End of Life Walk

My writing here is meant to offer up my experience, and to start a conversation about an area that we rarely approach or deeply discuss around pets. In the 6 months that I provided end of life care for Ranger, I don't think once I thought about it as such - I was focused on finding solutions for him, keeping him as comfortable and out of as much pain as possible and letting him know that I loved him with every part of my being. Upon reflection, there is no formula for end of life care for pets or humans, each situation is uniquely different - but I do believe that we can think about this subject more deeply and thoughtfully, and by asking questions we can create better, more positive and loving end of life scenarios for our beloved pets.

Long before Ranger ever started on his journey to cross from this life to the next life, I have been acutely and painfully involved in and aware of end of life care with humans. For some reason, in a number of situations I have also been one of the last people with a beloved family member or friend to walk with them up to their last breath. These experiences have been profound for me, on so many levels - deeply emotional, deeply spiritual and deeply troubling all at the same time. I'm not going to delve deeply into human end of life care except to say that we can't have a full conversation about end of life care for pets without including end of life care for humans. In my experience, I have witnessed some of the humans I love in my life receive something called 'palliative sedation' to help them on their final walk. Prior to Ranger's journey, I had been deeply troubled by witnessing palliative sedation applied to the humans I know at the end of their lives. I saw them slip away, usually from a place of consciousness that included alertness, connection, fear, anxiety and sometimes denial into a place of unconsciousness, unresponsiveness and later what I would come to feel was peace. An elixir of drugs, which could consist of Lorazepam, Propofol, Levomepromazine, and/or Morphine would be administered that would allow them to make this transition before their final breath. Elements of this cocktail are also known to slow respiration, and lower conscious activity - and it inevitable leads one to the question, is medical palliative care a form of helping a being make that final step towards letting go? There is lots written on this subject - and it has been argued that some palliative sedation is a form of terminal sedation - but you will see that doctor's steer clear of making any association between terminal sedation and euthanasia.

Before I write further, I'd like to recommend the reading of a very special book, entitled, 'The Last Walk', by the animal bioethicist, Dr. Jessica Pierce. It is a profound book both from a point of view of the author taking the end of life journey herself with her own dog Ody, and from an ethical point of view of deeply exploring the themes of euthanasia, hospice for animals and end of life care. I would also recommend reading this book when your pet is healthy, or at a time once they have passed that you can read the book from a place of emotional grounding. It's heavy stuff, all these ponderings and explorations of what it means for an animal to have a good death, to be cared for during end of life, what animal hospice could look like and how as a society we evolve in caring for and stewarding our beloved pets, especially when they are sick and taking that final walk to the ends of their lives.

Dr. Pierce's book offers a deep and thorough exploration of the practice of euthanasia, which literally translates into 'good death'. She doesn't offer solutions or judgement, only helps us to question and examine our attitudes and usages of it. She points out the difference between the use of euthanasia applied on many shelter pets, as opposed to euthanasia carried out with a terminally ill pet where all other rehabilitative and/or palliative efforts have been exhausted and helping them cross is the biggest act of love we can give to our beloved animals. In this illustration, the shelter pet was not given a 'good death', but the beloved suffering pet was. I recommend reading Dr. Pierce's book for an exploration of what hospice can look like for an animal, an exploration of quality of life during the dying spectrum, and also for an excellent suggestion regarding advanced care directives for animals. Dr. Pierce writes this about animal hospice:

“Hospice can do many things: it can help expand and fill in that space between diagnosis and euthanasia; it can challenge the dominant narrative of euthanasia by presenting other possibilities for a good death; it can improve quality of life in a dying animal; it can suggest how to prolong life, without simply prolonging the dying process (although this is, admittedly, a crude distinction); it can make the dying process less painful, less protracted, less lonely, and more dignified; it can get people thinking creatively about end-of-life care for ill and aged animals; it can help people deal forthrightly with their grief and denial over the impending death of a companion, so that decisions about treatment can be based on the needs of the animal, not our own needs. Above all, hospice offers us a gentler way down into the Valley of Death, a slow path down that we can travel hand-in-paw with our animal rather than shoving them brusquely off a precipice. In its best iterations, hospice offers us the possibility of a good death, a fulfillment of the sixth freedom, for our animal companions.”

