Saturday, October 22, 2011

Twinkle's timeline

In trying to remember the sequence of things, I guess I owe it to myself to record how things went with Twinkle, while I'm still able to sort it out.

When did I first notice she wasn't eating? Maybe Tuesday, Sept. 27th? I'm pretty sure I'd noticed she wasn't interested in treats by Wednesday, because I was off that day. Thursday it was pretty apparent to me she wasn't well; she was sneezing and coughing a little, and threw up a little bit of something that looked like phlegm that evening when she uncharacteristically jumped up onto the back of my chair to sit with me. At the time, I took it for a cold or a flu, but I started to worry she might dehydrate, and I determined that if she was still obviously unwell in the morning, I'd take her to the vet. She was, so I did, taking a day of vacation.

I also remember now that during the week, she started hiding. That should have been a sign to me—it always is with Bonnie—but I didn't get "sick" from that with Twinkle. Of the three, Twinkle was the least likely to hang around with me. She was off on her own somewhere most of the time. I didn't take it as anything unusual. I don't imagine we could have done anything different if I had, but I didn't. I remember roaming around, trying to find her, and she seemed to find different spots. One evening, it all seemed like a game because eventually, she stood up in the little cabinet in the dining room and meowed to me... "Here I am." After that, she got really good at hiding, and I figured out later she was hiding underneath the old dresser in my bedroom.

When I took her in to our regular vet on Friday, Sept. 30th, she was there for a couple of hours. They thought it might have been an intestinal infection and they gave her some antibiotics she fought against. Just to be on the safe side, they took blood from her for testing. They charged me about $230, which seemed like a lot of money at that moment but looks like chump change in retrospect, and sent her home with me. At some point, I think it was Saturday, I saw Twinkle run and jump up onto one of the tables in the enclosed balcony to bird watch, and it made me happy. I think it was the last time I saw Twinkle well, or "normal".

At some point overnight Sunday morning, Twinkle's illness really became profound. I woke to find her lethargic and tucked in by the door of the condo. Aside from shifting to the other side of the door and trips to the litter box, that's pretty much where she stayed all day. It's where she was Monday morning, too, when I left for work. Somewhere around 2 p.m. that day, the vet called with the terrible news that Twinkle's blood test had shown she was extremely anemic, with a packed blood volume (PBV) of 12, when the normal is between 30 and 40. And remember, that blood was drawn Friday, before her Sunday morning downturn. The vet advised me to rush her to the Toronto Veterinary Emergency Hospital just north of them for a transfusion. He mentioned that I was looking at $2500. I blanched at the figure, but what can you do? I had an internal interview for another job in the company that day, and I barely had time to send medical emergency email and beg off before leaving. The bus ride home took around half an hour, and my appointment was for 2:45. All that way I was wondering if I'd find her dead when I got home, but no, she was still there by the door. I got her into the cat carrier and off we went.

The next couple of days were about securing a line of credit from my bank to cover the costs of Twinkle's treatment, and listening to reports of how low her PBV was, and that she needed a second transfusion. Somehow it escaped my good sense to go in and visit her on Tuesday, and I regret that. A pound cat, Twinkle must have wondered if she'd been abandoned again. I went into work Tuesday morning but found I didn't have the stomach for it, so I took the laptop and decided to work from home, with my manager's permission. And that's what I did for the next week and a half.

It finally occurred to me on Wednesday that, since she was only about a 7 minute drive away, I ought to be visiting her and reassuring her. I went in around noon and she was just a mess of tubes. One in her side to drain excess fluid from her abdomen. One in her nose to feed her. One in back leg, one in her front. The poor little thing. It was all about tests, and trying to figure out what was wrong. I'm not sure what day it was now, but they shaved her belly and ultrasounded her, looking for tumors. Nothing showed up, and none of the tests indicated cancer. Eventually they ruled out the blood parasite possibility, which largely left us with autoimmune disease.

I guess it was Wednesday night she got a transfusion of fresh blood from an on-site donor. Michelle was with me, visiting, as we saw Twinkle get the last of that blood. When I visited her on Thursday, she ate on her own for the first time in a week, and it was amazing to see. At that point, I was more or less convinced she'd get well again. Michelle visited with me again Thursday night and we watched Twinkle eat for me again.

By this time her PBV was holding around 17. Not great, but sustainable and on the verge of a new normal, something she could potentially adapt to. She started going off her food again, and we discussed the option of a feeding tube. Given that I'd have to give her medication at home, to be honest, I was anxious to have it as an aid to doing so... the idea of forcing stuff down her throat several times a day was anathema... I knew she'd wind up hating me, and then what was the point? But by Sunday, they were ready to release her and give her a trial basis at home, hoping the comfy environment would stimulate her appetite. The idea was to bring her back Tuesday if she weren't eating enough, and she'd get the tube. Well, she didn't eat at all for me, so I decided to be proactive and take her back on Monday, rather than wait. One more fresh blood donation and she got the e tube on Tuesday. They began feeding and medicating her through that. Given that I knew that was where it was going, I ordered two Kitty Kollars from a place in California on Monday. These are designed to ease the cleaning and protection of a feeding tube over the long term. The order came to just shy of $120, but I was looking forward to getting them and putting them on her.

By Thursday night, she was ready to come home again, with a reassessment scheduled for Tuesday. She came home with a bewildering array of medications, six or seven of them, including a new one that has only rarely been used with cats... generally it's intended for use with humans who've had organ transplants. We hung our hope on this one in particular, that it would arrest the process of her body killing its own red blood cells, and put her into remission. I came home and wrote up the schedule of feedings and medications that would rule my world for weeks, maybe months to come. I had a Magic Bullet blender to puree all the food she'd be getting through the tube, and I learned to feed her 50 ml over about 15 minutes. It was good to be close to her, to do something for her. It was a sad way to do it, but I'll always remember how good it made me feel. I was taking real, critical care of another life. I was doing my all to make a difference. I was in for the long haul.

Of course, that's not how it turned out.

My thinking was that if she could at least break even on Tuesday with regard to her PBV, that is, she didn't need another transfusion (and she was getting to the point, they told me, that her body would soon be producing antibodies and rejecting them), I was prepared to soldier on. I was prepared to give her one more transfusion, to give the drugs a real chance. If after another assessment they weren't working, well, I was steeling myself to have her put to sleep, since that would be our indication that we'd done everything and she really was never going to get better or have any kind of a life. But then she died on Saturday afternoon of the complications of her condition, and spared me having to ever make that decision. And now, I'm waiting to get her ashes back, in a little tan urn, to place beside the grey one that houses the ashes of Jenny, a cat she never knew.

Twinkle was dear to me, not because she was a cuddly cat particularly, or very demonstrative, though she had her moments. She was willful and self-possessed, contrary and sometimes quite difficult. But all those personality quirks, in the end, were the things that endeared her particularly to me. I'm going to miss those things. The sad fact is I had her in my life so briefly, only a year and a half, that I think much of what I knew about her will fade quickly, and I'll largely be left with the broad strokes. But whatever... at least that's something, and it's a part of my life, what I've experienced, and who I've become.

Thanks, Twinkly-Dinkly. You were unique.

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