D started this as a simple email, but it grew into a journal of sorts. Though some of you have read this already, I thought I’d share it here. I hadn’t intended to – I didn’t want to write about this here at all – but D has summarized the details of our last week so very well, and likewise has captured the fragility and strength we’ve both found in these intense days such that I felt compelled to share it here.
There’s more, much more, to come as we face the next steps of this journey.
Tuesday — In Which We Receive Bad News
Last week we took Koko in because he had lost even more appetite and hadn’t been generating any “output” as it’s euphemistically called. We were concerned about his backed-up little guts and his weight loss, so we went to the next step which was an ultrasound.
The ultrasound on his tummy showed some weird masses which did NOT appear to be backed-up poop as we’d been hoping. The vet (not our usual one) said that it would take surgery to determine exactly what was going on, so we gave the go-ahead. The surgery showed a lot of cancerous tumors all around the blood vessels leading to the top of his small intestine, so interwoven with that tissue that the vet deemed it inoperable. His little football-shaped body, which we’d just sort of accepted as part of his character, was due to the fact that these tumors had been growing for a while now.
Tuesday night was pretty rough. Koko had to stay at the vet recovering from abdominal surgery; Meg’s own experiences bear out the fact that it’s an exhausting procedure to go through no matter what species you are. So we were at home and Biscuit-less, we knew he had “inoperable cancer,” and it was a lonely, teary night.
Wednesday — In Which Our Cat Is Returned to Us
At lunch I met Meg at the vet to pick up our kitty. Our usual vet was there, and she was very helpful. If you’re tired of managed care and impersonal doctor offices, perhaps you should consider being treated by a veterinarian, because they’re given the opportunity to work with patients they really like and often don’t have to deal with all the bureaucracy of insurance. Biscuit was hobbling around and had a line of staples (not stitches — staples!) in his little bald shaved tummy. It looked for all the world like they’d installed a zipper.
It was time to talk about our options. We had to consider that we wanted to keep him with us as long as we could, we wanted to keep him as comfortable as possible, we wanted to try all reasonable treatments in hopes for remission, and we had to consider our resources, especially with me having just quit my job for the feast-and-famine world of consulting.
Step 1 was to keep him as comfy as possible while he recovered from having had all his innards turned into outards for a while. His incision didn’t look too big, not much bigger than Meg’s scar from her abdominal surgery. But cats are smaller than us, and a corresponding incision on us would run from groin to sternum and as long as a medium pizza is wide. So we were loaded up with some kitty dope for pain and antibiotic pills to add to our collection of specialty cat items.
Step 2 was to test the biopsy of the tumor sample that was taken during surgery to determine what KIND of cancer is involved. If it’s lymphoma, and we’re hoping it is, then this is about as good a thing as can be hoped for because lymphoma is especially responsive to chemotherapy. The vet said that huge lymphatic tumors can shrink to invisibility under the right care.
Step 3 was to start talking with an oncology specialist. The vet was very happy to recommend us to the University of Wisconsin vet hospital. She said she personally has 7 pets (and 2 are horses) so she thought that the additional effort / expense would be well worth it, “if for no other reason than to know that you talked with someone there and knew that you had asked” should there be nothing more that we could do for Koko.
So I took Koko home that lunch while Meg took care of her remaining dog that day. Then she came home and I went back to work. Wednesday night was better than Tuesday, because at least he was here with us. He mostly sat in his “quiet place” in the upstairs closet. From time to time we’d check on him and make sure he wasn’t trying to unzip himself, but he didn’t come out much.
Friday Afternoon — In Which There Is Much Medical Learning
Meg noticed Koko was getting a little dehydrated (by checking his turgor — how the skin snaps back when pulled). So I stopped by the vet on the way home from my last day of work, and picked up a bag of lactated Ringer’s solution (we call it Lant-ated Rigor’s Solution, since Lanty is such a hearty cat and Meg’s late cat Rigor was receiving it before he died). I also enjoyed a lengthy talk with the vet who pulled out pictures from animal anatomy books and showed me exactly what the tumor was doing. I also picked up the lab report on the biopsy so we could take it to U of W.
Cancer is a weird, fascinating, and creepy thing. It’s not a disease in the sense that it’s not a foreign thing like a virus or bacterium replicating away and doing bad things to you. I vaguely remember discussing cell mitosis and meiosis in biology, and then later studying DNA and RNA, the AGCT-U chains in chemistry. As a computer geek who works every day with encoded information, it fascinates me how our cells contain these programs in them which instruct them how to run, how to divide and grow, what to become once they’ve divided, and under certain conditions, when to stop growing.
The cells around Koko’s tummy have lost some information, or had some added somewhere… the program has an error in it. So the cells grow, divide, and then keep on dividing. The lab report we were waiting on to give us the verdict of lymphoma or some other -oma was actually inconclusive — the cells are dividing so rapidly that before they’ve had time to decide that they’re a lymph node cell and not an intestinal cell, or a blood vessel cell and not a lymph node cell, they’ve split apart and are forming new cells again. So what’s accumulating down there is a mass of completely “undifferentiated” tissue; just random cellular gunk that doesn’t even remember how to do anything useful — except grow. I asked, and the vet said we’re probably talking about exponential, not linear, growth rates here. So the growth needs to be halted, and soon, or the mass will actually start causing physical issues like impeded blood flow or more digestion issues.
