When I announced Ruby’s passing in December, I promised you that I would eventually write about my experience during the last four months of her life, from diagnosis to caring for her through her illness, to having to let her go.

I decided to title this four-part series “Ruby’s Last Journey.” My own journey through grief, which is, of course, a large part of all of this, is ongoing. I suspect I will inhabit planet grief for quite some time as I try to move forward without my little girl. Life goes on, but the pain of missing her hasn’t really softened all that much over the last two months.

Writing this series was hard. In the past, writing about losses helped me heal. That doesn’t seem to be the case this time. I know in time, I’ll come to terms with this loss, like I have with all my other losses. The reality is that we never get “over” a loss, nor should we want to. Loss changes us. The best we can hope for is that in the end, it changes us for the better.

A four-part series

The series will run in four parts on consecutive Wednesdays. In this first part, I’ll address her symptoms, her diagnosis, and how I made my treatment decisions for her. In part two, Practical Considerations of Hospice Care, I’ll address all aspects of caring for her, including nutrition, comfort, litter box issues, appearance, holistic treatments, and more. In part three, Water, Water, Everywhere! Hydration for Cats With Kidney Disease, I address why hydration is critical for cats with kidney disease, and how I handled that with Ruby. And finally, in part four, The Long Good Goodbye, I share my own journey from denial to acceptance, and how I made every moment I had with Ruby count.

Slowly appearing symptoms

Allegra and Ruby had their annual checkup in late August of last year. Everything looked good. Then, starting the beginning of September, Ruby’s appetite started to drop off. Since this had been a previous occasional pattern with her, I chalked it up to “fussy eating,” even though I could hear my veterinarian’s voice in my head from when I had mentioned Ruby’s finickiness in the past. “There’s no such thing as a fussy eater,” says Dr. Andrea Tasi, a holistic veterinarian and owner of Just Cats, Naturally. “A healthy cat will eat her food with relish. There’s always a reason when a cat becomes finicky.” Ruby was eating, she just wasn’t finishing her meals.

Toward the end of September, I noticed her drinking more water. Before that, I’d rarely seen Ruby drink from the bowl. The girls both eat raw and the occasional canned food, and I mix additional water in with their meals, so she was getting plenty of moisture from her meals. Now, apparently, that wasn’t enough. Something had changed.

The moment that changed everything

It was time for Dr. Tasi to take another look at Ruby. And that’s when my world started to fall apart.

While Dr. Tasi gently palpated Ruby’s kidneys, I petted her and told her what a good girl she was. Suddenly, Dr. Tasi stopped what she was doing. I looked up from kissing Ruby’s head. When I saw the look on Dr. Tasi’s face, I knew something was very wrong. I realized right then that our lives were about to change drastically.

One of Ruby’s kidneys was enlarged. The most likely causes for an enlarged kidney are a benign cyst, an infection, inflammation, or cancer.

Dr. Tasi and I talked about next steps as I was trying to wrap my mind around the idea that Ruby was really sick. I think I was in shock, because I was very matter of fact about discussing the various possibilities. It wasn’t until after Dr. Tasi left that I started to cry.

We would start with running bloodwork to assess Ruby’s kidney function.

Bloodwork results

My heart felt like it was shattering into a million pieces when Dr. Tasi called with the bloodwork results the next day. Given Ruby’s symptoms, we expected to see increased kidney values, but we didn’t expect them to be as elevated as they were. Ruby’s kidney values were so high, it was surprising to Dr. Tasi that she was even alive, let alone doing as well as she was.

I thought I had prepared myself for bad news, but while listening to Dr. Tasi, I broke down in tears.

Making treatment decisions

Conventional treatment for kidney failure typically starts with rehydration via IV fluids, which would require hospitalization for at least two or three days. And while this might have been right for another cat, I knew in my heart that it wouldn’t have been right for Ruby.

The only way to know for sure what was really going on with Ruby’s kidneys would be an ultrasound. I chose to decline, with the full support of Dr. Tasi.

I previously wrote about the topic of diagnostic testing, and how one of the most important questions to ask yourself before agreeing to any test is “what will you do with the information from the test?”  In Ruby’s case, that meant: if the ultrasound showed a growth or cyst on her kidney, it would most likely have required surgical removal. If it looked like cancer, it would have meant getting a biopsy, possibly followed by surgery and/or chemotherapy. And while surgery and chemo might have been right for another cat, I knew in my heart that they were not right for Ruby.

