Yochabel's Wisdom: Hospice at Home

Written by Casey Hersch, MSW, LCSW
August 28, 2019
Originally published on www.consciouscat.com

This is the fifth of a series of blog posts over the next few months. In this series I discuss what it is like to live with a chronically ill cat, the stress, the joys, and the heartache of loss. I also talk about how Yochabel has helped me live with my own chronic illness and ways she helped me cope and gain resiliency. My philosophies about integrative healing apply to Yochabel's treatment as does the use of my healing wheel.

Cancer changes lives

When Yochabel was diagnosed with a bladder tumor both of our lives changed. I felt weighed down by a daunting fear that I was racing against time while the tumor might be growing faster than we could intervene. The ultrasound showed the tumor was one third of the size of her bladder. While the specialist told me these tumors grow quickly, I couldn’t know for sure how quickly without ongoing testing. What I knew for sure was that Yochabel’s world was shrinking, and our normal day to day routine was changing.

Prior to the tumor diagnosis, her physical health had improved so much she could walk a lap the entire length of our small home, and she did so many times a day. Her litter box was at one end of the home. The office, at the other end of the home, was where we spent most of our time together.

When she first came to live with me, I liked that she got so much exercise going back and forth. Exercise had greatly improved her health. However, with the sudden onset of bladder infections, Yochabel’s time in the litter box increased, and so did her laps across the house. As she made her normal trek down the hallway, she plopped down by my side only to have to get up and do it all over again–back to the litter box. The greater her urge to urinate, the faster she motored down the hallway.

Eventually, she didn’t have the bladder control or the energy to make it to the box. I placed additional litter boxes near the office, but she preferred to hold on to her dignity and exclusively used the comforts of her long term litter box. Her desire to be with me prevailed, and for several weeks I honored her request by following behind and lovingly cleaning up her dribbles along the way.

Illness and aging can be hard on dignity. She deserved to feel “normal” without shame. She had worked hard to claim ownership of the entire length of our home. I wanted her to relish this victory for as long as she could and leave her in charge. I believed that she would tell me when she could no longer come down the hallway.

When that day came, she met me halfway, and I carried her the rest of the way. Sometimes she only rested by my side for a few seconds before she jumped up as if to say, “Here it comes again. Gotta go NOW.” And again, I would carry her to her litter box as fast as I could.

One day as I walked down the hallway wiping up dribbles, I realized Yochabel wasn’t in front of me. I was wiping up puddles of my own tears. None of us want to get old and to see our bodies change. I was sad for her and sad for myself. I realized at some point in all of our lives, we may have to accept our bodies don’t work the way they used to. We may have to face that hospice and palliative care are a part of life. Yochabel was reaching a point where her organs were tiring before her spirit ever would. With each change, I felt the grief of knowing our time together was limited. These changes were symbolic of the cycle of life.

Yochabel’s Beach: Modifying the environment with dignity

Yochabel had tested many litter boxes since she came to live with me. Ultimately, she chose a spacious, round (27 inch) pan, inspired by my husband’s ability to “think outside the box.” I am most grateful she loved this pan, because with the tumor competing for space inside her bladder, Yochabel spent more time in this pan than anywhere else. Sometimes she fell asleep in it. As her illness progressed, she wasn’t always able to leave the pan for her meals. Therefore, I brought her meals to her and hand fed her while she sat in her spacious litter pan.

I could not believe how hard she tried to avoid an accident. Cleaning up after her wouldn’t have bothered me one bit, but this was the Yochabel way: dignity first. We named her litter pan Yochabel Beach: a place associated with joy, peace, her love for food, and fun, not cancer.

 We needed all the joy we could cultivate during this hard time. I arranged her beds around her beach so she could get to them with little effort. I lined them with wet pads. I selected a premium dust free litter to reduce the dust that collected in her fur. When I couldn’t hand feed her, I placed meals and water on an elevated riser that was level with her head. She could eat and drink either standing or lying down without straining her neck or depleting her energy. Cancer made the simplest tasks, even eating and standing, exhausting. Our home had to fit her needs by becoming functional and hospice friendly. If her world had to shrink to the litter box, then we would make the best of it.

