Tuesday, November 10, 2009

I Sorta Understand Cats, but I'll Never Understand People

Try as I might, I'll never understand some people.

About two months ago, I examined a sweet 8 year-old female mackerel tabby with a tumor on her back. On physical exam, everything was fine except for the tumor. I could tell that this was a terrible tumor - large, firm, ulcerated, infiltrative. A disaster. The clients, who I guessed to be in their late fifties or early sixties, had taken their cat to the Animal Medical Center and were told that this was likely a vaccine-induced sarcoma; the only chance they had to cure this cat was to remove the tumor completely, and that this would involve the removal of the right hind limb. Even then, there was no guarantee that it wouldn't recur. They decided not to amputate. A reasonable decision.

As expected, the tumor grew, and they came to my office to see if I could offer some palliative treatment. Removal of the tumor was impossible, but I could see that there were some areas of the tumor that had become cystic and were leaking fluid. I offered the option of draining some of this fluid from the tumor, and cleaning it with an antiseptic as best I could. I told them that the cyst fluid would recur, but that removing it might provide some improvement. They were fine with this.

During the course of the appointment, while I was draining the cyst, I was making small talk with the husband. He had used some medical terms to describe the appearance of the tumor. I guess I looked a little surprised at his use of medical jargon, until he told me that he was a human radiologist. We chatted some more. I mentioned something about the size of the tumor, and he said, "yeah, and to think, it was so small when we first discovered it". I was kinda shocked. I just assumed that when he first felt it, it was already fairly infiltrated into the underlying tissue, like many of them usually are when they are first detected by the owner. I asked him about this. "Yeah," he said, "it was about the size of a pea." Before I could say anything further, his wife said, in a very matter-of-fact manner, "we made the decision not to pursue any treatment".

So here I have, in my exam room, a man and a woman who were fortunate to discover a pea-sized growth on their cat. Not just any man, either. A human radiologist! I mean, who would know better than a radiologist that early detection is the key to successful treatment of cancer?! They discover a small growth on their cat, and they put their heads together and decide that they're going to let this thing grow! And that's exactly what they did. They let this thing grow until it consumed and destroyed their cat. It's not like these people are ignorant! He's a radiologist, for heaven's sake!

I got very worked up about this with my staff, after the appointment, fuming and raging about this. I was also angry at myself for never asking them the simple question: why? I guess I was too flabbergasted to even ask.

Today, the husband brought the cat in for euthanasia. The tumor was now a huge, oozing, foul-smelling, infected monstrosity. Clearly, the cat needed to be euthanized, and as my staff and I prepared for this, I mentioned to the owner, as kindly as possible, that I recall him saying that they discovered the mass when it was small, and that they decided not to pursue it. "Why, if you don't mind me asking, did you not pursue it when it was small?", I asked, quietly. I needed to know. He replied, "I guess we just felt that we should just let the disease run its course." He added, sheepishly, "Maybe that was a mistake."

Maybe? Maybe?? I wonder, as a radiologist, had he ever detected a mass in a person's lung and said to that person's son, or wife, or mother, "We found a small mass. I think it would be best to just let it run its course." I think not.

I will say, though, that despite what I considered to be some truly stunning callousness, the man did appear to be grieving for his cat. I had my answer, and of course I now let the matter drop. We humanely euthanized the cat. After 21 years of treating cats, I like to think that I get closer and closer to understanding what they're truly about. I could live to be 150, though, and I know that I'll never come close to understanding people.

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Related: http://manhattancats.com/Articles/Feline_Cancer.html


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