Visiting Veterinarian : In time to say goodbye
One Halloween I dressed up as a vampire. Ghoulish make-up. Fake blood dripping from my mouth. It was fun...until a terminally ill dog arrived. Discretely ditching wig and cape, there was no time to remove the make-up. I proceeded awkwardly with the euthanasia with as much grace as I could muster. This year's Cleopatra costume was less macabre, but I still opted for work scrubs, reserving kohl, headdress, and asp for after hours when some other poor veterinarian was officially on call and I had promised to go trick-or-treating with my children.
Midmorning my secretary called me. "Someone's on the phone with a vomiting cat. She's pretty new here and doesn't have a veterinarian, but lives nearby." I hesitated. Normally I would refer this to the vet on call, but it was early and it didn't sound too serious.
"I'll see her," I replied offhandedly. It wouldn't hurt to be neighborly, and I had the time. The cat probably had worms, or hair balls, or ate a bad mouse. An easy fix.
Cupcake arrived post-haste, a beautiful creature in the prime of life, accompanied by a mother and young daughter. "She was fine until last evening," the owner said. "She threw up six times and defecated in the house. There was blood in the stool...and something sharp, like a toothpick." With a worried glance, she indicated the sample she had brought. I poked the poop. Fibrous plant material. Paper towel. No toothpick. "I don't see anything sharp," I remarked. "It was definitely there," the girl piped up, emphatically. "We both saw it," her mom agreed. Nodding noncommittally, I continued my exam. This cat was sick. Dehydrated, depressed, with a 105.9 fever, she cried when I palpated her abdomen. Visions of a quick fix receded into the distance. "Cupcake is very sick," I told the girl gently. "We need to figure out why she has this fever and why her belly hurts." Transferring my attention to Mom, I recommended blood tests and radiographs. "Can I watch you draw the blood?" the daughter asked, with a combination of dedicated concern and intellectual curiosity. What an interesting kid, I thought, as she intently observed me work.
We quickly ruled out infections like Feline Leukemia, FIV, Lyme, and Ehrlichiosis, then took radiographs. There were no blatant abnormalities on the films, but something was odd. The abdominal organs looked more clearly defined than they should. "I'm not positive, " I said haltingly, "but there may be free air in her abdomen. That could indicate a perforated bowel, with peritonitis."
Peritonitis is defined as inflammation of the peritoneum, the membrane lining the abdominal cavity and organs. A serious, often fatal, condition, it typically presents with fever, depression, vomiting, and diarrhea. The most common cause is a damaged gastrointestinal tract allowing leakage of intestinal contents. This can be the result of intestinal surgery, gastric ulceration, gunshot wound, being hit by a car, ingestion of a foreign body, or other trauma. Once intestinal contents contaminate the abdominal cavity, life-threatening infection ensues. Treatment requires surgery to identify and correct the damage, remove foreign material, and flush out infection.
"Cupcake may need surgery," I said carefully. "If you want optimum care, take her off-Island, right now, to a surgical specialist with a 24-hour ICU." The mother's face betrayed her turmoil. Times were hard, but Cupcake was precious. I, too, was conflicted, reluctant to send them on an expensive, stressful journey when Cupcake might not even survive the trip...and without definitive diagnosis. "Let me finish the tests," I said. "We'll start fluids, antibiotics, pain and fever medications, and explore our options."
"Can I help make up her cage?" the daughter asked. Tenderly choosing fluffy, pink blankets, she tucked Cupcake into a cozy nest before going home to wait.
Blood work showed normal kidney function and electrolyte balance, elevated liver enzymes, and low blood sugar. Her white blood cell count was up, consistent with infection: her platelet count low. That could mean clotting problems during surgery.
I called an internal medicine specialist. "Sounds consistent with peritonitis," she agreed. "Do a four quadrant abdominal tap. Evaluate any fluid you get." I did the tap but got no fluid. "Try peritoneal lavage," she offered. Cupcake cried as I touched her side. I didn't relish the idea of injecting large quantities of saline into her belly, rolling her around, then drawing the fluid back out to examine.
"OK, maybe, thanks." I hung up and called a nearby colleague and the vet on call. Both stopped by. Both concurred with the diagnosis. The vet on call had already had one emergency surgery that morning and preferred not to take on another. I called the referral practice off-Island. Conferring with the surgeon, it became clear there was no way to work out the logistics for Cupcake to go there. But without surgery, the cat would die. The universe was handing this one to me. My daughters would forgive me for missing Halloween.
I made one last call. "We should go ahead with surgery." I told the mother. "Here. Now. Come and say good-bye first...just in case." Awaiting their arrival, I got set up. Surgery pack. Gloves. Anesthesia. Moments later I was escorting them in.
As I opened Cupcake's cage door, the cat suddenly stiffened, arching dramatically backwards. I knew what that meant. Damn. Deep breath. Damn. "Honey," I said softly. "I think Cupcake is dying." We sat together, cradling the cat as she let go of this life. "She waited for you," I offered. "The surgery would have been too much for her, but she waited for you."
The girl patted the sleek, black coat. Crying, yet contained. Communing with Cupcake. After a long time she whispered to her cat's still body, "You did that well." Silently, I agreed, watching the mother and daughter, grieving together, after a day of tough decisions, life lessons, and difficult emotions. You did that well.
