Hope

Hope is the thing with feathers

That perches in the soul

And sings the tune-without the words,

And never stops at all,

 

And sweetest in the gale is heard;

And sore must be the storm

That could abash the little bird

That kept so many warm.

 

I’ve heard it in the chillest land,

An on the strangest sea;

Yet, never, in extremity,                       

It asked a crumb of me.

–Emily Dickinson

There is a book that my father in law loaned me (that I conveniently haven’t returned to him because I love it) that among other things, touches on a Doctors role in the administration and removal of hope.  It’s a hefty respnsibility with some hefty consequences.   This is part of the art of practice, the lessons are frequent and range from sublime to tragic.

Give too much or “false” hope and the patient may suffer unnecessarily.  Give too little and the client may elect to euthanize before the pet gets a real chance to recover.  This part of the job is often based on pure intuition and it can be exhausting.

It’s often really hard figuring out when to abandon hope.   There are times when  it’s pretty cut and dry, but even then, I can be dead wrong. 

Take “Mikey”.   Mikey is a 16+ year old female domestic shorthair calico cat.  She’s a sweetie.  Mikey had what we think is a stroke a couple of weeks ago.  She had an acute episode of weakness that quickly progressed to her being unable to even sit up.  She had numbness in her face, and abnormal reflexes in her legs. 

It was as if all her wiring was disconnected.  Generally, in a geriatric cat this is either caused by a stroke or a brain tumor.  Prognosis is usually poor.  This cat was old, had some kidney disease, she’s lived a good life.  The owner’s husband came in and said “tell it to me straight, tell me what we need to do”.  In light of this old kitty who couldn’t walk, or get up to goto the bathroom, I recommended euthanasia.  It’s what I would have done if it were my own cat.  I sent Mikey home so they could talk about it as a family.  I figured they’d sit around and look at the cat in that condition then bring her in for euthanasia in the morning. 

The Mrs. wasn’t ready to make that decision.  She couldn’t end Mikey’s life.  And frankly, Mikey didn’t really seem ready to go.  She was still eating (with help from her owner).  For a cat in that condition to keep eating is pretty darn remarkable.  Most cats would have just given up at the indignity of it all. So, Mikey got an antibiotic shot and some steroids (won’t hurt, and might help).

This owner has the patience of a saint and a heart of gold.  She carefully hand fed Mikey, gave her ice chips to keep her hydrated, carried Mikey from room to room with her.  She made sure Mikey was clean and her bowel habits addressed (she experimented with multiple types of diapers, pads etc). 

I kept waiting for her to call and tell me Mikey had passed away, but she never did.  A few days later she asked me what I thought about accupuncture.  I think it’s worth a try, and it certainly won’t hurt anything. 

After two accupuncture treatments, Mikey was trying to get up.  Coupla days later, she is trying to walk.  She really can’t stand, her front legs are very strong, but her back ones are weak.

However, Mikey is upbeat, clean with a sparkle in her eyes.  She’s eating well, and managed to drag herself across the house the other day.  She’s able to stand for a short time  with support.  All things considered, she’s doing phenomenally.

I talked to the neurologist, who said that if she’s doing this well after a week or two, she’s got a good chance of continuing to regain function.

So, against my advice, this owner refused to give up hope.  She was right and I was wrong, and I’m pretty cool with that.  God knows I’m not perfect, and if I’ve got to be wrong from time to time, I’d rather it be in a happy way like this one.

So we’ll hope for the best…

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