Treat the patient, not the lab findings.

I am blessed that in Dr. Tasi, I have a vet who treats the patient, not the lab values. She is also one of my closest friends, so she not only knew Ruby, she also knows me really well. She understood the unique bond between me and Ruby. We share the same philosophy when it comes to treating cats: just because veterinary medicine has advanced to the point where you can treat pretty much anything, that doesn’t necessarily mean that a particular treatment is the right choice for every cat. Having my veterinarian support my decision to forego aggressive diagnostics and treatment made the unbearable bearable.

I chose hospice care, also known as palliative care, for Ruby.

Coming next week:
Practical Considerations of Hospice Care

43 Comments on Ruby’s Last Journey: The Moment That Changed Everything

  1. Reading your story of Ruby’s last journey struck a bittersweet chord for me too Ingrid,. it’s only been less than 2 months since I had to let my sweet boy Frankie go. He too had erratic appetite and initially I chalked it up to food dislikes of one sort or another. Eventually I ended up taking him to my vet and after tests came back his diagnosis was large cell intestinal lymphoma. In retrospect, I wish I had taken your path but the retired nurse in me just struggled to buy him more time. You see this kitty was a big reason why I’m still here today. At night when I would have physical or emotional pain Frankie would know and come upstairs to stay the tears and cuddle and let me know” it’s ok mom, I’m here now. When I knew I had to let him go I called my vet who came out to my home the afternoon when I came back from the hospital and he passed peacefully in my arms. That’s when my journey went south as I sank into depression and just wanted to go to my heavenly home. I knew my hubby would have his Buddy cat here. Of all the animals in my life each of their deaths were heartbreaking but Frankie was special. I spent many hours in prayer and was beginning to recover when my vet tech called to say they had this 1 year old cat showed up at their clinic….collar but no chip or tags. Well Beemer found a home with us and laughter has now come back into my life. However Buddy still gives me “ the look” as if to say …REALLY!!!! Thank you for chronicling your last journey with Ruby Ingrid, as through your grief I felt a kindred spirit. Through it all I so strongly feel that one day all of us will be reunited again with our healthy loving furbabies

    • I’m so sorry about Frankie, Sandy. Losing a soul cat is devastating. I’m so glad Beemer is lightening your spirit. I’d like to think that maybe Frankie had a paw in sending him? I, too, believe that we will be reunited again with your lost loved ones.

      • Thank you for your kind words Ingrid.
        Btw…..i’ve Been a huge fan of Gwen Cooper’s cat stories and now I’ve been lucky to find you. Where would you suggest the best place to purchase your books. Does each purchase benefit a cat charity/rescue? I’m all for helping our fabulous felines

  2. I knew when I read this I was going to be sad, so I delayed reading it. Not because I didn’t want to…but….out of fear. Both of my boys are older, Dakota is going to be starting a renal diet later this month probably (nothing serious at this point, just his protein is a little higher than the Vet would like, and with a 13 year old dog, he will be 13 tomorrow) the higher protein is “normal”……..
    All of that being said, I know how hard this is for you to write about Ruby but you are helping soooo many others……….I thank you with all of my heart for doing this series and I look forward to reading the parts to come. Sending tons of love.

  3. A heartfelt thank you to all of you for your comments, for sharing your own stories of loss or impending loss, and most of all, for caring. It means so much that I can share Ruby with this wonderful community.

  4. My almost 15 year old Welsh Spring Spaniel passed about 5.5 years ago and I can still sit here a cry thinking about Teddee Burr. The day to day grief goes away, but you can never forget…the feelings of joy your pet brought to you and that empty hole.
    You can get other pets…I have another Spaniel, now 5 yrs and 5 cats, all about 1.5 years old (what an exciting adoption year that was!), but Burry was my heart dog. I am told you have one heart pet in your life. I am not too sure about that, but you dont forget all that unconditional love…. Kind wishes to you….

