Sunday, October 16, 2011

Little star lost

Twinkle died, quite suddenly, mid afternoon yesterday. She was at home and I was with her. Despite the fact that she still really wasn’t well, it was completely unexpected.

I haven’t been blogging about the process of her treatment and recovery because it’s been all I could handle going through it, and I had a few angels on my shoulders during the process to whom I gave frequent reports, and that was enough. But now that she’s gone, P-Doug has said I should write it out and put it into perspective, and I agree.

Maybe a little of her background first to remember who she was. Well, when Larry was my roommate last year, he asked me what I wanted for my birthday. Since the Toronto Humane Society was undergoing a reorg and they needed to place their animals quickly, I suggested a third cat. That cat turned out to be Twinkle.

I’ve had four cats in my adult life, and of the bunch, Twinkle was problematic in various ways. It took her over a month to get adjusted to living with Bonnie and Max, which meant me waking up several times a night as Twinkle warned off a curious Max with a growl that sent goosebumps up my spine. That settled down, but her propensity to pee on just about everything but my bed took a lot longer to sort out. She uttered ruined a futon; we had to throw it out. I had some very dark thoughts in relation to that... about taking her back, about even having her put to sleep, because it seemed to me her life would be nothing more than bouncing from pound to home and back to the pound. But I reminded myself that it was my idea for her to live with us, not hers, and it was up to me to find a way to put up with it. I did, and the episodes trailed off to at least a mere occasional incident as she grew more confident the place was hers as well... I guess that’s what it was. I think I’m right in that because when I moved last summer, it stopped. Aside from peeing on my sandals a few times, which I’m sure was meant as some kind of protest (for what, I’ll never know), she quit doing it.

On the cat-to-dog spectrum of cat nature, she was further back on the cat end relative to Bonnie and Max. She was self-possessed, didn’t really take guff from me, and gave and showed affection on her own terms. There were definitely endearing things about her. One quirk I never really figured out was that she loved to follow me, or anyone, into the bathroom, and see if she couldn’t get that person to run the water in the basin for her. We developed a rust spot in the basis at the apartment last year catering to her. I also got her to eat treats right out of the palm of my hand a few months ago after we moved. I’ve had cats I could feed from my fingertips before but Twinkle was the first to trust me and put her whole head into my hand. I’m going to miss that daily display of trust.

She was energetic, she was the boss, she used to love to jump Max and put him on the run. Hard to believe it was over two weeks ago now that Bonnie and Twinkle used to quietly vie for position on the table by the window to keep a watch on the landing birds just inches the other side of the glass. Seems like yesterday. On the other hand, some of the things I’ve been through with her more recently seem like months ago. Taking her in feels like it was in August, but was itself in October.

So, as previously said, I took her in Monday about two weeks ago. She was extremely anemic and needed a couple of transfusions over the next couple of days. I was very lucky in two things: one, the responsibilities of my job made working from home an option, and two, the emergency clinic Twinkle was at was about a seven minute drive from my home. I didn’t go in and see her that first Tuesday. I was overwhelmed and guess I had a blind spot. But Wednesday I remember she had been a pound cat and I was concerned she’d think she’d been abandoned again. So, from then on, I did my best to get in and see her twice a day, and unless she was undergoing a procedure, I managed that. I don’t think the was day in there she didn’t get a visit from me at least once.

Since she wasn’t eating, they’d put a little tube in her nose to feed her. There was fluid on abdomen and they had a tube in her side to drain it. A tube in her hind leg, another in a front leg. She was a mess, and it really broke my heart seeing her like that. But she purred for me, knew I was there, and seemed grateful to see me, meowing.

Michelle was goddess of mercy. She talked with me, sat with me, visited Twinkle nearly half a dozen times. Text messages went back and forth daily. She was as privy to Twinkle’s progress as I was, and I’ll always be grateful to her for her compassion and patience.

Wednesday night, they gave Twinkle a transfusion from a fresh donor. She ate for me with surprising gusto when I came in on Thursday, both times, and it made my heart sing. I felt sure then that this was her coming out of it. After that, she only ate on her own a couple of time, but it was still good to see. After Wednesday, her PCV (packed cell volume) was low, but stabilized in the 17 range, give or take, pretty much from then on. Tubes started coming out. Ultrasounds eliminated the fear it was cancer, tests kept coming back negative, and eventually they settled on an undiagnosed auto-immune disease that was causing her to destroy her own red blood cells. The treatment would be immunosuppressant drugs till her disease went into remission, if ever.