I read The Last Walk a couple of months after Ranger crossed over, and came away from reading it, with a desire that our pet-owner communities discuss more what it means to care for our animals in their final journey, what hospice can look like for our animals and to bring more congruency between how we treat human end of life and how we treat end of life for our pets. Personally, I need to find reconciliation between the fact that as a society we don't euthanize our terminally-ill and suffering human child, but we euthanize our terminally-ill and suffering fur baby. I believe that while it is a taboo topic to talk of euthanasia for humans, that sometimes we let human suffering go on too long and even in some cases, protract it, while we often end the lives of our animal companions too soon...

In the end, I had to help Ranger cross, with euthanasia. By the time I arrived at this moment, I was in peace. But my journey beforehand was searching and very difficult, and I struggled with the whole matter of euthanasia and the thought of letting my beloved and best friend go. I needed help with this journey, and I received it. As I mentioned in the beginning of this writing, I was focused on solutions, comfort and love during his 6 month journey - I would have done anything to bring him back to full health and to never have to make the decision to help him with the final letting go process.

I want to write about my experiences during reflectively what I would call hospice and palliative care for Ranger. There are lots of things, I feel I didn't 'get right' - and if I were called to do it again, I would do some things differently. One, is I would have created an advance care directive, so that it would have been easier to follow a set of guidelines I had laid out before the depth of emotion of the situation would overtake me. Second, I would realize how utterly consuming being a caretaker to a sick being is, and I would take the steps to make sure I had the right support and community to help me in the journey. Thirdly, I would have incorporated more of Traditional Chinese Medicine when Ranger was visibly healthy. As Dr. Dennis Thomas, the author of Whole Pet Healing, puts it - disease is a spectrum that starts well before we can visibly tell anything is wrong with the animal or human, in Western medicine we see illness as the start of the disease but it has actually started as an imbalance well before the visible signs of the illness set in. Lastly, I would have focused more on Ranger's pain management earlier on, and been less worried about the consequences of pain management on his future state. I write these things in retrospect not to judge myself, but to take stock of what I learned, to file these learnings away and maybe to help someone else with their journey.

Ranger was diagnosed with a differential diagnosis of a brain tumor. A differential diagnosis is once that is made by a qualified doctor, in this case Ranger's neurologist doctor, using the data they have from their examination and lab tests to determine from a spectrum of possibilities what the most likely illness(s) is/are. Ranger's differential diagnosis was never confirmed by the MRI that would have delivered a conclusive diagnosis. Because of Ranger's age, and proven sensitivity to many different drugs and his propensity towards constant seizuring - I weighed that putting him under general anesthesia was too great a risk. I was afraid that the process of getting the conclusive diagnosis could likely end in his death.

Ranger's neurologist examined him in early March after a 3-day period of cluster seizuring, and told me that he had a front left-lobe brain tumor and that he would live most likely another 2-3 months at most. It was a horrendous moment in my life hearing this. How does one even take this in? Just two weeks ago he was trotting down a beautiful beach with us in Norfolk, VA - his normal, inquisitive and joyous puppy-like self...

I embarked upon a journey of reading everything I could about his diagnosis and the symptoms he was experiencing. I opened up my research to everything in Western and Eastern medicine. My searching took me to reading the book, Whole Pet Healing, by Dr. Dennis Thomas. It was a seminole moment in my life as Ranger's Mama, reading Dr. Thomas' book. I sought out Dr. Thomas and commenced having sessions with him on Ranger's holistic care remotely from his office in the state of Washington (we lived in northern NY). I will write an entire separate blog on my experiences with Eastern Medicine and the spiritual awakening that resulted with my work with our two TCM doctors, Dr. Thomas and Dr. Kris. What I would like to say here though, is that in addition to Ranger's holistic medical care that he received from both of them, that both of these doctors were fundamental to guiding both myself and Ranger emotionally and spiritually on his end of life walk. I cannot express the magnitude of thanks and gratitude I have for both of them, without them I would not have not known how to put one foot in front of the other, or how to best support Ranger, or how to make difficult ongoing decisions from a place of grounding, and love. What I learned from both of them is that the end of life journey is full of profound spiritual awakenings for both the participant and the people that are around them, and full of gray areas to navigate. If we stay open to walk through the very difficult emotions and events unfolding before us, we have the opportunity to walk with our beloved, and with God right beside us. We are able to have an experience of love so profound that it changes our very being and purpose on this Earth. I learned from both of them that love is receptive but it is also an action word, that death is the greatest freedom we will ever experience, that grief takes many many forms and is something to be honored and accepted, I learned how to walk with Ranger through all the terrifying moments - and most importantly how to make every decision I made and every act come from a place of love...

