segunda-feira, 16 de março de 2015

Five Seconds

Last December, Luís asked me if I wanted to write for this blog. I thought his request was extremely strange because he did not know me that well. But somehow, through our interactions on Facebook, I guess he thought that I had something to say. But still I felt awkward because sometimes the stuff that I want to talk about is a little bit strange, for I, as my mother would often tell me since an early age, I am bit strange, a bit unlike other people. Luís sensed my awkwardness and he specifically told me that I should consider the blog as if it were my own, I should consider it as a medium where I could explore some of the things that interest me. And I thought that for having sensed all that and giving me such liberty, he was a wise and trusting person, much more so than me.

A few days later, he said another remarkable thing as if he wanted to make sure that I truly understood what it meant that I should consider it my own. He said that if I ever needed to, I could write in English in case I wanted some of my non-Portuguese speaking friends to be able to read it. I acquiesced, but I never felt the need to write in English until yesterday. So today, I write in English because this feels like the best way to express what I feel and the best way for my friends, who come from many countries, to know what I feel, so that they are not as concerned with me. I tend to isolate myself from other people, for I am very much an introvert. I mostly live in a world of my own: I am good at working with people and I am good at taking care of people and making them at ease, but I am not good at letting other people take care of me. In a way, that is a characteristic of many women: we are caregivers and seldom are we comfortable being the ones receiving care. But I digress, as usual, as this is not what I wanted to talk to you about. I wanted to talk about yesterday--yesterday started a long time ago...

I realized that last Friday was coming quickly, perhaps, on February 17, 2015, when I was listening to the Diane Rehm show on my way to work and the topic being discussed was "aid with dying" or "death with dignity". Those are just code names for euthanasia. In the show, Diane said two things that stayed with me. One thing was that the United States was ready to start discussing the issue of how we should die and when. The other thing she said was regarding the death of her husband. Since they lived in a place that did not allow euthanasia, the doctors could not actively help him die, he had to die on his own. However, he was able to ask how it could be done the quickest, and his doctor informed him that, if he refused to eat and drink, he would eventually die after a few days.

As soon as I heard that, something went through my head. I immediately knew that we, humans and our ancestors, used to die like this. Those who would get old or ill would get to a point when they would stop drinking and eating and their bodies would eventually die. It was as if their bodies knew somehow that at that point, the effort to stay alive was not worth it and death was a better choice. And I thought of the first people (were they people, already?), our ancestors, who started caring for the sick and old, giving them water and food, and thus extending their life and sometimes allowing their body to heal and continue living. We have no way of knowing when that took place in our evolution, but we know that that was one point that distinguished us from most animals. Most animals still get to a point when they become too weak and stop eating and drinking on their own and they wait for their own death like that. That led me to think about my dog Stella.

Stella was a special needs dog that I adopted in 2008. She had several health issues: being almost blind, a propensity for having heat strokes, and global epilepsy. She also had other issues that we, her vets and I, were able to cure or control, like a yeast infection on her skin, chronicle ear infections resulting from seasonal allergies, and depression. You could say that I basically went to the Northwest Arkansas Pug Rescue website and picked the dog that most people did not want or did not think were able to handle. She had been up for adoption for over a year. When I read her story I knew that that was the dog I wanted to adopt. I like challenges as as far as dogs go, this was a pretty good one. Plus, I like to take care of others and she would be able to fulfill that need. It was a win-win situation or, as we say in economics, a first best solution. That is how Stella and I met.

Stella was a pug and the median life expectancy of a pug is 12 years, meaning that half of the pugs make it to 12 years old and the other half don't. Stella was born in 2003, but I do not know the exact date. One day, this year, 2015, her 12th birthday would take place, so this year was a goal for me. If she made it to 2015, given all her medical history, I would consider myself a very lucky person. Stella did make it to this year; she made it until Friday, March 13.

