Saying a very special goodbye

Estelle’s lipstick was apple-red and generous.  She did not limit its application to lips, but wore it in the general area of her mouth.  Together with pink rouge, color stood out brightly on her pale face.  She wore a threadbare dinner dress, years faded.  Estelle had dressed carefully for the visit and I showed respect.

I met Estelle in the winter of her life.  92 years old, she lived by herself in a proud Victorian house, not far from our office.   The broad wooden porch, paint pealing, recalled gathering on hot summer nights.  Leaves left from fall’s passing covered the sparse lawn.  Broken sun through ancient window glass cast ripples of light over empty furniture.

We had caught her illness too late to cure and her age prevented aggressive therapy.  She accepted this with tears and pride.  So many had already passed, she understood her time had come. Estelle had only one remaining concern.  She was worried about her cat.

Now, I never met that equally elderly cat, but I did see a picture.  Felix was a large, probably over fed, immaculate grey tabby.  Like its owner, Felix was a bit over dressed. In the image, he wore a bright, large, rhinestone collar.  I do not remember any lipstick.

Estelle wanted to end life in her home of many decades.  She wanted to be with her cat.  She was concerned who would let Felix out and in each day.  The descent down the stairs from her bedroom was getting harder.  Her neighborhood had long transitioned and she had no friends.  Her nearest relative, a nephew, did not live close.  She did not want to confine her feline companion to the house, just because she was no longer mobile.

When I was a child, my father’s answer to this problem was to cut a hole in the garage doors, with a small flap.  This gave our pets the independence they desired and released us from the task of cleaning litter boxes.  After thought, Estelle settled on this solution.  Her nephew agreed to create the cat door.

This gave joy and comfort to both Estelle and Felix.  The cat had the freedom to explore and take in the smells of spring.  I picture him rolling in fresh mulch or basking in warming sun.  Felix always returned to Estelle to sit on the sofa or at her feet during quiet meals.  Her thin hand would stroke his heated fur. Their love continued as Estelle’s life approached its end.

In her last weeks Estelle took to bed.  We arranged a full time aide and hospice, so she was able to stay in her home.  The cat remained loyal, spending most of his time on her bed.   However, not satisfied with our medical care, Felix decided further treatment was required.

Felix started to bring Estelle sanative gifts from the outside world.  Apparently seeking, as loved ones do, to build up her strength, he delivered choice morsels.  Felix began to hunt in the neighborhood for Estelle.

Generally, he brought Estelle birds.  The old cat would scour the yards and gardens, and then carry his gift through the cat door, up the stairs and into her sick room. He would place each prize on the bed at her feet.  Estelle would react in confusion, understanding the gift’s nature, but upset by the kill.  She would gently scold Felix even as she thanked him for his generosity.  The aide would become hysterical.

The frantic response induced from the aide and Estelle’s failure to eat these fine offerings did not dissuade Felix.  He continued the healing hunt.  When birds did not restore Estelle, he moved to mice.  Failing mice, he brought home a half eaten piece of chicken.  It was when Felix bought home the panicked, raging, running-around-the-whole-house squirrel that the nephew taped up the cat door.

Estelle died a short time after and the old tabby went to live in the nephew’s home.  That had been Estelle’s last wish.   However, the love given by that cat stays with me.  Her sole remaining friend, doing all he could to help, saying a very special goodbye.

James C. Salwitz is an oncologist.

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  • Bobbi Emel

    Very sweet story, thank you!

    • http://twitter.com/DRSALWITZ James C Salwitz

      Thank you. She was one of those patients who touch and change you.  jcs

  • http://secondbasedispatch.com/ jackiefox

    I love this story and your writing. You reminded me of a quote by Yeats, “And say my glory was I had such friends.” Not all of those friends have to be the same species as we are, and you illustrated that so beautifully. Thank you.

    • http://twitter.com/DRSALWITZ James C Salwitz

      One of the wonders of life is where we find love and companionship.  Not what we always expect or even understand.  Thank you for your kind comment.   jcs

  • Anonymous

    Wonderful story.
    Right after I finished reading it I went and hugged my cat.

  • http://twitter.com/DRSALWITZ James C Salwitz

    Thank you.
    We sometimes forget how much our feline (and canine) friends mean to us.jcs

  • http://twitter.com/aek2013 aek

    OK – the animal welfare perspective on this:

    I have been both nurse – gerontologic and critical care – and animal sanctuary worker for senior and special needs companion and farm animals. I have provided hospice care to human and mammalian patients.

    1)  End of life care involves specific instructions for pets and owned animals (farm, exotic, water-based, etc).

    2) Domestic cats should not be allowed to roam freely.  There are both environmental hazards and zoonotic illnesses to take into consideration.  (Scold here to oncologist author – think immunosupression)

    3) Many animal rescue and welfare organizations will contract to take ownership of animals after the owner’s death via pre-payment/donation and contracts.  Do your homework and affiliate with the organization of your choice.

    4)  Failure to make arrangements for pets after the owner’s death almost always results in their surrender to overwhelmed animal shelter, most of which are high kill.  Adult and elderly animals are always euthanized as a result of too few adopters and adopters universal preference for kittens and puppies.  Moreover, most pets are highly traumatized when placed in shelters.  The death rate is very high for these animals, and they do indeed suffer from circumstances over which they have no control.

