Help me talk to my vet.

March 28, 2011 3:48 AM

How do I tell my vet that it's time to stop trying to diagnose my cat, and help him have a peaceful end? Looking for a possible script to follow.

My cat, after a long and happy life, has been having health problems lately and we brought him to see our local vet. Before visiting the vet, my husband and I discussed what lengths (procedural and financial) we were willing to go to treat our cat before making the final decision.
At the first visit, we ended up going above our discussed limit, but things were going very quickly, and it was really beginning to look like it was going to be our second last vet visit ever. :(
Now the vet has called back, saying there is some question regarding her initial diagnosis, and they would like us to bring our cat back for further testing. One part of the testing is not extremely invasive (it's a chest tap, to remove possible fluid which may also be a tumor) but it is invasive enough that our skittish cat will be very, very unhappy.
When speaking to the vet about this, and expressing my feeling that the multi-organ nature of his illness leads me to think that it is most likely cancer (which the vet agreed was the most likely diagnosis), she continued to push the additional testing.
We are not willing to perform these tests when the outcome will most likely be the same. We would like to say goodbye to our little guy while he is still the cat we remember, and before he is in any more pain.
My problem? I can't say this to my vet. I've always caved under pressure, and she is very convincing. What I need is a script to follow, when making the appointment and while talking to the vet that will make it clear that we feel we are making the right decision.
Thank you for your help during this difficult time. I hope you understand the lack of photos, but trust me, he's a very sweet guy.

posted by nprigoda to human relations (22 answers total)

"My cat has had a good life and doesn't understand that this invasive testing, which will most likely show she is dying, is for her benefit. I'd like her to her to spend the rest of her days peacefully. I respect your view as her vet, but that is my decision and it is final."
posted by MuffinMan at 4:09 AM on March 28, 2011 [14 favorites]

What Muffinman suggests is perfect. If your vet continues to try and persuade after that, I would never go back. I think you will find your vet to be understanding once you state your decision. My city has a veterinary teaching hospital and I have always claimed that they would want to try anything regardless of the pets best interest yet when I brought in my dog to be put down (who had her treatment leading up to that decision with a different vet), I was braced for a terrible experience. It is a very hard thing to do and I arrived at the vet so saturated in sorrow and guilt that I was blown away with the level and kindness and sympathy they offered. Not one word or question to me about my decision. Do you have a friend who could go with you who might be in a better place to advocate should it be needed?
posted by InkaLomax at 4:36 AM on March 28, 2011

Vet: "I think we should do this procedure, just to be sure."

You: "We've thought about this a lot in the last few days and we think it's best for Kitty for find peace now."

Vet: "We've almost done all the procedures. There's a chance that this next procedure will help us determine what to do next."

You: "I understand that and we've considered it. However at this point, anything that we are doing in this process, we are doing for ourselves and not for Kitty. Kitty has had a good life and these procedures are making the end of that life painful for Kitty. We would much rather enjoy a little more time with Kitty and then help him go peacefully, without any more pain."

Vet: "Yes, I understand and this is a very common reaction from pet owners in these times. I can assure you that we have the Latest Greatest Pain meds available and Kitty will not experience pain. In my professional opinion, we want to make sure we have done everything we can."

You: "I respect your opinion -- I really do -- and I appreciate all of the time and energy you have put in with us and Kitty. I know it's hard for you to because there is that chance that we can do something for Kitty. But we see Kitty in pain and we would rather Kitty goes with dignity and simplicity than try everything we can. We already see Kitty's quality of life deteriorating and we must do for Kitty what is right in our hearts."

Vet: "But... And... Or... Well... etc."

You: "Please help us do the best thing for Kitty. We are already grieving and this is a very difficult process for us. We have considered all the options and believe it is time to let go. Please help us do that."

--

I feel for you and wish you the best in this process. It is not easy. Just remember to be gentle with yourself and know that you are making the best decisions that you can -- there's no right answer.

Also, take a picture of Kitty in a happy pose to remember him by.

Good luck and take care.
posted by nickrussell at 4:37 AM on March 28, 2011 [1 favorite]

Similar problem in process here. Ongoing annual medical costs for the 7th of my late wife's 7 cats will be absurd and will go on for the next 5 years. I love the critter, and she is my favorite, but I cannot justify thousands of dollars in cat costs. Insulin and syringes at $100/15 days and cat litter at $15/5 days is nearly $300/mo or $3600/yr or nearly $20K for the next 5 years, not including normal expenses like flea control, vaccinations, special food.

