vital signs

We all know the importance of vital signs -- are you breathing, do you have a pulse, does your temperature register. Basically, be ye alive or dead? Yesterday, Robert added a new indicator, one that I think is important. For cats, it's Do you purr.

It's so easy to get distracted by quantitative measurements and scientific experiments. (Oooh -- if we add this chemical, what measurable effect will there be, and can we avoid killing the patient.) And yet, time after time, I've seen truly sick people who are happy to be alive, grateful to have some joy in their lives, while still being fully cognizant of dying.

I'm certainly not advocating for misery, illness, or negligence. Nor am I ignoring the set of human emotions that come with dying, including the rage and resistance. But I'd rather err on the side of a little more illness and a little more joy than vice versa, especially in an end of life situation.

I think with animals, it's even easier to go into quantitative mode. After all, animals have traditionally been the first experimental subjects of choice. And they can't speak for themselves -- they need human interpreters to act on their behalf. There are no medals for merely keeping an animal alive.

Quality of life has to enter into the equation alongside all the medical care, the medications, treatments, potions, and lotions. Otherwise, what's the point?

world's worst cat caretaker

OK, no one actually called me the world's worst cat caretaker, but I sure felt like that after I got off the phone last night, as gentle as my caller was. When Juliet was experiencing what I believed to be side effects from her new meds, I put in a call to the e-room. The person who answered the phone suggested that I call back, but apparently caught enough information from me that she passed a message on to the doc I saw on Tuesday.

Last night, some time after 8, the doc called back (wow, long day). She told me that there was no way the meds could have caused this reaction. (OK, I've heard that line before, and then looked up a med in the PDR, and found the reaction listed.) She told me that Juliet is very sick right now. We don't know if her cancer has spread. (Maybe she has information that I don't, but from my readings, this cancer doesn't metastisize easily, though it does some times.) She told me that Juliet's kidney disease has probably kicked up (ok, but then why is she eating so well) and that Juliet should be on Pepcid at least once a day (first I've heard that advice, but I'll ask about it). She told me that it's lethal for Juliet to have high blood pressure (agreed, but will a few days make a difference? Maybe, maybe not) and that when we recheck on Tuesday, the number will be high (maybe we should delay the recheck?). And she told me that I should put Juliet back on the meds (ok, can we talk about *my* quality of life? maybe that's not appropriate here).

She also admitted that there are a lot of cooks stirring the broth right now, something I've already talked to Dr. Randy about. On the other hand, when I got off the phone, I felt like the most ignorant, superstitious, unscientific, uncaring, cat tender on earth. And I felt torn.

It helps to realize that this doc is in emergency and critical care. She has to be aggressive. It's her job. She deals with sick and actively dying animals day in and day out and works hard to get them back on their feet quickly. She's got a broad knowledge of medicine, and I imagine that she's enormously successful at her job. Actually, I know she is because her clinic has a terrific reputation, and I've heard stories about the geographically closer one that make my skin crawl.

Yes, the blood pressure is a very high priority right now. But yes, I have a lot of trust in Randy, and he recommended stopping the meds until Friday, when we'll address this issue again. And yes, frankly, Juliet is dying anyways. It might happen next week, or next month, or she might be around longer. It might happen for any number of reasons -- cancer in her mouth, high blood pressure, kidney disease (probably less likely in the short term) or something we haven't thought about yet. This is a huge balancing game in terms of medicine and in terms of comfort, one with no easy answers. I'd like to prolong the inevitable as long as we can, but I also want Juliet (and ok, secondarily, me) to be comfortable and happy during this end game.

So I thanked the doc for her insights and wished her luck and she seemed relieved to get off the phone. And then I sat around for hours feeling guilty and inadequate, but also feeling like I'm ultimately doing the right thing.

Oh, and not only has Juliet not had any "incidents" since yesterday morning, but she's been eating ravenously and purring more. Doesn't mean that I'm right or the emergency doc is wrong, but it does mean that right now, at this moment, life is good.

my favorites!

We've had a couple of vet visits in the last few days. On Monday, Dr. Randy's staff made time for him to see Juliet. We decided that because she's, well, blind, a trip to the opthalmologist, as recommended by the e-room doctor, wouldn't yield much new information besides that she's blind. Juliet was duly examined, we asked questions and got some answers. Randy said there's a possibility she can get some of her sight back, but my guess is that's true only if we can control the blood pressure.

