Vet AI Scribe for Palliative Care

Mabel

Wednesday, October 14, 2026 at 11:00 AM

Home hospice visit — quality-of-life review

Subjective

Reason for Visit

Scheduled home hospice visit for Mabel, a 17-year-old spayed female domestic shorthair cat with chronic kidney disease (IRIS stage 4) and a history of hyperthyroidism treated with radioiodine in 2022. Enrolled in hospice care on September 30.

Family Report

• Eating about half of her usual amount over the last 5 days, mostly the renal pâté when offered by hand.
• Vomited twice this week, both times in the morning before food.
• Still uses the litter box, but has had two accidents on the bathroom mat when the stairs were in the way.
• Spends most of the day on the heated bed in the living room; still comes to greet the family in the evening.
• Subcutaneous fluids (100 mL daily) given by Mr. Okoye without difficulty.
• The family's daughter is home from university this weekend; they want time together before making any decision.

Objective

Examination (in the home)

• Weight: 2.9 kg (3.2 kg on September 30)
• Body condition score: 3/9; muscle condition score moderate loss
• Temperature: 99.6°F (37.6°C)
• Heart rate: 176 bpm, regular
• Respiratory rate: 28 breaths/min, effortless
• Hydration: Mildly tacky mucous membranes despite daily fluids
• Oral: Pale pink mucous membranes; mild uremic odour; no ulcers
• Mobility: Stiff when rising; reluctant to jump onto the sofa
• Pain: Feline Grimace Scale 3/10 at rest

Quality-of-Life Assessment (HHHHHMM scale, completed with the family)

Category	Sep 30	Today
Hurt	7	6
Hunger	5	3
Hydration	6	5
Hygiene	7	6
Happiness	6	5
Mobility	5	4
More good days than bad	6	4
Total (of 70)	42	33

Assessment

1. End-stage chronic kidney disease with progressive weight loss, reduced appetite and nausea.
2. Quality-of-life score 33/70, below the 35 the family and I agreed would prompt a conversation about euthanasia, and down from 42 two weeks ago.
3. Degenerative joint disease limiting access to the litter box upstairs.
4. Family understands the trajectory and wishes to focus on comfort for the coming days.

Plan

Comfort Care

• Maropitant: 4 mg (one quarter of a 16 mg tablet) PO once daily in the morning, for nausea.
• Mirtazapine transdermal ointment: 2 mg (a 1.5-inch line) to the inner ear flap once daily, alternating ears, to support appetite.
• Gabapentin: 50 mg PO every 12 hours for joint pain; may cause sleepiness for the first few days.
• Continue subcutaneous fluids 100 mL once daily.
• Second litter box and water bowl placed downstairs next to her bed; low-sided tray for easier access.

End-of-Life Planning

• Discussed signs that would mean her comfort can no longer be maintained: refusing food for more than 24 hours, hiding, vomiting despite maropitant, or unable to reach the litter box.
• Family prefers euthanasia at home, on her heated bed, with the family present.
• Aftercare: private cremation with ashes returned; clay paw print requested.
• Tentative home appointment held for Monday, October 19 at 10:00 AM, to be confirmed or moved by the family.

Follow-Up

• Phone check-in Friday, October 16.
• Family to call the hospice line at any time if Mabel declines before Monday.

Family Communication:
Went through the quality-of-life scores with Mr. and Mrs. Okoye and explained that the drop in appetite and good days is what moved the total below the threshold we set together. Made clear there is no wrong choice in waiting for their daughter to be home, as long as Mabel stays comfortable with the new medications. Explained what to expect at a home euthanasia, including sedation first, and confirmed their aftercare wishes so nothing needs deciding on the day.

— Dr. Ruth Calloway, DVM, CHPV