Ranger's hospice journey was replete with miracles, so in some ways it was not always viewed by me as a hospice journey, I always held out that that maybe he would make it and come back to health, on account of his extraordinary rallies. Retrospectively, I can see how this was never the path. What is palliative care for an animal? I'm not sure I can answer this definitely. I do know for Ranger that it was composed of many things. One thing I feel I can say surely, is that palliative care is not just medicine that reduces physical pain for a being. I would say that palliative care involves both Western and Eastern medical approaches, that it involves a lot of love, that it is about touch, it is about just being present for our beloved, it is about prayer and openness to guidance, it is about a loving, individual and wholistic ongoing assessment of quality of life, it is about the calming and connective aspects of being in nature, it is about moments of hope and victory, it is about receiving support from our families, friends and communities, it is about awakenings, and it is about always trying to come from a place of love.

Initially in Ranger’s journey, I was cautious about the application of all the recommended Western drugs. And during his journey, I questioned his neurologist a lot on the drugs that were given as his protocol, he had so many very difficult reactions to some of them and from the point of being Ranger’s advocate I wasn’t going to fall compliantly into the paradigm of ‘doctor knows best’, especially when I could see that some of them were affecting him terribly or making things worse. The journey of arriving at the right anti-seizure medication was horrific - we arrived at using a certain dosage of Levetiracetem, and later after his status epilepticus episode would combine that with a small amount of Phenobarbitol again.

The application of the anti-convulsant(s) gave Ranger a large reprieve from the occurrence of grand mal seizures. The anticonvulsants were essential in Ranger’s palliative care, and therefore Western medicine played its important part. It was also initially recommended that he start on a course of steroids, but I didn’t apply these until much later on. I was concerned about the effects on Ranger’s liver - due to past routine bloodwork and Ranger’s great drug sensitivity I had reason to be concerned about Ranger’s liver health. Perhaps in retrospect, I would have started the steroids earlier, who knows...

Although Ranger was given a differential diagnosis in early March of a front-left lobe brain tumor, there were indications during his journey that something else was going on with his spleen & liver, and a huge marker that he was dealing with a form of hypothyroidism. Ranger’s euthanasia doctor thought that he was sick euthyroid, but my examination of the numbers from a series of bloodwork, a comprehensive thyroid test and the total efficacy of the application of Levothyroxine had me thinking that true hypothyroidism was a component of Ranger’s disease. Ranger, the day before he crossed over, had a sonogram which revealed a huge mass on his spleen.

I believe that a great part of palliative care, is being able to get early and accurate diagnoses. I believe that for animals, as well as humans, that we may not need as much end of life care if doctors and vets are willing to look at all the data when initially diagnosing an animal or human. Not just data that falls under their scope of knowledge or from lab results, but also the data given from the human caretakers and from areas of medicine that may be beyond their scope of specialty. A few years before my experience with Ranger, my Uncle had been misdiagnosed with MS - and died only a few short months later from undiagnosed pancreatic cancer. My experience in the human and pet realm is that some Western medical doctors suffer the most from this myopic diagnostic and care approach, many of them are not open to data that comes from the caretaker narrative or Eastern medicine data.

Unfortunately during my journey with Ranger, it was not possible to wholly share with his Western doctors all the things that were happening with him or our TCM doctors or the data that was coming from my direct experience with Ranger. This was a great heartache to me. I expressed this heaviness to Dr. Kris one acupuncture visit, and her insight was helpful to me - to recognize what the Western doctor’s could help with, use that, and give up my desire to bring them into the whole of Ranger’s health journey.

Ranger received Traditional Chinese Medicine herbs from his holistic doctors, and acupuncture from Dr. Kris. The herbs and acupuncture I credit to Ranger living well beyond his diagnosis, giving him beautiful quality of life, giving rise to miracles and allowing him to live and die with victory, peace & dignity. They were an essential part of Ranger’s end of life care, and I really cannot imagine how a purely Western medical approach could really give an animal or human the full spectrum of palliative care warranted during the end of life walk. Early in my work with Dr. Thomas remotely, he deeply encouraged me to also find a nearby holistic doctor for Ranger who came from a completely Eastern medicine mindset. Ranger had received acupuncture for 3 years from his Western-Integrative vet for his arthritis, and it really made a big difference for him. I knew the effectiveness of acupuncture from my experience with Ranger's primary care veterinarian, so I was interested to seek out a nearby holistic doctor to also help Ranger. Dr. Thomas explained that a holistic veterinarian would employ the Eastern mindset model of working with imbalances and the system. Dr. Thomas has over 40 years of experience as a vet, and he started out practicing solely in the area of Western medicine, and had made the transition to becoming a holistic vet - unfortunately he was on the other coast from us so we could not go see him.

