Illness & Suffering: A Cat’s Viewpoint of the Medical System
My cat Jaspurr stopped eating sometime in the fall of 2015. I did not notice this because the other cat was finishing up the left overs in all the dishes. But I finally did notice when he became emaciated to the point that he was skin, bones and fur. I took him to the vet. The vet took blood and ruled out all the diseases that could be detected by that test. Then we were referred to an animal hospital that our neighborhood vet had worked for at one time. They performed a sonogram, and then exploratory surgery, and still we did not know what was wrong with Jaspurr. But what we did know was that I was out about $6,000 and I had a cat who was still not eating and now was recovering from surgery. And wearing a feeding tube. The neighborhood vet prescribed Prednisone, on the theory that Jaspurr had an inflamed digestive system, and I force fed him three times a day. For two months we lived that way, until recently the feeding tube was removed and he is now eating on his own, but still on medication.
I have reflected on this experience. The vets at the animal hospital failed to ask about Jaspurr’s quality of life. Why not try the Prednisone and see how he did? Why do exploratory surgery? The sonogram supposedly revealed a mass, but that turned out to be his pancreas, which was not enlarged. And what if it had been? Throughout the consultations, I kept saying to them that as an elder law attorney, I was used to hearing the experiences of my human clients who felt railroaded by some medical providers into extraordinary procedures, just so the doctors could feel satisfied that they had turned over every rock and suggested every method to cure the condition. But chronic conditions, such as digestive inflammation, are rarely cured. It brought to mind that doctors, and vets, are not trained to inquire about the difference between illness and suffering. Both need to be treated, not just one.
In December, in the midst of the three times a day tube feedings of Jaspurr, I received an email from a colleague and friend about the death of his mother in Massachusetts. His father had died earlier in 2015. Both of his parents had escaped Hitler’s Germany, and had led heroic lives in the United States since World War II. They had endured plenty. His mother presented at the emergency room in cardiac arrest. She had made her wishes known in several places that she did not want to be revived if she died, and that she did not want any “heroic measures” taken should she be terminally ill. Instead, and in direct violation of her stated wishes, the hospital personnel revived her, and then did everything they could to keep her alive for the next two weeks. My friend arrived in the midst of this treatment and it took him four days of argument, including contacting the Attorney General of Massachusetts, to convince the hospital to cease the “lifesaving” measures and to let her go. She died at the end of two weeks of needless treatment. My friend was heartbroken about her death, but exhausted and frustrated by the efforts that he had had to go to so that he could get the hospital to stop its procedures.
One wonders about the economics of these medical protocols. In the case of vets, of course the expense is not covered by insurance. It is easy to market extraordinary procedures when we pet owners are distraught about the suffering of a beloved animal. And I suppose that the animal hospital and its vets make a lot of extra money this way. But the same happens with human patients, when insurance is paying for the treatments. It is still very, very expensive.
In his book, Being Mortal, Dr. Atul Gawande makes the point that doctors are not taught to ask the question, “Given your diagnosis, what would be the best possible day for you?” Neither are the vets at the animal hospital, apparently. Doctors and vets should read what Dr. Gawande has to say about focusing on suffering as well as focusing on illness. Oddly enough, my colleague’s mother died in the same hospital in Massachusetts in which Dr. Gawande practices as a general surgeon.