best laid plans

I keep thinking that Cricket will be back soon, that this is temporary.

I miss her.

I am in the strange position of watching my cat recover while preparing for her death.

When I wrote on Monday, I thought that Cricket would probably be gone by now. I should know better than to underestimate her like that.

At first, she only left the bed to use her litter box. I fed her by hand several times a day and brought her fresh water regularly. She slept for long stretches lying against me. I rubbed her neck and watched her sleep and wondered what to do.

And she started getting better. She ate a little more. Her eyes got brighter. When I woke yesterday, she was in the living room, lying in the sun on the sofa. She's gone back to hanging out on the windowsill and in her perch on the shelf unit, trilling at me when I come near. Last night, she ate her dinner without coaxing and licked the bowl clean. Seriously.*

Still, her breathing is a bit faster and harder than is normal, and she coughs after jumping. Nothing has changed.

Google searches offer lots of suggestions on when to put your pet to sleep. None of them really addresses my situation. By observable measures, Cricket isn't suffering. She's eating, she's social, she's engaged. But her chest is filling with fluid, and soon she will be struggling to breathe. Again. And she's not going to beat cancer.

Is it fair to remove the fluid again when I know it will come back? How can I take her life if she's still using it? What the hell do I do?**

* I tried a different canned food, hoping to tempt her. Heh.

** I talked to Cricket's vet on Tuesday night. I've known her for years and I trust her. She believes that because of the advanced state of Cricket's cancer, we should put her to sleep when she starts having trouble breathing instead of removing the fluid. She is probably right. I don't want to face it.

Cricket is dying.

Her pet sitter noted that she ate very little while I was away. When I got home, the apartment was much colder than when I had left, and Cricket was in a pile of blanket on the sofa. I left my suitcase where it fell, brought her into the bedroom, and turned up the space heater. I mixed tuna with cat food, warmed it up, and coaxed her into eating some by hand. She spent part of that night against my belly, perhaps still cold, then took her spot on the pillow.

Then she started coughing. She refused food, even by hand. She was social and attention-seeking, but listless.

We took her to the hospital. The x-rays showed that her chest had filled with fluid again, probably from the cancer with which she was diagnosed five months ago. After some discussion, they drained the fluid and sent her home.

She accepted some pieces of turkey from me, but is mostly sleeping. She had a rough day. And she's dying.

I'm not ready. I will never be ready.

Every four years, the world pays attention to gymnastics. On the internet, that translates to an enormous influx of new message-board posters (the n00bs). I don't begrudge anyone the every-four-years interest; I'm the same with other Olympic sports. I'll sometimes go to websites for enthusiasts of a given sport and read the discussion. What I don't do, however, is break in and start posting.

The new fans argue about which top US gymnast is better. They post endless variations on their choices for the team, on who will compete what event in what round, on what skills each athlete will compete. They don't know about athletes from other countries unless they competed four years ago. They ask questions that Google would answer. They seem not to understand that a message board is a community and they are tourists.

I've been posting with the same group of people, more or less, for about eight years. The message board is ruled with an iron fist. New posters who piss off the moderators are banned with a public announcement; the rest learn to think carefully before posting. The result is a streamlined discussion full of relevant information. (Mostly.)

The moderators were out of town at the Olympic Trials last week and weekend. Despite the presence of temporary mods, almost every discussion was infested with stupid. When they got home, the hammer came down. The board is suddenly quiet. I love you crazy kids.

* * *
Cricket has continued to recover. Surgery was almost two months ago and her breathing is still easy. She's comfortable enough to curl up in a little cat circle rather than sprawling out. The hair on her left side is growing back slowly, and both front paws are black again, though the undercoat will take longer to fill in.

During the operation, the surgeon took samples of tissue from inside Cricket's chest to send to pathology along with the collapsed lung lobe. The lung lobe was absolutely flattened, the vet told me. The test results showed that the lobe collapsed because of pneumonia. How did I not notice that my cat had pneumonia? She never even stopped eating.

But the biopsy results on her chest tissues were worse. Cricket has cancer. Specifically, thymic T-cell lymphoma.