For almost two years, Stella had been struggling with her appetite. Her vets and I had been giving her medicine to increase her appetite and that worked well until a few months ago. She also had trouble drinking water, and I had to either inject her with fluids or give her water with a syringe. I have learned a lot from taking care of Stella. For example, her vets taught me how to check if she was dehydrated, if she was anemic, and how to inject her with fluids. But I also learned how to be observant, how to pay attention to others because sometimes they cannot communicate, like Stella could not, or they may say something when they actually want to say something else. The good thing about taking care of a special needs dog is that it takes you back: it takes you back to a time when humans could not communicate verbally with each other and so they had to pay attention to body language and try harder to understand each other. I think that taking care of Stella honed my skills of empathy and intuition.

I had been training Stella for a long time to communicate with me and trust me. When she was in pain or restless, I would pick her up and hold her close to me. I would put her head next to my heart, so that she could find solace and comfort in my heartbeat. And I would put my hand over her heart so that I could feel it, so that the touch of my hand could learn what it felt like for her to be alive. I wanted us to be bonded as animals so that when her time to die came, she could let me know that it was her time and I would be ready to do what she wanted. Of course, taking care of a dog like this means that every day can be the last, but that is true for all of us. My mother used to say that the only requirement to die was to be alive. Every day can be the last. Marcel Proust put it very eloquently, when he said, in one of my very favorite quotes:

"We say that the hour of death cannot be forecast, but when we say this we imagine that hour as placed in an obscure and distant future. It never occurs to us that it has any connection with the day already begun or that death could arrive this same afternoon, this afternoon which is so certain and which has every hour filled in advance."
One of my worst fears was not of Stella dying; it was of me dying, or becoming unable, and leaving her alone. Very few people have the resources to take care of a dog like this. It's not even the money that I am talking about; it is the emotional availability. Most people live their life afraid of being hurt and losing a pet is something that can be very hurtful, so they choose not to get an animal. My mother trained me well. She had a chronic heart condition and she suffered from depression. From an early age, maybe eight or nine years old, she started telling me that she could die at any moment. Every day could and can be the last and, if that is the case, you have to pay attention, you have to slow down. Slow down, be still, and be present in the moment.

I did my best to be ready for Stella every day, but this past week I was particularly ready. Last Sunday, I woke up early, I suppose that my brain was still confused about Daylight Saving Time. I got up and I picked Stella up from her bed. I curled up with her on the couch and we slept together until mid-morning. And then on Tuesday evening, I took her to bed at night and kept her in my arms. I was afraid of putting her in the bed and falling asleep because she could overheat with the heat of my body or she could get up and fall off the bed. So I just held on to her while I was sitting on the bed. But I did fall asleep and I woke up at 2 AM holding her still and she was peacefully sleeping in my arms. I got up and I took her to her own bed because that would be the safest place for her and I went back to sleep. Almost everyday, when I woke up, I would pick her up and take her to my bed and I would hold her for a few minutes until I got up and fed her.

Throughout the week, I had trouble feeding her and giving her water. I would put a paper towel around her neck and when I would squirt water in her mouth, all the water would come oozing out and all I got was a very wet paper towel. Then, when I would try to feed her, she would hold her jaws shut and it would take an enormous amount of effort to open her mouth so that I could slide a spoonful of soft pet food in her mouth. And she would often bite me, nothing too serious, she was not trying to hurt me. She was just refusing to eat and drink, she was trying to tell me that I should let her die. But still I persevered until Friday morning, when she completely closed her mouth, I could barely open it. I was surprised at her strength and I understood that I needed to take her to the vet. Some of you may wonder why I had not taken her sooner, but I did take her many times before. And he always did his best to help her but every time he could do less and less, and so he started ending the appointment by telling me "You know, she is getting kind of old. You need to think about that." And one of those times I told him that I knew that the time was coming, but I also knew that she and I would know when the time had come and I did not feel that that time was it. My idea was that Stella would let me know when the right time had arrived. On Friday, she told me and so I understood.