Randy's office doesn't yet have a blood pressure monitor, so we decided that I should go back to the e-room for a re-check. That happened yesterday. The number wasn't good, and suddenly, I was in consultation with the very capable chief of medical staff, who is also co-owner of the facility. Blood was drawn without incident, but at least one number has shifted for the worse in the last few weeks. The doc coached me on how to effectively use their services, and consulted with Randy and the on-site internist.

Because Juliet's blood pressure is still way too high, her blood pressure meds were switched to something that Randy later told me is a standard offering with minimal side effects. Except for Juliet. She got her first dose at 8 last night. At 5 this morning, after being awakened by a dreadful noise, I realized that she was -er- spewing from both ends. Poor kitty. I cleaned her up, cleaned up the places where she'd missed the designated receptacle (despite good effort), and thought about what to do.

I did call the e-room, but they suggested I call back at 8 when the original prescribing doctor would be in. So I surfed and found the medicine in question. Side effects usually set in within 6-8 hours of administration. (OK, so we were delayed by an hour; maybe this started a little before I woke up. There was certainly -er- evidence of such.) And amongst the side effects listed were the ones that my friend Mark used to crow about whenever he'd get a new medication -- "Nausea, vomiting, and diarrhea -- my favorites!!"

Dr. Randy's office opened at 8 this morning, so I faxed over a little writeup and eventually talked to Randy himself. We decided to stop the meds, let the blood pressure do its thing for a few days, and reconsult on Friday, when Juliet has her next appointment. (This is a test. Can we go vet-free for two whole days?)

Meanwhile, Juliet had two more incidents before I left for work (out of one end only, and more minor than the first bout). While I was gone, nothing else happened, thankfully. So now, I really am suspecting the new meds. I'm hoping they're out of her system and that nothing bad happens while we're figuring out our next steps. A friend has already warned me of even more dire things that happen to kitties with high blood pressure; I'll just have to hope that Juliet has met her quota at this point.

Miss thing is currently resting comfortably on a flannel-covered down comforter, under a small towel, with the gas fireplace blazing nearby. A good life for a good cat.

christmas morning

Last night, we spent our traditional Christmas Eve with our friend Cen. It was his party, at the home of his dear friends. The usual crew was there, people we don't see often but who are beginning to feel like extended family because they truly are part of Cen's family, and Cen is part of our family. Most people brought their usual pot luck offerings. I can't complain because it's all good, perhaps a little too good.

We spent a pleasant, though subdued evening together. I'm not sure why it was so quiet, perhaps because most of us only partially celebrate Christmas, if at all. I know that the latest development with Juliet was affecting me -- I was a little distracted with concern that Juliet would be ok in our absence. Robert and I made an early, for us, departure. And of course, Juliet was fine.

Today, Cen is coming here. There are no decorations, but there will be a good meal, which we partially prepared yesterday. I imagine we'll have some good conversation too; it's always a treat to get Cen by himself.

The kitty continues to do well. She's been tired, but I guess I would be too. She spent the first night in the bath room, probably afraid to stray too far from amenities, until I fetched her. Last night, we closed off the addition again so she'd be near by. She quickly came to bed and was there this morning. One trick she hasn't learned yet is how to navigate out from between us. So in the middle of the night, she pawed my chest and I was able to point her to the little stair case by the bed.

Yesterday, Juliet disappeared from the down stairs for a while. Robert went looking for her and found her in his bed room. When she came out, she navigated down the hall using her whiskers along the wall. One of the big warnings we got at the e-room was to keep her away from stairs (as part of the advice to keep her safe while she's adapting). One of the first things she learned to do was to go up and down the stair case. Our original plan was to shut her in the addition whenever we left the house. I don't think that will be necessary.

The 'f' is silent

Juliet went blind last evening.

It happened about that quickly, at least from my perspective. One minute she was happily toodling around the house. The next, she was suddenly paying attention to the front door, acting as if someone was on the other side. She hasn't noticed the door for months, at least.

Then she started to go upstairs, except that every other step or so, she paused and looked behind her as if the aliens truly had come and were hovering just over her, encouraging her to jump, jump up to their little saucer.

By this time, of course, I was intrigued and had started to follow her. When she got to the top of the stairs, she started slurking low to the ground the way cats do on unfamiliar territory. I looked into her eyes and her pupils were huge, with almost no green visible.

