The Guardian (USA)

What Fifi the dog’s final months can show us about cancer treatment and caring until the end

- Ranjana Srivastava

“Ranjana, how long can Fifi live with liver cancer?”

An unexpected aspect of being an oncologist (for humans) is being approached for advice about pets (usually dogs) with cancer. Bruno, Marco, Maisie, Ziggy, Chloe, Tiger, Muppet, Jessie, Bella, Buddy, Johnny, Wilfred. Apart from my own Odie, the dogs of my friends form the backdrop of my life. Not all of them develop cancer but when there is a diagnosis, I know.

When I first qualified as an oncologist a neighbour told me about his cancer-afflicted dog, and the options for treatment being surgery or “let him die”. My first alarmed instinct was to beg that I knew precious little about human illness let alone canine oncology but, as he talked about his choices, I realised that I was merely a vessel for the anticipato­ry grief of losing his “top person”. This I was comfortabl­e with.

There have been many conversati­ons since: whether to do the biopsy, remove the kidney, resect the bowel, detach the leg, accept chemothera­py, when and where to palliate.

Now it’s Fifi’s turn. Fifi, who has lost her senses but navigates her surroundin­gs with determinat­ion and behaves with unobtrusiv­e gentleness, never one to bark at guests or nose her way into their laps. Fifi’s liver is heaving with cancer and the bloods are dire. Decisions weigh on her owners. To treat or palliate. How to gauge pain and define suffering. What is the right thing to do by a beloved pet?

I am running late to a work meeting and promise to call back.

Entering the room, I feel the gaze of hope and note with dismay the average age of the room. A young wife and kids. Youthful parents. And the patient? He is too weak to stand up. Uncannily, his liver is also full of cancer and the bloods are grim.

“What does your husband want?” I gently ask the wife.

“To go home to die.”

“And what do you want?”

“To take him home to die.”

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In an era of (justly) seductive advances in cancer, it is hard to describe the heroism it takes for a patient to say enough. The decision to forgo treatment can vex oncologist­s who wonder if they could have done better. But my dying patient has made an informed choice and the tears that flow are tears of relief.

Leaving, I call my friend.

Fifi is lethargic and the vet has prescribed analgesia. I suspect she is actively dying.

After years of practice I now know that there are two kinds of conversati­ons – one where I am expected to fix a problem and the second where I need only bear witness for the solution to reveal itself.

In place of “What does Fifi want?” I ask my friend, “What do you want for Fifi?”

This brings forward mature though heartbreak­ing insights, and a conversati­on with the thoughtful vet which

 ?? ?? ‘Now, it’s Fifi’s turn. Fifi, who has lost her senses but navigates her surroundin­gs with determinat­ion and behaves with unobtrusiv­e gentleness’
‘Now, it’s Fifi’s turn. Fifi, who has lost her senses but navigates her surroundin­gs with determinat­ion and behaves with unobtrusiv­e gentleness’

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