  5. The stories are making me just blubber away thinking about when my beloved Widget passed away in 2014. It’s always a hard loss but there is a lot of healing in sharing these stories. ❤️

  6. I lost my baby Misty on June 6, 2018 and it was the absolute worst day of my life. She was diagnosed with renal disease in 2015 and for the next four years after her diagnosis lived a relatively normal life. Other than fluids, a different diet and medications that had to be administered twice per day she was perfect. She was my world. It’s been a little over a year and a half and I still haven’t gotten over her passing. When she passed, she passed away in my arms with her dad (my husband) by her side. Ever since her passing I have been snuggling with the blanket she passed away in every time I missed her and started to cry. It just never seems to get any better. Despite me “wanting” her to pass so she would be out of pain, the pain of not having her here with me is unbearable at times. We now have a new little kitten who is almost 2. She helps with the loneliness when my husband is at work but there are times that I will see shows that have episodes about euthanasia and I just break down balling. God when the hurting stop.

  7. Thank you very much, Ingrid, for writing this for us. May Allegra comfort you in your pain. But, although things are certainly different, your love for Ruby lives on.

    May many good things come to you and Allegra in the coming year and beyond.

  8. Ingrid, I know what you mean when you noticed that Ruby’s appetite had dwindled a little. I too, chalked it up to being finicky when Two-y’s appetite decreased. Unfortunately I was hospitalized and couldn’t do anything more until I returned and he stopped eating. Again, I thought he was being nervous because of all the strangers coming into my house. But no, he had kidney failure and he was too far gone. I sat with him as we let him go at the local veterinarian’s. I’ll miss him forever, as I’m sure you will Ruby. But we are so lucky they graced our lives, aren’t we?

  9. What a wonderful gift you are giving to so many, through Ruby. And what a wonderful gift Ruby was to you and all of us. Thank you. Sending you love for your pain and grieving, and admiration for all that you do. Wishing you peace with wonderful memories of your beautiful Ruby girl.

  10. I’m so sorry for your loss. I have a 15 1/2 cat that is 4 years post gastric lymphoma treatment and his kidneys are going bad. I keep plenty of water around and get an appetite stimulant when he starts not finishing his food. I dread his passing. Thank you for discussing how to deal with the loss.

  11. I am so glad you are writing about this. So true some animals can be treated/should be treated while others palliative care is best. Death has become far removed from our lives and it is hard to accept it we tend to over treat especially those who are not good candidates for it and it stresses them into more bad days then good..
    I have done TNR for many years and of course have had special animals of my own. Like your Ruby some you have such a bond the pain takes so very long to just ease.
    Some ferals I have lost fairly young (they are all named and loved) but the vast majority have been geriatric. My cat ‘soulmate’ Tan’na passed many years ago of cancer. He was a special boy and at 18 I knew vet visits were not for him as his bad days would outnumber his good he had left. It was hard, he meowed ‘Mama’ softly on his last car ride but he snuggled in trying to comfort me.
    I feel as stewards to the animals that grace our lives they know we do all we can, there is nothing we wouldn’t do. I think the lifetime of love doesn’t end.

  12. I am glad you are discussing palliative care – so many people spend so much money on “saving” their cat and in the end there is no saving and are now $$$ in debt and still have lost their baby. Hard decisions are hard, but you chose what was best for Ruby, not you and that is the love of an animal to put their needs before yours.

    • My instinct as I said was to throw as much money at Iggy’s cancer as I could. It was hard to look at the situation and more importantly to look at my cat and accept that the cost to Iggy of my trying to save him was far too high for him in causing him stress and wrecking the quality of his life. I too am glad that Ingrid will be discussing palliative care as even as I have made my decision not to proceed with chemo, I wrestle with the emotions and more than anything, I do not want to cause Iggy stress with my own sorrow. It is so hard to talk about this and I am glad and grateful for Ingrid to be sharing her experiences with us.

    • I chose chemo for Ben because cats respond very well to the type of cancer he has and Ben tolerated it very well. But it’s not for everyone. A second round of chemo would not be the best choice for Ben, so I will enjoy what ever time he has left. He has become much more affectionate, and more often, so I think he knows he is sick.