After extensively looking at vets in the area, I found Dr. Kris Dallas of Ancient Arts Veterinary in Saratoga Springs, NY. She is a holistic TCM and acupuncture doctor. Dr. Kris, as she is known to her clients, had a profound effect on the arc of Ranger’s journey and my story. When we were finally able to get into see Dr. Kris, Ranger was at the point of death. I talk about Ranger’s miracle in Miracle Walk, so won’t go into detail here.

Ranger’s hospice & palliative care also was a lot about food. I hand fed Ranger 3 times a day for six months. I fed him a diet put together by Dr. Thomas. Not only was the food nourishing and nutritionally complete, the act of feeding Ranger by hand was part of our care process. I felt the deep bond and utter love in this act of care-taking each time it happened. Ranger would lovingly look me in the eyes as he took the first portion of food out of my hand. I could feel his soft warm muzzle, and the moist velvet of his tongue as he caressed my palm while taking his food. These feedings were rituals, they were silent acts of love and devotion. At times this aspect of the care-taking was difficult - the preparation of his food was time consuming, I had to juggle the demands of feeding myself and other family members as well as working late nights (during the COVID-19 pandemic no less). But I will always hold on to what I feel were some of the most loving and holy times between Ranger and I during his mealtimes. Due to Ranger’s seizure condition and transient blindness, he was not always able to successfully eat out of his bowl on his own and this is how the hand feeding ritual was birthed.

Ranger’s palliative care involved acupuncture given by Dr. Kris and also acupressure with essential oils given by me as directed by Dr. Thomas. When Ranger received acupuncture from Dr. Kris, he just loved it. He would become very very peaceful, and seemed to rejuvenate almost immediately under the application of the needles and after the touch of her hands on him. I have several videos of Ranger after his acupuncture sessions out on the grass lawn outside her office - he’s deeply happy and content, and almost like his former self. Ranger’s acupuncture with Dr. Kris was a deep component of his ‘healing’ process, as well as the key to a miracle event in his journey. Healing, I feel, in the end of life process is not always about making a physical recovery and evading death - healing is about journeying to wholeness and completion along the journey. Both Ranger and I received deep deep healing along this journey. The healing came from God, the acupuncture, from nature, from my partner and also from the deep expertise and love both Dr. Thomas and Dr. Kris administered to both of us during our time with them.

Healing, which I believe is the true underpinning of palliation, also came from the time I spent in nature with Ranger during these last 6 months. The lake was always a favorite destination of Ranger’s when he was healthy, so I always made it a point to go there - whether he could walk from the truck to the lake, or I had to carry him. I always noticed a profound shift in Ranger while at the lake, he might have had anxiety in his day prior to, but when he arrived at the lake I could see nature calm his mind, body and spirit. It was truly amazing to watch this shift many times over, and I came to realize that being at the lake, attempting to take a walk (and very often taking the walk) and spending time on the grass outside our home was as important to his journey as the anticonvulsants, the TCM herbs, the prayer, the acupuncture, the food and all the other elements of this journey together.

Early on in Ranger’s illness I became aware that I was ‘picking things up’ from him. I would lay may hands on him to do some prayer work, and start to receive colors and feelings about areas in his body where he wasn’t feeling good. Ranger’s illness was the start of me discovering and recovering my latent intuitive abilities. Throughout Ranger’s illness I prayed to God, and would ask for his healing in His name for Ranger. I had a special prayer that I found on a website written by a women who detailed the healing of her dog through the power of Christ. One does not usually look at a time of deep illness as being the vehicle of spiritual awakenings, but in retrospect if we are kind enough to ourselves and willing to follow the arc of this journey through sickness and beyond death, we can see where this whole process is one of deep soul awakening. The intuitive abilities I started to become aware of when Ranger was sick, become more pronounced after he crossed over and I continued to study Reiki, meditation and animal communication after his crossing. I would not have gone on that path were it not for Ranger. I believe that Ranger was helping me develop these abilities and that he is continuing to do so. His illness and death gave me access to many great gifts. One has to be patient though to see the gifts, and willing to walk the path of grief and a broken heart to receive them.

