Coping with grief at your veterinary practice

I knew something was wrong when she got really picky. She would run to the bowl at mealtime but refused to eat. For my cat Cleo, this was unusual. In her 16 ½ years, she never refused to eat. I tried different varieties of canned cat food, treats, and a smorgasbord of people foods to no avail.

Cleo first appeared in Firstline in an article I wrote about nearly missing that she was hyperthyroid ("When your pet is the patient," July 2009). I've worked as a receptionist in veterinary practice 14 years, so I thought if Cleo had a problem I'd recognize it immediately. It gave me a new perspective on how our clients feel. For the next three years, we navigated endless medical information and lab tests together.

A medical journey

Since her hyperthyroid diagnosis, Cleo's kidney levels were always a concern. One of the many problems with hyperthyroidism is that it masks kidney insufficiency. At first, her numbers were at the high end of normal. But over the past year they slowly began to creep up. I switched her to a kidney diet. She remained stable for months. The day after she refused all forms of food, I took her to work with me for more lab work. She had been in for her regular monitoring tests just three weeks before, so I was completely unprepared for the results: her BUN and creatinine levels had doubled. Her little kidneys were failing.

After consulting with her doctor, we decided on an IV and intensive fluid therapy. Now Cleo is an orange tabby. Despite her beautiful face and quiet demeanor, she can be a little uncooperative. The IV lasted one day. Removing it was just as traumatic as placing it. So we opted for subcutaneous fluid therapy instead.

Because of my experience and cross-training as a veterinary assistant, I felt comfortable giving the fluids at home. I would give as much—or as little—as she would tolerate, as often as I could. I'm not sure if it was the fluids or the extra attention, but she always seemed a little perkier afterward. She tried to rally here and there, eating well for a meal or two, then refusing it.

A fork in the road

Although I knew how the disease would progress, I still wasn't ready to face those last days. Days after her diagnosis, Cleo and I made an agreement: I would do everything I could to keep her happy, healthy, and comfortable, and in return, she would tell me when it was time to let go. Watching her fade away was almost unbearable. My beautiful orange girl, who was once a robust 13 pounds, was now barely 7. She slept all the time. She drank a ton of water and as a result, urinated a lot, often having accidents outside the litter box. Other than the hours when I was at work, I didn't leave her side.

I struggled with the decision to euthanize for nearly a week. One evening as I watched her sleep on the couch, I texted my good friend and veterinary technician Wendy: "How do you know when it's time?" She responded, "Think of her five favorite things. When she can't or won't do three of them, then you know it's time."

I broke down. She refused to eat, didn't want to play, and wasn't interested in my other cats or anything other than sleeping. I had my answer.

Some may say that Cleo was just a pet. But to me, she was my companion, my furry friend, the subject of so many photos and the inspiration for so much of my writing and creative endeavors. I've read about dealing with pet loss and have talked endlessly with friends at work who have been though the experience.

Three months after I let Cleo go, her bowl is still in the kitchen because I can't bear to put it away. Looking at photos is bittersweet. Instead of remembering her struggle through her last days, I try to remember her amazingly soft orange fur, the freckles on her pink nose, her little voice, and all the ways she made me smile.

I'm thankful for veterinarians and technicians at Bradford Hills Veterinary Hospital, especially Dr. Dan Graham and technicians Wendy Colonello and Heather Mallozzi, who cared for her—and me—with respect and compassion, especially during her last weeks. For that, I will be forever grateful.

Jennifer Graham is a client services team member at Bradford Hills Veterinary Hospital in Wexford, Pa.