We met with an oncologist to discuss what to do. Cricket's opinion of vets hasn't changed, and she's considerably stronger than she used to be, so the brief exam turned into a big production. Cricket got extremely upset and several people were bitten and scratched. The vet was kind of whiny about it, which did nothing good for my impression of her. Cricket's critical-care vet had been able to hold her by the scruff of the neck with one hand and examine her with the other, keeping the drama to a minimum. The scene made me decide that from now on, anyone who can't scruff her will have to sedate her.

She talked and I listened. She recommended chemotherapy and told me about different drugs and their side effects. She discussed options for treatment plans and pills versus intravenous drugs and hospital visits per week. I finally asked what her goals were for treatment. There is no tumor or mass to watch, no blood level to check. How would we know whether a treatment worked if we have no way to measure the cancer?

She didn't have an answer for that. I wasn't trying to play Stump the Doctor, though. I was hoping for an answer. The lack of one made me wonder why I was thinking about making my happy cat into a sick one.

And that's my decision: no treatment. She's elderly. She's been through an exhausting, painful illness, surgery, and recovery. She's finally feeling better. Enough. We'll deal with the future when it arrives.

* * *
Congratulations, ernestinewalker!

I have been unable to write. I tried writing about being unable to write, but I couldn't do that either. I'm so dumbfounded by the events of the past week and a half that I have no words to explain. Over and over, I've turned away from the blinking cursor and watched my cat.

Cricket has taken over my pillow.

I gave her a pillow of her own, covered with a pillowcase I'd slept on. I tucked a heating pad inside to make it more inviting. Still, she prefers mine. She doesn't bother with stealth; the instant the pillow is unguarded, she claims it. At night, she climbs onto the pillow and wraps herself around my head.

The incision is three inches long. It runs vertically from the top of her ribs down behind her left front paw. The surgeon had to spread her ribs to reach the damaged lung, and despite a nerve block and pain medicine, she's hurting. She cries when I pick her up. I am naturally reluctant to move her. She knows this.

She came home last Sunday, her left side shaved clean from shoulder to hip. Not knowing how mobile she would be, Seatmate and I had built cat steps with shoe boxes and duct tape. She took one scornful look at them and jumped up to the bed. She was equally scornful of the Elizabethan collar meant to keep her from licking her stitches. She left the stitches alone, and I left the collar off.

Boston has turned suddenly warm, and Cricket has occupied herself with grooming. Her efforts have left drifting piles of hair everywhere, rolling across the floor like tumbleweeds. Now and then she pauses, her head up, a clump of hair dangling from her mouth, dignity and comedy in one, and it hits me again how lucky I am that she's alive.

The story isn't over, but I don't know what happens next. Preliminary biopsy results were vague, and now we're waiting on the results from a new series of tests (thankfully run on the tissue samples they already have). I'll deal with the results when I know them. For now, my funny girl is back, and she can have my pillow.

Cricket went back to the animal hospital tonight in preparation for surgery tomorrow.

After fairly exhaustive testing, the vet can say with some certainty that he doesn't have any idea what's causing fluid to leak into Cricket's chest. All of her tests are normal. The only abnormality, aside from her extra ribs, is that a section of one lung is collapsed and won't reinflate. She doesn't need that extra lung space, but the prevailing hypothesis is that the collapsed lobe is somehow causing the pleural effusion, or fluid in her chest.

I know that correlation != causation, but we're hoping pathology can prove it afterward. Tomorrow, a surgeon will remove the collapsed lobe. Cricket will be in intensive care for a few days, then home with a funny collar. She just has to live through the surgery.

How can I sleep without her wrapped around my head?

Saturday
I woke in the predawn darkness and opened my eyes. Cricket wasn't on her pillow next to me. I rolled over and found her on the floor. She was lying next to the space heater and purring to herself.

They say that cats will purr at times of stress and pain, that the vibrational frequency is conducive to healing. Cricket had barely made a sound since arriving home. I closed my eyes and let it take me back to sleep.