She was well enough by last weekend to try going home for a couple of days. The idea was to see if she’d recover her appetite in a home setting, which sometimes happens. I took her home Sunday. She seemed content and comfortable at home, but her appetite was still pretty much zero. I’d wished for more but was ready for the next step, which was an e tube, placed through the left side of the neck into the esophagus. Not uncomfortable, I’m told, and many cats live with them for years, though obviously we were hoping it would be just a few weeks or months for Twinkle. In a way, I was happy, because it meant she could be looked after at home, that I could be sure she’d get the nutrition she’d need, and I wouldn’t have to fight her every time I turned around to give her the life-saving meds she needed. I saw it as a good thing and settled in for what I started calling “the long haul”.

Sometime last week Jim, a fellow blogger and one with dedications that have always delighted and fascinated me, offered to put me in touch with a friend who had mastered the home care of her cats. I’ll call her Astra. Several times a day we exchanged emails about Twinkle’s condition and progress, and I got encouragement and ideas from her. I told her it was like having an angel on my shoulder. Being able to talk hopefully with someone who really understood was a great source of strength and solace for me. Astra, in turn, put me in touch with Erica, and we engaged in a three-sided conversation for days, days full of wisdom, sheered experience, compassion, and encouragement.

Twinkle got her e tube on Tuesday. At some point, she also got one more top-up transfusion from a fresh donor to try to boost her PCV over 20 (turned out the donor was a cat owned by one of the technicians, which I found touching). It never got quite that high, but she did stay stable in the high teens and they figured the rest was a matter of her bone marrow catching up. Thursday night they ready to send her home.

I have an enclosed balcony and my intention was to set her up there where I could keep an eye on her. Had a table set up for feeding and medicating her, a cat bed near the desk, water, food, a litter box a little further away. Once she was home, Twinkle quickly had other ideas. She wandered off to the dark seclusion, once again, of the front door. Fine, I decided, work to her comfort. So, for most of Thursday and Friday, we did our things there. Friday evening, a little before Michelle came for a visit, Twinkle wandered into the spare room, and figuring I’d have to fight to get her out from under the bed, I put her on the bed, with a step down so she could use the litter box. We visited with her there and to my joy, Twinkle climb into Michelle’s lap to be stroked. I decided to rearrange the spare room for Twinkle... but I honestly can’t remember if that was Friday night or yesterday morning. That’s a blur. But I wanted to give her a place she was happy, and maximize my access to her for food and medication. So I managed to get her out from under the bed and move her, temporarily, to my bed, while I moved things. I put the box spring against the wall, with the mattress beside it on the floor: a place for me to lie while feeding her. Put the cat bed near the rad, since that’s where I found her sitting under the bed, probably for the warmth. Moved the food, water, and litter box in. And I hope she was happy with that.

I went home with seven different medications. Combined with the feedings, it was almost overwhelming. So I sat down with Excel and charted out what she had to be given and when, and I pasted it up over the cabinet in the kitchen. I started pureeing cat food. I would lie with Twinkle and count out the minutes and feed her 5 ml at a time. Took 15 or 20 minutes but I was surprised how little time it seemed. I was helping her get well. I felt good about that. She took well to the tube, both for the feedings and the meds, though she was a little balky about it a few times. And it seemed hard on at 8 Friday morning when I gave her four or five meds at a shot, so I decided I’d stagger those out over 15 minute intervals in the morning from then on, and yesterday morning it seemed to go off great.

I had eye drops I was supposed to give her... two in each eye, once a day. It went terribly wrong yesterday morning and I’m always going to wonder if that’s not what set it all off. It was hard giving her the drops, and some of the fluid got into her mouth. I don’t imagine it’s toxic, but it put her through agony for a few minutes. She was writing and moaning, and it broke my heart. I swore to her, no more eye drops. Because she’d just been through so much, I cut her next feeding an hour later down by half, just to make sure she didn’t get nauseous.

After that, I had a three-hour window, so I met up with P-Doug at Swiss Chalet and we talked. It was good. I needed it. One of the thing I touched on was, if the time came I should have to let Twinkle go, I asked if he’d be there, and he kindly offered to. We split up about 2, and I hurried to get cat food for Bonnie and Max and then head home.

