I continued agonizing about what to do, which greatly increased my sympathy for those trying to make decisions for their human loved ones. It’s hard! I felt that whatever I did would be wrong: Making Hammett undergo an unpleasant course of treatment would be wrong, but wouldn’t giving up too soon also be wrong?
But if both sides of something are wrong, then both must also be right: To choose not to do chemo would be to prioritize his happiness and comfort. To choose to do chemo would be to give him a chance of having a longer life.
The next day at County Hospital, I saw a man in the ICU whose elderly mother had been in an accident. He said, “I didn’t want her end to be like this.” I took him for a walk in the rooftop garden to discuss the surgery the patient’s doctors were planning to do. (Tsk!) The man said, “Would it be wrong to let her go?” I told him that he should feel empowered to decline any treatment for his mother he didn’t think made sense, and then I wondered if I was being too blunt. I couldn’t recall ever hearing any palliative care physician use those words.
I discussed it with Robert, and he said sometimes the chaplain’s role is to be blunt, so I guess that was OK. I asked him if it angers non-palliative care doctors when the palliative care team meets with a patient or family, and then the patient or family declines treatment the primary team was all set to go ahead with, or does that rarely happen because a doctor who believes in aggressive treatment simply won’t engage the palliative care team? Robert agreed that the latter is how it usually goes.
The patient cannot directly request a palliative care consultation. It has to come from a doctor. Usually, a doctor will relay a patient’s request to the palliative care team, but not always. If the patient of a doctor who believes in aggressive treatment requests a palliative care consultation and the doctor does pass on that request, then it can happen that a palliative care attending physician dukes it out with a non-palliative care attending physician. “Clash of egos” is the phrase I believe Robert used.
He said that in such a dispute, the primary team physician will typically point out that he is the one with the longer relationship with the patient and that not two days ago, the patient said she really wanted a fourth round of chemotherapy.
As for Hammett, trying to predict the future didn’t seem to be helping me to make a decision, so I thought about what values might apply, and concluded that any choice I made would be made out of love. Hammett himself was bulking up rather astonishingly, thanks to the prednisone. In two days, he went from 6.75 pounds to 7.5 pounds! He seems happy enough, but not quite like himself. Certain routines he has had for a long time have suddenly been abandoned, though he still does a lot of things he has always done. One new thing is that he has taken to clambering onto my lap, underneath the table, when I’m eating breakfast. It’s nice to have his warm little body there for a time.
Dr. Press had said that if we were going to try chemo, we should start ASAP, because once cancer starts to be resistant to prednisone, as it will soon enough, it also becomes more resistant to chemotherapy. Being urged to hurry up was a red flag. Katy Butler, in her wonderful book Knocking on Heaven’s Door: The Path to a Better Way of Death writes about the perils of Fast Medicine, where people feel hurried into decisions that turn out to have catastrophic consequences.
The following day, I told my co-worker Nevada about my dilemma. She said, “I don’t know about chemo for an old cat. If he were young … .” In the end, something my mother said helped me make the decision, which was not to do chemotherapy. She pointed out that Hammett’s quality of life was not the only consideration—that mine also would be affected. She said that if Hammett were to undergo chemotherapy, I would be worried about it every single day. This is correct. I’d be worried about whether it was working and if he was unhappy. I’d be worried about this symptom and that symptom. I’d be worried about spending so much money. If the chemo didn’t work, I’d be worried about that (and I’d also feel guilty that I had made the end of his life miserable). If it did work, I’d be worried about it ceasing to work—which it is guaranteed to do, sooner or later. (My mother also pointed out that once upon a time, we didn’t have to make these kinds of decisions: If a cat got cancer, it died of cancer, and that was all there was to it.)
So Hammett continues on his prednisone and is still eating like a horse. His cat sitter said he might live years on prednisone. The internet says more like a couple of months, maybe six at the most.
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