I brought Cricket home on Friday afternoon. She looked sort of awful. Parts of her had been shaved: her belly, her chest, a circumferential band on her front paw for the IV line. Her normally spotless coat was ratty and matted. She was tense and watchful. And she was, is, thinner than before.

Tempt Cricket to eat, advised the discharge note. Cricket looked blankly at the lactose-free milk I put in front of her yesterday. Usually, I can't have cereal without bribing her, but she was indifferent. Early this morning, I found her standing in a shaft of sunlight in the kitchen and drinking the milk I had left a few hours before. Today we broke the solid-food barrier with a forkful of hand-fed tuna. Baby steps.

She's on medication. It's easy enough to dose her, but she hates it. I've never seen a cat drool as heavily as Cricket does when she tastes something bad. She looks rabid. I wind up following her around and cleaning up the trail until she gets it under control. For today, I've skipped the meds. I want her to relax and stop waiting for something unpleasant to happen.

Despite a multitude of tests, the vet still has no firm diagnosis. Cricket's heart, we learned via echocardiogram, is not failing. On the contrary, it's healthy and strong. With the exception of her mildly ailing kidneys, Cricket's systems are go from nose to tail. The consensus among the vets is that Cricket has chylothorax, which is treatable. Unfortunately, she'll go through this again before a diagnosis can be made.

My family is gathered in Florida for Passover. I couldn't leave Cricket. I made the right choice, but it's hard. I imagine that this is what it feels like to be alone on Christmas.

Sunday
Cricket is much better today. She slept for hours yesterday; I'm sure she had a hard time sleeping in the hospital. She's putting in serious grooming time and her coat is becoming clean and shiny again. She's eating more and her eyes are brighter. Best of all, her breathing is slow and easy and comfortable.

She really needed to come home.

Life continues.

Cricket was very quiet the day after the vet. I rubbed her head occasionally, but mostly let her be. The process of draining the fluid from her chest, thoracocentesis, had left her sore and dehydrated. I brought an extra bowl of water into the bedroom and kept the lights down and noise low. And slowly, she came back. When I woke on Thursday, she was curled against my stomach.

The fluid contained nothing diagnostically helpful. No bacteria, no lymph, no cancer cells. The most likely answer is simple congestive heart failure. Normally, the vet would do an ultrasound to look at the heart, but Cricket refuses to cooperate, and no one likes the idea of sedating an elderly cat. The standard treatment for excess fluid is a diuretic, but she also has kidney disease and may not be able to handle the medication. In short, there's probably not much we can do.

We can do palliative care. We can keep her comfortable and happy. The quality of her life is the highest priority, and invasive medical procedures aren't what she would consider good. On the other hand, suffocation is not what I consider good, so I have some difficult decisions to make. I don't have any idea how much time she has left. I guess we'll find out.

We're going back to the vet tomorrow so they can take some blood and I can ask some questions. For now, Cricket is on my lap, purring. This is not an unhappy cat. She is not hiding under furniture and refusing food. She's alert and affectionate. And I'm grateful.

I was reminded last night that Cricket is not getting younger.

I was crosslegged on the bed, the cat draped over my left leg, when the time came to go to sleep. I picked her up with a hand under her ribs, as I've done a thousand times, and she replied with an earsplitting yowl of pain. Horrified, I set her down on her pillow, but the yowl continued. The decibel level alone was alarming; she must have woken the whole floor. What was more alarming was the way she held her right hind leg off the pillow.

Three in the morning and my cat is injured. Oh my God.

As I fluttered helplessly around her, she grew calm, lay down, and dozed off. By this time, I was wide awake. I watched her for half an hour until she stood up, turned around, and lay back down. Relieved that the crisis was past, I turned off the light and slept.

Today, she seems nearly her usual self, climbing into my lap, reaching for the keyboard and my dancing hands. She's talking a lot, though, which isn't normal, and suggests she's still in pain. We have an appointment with the vet tomorrow afternoon to find out what's wrong and look into some pain medication.

As I write this, she's trotting around the apartment, looking unconcerned. Can I go back to sleep now?