Saturday, November 14, 2009

Knowing (And the Proper Use of Power)

Knowing is hard--and, paradoxically, uncertain.

We had to put Kashmir down last night. Through a roller coaster of possible diagnoses and prognoses, the doctor at the animal hospital--to which we were referred by the vet--ultimately determined she had a mass the size of his fist in her abdomen: lymphosarcoma, or some equally mystifying term like that.

She was, indeed, very sick. Her breathing was labored, her walking was slumped, and she was dangerously dehydrated. Here at the house from our untrained eyes, we knew she was losing weight and acting very un-Kashmir-like. Seeing her through the trained eyes of the professionals, she suddenly appeared so terribly ill. We had not realized the severity of her condition.

At the risk of sounding sappy, it is hard to lose a pet, very hard. But I'm learning that grief is about so much more than the loss. It's also about processing all the decisions and circumstances leading up to it; it's about how everything happens as much as what happens; and, for me, it's about reviewing and second-guessing the series of events leading to the outcome.

I won't go into all the details, but the doctor at the hospital--the second one we saw last night--was cold, cavalier, rushed. His callous approach leaves me questioning, doubting. His exam was cursory, his conclusion contradictory to what we had been told by the previous vet. We had to make a decision based on the recommendation of someone I found it difficult, if not impossible, to trust. Even as we tried to elicit explanations or assurances of certainty in the diagnosis, he provided half-baked answers and ingenuine alternatives to death. He had opportunities to inspire confidence, but he didn't care to. His role gave him authority, and he seemed to think that ought to be enough. The last two hours of our time with Kashmir were painful, not only because we realized we were losing her but also because she was in the hands of someone who didn't really see her, or us.

He brought his complete lack of sensitivity into our final moments with Kashmir. By the time we gathered around to administer the "medication" to end her suffering, her state of dehydration and her low blood pressure made her veins invisible. The doctor, rather than comforting her or apologizing for his multiple attempts to place the needle, acted irritated, commenting aloud over and over about how hard it was going to be for him to do this when he couldn't see her veins. It became so horrific, I took the kids out of the room when originally we had decided, based on Ben's wishes, to be there all together.

It was awful--an ugly, ugly, painful mess. So I'm left replaying all of my decisions over the last few days about when to bring her in and who to bring her in to, wondering if seeing someone else would have resulted in a different, or at least more compassionate, outcome. If she did, indeed, have the tumor, we made the right decision. I just wish I could trust his assessment, and I wish her last few hours had been handled with kindness.

The beauty in the night, which stands in stark contrast to the professional's bruskness, was sweet little Benjamin. We had been preparing him for all different outcomes, and I walked him through every step of the evening, from the first vet's original suspicion of diabetes (which I explained was just like Grandpa and Papa's condition) to the vet's subsequent conclusion--based on the results of the bloodwork--that she had pancreatitis (explaining that Kashmir was very, very sick; that they were going to try to give her medicines at the hospital for a few days to help her get better; but that we didn't know if she would get better or not), to the hospital doctor's conclusion that she was too sick to treat (explaining through tears that medicine wouldn't help her and she was going to keep getting sicker until she died, so we had to decide if we were going to bring her home, which would be very painful for her since she couldn't eat or drink, or if we were going to let the doctor help her die there so she wouldn't hurt anymore).

He got it. Every detail. And he comforted me through the evening.

When we first entered the room where they euthanized Kashmir, we asked the kids if we should pray for her. Ben immediately said yes and prayed this simple prayer: "Dear Jesus, Thank you for Kashmir. I pray that Jesus will take good care of her in heaven. She was a good kitty. Amen." When Ben noticed I was crying, he said, "Don't be sad, Mommy. We love Kashmir." Later he attempted to comfort us by reasoning, "If Kashmir's going to heaven, then when we go to heaven, we'll all be together. And that will be happy."

When I brought the kids back into the room after the doctor was finished, we all petted her one last time and said goodbye. Ben asked, "Who will come to take her to heaven?"--in his literal and simple faith, he believed an emissary of some sort would escort her body away. I adore this notion. We discussed, then, concepts of body and soul, why we can still see her even though the "her" that we love is no longer there, and where her body will go when we leave the hospital. After answering his questions and giving Kashmir our final demonstrations of our affection, we loaded into the car with our now-empty cat carrier and drove home.

He has continued to offer little statements of hope since. "Mommy," Ben said as we drove home, "Today is sad, but tomorrow won't be sad because we won't have to worry about Kashmir anymore." This morning, when we first came downstairs and saw Jasmine, our now lone kitty, he crouched low and said, "Jasmine, Kashmir isn't here. She moved..." At this point, he was cut off by his sister, but I'm pretty sure he was going to say, "She moved to heaven," his four-year-old explanation of death: relocation. Then this afternoon before naps, he lay down next to Jasmine on our bed, stroked her head and said tenderly, "Jasmine, you're not going to see Kashmir again until you die." He's trying to make sure she understands, just as we've tried to make sure he understands what is going on. His heart radiates compassion and purity and truth.

I realize that Ben is taking this loss in stride because we took the time to walk through it with him, to explain in terms he could understand what was happening, to answer all his questions as candidly and as thoroughly as possible, to do everything in our power to make him comfortable with the potentially uncomfortable. Our knowledge of life and death and health and illness and doctors and medicine puts us in a position of authority--and power--in his life, but we used that authority to teach and model and comfort.

This is what the doctor failed to do. His knowledge of veterinary medicine and Kashmir's body and the severity of her symptoms and treatment options and outcomes put him in a position of authority, and power, in our life. We had no choice but to trust his evaluation. But he wielded his authority carelessly, assuming our trust based on his position alone, refusing to enter in and explain, reassure, teach, comfort. This abuse of power leaves us feeling uncertain, taken advantage of, dare I say violated?--exacerbating the pain of an already difficult situation. Our grief was compounded rather than assuaged.

I realize Kashmir is just a cat, but there was a lot more than a cat at stake here, which, I think, is why this is hitting me so hard. It was the treatment of our family in a vulnerable moment. It was the abuse of power. It's the fact that I couldn't bear to let our children stay in the room to comfort Kashmir because of this man's callousness.

But now we have no choice but to move on. I'm trying to follow Benjamin's lead, trusting that we did what was best for our charming kitty. I'm trying to quiet the barrage of "what if's" that have plagued my mind since last night in hopes that the tears sitting just below the surface will stop spilling over. We did what we could. The finality of death means we cannot change it now.

So I'm refocusing my thoughts away from the circumstances of Kashmir's death to the hilarity she brought our lives. I'm holding onto Benjamin's wisdom: "Don't be sad, Mommy. We love Kashmir." Yes, we do. She was a good kitty, and she will be greatly missed.

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