I immediately knew what was happening. A while back, I had a vet who loved kitties and used to comb Juliet's tail while she talked to me. When she moved away, I inherited a kidney specialist, someone who became a vet just to study kidney disease, who was widely read in the topic, and who was also a catastrophizer. He's the sort of guy to whom you could present a cat with a hang nail and the first thing he'd say would be: "You know, she'll be fine if we have to amputate; cats do really well with a missing limb." It was in this spirit that he had warned me to be vigilant about her pupils. Kidney disease can lead to very high blood pressure, and once it starts, you have about 24 hours to take action before blindness sets in. The clue is in the wildly dilated pupils.

So at 7pm, Robert had just come home, I had a cat who was going or had gone blind, the vet's office was closed (as it should have been). We called the emergency room. They were unhelpful and said they couldn't tell us anything without seeing the cat. We consulted. And by 8pm, we were in Waltham at the e-room.

They were very nice -- they gave us our own living room to sit in. We let Juliet out of her cage, and she slept on the couch between us.

We eventually saw a lovely vet who seemed to ask all the right questions. Juliet's blood pressure was indeed out of control -- 260 when it should have been 120. She has cataracts but not glaucoma. The vet said that her retinas probably detached (I hope that isn't painful) because of the high blood pressure. And she could barely perceive light, but was "legally blind." Of course, Robert and I immediately both said "Darn. She can't drive anymore."

We put her on the floor and she started methodically exploring the room. Simultaneously, I thought, and the vet said, "she's like a Roomba." And they sent us home with a prescription to lower blood pressure with strict advice to follow up with our regular vet. Good care; glad they're there when we need them.

At home, we're able to close off the addition. We put her in the bathroom, where she has food, water, and litter. She spent most of the night on top of a sheep skin, which is on top of the heated floor, not a bad choice on her part. Around 5 or 6 this morning, I picked her up and put her between us in bed, where she felt secure, happy, and loved. She seems to know the bathroom at this point, and she's exploring the rest of the bedroom and study. We'll have to be very careful not to move things around as she's getting her bearings. We'll confine her to the addition when we're not here, at least in the beginning.

And Robert, rude boy that he is, said that now that she's both blind and deaf, we'll have to start finger-spelling into her paw.

Finally, she doesn't seem at all distressed by this change. She hasn't meowed in confusion or frustration once. I'm fine with it. But I do feel bad and perhaps a little anxious for her. I'm sure we'll all grow more comfortable with this latest change.

life's little victories, spelled P-H-E-W

There's a comic strip author who writes occasional one-cell comics called Life's Little Victories. I had one today -- wahoo! Getting on toward Christmas, there's always a tough balance between acquiring the freshest possible food for Christmas dinner and getting beat into a pulp by all the other last-minute grocery shoppers. I dread the crawl across the parking lot, the fight for the last shopping cart, the tussles over half-dead picked-over produce, and the unending lines to check out, complete with shoppers abandoning carts to go back and forth picking up last items.

Today, I had lunch at a restaurant that shares a parking lot with a grocery store. It was grim. Although there were loads of parking places around the side, everyone wanted to be close to the door (so they could make a getaway after shoplifting?). Cars were everywhere they weren't supposed to be and drivers were horribly aggressive.

That experience really helped me get into the mood. Yeah, Christmas!

I finally forced myself to venture out a little after 4, and... not bad. Drivers were politely yielding right of way. There were spaces in the parking lot, and carts readily available. The produce department was overloaded with fresh, sparkling produce and cheerful workers. They were out of only one item that I wanted, and that was non-essential. (But it's due in at 8am tomorrow morning if I want to go back.) The shelves were well-stocked. There were lots of shoppers, but it wasn't crowded. And when I slid into the checkout lane, I was second in line behind someone with a relatively small order.

Well done, Shaw's. I'm impressed. And I'm not nearly half as crabby as I should be at this point.

christmas is a comin', cat's still with us

So Christmas is two days away. I've made end-of-year donations, bought and wrapped presents, planned Christmas dinner, planned our contribution to Christmas-eve dinner, and will go food shopping today. I feel ... fine, though not terribly festive.

I just read a blog post in which the author said that as a child, he wished that everything could always stay as it was -- that he loved Christmas and felt warm and loved. As an adult, he gets very blue at this time of year and tries to crawl his way through it.

I'm rather the opposite. Through most of my childhood, I despised Christmas. The best part was the day after when the next ordeal was an entire year away.

Now as an adult, I get to create my own holiday and for myself, try to make the day itself as peaceful, loving, and calm as absolutely possible. Our usual pattern is to wake up, light a fire, have breakfast, open presents, clean up, and cook. This year, a dear friend will be joining us after the morning festivities. We'll have a nice dinner, laze about the fire, and be in bed at a reasonable hour. It is possible to have Christmas without chaos.

