Saturday, March 01, 2003

How Do You Make A Decision? In Which Ellen Ponders and Curses the Inevitable.

I've received two nice letters this week from strangers on the internet who've found our site while searching for info on hemangiosarcoma. What a rough disease. One letter inspired the following thinking-out-loud dump of the load I'm carrying.

With Remington's current status looking like this might be his last week or 2, I can't help but wonder whether the medical fees have been worth the 4 extra months. (Without any treatment, they didn't think he'd survive a month.) I had the financial resources and I've tried to make sure that Rem has had a good time whenever possible, and we've done some things that I wouldn't have gotten around to doing for a long time, maybe never, if I hadn't known he had a fatal illness. If I hadn't had the financial resources, say a few years ago, I'd have had to let the illness take its course or possibly even have him put to sleep much earlier. That's not a terrible thing at all. In fact, Rem has had some unpleasant experiences during these months, too--long periods in the hospital without me, getting those 2 transfusions or whatever--so it hasn't all been gophers and home-cooked chicken. But--having spent the $--I don't regret it. Now, if I had to spend that much a month to keep *all* my dogs alive all the time, that would be wayyy different.

And I still have cash, and I could still spend more, but how much more do I spend on what is ultimately a losing proposition, and at what expense to *Remington*, who is, after all, the one who matters the most in all of this?

In some ways, it's a smarter decision not to fight it, since you know that the results are foregone and the end will be much quicker than you could possibly hope, and of course it's the *dog* who bears the brunt of all of our medical attempts to keep him alive. I think all they want is to be with their loving families.

I'm wrestling now with the dilemma that we have the power to prevent a dying dog from going through an extended period of misery, something we don't have for people. When is the dog's quality of life compromised enough that he would be better off closing his eyes and going peacefully on to the great milkbone in the sky? How do I know whether I'm keeping him alive because *I* don't want to lose him or because he's enjoying life enough? I don't really want him to slowly bleed to death, either. That doesn't seem fair to him.

I keep thinking back to the phrase, "Where there's life, there's hope--" but, with hemang., there's really no long-term hope. But there might be hope for another few good days. I don't see that Rem is in pain at the moment, although his energy is low. However, he's certainly so miserable when bleeding is going on that, if it happens too frequently, I can't see forcing him to continue to go through that. And there's only so much that a transfusion can do. It might give him enough energy for another day or 2, but it's just holding off the inevitable, and I'm not willing to trade a day in the hospital for a day or 2 of false energy. So I don't think we'll be doing any more transfusions. The other problem with transfusions is that they can increase the blood pressure, so if there's active bleeding going on, it can just keep it happening rather than leaving the lower blood pressure which possibly allows the rupture to close up.

I cried a lot the first days after the diagnosis while he was in the hospital. And every time he's bled badly inside, I lose him all over again and the tears come again. Thinking about all the holes that will be left in my life with him gone hurts a lot. I have gradually been able to build myself a usable mental image of life with the other two beasties. And this is just my dog, for crying out loud, who'd probably have not lived more than a few more years anyway. I can't imagine how people find the strength to handle the loss of a spouse or a child or a parent. I think that as people and dogs gradually age, you gradually build your own mental and emotional model in which the logical progression beyond very old age is death, and you also expect a gradual changing of activity level and slowly decreasing strength and robustness--not that frailness is inevitable, but someone's who's 80 just isn't going to be as robust as someone who's 40.

But when the illness or death comes suddenly, early, unexpectedly, you have to fight the whole "It's not fair." "Why me? Why now?" thing and the sudden unexpected change in your life and your plans and your vision of what your life would be like for the next however many years AS WELL as dealing with the loss.

I'm fortunate in that I work from home most of the time, so I am with him almost all the time now. He now won't eat anything other than meat, and I don't think it's because he's spoiled by all the extra stuff. He really just doesn't have the appetite or interest in anything else any more. And that's sad.

We went for a walk, just the 2 of us, again today, over in the field where there are gopher holes. Today he had the energy to try to dig one out. And he had the energy to sniff around at stuff and go looking for squirrels, too. Rest of the time he's on his bed, sleeping deeply, saving his small amount of energy reserve. Does have the energy today to get up and join the other annoying beasts when they start woofing at an imagined offender out the front window, and when he lifts his head, it's with bright eyes and raised ears, not with a sick dog's demeanor.

So we keep going.

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