  13. Being a true animal lover I have taken in as many cats and dogs as possible. I limit my additions to animals I can take from the streets. For the first fifteen years I had dogs only .For the past fifteen years it has been mostly cats since they can be trapped.
    Initially I had but one dog. In the last thirty years nearly fifty animals have lived with me. There are about thirty now.
    Nobody is more attached to animals than I am. I cannot accept their deaths, not only the deaths of ” my ” animals , any animal.
    The change in my emotional state is to use an over – used word, profound. I am constantly depressed and unhappy, two different states, but I would not wish to be any other way. It is my bond with them.
    For reasons I need not go into I am aware that everything that happens is fate. Events could not go, in the slightest way, any different than they do. Does not help much to know this. I am so close to my animals in a metaphysical way that I have been involved with their deaths , that is have caused them, every time. I have to live with that.
    I consciously keep thoughts of them just a half step away from my feelings most of the time to stay functional, but I frequently think of them. There are so many that sometimes I think of them as a group, but at times I think of each separately. Once due to stress and a long time spent dwelling on their loss my psychological defenses were stripped away and I felt an anguish that cannot be imagined for ten days. I cannot go to that place again.
    I’ve read a lot about various cat and dog illnesses and for me due to the number of animals involved, most of my cats are nor friendly, and the poor ability of veterinary medicine to help serious problems I will most likely not take sick animals beyond the GP stage. I neither have any confidence in specialists nor do I trust them.
    I would strongly suggest people have several animals . Not only to save lives but to be able to deal with the passing of individuals.
    I know several things about the nature of reality unknown to others…I live in a metaphysical world and my views are based on my experiences , not wishful thinking…but I do not know what comes after death of a person or animal. I suspect it is very complex.
    Love , in large part, is evidenced by effort and sacrifice . Of all the cats who have lived with me perhaps only one has loved me, she’s still with me and may be here for some time, but II have loved and do love all of the animals who have shared this home with me. Maybe that love will never die, but what that could mean I do not know.
    There are reasons I am virtually certain that I will live to be very old. Would not want to die when animals are still with me, I know what happens to them, but whatever will happen will happen.
    Not many people really love animals, I don’t mean ” pet owners ” who have them around for their own purposes, but when I think of who I am I, and I am not anything like any other person, I first think, ” I am an animal lover and they get the worst of the cruelties of life. “.

  14. My heart broke for you the day you said Ruby was gone. I know the bond y’all had and I know how you did everything to comfort her in her final days. I also know how hard it is to lose a special cat like Ruby. I changed when I lost Nani. I think it made me more bitter and afraid to trust love again. It’s eight years later and nothing has changed. Of course I have other cats, but I still have that fear of getting as close as I was with Nani. So, I know exactly what you’re going through. The best advice I could give is to cherish the memories you have with her because as long as you’re still thinking of her, she is still there with you (just in a different way) and one day you will be together again.


      • Maureen – I am so sorry for your loss of your beloved Nina. If there is another place after this one, I do hope that you will be with Nina again. And hopefully with time, the memories of the years you spent together will bring a smile to your face. It is always too early to say goodbye, always too soon. Sending you hugs and comfort.

  16. I’m so glad you chose to write about your experience, Ingrid. I will be forever greatful for the sound advice, and the invaluable emotional support, you gave me when I was faced with the same situation with my Hi-Dee. I know how hard it is for you to write this series, but you are doing many cat parents a great service. Big hugs!

  17. My cat Midori I started losing weight in February of 2017. I took him to 2 vets before I was finally referred to a specialist, where they could do an ultrasound. I knew something wasn’t right, even though all the other 2 vets were saying that the lump I was feeling was just one of his organs from weight loss. That made no sense to me at all. Finally, in May of 2017 we got the diagnosis of GI lymphoma. It truly shattered my world. He was my best friend and I wasn’t going to accept the fact that they were only giving us 2 months. He too was not the kind of cat to deal with chemo treatments and continued vet visits and I wasn’t going to put him through that. I wanted to soak up any of the last moments we had, whether they be 2 weeks to months or 2 years. We also opted for palliative care, even though they didn’t really call it that. I tried to keep him as comfortable as I could. I tried to offer food as often as I could even if he didn’t eat it all. We did CBD oil, we did off label low dose Naltrexone, and prednislone. In the and, we ended up getting 12 more months. I cherish every moment I got to spend with him and I’m very proud of the fact that we beat that 2 Month diagnosis. He was very happy for about 11 and a 1/2 months and then the last couple of weeks he just started to really decline rapidly. It was really hard and even though we’re coming up on 2 years of him being gone I think of him every single day, still hurts and I still cry. It’s true that you never really get over the loss, I just learned to live with it. My other cats have been helpful with keeping me company in helping to make me laugh, but no one will ever replace him, or his brother who have lost to wet FIP in October 2013. One thing I learned is it’s never easy even if you know in advance or if it’s sudden. Loss is loss.