And the kitty is still with us, so she gets to celebrate Christmas, and we get to celebrate having her there. I think her tumor is getting a little bigger; I've recently caught her chewing gently on that side of her (otherwise empty) mouth and last night I thought I saw her chewing food on the good side of her mouth only.

On the other hand, we went to the vet yesterday, and he was delighted to see how alert she was. In fact, when he walked into the room, she was lying on her side purring really loudly. (It's ironic to have a cat who's both getting sicker and healthier at the same time.) I've rarely seen a cat purr even a little at the vet's. I told him she likes being there, and he said "All Riiight" and gave her a little noogie on her head, which just made her purr more.

Later, during catupuncture, he stuck a needle in and she nipped him (not hard -- just a warning that he'd better quit) and hissed, but then settled right in once all the needles were in. I get worried when she's too placid -- and it's heartening to see her express her opinion about things. Of course, we humans laughed and laughed, perhaps out of astonishment and also out of pleasure to see her so full of life.

We had a good discussion about pain. I asked if he thought she might be in pain. I don't think she is because she'd be really crabby. He also thinks she's pain-free right now and said that if she gets to that state, she'll be depressed, lethargic, and not want to eat. Good signs to watch out for. I reiterated that I don't want her to suffer. So far, I think the three of us are doing well at our respective jobs, and he's already demonstrated that he's willing to treat pain generously.

And the icky powder -- I continue to give it to her but in tiny quantities. Dr. Randy said that it's powerful stuff and to give her what I can.

Last night, she ate well, got lots of lap time with RP, and then slept with me all night. And we woke up to face another day together with much love and joy.

apb for heaven

"Where is heaven?" a recently widowed friend asked yesterday.
I thought, "wha huh? is it ok to ask that question? and besides, i thought it was up -- clouds and sky and so on"
She continued, "is it all around us? People keep saying my husband is here 'in spirit,' but if he is, does that mean that heaven is right here all around us in some other dimension we don't know about?"
I thought, "and if he is, how come everyone except my friend knows it -- don't you think she'd be the first, not the last, to know?"

make it work faster please

Juliet has often gotten close to the wood stove, but I've never before seen her this close. The other day, we returned from the vet, and the fire had died down. As I was starting it back up again, she climbed onto the stove's apron. When I went to touch her, I realized that her fur was too hot for prolonged contact. She eventually got down when she was more satisfied with the temperature.

last watch

In the earlier part of the 90s, I discovered Paul Monette's first two memoirs and practially inhaled them. By early 1995, I knew that his third memoir, Last Watch of the Night, had been published, but I was waiting, oh so patiently for it to come out in paperback.

Mark died in March of that year, and after visiting with him and his family, I (ok, it sounds weird now) flew off to San Diego for part of a business trip while waiting for the memorial service to happen. I knew I was supposed to read at the service, but the minister took forever to give me my passage.

One night after work, I went to the gay bookstore in San Diego and was wandering around when I saw Last Watch in hardcover. I decided to stop waiting and just buy it. When I returned to my hotel, I learned that a fax was waiting for me. It was my reading, and it was from Last Watch of the Night.

So, yes, I inhaled the third memoir, too. I can't remember if I've read it since, or if I've read excerpts. When my friend Ed died this fall, there was something about the scene at the cemetery that prompted me to pull the book back off the shelf.

It's a series of essays written when Monette had already buried two lovers and countless friends and was himself dying in fits and starts. The essays are full of anger, love, sentimentality, longing, and death. It's one of the best books about grieving I know of, though it's not a How To book, or even a How I Did It book. It does leave a lot of questions unanswered, kind of like my own experience.

This fall, I started in the middle, with the essay that describes visiting various grave sites of famous people, and then switches to the story of picking out the grave site for his first husband, which came with an extra side for him. (The second grave site has another space for a good friend.) In one of my favorite passages, Monette talks about taking his Sunday paper and continuing the tradition of lying in bed next to his partner and reading. He also talks about the hunger to be at the grave site in the beginning, the inability even to travel for fear of leaving the site for too long.

This probably doesn't sound like the most cheerful reading out there, but somehow, I derive great comfort from it, and perhaps feel a little less crazed from the reading and re-reading. I decided to read the whole book again, and as is typical with favorite books, it took on new meaning, or perhaps I took away new lessons.