There is no downside for the vet, as long as you are paying to satisfy their curiosity. Vets are some of my favorite people, but when we start doing CT scans, organ transplants, chemotherapy, etc. on companion animals, I think a line is crossed into compulsive behavior. I don't want to be that person. If you don't, then you just have to be blunt. Find another vet if that one won't cooperate.

I've had to eventually put down several cats, and I now get the vet to sedate them first, and let them go to sleep in my arms before euthanasia. They can be calmed by the presence and smell of me, and meet their end in as calm and fear free way as possible.

Good luck. Sorry it has come to this, but it really is better to circumvent the physical pain for the animal and take the emotional pain yourself. Animals learn about death for the first time when they die and to them, it's not a problem, but in many cases, a gift.
posted by FauxScot at 4:42 AM on March 28, 2011 [3 favorites]

"Palliative Care" is the technical term. If you tell your vet that you are just looking for palliative care at this point. You've made a tough decision, and your vet should be supporting you with that. If they won't, there is no shame in going to another vet and explaining the situation to them. People will often switch vets at the end of their pet's life, if for no other reason than they want to avoid having bad associations with the regular vet that they see for their other and/or future pets. Good luck.
posted by Rock Steady at 4:43 AM on March 28, 2011 [2 favorites]

Add "they should understand that." after "at this point".
posted by Rock Steady at 4:45 AM on March 28, 2011

My cat has a bizarre problem that no one's ever been able to solve. When he flares up and the vet people start trying to push the diagnostics, we've found the magic words are, "We understand that this cat will die." I have to use that phrase with every new vet, vet tech, and receptionist we meet (it's a big vet hospital) but once we do, the focus immediately changes to palliative care.

Good on you for trying to save pain from your cat. You have my sympathies.
posted by arabelladragon at 5:49 AM on March 28, 2011 [3 favorites]

I am so sorry for your pain at this difficult time.

While I don't have a script for you, I'd like to make sure you have someone supportive with you during and after the visit, and have access to support for several days afterward. Be prepared for the vet to be extremely disapproving and communicate that to the entire office.

When I put my beloved greyhound to sleep because she had no quality of life left, the vet and his assistants made it unutterably harder than it had to be. They went out of their way to show me they thought I was a bad owner for not spending thousands of dollars on exploratory surgery that I could not afford. It was crushing to have that from them along with my grief.
posted by winna at 6:02 AM on March 28, 2011

i'd suggest that you pick the words you see in this thread that feel right to you, write them down and phone the vet.

If your vet is still resistant, go to another vet. When our pup's time came we took her to the emergency vet because it was the weekend. Though they didn't know us or our pet they were very kind and understanding, and did what was needed.
posted by Sir Cholmondeley at 6:06 AM on March 28, 2011

You say you often cave under pressure. What about your husband? Can you let him handle the talking, or does he have the same issue?

If you're feeling pressured and neither of you is better at this sort of thing, it may help to remind yourself, throughout the visit, that you're doing this for the kitty.

I, too, encourage you to find a new vet if your current one seems more inclined to persuade you to continue expensive testing rather than hearing what you're saying.
posted by galadriel at 6:10 AM on March 28, 2011

[folks, OP is not anonymous, if you have non-answers that you'd like to share, feel free to use memail, thank you.]
posted by jessamyn at 6:46 AM on March 28, 2011

Thank you everyone for your kind responses. The scripts by MuffinMan and nickrussell were exactly what I was looking for. I also really appreciate all the responses by everyone else.
galadriel: My husband doesn't want to appear to the vet to be forcing my decision (Reilly was my cat before we were married), however I think he's probably dealing with anxiety and sadness as well so I'd rather be able to do this myself.
Thanks again everyone. If anyone else has additional input, I would appreciate it.
posted by nprigoda at 7:06 AM on March 28, 2011

Also, you can just write it out and fax it to them. You don't need to call or be there or talk to them.
posted by BlahLaLa at 7:34 AM on March 28, 2011

I have lost two cats in the past couple of years and have never had a vet pressure me one way or the other about the decision to let them go. I would be surprised if your vet gives you any trouble once you simply say you'd rather let your kitty die in peace. If she does, I would highly recommend finding a new vet.
posted by something something at 7:52 AM on March 28, 2011

The scripts above are great. If the vet continues to push, I would add this point:

"There is no point in doing more tests, because the results will not change our plan. We want to keep Kitty comfortable until the end. Whatever you could discover with more testing, it won't change this plan, so we're not doing any more tests."