I called the vet and I told the receptionist that I thought my dog was dying and I needed to take her in. She told me to bring her in and I hung up. It was 8:18 AM. About that time, the electricity went out at my house. It caught me off guard and I was confused. I started to get ready to take Stella in. I changed her dress and the diaper she had on (yes, they do make doggie diapers). I put clothes on her because she started losing her coat and she would get cold; it was also a good way of keeping her clean. I put her all clean in her fuzzy carrier and I made one last video of her, with perfect knowledge that that would be the last. Then we got ready to leave and I went into the garage and pressed the button to open the garage door. Of course, it did not work because the electricity was out. I tried to open the garage door manually, but I could not do it easily enough. Then I thought about Uber.

The previous day, my friend Larysa had called me to check on me and Stella and she told me about using Uber if I needed to go somewhere and could not drive. She sent me a coupon for it, so on Friday morning, I tried to download the app to use it. It was taking too long and, as it downloaded, I started thinking of the conversation that I would have with the driver. He might not want dogs in his car, even though my dog was small and fit inside a bag. And I thought whether I wanted to spend the last minutes of Stella's life being upset at someone that I did not know. I realized that that was the wrong call to make. So I decided to walk to the vet, it is about a mile away and it would take me 20 minutes or less. So I left the house and started walking.

I held Stella close to me, I put her head next to my chest and I was on my way. The sidewalk ended and I had to cross the street to be against incoming traffic because there were no sidewalks on either side. I was angry. I thought "I see million dollar homes, and no sidewalks, not to mention the potholes around the city, and the electricity just went out and there is not even a storm going on. What kind of place is this?" There I was, walking east on Evergreen St., thinking about how stupid this all was, while I was trying to keep my dog comfortable, when my phone rang. I could not find my phone, I was looking for it in my bag and I could feel it and hear it, but I could not find it in time to answer it. Then, I realized that it was in my pocket--that's why I could feel it...

It had been the vet. I called them back and I told the receptionist, Sharon, that the electricity was out and that I was on my way by foot and would be there shortly. We hung up and within a minute she called again. She wanted to know if I wanted a ride. I did not want to impose, but agreed because I also did not want to keep everyone waiting. I did think that if I walked maybe I would have more time with Stella, but I think it would have been about even. I told Sharon to pick me up on the corner on Evergreen and Chimney Rock because I was almost to that point. I crossed Chimney Rock and waited for her. As I was sitting there, I realized that I was holding my dog. I got to spend all this time holding my dog. If the electricity had been working and I had driven to the vet, I wouldn't have held her all that time. The next time the electricity goes out, maybe someone will get to hold their dog longer and I should not be so upset about it.

We made it to the vet and they took me back to the critical care room. Stella was yelping as she had been that morning. The vet said that he would give me options but his advice was to terminate her life. He asked me if I thought she was in pain. I told him that I did not know and that none of my options allowed for her to be a normal dog. He told me that he thought her body had begun to shut down and she had lost kidney function, but he might be able to do something to make her live an additional four days and that would be my best option, probably. And then we'd be back to the same place, just at a different time and, in between, for me to have her longer, I would need to prolong her suffering. I asked if she was in pain and he said that "We think that at this point they become delirious." There is no way of knowing what a dog is going through because they cannot speak but that took me back to the eve of my mother's death.

I called my mother at the hospital and she spoke to me, but made absolutely no sense; she was rambling on and on about what would happen after she died, and I told her that she had not died yet and she was in a hospital, so they could take care of her such that she could live longer, but she persisted rambling. I finally said that I could not make any progress talking to her like that, so I wanted to speak to a doctor. She said "Yes, you should do that." I asked her the best time to do it and she told me to call at 9 AM the following morning, so we said our goodbyes. The following morning was Friday, October 13, 2006. I woke up a little bit before 3 AM, my time, because I was six hours behind, to make the call but the doctor was not available and they asked me to call back at 10 AM. I waited for an hour and called again and the person that answered the phone said that she had died at 9:30 AM. I had been the first person to know. Looking back now, I realize that the last time I spoke to my mother she had been delirious. Probably, her body had begun to shut down.