We’re still hoping for lymphoma, as the alternative (adenocarcinoma) is a much lower cure rate, but either way we’re sticking to our goals of remission, longevity, comfort, and resources.
Friday Evening — In Which We Begin Our Medical Practice
So, given all this knowledge and our now formidable array of items to use for Biscuit’s comfort, we are keeping him comfortable, rested, hydrated, fed, and as pain free as possible. On top of, or in, our fridge is:
— 1000ml “I.V. bag” of Ringer’s solution (basically saline)
— hypodermic needles, for the above
— little syringes of buprinex (liquid pain killer) to be taken orally. It’s for Koko, but he looks so happy on it that we’ve considered having a little bit ourselves.
— a cough-syrup sized bottle of lactulose (laxative) to help Koko’s insides do their job
— foil packets of antibiotic tablets
— several cans of Fancy Feast
— several cans of special veterinary soft food
— a can of Clinicare liquid diet — it’s Enfamil for cats. You pour it out into a saucer and think it’s condensed milk, and then you get a whiff and discover it’s condensed TUNA milk. Would make a heck of a shake.
Each morning Koko gets some soft food (aka “mush”) to nibble on, and then a squirt in the mouth of his laxative, and then his antibiotic pill popped in his mouth, and THEN a squirt in the mouth of his painkiller. Shortly thereafter he’s getting sleepy and so it’s a good time for his fluid supplement.
Koko has been prescribed 200ml of fluid / day, so each morning and night we pull the Ringer’s solution out of the fridge and put the bag in a bowl of hot water to warm up. We hang it on a coat hanger suspended from the bookshelves, run the line down to where Koko is reclining on the couch, pinch the scruff of his neck, stick in the needle, and let some of the fluid drip in to pool up under his skin where it then gets absorbed into the body. I don’t know if people can get fluids this way, but it’s pretty cool.
Meg started a medical diary and log for Koko; she’s recording how much he eats and, uh, produces each day, and our general observations of him. We expect this will be more useful to vets than vague recollections. She’s bound up all his medical charts and our own notes in a binder, and created a title page for it: “Biscuit’s Book — The Cancer Cat Chronicles.”
This may seem like a lot of work, but so far it actually hasn’t been too bad. In fact we’ve all got it down to a fairly routine procedure. One thing we’ve been grateful for is that Koko’s sickness has come upon us all at this stage of our lives. I will be at home after my trip to Belgium, and with Meg walking dogs she is only gone from 9 — 2. We can’t imagine how we’d cope if Meg was still working downtown and I was still working at Grainger with only 2 weeks of vacation / year.
We’ve also found a new respect for other such caregivers — nurses, adults caring for aging parents, parents caring for sick children — in from the giving we grow into something greater our present selves; a type of growth that we hadn’t even realized still lay before us.
Saturday — In Which I Buy An Embarrassment of Groceries.
Meg stayed at home to keep an eye on our patient, and since I needed to get out of the house I went shopping at Costco. Perhaps it was a nesting instinct, perhaps I was just looking forward to my days as a consultant “working” at home, but I bought a LOT of groceries. Cases of tuna, beer, grains, paper goods, frozen foods, cleansers, and lettuce. Cases. Costco doesn’t let you do anything small. So Meg won’t have to go shopping until I get back in the country.
Meg, Koko, Lanty and I watched “Office Space” in celebration of my lack of a 9–5 job.
Sunday — In Which The Patient Gets Restless
The Biscuit was a bit more active today; once his morning opiate wore off he was hopping up to and down from the couch before we could prevent him, and a few times made it up the stairs. He even played a bit, batting at a sock Meg dangled above him, and took his evening meal in the kitchen at his usual place, disdaining to be fed on the couch like an invalid.
I was reminded of my own progressions after many surgeries in the hospital, how I would progress from clear broth to solid food, and then would get restless and want to take a trip to the cafeteria. Dealing with so many medical topics and supplies has brought on quite a few memories for me. At one point when I had my ear to Koko’s tummy to listen to his digestive sounds, I caught a whiff of that hospital smell — Betadine antiseptic, bulk-laundered clothes, and medical plastics — and had a sense memory of my time in St. Joseph’s Hospital at the age of 5.
Tomorrow we journey up to the city of my birth, Madison Wisconsin, to meet with the feline oncologists there, perhaps learn more about Koko’s Kondition, and hopefully even get started on the next phase of treatment. Sometimes I’m at a bit of a loss to explain to others the steps we’re taking and the expenses we’re considering for an animal — especially when so much dear human life is at risk in this world — but then I consider that other people take as much time and spend as much on their automobiles… and little Kokoro has given us so much more joy than any machine could bring.
We knew when we adopted Koko that, as a cat, the time of his passing would come before ours. And we chose to adopt a “mature” cat knowing that he’d have even less time with us than a new kitten would, but we wanted that time to be spent in our care and not in a shelter. This past week has given us a reminder of the consequences and benefits of that choice, for even as we’ve been warming up his fluid bag or checking his litter box for a new deposit, we’ve been so grateful for solemn glances from his earnest little face, and the selfless affection of his crackling purr.