Twinkle was a little drooly, which can be sign of nausea, and I thought it might be because she had so little on her stomach. Well, it was time for one of her meds, so I gave her a mil of that, and went out to prepare some food, another half-meal of about 20 ml. Since it’s kept in the fridge, I had to warm the syringe in warm water, and that takes a few minutes. I heard a cat being sick and rushed to the foyer to find Bonnie horking up a fur ball. I told her, “You could have time that better.”

But it was just a couple of minutes after that that I started hearing loud thumping. I found Twinkle twisting in her litter box, moaning, drooling. I petted her, tried to calm her down. It was the worst I’d seen her. My mind was racing... should I take her in, or would this pass again? Was she rejecting the medicine she needed to get well, and if so, how could she ever recover? If I took her in, what would the bill be? And if I took her in, was I admitting that the time had come to let her go?

I decided I’d better take her in. I grabbed the phone, called P-Doug and left a massage saying I thought maybe this was it, and to please meet me there. I went back into the bedroom, and she was just gasping. Just a couple of times. And I realized she’d died on her own. It was hard, but it was quick. But so unaccountably sudden. She hadn’t been great, but she’d been stable, and comfortable, and there was every reason to believe in the weeks and months to come, she had a shot at some kind of recovery and a new normal. But she was just gone.

I gathered her in a towel and took her in on the off chance she was in a coma or still needed help. She was just limp. I think that was the worst part; it was a horrible feeling. Called the vet as I got in the car. They began resuscitation work but the doctor told me she wasn’t breathing and there was no heartbeat, and by then it had been about 15 minutes since the spell. I told them to stop. There was no point.

The doctor brought her in and we sat and talked for about 15 minutes. His speculation was that it had been a blood clot, which cats in her condition are prone to. As it turned out, he himself had had to have his own dog put to sleep a couple of weeks before. I decided to get her ashes back, in a beige urn the same style as Jenny’s grey one, as well as with a paw print made.

P-Doug raced back up to see me. We spent a little time putting things back the way they’d been so everywhere I looked I wouldn’t be reminded of the disjointment of my life over the past two weeks and the reason for it. We gathered up her meds and disposed of them. We put together the sterile, unused medical supplies. We talked for a little while, and then we went out. Took the supplies back to the clinic; they’re needed there. Went to the Working Dog Saloon but it was packed with a couple of parties, so instead we passed a couple of hours at the pub that used to be The Beaver and Furkin. I didn’t drink, but we talked and I ate a little. Strangely, the evening was cut short when G called us up because she’d fallen at home, and we headed back to make sure she was alright. She was, but had tripped over one of the cats, Oscar, and come close to crushing him. He, too, was alright.

They gave me a few sleeping pills for the next few nights... I don’t want to be tormented by dreams; that I would find hard. Right now, I’m fairly emotionally stable. I’m avoiding looking at pictures of her because it seems just like poking at a wound to make it bleed and I’d rather just let it ease slowly than in some big burst. I guess in the back of my mind, after seeing her go through so much over two weeks, worrying about maybe getting phone calls in the middle of the night about sudden downturns, or that she was rejecting transfusions and her cell count was too low and there was nothing more to do... I guess I was kind of steeling myself to have to make a decision. Even this Tuesday she was supposed to go in to see how she was doing, and I knew I might have to make the call then. So I guess what I’m feeling now is sadness, disappointment, loneliness, combined with a sense that, well, it’s over, and the realization that, probably, she wasn’t really going to get better after all, so maybe it’s good she didn’t just linger on in this semi-life for weeks or months where the big accomplishment for the day was a couple of trips to the litter box. Something just went wrong, something we tried but couldn’t fix, and living much longer just wasn’t in the cards for little Twinkle.

Well, the whole thing cost about $14,000. That’s going to take me about three years to pay off, probably. I don’t know what, if anything, I’ll get back from the pet insurance, but that’s how it is. I only wish I’d still had Twinkle to show for it once it was all paid off. But I did everything I could for her, right down to the tube feedings, and arranging things to work from home to look after her. I stood by her and I never gave up. I think in her own way, she loved me, and maybe even knew I understood how she was feeling. I sure hope so. For her part, Bonnie seems to know I’m sad, and she just looked at me and crossed the room to be with me. The ironic thing is, when I got Twinkle, I thought of her as the much younger cat who’d see me through the rough times, one day, with Bonnie and Max. None of this seems right.

But I had her, a year and a half. And the little tigress delighted me and often thrilled my heart. I just wish it had been a lot longer than that.

There’ll probably be more later, but this has really rambled, and I’ll just close with my thanks to everyone who cared, and all of you who made this easier to bear. Thank you all so much.

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