I told the vet that we should terminate Stella's life. They took me to a private room so that I could be with her and I held my dog in my arms one last time. She was so small and skinny, her hair was thin because it had started to fall out. Her frailness reminded me of the last time I saw my maternal grandmother before she passed away, when I was nine years old. I held Stella with my left hand and took one last picture of her, knowing that that would be her last. After a few minutes, a lady knocked on the door and told me to take my time but to let them know when I was ready. I told her that I was ready and everyone came in. The vet explained the procedure: first an injection with a sedative, which would make her very drowsy, then the actual overdose of another medication which would cause her death within five seconds. "Five seconds," I repeated. I had no idea that it would take that little time. He had trouble finding a vein to inject Stella because she was so dehydrated, but he finally found one in her neck and he injected her. She became relaxed, there was one one small little spasm, and she died with me watching over her, around 9:20 AM.

After my little dog was gone, they gave me more time with her. I petted her lifeless body, that was still warm and relaxed. She did not smell bad. When I got her, she probably had been the stinkiest dog in the rescue, but now she was always clean. I took out her dress and I left the room and paid my last vet bill for Stella. I was ready to just walk out, when Sharon said "Let me take you home." and that brought me back. I got into her car and she began driving. In a few feet, I almost told her to stop the car so that I could go back to be with my dog, but I controlled myself. I did not want to impose any more than I had to. We got to the intersection of Evergreen and Chimney Rock. The traffic lights were on and Sharon said "At least, you've got the electricity back in your neighborhood." It was as if it had only been out long enough for me to not be able to drive my dog to the vet.

The whole thing felt like a very humane and intimate procedure, it was very kind to spare her from any more suffering. And it felt strange that we allow our pets to have such kind deaths, but people in most places are not given that opportunity. I find veterinary offices much better places than human doctor offices; sometimes, I wish that I could just take myself to the vet, rather than having to deal with health insurance policies, finding doctors that are accepting new patients, and figuring out which procedures will be covered by my insurance. This process makes me feel like my health and caring for it is not as important as the accounting that it entails.

I looked back at old photos of Stella and realized how far we had gone. She went from being a chubby little pug weighing 15 lbs, in 2008, to a tiny little thing that maybe weighed 9 lbs on a good day, today. Throughout all this time, I kept coming up with ways to make her live a little bit longer but it got to a point when no more could be done. Ever since I was small, my mother would tell me that I was very slow: I move slowly, I walk slowly, I speak slowly... She would say that I would be a good person to fetch someone's death. This might sound like an odd thing to say or even a very crude thing to say to a child, but the upshot is that if you take your time fetching someone's death, then it is you who has the gift of life, the gift to make them live longer. People often tell me that Stella lived long, much longer than it would be expected given all her medical history. I suppose that I was so slow accepting her death, that she just had to wait until I was able to fetch it.

I do not feel sadness or anger, but I still cry a lot. I feel this emptiness inside and I have no way of filling it, and it seems like filling it with tears might be the best thing. When I wake up in the morning I hear the birds chirp outside the window but in my house there is silence--there is this deafening silence that makes the house feel completely empty. I don't remember hearing this silence before she died. And I keep thinking "How on Earth could a dog, that could barely move and did not bark, make so much noise that she could fill a whole house even while she was sleeping?"

4 comentários:

  1. Obrigado por este texto transparente de tão bem escrito. Com o meu cão, os passos foram os mesmos. É um momento muito triste mas ao mesmo tempo agora só choramos pelas alegrias que eles nos deram e que mantemos connosco. Isso é que importa recordar, o tanto que eles contribuiram para a nossa vida :)

  2. Excellent text, there are pugs who live longer than 12. Death is serious business and your description is brilliant. I've taken a cat, and a pug to the vet,and I've had a pug die unexpectedly in my arms after surgery. The latter was the worst.Your courage is remarkable. Your writing skill admirable.I will follow your pieces.


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