  18. Thank you for sharing Ingrid….. my boy Mr Ringo has just been diagnosed with stage 2 kidney failure….. we are managing it with diet and lots of love and check ups….. your posts are a comfort as we share similar thoughts on treating the cat not the rest results:) I’m also lucky that my vet is a close friend xx

  19. How awful, discovering this when Ruby was so young, and how awful.

    My human thinks a lot about my future – I am going to be six in March, can you believe it? And she knows that if I have any health problems, that we will probably address them with full treatment because I’m the kind of cat that can handle it. Not many cats can – my human’s heart cat was one of those who couldn’t and she opted for palliative care. (She lasted for a year and a half after her bone cancer diagnosis.) And maybe as a therapy cat I can share that with my patients too. Time will tell – and I hope that is a lot of years off!

    • I hope your human never has to make these decisions about you, Summer, but if ever there was a cat who could tolerate frequent vet trips, it’s you, that’s for sure! But let’s hope that you’ll never have to go through that, and can just continue to bring joy to all you visit as a therapy cat.

  20. Thank you for sharing that Ingrid.
    I will be waiting for the next post so I can share in your journey.
    I do hope you are finding peace. It’s been 15 mos since Casey‘a gone and it doesn’t feel easier. I just want him back. I wouldn’t question a thing if I called out “who’s hungry” and he walked into the kitchen… I’d fill his bowl without skipping a beat and my heart would swell again…

    I found it interesting when you said there’s no such thing as a fussy eater.
    All of mine go through phases. For the most part they eat as they seemingly should. But there are definitely times for each of them when they just don’t. They eat a bit, then move on. One or more might peck at another’s bowl. Sammy, in particular, will eat half of what’s in his bowl. When I come back from filling the other dishes, I’ll find him staring at me so walk into the kitchen. Then he’ll circle back to his dish and sit in front of it. He’ll head butt me or “paint” my face. I feel like he’s trying to tell me something.
    I’ll pick up his bowl and he’ll finish it off like that.
    If I don’t pick up that bowl he will jump down and inspect the others’ bowls for leftovers. Of which there are because seldom does everyone eat at one sitting … tonight alone, Charlie kept going for his bowl then followed me around while I fed the others. Every time I went back toward his, he’d put his head into the dish and then walk away and circle the area.
    I emptied a different flavor into another bowl for him and he went at it with gusto.

    Maggie does something similar as well at times. Casey was the only one who ate all the time, every time with pleasure. My boy…

    So does that mean there’s something wrong with the kids? They’ve always been somewhat picky. Depends on the day.
    What am I missing? Are mine the only ones?

    I’m concerned now that I’m missing something.

  21. Thank you for sharing what I know is very difficult for you to talk about. I too have had to make a difficult treatment decision for my Iggy who has mast cell cancer of the intestines with lymph node involvement/inflammation. As with your Ruby, I needed to consider who Iggy was and while my instinct was to throw everything I could at him in the hopes of keeping him alive, when I looked at him seeing the cat he was, I knew the stress of treatment, of going to the vet every 3 weeks, the stress of treatment would make the quality of his life nil. It is a decision I have made over the past 4 weeks and giving voice to it still is difficult. But I give Iggy two micro tabs of Prednisolone each morning and that stresses him out and he refuses to come for breakfast and in that alone I know that while the decision was difficult, I know it was the right decision for Iggy. I do not know how long Iggy will have before he faces decline which I have been told will be rapid. And I try to make each day the very best for him. I do not worry about how much he eats for the most part – he gets generous meals and treats and as much love and petting as he wants and as much alone time as he wants. I feel sadness each day and I keep hoping the diagnosis is wrong and dread the day when I will no longer be able to stroke his long fur and hear his demands for dinner. It is a painful journey for me but I know he is living for the moment and I am determined to keep him happy and make him feel safe and loved. Though I do not know how I will manage when he begins to go into decline…. and I cannot bear to think about losing him.

    • Erica, I have been where you are and my heart breaks for you . .y cat had a similar diagnosis, although we never did learn which type he had. Soak up those cuddles, kisses and love. Wake up early and stay up late with Iggy. Sleep on the couch with her, or the floor, wherever she is comfortable. I always told myself I could sleep later. Tell her everything you ever wanted to say. They understand, even without words. You , Ingrid, Iggy, Ruby and everyone else who has to deal with pet loss are in my heart. ❤

    • My heart breaks for you and what you’re going through with Iggy. Just cuddle, comfort and love him as you have been. he knows you are doing everything possible for his comfort.

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