Hospice care also means as a caretaker that you need a good deal of support around you. Care-taking for a deeply ill person and/or animal is profoundly exhausting - it will take you to the end of your rope and beyond. Having the right support, both on a practical level and emotionally is just so essential for caretakers. This fact is why I believe that end of life care for animals is not more common, caretakers for pets are deeply disenfranchised in our society, as is the grief that pet owners can feel in advance and after their beloved pet dies. Finding support so that you can continue to give with love to your pet, as well as continuing to take care of your family, work, and take care of yourself is a monumental enterprise. Finding emotional support, people that understand this journey you are on and support you while on it, is also terribly challenging. Well-meaning friends and family members will tell you "to just put your pet down", or they will tell you in another way by asking "when are you putting your pet down?". The language of supporting a pet owner who chooses a different path than immediate euthanasia is just not there. I found I had to temporarily disconnect from most people that I care about during this period, but stay open to those who got it and could support us. These people were my boyfriend, Dr. Thomas, Dr. Kris and Dr. Baker. I also received support on a spiritual level from my deceased Dad - he was there for us during the whole process, and I know that Ranger is near him now.

People that truly support the caretaker during this journey are not there to tell you what to do, or what you want to hear. They are people who can walk all or part of this journey by your side, offering presence, insight and the right questions to ask yourself. They are gentle people, who have often walked a path of grief themselves, they are not only the medical experts with soul, but deeply compassionate people. I will just offer some examples of this compassionate guidance I received. My boyfriend was always ‘present’ for Ranger and I, he never judged or told us what to do - he listened deeply, he heard Ranger as well as myself, and he walked with us through the entire landscape - all the mountain tops and all the low places. Dr. Thomas, if there’s one thing he really gave to me, was the guidance to do all that I did for Ranger from a place of love. He told me this would be challenging, and that I would reach a place where the ego wanted to take over. He guided us spiritually through a time when Ranger almost died from asphyxiation, he gave me the permission to think about euthanasia from a place of love, he let me know that part of my journey with Ranger was also celebrating the great freedom that death would one day bring us all. Dr. Thomas was focused on helping Ranger from a medical point of view, but he was also instrumental for me from a spiritual point of view and in being able to embrace ‘letting go’. Dr. Kris had several deep conversations with me about all the emotions I was going through and about Ranger making the final transition. She explained to me how the grief felt by a woman without children for her pet, could be different than that of a person who had children...she talked about the heartache of anticipatory grief I was experiencing daily. Most profoundly she offered me this - that a natural death for a pet is not always possible, especially because modern medicine has made it possible for us to take up the mantle of God and extend life for people and animals, that therefore our human involvement through the entire length of the process is sometimes requisite, right through to the decision of how our beloved dies. She also let me know that certain diseases like brain tumors often required a more active decision in helping the animal pass to peace, than some other diseases which could better support a natural death. After Ranger passed over, she further offered her guidance and support by sharing with me a path of personal deep grief she had to traverse once in her life.

I had time with Ranger, good time with him, special time with him - where he was comfortable and we fully enjoyed each other’s company and were at peace, because of the blessings of our end of life walk and those who supported us. I will never forget his Miracle Walk, I will never forget the blessed week we spent just the two of us up in Malta where he was walking, having fun and virtually normal and pain free, I will never forget that he got to make the journey with us to our new RV home and spend time with us there at our new campsite life, I will never forget all the extra canoe trips and lake visits we got to make, I will never forget all the massages, acupressure rituals and baths I gave him - the time I got to express my love with my hands, I will never forget all the love we got to share because we had this time together. These 6 months of his end of life walk were a form of God’s grace.

The end of life walk when caring for your pet is not for the feint of heart. You will be exhausted, you will face things that make you deeply scared, you will face the unknown and you will also receive many deep blessings. You will understand love in its most sacred form. And you will understand what an honor and blessing it is to care for someone you love with all your heart, and you will learn to let go...

I believe that hospice and palliative care in its most authentic and loving form, is healing. Healing for the one who will pass over, and healing for those who walk in presence beside them.