There was the rage at society for doing nothing about AIDS; the irony of being mildly censored at a speech about censorship for the Library of Congress; the fury at the limitations caused by his own disease; the grief of losing two husbands; the loving relationship with his dogs; the delight in traveling; the love of antiquities; the letting go of physical possessions.

And finally, nearly at the end, the piece that I read at Mark's memorial service:

I see the difference now between mere baggage and what the heart possesses. Not that the latter is any less stolen goods -- the brimming of love and the joy of a comrade -- requiring every bit of a pirate's brazen stealth. And no less snatched in the end by the icy clutch of Death than all the baronies and all their rummage.

But the heart transformed in the process, no longer just a thing that ticks and no longer simply mortal, though half in shadow already. There's a cautionary tale in there as well, perhaps, involving a soul-deep self-delusion -- but not worth the caution anyway. Something lasts, firm as the pen in my hand. Jackals and buzzards cannot get at it. Its price doesn't translate into dollars. Saved as it is in the spending, till nothing's left in the vault. Invisible in the blinding shine of the setting sun, weightless as a mid-ocean breeze. To have greatly loved is to sail without ballast -- with neither chart nor cargo, not bound for the least of kingdoms. Nothing remains, except this being free.

further adventures of a sick kitty

Juliet's googly eye almost got better. But then it started looking worse, at first so little that I thought I was imagining things or that perhaps the healing was just slowing down. But yesterday, I was home sick, and things just didn't look right, so in we went to the vet.

And it turns out that it's not the advancing tumor, as I had feared, but a small case of conjunctivitis. We started her on what looks to be the veterinary equivalent of opthalmic neosporin and she's responding nicely.

While at the vet, we gave her an acupuncture treatment, this time with some twists. There's a technique called moxa, where you insert the needles and then heat them until just before they're uncomfortable. So you're delivering heat directly into the acupuncture points. Afterwards, Dr. Randy also gave J some aquapuncture, where he injected a liquid (containing vitamins, and perhaps other goodies) directly into a few of her less sensitive acupuncture points.
At the end, I had a totally relaxed kitty who purred and purred for a long time.

(Incidentally, I finally asked for a referral for moi and now have an appointment with a human acupuncturist; it's time to take the next step on some arthritic spots that I haven't quite been able to conquer using my traditional methods of exercises and braces.)

----------

I talked to Dr. Randy about wanting to keep Juliet around as long as I can while keeping her comfortable and happy. At times, it seems like a hard balance to achieve. He did say that I've done a good job so far of striking that balance, but I think that most recently, all compliments go to him.

For a little more than a year now, we've been adding treatments to her regimen, starting with regular hydration, that are perhaps slightly uncomfortable or a little unpleasant in the moment, but that are good for her in the long run. We've included twice-daily medications, and now goop in her eyes three times a day. She weathers all this with good humor, much grace, and perhaps some small understanding that we are acting with good intentions.

Yesterday, I was given an immune-boosting powder to add into the meds. Dr. R doesn't have the appropriate measuring devices yet, so told me that I'm on my own with it. I tried giving it to her twice with awful results. I'm at a bit of a loss of how to measure .3 ml of a thick liquid with 1/8 teaspoon of a powder and deliver the whole thing into a small cat. So I tried mixing it with water the first time and with water and the sticky liquid the second.

Apparently, it tastes putrid, at least to kitties, though it smells kind of nice to me. Then again, this link implies that humans also struggle with the taste.

The first time I gave it to her, she swallowed it, I left the room, and I came back to find little piles of wet yellow blobs and enormous amounts of white foam around the living room. The second time, she started foaming before I finished delivering the stuff. I quickly picked her up and held her over the sink for ten minutes while she gagged and foamed and basically spit up an entire evening's worth of medicine.

As if I wasn't feeling bad enough already, Robert said, "if she's a short-timer, why are you even bothering to give her that stuff?" He was right, of course. Sometimes I go in with the best intentions in the world, and I end up with a disaster anyways. And "But I meant well, and I'm so terribly sorry" just doesn't cut it.

This morning, she saw me coming and made every effort to avoid me. I just gave her the regular meds and left the powder out of the discussion. I have a call into the vet to get a week's worth put together into a more palatable form, if that's possible, and if we can't do it, well, we'll just drop it, alas.

and the diagnosis is...

The surgeon called today (on a Saturday) to let me know that the pathology report is in. Juliet has squamous cell carcinoma, a vicious and quick cancer that sometimes shows up on the skin but in this case is in the mouth. It doesn't metastisize much, which is probably why she's otherwise so healthy. But it does grow locally and makes it, well, impossible to go on living, basically.

