Monthly Archives: February 2012

Good Morning and Goodnight, Domino

“Good morning, Domino, what are you doing?”

I had rushed down the stairs to get my 20 minutes in on the treadmill.  I hadn’t seen him lounging on the couch.  I was perplexed why he was lying with his feet handing off the edge.  No response.  That’s weird.  He’s such a cat-napper. Must be really tired, poor guy.  Getting old. 

“What’s the matter, Domino?”

Then it struck me – he wasn’t just lying there, half-sleeping.  He was completely still.

My insides froze in realization.   I immediately reverted “doctor-mode”, moving closer and searching for breathing.  Or some kind of movement.  Not trusting my eyes and heart,  I laid my hand on his chest.

Nothing.

He was gone.   Our housemate of 17 years, whom I seen just hours ago as he went bounding down the basement steps, was dead.

I hadn’t seen it coming.  I felt ashamed.  How come I didn’t realize it was coming? 

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He was one of those individuals who was so full of life, you just never thought he’d stop.  So alive – so infuriatingly alive, in the middle of everything, demanding, persistent, insistent, and loving — he didn’t do anything half-heartedly.  Even as he got older and thinner, with a little less sparkle in his eye, he remained adolescent in his ways.  Snuggling aggressively.  Whining demandingly.  Sneeking persistently.  Purring excessively.

How could that all be over?

Domino, the cat who would seemingly never die, who had hardly been sick his entire life, was dead.  Just like that.

It’s crazy, I thought, I’m a doctorNot just a doctor, but a geriatrician and palliative medicine specialist.  I’m always counseling people about prognosis and end-of-life.  I had just been saying how spry Domino was for an “old man”, how he would probably live at least another 5 years.  Of course, I had noticed that he was a little thinner, that he was developing cataracts, that he couldn’t jump onto the bed anymore.  But he seemed so, well, ALIVE.  How had I missed it?  What’s wrong with me?

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How do I tell Tamra?

Domino was always hers.  She had picked him out that day – or rather, he had picked her out.  Came right over and introduced himself to her, the smallest of the litter.  She brought him back to our grad-student apartment, let him run around, allowed his bright blue eyes full of curiosity to win her over, letting her make the case to me for him to stay.  I was against it – we didn’t have time for a cat, we were both too busy, too wrapped up in our own concerns, ambitious young folks making our way to careers in academic medicine and business in the middle of the bustling City.  We already had a cat, inherited from a friend, an adult animal that lived with us, tolerated us, but wasn’t part of us.

They both looked up at me, his mischievous blue eyes beside her beseeching brown ones.

I didn’t have a chance.  We were now his family.

The thing about pets – they are always there, and they’re always the same.  Over all of those 17 years, Domino never changed – he lived the most consistent life.   He was always there, a constant source of energy, trouble, and love – through our student-apartment life, our move to our first grown-up house, to another apartment in Steel City with real jobs, to another house in that city, and a final destination in a bigger house, back in Chicago where we started.   Thinking through those many years, like a time-lapse film running  at super-speed, he’s a remarkable constant.  Same personality.  Same insistent demands.  Same acceptance when demands were met.  No worries about anything else.  Quick to cuddle and purr, regardless of what happened before.

I’d gotten so used to him.  So reassuring to know he was there with Tamra when I couldn’t be.  That constancy was assumed.  Over time, it was required.  Having that constancy gone, out of the blue, is…terribly…upsetting.

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I went upstairs, heart flailing, into the usual frenetic pace of another morning with the boys.   I walked slowly into the schoolroom.  She was there, working with the twins on their lessons, as usual.  I didn’t want to scare them.

I failed.

“Tam.”  My voice sounded weird, even to me.  They all turned, concern in their eyes.

“What’s the matter?”

“Can I talk with you…privately?”   I motioned with my head out in the hall.

“Sure.”

Realizing a had less than a minute before the boys would descend, I tried to sound normal.

“Domino died last night.”

“What?”

“He died last night.  He’s lying on the sofa downstairs.”

Like me, she didn’t believe it.  “Are you sure?”

Was I?  “I’m pretty sure.”

“I want to see him.”

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“Should we tell the kids?” she asked.  I had wondered the same thing.  It was just about time to pack them up and take them to school – how would they respond?

“Yes, of course, it’s what we call a ‘teachable moment’ in the hospital.”  Somehow the obvious thing to do, to expose one’s children to all of life’s events, is questioned when we’re struggling with our own feelings of inadequacy.

I gathered our 3 boys together around me, squatting down to look them square in the eye.

“Listen guys, I have something important to tell you.”

Serious nods.

“Domino died.”

“He DIED!?!”

“Yes.”

“Where is he?  Can we see him?”

I took them downstairs, and they wanted to touch him, to experience it for themselves.  Smart.  Appropriate.   Their individual reactions were perfectly in character – amazing how they never break character, I thought.

Harrison (5): (While sucking on his thumb.)  “It makes me sad.  At least we’ll still be able to play with Grandma’s kitties.”

Xander (8): “What happened?”  [I don’t know]  “When did it happen?” [Some time last night.]  “Why are his eyes open?”  [That’s what happens sometimes when people and animals die.]  “Is he warm?”  [Go ahead and touch him.]  Etc, etc, etc.  Ever the nervous questioner.

Austin(5): “Can we get a dog?”

I noticed my wife didn’t want to touch him.  Later, she confessed to me that he always purred when she touched him, that he wouldn’t, and she knew she would bawl if she touched him.

I’m glad we had the boys experience this.  The author E.B. White, of Charlotte’s Web and Strunk & White’s Elements of Style,  once said that one should always treat children with respect by talking about adult things in terms they can understand.  As usual, Mr. White was correct.

I will try to keep this in mind when considering end-of-life discussions with families.  If they ask, always let the kids participate.  They often bring an honesty and openness that adults lack.

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I spent the rest of the day feeling remarkably melancholy, unable to shake my feelings of sadness, loss, and guilt.  A little over a year ago, my father passed away, a victim of cancer (http://chicago.academia.edu/WilliamDale/Papers/855803/My_Fathers_Life_and_Death_from_Cancer ); in certain respects, my emotions are more disheveled over Domino.  Because I care for cancer patients regularly, I knew well before my family that my father would die from his cancer, and I had prepared for it.  I was completely shocked to find my cat had died.  Although I thought about my father a lot, we had become estranged over time, and we didn’t talk regularly, so his death did not change my daily life and routines signficantly.  Domino, in contrast, was a constant presence our lives, especially my wife’s life.  It’s impossible right now to walk through the house and not be constantly reminded of him.  And, unlike my father, who could be temperamental and unpredictable, the cat was consistently contented and friendly, a soothing presence always.   The combination of his constant, supportive nature and his unexpected sudden departure, is making these feelings very difficult to shake.

I really want to be a more consistent source of support to my friends, family, and colleagues.  A steadying influence can be instrumental in helping people make it through the day.  And when working with families as their doctor, I need to keep in mind just how difficult a death, especially an unexpected death will be, how much of a “hole in the universe” the loss of a loved one will create, and how empty one will feel.

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We reflected on Domno’s life tonight.  It was a great life – better than most of us get.  He was happy, vibrant, and engaged right up until the very end.   He was able to live life on his own terms.  And he died at home, not in any pain, around loved ones, in his sleep.  I will do better to emulate these characteristics, and hope my own earthly departure will be as short, simple and easy.  And I will work harder to help my patients have the same sort of “healthy death.”

“How are you doing?”

“I’m so sad.  I’m really going to miss him.”

“Me too.”

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Filed under End of Life Care, Pets