
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Saturday, September 4, 2010. I spent most of the night in the sleeping bag next to Augusta. She left the closet at least once, when I was asleep, to eat some of the raw hamburger and all the Pounces that had been left out and also to use the litter box in the bathroom. I went to bed about three and returned about seven. She was wide awake but showed no inclination to come out. Her posture looked uncomfortable. She did not sleep at all. She did orient towards me, and she was purring constantly—the constant purr, I have read, being either a symptom of pain or a harbinger of death. I have also read recently, online (and who knows what information online is reliable), that the purring is a self-calming, and that a cat who is terrified or in extreme pain does not do it. One writer said that it means that the cat both knows she is dying and is comfortable.

I went back to bed till eight o’clock. Then when I put on my robe, she came out and followed me readily downstairs. She acted hungry, following me to the pantry. I presented her with raw beef, fresh crunchy food, a few Pounces, and three successive kinds of canned cat food, at each of which she only sniffed. Nor did she touch her water. After sitting with me for a while, she went back upstairs.

When Elizabeth came down about half an hour later, Augusta followed. We tried milk, and two more fresh cans of cat food, and a different flavor of Pounce. She ate one Pounce. I sat on the floor, and she stayed with me again for a while, and I brushed her, which she seemed to enjoy. But her posture remained uncomfortable.

Elizabeth and I agreed that if we could get Randy Bowman to perform the euthanasia today as he had said he thought he would be able to do on his lunch hour, then today was the day.

Augusta would face only further weight loss, and further decline. It would not be long before some organ or another would fail. She seems no longer to experience pleasure beyond a few seconds of petting or brushing—and even that soon becomes bothersome, and she moves away from it. In her hidey hole, she has begun turning her face away from us.

Elizabeth has left a message on Randy’s voicemail.

I spend much of the morning lying on the floor outside the closet, just to be with Augusta. I hope it comforts her, but there’s no way to know.

11:45 a.m. An assistant has called back, and offered either 12:30 or 4:00. We choose the earlier time. She assures us that we will not have to wait in the waiting areas, where barking dogs always scare Augusta. She recommends that we arrive at 12:40, and we will be taken straight to some room.

12:15 p.m. I go again to lie on the floor next to Augusta. She is curled up well back in the closet, where it’s quite dark. She is purring much of the time. Occasionally she changes position very slowly, and, I think, painfully. Occasionally I stroke her head, and I think she likes it. She begins to lick a front paw, as though she’s going to wash her face, but then she lays her chin on the paw. From time to time she looks at me. From time to time she closes her eyes. Mostly she just stares at nothing.

These are my last minutes with her, her last minutes alive. They pass one by one by one.
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12:40 p.m. We are shown into a room at Pets Unlimited, and Randy Bowman comes in right behind us. We put Augusta on a soft towel underlain by a pad on a table. It seems to be both an operating room and a death room—there are two cheesy paintings each of a pair of animals gazing into a sunset. Augusta is calm and no more afraid than she usually is at the vet’s. Randy explains that he will first give her an intramuscular injection that will act over the course of five to ten minutes to sedate her into unconsciousness. He administers that at 12:45, and it hurts: Augusta squirms and turns as though to try to bite him, and she makes brief eye contact with Elizabeth, but she relaxes quickly, staring straight ahead, very still. I watch her flanks moving as she breathes, and as her breath slows very slightly. As imperceptibly as the hour hand on a clock, it seems, she lowers her head to the towel. We continue to stroke her gently as she relaxes, relaxes.

12:50 p.m. Her nose is on the towel. I move her chin so she can breathe more easily. Randy checks her blink response, which is still there. Two minutes later it is not. He takes an amazingly noisy electric shaver to the front of her right front leg, making the vein there easily visible. She does not react at all to the noise, which under ordinary circumstances would have scared the shit out of her. Her eyes are open, but she is totally unconscious.

Elizabeth and I both continue to stroke and to hold Augusta. Elizabeth asks Randy to show her where to put her hand so that she can feel Augusta’s heart beating.

12:55 p.m. Randy injects a very large syringeful of barbiturates into the vein in her shaven foreleg. Her heart stops instantly. He tells us that her brain has died equally instantly.

We have read to expect several possibilities: a series of deep, searing last breaths; shuddering; urination; a release of her bowels. None of these comes to pass. She is simply utterly still.

We stay with her a few minutes. She looks exactly like herself alive. I try unsuccessfully to close her eyes. I put my fingers between her toes, something she didn’t like much when she was alive but something I alway loved the feeling of. As we leave, Randy is wrapping Augusta’s body in a towel, to take her to a freezer.
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He has given us a brochure for a pet crematorium and cemetery in Colma, the Bay Area’s famous city of the dead. They will pick her up and return her ashes to Pets Unlimited. They have a ghoulish website offering a wide variety of urns. You cannot enlarge the pictures, nor are the prices given. You can have a pine box for free. That’s what we’re going to take.
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She was never afraid of us. Inevitably sometimes we would step on her tail or trip over her, but that left no memory: She was never afraid we would hurt her.

Soon her places are empty, the litter boxes gone, her food bowls, the Bucket.

Even her last morning, she would come when I called her name. In my mind I can’t stop calling her name.
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Augusta was born in Montana—abandoned in the snow —and grew up there. She has come back with us every summer since we moved to San Francisco, and always loved it. This is our last picture of her, taken this past July 29, in Elizabeth’s shadow, on the lawn of our little rented house in Melville, Montana.