Many treatments have been tried, with quite unimpressive results. I did find one report on the net of someone trying alternative treatments. It helped for at least a while, and I might pass it along to my vet, to whom I expect to be speaking in the next few days. But the surgeon said to expect Juliet to last a couple of weeks to maybe a couple of months, which frankly sounds like a stretch.

Our time together is short. We'll keep her as hot as she wants to be (today: time on the heated mattress pad in the sun, followed by hearth time in front of the wood stove, followed by snuggling up to Robert's side in their favorite chair). We'll love her a lot, and we'll be vigilant for any sign of suffering.

my starched white cap is about to be retired

The Kat is improving by leaps and bounds. Her googly eye is nearly normal -- there's a small bit of third lid still showing, but the swelling has gone down dramatically. There seems to be no tenderness left. She's started to rub the outside of her face on scratchy objects, right at the surgery site. She's lovey and full of purrs and is once again leading a happy life.

I realized that I've internalized her values around vanity and cleanliness. It used to be very important to her to be beautiful at all times. Now that she can perform very few grooming duties (because she's so arthritic), I've taken them on. I brush her a lot. If I spill medicine on her, I wash it off immediately. I'm vigilant about removing knots as gently as I can. And part of me was relieved that she didn't have to die looking like a shipwreck. (I'm somehow reminded of my friend who was recently wheeled into -- and out of -- surgery with lipstick perfectly intact.) I think I've cleaned up almost all the crud on her face from the surgery, and I feel better about that. Her coat once again shines and feels lush.

Today, Dr. Randy got to see her and was very pleased. He did admit that a lot of cats wouldn't have made it through what she's managed. She got acupuncture today, and we won't go back for another week. We'll cut back on the eye goo and the hydration, keep the meds the same, and she's off her kidney diet for now, until we have the biopsy results. Instead, she's eating something called "Coat Care." I first heard it as "Code Care" which made me think that it was for kitties who had come close to what in humans would be called coding. But it's a high-protein (bad for kidneys), super tasty, highly digestible food that kitties, even Juliet, can't resist. It should help her with her recovery, and perhaps it'll fatten her up a little too.

When the biopsy results come in, we'll have more of a sense of how long she'll last. If it looks like the cancer will take her swiftly, it won't matter if her kidneys take longer to kill her. If it looks like things will go more slowly, I would think about providing more of a balance between kidney food and tasty Coat Care. We'll see.

So the week is turning out well. I'm looking forward to sleeping well tonight and enjoying more kitty happiness tomorrow.

did you hire your competitors to market for you?

in the snicker-worthy department, I got one of those yule-time advertising emails for a lighting shop I once did business with. They were excited to tell me about their sale on fancy ceiling fixtures, announcing it with this headline:

Holiday Chandelier Blow Out Sale

I dunno, but the words "chandelier" and "blow out" juxtaposed don't do much to get me into the buying mood.

don't call me nurse ratched

(thank you imdb; i originally thought it was "Nurse Cratchit," as do many others in cyber space).

Juliet's saga continues with a bit of an upturn in the story.

I arrived at the vet's last evening, and Juliet was brought to me. She looked awful, and I thought she might be in a coma. She just laid in her roaster pan with heating pad on, breathing. Sometimes we are grateful just for breathing. I tried petting her very gently, and there was no response. I was told that the vet wanted to speak to me (gulp). We waited a long time, during which I kissed and stroked and just watched her. I wondered if this was the end and whether Robert could make it down Route 495 before closing time.

Dr. Randy came in and we had a long talk. I'm of the mind that we have the power to alleviate suffering. I was seeing what looked like misery with little quality of life, unless you count the pleasures of lying very still in a heated roaster pan, covered with a tiny, cat-sized blanket.

Randy said that he recommended giving her 5-7 more days. He said that the past 24 hours had shown us that we didn't have to put her down right away. And it would be fairest to her if we gave her more time, especially since the biopsy results could give us some guidance about next steps. Then he really got my attention by saying, "If you're questioning whether it's time, then it's not time. If it is time, there will be no question about it." I'm not sure if I was even questioning, but I was willing to take his advice on faith, especially since my solution was not making me very happy.

So, with some skepticism, I agreed to take her home. I also decided to postpone our trip to Costa Rica, which was supposed to start today ; I just didn't feel I could ask anyone else to take on the tasks of caring for her. (My niece later wrote and said "couldn't you come and leave Uncle Robert at home?") Randy gave her some steroids to reduce swelling and a magic potion of various drugs and vitamins to promote healing. He didn't even want me to put her in her carrier, but I eventually did because she looked like she might try to climb out of her pan.