    5) Petfinder.org is a US national database of animal welfare and rescue organizations.  Search via your zip code to find those which deal with the specific qualities of the pets that you are concerned about.

    6) Caveat emptor.  There are no national regulations or accreditation criteria of animal welfare/rescue organizations.  Meet their officers and volunteers as well as the animals they care for to determine your comfort level with placing your animals with them

  • Anonymous

    After reading this story, I projected myself in the future having a life of independence like Estelle.  I felt very content to live in an old house with a beloved pet, many memories and a caring doctor to see me to my end.  Thank you for this lovely story.

    • http://twitter.com/DRSALWITZ James C Salwitz

      Works for me, too.  Rocking chair would be nice.
      Thanks,
      jcs

  • http://twitter.com/DRSALWITZ James C Salwitz

    Very informative input.  Not all families with pets will have the resources for their care, after the end of the patient’s life.    Not really worried about infections from cats in terminal patients…more of an issue with patients receiving high dose chemotherapy with curative goals.
    Thanks very much.  jcs

    • Anonymous

      I’m with you on this one. Worrying about getting an infection from her beloved cat is like worrying if she would become addicted to narcotics for pain management.

  • http://profiles.google.com/mhirzel Mary L. Hirzel

    Considering the enormous burdens most physicians now work under, it is REALLY heart-warming that one, at least, retains such compassion for his patients – though I wonder what that costs you…..

    Thank you, sincerely and keep writing!

    • http://twitter.com/DRSALWITZ James C Salwitz

      Thank you very much.

      As I tell my students, I have found in relationships such as this is the sustanence to practice medicine.  For me taking care of patients becomes hard when it is mechanical or distant. This is why this is still the best profession.

      jcs

  • http://www.facebook.com/profile.php?id=1171503641 Julia Gallant McConnell

    James, 
    What a wonderful piece of writing. Thank you for sharing it this morning. I cried 3/4 of the way through, actually starting 3/4 of the way through. Your patients are lucky to have you as their physician. 

    • http://twitter.com/DRSALWITZ James C Salwitz

      Thank you very much.
      There is a certain sadness, even in a story of hope.
      jcs

  • http://www.facebook.com/profile.php?id=1171503641 Julia Gallant McConnell

    Good morning,
    I subscribe to kevinMD.com and this came up on his daily newsletter. I found it to be very touching and wanted to share it with some special people in my life that I think could really appreciate it. Kathy, Nancy Cramer, and Lal–Eva and Erskine are both doing ok, as best can be. Eva has her beloved cat, Sasha (whom she adopted on Martha’s Vineyard–although she doesn’t remember that), and Erskine Jr. is currently fostering a beautiful cat, Kiki. Kiki lived with an elderly couple that could no longer keep her. Kiki was days away from being surrendered at the shelter, where she most likely would have been euthanized. But Julie (yay!) and I happened to cross paths at the same time–just in time. I had contacted our cat community friends to put out a request for anyone who might know a “senior” cat that needed a home, even if only for a short time.  I thought if I could find my dad a foster cat it would be a win-win, and it has been. Thanks. –Julia

    Note–I sent this email out to some friends and family just now (sorry, wasn’t up to editing the email for this post) and wanted to say one thing, which is in reference to an earlier post from a strong animal advocate. Kiki lives with my dad, and they both reside in his small assisted-living residence. I have hired a pet-sitter, who is just wonderful, that goes in to see my mom and Sasha (mom has Alzheimer’s) 3 days a week (and we will increase this as needed) and she visits Dad and Kiki once per week. It has been a great arrangement so far. I would encourage other people to consider this as an option–joining senior cats with senior humans, who both need and want companionship late in life. As long as an elderly person is able to care for a beloved furry friend they should indeed stay together if proper arrangements for assistance are available when needed to make it happen. 

    Peace out to everyone! :))

  • Cheryl Lappas

    I have been blessed by two heart-warming stories of 90-ish old women this week. One, is the video gone viral of the 90 year old woman dancing with abandon as her grandson films her making ‘moves like Jagger’, and now this story, of a woman whose sole concern was for the care of her cat. In each case, these women knew what is important in life, namely, living it to the fullest and caring for others. Thanks for a wonderful post!

  • http://pulse.yahoo.com/_GPVS3W7KW7HKGZV3BMSKCNHSU4 Kim

    You certainly made this lifelong cat lover cry a little. Enough can’t be said about the tremendous value in the unconditional love of an animal; many people would do well to learn from their example.

  • Anonymous

    I too was brought to tears as our cat is also very loving and loyal. When my husband was seriously ill and confined to bed, our little furry boy stayed with him night and day to comfort him and to watch over him. Animals do love, do have feelings and are smarter than we humans give them credit.  I some times think we do this so we don’t feel so bad when we mistreat them. 

  • http://www.capko.com Laurie Morgan

    What a story. Thank you.

  • Paul Clagett

    I loved this story!  Thank you so much for sharing it with us.

  • Mari-Ann Wise

    Tears in my eyes, yet so glad that I read it.  Thank you for taking the time to write this wonderful tale of friendship and “alternative medicine”.

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