Sorry you have to go through this.
posted by vytae at 8:13 AM on March 28, 2011

like BlahLaLa said, fax it in.
posted by kristymcj at 10:08 AM on March 28, 2011

A lot of the above answers give a list of reasons to recite: "We don't want to do more tests because we believe X and Y and Z."

That's awesome, but bear in mind it's unnecessary. Ultimately your vet isn't going to do anything without your permission. So you don't have to convince her to see things your way. You don't need to articulate and defend your reasons. All you need to do is say "no, we don't want that," and stick with that answer.

Some people, for better or worse, hear a list of reasons as an invitation to try to change your mind. ("Okay, you've explained why you feel you're right — so now it's my turn to explain why I feel you're wrong.") A flat-out unqualified "no" makes it clear that you're not looking for that sort of back-and-forth: that you've already made an incontrovertible decision, and you just want help carrying it out.
posted by nebulawindphone at 12:01 PM on March 28, 2011

I could have written this exact letter a few months ago about my beloved Peter, aka Mr. Fluffypants, age 13. We did allow the vet to draw some fluid off his chest, and we got the same "probably cancer" diagnosis. But when she started in on how he needed surgery to crack open his breastplate so she could look at his lungs, I said almost word for word what MuffinMan suggested above.

The vet didn't listen. She kept saying "Age isn't a disease," and gave me a list of things to tell the receptionist when I scheduled Peter's surgery. Well, I never scheduled it. I paid the bill and took Peter home. I didn't call back, and I didn't answer when they called me. Peter died within the week, at home, in my arms with my kids snuggled up around him. I never have doubted my decision, and I don't give a damn what the vet thinks.

Keep Reilly home, give him lots of love, and simply ignore the vet. You don't need a confrontation, just walk away.
posted by SamanthaK at 12:10 PM on March 28, 2011 [4 favorites]

I have an alternative script suggestion. Can you call around to other vets and say, "My cat is going to die. According to the tests we've had done already, he likely has cancer. He's scared and in pain and I will not make him go through any more tests. I want to let him to die peacefully and comfortably, and I want his final days to be as good for him as I can make them. Can you help me with that?"

Because, yeah, you can arm yourself with a script for being assertive with your current vet. But you don't need even a little tiny bit of extra guilt about letting Reilly go. You don't need to even hear your vet suggest one more test, or question your judgment. You know what's best for Reilly. If your vet can't respect your decision-making about Reilly, you don't need to subject yourself to extra stress by explaining your reasoning to her. Just cut her out. She doesn't get a say in this and doesn't need an explanation.
posted by Meg_Murry at 7:48 PM on March 28, 2011

Just for note, I wouldn't blame the vet too much here.

Doctors of all manner have a tremendously difficult road to navigate and each situation is unique, thus they must offer all manner of alternatives in each situation. Some patients want to press-on as far as possible and exhaust every possibility. Others would prefer less treatment and more natural proceedings.

It's not any easy line to walk, especially given the legal context in which they operate and the emotional states of the people that they are dealing with. They must remain objective through the process.

Thus, I am not saying that doctors should ignore patient wishes, rather if you look at the world from their perspective, they must do their best to save lives. There is tension in the relationship between doctor and patients in these situation -- and that tension is going to be unavoidable due to the very nature of the situation.

Summary point is just realise that doctors have no malice or self-interest contrary to patient intentions.

There is heaps of anecdotal evidence to the contrary but overall, doctors are a pretty good lot. The difficulty of medical school and subsequent requirements is a substantial barrier to anyone entering into the field with the wrong intentions.

For note, I am not a doctor but my partner comes from a medical family and we are fortune to count many doctors as great friends.
posted by nickrussell at 4:42 AM on March 29, 2011

nickrussell, I understand your sentiment. I have doctors in my family as well and it is very difficult to see them coping with so much every day.
I think one of my issues is guilt over not treating Reilly as my child, but instead as my pet.
Thank you again everyone for all of your help. I will be calling today and if there is any trouble I will call another vet (thank-you Meg_Murry).
We've been looking through photos of Reilly in happier times, so I feel like I can share one now. Thanks.
posted by nprigoda at 5:47 AM on March 29, 2011

In the end the vet asked me if something had changed since our last visit, and I basically followed MuffinMan's script. Thank you for all your help and kind thoughts.
posted by nprigoda at 3:41 PM on March 29, 2011