I got home, opened the carrier, and ... she crept out, and then ran down the hallway. She was so fast that I couldn't keep up with her. Then she attached herself to the baseboard heater, which is really hot, and didn't move for a long time.

There followed a delightful evening. I put food in front of her; she ate. I put her next to Robert, and she climbed onto his lap for some petting, then jumped down on her own. She asked to be picked up so she could sit next to me for a while. I brushed her; she purred. She meowed a little (a not complainin' just sayin' kind of a meow). She ate some more.

I was very very brave and started putting goo on her googly eye instead of asking Robert to do it. I'm totally squeamish about eyes, and had up til that point managed to get other people to place the goo. In part, I was feeling guilty about waking up just so I could wake up Robert to put it in. So I tried and succeeded, and it's icky but not that bad.

Randy had suggested that I set up a little nursery for her in my bathroom. She refused to have anything to do with her roaster pan, even with the heat on, she wolfed down more food, and then she climbed into bed with me and stayed there all night. (aww...)

We awoke this morning and she purred with delight and washed my face a little. She wasn't at full strength yet, but what a pleasure to renew our morning ritual. Her googly eye is much better and she's continued eating, though she's not quite as starving as she was last night.

I faxed a one-page "overnight nurse's report" to the vet's office.

Today, she's gotten more brushing. I've also tried to clean her face a little; there's still some crud left over from the surgery and the bleeding. I had some business to transact, so was in my study most of the day. She's been on the bed, with the mattress pad turned up and the gas fireplace going. For a while, she was in full sun, too. I would say that despite my insistence on putting goo in her eye, she's had a good day filled with sun, heat, and love.

And sweetly, the surgeon called to check in with me; she had heard from Dr. R that I had decided not to travel. I gave her an update and she said that everyone in the office was concerned about Juliet. I think she was relieved to hear that things were going well. She commented that Juliet has gone beyond her ninth life and is now working on her twelfth or thirteenth.

We'll go back to the vet tomorrow for another assessment and next steps. Large blessings come in small furry packages.

i knew there was a chute around here somewhere

Good news but mostly bad. Juliet sailed through surgery, and yes, woke up on the other side. However, the surgeon said that the results aren't good. Even without a biopsy, the lump is cancerous and extensive. She didn't bother trying to remove even a part of the lump -- she just took a biopsy, knocked off some tooth calculus, and got out.

We know that the lump is growing and that eventually, it'll interfere with Juliet's ability to eat, if we let it go that far.

So I went to pick up the kitty, and swelling had set in, so J now has a googly eye that won't shut completely. And of course, she's very groggy and floppy from the anaesthesia. At home, I made her a fire and set her up in her roaster pan.

I settled in to make some calls. While on the phone, she started spitting blood, and when I looked at her, she reminded me of a vampire who had just fed; it looked like her whole lower mouth was full of blood. So, back to the surgeon we went. The surgeon said that she was getting her teeth tangled in the tumor, and after some discussion said that she has a habit of keeping her animals alive too long, but she'd be inclined to wait at least until tomorrow (which is now today).

She consulted with Dr. Randy and the two of them decided that Dr. Randy and staff could provide kitty day care yesterday afternoon and today. So off we went, and on the way, Matt, the wonder vet tech called and suggested that I might want to sit with her for a while. We got there around 4 and stayed til 9 (an hour past closing time).

Much of the time, I sat with one arm extended the length of Juliet's body. I tried to be fully present and think hard about what she'd want, realizing that she was still under the influence of groggy drugs. Matt and Dr. Randy dropped in a few times, but mostly, it was just the two of us. It reminded me of Mark's last day when I climbed into bed with him and just held him, and tried to make sure that his wishes were represented. It reminded me of so many hospital and hospice vigils I've sat. Ironic, isn't it, that all the human deaths that have touched me have worked to prepare me for Juliet's end time.

During our time together, Juliet seemed to get more comfortable, and she stopped chewing and bleeding. Dr. Randy and I decided that it's not time to put her down quite yet. I'm wondering whether the swelling will recede and if she'll be comfortable beyond today. We'll see.

Last night, we gave her more wood stove time, then brought her to bed. I kept the mattress heating pad on as long as I could stand it and woke both humans up several times to lubricate her still-googly eye. I'll drop her off chez vet this am, then return this afternoon and we'll decide on next steps.