Finding a vet who puts your needs first

While we already had a housecall veterinarian and a team of integrative healers, Yochabel still needed diagnostic tests, which had to take place in a clinic. It was difficult to find a vet for this specific role. It was also difficult because historically, Yochabel was cranky and feisty at the clinic. This was a dramatic contrast from her docile and accommodating nature in our home, especially during chiropractic and acupuncture sessions.

I called various vet clinics and asked to interview the vet prior to bringing Yochabel in. I refused to trouble Yochabel with a car ride and the turmoil of being separated from her litter box, without knowing if the vet’s philosophy was a good fit for us. Unfortunately, I was told repeatedly that the vet would not speak with me without bringing Yochabel in for a consultation. They wanted Yochabel and I to work around their standard protocols, but I advocated for a vet that would work with Yochabel’s needs and our treatment philosophy. I persisted and found the perfect vet for us. Dr Blair took time to return my phone call and spoke with me at length so that I could be assured she was a proper fit prior to bringing Yochabel in. Her philosophy was simple:

“My focus is on what is in the best interests of Yochabel and making her life more comfortable. How can I help you do this?”

To make Yochabel’s trip to the vet more comfortable, we made one more accommodation: a litter box that fit inside the cat carrier. This way, Yochabel would have her “mini” Yochabel’s Beach en route. Dr Blair honored her word, and Yochabel was promptly and swiftly examined and returned home. I followed up with her for treatment discussions with Yochabel comfortable at home. It was a beautiful collaboration, with Yochabel’s needs coming first. Surprisingly, Yochabel was a “star student” at this vet clinic. Not only did she tolerate the exam, she allowed Dr Blair to express her anal glands without a hiss, fit, or cuss word. I believe this was because Dr Blair was attentive and patient. She told me she let Yochabel take the lead, and she wasn’t going to push if it seemed too much for Yochabel.

Acceptance, and creating new rituals

As I sat in my office, working alone, I could hear the clip clop of Yochabel walking down the hallway, only she wasn’t coming to me. She was at her beach. As I typed on my computer, tears rolled down my face as I imagined that one day very soon, I might hear her clip clop, only to remember that she would no longer be in her room at the other end of the house. She would be in heaven. I missed my work days with Yochabel at my feet. I missed all the play we had together and the silly times.

Things were changing and we couldn’t go back in time, but we could hold on to our memories together. While I fed her in Yochabel’s Beach, we both looked at each other as if to say, “We know this is sort of gross, but we gotta do what we gotta do.” I wanted her to grab her food quickly so she didn’t drop it into the litter (yuck!). As singing and playing was our way to bond, we made a new ritual. We pretended to have our picnic at the beach and we sang our new song together.

♪ “You’re not a kitty cat, you’re a mountain lion… ROAR ROAR. Look at you go!” ♪

Together we imagined Yochabel as a mountain lion, taking big bites of food quickly so as to not lose it to nearby predators (the litter below). The more I sang, the more she ate her food with vigor. Imagining the strength of a mountain lion gave both of us the strength we needed at the time. No matter how things had changed, we still had each other.

Hospice wasn’t all bad. It was about living life together one day at a time and making the most of it. It was about being courageous and accepting things we couldn’t change. Our love would never change.

Part One:
Yochabel's Wisdom: Lessons in Healing

Part Two:
Yochabel's Wisdom: Securing the Bond

Part Three:
Yochabel's Wisdom: The Food Connection

Part Four:
Yochabel's Wisdom: Coping with Cancer

Part six:
Yochabel's Wisdom: Emotional Turmoil

Part Seven:
Yochabel's Wisdom: The Last Day

Part Eight:
Yochabel's Wisdom: Living With Loss