If, before surgery we knew what we know now, we wouldn't have done the surgery. On the other hand, we worked with the information we had at the time, and together made the best decision we knew how to make, with Juliet's best interests at heart. I continue to be astonished by the caring care she's getting and that's washing over me as a side effect. Onward.

what a long strange trip

Robert and his coworker Dawn had a business trip last week to the world headquarters of their company -- Glenwood Springs CO, between Aspen and Vail. I somewhat resented that his return travel day was Saturday, leaving us just Sunday together before the week started up again. But I was trying to be a grownup about the whole thing.

Apparently, on the way out, things went smoothly until Denver. The plane took off for Aspen, then turned around and the passengers were told that no planes were landing at Aspen. Robert's boss (and brother), who was standing at the Aspen airport at the time, reported that plenty of planes were landing there, and that skies were clear and visibility good.

They considered renting a car, but were told that the mountain pass was in whiteout conditions and chains were required, and the two travelers were just too tired to make the drive by that point.

The next morning, they set out again, got all the way to Aspen. Dawn (who's had some flight training) reports looking down and completely agreeing with the pilot who said it was unsafe to land. So back to Denver they went.

And finally, after getting advice from the airline (there's no way we'll find a flight for you), they crammed into a van, rode to Glenwood Springs, and arrived perhaps 18 hours after their scheduled time. This late arrival of course pushed the meeting into overdrive, so they were run ragged over the next couple of days.

When they tried to return to Denver, they discovered that in canceling the third leg of the journey, someone had managed to cancel legs four through six too. And maybe the plane from Aspen to Denver wasn't flying either -- things got a little unclear. All I know is that I received a series of calls updating me on new arrival times. Back they got into a van to travel the icy roads to Denver with a driver who was on a hand-held cell phone the whole time.

They arrived in Boston at midnight and I picked them up; we finally got to bed at 2 am. And yesterday, in the snow, I got to drive the two of them up to New Hampshire to retrieve their cars (they'd started their journey at an entirely different airport). When I returned home, I went back to bed for a nap so that I could keep my eyes open until bed time.

And now it's Monday. I'm counting on my day off tomorrow for a little recovery.

climbing rungs, feeling closer to a chute

A few weeks ago, Juliet and I went to meet the kitty dental surgeon, a confident and capable-seeming woman. She told me that her nineteen-year-old kitty "went to heaven with pearly white teeth" because she was putting her own kitty under twice a year for teeth cleaning.

She was very gentle with Juliet, but still, J showed her displeasure by walking to a corner of the examination table and hissing at all of us. Quite understandable.

I was pleased that the doc kept telling me that she has a special place in her heart for old kitties, and she kept sneaking in little pats on Juliet's head. And the doc says she will take the risk if I will. So we've scheduled surgery for next Tuesday, with a bunch of prophylactic preparations to make before then.

Sidenote 1: In the small world department, I mentioned all this to a dear friend who immediately knew the name of the doc because they're neighbors. Somehow that makes me feel better, perhaps because of the warmth with which the discovery was made.

Sidenote 2: The vet techs I know have all responded positively to the doc's name. They like her personally and she has a good reputation. Given the number of vets one of these techs does not like, I feel that I have gotten a high recommendation, not to mention the one from Dr. Randy.


Juliet contines to do well, and even to improve in tiny bits. Her jumping is more sure, her appetite is good, her affection level is high. She usually hates sitting in my lap, but the other night (ok, in the absence of Robert), she stayed on my lap for over an hour. Most days when I wake up, I'm subjected to a face washing. In short, I feel my connection to Juliet deepen, and I am heartened to see her act with such vigor and joy.

Our visits to Dr. Randy continue. I am convinced that much of the slow, steady improvement I'm seeing is due to his care. And so, on Tuesday at our last visit, it was a real blow when R felt her cheek and said that the lump has gotten larger. He looked inside her mouth and told me that pretty soon, the lump will get in the way of her ability to eat.

Earlier, I was wrestling with the decision to have the surgery, but now it's pretty clear we have to do it -- that she's likely strong enough to get through the surgery, and we can't let this lump take over her mouth. On the other hand, the fact that the lump is growing makes me wonder if we can get the whole thing, if it's spread, if it's all pointless.

Last night, over dinner, a friend asked how Juliet is doing. I told a brief version of this story, and my friend immediately replied "Are you ready to say goodbye to her?" Of course not, but I will let go if need be.